Amoebiasis natural history, complications and prognosis: Difference between revisions
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==Overview== | ==Overview== | ||
==Natural History== | ==Natural History== | ||
===Luminal | ===Luminal Amoebiasis (Asymptomatic)=== | ||
*Following transmission, individuals remain asymptomatic for approximately 1 to | *Following transmission, individuals typically remain asymptomatic for approximately 1 to 4 weeks (up to several years), during which the parasite starts to actively destroy to integrity of the intestinal wall. | ||
*The majority of patients | *The majority of colonized patients do not develop any clinical manifestations. | ||
*The infection rate of ''E. histolytica'' is approximately 20%, whereas the infection rate of ''E. dispar'' is approximately 0%. | *The infection rate of ''E. histolytica'' is approximately 10%-20%, whereas the infection rate of ''E. dispar'' is approximately 0% (since ''E. dispar'' is not associated with invasive disease). | ||
===Invasive Intestinal | ===Invasive Intestinal Amoebiasis=== | ||
*As the parasite continues to invade the intestinal wall, the integrity of the wall is compromised, and the host immune cells are activated. The activation of neutrophils, macrophages, lymphocytes, and eosinophils contribute to inflammation and the development of clinical manifestations. | *As the parasite continues to invade the intestinal wall, the integrity of the wall is compromised, and the host immune cells are activated. The activation of neutrophils, macrophages, lymphocytes, and eosinophils contribute to the inflammation and the development of clinical manifestations. | ||
*Early symptoms include profuse, watery diarrhea, abdominal pain, bloating, and nausea. | *The development of symptoms occurs gradually over 1-2 weeks. Early symptoms include profuse, watery diarrhea, abdominal pain, bloating, and nausea. | ||
If left untreated, patients may progress | *If left untreated, the majority of patients report self-resolution of symptoms. | ||
*In a minority of cases, however, the disease may progress and patients develop bloody diarrhea (dysentery), fulminant colitis, appendicitis, toxic megacolon, and ameboma (granulation tissue in the colon). | |||
===Invasive Extraintestinal Amoebiasis=== | ===Invasive Extraintestinal Amoebiasis=== | ||
*As the infection advances, the parasite is able to migrate outside the intestinal lumen into the bloodstream, where it is able to migrate to distant organs. | *As the infection advances, the parasite is able to migrate outside the intestinal lumen into the bloodstream, where it is able to migrate to distant organs. | ||
*If left untreated, the most site of parasitic migration is the liver, whereby the parasite travels in the portal circulation and causes amoebic liver abscess. | *If left untreated, the most site of parasitic migration is the liver, whereby the parasite travels in the portal circulation and causes amoebic liver abscess. | ||
*Other organs may also be affected, including the brain ( | *Other organs may also be affected, including the brain (cerebral amoebiasis), pulmonary system (pleuropulmonary abscess), skin, and genitals. | ||
===Chronic Amoebiasis=== | |||
*Patients with untreated amoebiasis may develop chronic disease. | |||
*The symptoms of chronic amoebiasis resemble inflammatory bowel disease (IBD). | |||
*The distinction between chronic amoebiasis vs. IBD is important since corticosteroid therapy is effective for IBD but worsens amoebiasis. | |||
==Complications== | ==Complications== | ||
Complications of amoebiasis may be either intestinal or extraintestinal: | Complications of amoebiasis may be either intestinal or extraintestinal: | ||
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*Dysentery | *Dysentery | ||
*Colitis | *Colitis | ||
*Appendicitis | *Appendicitis<ref name="pmid23665815">{{cite journal| author=Otan E, Akbulut S, Kayaalp C| title=Amebic acute appendicitis: systematic review of 174 cases. | journal=World J Surg | year= 2013 | volume= 37 | issue= 9 | pages= 2061-73 | pmid=23665815 | doi=10.1007/s00268-013-2079-5 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23665815 }} </ref> | ||
*Toxic megacolon | *Toxic megacolon | ||
*Ameboma | *Peritonitis | ||
*Ameboma (granulation tissue in the colon) | |||
*Intestinal perforation | |||
===Extraintestinal Complications=== | ===Extraintestinal Complications=== | ||
*Amoebic liver abscess | *Amoebic liver abscess | ||
* | *Cerebral amoebiasis | ||
*Pleuropulmonary abscess | *Pleuropulmonary abscess | ||
*Skin lesions | *Skin lesions | ||
*Amoebic genital lesions | *Amoebic genital lesions | ||
* | *Amoebic pericarditis | ||
==Prognosis== | ==Prognosis== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Natural History
Luminal Amoebiasis (Asymptomatic)
- Following transmission, individuals typically remain asymptomatic for approximately 1 to 4 weeks (up to several years), during which the parasite starts to actively destroy to integrity of the intestinal wall.
- The majority of colonized patients do not develop any clinical manifestations.
- The infection rate of E. histolytica is approximately 10%-20%, whereas the infection rate of E. dispar is approximately 0% (since E. dispar is not associated with invasive disease).
Invasive Intestinal Amoebiasis
- As the parasite continues to invade the intestinal wall, the integrity of the wall is compromised, and the host immune cells are activated. The activation of neutrophils, macrophages, lymphocytes, and eosinophils contribute to the inflammation and the development of clinical manifestations.
- The development of symptoms occurs gradually over 1-2 weeks. Early symptoms include profuse, watery diarrhea, abdominal pain, bloating, and nausea.
- If left untreated, the majority of patients report self-resolution of symptoms.
- In a minority of cases, however, the disease may progress and patients develop bloody diarrhea (dysentery), fulminant colitis, appendicitis, toxic megacolon, and ameboma (granulation tissue in the colon).
Invasive Extraintestinal Amoebiasis
- As the infection advances, the parasite is able to migrate outside the intestinal lumen into the bloodstream, where it is able to migrate to distant organs.
- If left untreated, the most site of parasitic migration is the liver, whereby the parasite travels in the portal circulation and causes amoebic liver abscess.
- Other organs may also be affected, including the brain (cerebral amoebiasis), pulmonary system (pleuropulmonary abscess), skin, and genitals.
Chronic Amoebiasis
- Patients with untreated amoebiasis may develop chronic disease.
- The symptoms of chronic amoebiasis resemble inflammatory bowel disease (IBD).
- The distinction between chronic amoebiasis vs. IBD is important since corticosteroid therapy is effective for IBD but worsens amoebiasis.
Complications
Complications of amoebiasis may be either intestinal or extraintestinal:
Intestinal Complications=
- Dysentery
- Colitis
- Appendicitis[1]
- Toxic megacolon
- Peritonitis
- Ameboma (granulation tissue in the colon)
- Intestinal perforation
Extraintestinal Complications
- Amoebic liver abscess
- Cerebral amoebiasis
- Pleuropulmonary abscess
- Skin lesions
- Amoebic genital lesions
- Amoebic pericarditis
Prognosis
References
- ↑ Otan E, Akbulut S, Kayaalp C (2013). "Amebic acute appendicitis: systematic review of 174 cases". World J Surg. 37 (9): 2061–73. doi:10.1007/s00268-013-2079-5. PMID 23665815.