Amoebic dysentery, Latin amebiasis, refers to an infection of the human intestinal tract caused by amoebae. This article discusses the causes, diagnosis, course, treatment, and prevention of amebic dysentery.
What is amoebic dysentery?
Amoebic dysentery is a diarrheal disease caused by the amoeba species “Entamoeba histolytica”. Amoebic dysentery is a diarrheal disease that occurs primarily in tropical and subtropical areas such as Thailand, Kenya, Vietnam, and India. The infection is caused by a species of amoeba that lodges in the human large intestine, where it multiplies steadily through cell division. Every year, approximately 100,000 people die as a result of such an infection. Physicians distinguish between three different forms of amoebic dysentery:
1. symptomless infestation: in this case, the affected patient does not experience any symptoms of the infection. However, the amoebae live in his digestive tract and are excreted through the stool. Thus, despite the lack of symptoms, the patient can become a carrier of the infection. 2. invasive amebiasis: the pathogens infect the human digestive tract and trigger the formation of abscesses and ulcers there. 3. extraintestinal amebiasis: advanced form of amebic dysentery, the pathogens additionally affect organs outside the digestive tract such as liver, heart, spleen or urinary tract.
Causes
The main cause of amoebic dysentery is the pathogen Entamoeba histolytica. It belongs to the protozoan family and the rhizopod subgroup. Entamoeba histolytica is transmitted mainly through contaminated drinking water and general unhygienic living conditions. The incubation period varies depending on the case and may take several days or several months from infection with the pathogen to the onset of the disease.
Symptoms, complaints, and signs
Patients infected with the amoeba E histolytica do not show any symptoms in the vast majority of cases. Intestinal amebiasis, on the other hand, is noticeable through various signs that can be used to diagnose the disease. After a gradual onset, mucopurulent, bloody diarrhea and abdominal cramps occur after a few weeks. The stool is jelly-like and is often described as foamy. Constipation, severe pressure pain in the lower abdomen and nausea may also occur. With prolonged illness, weight loss occurs. Fever and chills are also typical symptoms of amoebic dysentery. Externally, the disease is noticeable, among other things, by the altered skin appearance. Patients usually have pale, blemished skin and often sunken eyes. Some patients also experience redness and, in the case of an infestation of the liver, symptoms of jaundice. Complications such as a ruptured intestine or an amoebic liver abscess cause further symptoms. In most cases, stomach cramps, severe pain and diarrhea occur. Listlessness, fatigue and chronic gastrointestinal complaints are also typical symptoms of chronic intestinal amebiasis. Repeated vomiting of bloody and mucopurulent bile is also a typical symptom.
Diagnosis and course
Amebic dysentery is diagnosed by physicians using stool and blood samples. If typical symptoms such as bloody diarrhea, cramps, and fever occur, the responsible pathogens are detected by examination with a microscope. In a few cases, colonoscopies or ultrasound examinations of the abdomen are also used to diagnose amoebic dysentery. In stool examinations, it should be noted that the pathogens are very sensitive despite their high risk of infection. For this reason, fresh stool should always be used in diagnostic examinations. The course of amoebic dysentery can usually be considered harmless if the disease is diagnosed and treated early. If the disease is treated professionally in time, it subsides without consequences in most cases. However, if the infection is discovered and treated too late, severe to fatal complications can result. These include intestinal rupture, inflammation of the peritoneum, and inflammation of the intestinal mucosa.
Complications
A very rare but also extremely dangerous complication of amebic dysentery is the so-called toxic megacolon, which often involves severe vomiting, high fever, and a state of shock in the patient.In general, however, dangerous complications of amoebic dysentery are rather rare. In severe cases, for example, intestinal perforation is possible, which is often accompanied by peritonitis. In addition, necrotic colitis can occur; an inflammation of the mucous membrane of the large intestine that leads to the death of the tissue. The colitis is accompanied by fever symptoms and bloody diarrhea. A rare complication of amebic dysentery is toxic megacolon; a dilatation and obstruction of the colon. Megacolon leads to a rapid deterioration of the general condition and is accompanied by nausea and vomiting, among other symptoms. As it progresses, there is dilatation of the colon, and subsequently intestinal rupture. Amoebic dysentery can also cause nodules on the intestinal walls and lead to constipation. In rare cases, the amoebae enter the bloodstream and cause extratestinal amebiasis. Amebiasis is associated with chronic diarrhea and the formation of abscesses; as it progresses, liver abscesses, weakening of the immune system, and sometimes the infection spreads to the chest or heart. If amoebic dysentery is treated early, however, severe complications usually do not occur.
When should you see a doctor?
In any case, amoebic dysentery must be medically clarified and treated. A visit to the doctor is advisable if typical symptoms of an infectious disease are noticed after a long-distance trip. Cramp-like abdominal pain, weight loss and painful bowel movements should be taken to the doctor immediately. If this is accompanied by bloody, mucous diarrhea and fever, it is most likely amoebic dysentery or another infectious disease that requires medical treatment. A visit to the doctor is recommended in the first hours of the disease. Otherwise, serious complications such as an amoebic liver abscess or circulatory collapse may occur, resulting in further discomfort. As a general rule, if diarrhea persists for more than three days, a doctor must be consulted. If pronounced weakness and dizziness occur, or if bloody or purulent stools are noticed, possibly accompanied by a high fever, a doctor must be consulted immediately. People with an immunodeficiency or a corresponding medical history should go to the doctor with amoebic dysentery just as immediately as children, the elderly and pregnant women.
Treatment and therapy
A simple amoebic infestation of the intestinal tract diagnosed in time can be treated very quickly and successfully with antibiotics of various types. Usually, the drugs are administered intravenously under constant observation by healthcare professionals. As the disease progresses, the antibiotics can also be administered in tablet form if the results are good. In the case of amoebic infections and abscesses in various human organs, however, a separate therapy by the physician is necessary; in this case it is quite possible that the patient will have to take medication for a longer period of time. In the case of complications during the course of the disease and severe abscess infestation in the organs, in individual cases it may also come to a surgical treatment of amoebic dysentery.
Outlook and prognosis
As a rule, those affected by amoebic dysentery suffer from severe discomfort in the abdomen and intestines. It is not uncommon for severe abdominal pain and cramps in the stomach to occur. Likewise, it is not uncommon to experience diarrhea and furthermore bloody bowel movements. The bloody bowel movements can lead to a panic attack and significantly impair the patient’s quality of life. Furthermore, the patients suffer from a general fatigue and tiredness. The patient’s ability to cope with stress decreases significantly as a result of amoebic dysentery. If the patient does not receive treatment, the disease can also lead to intestinal perforation in the further course of the disease. It is also not uncommon for patients to suffer from vomiting and nausea. The patient’s daily life is significantly affected by amoebic dysentery. With the help of antibiotics, the symptoms can be treated and limited relatively well. As a rule, no particular difficulties or problems occur. If an infection in the internal organs has occurred, a longer therapy is usually necessary. Life expectancy is usually not reduced with early treatment of amoebic dysentery.
Prevention
To prevent infection with the highly infectious amoebic dysentery, increased attention should be paid to hygienic living conditions in tropical and subtropical areas at risk. Tap water should never be used for drinking, making ice cubes or brushing teeth. If hygienically bottled mineral water is not available, tap water must be boiled for at least five minutes to kill any pathogens it may contain. Raw fruits and vegetables should be eaten only peeled. If symptoms such as diarrhea, severe abdominal pain or fever occur, a doctor should be consulted so that the disease can be diagnosed and treated at the earliest possible stage.
Follow-up
There is no immunity after infection with amoebic dysentery. The typical symptoms may recur again and again. Patients can only prevent re-infection by taking precautionary measures. Doctors provide information about possible causes as part of the initial diagnosis. Before setting out, travelers can also ask their family doctor about risks in tropical countries where amoebic dysentery mainly occurs. Maintaining drinking water hygiene is considered the most important preventive measure to prevent recurrence of symptoms. If a repeated infection occurs, those affected can request a diagnosis at an early stage. This helps to avoid complications. The course of the disease is then milder. The most important method is the stool examination. Antibodies in the blood also provide information about amoebic dysentery. Antibiotics promise rapid treatment success. Other drugs are sometimes prescribed for severe abdominal pain. There is no common aftercare that provides practical tips. Since there are hardly any infections with amoebic dysentery in Germany, existing knowledge leads a shadowy existence. Tourists to exotic destinations represent the main risk group. The use of high-class hotels and restaurants is the best way to prevent an emergence. It is not possible to be vaccinated against amoebic dysentery. Preventive use of certain medications is not advisable.
This is what you can do yourself
If amoebic dysentery is suspected, medical treatment is necessary. Antibiotics (tinidazole, nitroimidazole, metronidazole, and others) can then be administered under medical supervision. Subsequently, follow-up treatment with further antibiotics (paromomycin, diloxanide furoate) is usually required. Accompanying these measures, the symptoms can be alleviated by antispasmodic medicinal herbs and medicinal plants such as angelica, bergamot or columbine. In addition, it is recommended to drink enough and to take care of the body during the first seven to ten days after the infection. Those affected should drink herbal teas made from peppermint, fennel, chamomile or bilberry. For acute diarrhea, grated apples, carrot soup, rusks and gruel are helpful. What should be avoided during amoebic dysentery: very fatty or strongly spiced dishes, sweets and legumes. In addition, alcohol, caffeine and other drinks and foods that could further irritate the digestive tract should be avoided. If severe symptoms still occur, a physician must initiate further treatment steps. Often, for example, cysts form during amoebic dysentery, which must be surgically removed. If symptoms are severe, home remedies and self-measures should first be discussed with the family doctor.
