Chronic amebic dysentery

Introduction to chronic amoebic dysentery Amoebic dysentery is an intestinal infectious disease caused by Entamoebahistolytica invading the colon. It is easy to relapse into chronic disease. It is called chronic amoebic dysentery. It can also cause intestinal complications, especially liver. , lungs and other organ abscesses. basic knowledge The proportion of illness: 0.95% Susceptible people: no special people Mode of transmission: mouth communication Complications: amoebic liver abscess

Chronic amoebic sputum

The main source of infection is the fecal sacs and the worms in chronic and convalescent patients. Due to the weak resistance of the trophozoites, acute patients do not have a source of infection. Domestic pigs can also be valued as a source of infection. Oral infection of the amoeba is the main route of transmission. Encapsulated water sources are the main cause of regional outbreaks and high infection rates; secondly, contaminated hands, food or utensils; flies, cockroaches, etc. can carry cystic diseases; male homosexuals anal-mouth contact or sexual behavior The mode of transmission is very important in European and American countries.

Chronic amoebic dysentery prevention

1. Health education educates the masses through widely-influenced propaganda tools, paying attention to food hygiene, personal hygiene and civilized lifestyles, not drinking raw water, not eating unclean fruits and vegetables, growing up before or after meals or before making food. Wash your hands and other health habits.

2. Strengthen the management of manure, the sanitation management of the livestock pen, and do a good job of harmless disposal of manure according to local conditions to improve environmental sanitation.

3. Protect public water sources and prevent fecal pollution. Drinking water should be boiled.

4. Strengthen the hygiene management of the catering industry and public canteens. Health supervision measures should be in place for food production and staff operations.

5, vigorously put out flies, cockroaches, use fly-proof hood or other measures to avoid food contamination.

Chronic amoebic dysentery complications Complications amoebic liver abscess

Intestinal complications

1, intestinal bleeding: a wide range of intestinal lesions, or invading the blood vessels of the intestinal wall can cause blood in the stool. Large bleeding caused by corrosive large blood vessels is rare, and the condition is critical, often leading to shock.

2, intestinal perforation: severe deep and serosal amebic ulcer can lead to perforation, more common in the cecum, appendix and ascending colon, often with multiple perforations. Most of them occur slowly, without severe abdominal pain, and the specific time of perforation is difficult to determine. The patient had progressive bloating, vomiting, loss of water, and the general condition deteriorated rapidly. The bowel sounds disappeared with local peritoneal irritation. Abdominal plain film sees free gas under the armpit, and forms a local abscess or internal hemorrhoid when there is intestinal adhesion.

3, appendicitis: amoebic appendicitis symptoms similar to ordinary appendicitis. Easy to form an abscess. Chronic diarrhea or a history of amoebic bowel disease, the discovery of amoeba in the stool helps to differentiate the diagnosis.

4, non-dysentery colonic lesions: caused by proliferative lesions, including amoebia, intestinal amoebic granuloma, fibrous stenosis. Amoebic tumor is an inflammatory pseudotumor of the large intestine wall. It has the most changes in abdominal pain and stool habits, and some with intermittent dysentery, can induce intussusception and intestinal obstruction. The main signs are that the right axillary fossa touches the movable and tenderness. Smooth goose-shaped or intestinal-like mass, seeing space-occupying lesions on the X-ray, has a good effect against amebic treatment.

Extraintestinal complications

1, lung, pleural amebiasis: pathogens can come from the liver or intestines, mostly secondary to hepatic amebiasis. It is common on the right side through direct spread or lymphatic pathways, and individual meridians circulating to the lungs. Liver abscess complicated by pleural and pulmonary amebiasis accounted for 10% to 20%, and when the bronchial hepatic sputum can cough up a lot of brown pus, equivalent to drainage, the condition can be quickly improved. There is a large amount of pleural effusion in pleurisy, and the pleural effusion is chocolate-colored to help diagnose.

2, pericardial amebiasis: caused by the left amygdala abscess into the pericardium, is the most dangerous complication of this disease. Symptoms and signs of pericarditis, such as precordial pain, shortness of breath, palpitations, pericardial friction, accompanied by various manifestations of liver abscess. Sometimes the perforation of the liver abscess causes an acute pericardial tamponade, which leads to shock and sudden death.

3, brain amoebiasis: less common. More secondary to intestinal, liver, lung amebiasis.

4, amoebic peritonitis: can be caused by liver abscess or intestinal ulcer perforation or direct spread. Amoebic liver abscess complicated with peritonitis, the chance of jaundice is more than simple liver abscess, easy to be misdiagnosed as cholecystitis.

5, urinary tract amoebia: symptoms of low back pain, urine is rice soup and so on. Every time there is urinary pain, urgency, urinary turbidity and bloody urine, urine, protein, red blood cells, white blood cells and amoeba trophozoites.

6, reproductive system amebiasis: such as amoebic cervicitis and vaginitis, more pain with bloody or pus and bloody secretions, can form fistula. The cervix is significantly deformed and ulcerated, and palpation is easy to bleed. The vaginal mucosa is rough, granule-like, with granulation tissue or ulcer formation, which is easy to be mistaken for cancer. A smear or biopsy of the cervicovaginal secretion can be seen as a trophozoite.

7, skin amebiasis: even in severely endemic areas are rare. Common in perineal and perianal skin, followed by chronic dysentery infection or visceral amoebic perforation, or local infection after surgical drainage, the formation of ulcers and granuloma.

Chronic amoebic dysentery symptoms Common symptoms in the aftermath of severe diarrhea and constipation alternate mucus stool feces pity blood bloating abdominal pain abdominal discomfort low fever

1, the common type: the onset is slow. Often started with abdominal pain and diarrhea. Diarrhea days several times to more than ten times. After the rush, the severity is different. Moderate stools, often with pus or mucus, typical feces are jam-like, stinky and stinky. It can also be expressed as simple diarrhea. The right lower quadrant has obvious tenderness. The course of the disease can be relieved by itself for a few days or weeks. If it is not treated, it is easy to relapse.

2, violent hairstyle: rare. Acute onset, high fever, aversion to cold, diarrhea more than ten times a day, before the severe abdominal cramps, heavy and obvious after the urgency. The stool is mucous blood or bloody, stinking. And there is vomiting, loss of water, and rapid collapse. Physical examination showed obvious abdominal distension, diffuse tenderness in the abdomen, and hepatomegaly. Failure to rescue in time, and intestinal bleeding, intestinal perforation, can cause death.

3, chronic type: symptoms persist or recurrent. Often abdominal pain, bloating, diarrhea and constipation alternate. Due to long-term bowel dysfunction, patients may have symptoms of wasting, anemia, malnutrition or neurasthenia. Due to the thickening of the intestinal wall of the colon, it is possible to touch the block and have tenderness.

Chronic amoebic dysentery

1. Fecal examination: an important basis for diagnosis. The feces of typical amoebic dysentery are dark red jam-like, with special odor, more faecal, blood and mucus. Microscopic examination revealed a large number of mucus red blood cells and a small number of white blood cells, sometimes visible active, phagocytic erythrocyte trophozoites and Charcot-Leyden crystals. Generally, cysts can only be detected in the formed feces of chronic patients, and can be iodine after concentration by zinc sulfate centrifugal flotation or mercury iodide centrifugal precipitation or silica colloidal suspension (trade name percoll). Staining to check the cyst can increase its positive detection rate. The fecal specimens were isolated and cultured, and the Robinson medium was used. The detection rate of subacute or chronic cases was relatively high. Because of the high requirements, it is not yet a routine examination for hospital diagnosis. When examining the amoeba, it should be distinguished from other intestinal non-pathogenic protozoa, such as amoeba and Haemophilus sinensis, from the size of the worm, the number of nucleus, the shape of the pseudopod and the way of movement. If necessary, the capsule or trophozoite can be stained and identified according to the structure of the nucleus and the chromosomes and glycogen vesicles. At present, there are various methods for distinguishing E. histolytica from Despana Amoeba, including isozyme analysis, enzyme-linked immunosorbent assay and PCR analysis. The surface molecular weight of E. histolytica is 260×103Gal/GalNAC lectin as the target antigen, which is detected by monoclonal antibody, and its sensitivity and specificity in blood and feces are 88% and 99%. Kits are available for sale in Europe and America. The PCR method can directly identify two kinds of E. histolytica from the DNA level, among which the detection of a gene encoding a molecular weight of 29×103/30×103 polycysteine antigen is most specific and feasible. It is said that two kinds of E. histolytica can be identified directly from the stool PCR method.

2, serological examination: the application of amoeba pure antigen can be used for a variety of immune serological diagnostic tests. Asymptomatic cysts were negative for antibody detection, and antibodies were formed when there were invasive lesions in the body. The detection methods include indirect hemagglutination (IHA), indirect immunofluorescent antibody (IFA), agar diffusion method (AGD), and enzyme-linked immunosorbent assay (ELISA). The positive rate of amoebic dysentery can reach 60% to 80%. This antibody can persist for 2 to 10 years after treatment, and the ELISA antibody titer can be negative within a few months after the disease, indicating that the antibody is positive. Prompt for an acute infection. In addition, the IFA test generally takes half a year to one year after recovery, and its antibody titer can be significantly reduced or negative, and can also be used as a diagnostic tool. Recombinant antigen detection antibodies have been applied, and their sensitivity and specificity are reported to be above 90%.

3. Nucleic acid detection: mainly extract the DNA of pus or fecal culture, biopsy intestinal tissue and pus and blood, and carry out amplification reaction with appropriate primers. It is considered that the molecular weight of Amoeba in the dissolved tissue is 29×103/30. The primers designed for the 103 polycysteine antigen (also known as peroxiredoxin) have the best specificity and sensitivity.

X-ray barium enema examination: filling lesions, sputum and congestion.

Diagnosis and diagnosis of chronic amoebic dysentery

1, epidemiology: more incidence in autumn, mostly for dissemination. Patients often have unclean eating habits or close contact with chronic patients.

2, clinical features: the disease is more slowly, the course of disease is longer, and there is a tendency to recurrent.

(1) Acute amoebic dysentery:

Typical: systemic symptoms are mild, no fever or low fever, diarrhea is more than 10 times a day, the amount of feces is medium, often with mucus and blood, typical of a hazel-like appearance, and stench. There is tenderness in the right lower quadrant. Heavy or light after no hassle.

Light weight: only mild abdominal pain and loose stools.

The fulminant hair: anxious fever, obvious toxemia. The stools are more than 20 times a day, mostly bloody or gravy-like, with heavy and obvious abdominal tenderness, and complicated with intestinal bleeding or intestinal perforation.

(2) Chronic amoebic dysentery: When the symptoms of dysentery occur, the time is heavier, lighter and heavier, or abdominal pain, bloating, alternating constipation and diarrhea, which lasts for several months or years. Long-term illnesses are malnutrition and anemia.

3, laboratory inspection

(1) Fecal microscopy: visible clusters of red blood cells and a few white blood cells. Find a dissolved tissue amoeba trophozoite can be diagnosed. It is helpful to diagnose the amoebic encapsulation in the chronic phase.

(2) Amoebic culture or serological examination: conditions can be used for amoebic culture or serological examination, such as: complement fixation test, indirect hemagglutination, indirect immunofluorescence, ELISA, etc.

(3) colonoscopy: there is scattered buttonhole-like ulcer on the normal mucosa, scraping its contents to check the amebic trophozoites, the positive rate is higher. In addition to ulcers in chronic patients, mucosal thickening and polyp formation can be seen.

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