Amoebiasis protozoal infection of human beings initially involves the colon, but may
spread to soft tissues, most commonly to the liver or lungs, by contiguity or hematogenous
or lymphatic dissemination.
Amoebiasis is the third leading parasitic cause of death worldwide, surpassed only by
malaria and schistosomiasis. On a global basis, amoebiasis affects approximately 50
million persons each year, resulting in nearly 100,000 deaths.
Etiologic Agent:
Enatamoeba Histolytica
1. Trophozoites/vegetative form
o Trophozoites are facultative parasites that may invade the tissues or may
be found in the parasitized tissues and liquid colonic contents.
2. Cyst
o Cyst is passed out with formed or semi-formed stools and are resistant to
environmental conditions.
o This is considered as the infective stage in the cycle of E. histolytica
Incubation Period: The incubation period in severe infection is three days. In subacute and
chronic form it lasts for several months. In average cases the incubation period varies
from three to four weeks
Modes of Transmission:
1. The disease can be passed from one person to another through fecal-oral
transmission.
2. The disease can be transmitted through direct contact, through sexual contact by
orogenital, oroanal, and proctogenital sexual activity.
3. Through indirect contact, the disease can infect humans by ingestion of food
especially uncooked leafy vegetables or foods contaminated with fecal materials
containing E. histolytica cysts.
Food or drinks maybe contaminated by cyst through pollution of water supplies, exposure
to flies, use of night soil for fertilizing vegetables, and through unhygienic practices of
food handlers.
Clinical Manifestations:
1.Hepatic
•
o Pain at the upper right quadrant with tenderness of the liver
o Abscess may break through the lungs, patient coughs anchovy-sauce
sputum
o Jaundice
o Intermittent fever
o Loss of weight or anorexia
Clinical Features:
1. Onset is gradual
2. Diarrhea increases and stool becomes
bloody and mucoid
3. In untreated cases:
Amebiasis is an intestinal illness that’s typically transmitted when someone eats or drinks
something that’s contaminated with a microscopic parasite called Entamoeba histolytica
(E. histolytica). The parasite is an amoeba, a single-celled organism. That’s how the
illness got its name — amebiasis.
In many cases, the parasite lives in a person’s large intestine without causing any
symptoms. But sometimes, it invades the lining of the large intestine, causing bloody
diarrhea, stomach pains, cramping, nausea, loss of appetite, or fever. In rare cases, it can
spread into other organs such as the liver, lungs, and brain.
I. Structure. The GI System consists of the oral structures, esophagus, stomach, small
intestine, large intestine and associated structures.
A. Oral Structures include the lips, teeth, gingivae and oral mucosa, tongue, hard
palate, soft palate, pharynx and salivary glands.
B. The esophagus is a muscular tube extending from the pharynx to the stomach.
C. The Stomach is a muscular pouch situated in the upper abdomen under the liver
and diaphragm. Te stomach consists of three anatomic areas: the fundus, body
(i.e., corpus), and antrum (i.e., pylorus)
D. Sphincters. The LES allows food to enter the stomach and prevents reflux into the
esophagus. The pyloric sphincter regulates flow of stomach contents (chyme) into
the duodenum.
E. The small intestine, a coiled tube, extends from the pyloric sphincter to the
ileocecal valve at the large intestine. Sections of the small intestine include the
duodenum, jejunum and ileum
F. The large intestine is a shorter, wider tube beginning at the ileocecal valve and
ending at the anus. The large intestine consists of three sections:
1. The cecum is a blind pouch that extends from the ileocecal valve to the
vermiform appendix.
2. The colon, which is the main portion of the large intestine, is divided into four
anatomic sections: ascending, transverse, descending and sigmoid.
G. The ileocecal valve prevents the return of feces from the cecum into the small
intestine and lies at the upper border of the cecum.
H. The appendix, which collects lymphoid tissues, arises from the cecum.
1. An inner mucosal layer lubricates and protects the inner surface of the
alimentary canal.
5. The peritoneum, an outer serosal layer, covers the entire abdomen and is
composed of the parietal and visceral layers.
3. From the pylorus, the mixed stomach contents (i.e. chyme) pass into the
duodenum through the pyloric valve.
4. In the small intestine, food digestion is completed, and most nutrient absorption
occurs. Digestion results from the action of numerous pancreatic and intestinal
enzymes (e.g., trypsin, lipase, amylase, lactase, maltase, sucrase( and bile.
B. Elimination of waste products through defacation occurs in the large intestines
and rectum. In the large intestine, the cecum and ascending colon absorb water
and electrolytes from the now completely digested material. The rectum stores
feces for elimination.
Pathophysiology
Laboratory Diagnosis:
1. Stool exam (cyst, white and yellow pus with plenty of amoeba)
2. Blood exam (Leukocytosis)
3. Proctoscopy/Sigmoidoscoppy
Diagnosis of amoebiasis can be very difficult. One problem is that other parasites and
cells can look very similar to E. histolytica when seen under a microscope. Therefore,
sometimes people are told that they are infected with E. histolytica even though they are
not. Entamoeba histolytica and another ameba, Entamoeba dispar, which is about 10
times more common, look the same when seen under a microscope. Unlike infection with
E. histolytica, which sometimes makes people sick, infection with E. dispar does not
make people sick and therefore does not need to be treated.
If you have been told that you are infected with E. histolytica but you are feeling fine,
you might be infected with E. dispar instead. Unfortunately, most laboratories do not yet
have the tests that can tell whether a person is infected with E. histolytica or with E.
dispar. Until these tests become more widely available, it usually is best to assume that
the parasite is E. histolytica.
A blood test is also available but is only recommended when your health care provider
thinks that your infection may have spread beyond the intestine (gut) to some other organ
of your body, such as the liver. However, this blood test may not be helpful in diagnosing
your current illness because the test may still be positive if you had amoebiasis in the
past, even if you are no longer infected now.
Complications:
1. Amebic colitis
o Fulminant or necrotizing colitis
o Toxic megacolon
o Ameboma
o Rectovaginal fistulas
2. Amebic liver abscess
o Intrathoracic or intraperitoneal rupture with or without secondary bacterial
infection
o Direct extension to pleura or pericardium
3. Brain abscess
Treatment:
Nursing Management:
Methods of Prevention:
1. Health education
2. Sanitary disposal of feces
3. Protect, chlorinate, and purify drinking water
4. Observe scrupulous cleanliness in food preparation and food handling
5. Detection and treatment of carriers
6. Fly control (they can serve as vector)