Amebiasis - Causes, Symptoms and Treatment .MF .
Amebiasis - protozoal infection with the fecal-oral transmission mechanism, characterized by ulcerative lesions of the colon and extraintestinal lesions in the form of abscesses in other organs and tissues, as well as a tendency to a prolonged and chronic course.Once people get sick.Activators are protozoan parasites - amoeba.This is one of the diseases of "dirty hands".
Back in 1875, were first discovered pathogens amebiasis, and in 1891 - the disease is allocated as an independent nosological form, called "amoebic dysentery".The term "amebiasis" is used with 1906 to the present day.
known that a person can parasitize 6 species of amoebae, 5 of them are pathogenic and feed on the intestinal bacteria, and 1 - Entamoeba histolytica - pathogenic, cause severe intestinal symptoms.
dysentery amoeba in the gut
Like any parasite from dysentery amoeba there are 2 forms of life - trophozoite (vegetative stage) and cysts (resting stage).Trophozoite also goes through several stages, an
• Tissue form (only found in acute amoebiasis in the affected organs, and rarely in the faeces);
• big vegetative form (this form is already lives in the intestine and is found in coprogram, it absorbs the red blood cells);
• luminal form (found in chronic amebiasis or rekonvolisttsentsii stage after taking a laxative);
• predtsistnaya form (found under the same conditions as the luminal).
All of this matter to determine the source and methods of struggle against its parasites.
cysts are found in patients with chronic relapsing amebiasis in remission and in carriers of amoebas.
Stability trophozoite and all its varieties is very small, in the external environment are killed within 30 minutes.Cysts are the most stable, for example:
- 17-20ºS when stored for a month, in a darkened and moist soil - up to 8 days;
- in refrigerated foods, fruits, vegetables and household items - up to 5 days on average;
- in sub-zero temperatures persist for several months.
Drying and heat destroys the amoeba almost instantly.From disinfectant has a devastating effect on them only cresol and emitin and even chloramine does not render negative influence on them.
Causes infection amebiasis
Ill amebiasis age groups of both sexes, but mainly because of the pregnant physiological suppression of the immune system, namely cellular immunity.For high-risk of infection may also include persons receiving immunodeperssantnuyu therapy (corticosteroids, cytostatics, etc.).The incidence of recorded year-round, with the highest rise in the hottest months.This is especially a disease common in countries with hot climates, including in Central Asia, in the Caucasus.Quite often, common carrier when no symptoms, and the amoeba in the body there.
Source - man, releasing cysts, can be both the symptoms and without.Isolation of the pathogen continues for many years, allocated 300 million cysts per day or more.When striking symptoms, patients are not dangerous, because it is isolated vegetative forms are not stable in the environment.
Ways of transmission - fecal-oral (through contaminated food and water) and contact-household (through the "dirty hands" is an infection of household items contaminated with faeces of the patient).
Factors that reduce the body's resistance to pathogens: bacteria overgrowth, protein deficiency, associated worm infestation, pregnancy, and other conditions associated with decreased immunity.
symptoms of amebiasis
Symptoms pathogenesis will be determined, ie the technique of damaging factors.Once the cysts reach the intestine, begins incubation period lasts 1-2 weeks, ie from the beginning of the introduction to the first signs of the disease.During this time, the cysts are moving on sections of the intestine and triggering factors they begin to move forward and put into the colon wall.The most commonly affected transverse colon, descending colon sections.
As you progress, the cysts are transformed into vegetative forms, which have in their composition of proteolytic enzymes (trypsin and pepsin) that destroy the intestinal wall and thus facilitate the penetration of the pathogen in them, up to the muscular layer of the intestine.This penetration and will initiate the clinical symptoms and further complications with the spread of the parasite.
symptoms of "acute" intestinal amebiasis (subacute beginning - ie the symptoms are not evident on the first day, and with the increase in 2-3 days):
• loose stools 4-6 times a day, with clear mucus and a pungent odor;
• gradually increasing the frequency of bowel movements up to 10-20 times a day, stool is not fecal character, but in the form of glassy mucus;
• after a few days or just in the faeces there blood in the form of a "raspberry jelly";
• persistent or cramping pain of varying intensity, aggravated by defecation;
• appearance tenesmus - false urges to defecate, they are painful, time consuming and does not lead to results;37-38ºS
• low-grade fever, is held a few days;
• bloating and abdominal pain.
appearance of blood in the stool indicates that the wall has been destroyed infiltrated by parasites, and the appearance of lesions caused by tenesmus nerve endings gut wall.This occurs symptoms for 4-6 weeks at the start of timely specific treatment.If not treated, then there is in remission and the disease takes a chronic course, which leads to more extensive damage gut wall, and later to a breach of digestion and absorption.
Chronic (due to late initiation of treatment):
• unpleasant taste in the mouth, more difficult to specifications;
• tongue coated with white bloom;
• belly at this stage retracted, in spite of the possible bloating, palpation - soreness;
• asthenic syndrome (weight loss), with a deficit of protein and vitamins (pale skin, brittle nails, dull hair, and so on, a lot of options and they will depend on the specific vitamin deficiency);
• appetite decreased / absent;
• from other organs and systems there is decompensation (but these symptoms are unstable and may be absent altogether), especially in the cardiovascular system and liver functions of the heart - tachycardia, and muffled heart sounds, and from the liver - perhaps a little of itsenlargement and tenderness.
When immunodeficiency, as well as in young children, to fulminant amoebiasis: disease develops within the first two days, manifested by high fever, severe intoxication, causing severe pain, frequent stools, dehydration.Quickly comes extensive damage of the intestinal wall, which leads first to the formation of ulcers, then to paresis, and there is a high risk of perforation of the intestinal wall and peritonitis development. When such forms a very high mortality rate .
There are also other clinical forms of the amebiasis, but it is better attributed to complications, because they occur more frequently due to late initiation of treatment.Diagnosis of amebiasis
possible to use a method from simple to complex:
1. Pay attention to the dynamics of the disease character + chair + epidemiological data.
2. Microscopic examination of feces of the patient, and the presence of complications - from abscesses of internal organs, sputum smears from the mucous nasopharynx, biopsies of the affected areas.Smears are stained for identification of cysts and trophozoites.For faeces can be used provocative method - laxatives, but it is applicable only in the case of remission in acute flow - is absolutely contraindicated.
3. Endoscopy is performed when the impossibility of obtaining feces for one reason or another.With this method taken from colon biopsies walls estimated condition of the walls, namely ulcers formed amoeba.In tissue cultures of biopsies reveal vegetative form with the red blood cells inside, so it is called gemofag and this partly explains the development of anemia.
4. Serological methods: IFA (immunofluorescence reaction), ELISA (enzyme-linked immunosorbent assay) - Methods aimed at the detection of antibodies.
5. Additional methods: ultrasound of the abdomen and kidney, biochemical analyzes, the KLA and OAM - these may be informative if you suspect the presence of abscesses, decompensation by the organs and systems, etc.
amoeba in a smear under the microscope.
Treatment of amebiasis
There are several groups of drugs that act at different stages of the disease:
1. preparations direct contact action (direct amebotsidy), which are detrimental to the luminal form of the pathogen.Apply for rehabilitation carriers amoebae and treatment of chronic amebiasis in remission.It Hiniofon, Diyodohin.Hiniofon can be used in the form of enemas.
2. Drugs acting on the tissue amoebocytes, ie against the tissue and luminal forms of acute intestinal stage (can be extra-intestinal) amebiasis: Emetine, Digidroemitin, Ambilgar, Hinamin (with amebic liver abscess).
3. Universal / combined action of drugs are useful in all forms of amebiasis: Metronidozol (Trichopolum) Furamid.
4. Antibiotics are used to modify the microbial biocenosis in the intestine.
5. Drugs that restore normal intestinal flora: prebiotics, probiotics, simbiotiki, possible complex immunoglobulin preparation (TRC).
6. Enzyme preparations (Digestal, panzinorm) for the relief of colitis syndrome.
Dosages not shown specifically, because a number of drugs are toxic, often used in combination with each other or other groups of drugs (with antibiotics) and are assigned under the control of laboratory diagnostics.
parallel with drug treatment used protein mechanically-chemically schadaschaya diet.Vitamin therapy with oral access, bypassing the gut, because it violated the absorption.In the presence of abscesses in various organs used surgical approach against the background of complex treatment.
complications of amebiasis
• The emergence of extra-intestinal amebiasis (liver abscess, pleuropulmonary amebiasis, brain abscess, skin lesions);
• intestinal perforation, leading to peritonitis and high mortality;
• stricture (narrowing of the areas) of the intestine;
• Intestinal bleeding;
• Breakthrough abscess.
Identification and division tsistovydeliteley and carriers.Compliance with sanitary and hygienic measures.Specific prevention is not currently developed.
therapists Shabanova IE