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Victoria-Hernández JA, Ventura-Saucedo A, López-Morones A, Martínez-Hernández SL, Medina-Rosales MN, Muñoz-Ortega M, Ávila-Blanco ME, Cervantes-García D, Barba-Gallardo LF, Ventura-Juárez J. Case report: multiple and atypical amoebic cerebral abscesses resistant to treatment. BMC Infect Dis 2020; 20:669. [PMID: 32928130 PMCID: PMC7490879 DOI: 10.1186/s12879-020-05391-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 09/02/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The parasite Entamoeba histolytica is the causal agent of amoebiasis, a worldwide emerging disease. Amebic brain abscess is a form of invasive amebiasis that is both rare and frequently lethal. This condition always begins with the infection of the colon by E. histolytica trophozoites, which subsequently travel through the bloodstream to extraintestinal tissues. CASE PRESENTATION We report a case of a 71-year-old female who reported an altered state of consciousness, disorientation, sleepiness and memory loss. She had no history of hepatic or intestinal amoebiasis. A preliminary diagnosis of colloidal vesicular phase neurocysticercosis was made based on nuclear magnetic resonance imaging (NMRI). A postsurgery immunofluorescence study was positive for the 140 kDa fibronectin receptor of E. histolytica, although a serum analysis by ELISA was negative for IgG antibodies against this parasite. A specific E. histolytica 128 bp rRNA gene was identified by PCR in biopsy tissue. The final diagnosis was cerebral amoebiasis. The patient underwent neurosurgery to eliminate amoebic abscesses and was then given a regimen of metronidazole, ceftriaxone and dexamethasone for 4 weeks after the neurosurgery. However, a rapid decline in her condition led to death. CONCLUSIONS The present case of an individual with a rare form of cerebral amoebiasis highlights the importance of performing immunofluorescence, NMRI and PCR if a patient has brain abscess and a poorly defined diagnosis. Moreover, the administration of corticosteroids to such patients can often lead to a rapid decline in their condition.
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Affiliation(s)
- Joaquin Alvaro Victoria-Hernández
- Departamento de Anatomía Patológica, Hospital General de Zona 3 IMSS Jesús María, Prolongación General Ignacio Zaragoza 905, Jesús María, CP 20908 Aguascalientes, AGS Mexico
| | - Anayansi Ventura-Saucedo
- Departamento de Anestesiología, Hospital General de Zona 3 IMSS Jesús María, Prolongación General Ignacio Zaragoza 905, Jesús María, CP 20908 Aguascalientes, AGS Mexico
| | - Aurelio López-Morones
- Departamento de Neurocirugía, Hospital General de Zona 3 IMSS Jesús María, Prolongación General Ignacio Zaragoza 905, Jesús María, CP 20908 Aguascalientes, AGS Mexico
| | - Sandra Luz Martínez-Hernández
- Departamento de Morfología, Centro de Ciencias Básicas, Universidad Autónoma de Aguascalientes, Ed. 202 Av Universidad # 940, Ciudad Universitaria, CP 20131 Aguascalientes, AGS Mexico
| | - Marina Nayeli Medina-Rosales
- Departamento de Morfología, Centro de Ciencias Básicas, Universidad Autónoma de Aguascalientes, Ed. 202 Av Universidad # 940, Ciudad Universitaria, CP 20131 Aguascalientes, AGS Mexico
| | - Martín Muñoz-Ortega
- Departamento de Química, Centro de Ciencias Básicas, Universidad Autónoma de Aguascalientes, CP 20131 Aguascalientes, AGS Mexico
| | - Manuel Enrique Ávila-Blanco
- Departamento de Morfología, Centro de Ciencias Básicas, Universidad Autónoma de Aguascalientes, Ed. 202 Av Universidad # 940, Ciudad Universitaria, CP 20131 Aguascalientes, AGS Mexico
| | - Daniel Cervantes-García
- Departamento de Microbiología, Centro de Ciencias Básicas, Universidad Autónoma de Aguascalientes, CP 20131 Aguascalientes, AGS Mexico
- Consejo Nacional de Ciencia y Tecnología, CONACYT, 03940 Ciudad de México, Mexico
| | - Luis Fernando Barba-Gallardo
- Departamento de Optometría, Centro de Ciencias de la Salud, Universidad Autónoma de Aguascalientes, CP 20131 Aguascalientes, AGS Mexico
| | - Javier Ventura-Juárez
- Departamento de Morfología, Centro de Ciencias Básicas, Universidad Autónoma de Aguascalientes, Ed. 202 Av Universidad # 940, Ciudad Universitaria, CP 20131 Aguascalientes, AGS Mexico
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Petridou C, Al-Badri A, Dua A, Dryden M, Saeed K. Learning points from a case of severe amoebic colitis. Infez Med 2017; 25:281-284. [PMID: 28956549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A case of amoebic colitis and liver abscess is described in a previously fit 59-year old man who had been given the incorrect diagnosis of ulcerative colitis. His symptoms were so severe that a colectomy was being considered. The patient had a significant travel history including trips to Morocco, the Gambia and Cape Verde, putting him at risk of acquiring amoebic disease. However, this history was not ascertained until much later on in the disease process. The case highlighted crucial learning points including the importance of taking a lifelong travel history, the difficulties in telling ulcerative colitis and amoebic colitis apart both clinically and histopathologically, and the importance of sending multiple stool samples for parasitological microscopy analysis in patients being investigated for inflammatory bowel disease.
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MESH Headings
- Colitis, Ulcerative/diagnosis
- Combined Modality Therapy
- Delayed Diagnosis
- Diagnosis, Differential
- Diagnostic Errors
- Drainage
- Dysentery, Amebic/diagnosis
- Dysentery, Amebic/drug therapy
- Dysentery, Amebic/parasitology
- Dysentery, Amebic/pathology
- Entamoeba histolytica/isolation & purification
- Entamoebiasis/diagnosis
- Entamoebiasis/drug therapy
- Entamoebiasis/parasitology
- Entamoebiasis/surgery
- Feces/parasitology
- Humans
- Liver Abscess, Amebic/diagnosis
- Liver Abscess, Amebic/drug therapy
- Liver Abscess, Amebic/surgery
- Male
- Medical History Taking
- Metronidazole/therapeutic use
- Middle Aged
- Parenteral Nutrition, Total
- Paromomycin/therapeutic use
- Travel-Related Illness
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Affiliation(s)
- Christina Petridou
- Microbiology Department, Hampshire Hospitals NHS Foundation Trust, Royal Hampshire County Hospital, Winchester, United Kingdom
| | - Adnan Al-Badri
- Pathology Department, Hampshire Hospitals NHS Foundation Trust, Royal Hampshire County Hospital, United Kingdom
| | - Anjana Dua
- Microbiology Department, Hampshire Hospitals NHS Foundation Trust, Royal Hampshire County Hospital, Winchester, United Kingdom
| | - Matthew Dryden
- Microbiology Department, Hampshire Hospitals NHS Foundation Trust, Royal Hampshire County Hospital, Winchester, United Kingdom
| | - Kordo Saeed
- Microbiology Department, Hampshire Hospitals NHS Foundation Trust, Royal Hampshire County Hospital, Winchester, United Kingdom
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3
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Ding J, Zhou L, Feng M, Yang B, Hu X, Wang H, Cheng X. Case report: Huge amoebic liver abscesses in both lobes. Biosci Trends 2010; 4:201-203. [PMID: 20811141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
We describe the case of a patient who returned to China from Africa and underwent emergency open surgical drainage with evacuation of 600 mL of anchovy sauce-like fluid from hepatic lesions. Computed tomography scans and surgical findings indicated abscesses in both hemilivers and communication between them. Bacteriological investigation of the fluid yielded negative results, but DNA assay of the pus detected 18S rRNA genes of Entamoeba histolytica. Serum anti-amoebic antibodies were detected using an indirect fluorescent-antibody test. Consequently, anti-amoebic drugs were administered and drainage was performed, leading to improvement in the patient's condition. As is evident from this case, an amoebic liver abscess in the left hepatic lobe is rare but treatable.
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Affiliation(s)
- Jia Ding
- Department of Gastroenterology, Shanghai Jing An Qu Central Hospital, Shanghai, China
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4
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Solaymani-Mohammadi S, Coyle CM, Factor SM, Petri WA. Amebic colitis in an antigenically and serologically negative patient: usefulness of a small-subunit ribosomal RNA gene-based polymerase chain reaction in diagnosis. Diagn Microbiol Infect Dis 2008; 62:333-5. [PMID: 18691843 PMCID: PMC2601554 DOI: 10.1016/j.diagmicrobio.2008.06.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2008] [Revised: 06/12/2008] [Accepted: 06/25/2008] [Indexed: 10/21/2022]
Abstract
Specific identification of Entamoeba histolytica in clinical specimens is an essential confirmatory diagnostic step in the management of amebiasis. Here, we report an unusual case of amebic colitis in a 20-year-old female immigrant from South China. The patient had experienced diarrhea, crampy abdominal pain, and fever for approximately 3 weeks prior to admission to hospital and had treated herself at home with metronidazole. On admission, stool microscopy and serology for E. histolytica were negative. Because the clinical findings raised the suspicion of Clostridium difficile fulminant colitis, she underwent a subtotal colectomy. Histopathology revealed flask-shaped ulcers characteristic of amebic colitis. Consequently, E. histolytica DNA was detected by a sensitive small-subunit rRNA polymerase chain reaction (PCR) from feces, and the patient was successfully treated for amebiasis with metronidazole. This case exemplifies the relative insensitivity of serologic tests for the diagnosis of intestinal amebiasis and the difficulties encountered in detecting the parasite antigen in a patient partially treated with metronidazole. We conclude that when the possibility of invasive intestinal amebiasis is suspected, detecting the parasite DNA directly in the stool sample by PCR using E. histolytica-specific primers may be an alternative, noninvasive, and reliable tool for the specific diagnosis of the disease.
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Affiliation(s)
- Shahram Solaymani-Mohammadi
- Division of Intestinal and Genital Protozoal Diseases, Department of Medical Parasitology and Mycology, School of Public Health and Institute of Public Health Research, Tehran University of Medical Sciences, PO Box 14155, Tehran 6446, Iran
- Division of Infectious Diseases and International Health, University of Virginia Health System, MR4 Building, Room 2115, Lane Road, P.O. Box 801340, Charlottesville, VA 22908-1340, USA
| | - Christina M. Coyle
- Division of Infectious Diseases, Department of Medicine, Room 3N21, Jacobi Medical Center, Albert Einstein College of Medicine, 1400 Pelham Parkway South, Bronx, New York 10461, USA
| | - Stephen M. Factor
- Division of Tropical Medicine and Parasitology, Department of Pathology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, USA
| | - William A. Petri
- Division of Infectious Diseases and International Health, University of Virginia Health System, MR4 Building, Room 2115, Lane Road, P.O. Box 801340, Charlottesville, VA 22908-1340, USA
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5
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Ozdoğan M, Küpelioğlu A. Crohn's colitis perforation due to superimposed invasive amebic colitis: a case report. Turk J Gastroenterol 2006; 17:130-2. [PMID: 16830298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
The clinical and microscopic appearances of inflammatory bowel disease may be very similar to those of amebic colitis. The coexistence of invasive amebiasis with inflammatory bowel disease may have disastrous results. Patients with inflammatory bowel disease have a greater prevalence of amebiasis, but this association is more significant for ulcerative colitis. There have been very few reports in the literature presenting the superimposition of amebiasis on Crohn's disease. In this report, a rare case of Crohn's colitis with superimposed amebiasis resulting in colonic perforation is presented. Patients with inflammatory bowel disease traveling to endemic areas may benefit from receiving a course of prophylactic anti-amebic medication.
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Affiliation(s)
- Mehmet Ozdoğan
- Department of General Surgery, Universal Hospital Bodrum, Muğla, Turkey.
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Abstract
Emphysematous pyelonephritis is an uncommon and life-threatening infection of the kidney that is characterized by gas formation within or around the kidney and is associated with diabetes mellitus and urinary tract infection. Amoebiasis is a protozoal infection caused by Entamoeba histolytica. In its invasive forms, the disease is characterized by visceral abscess formations. We present a case of concomitant emphysematous pyelonephritis and renal amoebiasis in a 42-year-old female with uncontrolled diabetes mellitus. The patient did not respond well to initial supportive treatment and antibiotherapy. Therefore, nephrectomy was performed. She did extremely well after the operation and was discharged with antidiabetics and antibiotics.
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Affiliation(s)
- Sezgin Guvel
- Department of Urology, Baskent University, Adana Teaching and Medical Research Center, Adana, Turkey.
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7
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Abstract
We describe the pathology of a unique case of Fallopian tube amebiasis, associated with hydrosalpinx, in a 21-year-old woman. She complained of lower abdominal pain, had a foul-smelling green vaginal discharge and fever during one week. There was a discrete increase in body temperature and a painful abdominal palpation at the lower right side, with signs of local peritoneal irritation. Pathological examination showed a marked dilatation of the fallopian tube and hydrosalpinx. Microscopic examination showed a poorly formed granuloma composed of large macrophages with many Entamoeba histolytica trophozoites inside the fallopian tube. Even though it is a rare disease the correct diagnosis of female genital tract amebiasis is of great importance for the indication of proper therapy.
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Affiliation(s)
- E E Calore
- Emílio Ribas Institute, São Paulo, SP, Brazil.
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Abstract
An unusual late complication to an orbital floor fracture is presented. Five years after trauma a now 22-year old man demonstrated an entamoeba infected cyst in the orbit.
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Affiliation(s)
- J Johansen
- Department of Ophthalmology, Arhus University Hospital, Denmark
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Gironés Vila J, Roig García J, Codina Cazador A, Masvidal Calpe R, García Oria M, Codina Barreras A, Pérez Bueno F. [Low digestive hemorrhage caused by amebic colitis]. Rev Esp Enferm Dig 1996; 88:223-5. [PMID: 8645519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Amebiasis is an infectious disease produced by Entamoeba histolytica, which has invasion capacity of the colon mucosa. It has different clinical forms, varying from the asymptomatic carrier state to severe, although not frequent, fulminant or necrotizing colitis, with an important necrosis of the colon mucosa. Perforation or intestinal bleeding are possible. We report one case of patient who had a history of recent travel to India. Was admitted with a clinical picture of abdominal pain, diarrhea and fever. Initially he received treatment with Metronidazole and steroids, because of doubts in the endoscopy diagnosis of Crohn's Disease versus Amebic Colitis. The patient developed a fulminant colitis, that required emergency surgery because of lower intestinal massive bleeding. During the operation perforations of the caecum and rectum were found. We performed a total colectomy with ileostomy and closing of the stump rectal. Six months later a second operation was made for the reconstruction of the intestinal continuity by an ileal pouch and rectal anastomosis.
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Affiliation(s)
- J Gironés Vila
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Dr. Josep Trueta, Girona
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Kchouk M, Ghedas K, Bouhaouala MH, Larnaout A, Touibi S, Khaldi M, Ben Rachid MS. [Amebic brain abscess. Apropos of a case]. Ann Radiol (Paris) 1993; 36:332-335. [PMID: 8239477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
We report a case of double primary amoebic brain abscess in a 22 year old man, with signs of intracranial hypertension and deficit. Computed tomography found two hypodense lesions, not suggestive of pyogenic abscesses. Aspiration of one of the two abscesses, revealed the organism, and the two abscesses regressed in response to medical treatment. The authors insist on the rarity of these abscesses, their gravity, and the difficulty of the diagnosis.
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Affiliation(s)
- M Kchouk
- Service de Neuroradiologie, Institut National de Neurologie, La Rabta, Tunis, Tunisie
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11
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Herrera Fernández FA, Sarmiento Robles C, Blasco Carratalá F, Muñoz Espejo J, Plaza Moreno F. [Acute, non-lithiasic, amebic cholecystitis]. Rev Esp Enferm Dig 1990; 78:41-2. [PMID: 2257193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The estimated percentage of non calculous cholecystitis is 2-14%. In most cases it is difficult to identify the cause and in very few cases it is possible to establish the etiology. Few cases are secondary to bacterial infections and the cause is very rarely a parasitic infection. We present a case of acute cholecystitis secondary to Entamoeba histolytica infection; the frequency, etiopathogenic mechanism and treatment are discussed.
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Affiliation(s)
- F A Herrera Fernández
- Servicio de Cirugía General y Apárato Digestivo, Hospital de la Cruz Roja e Insalud, Ceuta
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12
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Nadler S, Cappell MS, Bhatt B, Matano S, Kure K. Appendiceal infection by Entamoeba histolytica and Strongyloides stercoralis presenting like acute appendicitis. Dig Dis Sci 1990; 35:603-8. [PMID: 2185002 DOI: 10.1007/bf01540408] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A 58-year-old male from Puerto Rico who was taking orally administered cortisone analogs for chronic obstructive pulmonary disease presented with fever, absolute eosinophilia, right lower quadrant pain, and rebound tenderness associated with Strongyloides stercoralis infection of the appendix. A 37-year-old alcoholic male developed fever, right lower quadrant abdominal pain, and rebound tenderness because of infection of the appendix with Entamoeba histolytica. These are the seventh reported case of isolated amebic appendicitis and the ninth reported case of appendiceal involvement with Strongyloides. In all these cases the diagnosis was made only after surgery. Patients with unexplained right lower quadrant pain, particularly if immunosuppressed or with an appropriate travel history, should have stool examinations for ova and parasites. Early diagnosis and treatment may prevent life-threatening complications such as perforation and peritonitis.
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Affiliation(s)
- S Nadler
- Department of Medicine, Robert Wood Johnson, Medical School, New Brunswick, New Jersey 08903-0019
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Sigler Morales L, Mier y Díaz J, Melgoza Ortiz C, Blanco Benavides R, Medina González E. [Amebiasis. Surgical treatment in 1989]. Rev Gastroenterol Mex 1989; 54:185-9. [PMID: 2682975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Even when the number of patients with invasive amebiasis has decreased, the internist and surgeon must be alert in case that the patient requires an operation. Amebic liver abscess is treated medically; percutaneous evacuation is rarely used and surgical drainage is made when there is not response to medical treatment or there is high risk of abscess rupture. Operation is mandatory when the abscess has ruptured to the abdominal cavity or through the pericardial sac. In fulminant colitis it is necessary to resect the diseased portion of the colon without primary anastomoses. Amebic apendicitis is difficult to diagnosis before an operation. It may be suspected in cases of apendicitis if the cecal wall is inflammed. Colon ameboma requires medical treatment except if it is associated with necrosis or perforation. In a four year period (1985-1988) 294 patients with diagnosis of invasive amebiasis were admitted to three hospitals of the Instituto Mexicano del Seguro Social in Mexico City. 218 had hepatic abscess, 45 required surgical drainage with four deaths (9%) and four not operated patients died. In this series only four patients had their abscess drained percutaneously. 31 patients with amebic colitis were treated; three required colonic resection with one death. Ameboma was seen in five patients and there were 11 cases of amebic apendicitis. No deaths occurred in these last two groups.
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Abstract
This is a review article concerning the surgical aspects of parasitic disease in childhood. The surgeon encounters parasitic disease for a variety of reasons. Many forms of infestation produce or mimic anatomic diseases of the gastrointestinal tract. Others are characterized by soft tissue or visceral mass lesions, lymphadenopathy, portal hypertension, etc. The surgical aspects of parasitism extend to all subspecialties, including ophthalmology, gynecology, and plastic surgery.
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Abstract
This is a report of a rare entity—an amoebic ulcer of the penis. The gross loss of glans and terminal urethra was repaired by a new technique using an island based anterolateral dartos flap.
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Wu TP, Wu CY, Chen CM, Lu HM, Meng KY, Chu SP, Jung Sun C. Medical and surgical treatment in a case of amoebiasis of the left lung. Trans R Soc Trop Med Hyg 1979; 73:467-8. [PMID: 555077 DOI: 10.1016/0035-9203(79)90180-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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Mandal AK, Thadepalli H. Surgical aspects of amoebiasis and diagnostic clues. Am Surg 1978; 44:564-70. [PMID: 717906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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