Amoebiasis - Symptoms

In countries where amoebiasis is widespread (E. Histolytica), non-invasive amebiasis is noted in 90% of infected individuals, that is, they have no symptoms of amebiasis, thus they are asymptomatic carriers of luminal forms of amoebas, and only 10% infected patients develop invasive amebiasis.

There are two main forms of invasive amebiasis - intestinal and extra-intestinal.

[1], [2], [3], [4], [5], [6]

Symptoms of intestinal amoebiasis

When lesions are localized in the rectosigmoid region of the colon, the symptoms of amoebiasis can correspond to a dysentery-like syndrome with tenesmus and occasionally with an admixture of mucus, blood and pus in the stool. When the lesions are localized in the caecum, constipation with pain in the right ileal region and symptoms characteristic of the clinical picture of chronic appendicitis (in a number of cases appendicitis actually develops). In the ileum, amebic lesions are relatively rare.

Clinical variants of intestinal amebiasis

[7], [8], [9], [10], [11], [12]

Acute intestinal amebiasis (acute amoebic colitis)

Acute intestinal amebiasis (acute amoebic colitis) often manifests itself only in the form of diarrhea. Less often, the syndrome of amoebic dysentery - such symptoms of amoebiasis as: acute onset, cramping abdominal pain, tenesmus, loose stool with blood and mucus. High fever and other manifestations of intoxication syndrome are rare. However, young children usually have fever, vomiting, and dehydration.

[13], [14], [15], [16]

Fulminant colitis

Severely leaking necrotizing form of acute intestinal amebiasis - fulminant colitis. This form is characterized by a toxic syndrome, total and deep damage to the intestinal mucosa, bleeding, perforation, peritonitis. More often it is detected in pregnant women and women in the postpartum period, can develop after the appointment of glucocorticoids. The lethality is extremely high. The acute course of intestinal amebiasis in endemic areas is often due to a combination with shigellosis, malaria, typhoid fever, which are also widespread and have a mutually-affecting effect on the severity of the course of the infectious process. For example. Typhoid fever in 5-6 times increases the risk of developing both intestinal and extraintestinal lesions.

Prolonged intestinal (primary-chronic) amebiasis

Characterized by a violation of motor function of the intestine, relaxed stools, constipation (50% of cases) or unstable stool, pain in the lower abdomen, nausea, weakness, poor appetite. Over time, there are signs of hypochromic anemia, trophic disorders develop, hypovitaminosis, intestinal dysbiosis. Without antiparasitic treatment, the disease progresses, complications develop, cachexia.

Symptoms of extraintestinal amoebiasis

Pathological changes in extraintestinal amebiasis can develop in almost all organs, but more often they are observed in the liver. Amyobic liver abscess is recorded 5-50 times less often than amoebic colitis.

Abscess of liver

In patients with amoebic liver abscess, indications of a previous intestinal amebiasis are detected only in 30-40% of cases, and amoebae in faeces show no more than 20% of patients. Amoebic liver abscess in adults develops more often than in children, in males more often than in females. Single or multiple abscesses are formed mainly in the right lobe of the liver in the immediate vicinity of the diaphragm or in the lower parts of the organ.

For amebic liver abscesses, the following symptoms are typical: fever with chills and profuse perspiration at night; an increase and pain in the liver, moderate leukocytosis. With large abscesses, jaundice may develop, which is considered a poor prognostic sign. They reveal a high standing of the dome of the diaphragm, a limitation of its mobility; it is possible to develop atelectasis in the lower parts of the lungs. Relatively often (10-20%) note a prolonged latent or atypical course of the abscess (for example, only fever, pseudocholecystitis, jaundice) with a possible subsequent breakthrough of it, which can cause peritonitis or empyema of the pleura.

[17], [18], [19]

Pleurovellar amebiasis

Pleurovellar amebiasis often occurs due to the breakthrough of liver abscess through the diaphragm into the lungs, less often due to the spread of amoebas along the blood vessels. It manifests in the form of empyema of the pleura, abscesses in the lungs, liver-bronchial fistula. Characterized by pain in the chest, cough, shortness of breath, pus and blood in sputum, chills, fever, leukocytosis in peripheral blood and elevated ESR.

Due to the breakthrough of liver abscess from the left lobe through the diaphragm into the pericardium, amebic pericarditis may develop, which can lead to cardiac tamponade and death.

Abscess of the brain

Abscess of the brain occurs rarely, usually has a hematogenous origin. Defeats are single or multiple; are located in any part of the brain (more often in the left hemisphere). Symptoms of amoebiasis of this form are usually acute, are of a lightning character, resulting in a fatal outcome.

[20], [21], [22], [23], [24], [25], [26]

Amoebic skin damage

Amoebic skin damage develops more often in weakened and depleted patients. Ulcers are usually localized in the perianal region, at the site of breakthrough abscesses in the fistula, in homosexuals they are noted in the genital area.

[27], [28], [29], [30], [31], [32], [33], [34]

Complications of amebiasis

The main complications of intestinal amebiasis are intestinal perforation (more often in the region of the caecum, less often in the rectosigmoidal region), which may result in peritonitis or abscess of the abdominal cavity; amebic appendicitis; amebic stricture of the intestine (usually single, located in the region of the blind or sigmoid colon): intestinal bleeding, the formation of amoebas. The most serious complication in extra-intestinal amebiasis is the breakthrough of the abscess into the surrounding organs.

[35], [36], [37], [38], [39]