Manila Central Universit

NCM - 102
Communicable diseases

AMOEBIASIS
( AMOEBIC DYSENTERY )
 AMOEBIASIS
( AMOEBIC DYSENTERY )
Entamoeba Histolytica
Prevalent in unsanitary areas
Common in warm climate
Acquired by swallowing
Cyst survives a few days
outside the body
Cyst passes to the large
intestine
and hatches into
trophozoites.
It passes into the
mesenteric veins
to the portal vein , to the
liver,
Etiologic Agent :
Entamoeba Histolytica
 Entamoeba Histolytica
Two developmental stages:

Trophozoites /
Vegetative Form
-Trophozoites are
facultative parasites that
may be found in the
parasitized tissues and
liquid colonic contents.
 Entamoeba Histolytica
Two developmental stages:
Cyst
-Cyst is passed out with
formed or semi formed
stools and are resistant to
environmental
conditions.
- This is considered as the
infective stage in the
life cycle of E.
Histolytica.
 PATHOLOGY :
When the cyst is swallowed,
it passes through the stomach
unharmed and shows no
activities while in an acidic
environment.

When it reaches the

alkaline medium of the
intestine, the metacystbegin
to move within the cyst wall ,
which rapidly weakens and
tears.
 The quadrinucleateamoeba
emerges and divides into
amebulas that are swept down into
the cecum.

This is the first opportunity

of the organism to colonize, and
its success depends on one or
more metacystic trophozoites
making contact with the mucosa.

Mature cyst in the large

intestines leaves the host in
great numbers
(the host remains asymptomatic ).
 The cyst remain viable and
infective in moist and cool
environment for atleast 12 days,
and in water for 30 days.

The cyst are resistant to

levels of chlorine normally used
for water purification.

They are rapidly killed by

purification, desiccation and
temperatures below 5 and above 40
degree celcius.
SOURCE :
HUMAN EXCRETA
 INCUBATION PERIOD :
The incubation period in
severe infection is three
days .

in sub-acute and chronic

form it lasts for several
months.

In average cases the

incubation period varies from
three to four weeks .
PERIOD OF
COMMUNICABILITY :
The microorganism is
communicable for the entire
duration of the illness.
MODE OF TRANSMISION :
The disease can be passed
from one person to another
through fecal-oral
transmission.

The disease can be

transmitted through direct
contact, through sexual contact
by orogenital, oroanal, and
proctogenital sexual activity.
 Through indirect contact,
the disease can infect humans
by ingestion of food
especially uncooked leafy
vegetables or foods
contaminated with fecal
materials containing E.
histolica cysts.
üFood or drinks maybe contaminated
by cyst through pollution of
water supplies, exposure to flies,
use of night soil fro
fertilizing vegetables, and
through unhygienic practices of
food handlers.
PATHOGENESIS :
 The metacystic trophozoites
or progenies reaches the cecum
and those that come in contact
with the oral mucosa penetrate
or invade the epithelium by
lytic digestion.

The trophozoitesburrow
deeper with tendency to spread
laterally or continue the
lysis of cells until they
reach the sub-mucosa forming
flash-shape ulcers. There may
be several points of
penetrations.
 From the primary site of
invasion, secondary lesions
maybe produced at the lower
level of the large intestine.

Progenies of initial
colonies are squeezed out to
the lower portion of the bowel
and thus, have the opportunity
to invade and produce
additional ulcers. Eventually
the whole colon maybe involved.
 E. histolytica has been
demonstrated in practically
every soft organ of the body.

Tropozoites which reach the

mascularis mucosa frequently
erode the lymphatics or the
walls of the mesenteric
venules in the floors of the
ulcers and are carried to the
intrahepatic portal vein.
 if thrombi occur in the
small branches of the portal
veins, the tropozoites in the
thrombi cause lytic necrosis
on the wall of the vessels and
digest a pathway into the
lobules.

The colonies increase in

size and develop into abscess.
A typical liver abscess
develops and consists of:
a.Central zone necrosis
b.Medium zone of stroma only
and;
 c. an outer zone of normal
tissue newly invaded by amoeba. Most
amoebic abscess of the liver
are in the right lobe.

Next to the liver, the organ

which is the frequent site of
extra-intestinal amoebiasis is the
lungs. This commonly develops as
an extension of the hepatic
abscess.
CLINICAL
MANIFESTATIONS :
1 . Acute amoebic dysentery

a . Slight attack of diarrhea

altered wit periods of
constipation and often
accompanied by tenesmus
b . Diarrhea, watery and foul-
smelling stool often
containing blood streaked
mucus.
1 . Acute amoebic
dysentery

c . Colic and gaseous

distension in lower
abdomen.
d . Nausea, flatulence,
abdominal distension and
tenderness in the right
iliac region over the
colon.
2 . Chronic amoebic
dysentery

a . Attack of dysentery that

last for several days, usually
succeeded by constipation.
b . Tenesmus accompanied by
desire to defecate.
c . Anorexia, tenesmus and
weakness
d . Liver may be enlarge
CLINICAL FEATURES
OF AMOEBIASIS :
1 . Onset is gradual
2 . Diarrhea increases and
stool becomes bloody and
mucoid
3 . If untreated cases:
Fluid stool severe
bloody - mucoidstool
hemorrhage
Intestinal perforation
peritonitis DEATH
DIAGNOSTIC EXAMS :

1 . Stool exam ( cyst, white

and yellow pus with plenty
of amoeba).
2. Blood exam
3. Proctoscopy /
Sigmoidoscopy
TREATMENT MODALITIES :
1 . Metronidazole (flagyl) 800
mg TID x 5 days
2 . Tetracycline 250 mg every
6 hours
3 . Ampicilin, quinolones,
sulfadiazine
4 . Streptomycin SO4,
clorampenicol
5 . Lost fluid and
electrolytes should be
replaced.
 NURSING MANAGEMENT :
1. Observe isolation and enteric
precaution.
2. Provide health education and
instruct the patient to:
a. Boil water for drinking or
used purified water.
b. Avoid washing of food from
open drum or pail.
c. Cover left over foods
d. Wash hands after defecation or
before eating.
e. Avoid ground vegetables
(lettuce, carrots and etc.)
3. Proper collection of stool
specimen.
a . Never give paraffin or any oil
for at least 48 hours prior to
collection of the specimen.
b . Instruct the patient to avoid
mixing urine and stools.
c . If whole stool cannot be sent
to l aboratory, select as much portion
as possible containing blood and
mucous.
d . Send specimen immediately to
the l aboratory; stool that is not
fresh is nearly useless for
examination.
e . Label specimen properly.
4. Skin care
Cleanliness, freedom from
wrinkles on the sheet
will be helpful with all
the usual precautionary
measures against pressure
sores.
5. Mouth cares
6. Provide optimum comfort
Patient should be kept
warm. Dysenteric patient
should never be allowed to
feel cold, even for a moment.
7. Diet
a . During the acute stage, fluids
should be forced.
b . In the beginning of an attack,
cereal and strained meat broths
without fats should be given.
c . Chicken and fish may be added
when convalescence is established.
d . Bland diet without cellulose
or bulk- producing food should be
maintained for a long time.
COMMON NURSING
DIAGNOSIS :
Altered nutrition: less than
the body requirement
Alteration of bowel
elimination
High risk for infection
Anxiety
Altered body temperature
METHODS OF PREVENTION :
Health education
Sanitary disposal of feces
Protect chlorinate, and
purify drinking water
Observe scrupulous cleanliness
in food preparation and food
handling
Detection and treatment of
carriers
Fly control (it can serve
as a vector)
 GROUP 2
BATCH 2011

AGUILAR , FEVIE MARIE C .

AND
ALFECHE , ELVEN