ameb, ascar, fil, hydatid lecture.ppt

8/18/2019 Ameb, Ascar, Fil, Hydatid lecture.ppt

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Definition

• Amoebiasis is an infection with intestinal

protozoa Entamoeba Histolytica.

• 90% of infection – asymptomatic.

• 10% of infection – Clinical syndrome.

an!in! from Dysentery to Abscess of the

li"er or other or!ans.


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the intestinal lesion

Gut Minute crypt lesion

Extends through the muscularis mucosa and submucosa.

“Flask shaped” ulcer

Thrombosis of blood vessels

“Toxic megacolon”

rreversible coagulation necrosis of bo!el !all.

PATHOLOGY


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"symptomatic infection

Mild to moderate colitis #non dysenteric colitis$

%evere colitis #dysenteric colitis$

&ocalised ulcerative lesions of the colon

&ocalised granulomatous lesion of the colon

#amoeboma$

CLINICAL FINDINGS

INTESTINAL AMOEBIASIS


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LABORATORY DIAGNOSIS

Microscopy "nd 'ulture

1. Wet Mount Preparation

(i) mounts in saline solution(ii) mounts in saline + lodine

(iii) mounts in saline + methylene blue

2. Sample Fixative xamination Stain

1. Stool

2. Si!moid"olon

#. $spirate

%ire"t

Fixed

&. 'iopsy

P$ 1* ,ormalin

sodium a"etate a"eti"

a"id ,ormalin

P$- s"hauddins

,ixative

one

P$- S"hauddin/s

Fixative

Formalin

Permanently stained

slide

Permanently

Stained slide

Wet mount 0ithenyme di!est

Permanently stained

slide

outine histolo!y

3omori-tri"hrome-

4ron haematoxylin

3omori-tri"hrome4ron haematoxylin

P$F 3omori

5aematoxylin andeosin


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En(yme mmunoassay

ndirect mmunoflorescence

&atex "gglutination

Gel diffusion

%ensitivity)* + invasive ,o!el disease -** + !ith

"moeboma

Immunological Test

ndirect aemagglutination


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Clinicalpresentation

Drugs of Choice Adult Dosage

$symptomahi"

4ntestinal "arrier

4ntestinal in,e"tion

1st 6hoi"e

%iloxanide Furoate

2nd 6hoi"e

Paramomy"in(or)

4odo7uinol

1st 6hoi"e

Metronidaole,ollo0ed by diloxanide ,uroate

( or ) 8inidaole ,ollo0ed by diloxanide ,uroate

2nd 6hoi"e

Paramomy"in

9** m! t.i.d : 1* days

29 ; #* m!

>9* m! t.i.d : 2* days

=9* ; ?** m!.t.i.d : 1*days

9** m!.t.i.d : 1* days

2 !@day 2 # days

9** m! .t.i.d : 1* days

29 ; #* m!

doses : = ; 1* days


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PREVENTION

Health Ed#cation

$mpro"ed water s#pply

Chlorination – not effecti"e

"moebic cysts /estroyed by

0** parts 1 -*) of odine 2 3 -* acetic acid.

eating 4 )5*'

6emoved by

sand filtration

,oling for -* minutes kill the cysts


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This is the most common extra intestinal

form of invasive amoebiasis.

"dults 4 children # -* 7 - $

Male 4 female

0* + !ith past history of dysentery


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PATHOGENESIS

o#rney of E. Histolytica to the &i"er

-. /irect Extension from the Gut to the &iver

0. 8ia the &ymphatics

9. "long the portal stream

$nfarction – Enzymatic Dissol#tion


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Clear 'halo' around an amoeba


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Destruction of liver tissue


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Congestion of the sinusoids


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Bulge due to superficial abscess


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C&$'$CA& (EA)*E+

Symptoms

:ain/iarrhoea and 1 or /ysentery

;eight &oss

'ough

/yspnoea

Physi"al ,indin!s

&ocali(ed tenderness

Enlarged &iver Fever

6ales


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COMPLICATONS

6ight chest

:eritoneum

:ericardium

"moebic brain abscess > rare

emobilia 3 6upture in to ma?or bileduct

:ortal hypertension


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RADIOLOGY-. '@6 3 Elevated 6ight emi diaphragm

0. sotope liver scan

9. A%G "bdomen 3 , mode < ypoechoic

B. 'T%can

DD-. %ubphrenic "bscess

0. 'holecystitis

9. &iver ydatid cyst

B. :rimary and %econdary carcinoma of liver

2. &esions of the right lung and right pleura


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1st Choice

,nd choice

-etronidazole followed

by

diloanide f#roate

or

tinidazole followed by

diloanide f#roate

dehyderoemetine followed by

diloanide f#roate

/0200 m!.t.i.d

3 10 days

00 m! t.i.d. 310

Days

,!4day 3 5 days

00 m! t.i.d 3 10

Days

11. m! 6!1 day 1

7ma.90 m!4day 8 i." 3 days

00 m! t.i.d 3 10 days.

TREATMENT


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(ormal $ndications

To rule out a pyogenic abscess #< particularly !ith

multiple lesions $ "s ad?unct to medical therapy # Co response after D0 hours $

f rupture is believed to be imminent

"bscess in the left lobe !here the risk of rupture is increased.

ossible $ndications

To reduce the period of disability

INDICATIONS FOR ASPIRATION OF AMOEBIC

LIVER ABSCESS


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Ivory or creamy white pus.


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Brown coloured pus compared toanchovy sauce.


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ASCARIASIS

A COMMON ROUND ORM DISEASE


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INTRODUCTION

• Ascaris lumbricoides is the

lar!est nematode

(round0orm) parasitiin! the

human intestine.

• $s"aris lumbri"oides is an

intestinal 0orm ,ound in the

small intestine o, man.

• 8hey are more "ommon in

"hildren then in adult.• $s many as 9** to 9***

adult 0orms may inhabit a

sin!le host.


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The Egg of Ascaris


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LIFE CYCLE


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S!"pto"s of Ascariasis

• No s!"pto"s

• Sta!e 1A 0orm larvae in the bo0els atta"h to bo0el 0alls• Sta!e 2A 0orm larvae mi!rate into the lun!sA• Fever and breathin! di,,i"ulty• 6ou!hin! and pneumonia• Sta!e #A 0orms enter the small intestine and mature into 0orms

and remain there to ,eed• A#do"inal s!"pto"s • $bdominal dis"om,ort• 4ntestinal blo"


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Treatment

• 4n,e"tions 0ith A.lumbricoides are easily treated

0ith a number o, $nthelminti" dru!sA

• Pyrantel pamoate !iven as a sin!le dose o, 1*

m!@

• Mebendaole !iven as a sin!le dose o, 9** m!.

• $lbendaole !iven as a sin!le dose o, &** m!.


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PREVENTION

• Ceepin! !ood sanitation "onditions is the only 0ay to

prevent the in,e"tion o, $s"aris.

• Pollution o, soil 0ith human ,ae"es should be avoided.

•e!etable should be thorou!hly 0ashed in a mildsolution o, Pottasium perman!anate and properly

"oo


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L!"phatic $ilariasis


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L!"phatic $ilariasis 4n,e"tion 0ith # "losely related ematodes

; Wuchereria bancrofti

; Brugia malayi

; Brugia timori

D 8ransmitted by the bite o, in,e"ted mos7uitoresponsible ,or "onsiderable su,,erin!s@de,ormity and

disability

D $ll the parasites have similar li,e "y"le in man

D $dults seen in Bymphati" vesselsD E,,sprin!s seen in peripheral blood durin! ni!ht


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Disease Manifestation

%isease mani,estation ran!e ,rom ; one

; $"uteFilarial ,ever

; 6hroni"Bymphan!itis- Bymphadenitis-

lephantiasis o, !enitals@le!s@arms

; 8ropi"al Pulmonary osinophilia (8P)

; Filarial arthritis

; pididimoor"hitis

; 6hyluria


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Bymphati" Filariasis

%ia!nosti" Methods


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Diagnosis of L!"phatic

$ilariasis

• Bymphati" Filariasis "an be dia!nosed "lini"allyand throu!h laboratory te"hni7ues.

• 6lini"ally- dia!nosis "an be made on"ir"umstantial eviden"e 0ith support ,romantibody or other laboratory assays as most o,the BF patients are ami"ro,ilaraemi" and in the

absen"e o, serolo!i"al tests 0hi"h is notspe"i,i" other than 6F$ (468). 4n 8P- serumantibodies li


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La#orator! Diagnosis

%& De"onstration of "icrofilarae in theperipheral #lood

a. Thic' #lood s"ear( 2# drops o, ,ree ,lo0in!

blood by ,in!er pri"< method- stained 0ith GS'44b. Me"#rane filtration "ethod( 12 mlintravenous blood ,iltered throu!h #Hm pore siemembrane ,ilter

". DEC pro)ocati)e test *+"g,-g.( $,ter"onsumin! %6- m, enters into the peripheralblood in day time 0ithin #* &9 minutes.


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+& I""uno Chro"atographic Test *ICT.(

$nti!en dete"tion assay "an be done by 6ardtest and throu!h B4S$. 6ir"ulatin! Filarial

$nti!en dete"tion is re!arded as I3old StandardJ

,or dia!nosin! Wuchereria bancrofti in,e"tion.Spe"i,i"ity is near "omplete- sensitivity is !reaterthan all other parasite dete"tion assays- 0illdete"t anti!en in ami"ro,ilaraemi" as 0ell as 0ith

"lini"al mani,estations li


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/& 0uantitati)e Blood Count *0BC.(K'6 0ill identi,y the mi"ro,ilariae and 0ill help in studyin!

the morpholo!y. 8hou!h 7ui"< it is not sensitive than blood

smear examination.

1& Ultrasonograph!( Lltrasono!raphy usin! a =.9 M5 or 1* M5 probe "an

lo"ate and visualie the movements o, livin! adult 0orms

o, W.b. in the s"rotal lymphati"s o, asymptomati" males0ith mi"ro,ilaraemia. 8he "onstant thrashin! movements

des"ribed as IFilaria dan"e si!nJ "an be visualied.


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2& L!"phoscintigraph!(Stru"ture and ,un"tion o, the lymphati"s o, the involvedlimbs "an be assessed by lymphos"inti!raphy a,terine"tin! radiolabelled albumin or dextran in the 0ebspa"e o, the toes. 8he stru"tural "han!es "an be ima!ed

usin! a 3amma "amera. Bymphati" dilation obstru"tion"an be dire"tly demonstrated even in early "lini"allyasymptomati" sta!e o, the disease.

3& 45ra! Diagnosis(

Nray are help,ul in the dia!nosis o, 8ropi"al pulmonaryeosinophilia.

Pi"ture 0ill sho0 interstial thi"


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Bymphati" Filariasis

6lini"al Mani,estations


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Clinical Manifestations

• Mani,estations are 2 types

%& L!"phatic $ilariasis (Presen"e o, $dult

0orms)+& Occult $ilariasis (4mmuno hyper

responsiveness)


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Stages in L!"phatic

$ilariasis

• 8here are & sta!es A

1. $symptomati" $mi"ro,ilariaemi" sta!e

2. $symptomati" Mi"ro,ilariaemi" sta!e

#. Sta!e o, $"ute mani,estation

&. Sta!e o, Ebstru"tive (6hroni") lesions


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L!"phatic $ilariasisManage"ent


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Manage"ent of L!"phatic

$ilariasis

1. 8reatin! the in,e"tion

2. 8reatment and prevention o, $"ute $%B

atta"


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• Treating the infection(

emar


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Che"otherap! of $ilariasis

%ru!s e,,e"tive a!ainst ,ilarial parasites1. %iethyl 6arbomaine "itrate (%6)

2. 4verme"tin

#. $lbendaole &. 6ouramin "ompound

8reatment o, mi"ro,ilaraemi" patients may

prevent "hroni" obstru"tive disease andmay be repeated every > months till m,and@or symptoms disappears.


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Surgical Treat"ent

• 7!droceleA x"ision

• Scrotal ElipA Sur!i"al removal o, S


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Echinococcus granulosus

- h l


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-orpholo!y

Enly 2? mm lon!

Lsually "omprises o,

S"olexA 0ith ,our su"


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• 7!datid C!st(

; ound "ysti"

; Wall – "uti"le layer- !erminal layer

; 6ontents

• "ysti" ,luid- brood "apsules- protos"olex- dau!hter

!rand dau!hter "ysts (hydatid sands)


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5ydatid "yst

Daughter c!st

8randdaugher c!st

9rotoscole:

Brood capsule

Cuticle la!er

8er"inal la!er

Brood capsule


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ydatid cyst


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• Cause Hydatid Disease *7!datidosis.• Sites o, hydatid "ystA liver- lun!s-

abdominal "avity- spleen-


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Clinical "enifestations

• Depends on the si@e; the location and thenu"#er of c!st& ; 9ressure by tremendous sie o, the "yst. results in

dis,un"tion o, liver- lun! or nervous system

; Allerg! 5due to rupture o, "yst- may "ause severealler!i" rea"tion

; Regeneration due to rupture o, "yst- intra"ysti"protos"olex or !erminal layer may be transplantedand result in multiple secondar! infection

Secondar! regeneration 2&/? ; To:icosis by se"retion o, 0orm


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• Serolo!i"al examination ,or spe"i,i" $b or

6a!.• 4ntradermal (6asoni) test 0ith hydatid ,luid is

use,ul.

• $ntibodies a!ainst hydatid ,luid anti!enshave been dete"ted in a siable populationo, in,e"ted individuals by B4S$ or indire"thema!!lutination test.


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B5ultrasound; li)er CT; #rain

CT; li)er 45ra!; lung


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Control and treat"ent• Regular treat"ent of infected dogs to reduce or"

load&• 9re)ention of dogs fro" eating infected offals of

do"estic ani"als*sheep;etc. in the ende"ic areas&

• 7ealth education and strict personal h!giene&

• A)oidance of unnecessar! contact ith infecteddogs&

• Surger! is still re"ains the "ainsta! of thetreat"ent of h!datid disease&

• Al#enda@ole ha)e pro)ed to #e effecti)e againsth!datid c!st*for "edian or s"all si@e c!sts.&


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ameb, ascar, fil, hydatid lecture.ppt

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