1. Amoebiasis Clinical Case 10 Ellen Marie de los Reyes

2. EF, a fresh college graduate, is applying for a job at a pharmaceutical company. Routine laboratory examinations were requested. Fecalysis revealed (+) E histolytica cyst. Patient is asymptomatic.

3. 1. Give your Diagnosis

4. Amoebiasis An infection with Entamoeba histolytica produced by the ingestion of cysts in the organism In the intestines, the cysts develop into trophozoites that adhere to colonic epithelial cells by means of a lectin on the parasite

5. Amoebiasis Lyses the host cell invades the submucosa and secretes IFN- γ activated macrophages This will result in dysentery The parasite can invade the liver and can develop liver abscesses and an amoebic granulomas developing in the intestinal wall

6. Symptoms gastrointestinal including diarrhoea, vomiting, abdominal pain or discomfort and fever.diarrhoeavomiting abdominal painfever Duration: few days to a few weeks but usually it is about two to four weeks. Most are asymptomatic has the potential to make the sufferer dangerously ill Infections that sometimes last for years may be accompanied by no symptoms (in the majority of cases), vague gastrointestinal distress,gastrointestinal dysentery (with blood and mucus). dysentery

7. Asymptomatic Infection the amoeba lives by eating and digesting bacteria and food particles in the gut. It does not usually come in contact with the intestine itself due to the protective layer of mucus that lines the gut. Disease occurs when amoeba comes in contact with the cells lining the intestine. secretes toxic substances, including enzymes that destroy cell membranes and allow it to penetrate and digest human tissues, resulting in flask-shaped ulcers in the intestine.

8. Amoebiasis Amoebiasis is transmitted: fecal contamination of drinking water foods direct contact with dirty hands sexual contact

9. 2. How would you manage this case?

10. Main drugs Metronidazole Tinidazole Diloxanide *These agents may be used in combination

11. Drugs of choice for various forms of Amoeboisis Acute invasive intestinal amoeboisis resulting in acute severe amoebic dysentary> metronidazole followed by diloxanide Chronic intestinal amoeboisis>diloxanide Heptic amoeboisis>metronidazole followed by dilxanide Carrier state>diloxanide

12. 3. Discuss the pharmacokinetics of the drug of choice.

13. Metronidazole Kills the trophozoites of E. histolytica by damaging the DNA by toxic oxygen products generated by thedrug But has no effect on the cysts Most effective drug available for invasive amoebiasis

14. Pharmacokinetics Usually given orally Rapidly, completely absorbed Peak plasma concentration 1-3 hrs Half-life 7 hrs Distributed rapidly through the tissues reaching high concentrations in the body fluids and CSF Some are metabolized and most excreted in urine

15. Unwanted effects Bitter taste in the mouth Minor gastrointestinal disturbances Dizziness, headache, sensory neuropathies Drug interferes with alcohol metabolism

16. Tinidazole Similar to metronidazole Eliminated more slowly Half-life 12-14 hrs

17. Diloxanide Effective against the non-invasive intestinal parasite Drugs have a direct amoebicidal action affecting the amoebae before encystment Given orally No serious adverse effects

18. And now we reached the end! Thank you!