Amoebiasis

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A common parasitic infection of the gastrointestinal system acquired through oral-faecal transmission.

Causes

• Protozoan Entamoeba histolytica

Clinical features

It may present as:

• Amoebic dysentery
  • Persistent mucoid/bloody diarrhoea
  • Abdominal pain, tenesmus
  • Chronic carriers are symptomless
• Amoebic abscess (as a result of spread via the blood stream):
  • Liver abscess: swelling/pain in the right sub-costal area, fever, chills, sweating, weight loss
  • Brain: presenting as space-occupying lesion
  • Lungs: cough and blood stained sputum
  • Amoeboma: swelling anywhere in the abdomen, especially ascending colon
  • Anal ulceration: may occur by direct extension from the intestinal infection

Differential diagnosis

• Bacillary dysentery
• Any other cause of bloody diarrhoea
• Cancer of the liver
• Other causes of swelling in the liver
• Carcinoma colon

Investigations

• Stool: Microscopy for cysts and motile organisms
• Ultrasound

ManagementTreatment

• Correct any dehydration 
• Metronidazole 800 mg every 8 hours for 10 days
  • Child: 10 mg/kg per dose
• Or tinidazole 2 g daily for 5 days
  • Child: 50 mg/kg per dose

Caution

• Metronidazole/tinidazole: do not use in 1st trimester of pregnancy; avoid alcohol during treatment and for 48 hours thereafter
• Metronidazole: Take after food

Prevention

• Educate the public on personal and food hygiene (washing hands before eating), proper faecal disposal
• Ensure proper management of carriers and patients
• Promote use of clean drinking water