PATHOPHYSIOLOGY MEDICAL DIAGNOSTIC METHODS ADVANTAGES & DISADVANTAGES

PATHOPHYSIOLOGY
is a parasitic disease caused by the organism, Entamoeba histolytica Infection involves ingestion of cysts in focally contaminated food or water Cyst stage is the infective stage. Extraintestinal amoebiasis occurs when the parasite starts invading the liver or other organs within the body.

Medical diagnostic methods

X ray Tissue biopsy Serological test

X ray

Normal X-rays usually helps in diagnosing whether a person has amoebiasis For extraintestinal amoebiasis, liver X-ray can be done A person infected will have a result of pleural effusion at the liver and an elevation at the right dome of the diaphragm Advantages : advantage of this method is it is simple to conduct and can easily diagnose that the patients liver has abscess and does not cause any pain towards the patient Disadvantages : further test must be done to confirm the pleural effusion is due to amoebiasis and not other factors

Tissue Biopsy

A liver tissue biopsy is taken for examination. Microscopic examination will indicate whether there are trophozoites or cyst at the tissue. Symptoms of invasion usually results in formation of abscess or pus formation Advantages : this method can really identify whether the liver is being invaded by amoebiasis Disadvantages : it is a very painful method and further testing such as microscopic examination and serological testing needs to be done.

Method of Tissue Biopsy

After penetration of skin using needle, attach needle to a syringe containing 2ml of saline. Needle is pushed into subcutaneous tissue about half cm 1 ml of saline is injected into the tissue to expel any tissue fragments in the needle

THIS WAY

Maximal aspiration exerted on the syringe

Patient holds breath in expiration, needle pushed into max depth, quickly without rotating, aspiration maintained

Instrument withdrawn without rotating the needle, aspiration still maintained

Biopsy sample recovered by expelling remaining saline in syringe

SEROLOGICAL TEST
Is the study of blood serums and other body fluid Identification of a parasite based on the antibody production Serological testing can be divided into few types such as Gel diffusion precipitation(GDP), cellulose acetate membrane precipitation (CAP), enzyme linked immunoabsorbent assay(ELISA).

Advantages : This method is a very effective and accurate method in identifying whether a patient is infected with parasite. Fluids taken from the body might contain the trophozoite stage of the parasite Disadvantages : This method will only be effective if there is invasion of parasite into tissues and organs. Without invasion this method is not useful.

ELISA METHOD

Pathophysiology
Amebiasis is acquired by the fecal-oral route through consumption of fecally contaminated food or water. The ingestion of E histolytica cysts is followed by excystation in the small bowel and invasion of the colon by the trophozoites. The incubation period varies from 2 days to 4 months.

Gross pathology of intestinal ulcers due to amebiasis.

Histopathology of typical flaskshaped ulcer of intestinal amebiasis.

Entamoeba histolytica in liver aspirate, trichrome stain.

Medical Diagnostic Methods: Sigmoidoscopy

Principle
Sigmoidoscopy is a procedure by which a doctor inserts either a short and rigid or slightly longer and flexible fiber-optic tube into the rectum to examine the lower portion of the large intestine (or bowel).

Method
Preparation begins 24 hours before the procedure, when an individual must begin a clear liquid diet. Preparation kits are available in drug stores. In normal preparation, about 20 hours before the exam, a person begins taking a series of laxatives, which may be oral tablets or liquid. The individual must stop drinking any liquid four hours before the exam. An hour or two prior to the examination, the person uses an enema or laxative suppository to finish cleansing the lower bowel.

Result
The results of a normal examination reveal a smooth colon wall, with sufficient blood vessels for good blood flow. The results with a patient with amoebiasis will shows the production of ulcer on the wall of intestinal wall and blood on the site of infection.

Advantages
It is often possible to determine the specific cause of symptoms. Conditions such as colitis and diverticulosis can be monitored to determine effectiveness of treatment. Polyps, tumors, and ulceration can be discovered at an early stage.

Disadvantages
There is a slight risk of bleeding from the procedure. This risk is heightened in individuals whose blood does not clot well, either due to disease or medication, and in those with active inflammatory bowel disease. Sigmoidoscopy may be contraindicated in persons with severe active colitis or toxic megacolon (an extremely dilated colon).

Cutaneous amoebiasis refers to a form of amoebiasis that presents primarily in the skin. Is also known as Amoebiasis cutis. It can be caused by Entamoeba histolytica. Occurs by direct extension around around anus ,colostomy site or discharging sinuses from amoebic abcesses.

Usually occurs in Perianal and Genital areas. For female it may also occur on vulva,vaginal wall or cervix by spread from perineum. These manifestations are likely due to the skin or mucous membranes coming in contact with fluids containing invasive trophozoites. Fistulas forming between the rectum and vaginal have also been reported.

Cutaneous lesions have a wet, granular, exudative, verrucous plaque with a necrotic center. Extensive gangrenous destruction of skin occurs. Ulcerations,mixed inflammatory infiltrates and nodules.

Patients may also have genital lesions that have a punched-out appearance and abundant discharge. These lesions may be mistaken for Condylomata or Epithelioma. The prepuce and glans are affected in penile amoebiasis which is acquired through anal intercourse.

Skin biospy skin biopsy is basically the removal of a piece of skin for the purpose of further examination in the laboratory using a microscope. Types of skin biospy that can be conducted: A shave biopsy takes a thin slice off the top of the skin and can be used to remove superficial abnormal areas (lesions). A punch biopsy takes a core (a small cylindrical fragment of tissue from the area of interest) and can be used to remove small lesions as well as diagnose rashes and other conditions. Excisional biopsies are usually larger and deeper and are used to completely remove an abnormal area of skin such as a skin cancer.

After the biopsy, the skin sample is fixed in special solution, and thin sections of the tissue are cut and placed on microscope slides. The slides are stained for examination by a doctor. When observed under the microscope Trophozoites are found.

Enzyme-linked immunosorbent assay (ELISA) Is a analytic biochemistry assay that uses one sub-type of heterogeneous, solid-phase enzyme immunoassay (EIA) to detect the presence of a substance in a liquid sample or wet sample. The purpose of an ELISA is to determine if a particular protein that is present in a sample. There are two main variations on this method: determine how much antibody is in a sample, determine how much protein is bound by an antibody.

Blood is typically drawn from a vein, usually from the inside of the elbow or the back of the hand. The sample is sent to a laboratory where the targeted antibody (or antigen) is linked to an enzyme. If the target substance is in the sample, the test solution turns a different color.

Basic principles of ELISA

the antibodies fixed to a solid surface, such as the inner surface of a test tube; a preparation of the same antibodies coupled to an enzyme. This is one (e.g., -galactosidase) that produces a colored product from a colorless substrate.

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SKIN BIOSPY

Advantages
Accurate Fast

Disadvantages.

Bleeding from the biopsy site Pain Local reaction to the anesthetic Infection Healing problems

ELISA

Advantages Accurate Fast Disadvantages.

Excessive bleeding Fainting or feeling light-headed Hematoma (blood accumulating under the skin) Infection (a slight risk any time the skin is broken) Expensive