Transcript Amoeboisis Clinical Case 10

Amoebiasis
Clinical Case 10
Ellen Marie de los Reyes

EF, a fresh college graduate, is applying
for a job at a pharmaceutical company.
Routine laboratory examinations were
requested. Fecalysis revealed (+) E
histolytica cyst. Patient is
asymptomatic.
1. Give your Diagnosis
Amoebiasis


An infection with Entamoeba histolytica
produced by the ingestion of cysts in
the organism
In the intestines, the cysts develop into
trophozoites that adhere to colonic
epithelial cells by means of a lectin on
the parasite
Amoebiasis




Lyses the host cell
invades the submucosa and secretes
IFN-γ activated macrophages
This will result in dysentery
The parasite can invade the liver and
can develop liver abscesses and an
amoebic granulomas developing in the
intestinal wall
Symptoms





gastrointestinal including diarrhoea, vomiting,
abdominal pain or discomfort and fever.
Duration: few days to a few weeks but usually it is
about two to four weeks.
Most are asymptomatic
has the potential to make the sufferer dangerously ill
Infections that sometimes last for years may be
accompanied by



no symptoms (in the majority of cases),
vague gastrointestinal distress,
dysentery (with blood and mucus).
Asymptomatic Infection




the amoeba lives by eating and digesting
bacteria and food particles in the gut.
It does not usually come in contact with the
intestine itself due to the protective layer of
mucus that lines the gut.
Disease occurs when amoeba comes in
contact with the cells lining the intestine.
secretes toxic substances, including enzymes
that destroy cell membranes and allow it to
penetrate and digest human tissues, resulting
in flask-shaped ulcers in the intestine.
Amoebiasis

Amoebiasis is transmitted:



fecal contamination of drinking water
foods
direct contact with dirty hands
sexual contact
2. How would you manage
this case?
Main drugs



Metronidazole
Tinidazole
Diloxanide
*These agents may be used in
combination
Drugs of choice for various forms
of Amoeboisis




Acute invasive intestinal amoeboisis
resulting in acute severe amoebic
dysentary> metronidazole followed by
diloxanide
Chronic intestinal
amoeboisis>diloxanide
Heptic amoeboisis>metronidazole
followed by dilxanide
Carrier state>diloxanide
3. Discuss the pharmacokinetics
of the drug of choice.
Metronidazole



Kills the trophozoites of E. histolytica by
damaging the DNA by toxic oxygen
products generated by thedrug
But has no effect on the cysts
Most effective drug available for
invasive amoebiasis
Pharmacokinetics






Usually given orally
Rapidly, completely absorbed
Peak plasma concentration 1-3 hrs
Half-life 7 hrs
Distributed rapidly through the tissues
reaching high concentrations in the body
fluids and CSF
Some are metabolized and most excreted in
urine
Unwanted effects




Bitter taste in the mouth
Minor gastrointestinal disturbances
Dizziness, headache, sensory
neuropathies
Drug interferes with alcohol metabolism
Tinidazole



Similar to metronidazole
Eliminated more slowly
Half-life 12-14 hrs
Diloxanide




Effective against the non-invasive
intestinal parasite
Drugs have a direct amoebicidal action
affecting the amoebae before
encystment
Given orally
No serious adverse effects
And now we reached the end!
Thank you!