Amoebiasis (amoebic dysentery)

Amoebiasis (amoebic dysentery) is a protozoal disease characterized by ulcerative lesions of the large intestine, sometimes complicated by liver abscesses, lung and other organ damage.

Etiology, pathogenesis. The causative agent - dysentery amoeba - can be in three forms. A large vegetative form (tissue form, erythrophage) is capable of phagocytizing erythrocytes and occurs only in patients; The luminal form and stage of cyst are found in amoebae carriers. Infection occurs when cysts enter the human digestive tract. In the large intestine, the cyst is converted into a luminary form, and the carrier comes. The disease develops only when the luminal form passes into the tissue. When the tissue form is multiplied in the intestinal wall, small abscesses appear in the submucosa, which then break through into the lumen of the intestine and form mucosal ulcers. Hematogenous dysentery amoeba can penetrate the liver, less often into other organs and cause there specific abscesses. Scars caused by ulceration can lead to narrowing of the intestine.

Symptoms, course. The incubation period lasts from 1 week to 3 months. The disease begins relatively sharply. There are weakness, headache, mild abdominal pain, a loose stool with an admixture of vitreous mucus and blood. The temperature is subfebrile. After an acute period, as a rule, there is a long-term remission, then the disease becomes aggravated again and takes a chronic course. Without antiparasitic treatment, chronic forms can last 10 years or more. They proceed in the form of recurrent or continuous forms. There are pain in the abdomen, diarrhea alternating with constipation, at times an admixture of blood in the excrements. With a prolonged course of development, asthenic syndrome, a decline in diet, hypochromic anemia. With sigmoidoscopy, ulcers up to 10 mm in diameter are found, deep, with dented edges. The bottom of ulcers is covered with a purulent coating. Ulcers are surrounded by a hem of hyperemic mucosa.

Complications of amebiasis include peritonitis due to intestinal perforation, amoeba, intestinal bleeding. Out of intestinal complications, liver abscess is more common. It can develop both during an acute period, and after a long time, when there is no pronounced lesions of the intestine. In the acute course of the abscess, fever of a hectic type appears, chills, pain in the right upper quadrant. X-ray reveals a high standing of the diaphragm or a local protrusion of it. Even small abscesses can be detected by scanning the liver. In a chronic abscess, intoxication and fever are poorly expressed. Amoebic abscess can break into the surrounding organs and lead to the formation of a subdiaphragmatic abscess, peritonitis, purulent pleurisy.

The laboratory confirmation of the diagnosis is the discovery in the feces of a large vegetative form of amoeba with phagocytic red blood cells. More often amoebae are found in the material taken with sigmoidoscopy from an intestinal ulcer. The study should be conducted no later than 20 min after defecation or taking the material. There are serological diagnostic methods.

Amybiasis must be differentiated from dysentery, bapantidiasis, ulcerative colitis, neoplasms of the large intestine.

Treatment. Assign a 2% solution of emetin hydrochloride at 1.5-2 ml v / m 2 times a day for 5-7 days; A week later the cycle is repeated. In the intervals between the cycles of zmethin, hingamin (delagil, chloroquine) is prescribed 0.25 g three times a day, quinophone (yatren) 0.5 g 3 times a day. You can also give tetracycline for 0.5 g 4 times a day, monomycin 0.25 g 4-6 times per tribute for 5-7 days. The most effective and non-toxic drug for treating patients with both intestinal and extraintestinal manifestations of amoebiasis is metronidazole (trichopolum, flagel). Assign it to 0.5-0.75 g Zraza per day for 5-7 days. Priablybnyh liver abscesses the drug is prescribed for a longer time - before resorption of the abscess (given to the liver scan). With large abscesses of the liver, surgical methods of treatment are used.

The prognosis for intestinal amebiasis is favorable. Possible residual phenomena in the form of narrowing of the intestine. At an amoebic abscess of a liver or a brain the lethal outcome is possible, however the modern therapy has made the forecast more favorable.

Prevention. Isolation, hospitalization and treatment of patients. Amoeba carriers are not allowed to work in the public catering system. General preventive measures are the same as for dysentery.