Amoebiasis And Giardia

Question 1

Where is amebiasis predominantly found?

Answer 1

India
West and South Africa
SE Asia
Latin America

Question 2

How is amoeba spread?

Answer 2

Faecal-oral
Contaminated food and water

Question 3

What is the only pathogenic amoeba?

Answer 3

Entamoeba Histolytica

Question 4

Risk factors for amoebiasis?

Answer 4

Crowding
Lack of portable water
Institutionalised populations
Living in rural areas
MSM

Question 5

What are some of the clinical presentations of intenstinal ameobiasis?

Answer 5

Acute amebic colitis: abdo pain, fever and weight loss, left lower quadrant pain

Fulminant colitis: severe often in immunocompromised and malnourished

Question 6

What is colonisation of amoeba?

Answer 6

Non invasive amebiasis:
Haemoccult negative stool and normal colonoscopy
Get non specific GI complaints

Question 7

What is an Ameboma?

Answer 7

Usually in elderly
Mass of granulation tissue with Peripheral fibrosis usually in caecum and ascending colon

Question 8

What do you think of in a male with fecer, weight loss diarrhoea and hepatomegaly? Bloods show leukocytosis and raised ALP

Answer 8

Amebic liver abscess

Question 9

What are some of the complications of amebic liver abscess?

Answer 9

Fear it will rupture and spread to pleura pericardium and abdomen

Question 10

What does cutaneous amebiasis look like?

Answer 10

V rare
Ano gentian and personal ulcers with heaped up borders

Question 11

How do you diagnose amebiasis?

Answer 11

Can identify cysts or trophozoites in stool, PCR is gold standard and will differentiate between species

Question 12

When do you perform endoscopy?

Answer 12

If positive serum but negative stool
FLASK SHAPED ULCERS usually in caecum and ascending colon

Question 13

When do you drain a liver abscess?

Answer 13

> 10cm
In left quadrant as risk of pericardial imbasion
Not responding to medical tx ie no resolution of fever within 4-5 days

Question 14

Tx of colonisation of E Histolytica

Answer 14

Paromycin or Iodoquinol

Question 15

Tx invasive E Histolytica

Answer 15

Metronidazole and Paromycin

Question 16

Tx of liver abscess?

Answer 16

Metronidazole (10 days) or tinidazole (5days) and paromycin or diodoquinol

Question 17

What other antibiotics are good in amebiasis?

Answer 17

Metronidazole or tinidazole or nitazoxanide

Question 18

What are some of the luminal agents?

Answer 18

Paromycin or diiodohydroxyquin

Question 19

Cyst vs trophozoites appearance?

Answer 19

Cysts typically have 1-4 nuclei
Trophozoite is typically a single nuclei that’s ingested a RBC

Question 20

What do you think of a trophoozoite with a kidney shaped nuclei?

Answer 20

Balantidium Coli
Found in pigs, humans are incidental hosts- causes dysentery weight loss and colonic perforation
Tx with metronidazole or tetracyclines

Question 21

Name some of the giardia species

Answer 21

Giardia Lamblia
Giardia Duodenalis
Giardia intestinalis

Question 22

Symptoms of giardia?

Answer 22

Incubates for 1-2 weeks:
Prolonged diarrhoea, flatulence, bloating when it’s chronic get malabsorption of iron, vitamin A and B12

Question 23

What do bloods show?

Answer 23

Completley normal, no eosinophilia

Question 24

How is giardia spread?

Answer 24

Faecal Oral
Contaminated food/water

Question 25

Dx Giardia?

Answer 25

Antigen detection or stool examination

Question 26

Tx Giardia

Answer 26

Metronidazole or tinidazole (1 dose) or nitazoxinide

Question 27

Differences in Clinical presentation of amebic vs hydatid cyst?

Answer 27

Pts with hydatid cysts are rarely febrile or ill appearing pr toxic. On CT hydatid cysts have complex septations and daughter cysts