Complications of Amebiasis

There are intestinal and extraintestinal complications of amoebiasis. Among intestinal complications, pericolitis , perforation of the intestinal wall with peritonitis, intestinal bleeding, amoeboma , narrowing (stricture) of the intestine, acute specific appendicitis, exfoliating colitis (rarely) are of greatest importance .
A serious, but rare complication of amoebiasis is perforated purulent peritonitis, which can be ovarian or widespread.
Intestinal bleeding as a complication is observed in any form of intestinal amoebiasis. In some cases, bleeding can be profuse with the development of hypovolemic shock and high mortality.
Sometimes a complication of intestinal amoebiasis is an amoeboma , which is a tumor-like infiltration of the intestinal wall, which causes a narrowing of the intestinal lumen. Clinically and radiologically, amoebae are difficult to distinguish from a colon tumor. Complications of amebiasis include intestinal polyps, as well as amoebic appendicitis, without surgery and specific treatment in 80-90% of cases is fatal.
Extraintestinal amoebiasis. It develops due to hematogenous dissemination in case of acute or chronic amebiasis. There is an abscess of the liver, amoebic hepatitis, an abscess of the lungs, brain, spleen, kidneys, etc. The course of amoebic hepatitis can be acute, subacute, and chronic. Acute amoebic hepatitis often develops with acute or exacerbation of chronic intestinal amoebiasis. Within a few days, the liver increases (sometimes significantly), there is pain in the right hypochondrium. Minor jaundice is possible. Body temperature is normal or low-grade, sometimes with a significant increase. In the study of blood – moderate leukocytosis, eosinophilia . In some cases, a transition to the chronic form of amoebic hepatitis is possible. Amoebic liver abscess is a serious complication. It is observed relatively often. It can develop several months after infection, often without preliminary signs of bowel damage. According to the WHO, only in C-40% of cases, amoebic liver abscess is preceded by intestinal amoebiasis. The etiological diagnosis in such cases often decides the epidemiological history. With an abscess, the liver always increases, at the site of the development of the pathological process there is a sharp pain on palpation, which can radiate to the right shoulder and intensify during deep breathing, coughing, and a change in body position. More often, single abscesses of the liver are observed. If the abscess is small, the disease may have a low-symptom course and its recognition is difficult. In most cases, intoxication is significant, patients have a characteristic appearance – the skin is earthy in color, its turgor is reduced, sharp weight loss, facial features are pointed. The abdomen is swollen, sharply painful in the right hypochondrium. Sometimes there is a protrusion in the epigastric region. The boundaries of hepatic dullness are extended up. During X-ray examination, the high position of the right dome of the diaphragm is determined, its mobility is limited. An ultrasound scan makes it easy to diagnose an abscess. In the study of blood – neutrophilic leukocytosis, hypochromic anemia, increased ESR. A chronic course of amoebic liver abscess is possible. In some cases, an abscess breaks into the abdominal or pleural cavity, complicated by purulent pleurisy, peritonitis, subphrenic abscess, mediastinitis, pericarditis with the appropriate clinic. Timely surgical intervention and specific treatment give mostly good results. An abscess of the lungs, as a rule, has a chronic course. Body temperature is low-grade with periodic significant increase. When coughing, patients secrete a significant amount of chocolate-colored sputum (“anchovy sauce”), in which the pathogen can be detected. Radiologically in the lungs, a cavity with a horizontal liquid level is detected. A breakthrough of the abscess into adjacent organs or cavities, the formation of hepatic-pleural, hepatic-mediastinal or hepatic-skin fistulas is possible. With an amoebic brain abscess, neurological symptoms are determined by the localization and prevalence of brain tissue damage. Abscesses of the spleen, kidneys, female genital organs with the corresponding symptoms are also described. Cutaneous amoebiasis is mainly a secondary process in the form of erosions and ulcers, which are often located near the migrants, on the buttocks around the fistulas and postoperative scars. The ulcers are deep, with necrotic blackened edges, often with discharge of an unpleasant odor. In scraping from the surface of ulcers, a dysenteric amoeba is displayed. The prognosis for intestinal uncomplicated amebiasis is generally favorable. With the timely use of specific treatment, a full recovery occurs. In the case of intestinal and extraintestinal complications of amoebiasis, the prognosis is serious.

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