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Treatment and Prevention of Amebiasis
Published in Roberto R. Kretschmer, Amebiasis: Infection and Disease by Entamoeba histolytica, 2020
Administration — Metronidazole is usually administered orally at a dose of 2 g/day, in b.i.d. or t.i.d. fashion for a period of 5 to 10 days. The dose for children is 35 to 50 mg/kg/day also in three or four divided doses. Ornidazole and other derivatives are prescribed at the same dose.34 Powell35 used metronidazole at a dose of 2.4 g/day for 2 days to treat amebic dysentery. Leiman36 used ornidazole similarly. In our opinion, such short courses of higher doses are less well tolerated than conventional ones and their efficacy is inferior to a treatment lasting 8 to 10 days. Patients with amebic liver abscess respond favorably after 3 days of treatment. Up to 85% of recoveries are obtained if treatment is continued for at least 5 days, and 95% if treatment is extended to 10 days. Intravenous administration of metronidazole is highly effective in cases with severe forms of invasive amebiasis, such as multiple liver abscess, ameboma, amebic appendicitis, etc. The recommended dose is 500 mg every 6 h. Plasma concentration reaches 33.5 ± 3.2 mg/ml when metronidazole is intravenously administered. Metronidazole is also absorbed rectally and can therefore be eventually administered in the form of suppositories.
Tropical Colorectal Surgery
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Meheshinder Singh, Kemal I. Deen
This represents the mildest form of invasive disease. Even though small ulcers may be found in the colon in such patients, they do not have bowel symptoms. However, these patients are at risk of developing an amoebic liver abscess, or of progressing at a later stage to acute amoebic dysentery. Serum antibodies are usually present in such patients.
Tropical infections and infestations
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
The typical patient with amoebic liver abscess is a young adult male with a history of insidious onset of non-specific symptoms, such as abdominal pain, anorexia, fever, night sweats, malaise, cough and weight loss. These symptoms gradually progress to more specific symptoms of pain in the right upper abdomen and right shoulder tip, hiccoughs and a non-productive cough. A past history of bloody diarrhoea or travel to an endemic area raises the index of suspicion.
Infections caused by hypervirulent Klebsiella pneumoniae in non-endemic countries: three case reports and review of the literature
Published in Acta Clinica Belgica, 2023
Wannes Van Hooste, Marthe Vanrentergem, Eric Nulens, Christophe Snauwaert, Deborah De Geyter, Rembert Mertens, Jens T. Van Praet
A 54-year-old Belarusian male truck driver presented at the emergency ward because of diarrhoea in the last 3 days, cough, dyspnoea and fever. He had no relevant medical history and took no medication. Upon clinical examination, he looked severely ill and had fever up to 39°C, but other vital signs were stable. Deep palpation of the abdominal right upper quadrant was painful without muscular rigidity. Further clinical examination was unremarkable. Blood results showed mild neutrophilic leucocytosis (14,900/µl), normal kidney function, significantly raised C-reactive protein (CRP) (378 mg/dl), hyperbilirubinemia (3.30 mg/dL [reference value 0.30–1.20 mg/dl], with a direct bilirubin of 1.1 mg/dl) and minimally elevated AST (58 U/l) and ALT levels (91 U/l). Cholestatic parameters were normal on admission. As screening test for Covid-19, a chest CT without intravenous contrast was performed which visualised an atypical lesion in segment 6 of the partially displayed liver. After taking blood cultures, empiric antibiotic treatment (amoxicillin/clavulanic acid 1000 mg/200 mg every 6 hours IV) was initiated. Additional investigation with triple-phase CT of the liver showed an ill-defined, thin-walled and heterogeneous lesion with a diameter of 9 cm in the right liver lobe (see Figure 1, panel A-D). There was some heterogeneous enhancement after intravenous contrast administration, mostly sparing the outer rim. The differential diagnosis at this point included a pyogenic liver abscess, amoebic liver abscess or multilocular liver tumour.
Antigenic membrane proteins of virulent variant of Entamoeba histolytica HM-1:IMSS
Published in Pathogens and Global Health, 2020
Gaayathri Kumarasamy, Asmahani Azira Abdus Sani, Alfonso Olivos-García, Rahmah Noordin, Nurulhasanah Othman
The disease is commonly transmitted via ingestion of water and food contaminated with feces containing E. histolytica cysts. People in high-risk groups include returning travelers and immigrants from highly endemic areas such as South East Asian countries (6). Besides, atypical means of transmission are via oral and anal sex [7]. Furthermore, this infection also occurs in first-world countries with insufficient barriers between water and human feces [7]. After ingestion, the amoebic cysts enter the stomach and excyst in the terminal ileum, develop into trophozoites and then inhabit the colon. Almost 90% of the infections remain asymptomatic and 10% exhibit a range of diseases which include acute diarrhea, amoebic colitis, amoebic liver abscess (ALA) and dysentery [5]. The prevalence of E. histolytica diseases is apparently deceptive since over 90% of the infections are caused by E. dispar. In a study conducted by [8], the asymptomatic infections of E. histolytica/E. dispar is mostly attributed to E. dispar infections rather than E. histolytica.
When IBD is not IBD
Published in Scandinavian Journal of Gastroenterology, 2018
Bram Verstockt, Séverine Vermeire, Gert Van Assche, Marc Ferrante
Inflammatory bowel diseases (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), develop in genetically susceptible hosts, who’s immune system reacts inappropriately to the enteric microbiome [1,2]. Although intestinal microbiome dysbiosis has been observed in patients with CD [3], no single causative microorganism has yet been revealed. Studies suggested the importance of adherent-invasive Escherichia coli in CD pathogenesis, but its exact role remains debated [4]. Nevertheless, some gastro-intestinal infections can mimic CD, making the differential diagnosis of IBD challenging [5]. We report a patient diagnosed with Crohn’s colitis, who developed an amoebic liver abscess under anti-TNF. Based on further investigations the initial diagnosis of CD was finally changed to an amoebic colitis.