RESUMEN
We report the case of a 62-year-old male with cough and abdominal pain for two weeks, associated with pulmonary tomographic findings compatible with probable infection by SARS-CoV-2, and who received high doses of early corticotherapy as an outpatient. The patient showed clinical deterioration, was hospitalized and died in the immediate postoperative period due to acute surgical abdomen. The anatomopathological study showed parasitic structures with characteristics compatible with amebae, which was pointed to as the cause of a complicated acute fulminant colitis, with multiple perforations and acute peritonitis. Acute fulminant colitis due to intestinal amebiasis in the context of a patient with probable COVID-19 had not been previously reported in Peru. It is important to highlight the fulminant presentation with fatal outcome of this prevalent parasitic infection, in the context of corticosteroids use in a probable SARS-CoV-2 pulmonary infection.
Se reporta el caso de un varón de 62 años quien presentó tos y dolor abdominal por dos semanas, con hallazgos tomográficos pulmonares compatibles con probable infección por SARS-CoV-2, que recibió tempranamente corticoterapia a dosis altas y de manera ambulatoria. El paciente presentó evolución tórpida, fue hospitalizado y falleció en el posoperatorio inmediato por un cuadro de abdomen agudo quirúrgico. El estudio anatomopatológico mostró estructuras parasitarias con características compatibles con amebas, como causa de una colitis aguda fulminante complicada, con perforación múltiple y peritonitis aguda. La colitis aguda fulminante por amebiasis intestinal en el contexto de un paciente con probable COVID-19 no había sido reportada en el Perú. Resulta importante resaltar la presentación fulminante con desenlace fatal de esta infección parasitaria prevalente en nuestro medio, en el contexto del uso de corticoides ante una probable infección pulmonar por COVID-19.
Asunto(s)
COVID-19 , Disentería Amebiana , Peritonitis , Disentería Amebiana/complicaciones , Disentería Amebiana/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , SARS-CoV-2RESUMEN
INTRODUCTION: In Mexico, seroprevalence of Entamoeba histolytica is 8.4%. The intestinal amebiasis in patients with acute leukemia of novo, after the start of chemotherapy (CT) in the Hematology Service of the CMN 20 de Noviembre is 12%, even if patients show a negative baseline coprological test. OBJECTIVE: To find out if the administration of tinidazole, in patients with acute leukemia and negative coprological test, at the beginning of the CT, decreases the incidence of amoebic colitis during the induction to remission. METHOD: Prospective and not comparative study. Patients with de novo diagnosis of acute leukemia who initiate induction and initial coprological CT. Tinidazole was indicated, 2 g/day for 5 days in the first week of CT started. They were monitored until the induction was concluded and hematopoietic recovery started. RESULTS: 38 patients, 15 women and 23 men with a mean age of 44 years (16-72), with acute lymphoblastic leukemia 19, myeloblastic 16 and promyelocytic 3. Cases without and with intestinal amebiasis were 35 and 3, respectively. Patients with amebiasis only received tinidazole for 3 days and it was given 2 days after the CT started. CONCLUSION: Tinidazole, in patients with acute de novo leukemia who initiate induction CT, is effective in the prevention of intestinal amebiasis, during the induction stage, if administered at 2 g/day, for five days, starting on day 1 of the CT.
INTRODUCCIÓN: En México la seroprevalencia de la Entamoeba histolytica es del 8.4%. La amebiasis intestinal en pacientes con leucemia aguda de novo posterior al inicio de quimioterapia (QT), en el Servicio de Hematología del CMN 20 de Noviembre, es del 12%, aún si muestran test coprológico negativo basal. OBJETIVO: Averiguar si la administración de tinidazol, en pacientes con leucemia aguda y coprológico negativo, al principio de la QT, disminuye la incidencia de colitis amebiana durante la inducción a la remisión. MÉTODO: Prospectivo y no comparativo. Enfermos con diagnóstico de leucemia aguda de novo que inician QT de inducción y coprológico inicial. Se indicó tinidazol, 2 g/día durante 5 días en la primera semana de comenzada QT. Se vigilaron hasta que la inducción concluyó y se inició la recuperación hematopoyética. RESULTADOS: 38 pacientes, 15 mujeres y 23 hombres con edad media de 44 años (16-72). Con leucemia aguda linfoblástica 19, con mieloblástica 16 y con promielocítica 3. Casos sin y con amebiasis intestinal, 35 y 3, respectivamente. Los pacientes con amebiasis solo recibieron tinidazol durante 3 días y se dio después de 2 días de empezada la QT. CONCLUSIÓN: El tinidazol, en pacientes con leucemia aguda de novo que inician QT de inducción, es efectivo en la prevención de la amebiasis intestinal, durante la etapa de inducción, si se administra a 2 g/día, durante cinco días, a partir del día 1 de la QT.
Asunto(s)
Colitis/prevención & control , Colitis/parasitología , Disentería Amebiana/prevención & control , Tinidazol/uso terapéutico , Adolescente , Adulto , Anciano , Antineoplásicos/uso terapéutico , Colitis/complicaciones , Disentería Amebiana/complicaciones , Femenino , Humanos , Leucemia Mieloide Aguda/complicaciones , Leucemia Mieloide Aguda/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
Resumen Introducción: En México la seroprevalencia de la Entamoeba histolytica es del 8.4%. La amebiasis intestinal en pacientes con leucemia aguda de novo posterior al inicio de quimioterapia (QT), en el Servicio de Hematología del CMN 20 de Noviembre, es del 12%, aún si muestran test coprológico negativo basal. Objetivo: Averiguar si la administración de tinidazol, en pacientes con leucemia aguda y coprológico negativo, al principio de la QT, disminuye la incidencia de colitis amebiana durante la inducción a la remisión. Método: Prospectivo y no comparativo. Enfermos con diagnóstico de leucemia aguda de novo que inician QT de inducción y coprológico inicial. Se indicó tinidazol, 2 g/día durante 5 días en la primera semana de comenzada QT. Se vigilaron hasta que la inducción concluyó y se inició la recuperación hematopoyética. Resultados: 38 pacientes, 15 mujeres y 23 hombres con edad media de 44 años (16-72). Con leucemia aguda linfoblástica 19, con mieloblástica 16 y con promielocítica 3. Casos sin y con amebiasis intestinal, 35 y 3, respectivamente. Los pacientes con amebiasis solo recibieron tinidazol durante 3 días y se dio después de 2 días de empezada la QT. Conclusión: El tinidazol, en pacientes con leucemia aguda de novo que inician QT de inducción, es efectivo en la prevención de la amebiasis intestinal, durante la etapa de inducción, si se administra a 2 g/día, durante cinco días, a partir del día 1 de la QT.
Abstract Introduction: In Mexico, seroprevalence of Entamoeba histolytica is 8.4%. The intestinal amebiasis in patients with acute leukemia of novo, after the start of chemotherapy (CT) in the Hematology Service of the CMN 20 de Noviembre is 12%, even if patients show a negative baseline coprological test. Objective: To find out if the administration of tinidazole, in patients with acute leukemia and negative coprological test, at the beginning of the CT, decreases the incidence of amoebic colitis during the induction to remission. Method: Prospective and not comparative study. Patients with de novo diagnosis of acute leukemia who initiate induction and initial coprological CT. Tinidazole was indicated, 2 g/day for 5 days in the first week of CT started. They were monitored until the induction was concluded and hematopoietic recovery started. Results: 38 patients, 15 women and 23 men with a mean age of 44 years (16-72), with acute lymphoblastic leukemia 19, myeloblastic 16 and promyelocytic 3. Cases without and with intestinal amebiasis were 35 and 3, respectively. Patients with amebiasis only received tinidazole for 3 days and it was given 2 days after the CT started. Conclusion: Tinidazole, in patients with acute de novo leukemia who initiate induction CT, is effective in the prevention of intestinal amebiasis, during the induction stage, if administered at 2 g/day, for five days, starting on day 1 of the CT.
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Adulto Joven , Tinidazol/uso terapéutico , Colitis/parasitología , Colitis/prevención & control , Disentería Amebiana/prevención & control , Leucemia Mieloide Aguda/complicaciones , Leucemia Mieloide Aguda/tratamiento farmacológico , Estudios Prospectivos , Resultado del Tratamiento , Colitis/complicaciones , Disentería Amebiana/complicaciones , Antineoplásicos/uso terapéuticoAsunto(s)
Enfermedades del Ciego/etiología , Enfermedades del Ciego/parasitología , Disentería Amebiana/complicaciones , Disentería Amebiana/parasitología , Entamoeba histolytica , Anciano , Enfermedades del Ciego/diagnóstico por imagen , Ciego/diagnóstico por imagen , Disentería Amebiana/diagnóstico por imagen , Humanos , MasculinoAsunto(s)
Enfermedades del Ciego/parasitología , Enfermedades del Colon/parasitología , Disentería Amebiana/parasitología , Granulomatosis con Poliangitis/complicaciones , Perforación Intestinal/parasitología , Adulto , Biopsia , Enfermedades del Ciego/complicaciones , Enfermedades del Ciego/diagnóstico , Colectomía , Enfermedades del Colon/complicaciones , Enfermedades del Colon/diagnóstico , Disentería Amebiana/complicaciones , Disentería Amebiana/diagnóstico , Resultado Fatal , Granulomatosis con Poliangitis/diagnóstico , Granulomatosis con Poliangitis/tratamiento farmacológico , Humanos , Ileostomía , Inmunosupresores/uso terapéutico , Perforación Intestinal/diagnóstico , Perforación Intestinal/cirugía , Masculino , Resultado del TratamientoRESUMEN
TNF blockade has been successful in the treatment of some rheumatic diseases such as spondyloarthritis. Many infectious complications have been reported with anti-TNF therapy, mainly bacterial, mycobacterial, viral and fungal infections. Entamoeba histolytica is an extracellular protozoan parasite that mainly causes colitis and hepatic abscess; bowel perforation is an uncommon complication with high mortality. TNF is considered the principal mediator of cell immunity against amebiasis. Initially, it is chemotactic to E. histolytica, enhancing its adherence to enterocyte via galactose inhibitable lectin, and then activating macrophages to kill ameba though the release of NO, so that TNF blocking could be harmful, increasing amebic virulence. We describe the case of a 46-year-old woman with spondyloarthritis who presented a colonic perforation due to invasive amebic colitis during anti-TNF use.
Asunto(s)
Adalimumab/efectos adversos , Antiinflamatorios/efectos adversos , Colitis/complicaciones , Colitis/parasitología , Disentería Amebiana/inducido químicamente , Entamoeba histolytica , Entamebiasis/inducido químicamente , Perforación Intestinal/parasitología , Disentería Amebiana/complicaciones , Entamebiasis/complicaciones , Femenino , Humanos , Persona de Mediana Edad , Espondiloartritis/tratamiento farmacológico , Factor de Necrosis Tumoral alfa/antagonistas & inhibidoresRESUMEN
O bloqueio do TNF tem tido sucesso no tratamento de algumas doenças reumáticas, como a espondiloartrite. Relatam-se muitas complicações infecciosas com a terapia anti-TNF, principalmente infecções bacterianas, micobacterianas, virais e fúngicas. A Entamoeba histolytica é um protozoário extracelular que causa principalmente colite e abscesso hepático, sendo que a perfuração intestinal é uma complicação rara, com alta mortalidade. O TNF é considerado o principal mediador da imunidade celular contra a amebíase. Inicialmente, é quimiotático para a E. histolytica, potencializando sua adesão ao enterócito por meio da lectina galactose-inibível, e depois ativando os macrófagos para matarem a ameba pela liberação de NO; assim, o bloqueio do TNF poderia ser prejudicial, aumentando a virulência amebiana. Descreve-se o caso de uma mulher de 46 anos com espondiloartrite que apresentou uma perfuração do colo por colite amebiana invasiva durante uso de anti-TNF.
TNF blockade has been successful in the treatment of some rheumatic diseases such as spondyloarthritis. Many infectious complications have been reported with anti-TNF therapy, mainly bacterial, mycobacterial, viral and fungal infections. Entamoeba histolytica is an extracellular protozoan parasite that mainly causes colitis and hepatic abscess; bowel perforation is an uncommon complication with high mortality. TNF is considered the principal mediator of cell immunity against amebiasis. Initially, it is chemotactic to E. histolytica, enhancing its adherence to enterocyte via galactose inhibitable lectin, and then activating macrophages to kill ameba though the release of NO, so that TNF blocking could be harmful, increasing amebic virulence. We describe the case of a 46-year-old woman with spondyloarthritis who presented a colonic perforation due to invasive amebic colitis during anti-TNF use.
Asunto(s)
Humanos , Femenino , Colitis/complicaciones , Colitis/parasitología , Disentería Amebiana/inducido químicamente , Entamoeba histolytica , Entamebiasis/inducido químicamente , Adalimumab/efectos adversos , Perforación Intestinal/parasitología , Antiinflamatorios/efectos adversos , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores , Espondiloartritis/tratamiento farmacológico , Disentería Amebiana/complicaciones , Entamebiasis/complicaciones , Persona de Mediana EdadRESUMEN
La amebiasis intestinal es una enfermedad frecuente en países en desarrollo, que es común en regiones tropicales y subtropicales, así como en regiones con servicios sanitarios deficientes. Presentamos el caso de un paciente de 74 años de edad, sexo masculino, originario y residente de la ciudad de Guatemala, quién cursó una diarrea y dolor abdominal. Fue intervenido quirúrgicamente por abdomen agudo, con resección intestinal extensa por perforaciones. En el estudio de anatomía patológica se realizó el diagnóstico de colitis amebiana con perforaciones y peritonitis.
Intestinal amoebiasis is a disease common indeveloping countries, which is common in tropicaland subtropical regions, as well as in regions withpoor sanitation. We report the case of a 74-year-oldmale, resident of Guatemala City, who presented withdiarrhea and abdominal pain. He had a laparatomy foracute abdomen, undergoing wide intestinal resectiondue to perforations. The pathology diag-nosis wasamoebic colitis with perforations and peritonitis.
Asunto(s)
Humanos , Disentería Amebiana/complicaciones , Disentería Amebiana/diagnóstico , Entamoeba histolytica/clasificación , Entamoeba histolytica/parasitología , Perforación Intestinal/complicacionesRESUMEN
While Giardia duodenalis infection has been consistently associated with nutrient malabsorption and stunting in children, the effects of other protozoans on nutritional status or gastrointestinal morbidity are less clear. We sought to determine whether infection with common intestinal protozoans including Giardia duodenalis, Entamoeba coli and Blastocystis hominis was associated with anthropometric and micronutrient status, gastrointestinal symptoms, visits to the doctor or school absenteeism in children 5-12 years of age from Bogotá, Colombia. We obtained stool samples from 442 children enrolled in primary schools in 2006 and examined the presence of intestinal protozoans in relation to height, body mass index, plasma concentrations of vitamins A and B12, ferritin and zinc and erythrocyte folate. In addition, we examined the associations between protozoan infections and the incidence of common gastrointestinal symptoms, which were registered prospectively in morbidity diaries. The prevalence rates of G. duodenalis, E. coli and B. hominis infection were 6.3, 23.1 and 22.4%, respectively. Giardia infection was associated with lower height-for-age z-score (p = 0.04), whereas E. coli infection was associated with low erythrocyte folate (p = 0.04), and B. hominis infection was related to higher vitamin A levels (p = 0.05). Infection with E. coli was also associated with a significantly higher incidence of fever but fewer visits to the doctor, while B. hominis infection was associated with significantly less diarrhea, diarrhea with vomiting, doctor visits and school absenteeism. In conclusion, G. duodenalis and E. coli infections were associated with indicators of poor nutritional status in this population, while B. hominis was related to apparently decreased morbidity.
Asunto(s)
Disentería Amebiana/complicaciones , Giardiasis/complicaciones , Micronutrientes/sangre , Estado Nutricional , Absentismo , Blastocystis hominis/aislamiento & purificación , Índice de Masa Corporal , Niño , Preescolar , Colombia/epidemiología , Disentería Amebiana/epidemiología , Escherichia coli/aislamiento & purificación , Infecciones por Escherichia coli/complicaciones , Infecciones por Escherichia coli/epidemiología , Heces/parasitología , Femenino , Tracto Gastrointestinal/fisiopatología , Giardia/aislamiento & purificación , Giardiasis/epidemiología , Humanos , Incidencia , Masculino , Morbilidad , Prevalencia , Estudios Prospectivos , Instituciones Académicas , Factores SocioeconómicosRESUMEN
BACKGROUND: The efficacy of micronutrient supplementation on growth may be modified by specific gastrointestinal parasite infections. METHODS: We carried out a double-blind placebo-controlled trial to evaluate the effect of vitamin A and zinc supplementation on gastro-intestinal pathogen infections and growth among 584 infants in Mexico City. Children aged 5-15 months were assigned to receive either a vitamin A supplement every 2 months (20,000 IU of retinol for infants < or =; 1 year or 45,000 IU for infants >1 year), a daily supplement of 20 mg of zinc, a combined vitamin A-zinc supplement or a placebo, and were followed up for 1 year. Weight and length were measured once a month and morbidity histories were recorded twice a week for 12 months. Monthly stool samples were screened for Giardia duodenalis, Ascaris lumbricoides and Entamoeba spp. Growth velocity slopes, generated from the linear regression of individual child length, and height-for-age z-scores on time were analyzed as end points in regression models, adjusting for the presence of parasite infections. RESULTS: The main effect of vitamin A supplementation was in height improvement (P<0.05), and was only found in the model evaluating infants with any parasite. There was an interaction effect of slower growth (P<0.05) found in infants infected with any parasite and supplemented with vitamin A in slower growth (P<0.05). In addition, the interaction of zinc supplementation and Giardia duodenalis or A. lumbricoides was associated with reduced growth (P<0.05). CONCLUSION: Gastro-intestinal parasite infections may modify the effect that zinc or vitamin A supplementation has on childhood growth.
Asunto(s)
Estatura/efectos de los fármacos , Peso Corporal/efectos de los fármacos , Crecimiento/efectos de los fármacos , Parasitosis Intestinales/complicaciones , Vitamina A/farmacología , Zinc/farmacología , Animales , Ascariasis/complicaciones , Ascaris lumbricoides , Estatura/fisiología , Peso Corporal/fisiología , Suplementos Dietéticos , Disentería Amebiana/complicaciones , Heces/parasitología , Femenino , Giardiasis/complicaciones , Crecimiento/fisiología , Trastornos del Crecimiento/etiología , Trastornos del Crecimiento/prevención & control , Humanos , Lactante , Masculino , México , Oligoelementos/farmacología , Vitaminas/farmacologíaRESUMEN
INTRODUCTION: There are morphologically identical amebaes, but with differences that can distinguish them; one as pathogenic: Entamoeba histolytica, and the other: Entamoeba dispar, as inoffensive. That brought the new hypothesis that many of the cases treated as amebiasis, weren't so. OBJECTIVE: To identify E. hystolitica in patients with dysentery, supposed to be caused by amebae. METHODS: Transversal and observational study performed between March 2005 and November 2007 in the city of Santa Fe, Argentina. Stools from children aged 2 months to 15 years-old with dysentery and direct exams with E. hystolitica/ dispar, were studied with ELISA to detect the adhesin of E. histolytica (adhesin Eh). Permanent stains for amebae were done as well as stool cultures. Clinical data were charted. RESULTS: 75 children were studied; 35 were male and 40, female, with a median age of 3 years-old. All of them presented diarrhea with leucocyte, 73% macroscopic blood on stool and 27% detectable on the microscope. Elisa Eh was positive in 21; 3 cases had hematophagous trophozoites. In 15 stool cultures were found: S. flexneri S2 type in 5 cases. Other parasites: 6 (Blastocystis homini 5). In 54 adhesin Eh was negative, 19% of the coulouring detected E. dispar. From 44 stool cultures: S. flexneri S2 type was detected in 13, Shigella sp in 1, C jejuni 5, other: 3. Other parasites: 12 (Blastocystis homini 9). CONCLUSION: In this group of children with "amebic dysentery", half of them developed invasive bacteriae and only 28% had E. histolytica on stools; that means that the prevalence of positive cases in the population could be 18% to 38% [CI 95% (0.179; 0.381)].
Asunto(s)
Disentería Amebiana , Disentería/epidemiología , Disentería/parasitología , Adolescente , Argentina/epidemiología , Niño , Preescolar , Diagnóstico Diferencial , Disentería Amebiana/complicaciones , Disentería Amebiana/diagnóstico , Disentería Amebiana/epidemiología , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Lactante , Masculino , PrevalenciaRESUMEN
Amoebic liver abscess is the most common extra-intestinal manifestation of amebiasis with approximately 10% of the world's population infected by this parasite. Actually, incidence of this infection is also increasing in industrialized countries, as a consequence of the more frequent immigration or travelling. Only 3-10% of patients with intestinal amebiasis develop liver abscess. A clinical case of suprainfection of amoebic liver abscess consequent on acute appendicitis is presented.
Asunto(s)
Apendicitis/complicaciones , Disentería Amebiana/complicaciones , Absceso Hepático Amebiano/complicaciones , Peritonitis/etiología , Complicaciones Posoperatorias/etiología , Enfermedad Aguda , Adulto , Apendicectomía , Apendicitis/cirugía , Humanos , Italia/epidemiología , Absceso Hepático Amebiano/epidemiología , Masculino , México/etnologíaRESUMEN
Amebiasis caused by Entamoeba histolytica may be considered the most aggressive parasitic disease affecting human intestine, causing acute amoebic colitis and extra-intestinal diseases of high morbidity and mortality. 5-nitroimidazoles are the drugs of choice. In this multicenter, open and randon clinical trial, the efficacy and tolerability of secnidazole suspension in a single oral dose of 1ml/kg was compared with 0.5ml/kg doses of tinidazole suspension given for 2 consecutive days to 303 Entamoeba histolytica-positive children aged 2 to 13. Patients with extra-intestinal complications were excluded from the study. Clinical and parasitological follow-up using the Faus and Kato-Katz method were carried out 7, 14, and 21 days after treatment. Clinical improvement/cure was observed in 93 percent of the patients in the secnidazole group and 91 percent in the tinidaloze group. Parasitological sucess was reported for 77 percent and 63 percent of the secnidazole and tinidazole patients, respectively, showing a significant statistical difference between the two groups (p=0.007). Both drugs were well tolerated, and the adverse effects reported were mild, consisting mainly of digestive disturbances. This comparative study showed that a single oral dose of 1ml/kg of secnidazole produced a significantly higher parasitological cure rate than 2 doses of tinidazole. Secnidazole is a safe and effective drug for the treatment of uncomplicated intestinal amebiasis.
Asunto(s)
Humanos , Masculino , Femenino , Preescolar , Niño , Adolescente , Amebiasis/diagnóstico , Amebiasis/tratamiento farmacológico , Disentería Amebiana/complicaciones , Entamebiasis/diagnóstico , Entamebiasis/epidemiología , Entamebiasis/tratamiento farmacológico , Entamoeba histolytica/efectos de los fármacos , Entamoeba histolytica/aislamiento & purificación , Estudios Multicéntricos como Asunto , Nitroimidazoles/efectos adversos , Nitroimidazoles/farmacología , Tinidazol/efectos adversos , Tinidazol/farmacología , Administración Oral , Distribución de Chi-Cuadrado , Tolerancia a Medicamentos , Excipientes/administración & dosificaciónRESUMEN
UNLABELLED: Fulminant amebic colitis is a rare disease with high morbidity and mortality. PURPOSE: This study was designed to identify the most frequent clinical and histopathologic features of fulminant amebic colitis and to analyze results of surgical treatment and the existence of risk factors for mortality. MATERIALS AND METHODS: A retrospective analysis was conducted of clinical and histopathologic data of 55 patients with fulminant amebic colitis. Data were obtained from the files of autopsies and surgical operations that had been performed at a referral center in Mexico from 1943 through 1994. RESULTS: Median age was 52 (range, 18-79) years. There were 34 men (62 percent) and 21 women (38 percent). Diabetes mellitus and chronic alcoholism were the most frequent diseases in association with fulminant amebic colitis (40 and 31 percent, respectively). The most frequent clinical manifestations were abdominal pain, diarrhea, rectal bleeding, and fever. There was a coexistent amebic liver abscess in 54 percent of patients. The main histopathologic characteristics were necrosis, presence of trophozoites, and acute and/or chronic inflammation. Of 25 patients who underwent surgery, only six survived (operative mortality, 76 percent; overall mortality, 89 percent). The variables that correlated with mortality were longer duration of symptoms, lower count of leukocytes, nonsurgical treatment, nonresective surgical procedure, hospital admission before 1971, and invasion of trophozoites into or through the muscularis. CONCLUSIONS: The results may help to obtain an earlier diagnosis and establish proper treatment of fulminant amebic colitis.
Asunto(s)
Disentería Amebiana , Adolescente , Adulto , Anciano , Animales , Disentería Amebiana/complicaciones , Disentería Amebiana/mortalidad , Disentería Amebiana/patología , Disentería Amebiana/cirugía , Femenino , Humanos , Absceso Hepático/complicaciones , Masculino , México/epidemiología , Persona de Mediana Edad , Estudios Retrospectivos , Factores de RiesgoRESUMEN
Las manifestaciones clínicas siguen siendo el pilar diagnóstico del absceso hepático amibiano (AHA), a comprobarse por la sumatoria de análisis de imágenes hepáticas y de estudios serológicos para detectar anticuerpos con la Entamoeba histolytica o, en su defecto, la prueba terapéutica con derivados imidazólicos. El análisis retrospectivo de 64 casos de AHA en el Hospital San Juan de Dios de Armenia, recopilados durante un período de 12 años, muestra la presentación clínica típica de la entidad, cursando con mayor frecuencia en hombres, entre 20 y 39 años de edad, con dolor en el hipocondrio derecho en la totalidad de los casos, curso agudo o subagudo, acompañado de fiebre en 94 por ciento de los casos, y manifestaciones respiratorias en 50 por ciento de los pacientes. La presentación con disentería amibiana concomitante fue rara y las complicaciones se presentaron en 4.6 por ciento de casos, representadas fundamentalmente por ruptura del absceso a la cavidad torácica. Los pacientes con ocupaciones agrícolas fueron los más afectados, sin poder determinar correlaciones con la procedencia y estrato socioeconómico. La mortalidad por AHA fue de 1.56 por ciento, que representa un solo caso, asociada a ruptura del absceso al tórax. El manejo quirúrgico no aumentó la mortalidad.
Asunto(s)
Humanos , Absceso Hepático Amebiano/diagnóstico , Absceso Hepático Amebiano/epidemiología , Entamoeba histolytica , Disentería Amebiana/complicaciones , ImidazolesRESUMEN
We used the polymerase chain reaction (PCR) to study the epidemiology of pathogenic and nonpathogenic Entamoeba histolytica in a rural community in Mexico. Formalin-fixed stool samples were used for extraction of DNA. The PCR amplifications were performed using two sets of primers that discriminate between pathogenic or non-pathogenic E. histolytica. A total of 201 randomly selected individuals were studied. Among them, 25 (12%) were diagnosed to be infected with E. histolytica by microscopy; PCR identified 24 of these as positive (sensitivity = 0.96) and of 176 negative individuals, only three were identified as positive (specificity = 0.98). The PCR analysis defined three populations: 14 cases were positive for both pathogenic and nonpathogenic E. histolytica, nine cases were positive for pathogenic and negative for nonpathogenic E. histolytica, and only one case was negative for pathogenic and positive for nonpathogenic E. histolytica. Infection by E. histolytica was strongly associated to infection with Entamoeba coli (odds ratio [OR] = 9.41, 95% confidence interval [CI] = 3.09, 28.65, P < 0.0004) and Endolimax nana (OR = 6.15, 95% CI = 2.03, 18.17, P < 0.0004). This new technique has high specificity and sensitivity; it is simple, reproducible, fast, avoids the need to culture trophozoites, and can be applied in the field for epidemiologic studies.
Asunto(s)
ADN Protozoario/análisis , Disentería Amebiana/epidemiología , Entamoeba histolytica/patogenicidad , Adolescente , Adulto , Amebiasis/complicaciones , Animales , Secuencia de Bases , Niño , Preescolar , ADN Protozoario/química , Disentería Amebiana/complicaciones , Disentería Amebiana/parasitología , Endolimax/aislamiento & purificación , Entamoeba histolytica/genética , Heces/parasitología , Femenino , Humanos , Lactante , Masculino , México/epidemiología , Persona de Mediana Edad , Datos de Secuencia Molecular , Oligodesoxirribonucleótidos/química , Reacción en Cadena de la Polimerasa , Reproducibilidad de los Resultados , Población Rural , Sensibilidad y EspecificidadRESUMEN
Five cases of necrotizing amoebic colitis are described. The patients were seen at the University Hospital of Caracas during a period of 3 years in the surgical departments. In 3 patients the diagnosis was made preoperatively and antiamoebic treatment was started. Only one patient survived. The clinical manifestations, diagnosis methods and treatment modalities are revised.
Asunto(s)
Disentería Amebiana/patología , Adulto , Anciano , Apendicitis/diagnóstico , Diagnóstico Diferencial , Disentería Amebiana/complicaciones , Disentería Amebiana/terapia , Femenino , Humanos , Perforación Intestinal/diagnóstico , Masculino , Persona de Mediana Edad , Rotura EspontáneaRESUMEN
Se estudiaron en forma prospectiva 27 casos de megacolon tóxico amebiano (MCTA), en nuestro Hospital, desde el año 1977 a la fecha. Se presenta como complicación de la colitis ulcerosa amebiana con una frecuencia estimada entre 0,6 al 0,9 de los casos. Anatomopatológicamente, corresponde a una dilatación del colon por destrucción de los plexos mientéricos y que, unida a las ulceraciones de la pared intestinal termina por perforarla. El cuadro clínico inicial corresponde al de una gastroenteritis aguda corriente, pero que en las siguientes horas de su evolución presenta manifestaciones propias de un cuadro abdominal agudo, con características de sepsis violenta. El diagnóstico inicial, por tanto, es difícil. Todos los pacientes fueron intervenidos practicando cirugía resectiva de los segmentos comprometidos. La morbilidad es extraordinariamente alta y su mortalidad alcanza casi al 50%. La sobrevida, por consiguiente, dependerá de la precocidad del diagnóstico y tratamiento quirúrgico y, fundamentalmente, de manejo pre y postoperatorio en las unidades respectivas
Asunto(s)
Adulto , Persona de Mediana Edad , Humanos , Masculino , Femenino , Megacolon Tóxico/cirugía , Disentería Amebiana/complicaciones , Estudios ProspectivosRESUMEN
Fulminant amebic colitis is an infrequent complication of amebiasis with a high mortality rate. The presence of a tumoral mass caused by ameba (ameboma) in the rectum or the colon is also of rare occurrence and can cause diagnostic difficulties. We report the case of a pregnant 27 year old patient with the association of both pathologies.