Amebiaz – the parasitic disease caused by a gistolitichesky amoeba and proceeding with intestinal and extra intestinal manifestations. Intestinal it is characterized by a plentiful mucous chair with blood impurity, belly-ache, tenezma, weight loss, anemia; extra intestinal – formation of abscesses of a liver, lungs, a brain and so forth. The diagnosis of an amebiaz is based on data of a clinical picture, rektoromanoskopiya, kolonoskopiya, microscopy of dabs of contents of abscesses, a serological research, a X-ray analysis. In treatment of an amebiaz medicamentous means (prosvetny and system fabric amebotsida, antibiotics), surgical methods (opening and drainage of abscesses, a gut resection) are applied.
Amebiaz – the protozoan infection which is shown ulcer process in a large intestine and damage of internals with formation of abscesses. Amebiaz is most widespread in regions with tropical and subtropical climate; on death rate among parasitic infections it takes the second place in the world after malaria. In recent years in connection with significant growth in migration and foreign tourism the number of brought in cases of an amebiaz in Russia increased. Amebiaz is registered in the form of sporadic cases, epidemic flashes are rare. Amebiaz patients of middle age mainly are surprised.
Reasons of an amebiaz
The activator of an amebiaz - a gistolitichesky amoeba (Entamoeba histolytica) concerns to pathogenic protozoa and has two stages of life cycle: (cisthat) and vegetative (trofozoit) a rest stage, replacing each other depending on living conditions. Vegetative forms of an amoeba (predtsistny, prosvetny, big vegetative and fabric) are very sensitive to change of temperature, humidity, therefore they quickly perish in the external environment. Tsista show considerable stability out of a human body (in the soil remain up to 1 month, in water - up to 8 months).
Mature tsist, having got to the lower departments of a GIT, are transformed to not pathogenic prosvetny form living in a gleam of a thick gut, eating detrity and bacteria. It is a stage of an asymptomatic carriage of amoebas. Further the prosvetny form either intsistirutsya, or turns into a big vegetative form which due to availability of proteolytic enzymes and specific proteins takes root into an epithelium of an intestinal wall, passing into a fabric form. Big vegetative and fabric forms pathogens, are found at a sharp amebiaz. The fabric form parasitizes in mucous and submucous layers of a wall of a thick gut, causing destruction of an epithelium, microcirculation violation, formation of microabscesses with a further necrosis of fabrics and multiple ulcer defeats. Pathological process in intestines at an amebiaza extends most often to the blind and ascending parts of a thick gut, is more rare on sigmovidny and a rectum. Gistolitichesky amoebas as a result of a hematogenic dissemination are capable to get into a liver, lungs, a brain, kidneys, a pancreas with formation of abscesses in them.
The main source of infection with an amoeba - patients with a chronic form of an amebiaz during remission, and also rekonvalestsenta and carriers a tsist. A tsist of amoebas flies can be carriers. Patients with a sharp form or with a recurrence of a chronic amebiaz do not constitute epidemic danger as allocate unstable vegetative forms of amoebas in the external environment. Infection occurs in the fecal and oral way at hit to a GIT of the healthy person of the foodstuff infected with mature tsist and waters, and also a household way through the polluted hands. Besides, transfer of an amebiaz at the anal sexual intercourses, mainly, among homosexuals is possible.
As risk factors of infection amebiazy serve non-compliance with personal hygiene, the low social and economic status, residence in areas with hot climate. Development of an amebiaz can be provoked by an immunodeficiency, dysbacteriosis, unbalanced food, a stress.
Symptoms of an amebiaz
The incubatory period of an amebiaz proceeds from 1 week to 3 months (usually 3-6 weeks). On expressiveness of symptoms can be asymptomatic (to 90% of cases) or manifest; on disease duration - sharp and chronic (continuous or recidivous); on weight of a current - a lung, average weight, heavy. Depending on a clinical picture allocate 2 forms of an amebiaz: intestinal and extra intestinal (amoebic abscesses of a liver, lungs, brain; urinogenital and skin ). Amebiaz can be shown in the form of a mikst-infection with other protozoan or bacterial intestinal infections (for example, dysentery), helminthoses.
Intestinal is the main, most common form of a disease. Diarrhea becomes the leading symptom of an intestinal amebiaz. The chair is plentiful, liquid, at first kalovy character with slime impurity to 5-6 times a day; then excrements take a form of jellylike weight with blood impurity, and the frequency of defecation increases till 10-20 once a day. The constant accruing belly-aches, in podvzdoshny area are characteristic, it is more on the right. At damage of a rectum painful tenezma disturb, at defeat of a worm-shaped shoot – there are appendicitis symptoms. Moderate temperature increase, an astenovegetativny syndrome can be noted. Sharpness of process at an intestinal amebiaz abates in 4-6 weeks then there occurs long remission (several weeks or months).
Spontaneous recovery happens extremely seldom. Without treatment the aggravation develops again, and intestinal gets a chronic recidivous or continuous current (lasting up to 10 and more years). Chronic intestinal is followed by frustration of all types of exchange: hypovitaminosis, exhaustion, up to a kakheksiya, hypostases, gipokhromny anemia, endokrinopatiya. At the weakened patients, children of early age and pregnant women the lightning form of an intestinal amebiaz with extensive ulcerations of a thick gut, a toxic syndrome and a lethal outcome can develop.
From extra intestinal manifestations of an amebiaz by the most frequent amoebic abscess of a liver is. The single or multiple abscesses without piogenny cover which are localized most often in the right share of a liver are characteristic of it. The disease begins sharply - with a fever, gektichesky fever, plentiful sweating, pains in the right podreberye amplifying at cough, change of position of a body. A condition of patients heavy, the liver is sharply increased and painful, integuments of an earthy shade, jaundice sometimes develops. Amebiaz of lungs proceeds in the form of a pleuropneumonia or abscess of a lung with fever, thorax pain, cough, a blood spitting. At amoebic abscess of a brain (an amoebic encephalomeningitis) the focal and all-brain neurologic symptomatology, the expressed intoxication is observed. Skin arises again at the weakened patients, it is shown by formation of low-painful erosion and ulcers with an unpleasant smell in perianalny area, on buttocks, in a crotch zone, on a stomach, around svishchevy openings and postoperative wounds.
Intestinal can proceed with various complications: perforation of an intestinal ulcer, bleeding, necrotic colitis, amoebic appendicitis, purulent peritonitis, striktury gut. At extra intestinal localization the break of abscess in surrounding fabrics with development of purulent peritonitis, an empiyema of a pleura, a perikardit or formation of fistulas is not excluded. At a chronic amebiaz in a gut wall around an ulcer specific opukholevidny education is formed of granulyatsionny fabric – the ameboma resulting in obturatsionny intestinal impassability.
Diagnostics of an amebiaz
At diagnostics of an intestinal amebiaz the clinical signs epidemiological yielded, results of serological researches (RNGA, RIF, IFA), rektoromanoskopiya and kolonoskopiya are considered. Endoscopic at an amebiaza characteristic ulcers of a mucous membrane of intestines at different stages of development are found, at chronic forms - cicatricial striktura of a thick gut. As laboratory confirmation of an intestinal amebiaz serves identification fabric and big forms of a vegetative amoeba in excrements of the patient and separated a bottom of ulcers. Presence a tsist, prosvetny and pretsistny forms of the activator testifies to an amoebic carriage. Serological reactions show existence of specific antibodies in serum of blood of patients amebiazy.
The comprehensive tool examination including ultrasonography of abdominal organs, radio isotope scanning, a survey X-ray analysis of a thorax, brain KT, a laparoscopy helps to visualize extra intestinal amoebic abscesses. Detection in contents of abscesses of pathogenic forms of the activator is the proof of its amoebic origin. Differential diagnostics of an amebiaz is carried out with dysentery, campylobacteriosis, balantidiazy, shistosomozy, a disease Krone, nonspecific ulcer colitis, psevdomembranozny colitis, new growths of a thick gut; at women – with endometriosis of a thick gut. Amoebic abscesses of extra intestinal localization differentiate from abscesses of other etiology (echinococcosis, a leyshmanioz, tuberculosis).
Treatment of an amebiaz
Treatment of an amebiaz is carried out on an outpatient basis, hospitalization is necessary at a heavy current and extra intestinal manifestations. Prosvetny amebotsida of direct action are applied to treatment of an asymptomatic carriage and prevention of a recurrence (, a diloksanida , iodine medicines, ). In therapy of an intestinal amebiaz and abscesses of various localization system fabric amebotsida are effective (metronidazole, , ). For knocking over of a kolitichesky syndrome, acceleration of reparative processes and elimination of pathogenic forms of amoebas appoint iodchloroxyquinoline. At intolerance of metronidazole use of antibiotics (doxycycline, erythromycin) is shown. The combination of medicines, their doses and duration of therapy is defined by a form and disease severity.
For lack of effect of conservative tactics and threat of break of abscess surgical intervention can be required. At small amoebic abscesses carrying out a puncture under control of ultrasonography with aspiration of contents or opening with drainage of abscess and the subsequent introduction to his cavity of antibacterial and amebotsidny medicines is possible. At the expressed necrotic changes around an amoebic ulcer or intestinal impassability carry out a gut resection with imposing of a kolostoma.
Forecast and prevention of an amebiaz
At timely specific treatment in most cases forecast of an intestinal amebiaz favorable. In case of late diagnosis of amoebic abscesses of other bodies there is a risk of a lethal outcome. Prevention of an amebiaz includes early identification and full treatment of patients and amebonositel, observance of the sanitary and hygienic mode in life, ensuring high-quality water supply and sewage treatment, control of safety of foodstuff, sanitary education.