Amoebiasis

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Introduction

• A common parasitic infection of the gastrointestinal system caused by the protozoan Entamoeba histolytica
• Acquired through faeco-oral transmission

Clinical features

• Mucoid/bloody diarrhoea
• Abdominal pain
• Fever/chills

Complications

• Amoebic Liver Abscess (ALA)
• Intracranial space-occupying lesion
• Rupture:Hepatobronchial amoebiasis, Lungs Abscess, Peritoneal Abscess
• Amoeboma
• Anal ulceration
• Amoebic cutis
• Chronic carrier

Investigations

• Fresh Stool Microscopy for cysts and trophozoites
• Serology

Chest radiograph

• Abdominal ultrasound scan

Treatment goals

• Rehydrate adequately
• Eradicate the protozoa

Non-drug treatment of ALA 

• Ultrasound-Guided Aspiration, to prevent spontaneous rupture

Drug treatment

Amoebic dysentery
• Metronidazole
- Adult: 800 mg 8 hourly for 5 days
- Child: 30 mg/kg/day in 3 divided doses for 5 days
Or
• Tinidazole
- Adult: 2 g daily orally for 3 days (with food)
- Child: 50-60 mg/kg daily for 3 days
Or
• Secnidazole
- Adult: 1.5 g – 2 g statim

Amoebic liver abscess (ALA)
• Metronidazole
- Adult: 800 mg 8 hourly for 10 days
- Child: 50 mg/kg/day in 3 divided doses for 7-10 days
Or
• Tinidazole
- Adult: 2 g daily orally for 3 days (with food)
- Child: 50-60 mg/kg daily for 5 days

Chronic Cyst carriers
• Diloxanide furoate
- Adult: 500 mg every 8 hours for 10 days
- Child:
- over 25 kg: 20 mg/kg orally every 8 hours for 10 days
- under 25 kg ( I month – 12 years) 6.6 mg/kg every 8 hours for 8 - 10 days
- 12 years - 18 years: 500 mg every 8 hours for 10 days

Notable adverse drug reactions, complications and caution

• Metronidazole is contraindicated in the first trimester of pregnancy
• Avoid alcohol with the use of metronidazole 

Prevention

• Personal and communal hygiene
• Potable water, sanitary disposal of faeces
• Screen of food handlers