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Amoebiasis Clinical Case 10

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Amoebiasis Clinical Case 10 Ellen Marie de los Reyes EF, a fresh college graduate, is applying for a job at a pharmaceutical company. Routine laboratory examinations ... – PowerPoint PPT presentation

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Title: Amoebiasis Clinical Case 10


1
AmoebiasisClinical Case 10
  • Ellen Marie de los Reyes

2
  • EF, a fresh college graduate, is applying for a
    job at a pharmaceutical company. Routine
    laboratory examinations were requested. Fecalysis
    revealed () E histolytica cyst. Patient is
    asymptomatic.

3
1. Give your Diagnosis
4
Amoebiasis
  • An infection with Entamoeba histolytica produced
    by the ingestion of cysts in the organism
  • In the intestines, the cysts develop into
    trophozoites that adhere to colonic epithelial
    cells by means of a lectin on the parasite

5
Amoebiasis
  • Lyses the host cell
  • invades the submucosa and secretes IFN-?
    activated macrophages
  • This will result in dysentery
  • The parasite can invade the liver and can develop
    liver abscesses and an amoebic granulomas
    developing in the intestinal wall

6
Symptoms
  • gastrointestinal including diarrhoea, vomiting,
    abdominal pain or discomfort and fever.
  • Duration few days to a few weeks but usually it
    is about two to four weeks.
  • Most are asymptomatic
  • has the potential to make the sufferer
    dangerously ill
  • Infections that sometimes last for years may be
    accompanied by
  • no symptoms (in the majority of cases),
  • vague gastrointestinal distress,
  • dysentery (with blood and mucus).

7
Asymptomatic Infection
  • the amoeba lives by eating and digesting bacteria
    and food particles in the gut.
  • It does not usually come in contact with the
    intestine itself due to the protective layer of
    mucus that lines the gut.
  • Disease occurs when amoeba comes in contact with
    the cells lining the intestine.
  • secretes toxic substances, including enzymes that
    destroy cell membranes and allow it to penetrate
    and digest human tissues, resulting in
    flask-shaped ulcers in the intestine.

8
Amoebiasis
  • Amoebiasis is transmitted
  • fecal contamination of drinking water foods
  • direct contact with dirty hands
  • sexual contact

9
2. How would you manage this case?
10
Main drugs
  • Metronidazole
  • Tinidazole
  • Diloxanide
  • These agents may be used in combination

11
Drugs of choice for various forms of Amoeboisis
  • Acute invasive intestinal amoeboisis resulting in
    acute severe amoebic dysentarygt metronidazole
    followed by diloxanide
  • Chronic intestinal amoeboisisgtdiloxanide
  • Heptic amoeboisisgtmetronidazole followed by
    dilxanide
  • Carrier stategtdiloxanide

12
3. Discuss the pharmacokinetics of the drug of
choice.
13
Metronidazole
  • Kills the trophozoites of E. histolytica by
    damaging the DNA by toxic oxygen products
    generated by thedrug
  • But has no effect on the cysts
  • Most effective drug available for invasive
    amoebiasis

14
Pharmacokinetics
  • Usually given orally
  • Rapidly, completely absorbed
  • Peak plasma concentration 1-3 hrs
  • Half-life 7 hrs
  • Distributed rapidly through the tissues reaching
    high concentrations in the body fluids and CSF
  • Some are metabolized and most excreted in urine

15
Unwanted effects
  • Bitter taste in the mouth
  • Minor gastrointestinal disturbances
  • Dizziness, headache, sensory neuropathies
  • Drug interferes with alcohol metabolism

16
Tinidazole
  • Similar to metronidazole
  • Eliminated more slowly
  • Half-life 12-14 hrs

17
Diloxanide
  • Effective against the non-invasive intestinal
    parasite
  • Drugs have a direct amoebicidal action affecting
    the amoebae before encystment
  • Given orally
  • No serious adverse effects

18
  • And now we reached the end!
  • Thank you!
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