Amebiasis presenting as an acute abdomen

Amebic acute appendicitis: systematic review of 174 cases

BACKGROUND

This study aimed to determine the clinical and demographic features of acute amebic appendicitis by reviewing the reported cases.

METHODS

The PubMed and MEDLINE databases were searched to identify articles related to amebic appendicitis using key words. The search included all articles published between 1935 and 2012 without restricting language, journal, or country.

RESULTS

A total of 174 cases of amebic appendicitis reported in 42 articles were analyzed. The mean age of the patients was 23.5 years (range 2 months-83 years). The majority of patients were male (74.0 %), and the majority of cases were reported from countries with high/moderate risk for amebiasis (76.5 %). A history of traveling to a high/moderate-risk country was cited in 64.0 % of the overall cases. The interval between travel and onset of clinical symptoms ranged from months to years. History of or coexisting dysenteric diarrhea was present in only 7.0 and 14.0 % of overall cases, respectively. A preoperative diagnosis of amebiasis was cited for only five cases (3.0 %). Complicated appendicitis was present in 30.7 % of cases, some of which required colon resection. Severe postoperative intraabdominal complications (e.g., liver abscess, abdominal sepsis, gastrointestinal fistula, hemorrhage) occurred in 19.4 % of surgery-treated patients. The overall mortality rate was 3.2 %.

CONCLUSION

Appendectomy specimens should be routinely sent for histopathologic examination. In the case of suspected amebic acute appendicitis, extra precautions-early appendectomy, metronidazole for antibiotic prophylaxis, wet-preparation examination, obtaining a timely pathology result, increasing the awareness of uncommon complications of appendectomy-can hasten appropriate therapeutic intervention and improve outcome.

Fulminant amoebic colitis: a rare fierce presentation of a common pathology

We conducted a retrospective study of patients with fulminant amoebic colitis (FAC) over a 20 year period in an urban tertiary care hospital in Pakistan. After consideration for inclusion and exclusion criteria 25 cases were identified as FAC with the most common presentations being abdominal pain (84%). Nineteen (76%) underwent laparotomy for peritonitis with evidence of: colonic perforation in 10 (40%); faecal peritonitis in eight (32%); bowel gangrene in one (4%); and intra-abdominal abscess in two (8%). Nine (36%) deaths were recorded in the series - eight (53%) in the operated group and one (16.6%) in the medically-treated group. The optimal outcome can be achieved in FAC with aggressive resuscitation, intravenous broad-spectrum antibiotics, including metronidazole, and total colectomy without anastomosis in patients with peritonitis.

Fulminant amebic colitis: analysis of 55 cases

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.

Fulminant amebic colitis. A morphologic study of four cases

PURPOSE

The morphologic features of fulminant amebic colitis are poorly documented. In this report, we describe the clinical and pathologic findings in four of these cases.

METHODS

The surgical pathology reports and accompanying histologic slides were examined from four patients who underwent surgical resections for fulminant amebic colitis. Clinical information was obtained from the patients' medical records.

RESULTS

Large, geographic mucosal ulcers were typically present and were accompanied by yellow-green pseudomembranes. The muscularis externa was usually attenuated and necrotic, imparting a "wet blotting paper" consistency. Large numbers of amebic trophozoites were present within the inflammatory exudates. The mucosa adjacent to and undermined by the ulcers was often hemorrhagic or inflamed, resembling ischemic colitis or idiopathic inflammatory bowel disease, respectively. Two patients died within four weeks of their surgery. A third patient died one year later as a result of AIDS-related complications. The remaining patient has been lost to follow-up.

CONCLUSION

An uncommon but life-threatening manifestation of intestinal amebiasis is a fulminant colitis. Early surgical intervention and intensive antiamebic chemotherapy are essential for efficacious management.

Appendiceal infection by Entamoeba histolytica and Strongyloides stercoralis presenting like acute appendicitis

A 58-year-old male from Puerto Rico who was taking orally administered cortisone analogs for chronic obstructive pulmonary disease presented with fever, absolute eosinophilia, right lower quadrant pain, and rebound tenderness associated with Strongyloides stercoralis infection of the appendix. A 37-year-old alcoholic male developed fever, right lower quadrant abdominal pain, and rebound tenderness because of infection of the appendix with Entamoeba histolytica. These are the seventh reported case of isolated amebic appendicitis and the ninth reported case of appendiceal involvement with Strongyloides. In all these cases the diagnosis was made only after surgery. Patients with unexplained right lower quadrant pain, particularly if immunosuppressed or with an appropriate travel history, should have stool examinations for ova and parasites. Early diagnosis and treatment may prevent life-threatening complications such as perforation and peritonitis.

Acute fulminating amoebic colitis: survival after total colectomy

Acute fulminating amoebic colitis is a very uncommon complication of amoebiasis. Most patients die, with or without surgery. We report such a patient who survived after total colectomy. If an excision of diseased colon is done, an exteriorising procedure should be added and primary anastomosis avoided.

Fatal intestinal amoebiasis

The clinical presentation of amoebic colitis are diverse. Amoebiasis is comparatively rare in the U.K. and, unless the clinician is aware of the condition, wrong diagnosis often leads to delay in appropriate treatment resulting in high mortality. Diagnosis rests on clinical suspicion, stool examination, sigmoidoscopy with rectal biopsy and serological tests. Amoebiasis is readily treatable and death from it should be very rare.

Perforation of the colon in unsuspected amebic colitis: report of two cases

Two cases of amebic colitis that resulted in perforation of the colon, an ominous complication, are presented. The first was diagnosed preoperatively as acute ulcerative colitis with toxic megacolon, and the second as peritonitis complicating acute cholecystitis. In both instances the correct diagnosis was made after operation. The first patient recovered after colectomy and antiamebic therapy, but the second patient died in the early postoperative period, in septic shock. Amebic colitis occurs infrequently in the United States, and the diagnosis is rarely considered. In most cases an initial diagnosis of ulcerative or granulomatous colitis is made and the true diagnosis is recognized only after operation for colonic perforation or hepatic abscess. It is suggested that amebic colitis should be considered more frequently in cases of patients who have diarrhea. Stool examination for ova and parasites is often negative in amebic colitis. The IHA is usually positive in emebiasis, and should be performed early in casesof patients who have bloody diarrhea or other clinical symptons when amebiasis is suspected. Rectal biopsy is also a useful diagnostic approach, but failed to reveal amebae in one of our cases. Finally, it is suggested that operation be performed urgently when fulminating amebic colitis is not reversed by antiamebic therapy, when peritonitis occurs even with antiamebic treatment in progess, and for colonic perforation or toxic megacolon even when antiamebic therapy has not been indicated.