list of infections 2019

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Infection


Protozoal Infection


        Lyfe cycle of Entamoeba histolytica


A disease caused by Entamoeba Histolytica is called amoebiasis.

Type of Amoebiasis 


Amoebiasis is two types
1-Intestinal Amoebiasis
2-Extraintestinal Amoebiasis


Intestinal Amoebiasis


Involvement of large gut by E. histolytica is called intestinal amoebiasis.
Any part of colon may be involved but ileocaecal region and sigmoidorectal region are commonly involved.

Transmission


Transmission occurs via the faecal–oral route, either directly by person-to-person contact or indirectly by eating or drinking faecally contaminated food or water.

clinical features



It varies from asymptomatic cyst passer to acute amoebic dysentery.
The incubation period varies from week to months or years. Acute amoebic dysentery manifests with fever, nausea, vomiting, pain in abdomen with 2-4 loose stools a day mixed with blood and mucus in the form of streaks.
The stools are offensive and sticky.
some patients my complain of alternating constipation with diarrhoea.
On palpation of abdomen, there may be tenderness along the line of colon but commonly elicitable over the sigmoid or pelvic colon in left iliac fossa and caecum in right iliac fossa.The right iliac pain may resemble pain due to acute appendicitis.
Perforation of acute amoebic intestinal ulcers is rare, but if occurs, involves the caecal rigion.


Treatment


Oral Metronidazole 800 mg. ( 2 tabs of 400 mg. ) thrice daily or ornidazole 500 mg. b.i.d. for 5 days,
                            or
Oral Tinidazole 2.0 g. daily for 3 days,
                            or
Oral secnidazole 2.0 g. as a single fose


Prevention / Prophylaxis


1. Maintain personal hygiene.
2. Proper disposal of stools.
3. Treatment of acute cases as will as asymptomatic carrier.




Extraintestinal [ Hepatic ] Amoebiasis



Liver is involved by E. histolytica, when its trophozoites enter the portal circulation from active intestinal lesion. The trophozoites invade the liver cells, produce enlargement of liver with or withouy abscess formation. The enlargement of liver without abscess indicates nonsuppurative hepatic amoebiasis while necrosis and suppuration lead to development of an acute abscess in liver ( amoebic liver abscess )


Symptoms


There are usually no symptoms of intestinal infection. But people with amebic liver abscess do have symptoms, including:

Abdominal pain, more so in the right, upper part of the abdomen; pain is intense, continuous or stabbingCoughFever and chillsDiarrhea (in only one-third of patients)General discomfort, uneasiness, or ill feeling (malaise)Hiccups that do not stop (rare)Jaundice (yellowing of the skin, mucous membranes, or eyes)Loss of appetiteSweatingWeight loss


Diagnosis and investigation


1- Leucocytosis in the blood.
2- Raised right dome of diaphragm of X-ray chest.
3- Movements of the right dome of diaphragm are restricted on screening chest during respiration.
4- Ultrasonography .
5- Liver scan.
6- Serological tests.


Treatment



In general, metronidazole, tinidazole, emetine, and dehydroemetine are active in invaded tissues; chloroquine is active only in the liver; tetracycline acts on the bowel wall; and diloxanide furoate, paromomycin, and iodoquinol are luminal agents only. The details on tissue and luminal amebicidal agents are discussed in Medication.










                     Dr. Shamsheer Abbas

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