. According to the recommendations of the WHO Expert Committee (1970), three clinical forms of amoebiasis are distinguished: intestinal, extraintestinal, and cutaneous. Undisputed is the need for details of the above classification.
Intestinal amoebiasis (80%)
1. Acute amoebiasis: a) amoebic colitis, b) amoebic dysentery. 2. Chronic amoebiasis: a) amoebic colitis, b) amoebic dysentery. 3. Intestinal complications of amoebiasis: a) perforation with peritonitis, b) intestinal ameboma , c) amoebic appendicitis. Extraintestinal amoebiasis (2%). 1. Amoebic hepatitis: a) without suppuration, b) liver abscess. 2. Amoebic abscess of other organs (lungs, brain, spleen). 3. Skin amoebiasis. Combined amoebiasis (amoebiasis-mixed; 18%). 1. With bacterial dysentery. 2. With other protozoal intestinal diseases. 3. With other infectious diseases (malaria, typhoid fever, etc.). Intestinal amoebiasis is the most common of the clinical forms of the disease. The incubation period lasts from 1-2 weeks to 3 months or more. In typical cases, the disease begins gradually with malaise, decreased appetite, mild abdominal pain, and fatigue. Body temperature is more often normal or subfebrile. In some cases, the disease can begin acutely, with impaired bowel function. The pain in the abdomen gradually increases, localizing in its lower parts on the right. Disorders of the stool appear. In the initial period of the disease, feces are liquid, sometimes with an admixture of mucus, stool about 10 times a day. Over time, bowel movements become more frequent, more vitreous mucus is found in the feces, blood impurities are possible. In typical cases, feces have the appearance of “raspberry jelly” – glassy mucus, evenly stained with blood due to the high location of primary amoebic ulcers (right-sided colitis). In the case of a prolonged course of the disease, the feces acquire a chocolate color, in it impurities of pus. More often, the disease occurs with damage to the cecum and ascending colon (amoebic colitis). In patients with lesions of the sigmoid colon and rectum (amoebic dysentery), tenesmus, false urge to defecate, paroxysmal pain before defecation in the left half of the abdomen are observed. The sigmoid colon is spasmodic , painful. When sigmoidoscopy ( colonoscopy ) reveals a slight swelling of the intestines, in separate sections of the ulcer with ragged edges, which are separated by fragments of intact mucosa. In the initial period, the liver and spleen, as a rule, are not enlarged. In a typical clinical picture of amoebiasis, the inconsistency of objective data on the degree of intoxication is noteworthy. With uncomplicated amoebiasis, the manifestations of intoxication are insignificant, despite significant disorders of the gastrointestinal tract (bloody diarrhea), the general well-being of patients remains satisfactory, many of them continue to work, which can be epidemically dangerous. This discrepancy is due to the main pathogenic enzymatic, and not toxic, as in the case of bacterial dysentery and other intestinal infections, the influence of E. histolytica . Acute intestinal amoebiasis (uncomplicated) occurs without an increase in body temperature. Even low-grade fever is rare, usually with complications of amoebiasis or combined amoebiasis. During a microscopic examination of feces, in addition to amoeba, eosinophils, Charcot-Leiden crystals are found. After 2-4 weeks, acute manifestations gradually fade away even without specific treatment. Self-healing is possible, but more often (60-70%) the disease acquires a chronic course. Chronic intestinal amoebiasis can have a recurring or continuous course. As in the acute form, it is possible to damage mainly the blind and ascending colon (amoebic colitis) or the rectum and sigmoid colon (amoebic dysentery). In the case of a relapsing course of the disease, periods of exacerbation alternate with periods of remission, during which the stool can fully normalize and the patient’s condition becomes satisfactory. If the course of the disease is continuous, there are no remissions, periods of strengthening and weakening of the clinical manifestations of the disease are observed. In the chronic course of amoebiasis, there is an intermittent pain in the lower abdomen, more in the iliac regions. The appetite is reduced, the feeling of bitterness in the mouth, sometimes burning pain in the tongue (due to hypovitaminosis), the skin is dry, easily folds. The abdomen, as a rule, is retracted, although in some patients during exacerbations flatulence is possible. Periods of diarrhea, sometimes mixed with mucus and blood in the feces, alternate with constipation. Gradually, asthenia , irritability, headache, sleep disturbance, protein and vitamin deficiency, and weight loss develop. Muffled heart sounds, lability of the pulse, dystrophic changes in the myocardium according to EC.G. are observed. With a long course of the disease, hypochromic anemia, eosinophilia , relative lymphocytosis develops . If specific treatment is not performed, chronic forms of amoebiasis can last for years. Relatively often, there are cases of amoebiasis-mixed, which in 25% of patients is caused by the addition of bacterial dysentery. In such cases, the initial symptoms of the disease are due to bacterial dysentery.