Amoebiasis

Amoebiasis (synonym amebic dysentery) - protozoal disease proceeding with the expressed violation of the functions of the large intestine as a result of losing her ulcerative process; less frequent inflammatory changes in the form of abscesses in the liver, lungs, kidneys and other organs that may, in hematogenous drift by the pathogen from the tissues of the colon. Amoebiasis is distributed mainly in areas with hot climate. In the USSR is more common in Central Asia, Transcaucasia, rarely in the middle strip and in the North. Hit amoebae in the human body does not always lead to the disease; such people are the bearers of amoebae and can be dangerous in an epidemiological sense.
Etiology. The causative agent of MDR - TB histolytica amoeba dysentery (Entamoeba histolytica). In the human gut E. histolytica can exist in three forms: 1) vegetative tissue large, very mobile, faguoqitirute erythrocytesallocated from the faeces in the acute period of the disease (Fig. 1);histolytica amoeba dysentery 2) vegetative translucent smaller, less mobile, released by the remission of the disease or in healthy carriers; 3) cysts - stationary spherical or oval formation. Vegetative forms of unstable external environment, are very sensitive to drying, high and low temperatures, various disinfectants. Cysts under favorable conditions remain viable for up to 30 days and more.
Epidemiology. The infection is transmitted from person to person through dirty hands, various household items, infected food and water. Released from the excrement of cysts pollute the environment, especially in unsanitary content washroom, living quarters, the dispersion of faeces around dwellings. There have been isolated cases or small clusters of outbreaks mainly in the hot season, when it is used a lot of vegetables, fruit, and water, especially from random sources.
Pathogenesis and pathological anatomy. The disease occurs more frequently in people of weak, with low body resistance. Swallowed man cyst E. histolytica in the colon existerade (resulting from the dissolution of her shell and starts to multiply. In the colon amoeba penetrate into libertylove cancer, there continue to multiply and produce proteoliticeski enzymethat leads to necrosis of tissues (Fig. 2).changes the colon when amebiasis Clearance gland is clogged intensively produced by mucus, resulting in microabscess that the swelling and merges with other abscesses. When they break ulcers, deeply penetrating into the mucous membrane, submucosal, and often in the muscular layers. At infringement of an integrity of blood vessels dizenterina forming into the blood, shock, which can be included in the liver and to cause the formation in it amebic abscess. You can defeat and more distant organs.
Pathological changes when amebiasis is most pronounced in the blind and ascending colon guts. Ulcers of different size and depth with saped edges and sebaceous bottom have a greenish-yellow color. The intestinal wall swollen, flabby with traces of scars on the sites of former ulcers. The formation of inflammatory granulomas (albom) and prioritize them in the gut.
The clinical picture. The incubation period lasts from 3 to 4 weeks to a few months. The onset of the disease is usually gradual and slight increases chair, the emergence of the admixture of mucus in the feces. Then the chair becomes more liquid increases up to 6-8 times a day, appear admixture not only mucus and blood and pus, abdominal pain initially uncertain, then cramping localized in the right part of the stomach. Increased body temperature, worsens the General condition, appear tenesmus. A very characteristic appearance of the chair - liquid blood and mucus mass ("raspberry jelly"). Belly painful, more in the right iliac region, where is palpated densified cecum. Sometimes the disease starts acutely sharp pains in the abdomen, frequent liquid blood and mucus in the stool, fever and intoxication, very reminiscent in these cases, acute bacterial dysentery. Acute manifestations of the initial period often themselves subside, and the disease takes a chronic relapsing course. Aggravation in the next come in different periods of time, usually 2 to 3 times a year, sometimes less. The severity as the initial acute stage and exacerbation of different; possible anemia, depletion, the accession of secondary infection, including bacillary dysentery. Complications: a perforation of the intestinal wall with the development of peritonitis, intestinal bleeding, scar contraction of the colon, the development of ameba, education anal fistula, amoebic abscesses in various organs.
The diagnosis of amebiasis is based on the clinical picture and data rector of monoscope. Absolute proof of amebiasis is detected in the feces vegetative tissue forms of E. histolytica.
A necessary condition discovery amoebae are multiple studies (8-10 times) always fresh faeces (less than 10-20 minutes after defecation). Faeces take in clean containers are free from residual disinfectant. It is recommended that prior studies to give to the patient saline laxative (magnesium sulfate). Will microscopic smear of feces with izotoniceski solution of sodium chloride and Lugol solution. Indirect sign of amebiasis is the presence in Calais crystals Charcot - Leyden, plasma cells, macrophages, and eosinophils. Recognition of amebiasis requires differentiating it from bacterial dysentery (see), azwenne nonspecific colitis (see), balantidiozom, by schistosomiasis (see), sometimes by polyps, tumors of the intestine (see Intestine).
The forecast. In the absence of specific treatment is possible a lethal outcome. Recovery in chronic forms incomplete. Outside the period of exacerbation disability is not broken.


Treatment. To specific funds at amebiasis include emetina hydrochloride, hanifan (ETRAN), hingamin (chloroquine), anteroseptal, Einarson. You can also apply tetracycline, oxytetracycline (terramycin) chlortetracycline hydrochloride [biomitsin (0.2 g 4 times a day for 5 to 7 days)], especially for combined treatment. The basic tool is the emetina hydrochloride applied intramuscularly in 1% solution 2-3 ml 2 times a day for adults within 5-8 days; sometimes repeat the treatment after 10 days. Children emetine: hydrochloride appoint depending on the age from 3 to 40 mg cleansing of the drug a day. The treatment can be carried out only in a hospital under the supervision of a physician. Children up to 6 months. emetina hydrochloride should not be entered. Hanifan inside appoint adults on 0.5 g 3 times a day for 7 to 10 days with a repetition rate indicated. Hingamin especially recommended for liver damage. Give adults inside and 0.25 g 2 times a day for 2 weeks, the children, depending on age 1/3 - 2/3 adult dose. Anteroseptal assign an adult inside of 1-2 tablets (0,22 to 0.44 g 3-4 times a day for 10 days after an interval of 5 to 10 days course repeat. At the end of each course of treatment again (3-4 times conduct parasitological study of feces. - Control study of faeces carried out after discharge from the hospital for at least 3 months.
Prevention. Hospitalization of patients with acute symptoms of the disease. Media treated with oseltamivir atrena. All other events are the same as in bacterial dysentery (see).