Clinical manifestations and endoscopic findings of amebic colitis in a United States-Mexico border city: a case series.

BACKGROUND: Invasive amebiasis is not frequently seen in the United States. It is associated with considerable morbidity in patients residing in or traveling to endemic areas. We report a case series of patients with amebic colitis in a United States-Mexico border city to alert physicians to the varied clinical manifestations. CASE PRESENTATION: Nine patients were diagnosed with amebic colitis. Mean age was 56 (38-83), 6 were males, and all were Hispanic. Common symptoms were diarrhea (56 %), hematochezia (33 %) and abdominal bloating (11 %). The diagnosis of amebic colitis was established in the following ways: 8 patients by colonoscopy with biopsy, 1 by surgery for colonic obstruction. The diagnosis of amebic colitis was confirmed in 8 patients (89 %) by amebic trophozoites present in histopathologic sections. One patient was diagnosed with amebic colitis based upon clinical symptoms, colitis on colonoscopy and visualization of amebic trophozoites on stool examination. In the 8 patients in whom colonoscopy was done, 6 (75 %) had inflammation with rectosigmoid involvement and 5 (62.5 %) had ulcerations. Infection resolved after treatment with metronidazole in most patients; however, one patient developed a liver abscess and another had a colonic perforation and later developed a liver abscess. CONCLUSION: The occurrence of amebic colitis in this United States-Mexico border city hospital population was low, but in some cases potentially life-threatening. Physicians should be alert to the less common presentations of amebic colitis, such as overt gastrointestinal bleeding, exacerbation of inflammatory bowel disease, and the incidental finding of association with colon cancer, or a surgical abdomen. Rectosigmoid involvement was typically found on colonoscopy.

Amoebic liver abscess in USA: a population-based study of incidence, temporal trends and mortality.

BACKGROUND: Amoebic liver abscess (ALA) may be associated with significant morbidity and mortality, but nationwide American data is unavailable. Our objective was to describe ALA epidemiology and outcomes in USA from a population-based perspective. METHODS: Patients hospitalized with ALA between 1993 and 2007 were identified using the Nationwide Inpatient Sample. Patient characteristics, interventions and outcomes including mortality were determined. The annual incidence of ALA and temporal trends were determined using the negative binomial regression models. RESULTS: Between 1993 and 2007, 848 hospitalizations for ALA, corresponding to ∼4100 hospitalizations nationwide, were identified. The annual incidence was 1.38 per million population with a 2.4% [95% confidence interval (CI) 0-4.8%; P=0.06] average annual decline during this study. Most patients were hospitalized in western (54%) and southern states (27%), and 48% were Hispanic. Males (incidence rate ratio vs. females: 4.53; 95% CI 4.19-4.90) had the highest incidence rates. Percutaneous and surgical drainage was required in 48 and 7% of patients respectively. Although length of stay [median, 6 days; interquartile range (IQR) 4-10] and hospital charges (US$25,345; IQR US$15,030-42, 275) were substantial, in-hospital mortality was rare (0.8%). Females [odds ratio (OR) 6.12; CI 1.39-26.8], patients ≥ 60 years (OR 13.3; 95% CI 2.5-71.5), and those with ≥ 3 comorbidities (OR 5.80; 95% CI 1.30-25.8), particularly malnutrition, had an increased risk of death. CONCLUSIONS: ALA is rare and the incidence has decreased in USA. Young, Hispanic males in southwestern states are most frequently affected. Mortality caused by ALA is lower than what was reported previously.

A ten year (1999-2008) retrospective study of amoebiasis in University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia.

This is a ten year (1999-2008) retrospective study of amebiasis in patients admitted to UMMC. A total of 34 cases were analyzed. The most common were amebic liver abscess 22(65%) and the rest were amoebic dysentery 12(35%). Majority of the cases occurred among Malaysians 29(85%), with Chinese 14(41%), followed by the Malays 9(26%) and the Indians 6(18%). Foreigners made up of one Indonesian, one Pakistani and three Myanmarese and constituted 5(15%) of the total cases. Males 24(71%) were more commonly affected. Most of the cases occurred between the age group of 40-49 years, 8(23%) and 60 years and above, 8(23%). Age group of 20-50 years constituted 20(60%) of the cases. The most common clinical presentations were fever with chills and rigors 26(76%), diarrhoea 20 (59%), right hypochondrium pain 17(50%), abdominal pain 17(50%), hepatomegaly 16 (47%) and jaundice 7(20%). All were discharged well after treatment except for one case of death in a 69-year-old Chinese male with amebic liver abscess.

Common presentations of amebic liver abscess.

STUDY OBJECTIVE: The most common extraintestinal manifestation of Entamoeba histolytica, the agent of amebiasis, is a hepatic abscess. This infection is common throughout the world and can be associated with life-threatening consequences. Given the often nonspecific nature of the complaints related to an amebic abscess, a retrospective review of patients with confirmed disease was done to recognize the most common patterns of presentation. METHODS: A retrospective case series was conducted of all patients with confirmed amebic liver abscess over a 5-year period. All available emergency department and inpatient records were reviewed. Age, sex, country of origin, chief complaint (including duration), vital signs, and physical and laboratory findings were recorded. The use of ultrasonography, computed tomography scan, chest radiograph, and serum antibodies was noted, as well as the final ED diagnosis. RESULTS: Seventy-five patients were reviewed; mean patient age was 35.5 years, 80% were male, and Mexico was the country of origin for 64%. The most common complaint was fever (77%), followed by abdominal pain (72%), which was most often located in the right upper quadrant. Cough (16%), chest pain (19%), and chest radiographic abnormalities (57%) were also common. The majority of patients (69%) had symptoms for less than 13 days. The WBC count was the most consistent laboratory abnormality (83%), whereas the liver aminotransferase, alkaline phosphatase, and bilirubin levels were often normal. Most patients received their diagnoses on the basis of ultrasonography (85%), followed by a confirmatory serum antibody titer (88%). The diagnosis of amebic liver abscess was correctly made in the ED in 31.5% of the patients, with the most common misdiagnoses being cholecystitis (16.4%), hepatitis (12.3%), and pneumonia (9.6%). CONCLUSION: Patients with amebic liver abscess do present to EDs in the southwestern United States, especially in areas with a high immigrant population from endemic areas. Patients with complaints of fever and right upper quadrant abdominal pain, especially men of Hispanic origin, warrant a high degree of vigilance. Whereas most laboratory studies are unhelpful, the diagnosis can often be made in the ED by means of a bedside ultrasonographic test. Treatment should be initiated with metronidazole with disposition to an inpatient medical service.

Hepatic amebiasis among patients in a public teaching hospital.

The increase in immigration to the United States is associated with diseases, such as amebiasis, that are endemic to developing countries. We retrospectively reviewed 49 public-hospital patients with hepatic amebiasis occurring between 1985 and 1995. Most patients were immigrants (47) from Latin America (43), male (43), and young (mean age, 39.8 years). Symptoms noted by more than half were abdominal pain and fever. Ultrasonography showed single lesions in 70% and right-sided involvement in 85%. Serologies against Entamoeba histolytica were noted in 86%. After treatment, the median interval from admission to defervescence was 2 days, to normalization of white cell count 3 days, and to resolution of abdominal pain 4 days. Morbidity (one case of pericarditis) and mortality (one death in a cirrhotic man) were low. Hepatic amebiasis continues to be diagnosed in the United States, primarily among Hispanic and Asian immigrants. When appropriately considered, current diagnostic and therapeutic modalities result in rapid improvement and excellent outcome.

[Amebic liver abscess and amebic colitis in a couple]. / Absceso amebiano hepático y colitis amebiana en una pareja.

Amebiasis is a disease commonly extended all around the world, its prevalence depending on the population under study. In Spain, most cases published are of exotic acquisition. We present the case of a married couple from Venezuela presenting two different forms of invasive amebiasis: acute colitis and hepatic abscess. In our environment, once the diagnosis of amebiasis is established, a close follow-up of the patients must be made, including the evaluation of the closest contacts. Regarding the treatment, we think that the asymptomatic forms must be treated with a luminal amebicidal and the symptomatic forms, with hystic amebicidal followed by luminal amebicidal.