Amoebiasis differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Yazan Daaboul, M.D.; Serge Korjian M.D.

Overview

Amoebiasis must be differentiated from other causes of abdominal pain, bloating, acute or chronic diarrhea, and weight loss, such as other infectious causes of gastroenteritis, including bacterial, viral, fungal, and parasitic pathogens, in addition to non-infectious causes, including acute pancreatitis, appendicitis, bowel obstruction, diverticulitis, drug reaction, hyperthyroidism, inflammatory bowel disease, celiac disease, lactose intolerance, Whipple disease, tropical sprue, and lymphoma.

Differentiating Amoebiasis from other Diseases

• Amoebiasis must be differentiated from other causes of acute or chronic diarrhea, bloating, abdominal pain, and fever (less common).
• Differential diagnosis of amoebiasis includes the following:

Infectious Differential Diagnoses

• Bacterial infections (e.g. E. coli infection, shigellosis, salmonellosis, C. jejuni infection)
• Viral infections (e.g. norovirus, rotavirus, astrovirus, HIV)
• Fungal infections (e.g. Candida spp.)
• Parasites (Giardia, Cryptosporidium spp., Cyclospora)

Non-infectious Differential Diagnoses

The following are the non-infectious differential diagnoses of E. coli enteritis:

• Acute pancreatitis
• Adrenal insufficiency and Waterhouse-Friedrichsen syndrome
• Allergy (e.g. insect bite allergy or anaphylaxis)
• Appendicitis
• Bowel obstruction
• Celiac disease
• Diverticulitis
• Drug reaction (e.g. antimicrobial agents, antihypertensive therapy, chemotherapy, anticonvulsants)
• Endometriosis
• Familial Mediterranean fever
• Gastrointestinal perforation
• Hyperthyroidism
• Ileus
• Inflammatory bowel disease (Crohn's disease or ulcerative colitis)
• Intussusception
• Ischemic colitis
• Ketoacidosis
• Lactose intolerance
• Lymphoma
• Mesenteric ischemia
• Necrotizing enterocolitis
• Ogilvie syndrome
• Peritonitis
• Pneumonia
• Poisoning and toxicity (e.g. carbon monoxide poisoning, organophosphate poisoning, digitoxin toxicity)
• Ruptured abdominal aortic aneurysm
• Spider bite
• Tropical sprue
• Volvulus
• Urinary tract infection
• Whipple disease

To view a comprehensive list of abdominal pain differential diagnoses, click here.
To view a comprehensive list of diarrhea differential diagnoses, click here.

The table below summarizes the findings that differentiate inflammatory causes of chronic diarrhea

Cause	History	Laboratory findings	Diagnosis	Treatment
Diverticulitis	Bloody diarrhea Left lower quadrant abdominal pain Abdominal tenderness on physical examination Low grade fever	Leukocytosis Elevated serum amylase and lipase Sterile pyuria on urinalysis	Abdominal CT scan with oral and intravenous (IV) contrast	bowel rest, IV fluid resuscitation, and broad-spectrum antimicrobial therapy which covers anaerobic bacteria and gram-negative rods
Ulcerative colitis	Diarrhea mixed with blood and mucus, of gradual onset. Signs of weight loss Rectal urgency Tenesmus Blood is often noticed on underwear Different degrees of abdominal pain	Anemia Thrombocytosis A high platelet count Elevated ESR (>30mm/hr) Low albumin	Endoscopy	Induction of remission with mesalamine and corticosteroids followed by the administration of sulfasalazine and 6-Mercaptopurine depending on the severity of the disease.
Entamoeba histolytica	Abdominal cramps Diarrhea Passage of 3 - 8 semiformed stools per day Passage of soft stools with mucus and occasional blood Fatigue Intestinal gas (excessive flatus) Rectal pain while having a bowel movement (tenesmus) Unintentional weight loss	cysts shed with the stool	detects ameba DNA in feces	Amebic dysentery Metronidazole 500-750mg three times a day for 5-10 days Tinidazole 2g once a day for 3 days is an alternative to metronidazole Luminal amebicides for E. histolytica in the colon: Paromomycin 500mg three times a day for 10 days Diloxanide furoate 500mg three times a day for 10 days Iodoquinol 650mg three times a day for 20 days For amebic liver abscess: Metronidazole 400mg three times a day for 10 days Tinidazole 2g once a day for 6 days is an alternative to metronidazole Diloxanide furoate 500mg three times a day for 10 days must always be given afterwards.