Pharmacotherapy of Amoebiasis
PST 06106
Basic Pharmacotherapy
Session 11: Pharmacotherapy of
Amoebiasis
Learning Objectives
By the end of this session students are expected to be able to:
Define of amebiasis and
ameobic
liver abscess
Explain pathophysiology of amebiasis and
ameobic
liver abscess
Explain the clinical presentation of amebiasis and
ameobic
liver abscess
Outline diagnosis of amebiasis and
ameobic
liver abscess
Describe pharmacological treatment of amebiasis and
ameobic
liver abscess
Describe the monitoring of amebiasis and
ameobic
liver abscess therapy
Activity: Buzzing
is
Amoebiasis?
Definition of Amebiasis
Amebiasis
Amoebiasis is an infection caused by the protozoa organism
Entamoeba histolytica,
which can cause colitis and other extra-intestinal manifestations.
The infection is primarily acquired through ingestion of contaminated food and water and occasionally can be acquired through oral-anal sexual practices.
Amoebic Liver Abscess
It is the most frequent extra-intestinal manifestation of
Entamoeba histolytica
infection which results from the invasion of the portal venous system from the colon leading to inflammation and subsequently abscess formation particularly involving the right lobe of the liver.
Pathophysiology Of Amoebiasis
E histolytica
invades mucosal cells of colonic epithelium, producing the classic flask-shaped ulcer in the submucosa.
The trophozoite has a
cytolethal
effect on cells through a toxin.
If the trophozoite gets into the portal circulation, it will be carried to the liver, where it produces abscess and
periportal
fibrosis.
Amebic ulcerations can affect the colon, perineum, and genitalia, and abscesses may occur in the lung and brain.
Clinical Presentation Of Amoebiasis
Intestinal disease
Vague abdominal discomfort, malaise to severe abdominal cramps, flatulence,
bloody diarrhea (
heme
-positive in 100% of cases) with mucus
Eosinophilia is usually absent, although moderate leukocytosis is not unusual
Evidence of motile
trophozoites
or cysts on saline wet mount from a stool specimen
Clinical Presentation Of Amoebiasis Cont.…
Amebic liver abscess
High fever, rigors(sudden feeling of cold and shivering) and profuse sweating,
significant leukocytosis with left shift,
elevated alkaline phosphatase, and liver tenderness on palpation
Right-upper-quadrant pain, hepatomegaly, and liver tenderness, with referred
painto
the left or right shoulder
Erosion of liver abscesses may also present as peritonitis(inflammation of the membrane lining the
abnominal
wall and covering the
abnominal
organs).
Positive imaging evidence of liver abscess and Serological evidence of
E.
histolytica
antibodies or antigens.
Activity
: Small Group Discussion
is the
treatments
of
amebiasis?
Pharmacological treatment and diagnosis of Amoebiasis
Monitoring Of Amoebiasis Therapy
Follow up in patients with amebiasis should include;
repeat stool examination, serology, colonoscopy (for colitis), or
Computed tomography (CT) (for liver abscess) between days 5 and 7, at the end of the course of therapy, and a month after the end of therapy.
Most patients with either intestinal amebiasis or colitis will respond in 3 to 5 days with amelioration of symptoms.
Monitoring Of Amoebiasis
Therapy Cont.…
Patients with liver abscesses may take from 7 to 10 days to respond;
Patients not responding during this period may require aspiration of abscesses or exploratory laparotomy.
Serial liver scans have demonstrated healing of liver abscesses over 4 to 8 months after adequate therapy.
Key
Points
Amebiasis
is a parasitic infection of the intestines caused by the protozoan Entamoeba histolytica, or E. histolytica.
Infection
by Entamoeba histolytica occurs by ingestion of mature cysts
infecally
contaminated food, water, or hands
The
symptoms of amebiasis include loose stool, abdominal cramping, and stomach
pain
Treatment for uncomplicated cases of amebiasis generally consists of a course of
metronidazole
or
tinidazole
Evaluation
What
is Amebiasis?
What is the pathophysiology of amebiasis?
What are the signs and symptoms of Amebiasis?
How is the treatment of Amebiasis?
References
Wells
BG,
DiPiro
J,
Schwinghammer
T (2013),
Pharmacotherapy Handbook
(6
th
Ed). New York, NY: McGraw-Hill.
DiPiro
JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey ML, (2008):
Pharmacotherapy: A Pathophysiologic Approach
(7
th
ed
): New York, NY: McGraw-Hill.
Katz M D., Matthias KR., Chisholm-Burns M A., Pharmacotherapy(2011)
Principles & Practice Study Guide: A Case-Based Care Plan Approach
: New York, NY: McGraw-Hill.
Schwinghammer
TL, Koehler JM (2009)
Pharmacotherapy Casebook: A Patient-Focused Approach
(7
th
ed
): New York, NY: McGraw-
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