Amebiasis: Difference between revisions
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* Asymptomatic vs. dysentery vs. extraintestinal abscesses | * Asymptomatic vs. dysentery vs. extraintestinal abscesses | ||
* Intestinal- several weeks of crampy abdominal pain, weight loss, watery or bloody diarrhea | * Intestinal- several weeks of crampy abdominal pain, weight loss, watery or bloody diarrhea | ||
* Liver abscess-fever, cough | * Liver abscess-fever, cough, RUQ or epigastric pain, right-sided pleural pain or referred shoulder pain +/- GI upset | ||
** Hepatomegaly with tenderness over the liver a typical finding | ** Hepatomegaly with tenderness over the liver a typical finding | ||
**Abscess rupture can involve associated peritoneum, pericardium, or pleural cavity | **Abscess rupture can involve associated peritoneum, pericardium, or pleural cavity | ||
* Extrahepatic amebic abscesses in the lung, brain, and skin are rare | * Extrahepatic amebic abscesses in the lung, brain, and skin are rare | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
===Dysentery=== | ===Dysentery=== | ||
Revision as of 22:07, 11 June 2014
Background
- Fecal oral transmission of Entamoeba histolytica cyst
- Excystation in intestinal lumen
- Trophozoites adhere and colonizes large intestine forming new cysts or invade the intestinal mucosa to cause colitis or abscesses
- Liver abscess-10x more common in men
Clinical Features
- Asymptomatic vs. dysentery vs. extraintestinal abscesses
- Intestinal- several weeks of crampy abdominal pain, weight loss, watery or bloody diarrhea
- Liver abscess-fever, cough, RUQ or epigastric pain, right-sided pleural pain or referred shoulder pain +/- GI upset
- Hepatomegaly with tenderness over the liver a typical finding
- Abscess rupture can involve associated peritoneum, pericardium, or pleural cavity
- Extrahepatic amebic abscesses in the lung, brain, and skin are rare
Differential Diagnosis
Dysentery
- Infectious- Shigella, Salmonella, Campylobacter, E.Coli.
- Noninfectious- Inflammatory bowel disease, ischemic colitis, diverticulitis, AV malformation.
Liver abscess
- Pyogenic liver abscess, necrotic hepatoma, Echinococcal cyst
Workup
- CBC
- Chem
- LFT
- Stool or abscess microscopy
- Stool, serum, or abscess fluid antigen
- Indirect hemagluttination (antibody)
Management
Asymptomatic colonization
- Paromomycin or Diloxanide
Colitis
- Flagyl
Liver abscess
- Flagyl, Tinidazole, Paromomycin, or Diloxanide
- Consider drainage of abscess if no response to abx in 5 days, abscess >5cm or left lobe involvement
Disposition
- Home if no complications
Sources
- Haque R, Huston C, Hughes M, Houpt E, Petri, W. Amebiasis. N Engl J Med 2003; 348:1565-1573