AMEBÍASE: Entamoeba histolytica | Parte 2 | PARASITOLOGIA #9

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The period between the person catching the parasite, becoming infected and starting to show symptoms, that is, the incubation period, in amebiasis is very, very varied. You have cases like this from days to years to start manifesting the symptom. But the average is between 2 to 4 weeks.

Intestinal amebiasis, that is, non-invasive, has asymptomatic or symptomatic people with this form. Extraintestinal amebiasis, that is, the invasive form, the person is extremely likely to have symptoms. And then it will depend, the outcome of this disease will depend on the affected organ, so you have extraintestinal amebiasis in the hepatic form, in the pulmonary form, in the cutaneous form, among others.

When I say that most people are asymptomatic in intestinal amebiasis, man, I’m not kidding, you can have 8 to 90% of people in a certain location being asymptomatic, showing nothing, and then you can only find out if the person has the parasite or not making a diagnosis, examining feces, but who is going to do stool exam asymptomatic, you know? it is problematic. Now, if the person is symptomatic in intestinal amebiasis, he can have from very light symptoms to more severe symptoms, there is a huge variety of possibilities there in between.

Here in Brazil the most common manifestation in these symptomatic people is the diarrheal manifestation, in which people have stool evacuations 2 to 4 times a day with soft stools. Sometimes, the person may also experience abdominal pain or cramps. But a very interesting thing that can happen in amebiasis is that people have times when they have this very intense diarrheal condition and then they have times when their feces are normal, it seems that they have been cured but they are still infected.

Now, remember that I said that there is a range of possibilities for symptoms in the middle? While you have these people with this diarrheal form, doing 2 to 4 stool evacuations a day, you can have people on this most extreme: the dysenteric form, where they have, like, the diarrheal form at the absurd level. The person may have 8 to 10 stool evacuations a day, the stool may contain blood and mucus, that person may have very strong cramps and nausea, vomiting.

They can have a fever and, of course, a person with so many stool evacuations a day can reach very extreme levels of dehydration. In extraintestinal amebiasis, the most common is the hepatic form, because the liver is the first organ that is being affected and this form is characterized by an amebic liver abscess, so you have fever, pain, hepatomegaly. But these extraintestinal forms are rarer, okay?

they are not so common and usually these symptoms, depending on the person's situation, depend on several other factors, can lead to death. It is very important that you keep in mind that untreated amebiasis has high mortality and morbidity rates, as I said, right? it only loses to Malaria in number of deaths.

There are risk groups such as pregnant women and immunosuppressed people, such as using other medications like corticosteroids, other infections, other diseases, but these are the main groups. And look, patients with the non-invasive form that receive treatment have a mortality rate of only 1%. But not being treated, the list of complications is huge and I will put all the possible ones here so you can have an idea.

Both in the intestinal and in the extraintestinal form, you need to do the laboratory exam because clinically there is no way to hit the eye and say "oh, it's amebiasis! ". It is very similar to several other diseases.

So in the intestinal form, the easiest way for you to make the diagnosis is through the examination of feces, in which you will look for the parasite directly. But it is very important that you pay attention to the consistency of this patient's stool. If you have a patient with more liquid stools there, if you have the exam within 30 minutes, you can do it fresh.

But, sometimes in this fresh exam it is difficult to make the diagnosis unless you find the trophozoites there perfectly. But what happens many times is that you have to repeat the test, then it is no longer fresh, you need the person to collect the feces in a container with preservatives. Now, if the stools are firmer, then you do not have to look for the trophozoite, you will look for the cyst.

And then you can do it directly at first, and then you can do it with concentration methods. It is also possible to analyze scrapes or aspirates obtained through an endoscopy or a proctoscopy. Or analyze the aspirates obtained from abscesses there from the tissue.

It is also possible to use serological methods, such as ELISA and indirect immunofluorescence. You have to be very careful with patients with extraintestinal amebiasis, because not necessarily they are excreting more cysts or trophozoites in the stool and also if you only do the imaging exam you will see an abscess in the liver there, but so, there may be other things, right? So serological tests, as I said, are very important and also ultrasound, CT scans, all of this is important for you to be able to diagnose extraintestinal amebiasis.

The drug of choice has been secnidazole, you can give 2g for adults. It can also be used in children, but it is contraindicated in pregnant women in the first trimester of pregnancy. Next comes metronidazole, but it comes next precisely because it is not in a single dose, so we give preference to these treatments in a single dose for those who can.

However, in these more severe forms, it is common to use metronidazole. Then you have tinidazole as your third option. Sometimes, if the patient has a liver abscess, it may be necessary to aspirate that abscess and in rare cases surgery is necessary.

there other approved medications for amebiasis? Yes. The ones I mentioned are the ones practiced by SUS (brazilian public health system), but there are others, for example, chloroquine that has been widely talked about lately is one of the options.

Form of prevention: one that we are tired of hearing about? WASH HANDS. But in that case after going to the bathroom.

Wash the vegetables with drinking water and immerse them for at least 30 minutes in sodium hypochlorite. Avoid drinking potentially contaminated water. There is not much for you to know but if you suspect a place try to avoid drinking water from there.

Avoid the consumption of salads and raw fruits, so if possible remove the peel of the fruit. Wash everything well before cooking. And the government has to do its part by providing basic sanitation and health education, in this case not only the government, but us health professionals in general.

So that was our amebiasis, remembering that there is already a mental map in the Flavonoide store. Follow us also on Instagram, there's a lot more content there. Kisses, doubts down here, bye bye.