amoebiasis

Amoebiasis - invasive disease characterized by a prolonged course, ulcerative lesions of the colon and often the formation of abscesses in various organs (liver, lungs, kidneys, brain, skin, etc.).

Amoebiasis is registered in all countries; particularly the high incidence observed in the areas of hot climate. More common in adults.

Pathogen - dysenteric ameba, which exists in the form of vegetative tissue and luminal forms as well as in the form of cysts. In the body these forms can pass into one another depending on the conditions.

The source is the only person pathogen invasion (patient amebiasis) or tsistonositel, releasing cysts with faeces. The pathogen is transmitted through the hands of various household items, food and water contaminated with feces containing cysts. Sporadic outbreaks of disease or group found mainly in the hot season; they are associated with the consumption of unwashed fruits and vegetables, as well as water from contaminated sources. In epidemiological terms are especially dangerous tsistonositeli, the number of which is many times the number of patients with symptomatic forms, and in some countries reaches 40% of the population.

The clinical picture. The incubation period lasts from 1 - 4 weeks to several months. Typically, the onset of disease gradually, marked malaise, weakness, a slight acceleration of the chair, the appearance of mucus in the feces, which are gradually becoming liquid. Then the chair becomes frequent up to 5-15 times a day or more, there is an admixture of feces not only mucus but blood, which gives them a distinctive look - liquid muco-bloody mass ( "raspberry jelly"). Abdominal pain at first uncertain, then the cramping localized in the right half of the abdomen, may be painful urge to defecate without isolation or separation of a small amount of stool (tenesmus). Abdominal palpation is painful, more in the right iliac region, where dense palpable cecum. Sometimes the disease begins acutely, recalling in these cases dysentery. Acute symptoms of intestinal amebiasis last from one to several weeks, and then usually subside and the disease takes a chronic course with a change of periods of exacerbations and remissions. Exacerbations may occur 2-4 times a year, sometimes less. The clinical picture is similar to that of exacerbations in acute amoebiasis. Perhaps the development of anemia , exhaustion, protein and vitamin A deficiency, the defeat of the cardiovascular and nervous system, joining a secondary infection.

Complications. For intestinal complications include perforation of the wall of the intestine to the development of purulent peritonitis, intestinal bleeding, acute amoebic appendicitis , scar contraction of the colon, the formation of anal fistula.

Extraintestinal manifestations - amoebic hepatitis , amebic liver abscesses, lung, brain, amebic ulcers on the skin (usually on the skin of the perineum, buttocks, around the festering fistula occurring after the opening of amoebic liver abscesses). May occur during the acute manifestations of amebiasis or a few months, sometimes even years. The most common of them - amebic abscess of the liver, which is manifested by high fever with high temperature fluctuations during the day, chills, sweating, increasing intoxication. Characterized by severe pain in the liver region, worse on movement and palpation of the liver. Possible breakthrough abscess in the abdominal cavity with the development of peritonitis, subphrenic abscess formation of a breakthrough in the adjacent organs (lungs, pericardium, etc.) And the formation of abscesses in them.

Diagnosis is based on clinical, epidemiological history data (coming from the possible spread of amoebiasis places), sigmoidoscopy, and laboratory tests. Characteristic changes detectable during sigmoidoscopy or colonoscopy, is the presence of deep ulcers with podrytymi edges, surrounded by a rim of hyperemia, with a diameter of 2 to 20 mm, the bottom of which looks greasy. Absolute proof of amebiasis is the detection of vegetative tissue forms of the pathogen in the faeces, sputum, discarding skin ulcers, abscesses content.

For the detection of amoebas in the stool need multiple studies (8 - 10 times) must be fresh faeces (within 10 - 20 minutes after a bowel movement). Faeces taken in a clean container, carefully washed from disinfectants. It is recommended to give the patient the day before the study saline laxative.

The differential diagnosis is carried out with dysentery, ulcerative colitis nonspecific, polyposis, intestinal tumors.

Treatment. Compulsory hospitalization for the entire period of treatment. Apply protivoamebnye means (hiniofon, emetine, ambilgar, metronidazole, tinidazole, etc.). In amoebic abscesses in the case of treatment failure protivoamebnymi means operative treatment.

Forecast with timely specific treatment is usually favorable.

Prevention. Extract convalescent hospital made after clinical recovery and the three negative studies on fecal pathogenic protozoa with an interval of 2 - 3 days. Been ill amebiasis, especially those working at the food enterprises and related, are on the dispensary; during disorder of bowel function is performed scatological, bacteriological research and protozoologicheskoe faeces.

The focus of the current infestation is carried out and the final disinfection. Needed personal hygiene (washing hands before eating and after using the toilet), thoroughly wash fruits and vegetables, boiling water for drinking, food security and water from contamination with faeces, fighting flies.