The surgical management of amoebiasis in children

Gender distribution in asymptomatic and invasive amebiasis

OBJECTIVE

The majority of individuals infected by the protozoan parasite Entamoeba histolytica experience subclinical infections. However, a small proportion of parasitized individuals develop severe invasive disease such as amebic dysentery or amebic liver abscess. Invasive amebiasis affects predominantly men; the usual explanation for this has been that men have a higher rate of asymptomatic infections and therefore experience a higher rate of invasive disease. To date, there is no convincing evidence of an increased rate of asymptomatic infection of men as compared with women. The purpose of this study was to evaluate the evidence supporting the hypothesis that men have higher rates of asymptomatic infection and thus an increased frequency of invasive amebiasis.

METHODS

We reviewed published reports of invasive amebiasis and population-based parasitological studies from 1929-1997 to compare the gender ratio of asymptomatic and symptomatic E. histolytica infection. Infections with E. histolytica were differentiated from the nonpathogenic E. dispar whenever possible.

RESULTS

The reports of invasive amebiasis (dysentery, liver abscess, colonic perforation, peritonitis, appendicitis, and ameboma) showed a higher proportion of men than women (ratio, male:female = 3.2:1, p < 0.05). This contrasts with the epidemiological surveys, where the rate of asymptomatic infection with E. histolytica was the same (1:1) for both genders (p > 0.05).

CONCLUSIONS

Asymptomatic E. histolytica infection is equally distributed between the genders. The high proportion of men with invasive amebiasis may be due to a male-related susceptibility to invasive disease.

Colectomy for necrotizing amebic pancolitis in early childhood with survival

A case of necrotizing amebic pancolitis in a 6-year-old boy with asplenia, partial situs inversus, and cyanotic congenital heart disease is reported and the literature is reviewed briefly. Our patient was managed successfully by prompt colectomy, ileostomy, a Stamm gastrostomy, and extensive drainage of the peritoneal cavity with administration of metronidazole postoperatively and prolonged jugular vein Broviac catheter hyperalimentation. This child may be the first survivor of total colonic amebic necrosis in childhood. Necrotizing amebic colitis appears to be more hazardous in infancy and childhood than in adult years. Malnutrition and additional illnesses and malformations may produce greater immunocompromise in the very young, placing them at greater risk for the ultimate of amebic intestinal complications, total colonic necrosis and disintegration.

Surgical aspects of parasitic disease in childhood

This is a review article concerning the surgical aspects of parasitic disease in childhood. The surgeon encounters parasitic disease for a variety of reasons. Many forms of infestation produce or mimic anatomic diseases of the gastrointestinal tract. Others are characterized by soft tissue or visceral mass lesions, lymphadenopathy, portal hypertension, etc. The surgical aspects of parasitism extend to all subspecialties, including ophthalmology, gynecology, and plastic surgery.

Toxic dilatation in amebic colitis: successful treatment without colectomy

A patient with acute amebic dilatation of the colon and multiple intrahepatic abscesses was successfully treated by a combination of medical and surgical therapy. Creation of a loop ileostomy and blow-hole colostomy facilitated complete healing of the colon.

Toxic amoebic colitis and amoebic colon perforation in children: An improved prognosis

Fourteen children were treated for complications of severe colonic amebiasis. Seven had colon perforation; seven had toxic amoebic colitis. Those with perforation underwent colon resection limited to the perforation and adjacent abnormal colon. Those having toxic amoebic colitis without perforation were managed by temporary ileostomy. Vigorous general supportive treatment for endotoxic shopck and amebiasis was given pre and postoperatively. Careful barium enema examinations proved safe and effective in diagnosis and follow-up. Ten patients survived (72%), five from each group.