The supporting symptoms of the clinical diagnosis of intestinal amoebiasis are the gradual onset of the disease with a progressive increase in signs of intestinal dysfunction – diarrhea, the presence in the stool of impurities of vitreous mucus, subsequently uniformly stained with blood (raspberry jelly), lack of intoxication or its slight manifestations with increasing symptoms of mainly right-sided hemorrhagic colitis. Characteristic endoscopic changes are taken into account – ulcers in the form of an inverted funnel against the background of an almost normal mucosa. With extraintestinal amoebiasis, a painful liver is enlarged with corresponding changes in an ultrasound scan. In connection with the possibility of the formation of an abscess, it is necessary to determine the condition of other internal organs.
An important role in the timely recognition of amoebiasis is played by the data of an epidemiological history (stay of the patient in an endemic area, contact with patients of amoebiasis, swimming in open water, etc.).
Specific diagnosis of amoebiasis
Decisive in the diagnosis of amoebiasis are the data of a parasitological study – the presence of a large vegetative form ( hematophagus ) and other forms of E. histolytica in feces, abscess, sputum, and material from the bottom of the ulcers. During a microscopic examination, at least 5-6 smears are examined , which are made from svizhovidilennoy feces (not later than 10 minutes after emptying). In addition to native ones, smears stained with iron hematoxylin according to Gendengayn , Romanovsky- Giemsa or Lugol’s solution are also examined . Cultivation of amoebas on artificial nutrient media of Robinson, Pavlova, etc. is used. For the diagnosis of amoebiasis (especially its extraintestinal forms), serological research methods are used – RNGA, IFM, as well as RNIF, RSK, which are positive in 60-70% of cases with intestinal amoebiasis and in 90-95% – with amoebic liver abscess.
In some cases, a biological test is used – infection of laboratory animals (kittens, hamsters, etc.). So, with the introduction of kittens into the rectum of the patient’s feces containing amoeba, they develop hemorrhagic colitis ( Kartulis test ).
Differential diagnosis of amoebiasis
Intestinal amebiasis should be differentiated from bacillary dysentery, ulcerative colitis, balantidiasis , malignant tumors of the colon, helminthiasis (trichuriasis, strongyloidiasis , hymenolepiasis , shistosom- MH etc.). With extraintestinal amoebiasis, differential diagnosis with purulent cholangitis and liver abscess of another etiology, echinococcosis, liver cancer, abscessed pneumonia, metastatic damage to internal organs with oncological pathology, and septicopyemia is necessary . Confirm the diagnosis with data from ultrasound, computed tomography.