Amoebiasis

Simon Drysdale
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Amoebiasis - Differential Diagnoses
The differential diagnoses of amoebic dysentery are predominantly other infective causes of diarrhoea including E.coli, shigella, campylobacter, salmonella, Clostridium difficile, cholera, giardia and cryptosporidia. Non-infective causes of diarrhoea (e.g. inflammatory bowel disease) should also be considered, especially in individuals with chronic or atypical symptoms.

Most (>90%) infections are asymptomatic, including many of those with E. histolytica. Individuals who become symptomatic usually develop progressive diarrhoea over seven to 21 days. Symptoms range from mild diarrhoea to severe dysentery with colitis and/or extra intestinal features. Symptoms of intestinal amoebiasis include:
• Diarrhoea with blood and mucous
• Foul smelling flatus
• Weight loss and malnutrition
• Abdominal pain
• Fever
• Rectal bleeding without diarrhoea (mainly children)
In some cases, individuals can have relatively mild symptoms for several months or even years. This can be mistaken for inflammatory bowel disease (ulcerative colitis, Crohn’s disease, especially in children) or other non-infective gastrointestinal pathologies.
Amoebic colitis can result in intestinal perforation, intestinal necrosis, peritonitis and toxic megacolon.
Amoeboma are rare and represent granulomatous tissue due to an amoebic abscess in the intestinal wall. They present with a palpable abdominal mass but individuals also frequently have amoebic dysentery.

Extra-intestinal features
The most common extra-intestinal sites of amoebic infection are the liver, lungs and brain with liver abscesses the most frequently reported, although all are very rare. Only 5% of amoebic liver abscesses occur in children.

Amoebiasis is a worldwide problem but is most common in developing nations due to poor sanitation, malnutrition and poor socioeconomic conditions. Studies show up to 50% seroprevalance in children less than five years old in some endemic areas. Males and females are equally affected. In developed nations high risk groups include those with immunodeficiency, including HIV, institutionalised individuals, men who have sex with men and immigrants from, and travellers to, endemic areas. Humans are the only known reservoir of E. histolytica.
There are up to 500 million infections per year, although only 40-50 million of these are symptomatic as E. dispar is 10 times more common than E. histolytica. There are approximately 100,000 deaths per year, almost exclusively in developing nations.


References
Amoebiasis Amoebiasis 02/13/2016
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