Features of the course of contemporary intestinal amebiasis

Acute intestinal infections, including intestinal amebiasis, remain a pressing public health problem. Amebiasis still represents an important and partially solved problem to health care. In the Astrakhan region, intestinal amebiasis is being continuously recorded. We analyzed the clinical picture of acute intestinal amebiasis in 150 adult patients dominated by female patients comprising 60.7%, aged 18 to 79 years old, and treated within 2010–2016 at the Regional Infectious Clinical Hospital. All patients were mostly of young and middle age (up to 50 years) — 108 patients. More than 50% of patients were admitted to the hospital within the first three days of the disease. However, in 35 cases (23.3%), late hospitalization was carried out (5 days after the onset). Proper diagnosis was made to 44 patients (29.3%), most commonly diagnosing preliminarily with acute gastroenteritis and acute dysentery. All cases of intestinal amebiasis were confirmed by detecting in the feces of patients with a vegetative form of entamoeba histolytica. The disease was featured with sporadic course, being mostly recorded during the summer-autumn period (78.0%). In 142 patients (94.7%), the moderate severity was observed. Cardiovascular disorders were mainly found in severe amebiasis as well as patients comorbid with cardiovascular diseases. A coprological method was used to confirm the diagnosis. Microscopic examination of feces was carried out immediately after defecation (warm type). A combination therapy was applied to patients with intestinal amebiasis. A great attention was paid to patient nutrition: high-protein sparing diet, grated food. Patients with ulcerative colitis received individualized diet (restricted carbohydrates, exclusion of milk and fiber). Etiotropic therapy was carried out with using 5-nitroimidazole preparations: metronidazole (Trichopol, Flagin, Tiberal), MacGioror, Tinidazole (Phasycin) combined with tetracycline. The treatment included group B vitamin cocktail, methyluracil (suppository), enzymes (creon, mezim, pancreatin), enterosorbents (smecta, polyphepan, enterosgel), antispasmodics (no-spa, drotaverin). Patients were administered with therapeutic microenemas containing furacilin solution, rosehip oil, and sea buckthorn oil. Infusion therapy consisting of polyionic solutions was applied by assessing blood electrolyte level. Fresh frozen plasma and albumin were transfused upon decline of serum protein and albumin level. Packed erythrocytes Erythrocyte mass and hemostatic drugs were injected in case of severe intestinal amebiasis if indicated: dicynone, cryoprecipitate, and calcium preparations. Finally, anemia cases were treated as well. In all cases, the disease outcome was favorable, without any mortality. Complications were noted in the form of intestinal bleeding observed in 6 patients (4.0%), wherein amebiasis proceeded together with ulcerative colitis. Acute intestinal amebiasis is currently featured with typical clinical picture that proceeds with less severe symptoms. Intestinal bleeding was observed in patients with intestinal amoebiasis in combination with ulcerative colitis. Chronization of intestinal amebiasis occurs in single cases (3.9%).

Intestinal Amebiasis and associated risk factors among pregnant Women attending University of Maiduguri Teaching Hospital, Nigeria

Background: Entameba histolytica (E. histolytica), the etiological agent of intestinal amebiasis poses significant community health concern especially in pregnant woman due to their physiological status. Pregnancy-induced immunodeficiency can lead to reduced IgA activities which makes pregnant women susceptible to penetration of intestinal mucosal linings and placental barrier especially by E. histolytica. Objective of studyThis study aimed to determine the prevalence and associated risk factors of intestinal amebiasis among pregnant women with acute diarrhea (˂3 days post onset) attending University of Maiduguri Teaching Hospital (UMTH), Maiduguri, Nigeria.Materials and Methods: This hospital-based cross-sectional study was conducted among 200 randomly selected acute diarrheic pregnant women attending UMTH. Fresh fecal samples were collected and immediately analyzed microscopically for E. histolytica oocytes using iodine wet preparation method. Structured questionnaires were used to assess sociodemographic variables and risk factors for amebiasis. Data analysis was done using Statistical Package for Social Sciences (SPSS) version 22 (IBM, California Inc., USA).Results: Out of the 200 fecal samples analyzed for E. histolytica, 10 (5%) were positive. Those infected by moderate E. histolytica cysts had the highest occurrence rate, 4 (40%) and least by those infected by many E. histolytica cysts, 1 (10%). E. histolytica infection was associated with rural residence (OR=6.86 [95% CI:1.42-33.2]), lower Socioeconomic status (OR=22.0 [95% CI: 4.69-103.1]) and primigravity (OR= 5.76 [95% CI:1.19-27.8]) (p˂0.05). Drinking water from borehole (OR=0.24 [95% CI: 0.06-0.95], p=0.043) and large household (OR=0.1 [95% CI: 0.02-0.41], p=0.001) were significant risk factors of intestinal amebiasis.Conclusion: The results indicate that E. histolytica infection is one of the etiological agents of acute diarrhea in study participants. Its recommended that pregnant women should avoid risk factors for intestinal amebiasis identified in this study. Keywords: Immunosuppression, Amebiasis, Risk factors, Diarrhea.

AGE FEATURES OF INTESTINAL AMOEBIASIS

Study objective. To establish clinical and epidemiological features of intestinal amebiasis in adults and children at the present stage. A retrospective analysis of patient histories of 90 cases of intestinal amebiasisin patients aged 3 to 40 years who were on inpatient treatment in Regional Infectious Clinical Hospital named after A.M Nichogi, Astrakhan, in the period from 2014 to 2017. The diagnosis of amebiasis was confirmed by microscopy of feces, detection of antibodies by using reaction of indirect hemagglutination (RHAG) with a specific antigen, determination of DNA of the parasite by polymerase chain reaction (PCR).Results. It was determined that the incidence of intestinal amebiasis in the Astrakhan region is sporadic with the involvement in the epidemic process of persons of working age from 18 to 40 years (75.6%) and children aged 3 to 10 years (24.6%) of organized groups living in the city. Acute intestinal amebiasis in 86.8% of adults proceeded in mild to moderate form. The clinical course of the disease was characterized by a gradual onset in 82.4%, mucosal-bloody stool in 94.1%, the outcome of a chronic recurrent form in 11.8%. Raspberry jelly-like stool, extraintestinal complications of amebiasis, characteristic of amebiasis of previous years, were absent.The features of intestinal amebiasis in children were: acute onset of the disease in 63.6%, fever 38°C and above in 54.5%, abdominal pain in 95.5%, prolonged diarrhoea with a stool frequency of more than 10 times in 72.7%, stool with blood mucus in 95.5%, tenesmus in 36.4%, dehydration in 18.6% of patients. The mild form of the disease in children was not observed, severe was observed in 54.5%, moderate in 45.5%. The combined course of intestinal amebiasis with bacterial dysentery, proceeded more severely, changed clinical symptoms of the disease, made it difficult to diagnose amebiasis in a timely manner.

Colite necrohemorrágica causada por Entamoeba histolytica em um cão

Background: Intestinal amebiasis with morphological lesions and clinical manifestations is uncommon in dogs. The disease is caused by the protozoan Entamoeba histolytica, which is commonly observed in its natural hosts, humans and some non-human primates. It is occasionally found in the company of animals, usually associated with contact with infected humans. Thus, the objective here is to describe a case of necro-hemorrhagic colitis caused by E. histolytica in a dog infected with the canine distemper virus, in order to characterize the epidemiological and clinicopathological aspects of the disease.Case: An adult, mixed-breed bitch displaying anorexia and ataxia was referred to the veterinary hospital for treatment. Clinical evaluation showed a cachectic animal with 12% dehydration, ocular discharge, and bilateral purulent nasal dis-charge. A clinical diagnosis of distemper was made, and treatment was instituted. The dog’s signs progressed to walking in circles, aimlessly, with lethargy and blindness. After three days of the onset of neurological signs, the dog developed diarrhea with hematochezia. With no improvement noted, we elected to euthanize the dog. At necropsy, edema was present in subcutaneous tissues, and the lungs had yellow areas in the cranio-ventral portions, which the court was flowing purulent discharge. In the large intestine, segmental distention of the distal portion of the descending colon was observed. The segment was approximately 15 cm in length and consisted of irregular reddish areas. There was also slight thickening of the wall with edematous mucosa containing blood clots, fibrin, and multiple areas of ulceration. Microscopically showed necro-hemorrhagic colitis associated with rounded structures, approximately 15 μm in size, containing abundant eosinophilic cytoplasm that was slightly granular or vacuolated. They also contained nuclei and nucleoli that were central or slightly eccentric. These organisms were consistent with amoeba trophozoites. There was also demyelinating encephalitis associated with malacia, corpuscular intranuclear eosinophilic inclusions and / or intracytoplasmic inclusions in ependymal cells, astrocytes, and gemistocytes, characteristic of infection with canine distemper virus. Using immunohistochemistry with polyclonal anti-E. histolytica antibodies in the dilution of 1:1000, trophozoites were immunomarked, confirming the suspected amebiasis.Discussion: The diagnosis of intestinal amebiasis was based on clinical signs and by morphological characteristics on gross and microscopic examination, and was confirmed as E. histolytica by immunohistochemistry. Limited information on theepidemiology and pathological findings of infection with Entamoeba sp. has been reported in the literature, as it is relatively uncommon in pets. Affected animals are usually asymptomatic, but immunosuppression caused by canine distemper virus may have triggered the clinical manifestations of the disease in this dog. Enteritis due Entamoeba sp. should be considered in dogs with chronic weight loss and bloody diarrhea. It should also be included in the differential diagnoses for weight loss and hemorrhagic gastroenteritis, such as canine parvovirus, canine adenovirus 1, Pythium insidiosum, and Giardia sp.