Amebic Colitis and the Surgeon

Abstract

Amoebiasis is a disease of public health importance in developing countries like India. The disease is caused by Entamoeba histolytica. In India, the recorded incidence including the non-pathogenic Entamoeba dispar is 2–55%. Asymptomatic colonization by Entamoeba histolytica accounts for nearly 90% of all cases of intestinal amebiasis. Acute amebic colitis is the commonest manifestation reported in 95% of patients with symptomatic amebiasis. Fulminant necrotizing colitis (FNC) accounts for 0.5–11% of patients with symptomatic amebiasis. Examination of at least three stool samples on three separate days is required to achieve a detection rate of 85–95%. The sensitivity and specificity of monoclonal antibody–based ELISA for detection of E. histolytica-specific antigen in stool specimen is 85% and 90% respectively. Treatment of invasive amebiasis should be started with metronidazole. Current recommendations favour resection ranging from segmental excision to subtotal or total colectomy depending on the extent of colonic involvement. Simple closure of perforation is deemed to fail and not recommended.

This is a preview of subscription content, access via your institution.

References

  1. 1.

    Stanley SL (2003) Amoebiasis. Lancet 361:1025–1034

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  2. 2.

    Parija SC (2006) Amebae, intestinal amebae, pathogenic free-living amebae. In: Parija SC (ed) Text book of medical parasitology. All India publishers, Chennai, pp 29–64

    Google Scholar 

  3. 3.

    World Health Organization (1997) Amoebiasis. Wkly Epidemiol Rec 72:97–99

    Google Scholar 

  4. 4.

    Petri WA Jr, Haque R, Lyerly D, Vines RR (2000) Estimating the impact of amebiasis on health. Parasitol Today 16:320–321

    PubMed  Article  Google Scholar 

  5. 5.

    Mercado R, Otto JP, Musleh M, Perez M (1997) Human infection by intestinal protozoa and helminths in Calbuco Country, X Region, Chile. Bol Chil Parasitol 52:36–38

    CAS  PubMed  PubMed Central  Google Scholar 

  6. 6.

    Miranda RA, Xavier FB, Menezes RC (1998) Intestinal parasitism in a Parakana indigenous community in south western Para State, Brazil. Cad Saude Publica 14:507–511

    CAS  PubMed  Article  Google Scholar 

  7. 7.

    Braga LL, Mendonca Y, Paiva CA (1998) Seropositivity for and intestinal colonization with Entamoeba histolytica and Entamoeba Dispar in individuals in northeastern Brazil. J Clin Microbiol 36:3044–3045

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  8. 8.

    Roche J, Benito A (1999) Prevalence of intestinal parasite infections with special reference to Entamoeba histolytica on the island of Bioko (Equatorial Guinea). Am J Trop Med Hyg 60:257–262

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  9. 9.

    Magambo J, Zeyhle E, Wachira T (1998) Prevalence of intestinal parasites among children in southern Sudan. East Afr Med J 75:288–290

    CAS  PubMed  PubMed Central  Google Scholar 

  10. 10.

    Haque R, Ali IKM, Petri WA Jr (1999) Prevalence and immune response to Entamoeba histolytica infection in preschool children in Bangladesh. Am J Trop Med Hyg 60:1031–1034

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  11. 11.

    Mahajan RC, Sehgal R, Ganguly NK (1991) Recent developments in amoebiasis research. Indian Rev Life Sci 11:139–167

    Google Scholar 

  12. 12.

    Shetty N, Narasimha M, Eliott E, Raj IS, Macaden R (1992) Age-specific seroprevalence of amoebiasis and giardiasis in southern Indian infants and children. J Trop Pediatr 38:57–63

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  13. 13.

    Barwick RS, Uzicanin A, Lareau S, et al. (1998) Outbreak of amebiasis in Tbilisi, Republic of Georgia. In: Program and abstracts of the Annual Meeting of the American Society of Tropical Medicine and Hygiene; Washington, DC

  14. 14.

    Petri WA Jr, Mann BJ, Haque R (2002) The bittersweet interface of parasite and host: lectin-carbohydrate interactions during human invasion by the parasite Entamoeba histolytica. Annu Rev Microbiol 56:39–64

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  15. 15.

    Li E, Samuel L, Stanley Jr (2009) Parasitic diseases: Protozoa. In: Yamada T (ed) Text book of gastroenterology, 5th edn. Wiley-Blackwell, West Sussex, pp 2632–2650

    Google Scholar 

  16. 16.

    Ozer M, Erqul E, Donmez C, Sisman IC, Ulger BV, Kusdemir A (2009) Amebic perforation of small bowel, an unexpected localization of fatal complication. Bratisl Lek Listy 110:59–60

    PubMed  PubMed Central  Google Scholar 

  17. 17.

    Wanke C, Butler T, Islam M (1988) Epidemiologic and clinical features of invasive amebiasis in Bangladesh: a case control comparison with other diarrheal diseases and postmortem findings. Am J Trop Med Hyg 38:335–334

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  18. 18.

    Haque R, Huston CD, Hughes M, Houpt E, Petri WA (2003) Amebiasis. N Engl J Med 348:1565–1573

    PubMed  Article  PubMed Central  Google Scholar 

  19. 19.

    Cardoso JM, Kimura K, Stoopen M, Cervantes LF, Elizondo L, Churchill R (1977) Radiology of invasive amebiasis of the colon. Am J Roentgenol 128:935–941

    CAS  Article  Google Scholar 

  20. 20.

    Pelaez M, Villazon A, Sieres ZR (1966) Amebic perforation of the colon. Dis Colon Rectum 9:356–362

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  21. 21.

    Takahashi T, Gamboa-Dominguez A, Gomez-Mendez TJ, Remes JM, Rembis V, Martinez-Gonzalez D et al (1997) Fulminant amebic colitis: analysis of 55 cases. Dis Colon Rectum 40:1362–1367

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  22. 22.

    Wig JD, Talwar BL, Bushnurmath SR (1988) Toxic dilatation complicating fulminant amebic colitis. Br J Surg 75:713–716

    Article  Google Scholar 

  23. 23.

    Aristizabal AJ, Botero M (1991) Fulminant amebic colitis. World J Surg 15:216–221

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  24. 24.

    Chen HT, Hsu YH, Chang YZ (2004) Fulminant amebic colitis: recommended treatment to improve survival. Tzu Chi Med J 16:1–8

    Google Scholar 

  25. 25.

    Brooks JL, Kozarek RM (1985) Amebic colitis. Preventing morbidity and mortality form fulminant disease. Postgrad Med 78:267–274

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  26. 26.

    Gupta SS, Singh O, Shukla S, Raj MK (2009) Acute fulminant necrotizing amoebic colitis: a rare and fatal complication of amoebiasis: a case report. Cases J 2:6557

    PubMed  PubMed Central  Article  Google Scholar 

  27. 27.

    Lysy J, Zimmerman J, Sherman Y, Feigin R, Ligumsky M (1991) Crohn’s colitis complicated by superimposed invasive amebic colitis. Am J Gastroenterol 86:1063–1065

    CAS  PubMed  PubMed Central  Google Scholar 

  28. 28.

    Barker EM (1958) Colonic perforations in amebiasis. S Afr Med J 32:634–638

    CAS  PubMed  PubMed Central  Google Scholar 

  29. 29.

    Ozdogan M, Baykai A, Aran O (2004) Amebic perforation of colon: rare and frequently fatal complication. World J Surg 28:926–929

    PubMed  Article  PubMed Central  Google Scholar 

  30. 30.

    Stein D, Bank S, Louw JH (1979) Fulminating amoebic colitis. Surgery 85:349–352

    CAS  PubMed  Google Scholar 

  31. 31.

    Misra SP, Misra V, Dwivedi M (2006) Ileocecal masses in patients with amebic liver abscess: etiology and management. World J Gastroenterol 12:1933–1936

    PubMed  PubMed Central  Article  Google Scholar 

  32. 32.

    Hardin RE, Ferzli GS, Zenilman ME, Gadangi PK, Bowne WB (2007) Invasive amebiasis and ameboma formation presenting as a rectal mass: an uncommon case of malignant masquerade at a western medical center. World J Gastroenterol 13:5659–5661

    PubMed  PubMed Central  Article  Google Scholar 

  33. 33.

    Ooi BS, Seow-Choen F (2003) Endoscopic view of rectal amebiasis mimicking a carcinoma. Tech Coloproctol 7:51–53

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  34. 34.

    Manzano C, Torres G (1970) Amebiasis invasora del colon en ninos. Rev Mex Radiol 24:335–360

    Google Scholar 

  35. 35.

    Akbulut S, Tas M, Sogutcu N, Arikanoglu Z, Basbug M, Ulku A, Semur H, Yagmur Y (2011) Unusual histopathological findings in appendectomy. World J Gastroenterol 17:1961–1970

    PubMed  PubMed Central  Article  Google Scholar 

  36. 36.

    Singh NG, Mannan AA, Kahvic M (2010) Acute amebic appendicitis: report of a rare case. Indian J Pathol Microbiol 53:767–768

    PubMed  Article  PubMed Central  Google Scholar 

  37. 37.

    Andrade JE, Mederos R, Rivero H, Sendzischew MA, Soaita M, Robinson MJ, Sendzischew H, Danielpour P (2007) Amebiasis presenting as acute appendicitis. South Med J 100:1140–1142

    PubMed  Article  PubMed Central  Google Scholar 

  38. 38.

    Guzmán-Valdivia G (2006) Acute amebic appendicitis. World J Surg 30:1038–1042

    PubMed  Article  PubMed Central  Google Scholar 

  39. 39.

    Zardawi IM, Kattampallil JS, Rode JW (2003) Amoebic appendicitis. Med J Aust 178:523–524

    PubMed  Article  PubMed Central  Google Scholar 

  40. 40.

    Parija SC (2010) Progress in the research on diagnosis and vaccines in amebiasis. Trop Parasitol 1:4–8

    Article  Google Scholar 

  41. 41.

    Haque R, Ali IKM, Akhter S, Petri WA Jr (1998) Comparison of PCR, isoenzyme analysis, and antigen detection for diagnosis of Entamoeba histolytica infection. J Clin Microbiol 36:449–452

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  42. 42.

    Haque R, Mollah NU, Ali IKM, Alam K, Eubanks A, Lyerly D, Petri WA Jr (2000) Diagnosis of amebic liver abscess and intestinal infection with the Tech-Lab Entamoeba histolytica II antigen detection and antibody tests. J Clin Microbiol 38:3235–3239

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  43. 43.

    Blumencranz H, Kusen L, Romeu J et al (1983) The role of endoscopy in suspected amebiasis. J Gastroenterol 78:15

    CAS  Google Scholar 

  44. 44.

    Chun D, Chandrasoma P, Kiyabu M (1994) Fulminant amebic colitis: a morphological study of four cases. Dis Colon Rectum 37:535–539

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  45. 45.

    Matsui T, Iida M, Tada S, Fuchigami T, Iwashita A, Sakamoto K, Fujishima M (1989) The value of double contrast barium enema in amebic colitis. Gastrointest Radiol 14:73–78

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  46. 46.

    Bansal D, Nancy M, Mahajan RC (2006) Drug resistance in amebiasis. Indian J Med Res 123:115–118

    CAS  PubMed  PubMed Central  Google Scholar 

  47. 47.

    Athié-Gutiérrez C, Rodea-Rosas H, Guízar-Bermúdez C, Alcántara A, Montalvo-Javé E (2010) Evolution of surgical treatment of amebiasis-associated colon perforation. J Gastrointest Surg 14:82–87

    PubMed  Article  PubMed Central  Google Scholar 

  48. 48.

    Khan MA, Verma GR, Lokesh HM (2010) Fulminant amebic colitis with lower GI bleed with liver abscess. Int J Color Dis 25:535–537

    Article  Google Scholar 

  49. 49.

    Eggleston FC, Verghese M, Handa AK (1978) Amoebic perforation of the bowel: experiences with 26 cases. Br J Surg 65:748–751

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  50. 50.

    Luvuno FM (1979) Role of Intraoperative prograde colonic lavage and decompressive loop ileostomy in the management of transmural amoebic colitis. Br J Surg 66:630–632

    Article  Google Scholar 

  51. 51.

    Singh B, Moodley J, Ramdial PK (2001) Fulminant amebic colitis: a favourable outcome. Int Surg 86:77–81

    CAS  PubMed  PubMed Central  Google Scholar 

  52. 52.

    Dhawan KV et al Amebiasis clinical presentation. https://emedicine.medscape.com/article/212029-clinical#b1

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Mohammad Ibrarullah.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Ibrarullah, M., Bruno, W.H. Amebic Colitis and the Surgeon. Indian J Surg (2021). https://doi.org/10.1007/s12262-021-02723-3

Download citation

Keywords

  • Amebiasis
  • Amebic colitis
  • Necrotizing colitis
  • Colectomy