Diferencia entre revisiones de «Amebiasis»

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==Background==


[[File:Amebiasis LifeCycle.gif|thumb|The life-cycle of various intestinal Entamoeba species.]]
 
==Background== [[File:Amebiasis LifeCycle.gif|thumb|The life-cycle of various intestinal Entamoeba species.]]
*Fecal oral transmission of Entamoeba histolytica cyst
*Fecal oral transmission of Entamoeba histolytica cyst
*Most infection asymptomatic  
*Most infection asymptomatic  
*Excystation in intestinal lumen
*Excystation in intestinal lumen
*Trophozoites adhere and colonizes large intestine forming new cysts or invade the intestinal mucosa to cause colitis or abscesses
*Trophozoites adhere and colonizes large intestine forming new cysts or invade the intestinal mucosa to cause colitis or abscesses
*[[Special:MyLanguage/Liver abscess|Liver abscess]] - 10x more common in men
*[[Liver abscess|Liver abscess]] - 10x more common in men
*Incubation period usually 2-4 weeks, but may range from a few days to years
*Incubation period usually 2-4 weeks, but may range from a few days to years




==Clinical Features==


*Asymptomatic vs. dysentery vs. extraintestinal abscesses
==Clinical Features== *Asymptomatic vs. dysentery vs. extraintestinal abscesses
*Intestinal- several weeks of crampy [[Special:MyLanguage/abdominal pain|abdominal pain]], weight loss, watery or bloody [[Special:MyLanguage/diarrhea|diarrhea]]
*Intestinal- several weeks of crampy [[abdominal pain|abdominal pain]], weight loss, watery or bloody [[diarrhea|diarrhea]]
*[[Special:MyLanguage/Liver abscess|Liver abscess]]-[[Special:MyLanguage/fever|fever]], [[Special:MyLanguage/cough|cough]], [[Special:MyLanguage/RUQ pain|RUQ]] or [[Special:MyLanguage/epigastric pain|epigastric pain]], right-sided [[Special:MyLanguage/chest pain|pleural pain]] or referred shoulder pain +/- GI upset
*[[Liver abscess|Liver abscess]]-[[fever|fever]], [[cough|cough]], [[RUQ pain|RUQ]] or [[epigastric pain|epigastric pain]], right-sided [[chest pain|pleural pain]] or referred shoulder pain +/- GI upset
**[[Special:MyLanguage/Hepatomegaly|Hepatomegaly]] with tenderness over the liver a typical finding
**[[Hepatomegaly|Hepatomegaly]] with tenderness over the liver a typical finding
**Abscess rupture can involve associated peritoneum, pericardium, or pleural cavity
**Abscess rupture can involve associated peritoneum, pericardium, or pleural cavity
*Extrahepatic amebic abscesses in the lung, brain, and skin are rare
*Extrahepatic amebic abscesses in the lung, brain, and skin are rare




==Differential Diagnosis==


==Differential Diagnosis== ===Dysentery=== *Infectious- [[shigella|shigella]], [[salmonella|salmonella]], [[campylobacter|campylobacter]], [[E. Coli|E. Coli]].
*Noninfectious- [[Inflammatory bowel disease|Inflammatory bowel disease]], [[ischemic colitis|ischemic colitis]], [[diverticulitis|diverticulitis]], AV malformation.


===Dysentery===


*Infectious- [[Special:MyLanguage/shigella|shigella]], [[Special:MyLanguage/salmonella|salmonella]], [[Special:MyLanguage/campylobacter|campylobacter]], [[Special:MyLanguage/E. Coli|E. Coli]].
{{Liver abscess DDX}}
*Noninfectious- [[Special:MyLanguage/Inflammatory bowel disease|Inflammatory bowel disease]], [[Special:MyLanguage/ischemic colitis|ischemic colitis]], [[Special:MyLanguage/diverticulitis|diverticulitis]], AV malformation.
 


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{{Liver abscess DDX}}
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{{Fever in Traveler DDX}}
{{Fever in Traveler DDX}}
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{{Diarrhea DDX}}
{{Diarrhea DDX}}
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==Evaluation==




===Labs===


*CBC
==Evaluation== ===Labs=== *CBC
*Chem
*Chem
*[[Special:MyLanguage/LFTs|LFTs]]
*[[LFTs|LFTs]]
*Stool PCR
*Stool PCR
**Diagnostic gold standard  
**Diagnostic gold standard  
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===Imaging===


*Abdominal Ultrasound
===Imaging=== *Abdominal Ultrasound
**58-98% SN for liver abscess (depending on size/location)
**58-98% SN for liver abscess (depending on size/location)
*Abdominal CT
*Abdominal CT
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==Management==
===Asymptomatic colonization===


*[[Special:MyLanguage/Paromomycin|Paromomycin]] or diloxanide
==Management== ===Asymptomatic colonization=== *[[Paromomycin|Paromomycin]] or diloxanide




===Colitis===


*[[Special:MyLanguage/Metronidazole|Metronidazole]]
===Colitis===
*{{AntibioticDose|drug=Metronidazole|dose=750mg PO q8h x 5-10 days|context=Intestinal colitis|disease=Amebiasis|population=Adult}}




===Liver abscess===


*[[Special:MyLanguage/Flagyl|Flagyl]], [[Special:MyLanguage/tinidazole|tinidazole]], [[Special:MyLanguage/paromomycin|paromomycin]], or diloxanide
===Liver abscess=== *[[Metronidazole]], [[tinidazole|tinidazole]], [[paromomycin|paromomycin]], or diloxanide
*Consider drainage of abscess by IR if no response to antibiotics in 5 days, abscess > 5cm, or left lobe involvement
*Consider drainage of abscess by IR if no response to antibiotics in 5 days, abscess > 5cm, or left lobe involvement




==Disposition==


*'''Admission'''
==Disposition== *'''Admission'''
**Admit if signs of shock, sepsis, or peritonitis
**Admit if signs of shock, sepsis, or peritonitis
**Patients with toxic megacolon should be admitted for surgical intervention.
**Patients with toxic megacolon should be admitted for surgical intervention.
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==External Links==


*[https://www.merckmanuals.com/professional/infectious-diseases/intestinal-protozoa-and-microsporidia/amebiasis?query=amebiasis Merk Manual - Amebiasis]
==External Links== *[https://www.merckmanuals.com/professional/infectious-diseases/intestinal-protozoa-and-microsporidia/amebiasis?query=amebiasis Merk Manual - Amebiasis]




==References==


<references/>
==References== <references/>


[[Category:ID]]
[[Category:ID]]
[[Category:Tropical Medicine]]
[[Category:Tropical Medicine]]
[[Category:GI]]
[[Category:GI]]
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Revisión actual - 10:47 20 mar 2026

Otros idiomas:


==Background==

The life-cycle of various intestinal Entamoeba species.
  • Fecal oral transmission of Entamoeba histolytica cyst
  • Most infection asymptomatic
  • Excystation in intestinal lumen
  • Trophozoites adhere and colonizes large intestine forming new cysts or invade the intestinal mucosa to cause colitis or abscesses
  • Liver abscess - 10x more common in men
  • Incubation period usually 2-4 weeks, but may range from a few days to years


==Clinical Features== *Asymptomatic vs. dysentery vs. extraintestinal abscesses


==Differential Diagnosis== ===Dysentery=== *Infectious- shigella, salmonella, campylobacter, E. Coli.


Hepatic abscess


Fever in traveler


Acute diarrhea

Infectious

Noninfectious

Watery Diarrhea

Traveler's Diarrhea



==Evaluation== ===Labs=== *CBC

  • Chem
  • LFTs
  • Stool PCR
    • Diagnostic gold standard
    • 100% sensitive and specific
  • Stool or abscess microscopy
    • <60% SN; unreliable diagnostic test[2]
  • Stool, serum, or abscess fluid antigen
  • Indirect hemagglutination (antibody)


===Imaging=== *Abdominal Ultrasound

    • 58-98% SN for liver abscess (depending on size/location)
  • Abdominal CT
    • Alternative to ultrasound; equally effective in identifying abscess


==Management== ===Asymptomatic colonization=== *Paromomycin or diloxanide


Colitis


===Liver abscess=== *Metronidazole, tinidazole, paromomycin, or diloxanide

  • Consider drainage of abscess by IR if no response to antibiotics in 5 days, abscess > 5cm, or left lobe involvement


==Disposition== *Admission

    • Admit if signs of shock, sepsis, or peritonitis
    • Patients with toxic megacolon should be admitted for surgical intervention.
  • Discharge
    • Patients who are non-toxic and able to tolerate oral hydration/PO meds can be discharged with outpatient follow-up


==External Links== *Merk Manual - Amebiasis


==References==

  1. ↑ Marx et al. “Cholera and Gastroenteritis caused by Noncholera Vibrio Species”. Rosen’s Emergency Medicine 8th edition vol 1 pg 1245-1246.
  2. ↑ Rayan HZ. Microscopic overdiagnosis of intestinal amoebiasis. J Egypt Soc Parasitol. 2005;35(3):941–951
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