Preval Prev alen ent t in un unsa sani nita tary ry ar area eas s Common in warm climate Acqu Ac quir ired ed by sw swal allo lowi wing ng Cyst survives a few days outs ou tsid ide e th the e bo bod dy Cyst passes to the large intestine and an d ha hatc tche hes s in int to trophozoites. It passes into the mesent mes enteri eric c vei veins ns to th the po portal ve vein , to th the liver,
-Tro Tropho phozoi zoites tes are
facultative para pa rasi site tes s th that at may be found in the para pa rasi siti tize zed d ti tiss ssue ues s an and d liqu li quid id co colo loni nic c co cont nten ents ts.
-Cyst is passed out with
formed or semi formed stools and are resistant to environmental conditions. This is considered as the infective stage in the life cy cycl cle e of E. Histolytica
When the cyst is swallowed, it passes through the stomach unharmed and shows no activities while in an acidic environment. When it reaches the alkaline medium of the inte in test stin ine e, th the e me meta tacy cyst stbe begi gin n to move within the cyst wall whic wh ich h ra rapi pidl dly y we weak aken ens s an and d tears.
,
The quad quadrinuc rinucleate leateamoeb amoeba a emer em erg ges and di div vid ides es in into to amebulas that are swept down into the th e ce cecu cum m. Thi his s is th the e fi firs rst t op oppo port rtun unit ity y of the organism to colonize, and its success depends on one or more mor e met metacy acysti stic c tro tropho phozoi zoites tes maki ma kin ng co cont nta act wi with th th the e muc ucos osa a. Mature cyst in the large inte in tes sti tine nes s lea eav ves th the e ho hos st in grea gr eat t nu numb mber ers s the e ho host st re rema main ins s as asym ympt ptom omat atic ic). (th
The cyst remain viable and infective in moist and cool environment for atleast 12 days, and in water for 30 days. The cyst are resistant to levels of chlorine normally used for fo r wa wate ter r pu puri rifi fica cati tion on. They are rapidly killed by puri pu rifi fica cati tion on, de desi sicc ccat atio ion n an and d temperatures below 5 and above 40 degree deg ree cel celciu cius s.
The incu The incuba bati tion on pe peri riod od in seve se vere re in infe fect ctio ion n is in sub-ac acute and chroni nic c form it lasts for several months. In average cases the incu in cuba bati tion on pe peri riod od va vari ries es fr from om
The mi The micr croo oorg rgan anis ism m is comm co mmun unic icab able le fo for r th the e en enti tire re dur du rat ati ion of th the e il ill lne nes ss .
The disease can be passed from one person to another thro th roug ugh h fe feca cal l-oral oral transmission. The disease can be tran tr ansm smit itte ted d th thro roug ugh h di dire rect ct con co nta tac ct, th thro rou ugh sex exua ual l co con nta tact ct by orogenital, oroanal, and procto pro ctogen genita ital l sex sexual ual act activi ivity ty.
Throug Thro ugh h in indi dire rect ct co cont ntac act t, the th e disease can infect hum uma ans by ingestion of food espe es peci cial ally ly un unco cook oked ed le leaf afy y vege ve geta tabl bles es or fo food ods s cont co ntam amin inat ated ed wi with th fe feca cal l mat ma terials co containing E . hist hi stol olic ica a cy cyst sts s.
üFo Food od or dr drin inks ks ma mayb ybe e co cont ntam amin inat ated ed
by cy cyst st th thro roug ugh h po poll llut utio ion n of wate wa ter r su supp ppli lies es, ex expo posu sure re to fl flie ies s, use of night soil fro fert fe rtil iliz izin ing g ve vege geta tabl bles es, an and d thro th roug ugh h un unhy hygi gien enic ic pr prac acti tice ces s of food fo od ha hand ndle lers rs
The me The meta tacy cyst stic ic tr trop opho hozo zoit ites es or pr pro oge geni nies es re reac ache hes s the cec ecum um and those that come in contact with wi th the ora ral l muc ucos osa a pen enet etra rate te or invade the epith the elium by lyti ly tic c di dige gest stio ion n. The troph trophozoit ozoitesbur esburrow row deep de eper er wi wit th te ten nde denc ncy y to sp spre read ad laterally or continue the lysis of cells until they reac re ach h th the e su sub b-muc mucos osa a fo form rmi ing flash-shape ulcers. There may be several points of penetrations
From the primary site of inva in vasi sion on, se seco cond ndar ary y le lesi sion ons s may ma ybe produced at the lowe wer r lev le vel of the large int nte esti tin ne . Progen Prog enie ies s of in init itia ial l col co lonies are squeezed out to the lower portion of the bowel and thus, have the opportunity to invade and produce addi ad diti tion onal al ul ulce cers rs. Ev Even entu tual ally ly the th e wh whol ole e co col lon may ayb be in invo volv lve ed .
E. histolytica has been demo de mons nstr trat ated ed in pr prac acti tica call lly y every soft organ of the body . Tropoz Trop ozoi oite tes s wh whic ich h re reac ach h th the e masc ma scul ular aris is mu muco cosa sa fr freq eque uent ntly ly ero er ode the lymphatics or th the e wall wa lls s of th the e me mese sent nte eri ric c venules in the floors of the ulcers and are carried to the intr in trah ahep epat atic ic po port rtal al ve vein in.
if thrombi occur in the smal all l branches of the po por rtal veins, the tropozoites in the thro th romb mbi i ca caus use e ly lyti tic c ne necr cros osis is on the wall of the vessels and digest a pathway into the lobules. The co colo loni nies es in inc cre rea ase in size and develop into ab abs scess . A ty typi pic cal liv iver er ab absc sces ess s deve de velo lop ps an and d co cons nsis ist ts of: a.Ce Cent ntra ral l zo zone ne ne necr cros osis is b.Medium zone of stroma only and;
c. an outer zone of normal tissue newly inva vad ded by amoeba. Most amoe am oebi bic c ab absc sces ess s of th the e liv iver er are in th the e ri rig ght lo lobe be.
Next to the liver, the organ which is the frequent site of extr ex tra-inte intest stin inal al am amoe oebi bias asis is is th the e lungs. This commonly develops as an extension of the hepatic abscess.
Sli ligh ght t at atta tack ck of di diar arrh rhea ea altered wit periods of cons co nsti tipa pati tion on an and d of ofte ten n accompanied by by tenesmus Diarrhea, watery and foulsmel sm elli ling ng st stoo ool l of ofte ten n cont co ntai aini ning ng bl bloo ood d st stre reak aked ed mucus.
Colic and gas Col aseo eous us dist di sten ensi sion on in lo lowe wer r abdomen. Naus Na usea ea, fl flat atul ulen ence ce, abdo ab domi mina nal l di dist sten ensi sion on an and d tenderness in the right iliac region over the colon.
Attac Att ack k of dys ysen ente tery ry th tha at last for several days, usually succ su ccee eede ded d by co cons nsti tipa pati tion on. Tene Te nesm smus us ac acco comp mpan anie ied d by desi de sire re to de defe feca cate te. Ano An ore rexi xia a, te tene nesm smus us an and d weakness Liver may be enlarge
Onset is gr Ons grad adua ual l Diar Di arrh rhea ea in incr crea ease ses s an and d stoo st ool l be beco come mes s bl bloo oody dy and mucoid If un untr trea eate ted d ca case ses s:
Stool exam ( cyst, white and yellow pus with plenty of am amoe oeba ba). 2. Blood exam 3. Proctoscopy / Sigmoidoscopy
Metronidazole (flagyl) 800 mg TID x 5 days Tet etra racy cycl clin ine e 25 250 0 mg eve very ry 6 hours Ampi Am pici cili lin n, qu quin inol olon ones es, sulfadiazine Strept Str eptomy omycin cin SO4, clorampenicol Lost fluid and elec el ectr trol olyt ytes es sh shou ould ld be replaced.
1. Observe isolation and enteric precaution. 2. Provide health educat ati ion and inst in stru ruct ct th the e pa pati tien ent t to: a. Boil water for drinking or used pu puri rifie fied d wa water ter. b. Avoid washing of food from open dr drum um or pail. c. Cover left over foods d. Wash hands after defeca cat tio ion n or befo be fore re ea eati ting ng. e. Av Avoi oid d gr grou ound nd veg eget etab abl les ettu tuce ce, ca carr rrot ots s and etc.) (let
3. Proper collection of stool specimen.
Never give paraff ffi in or any oil for at lea eas st 48 hours prio ior r to coll co llec ecti tion on of th the e specimen. Inst In stru ruct ct th the e pa pati tie ent to av avo oid mixing ur urin ine e an and d st stoo ools ls. If whole stool ca can nno not t be se sen nt to l ab abor orat ato ory, se sele lect ct as mu muc ch po por rti tion on as poss po ssibl ible co cont ntain ainin ing g blo blood od an and d mucous. Send Se nd sp spec ecim imen en im imme medi diat atel ely y to the l aborat ato ory; sto too ol that is not fres fr esh h is ne near arly ly us usel eles ess s fo for r examination. Labe La bel l sp speci ecime men n pro prope perl rly y.
4. Skin care Clea Cl eanl nlin ines ess s, fr free eedo dom m fr from om wrinkles on the sheet will be help he lpfu ful l wi with th al all l the th e us usua ual l precautionary measures aga agains inst t pre pressu ssure re sores. 5. Mouth cares 6. Provide optimum comfort Patient should be kept warm. Dys Dysent enteri eric c pat patien ient t should never be allowed to feel fe el col old d, even for a moment.
7. Diet
Dur uri ing the acute stage, fluids should be fo forc rced ed. In the beginning of an att tta ack, cereal an and d st stra rain ined ed me meat at br brot oths hs with wi thou out t fa fats ts shou sh ould ld be giv iven en. Chi hic cken and fish may be ad add ded when con conval valesc escenc ence e is est establ ablishe ished d. Blan Bl and d di diet et wi with thou out t ce cell llul ulos ose e or bulk- producing foo food sho shoul uld d be maintained for a long time.
Alter Alte red nut nutri riti tion on: les ess s tha han n the th e bo body dy re requ quir irem emen ent t
Altera Alte rati tion on of bo bowe wel l elimination High Hi gh ri ris sk fo for r in infe fect ctio ion n Anxiety Alte Al tere red d bo body dy te temp mper erat atur ure e
Health edu Health educat cation ion Sani Sa nita tary ry di disp spos osal al of fe fece ces s Prot Pr otec ect t ch chlo lori rina nate te, an and d puri pu rify fy dr drin inki king ng wa wate ter r Observ Obs erve e scr scrupu upulou lous s cle cleanl anline iness ss in food preparation and food handling
Det etec ecti tion on an and d tr tre eat atme ment nt of carriers Fly control (it can serve as a vector)
