Amoebiasis Lecture Notes PDF

DIAGNOSIS AMOEBIASIS PUTU AYU ASRI DAMAYANTI 2 AMOEBIASIS PRESENTATION INTRODUCTION TITLE Eight species of amoebae naturally parasitize the human mouth and intestines Not all amoebae are pathogen, most of them...

DIAGNOSIS AMOEBIASIS PUTU AYU ASRI DAMAYANTI 2 AMOEBIASIS PRESENTATION INTRODUCTION TITLE Eight species of amoebae naturally parasitize the human mouth and intestines Not all amoebae are pathogen, most of them are commensal Mostly asymptomatic but treathening life in immunocompromize person Asymptomatic carrier is the resource of infection 3 EPIDEMIOLOGI AMOEBIASIS PATHOGEN AND COMMENSAL INTESTINAL AMOEBAE AMUBIASIS: ENTAMOEBA HISTOLYTICA Disease: amebic dysentery, amebic liver abscess 500 million people are infected. 100,000 deaths per year. Most cosmopolitan of parasitic disease, infect 10% of the world’s population Poor sanitation >> tropic country Men who have sex with men Immunosuppresed person  There are 6 species of Entamoeba: E. histolytica  pathogen E. dispar E. hartmanni E. coli E. gingivalis polecki  MORPHOLOGY Trophozoite Cyst Non infective Infective form Actively motile (quadrinucleate cyst) Pseudopodi(+) Iregular shape Non active RBC (+) Pseudopodi (-) ovoid/round shape Nucleus: 1 Glicogen mass, chromatoid bar and vacuole (+) Nucleus: 1-4 Trophozoite Cyst  MORPHOLOGY … Morphology E. histolytica and E. dispar sulit dibedakan Morphology E. histolytica and E. coli juga mirip E. dispar and E coli are commensal, non invasive  No RBC ingested Hasil berupa dugaan (presumptive/preliminary) harus dilanjutkan dengan permanent stain SALINE: T R O P H O Z O I T E B E R G E R A K S AT U A R A H (PSEUDOPODA) + ERITROSIT  MORPHOLGY … LIFE CYCLE  DIRECT TRANSMISSION With contaminated hands Can be sexually transmitted person -to -person contacts IN D IR EC T T R A N SM ISION MODE OF contaminated food , water TRANSMISSION Arthropods (flies as vector) 17  PATHOGENESIS Live in multiply  crypts of the mucosa of large intestine  break the mucus barrier  adhesion and cytolytic by lectin, amebapores, protease Cysteine protease hydrolize host tissue (intestinal wall  submucosa & underlying blood vessels “flask shape ulcer”travel with the blood and lymph to ectopic sites (liver, lung, brain, skin, penis) Liver: trophozoite enter mesenteric venules and hepatoportal system Lung: liver abscess rupture through diaphragm INTESTINAL AMOEBIASIS E. HISTOLYTICA IN MUCOSA OF THE COLON INTESTINAL AMOEBIASIS EXTRA INTESTINAL AMEBIASIS SYMPTOMS A. Intestinal amebiasis: Asymptomatic: carrier Acute: 1. dysentery or blood with mucous diarrhea with moderate colic pain preceding discharge rectal tenesmus fever and systemic manifestations are generally absent. 2. amebic colitis  DIAGNOSIS INTESTINAL AMEBIASIS … Diagnosis: Fecal examination (microscopic) Acute: trophozoite After 30 min trophozoit form will destroy. Chronis: cyst Serologic; ELISA RT-PCR DIAGNOSIS NON MIKROSKOPIS enzyme-linked immunosorbent assay (ELISA)  untuk mendeteksi galactose/N-acetyl D- galactosamine lectin for E. histolytica in stools Contoh kit: Entamoeba Test and E. histolytica II Test kits, Polymerase chain reaction (PCR), multiplex nested PCR B. Extraintestinal amebiasis Liver abscess/ hepatic amoebiasis Pulmonary amoebiasis Cerebral amoebiasis Cutaneous amoebiasis Splenic abscess Urogenital tract amoebiasis Hepatic amoebiasis (Liver abscess) Symptoms Pain in the right hypochondrium radiating toward the right shoulder and scapular (worsening while deep breathing, coughing, and stepping on the right foot during walking) In left hypochondrium if the PUS is left lobe Fever between 38°C - 40°C Anorexia, nausea, vomiting, diarrhea (with or without blood), and dysentery (rarely only 10% case) Jaundice unusual DIAGNOSIS HEPATIC AMOEBIASIS (LIVER ABSCESS) …. Diagnosis: 1. Physical examination, cardinal sign is painful hepatomegaly. Enlarged liver, palpable below the costal margin the liver is soft and smooth (tender) Liver dullness Diminished movement of the right side of trachea during respiration Spleen is not enlarged HEPATIC AMOEBIASIS (LIVER ABSCESS) …. 2. Blood examination Leucocytosis 25% of cases the cell count in normal limit Mild increase in serum bilirubin SGOT (AST) and SGPT slightly elevated Hiypoalbuminaemia & hyperglobulinaemia 3. Stool examination Only 10-15% cases show the presence of E. histolytica 4. Other exam: liver biopsy, sigmoidoscopic, x-ray, USG, CT- scan, IHA, ELISA AMOEBIC LIVER ABSCESS EXTRA INTESTINAL AMOEBIASIS Amoebiasis of the skin Amoebic abscess of lung Amoebic balanitis SYMPTOMS Symptoms depend on : E. histolytica virulence and susceptibility of the host Tissue invasion, intestinal or extraintestinal Severe: immunosupresive person (corticosteroid administration, HIV, pregnancy, transplant recipient, severe burn) DIFFERENTIAL DIAGNOSIS AMEBIASIS INTESTINAL  Charcot-Leyden crystals are composed of an eosinophilic lysophospholipase binding protein called Galectin -10 They are indicative of a disease involving eosinophilic inflammation or proliferation, such as is found in allergic reactions (asthma, bronchitis, allergic rhinitis and rhinosinusitis) and parasitic infections such as Entamoeba histolytica, Necator americanus, and Ancylostoma duodenale. TREATMENT OTHER OPTION OF TREATMENT … Metronidazole + Iodoquinol 650mg X 3  (21 days) Metronidazole +tetracycline 250mg X 4  10 days Chloroquine 500mg X 1.. 7days (Liver amoebiasis) Paromycine 250mg//kg X 3.. 7days PREVENTION Food and drink cooked/boilled properly Avoid raw food (fruit and salad) , ice cube in endemic area Personal hygine and sanitation  Food handler Latrine Flies and cockroaches avoidance from food Do not use human feces as fertilizer DIFFERENTIAL DIAGNOSIS FOR MICROSCOPIC IDENTIFICATION ENTAMOEBA DISPAR Dengan tidak adanya eritrosit dalam sitoplasma: E. histolytica secara mikroskopis morfologi identik dgn E. dispar yang hanya bisa dibedakan dengan pemeriksaan ELISA atau PCR ENTAMOEBA DISPAR E. dispar umumnya bersifat non invasive --> asymptomatic infections Hanya jika ada sel darah merah (RBC) pada trophozoite yang membedakan E. histolytica dengan E. dispar dan Entamoeba lainnya Pemeriksaan lebih lanjut: enzyme-linked immunosorbent assay (ELISA)  untuk mendeteksi galactose/N-acetyl D-galactosamine lectin for E. histolytica in stools Contoh kit: Entamoeba Test and E. histolytica II Test kits, Polymerase chain reaction (PCR), multiplex nested PCR Stool untuk pemeriksaan serologis dan biomolekuler: fresh stool -20oC atau dengan pengawet ethanol atau 2.5% potassium dichromate yang disimpan 4°C until further analysis. PCR/ELISA  Hasil berupa dugaan (presumptive/preliminary) harus dilanjutkan dengan permanent stain ENTAMOEBA COLI Common Nonpathogenic Must be differentiated from E. histolytica E.coli is the only species in the genus encountered in humans with more then four nuclei in the cyst stage Entamoeba histolytica Entamoeba coli Endosome central Endosome Nuclear membrane: Eccentrically distinct line Nuclear membrane: RBC (+) distinct line RBC (-) TERIMA KASIH  APPENDIX AMOEBIASIS 49 AMOEBIASIS APPENDIX 50