Amoebiasis differential diagnosis: Difference between revisions

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{{Amoebiasis}}
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==Overview==
==Overview==
Differentiation of amebic colitis from other enteric diseases is a major diagnostic challenge.  
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 enteritis|''E. coli'' infection]], [[shigellosis]], [[salmonellosis]], ''[[Campylobacter jejuni|C. jejuni'' infection]])
*Viral infections (e.g. [[Norovirus infection|norovirus]], [[Rotavirus infection|rotavirus]], [[Astrovirus infection|astrovirus]], [[HIV infection|HIV]])
*Fungal infections (e.g. ''[[Candidiasis|Candida spp.]]'')
*Parasites (''[[Giardiasis|''Giardia'']]'', ''[[Cryptosporidium|Cryptosporidium spp.]]'', [[Cyclospora]])
===Non-infectious Differential Diagnoses===
The following are the non-infectious differential diagnoses of ''E. coli enteritis'':
*[[Acute pancreatitis]]
*[[Adrenal insufficiency]] and [[Adrenal insufficiency|Waterhouse-Friedrichsen syndrome]]
*[[Allergy]] (e.g. [[Allergy|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|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 [[Abdominal pain causes|'''here''']].<br>
To view a comprehensive list of diarrhea differential diagnoses, click [[Diarrhea causes|'''here''']].
 
'''The table below summarizes the findings that differentiate inflammatory causes of chronic diarrhea'''<ref name="pmid8209928">{{cite journal| author=Konvolinka CW| title=Acute diverticulitis under age forty. | journal=Am J Surg | year= 1994 | volume= 167 | issue= 6 | pages= 562-5 | pmid=8209928 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8209928  }} </ref><ref name="pmid16151544">{{cite journal| author=Silverberg MS, Satsangi J, Ahmad T, Arnott ID, Bernstein CN, Brant SR et al.| title=Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. | journal=Can J Gastroenterol | year= 2005 | volume= 19 Suppl A | issue=  | pages= 5A-36A | pmid=16151544 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16151544  }} </ref><ref name="pmid16698746">{{cite journal| author=Satsangi J, Silverberg MS, Vermeire S, Colombel JF| title=The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications. | journal=Gut | year= 2006 | volume= 55 | issue= 6 | pages= 749-53 | pmid=16698746 | doi=10.1136/gut.2005.082909 | pmc=1856208 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16698746  }} </ref><ref name="pmid12700377">{{cite journal| author=Haque R, Huston CD, Hughes M, Houpt E, Petri WA| title=Amebiasis. | journal=N Engl J Med | year= 2003 | volume= 348 | issue= 16 | pages= 1565-73 | pmid=12700377 | doi=10.1056/NEJMra022710 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12700377  }} </ref><ref name="pmid12700377">{{cite journal| author=Haque R, Huston CD, Hughes M, Houpt E, Petri WA| title=Amebiasis. | journal=N Engl J Med | year= 2003 | volume= 348 | issue= 16 | pages= 1565-73 | pmid=12700377 | doi=10.1056/NEJMra022710 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12700377  }} </ref>
{| class="wikitable"
!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 [[Contrast medium|(IV) contrast]]
|bowel rest, [[Intravenous fluids|IV fluid]] resuscitation, and [[Broad-spectrum antibiotic|broad-spectrum antimicrobial therapy]] which covers [[Anaerobic organism|anaerobic]] [[bacteria]] and [[gram-negative]] [[Bacteria|rods]]
|-
|[[Ulcerative colitis]]
|
* [[Diarrhea]] mixed with blood and [[mucus]], of gradual onset.
* Signs of [[weight loss]]
* [[Rectal pain|Rectal urgency]]
* [[Tenesmus]]
* [[Blood]] is often noticed on underwear
* Different degrees of [[abdominal pain]]
|
* [[Anemia]]
* [[Thrombocytosis]]
* A high [[platelet]] count


Differential diagnosis includes:
* Elevated [[ESR]] (>30mm/hr)
* Bacterial [[dysentery]].
* Low [[albumin]]
* [[Inflammatory bowel disease]].
|[[Endoscopy]]
* [[Ischemic colitis]].
|Induction of  [[Remission (medicine)|remission]] with [[mesalamine]] and [[corticosteroids]] followed by the administration of [[sulfasalazine]] and [[Mercaptopurine|6-Mercaptopurine]] depending on the severity of the [[disease]].  
* [[Bleeding]] [[diverticula]].
|-
* [[Arteriovenous malformations]].
|[[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 [[Amoebiasis|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.
|}


==References==
==References==
{{reflist|2}}
{{Reflist|2}}


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Latest revision as of 16:36, 18 September 2017

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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

Non-infectious Differential Diagnoses

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

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[1][2][3][4][4]

Cause History Laboratory findings Diagnosis Treatment
Diverticulitis 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 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 cysts shed with the stool detects ameba DNA in feces Amebic dysentery

Luminal amebicides for E. histolytica in the colon:

For amebic liver abscess:

References

  1. ↑ Konvolinka CW (1994). "Acute diverticulitis under age forty". Am J Surg. 167 (6): 562–5. PMID 8209928.
  2. ↑ Silverberg MS, Satsangi J, Ahmad T, Arnott ID, Bernstein CN, Brant SR; et al. (2005). "Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology". Can J Gastroenterol. 19 Suppl A: 5A–36A. PMID 16151544.
  3. ↑ Satsangi J, Silverberg MS, Vermeire S, Colombel JF (2006). "The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications". Gut. 55 (6): 749–53. doi:10.1136/gut.2005.082909. PMC 1856208. PMID 16698746.
  4. ↑ 4.0 4.1 Haque R, Huston CD, Hughes M, Houpt E, Petri WA (2003). "Amebiasis". N Engl J Med. 348 (16): 1565–73. doi:10.1056/NEJMra022710. PMID 12700377.

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