Intestinal amebiasis in a group of patients with ulcerative colitis: influence on clinical course of the disease

Fulminant Amebic Colitis after Corticosteroid Therapy: A Systematic Review

BACKGROUND

Amebic colitis, caused by intestinal infection with the parasite, Entamoeba histolytica, is a common cause of diarrhea worldwide. Fulminant amebic colitis is the most devastating complication of this infection, associated with both high mortality and morbidity. We conducted a review of the English literature to describe cases of fulminant amebic colitis associated with exposure to corticosteroid medications in order to identify the risk factors for poor outcome and determine difficulties in diagnosis and treatment.

METHODOLOGY AND PRINCIPAL FINDINGS

Articles reporting severe and fulminant forms of amebic colitis between 1991 and 2016 were collected. 525 records were screened to identify 24 cases for qualitative analysis associated with corticosteroid use. Cases arose from areas of high endemicity or travel to such areas. Most cases (14 of 24, 58%) were given corticosteroids for initially misdiagnosed colitis, mainly inflammatory bowel, resulting in rapid progression of disease. Nearly half of all cases underwent surgical intervention, and 25% of cases died, despite all patients eventually receiving treatment with metronidazole. The odds of death did not differ significantly by prior misdiagnosis, co-morbidities, bowel perforation or need for surgery.

CONCLUSIONS AND SIGNIFICANCE

Infection with E. histolytica should be considered prior to the administration of corticosteroids, in particular for patients residing in endemic areas or those with appropriate travel history, especially prior to the diagnosis of inflammatory bowel disease. The development of preventative and treatment interventions are needed to improve outcomes of fulminant disease.

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.