Amoebiasis an Old and Important Cause of Intestinal and Liver Disease…

Amoebiasis an old and important cause of intestinal and liver disease…..

ESCMID Online Lecture Library Amoebiasis:

Illness caused by infection with

Entamoeba histolytica, an unicellular parasite

ESCMID Online Lecture Library Fedor Aleksandrevitch Lösch

Lösch, F. (1875) Massenhafte Entwickelung von Amöben im Dickdarm. Virchow's Archiv. 65: 196-211. ESCMID Online Lecture Library

Phase contrast micrograph of amoebic trophozoite of EntamoebaESCMID histolytica Online (5μ Lecturem /second) Library Trophozoite of Entamoeba histolytica

ESCMID Online Lecture Library Transmission of Amoebiasis

ESCMID Online Lecture Library

ESCMIDDevelopment Online of Lecture amoebiasis Library in colon Infection of E. histolytica can be asymptomatic and symptomatic: 4-10% develop disease over a year

ESCMID Online Lecture Library Asymptomatic

Intestinal

Extra-intestinal

ESCMID Online Lecture Library Life cycle of E.histolytica

ESCMID Online Lecture Library From the CDC web site

Blood onESCMID top of feces: Online blood Lecture contains Library parasites! Amoebic ulcer in intestine

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Typical flask shaped ulcer in amoebiasis of gut ESCMID(spread Onlinelaterally Lecture in submucosa) Library Spread of amebiasis from intestine

ESCMID Online Lecture Library Yellow necrotic tissue

ESCMID Online Lecture Library

Rupture of large amoebic abcess ESCMIDin Onlineperitoneal Lecture cavity Library

Intestinal Extra-intestinal

ESCMID Online Lecture Library Diagnosis of intestinal parasites

S. stercoralis Ascaris C. cayetanensis G. lamblia

T. trichiura E. histolytica/ D. fragilis hookworm dispar © by author

ESCMID Online Lecture Library Intestinal protozoan parasites observed in routine clinical practice

• Entamoeba histolytica • Giardia lamblia • Dientamoeba fragilis • Balantidium coli • Cytoisospora belli pathogens • Cyclospora cayetanensis • Sarcocystis spp. • Cryptosporidium parvum/hominis* • Microsporidia spp*

Blastocystis hominis

• Entamoeba coli © by author • Entamoeba hartmanni • Iodamoeba butschlii non- pathogens • Endolimax nana •ESCMIDChilomastix mesnili Online Lecture Library New discovery:

With microscope Entamoeba histolytica morphological identical Entamoeba dispar

But:

Entamoeba dispar: non-pathogen ! © by author Entamoeba histolytica: pathogen ESCMID Online Lecture Library New tests necessary for differentiation of Entamoeba histolytica from Entamoeba dispar: i.e. polymerase chain reaction (DNA-studies)

E. histolytica © by author E.dispar

ESCMID Online Lecture Library WHO/PAHO/UNESCO report.

A consultation with experts on amoebiasis. Mexico City, Mexico 28-29 January, 1997. WHO Epidemiol ©Bull by author18: 13- 14.

ESCMID Online Lecture Library Buddy Diamond & Graham Clark

© by author Diamond,L.S. and Clark,C.G. 1993. A redescription of Entamoeba histolytica Schaudinn, 1903 (Emended Walker, 1911) separating it from Entamoeba dispar Brumpt, 1925. J.Euk.MicrobiolESCMID40: 340-Online344 Lecture Library Entamoeba histolytica and E.dispar

We now believe that four , not three species of Entamoeba live in the human large bowel:

• Entamoeba hartmanni • Entamoeba histolytica© by author • Entamoeba dispar • Entamoeba coli ESCMID Online Lecture Library There are also a few rare species:

• “Atypical,” “low temperature” or “Laredo” strains of E.histolytica are E.moshkovski • E.polecki • E.chattoni • E.gingivalis © by author

ESCMID Online Lecture Library Diagnosis

Intestinal Extra-intestinal

ESCMID Online Lecture Library Temperature chart of patient with amoebic liver abscess

The triad of swinging temperature, profuse sweats and ESCMIDleukocytosis Online is indicative Lecture of liver abscess Library

ELISA method for detection of specific ESCMIDantibodies Online to Entamoeba Lecture histolyticaLibrary Diagnosis

Ultrasound scan: amoebic liver abcess ESCMID Online Lecture Library CT scan of amoebic liver abcess (500-1500 ml)

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Raised right hemidiaphragm due ESCMIDto amoebic Online Lecture liver abcess Library Drainage of an amoebic liver abcess

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ESCMID Online Lecture Library Epidemiology

ESCMID Online Lecture Library Classic data:

• New infections, world-wide, per annum: 480 million; • With disease: 10 – 50 million; • Deaths: 40 – 100,000

(Walsh, 1986)

ESCMID Online Lecture Library Reinterpreted - new infections per annum (very approximate)

• E.histolytica + E.dispar: 480 million

• E.dispar: 450 million?

• Deaths: 40-100 000 every year? ESCMID Online Lecture Library Therapy

# tissue phase: Metronidazol (750 mg tid x 7-10d)

# luminal agents: Paromomycin (30 mg/kg x 5-10d) or Diloxanide furoate (500 tid x 10d)

© by author Always treatment with a luminal agent after treatment for the tissue phase! Otherwise up to 30% will remain infected ESCMIDand may Online relapse (Irusen Lecture etal. 1192) Library Coccidians

ESCMID Online Lecture Library

ESCMID Online Lecture Library Diagnostic techniques

Cryptosporidium Cyclospora cayetanensis Cystoisospora belli sporulation In host weeks days seize 2-5 μm 5-8 μm flask

JKJ no uptake no uptake no uptake

Autofluorescence - + + ESCMID Online Lecture Library Auto fluorescence

• Prepare direct smear or a smear from Ridley sediment in saline (not JKJ)

• Screen smear with fluorescence microscope with excitation filter 340-380 nm (20x10; details 40x10)

• Also for SAF preserved samples ESCMID Online Lecture Library

ESCMID Online Lecture Library Treatment Cyclospora / Cystoisospora belli

• Co-trimoxazol – 2dd TMP 160 mg SMX 800 mg x 7-10 d

– Children – 2dd TMP 5 mg/kg SMX 25 mg/kg x 7-10 d

ESCMID Online Lecture Library