A Case Presentation

Abigaille A. Chua, M.D.

 Objectives
1. To present a case of intestinal amebiasis
2. To discuss the signs and symptoms, diagnosis, and
treatment of intestinal amebiasis
 General Data
• A.A
• 5 years old
• Male
• Filipino
• Roman Catholic
• Born on May 25, 2013
• Resides in Cavite
 Chief complaint
• Seizure
History of Present Illness
• (+) fever, Tmax 39.8C
• Paracetamol
250mg/5ml, 7ml q4
(13.72mkd)
• (-) cough
1 day PTC • (-) colds
• (-) vomiting
• (-) diarrhea
• (-) loose stools
 History of Present Illness

• Persistence of fever (Tmax 39C),

intermittent
• (+) colds, clear
• (-) cough
On the day
• (+) seizure, (+) vomiting, 1 episode
of consult
• (+) LBM, 4 episodes
• Consult at another institution  THOC
 Review of Systems
• General: no weight loss, no weakness
• Cutaneous: no masses, no lesions
• HEENT: no eye/ear/nasal discharge
• Cardiovascular: no murmurs
• Respiratory: no difficulty of breathing
• Gastrointestinal:
• Genitourinary: no hematuria
• Nervous/Behavioral: no seizures
• Hematopoietic: no bleeding
Birth and Maternal
The patient was born to a 25 year old G2, delivered
full term via NSD at a lying-in clinic assisted by a
midwife without fetomaternal complications.

Feeding/Nutritional
Patient was breastfed for 3 months then mixed
feeding afterwards. Complimentary feeding started
at 8 months.
Past Medical History
2014- S/P surgery for umbilical granuloma
2014- Acute Tonsillopharyngitis with Benign Febrile
Convulsion

Immunization History
Complete EPI at health center
Family History
(+) hypertension- maternal side
(+) convulsion- both sides of the family (mother and paternal
cousins)

Socioeconomic History
Patient lives with both parents
Mother- 31 year old, unemployed
Father- 31 year old, driver

Environmental History
(-) pets
(-) exposure to smoking
Drinking water, mineral
 Physical Examination
General Survey: awake, coherent, not in distress

Vital Signs
Pulse rate: 180bpm
Respiratory rate: 29cpm
Temperature 39C

Anthropometric Data
Weight: 25.5kg
Height: 117cm
• Skin: no pallor, no jaundice, no cyanosis, good
skin turgor, (+) sunken eyeballs

• HEENT: pink palpebral conjunctiva, hyperemic,

nonhypertrophic, nonexudative tonsils

• Chest and Lungs: symmetrical chest expansion,

(+) harsh breath sounds

• Heart and Vascular: tachycardic, regular rhythm

• Abdomen: soft abdomen, normoactive bowel
sounds

• Genito-urinary; Anus and Rectum: grossly normal

• Extremities: full and equal pulses

• Lymph nodes: not palpable

• Neurologic exam: GCS 15

Admitting Impression
Acute Gastroenteritis with some Dehydration;
Benign Febrile Convulsion
 Amebiasis
is the infection of the human gastrointestinal
tract by Entamoeba histolytica, a protozoan
parasite that is capable of invading the intestinal
mucosa and may spread to other organs, mainly
the liver
 Amebiasis
fourth leading cause of death due to a
protozoan infection after malaria, Chagas'
disease, and leishmaniasis and the third cause of
morbidity in this organism group after malaria
and trichomoniasis
Taxonomy
• Kingdom: Protozoa
• Phylum: Sarcomastigophora
• Class: Lobosa
• Order: Amoebida
• Family: Entamoebidae

Epidemiology
• 10% worldwide (2006)
• 14 per 1000 travellers (1996-2005)
• 10-20% of infected becomes symptomatic
• Size: 10-60um
• Transmission: fecal-oral
• Host: humans, primates
Note: Excystation occurs in the
terminal ileum or the colon
while encystation occurs in the
rectum. A mature trophozoite
can yield 4 mature trophozoite
Virulence Factors
• Epithelial galactose/N-acetylgalactosamine- specific lectin
(gal-lectin) binding protein- adhesion, complement resistance

Factors that determine invasion of amoeba

• Number of amoeba ingested
• Pathogenic capacity of the parasite strain
• Host factors
• Presence of suitable enteric bacteria
Spectrum of Diseases
• Asymptomatic infection
• Diarrhea and dysentery
• Fulminant colitis
• Peritonitis
• Extraintestinal amoebiasis
Liver (4% of clinical infection)
Lung
Brain
Spleen
Diagnosis
• Symptoms, history and epidemiology
• Fecalysis
– Cysts
– Trophozoite
– Distinction must be done from pathogenic intestinal
protozoa
• Proctoscopy often shows characteristic flask-
shaped ulcers in the mucosa
• Tissue body (recto-sigmoid)
• Antibody detection
Treatment
• Metronidazole 750-800mg TID for 5-10 days
• Tinidazole 2g daily for 3-5 days
• Paromomycin 25-35mg/kg per day, divided into 3
doses for 7 days (8-11mkd for asymptomatic)
• Diloxanide furoate 500mg TID for 10 days
• Iodoquinol 650mg p.o. TID in adults (10-13mg/kg
TID in children) for 20 days
Prevention and Control
• Proper excreta disposal
• Boiling of water (kills E. histolytica cysts)
• Chemical disinfection with iodine or chlorine-
containing compounds
• Water filtration
• Vaccine is not available yet