Thursday, February 28, 2013

Amoebiasis: Bowel amoebiasis and spread of infection to liver and lungs

The organism that causes amoebiasis is a unicellular parasite called Entamoeba histolytica. A variety of clinical presentations are seen. Though the disease is not a major health problem but in serious forms of amoebiasis, significant morbidity and mortality is unavoidable. We may have asymptomatic carriers of amoebic infection. On the other hand Entamoeba histolytica infection may result in fulminant dysentery with fever, diarrhoea, bleeding and even perforation of intestine. The organism can be identified in wet slide preparation of stool specimen obtained from infected patient.

The infection is transmitted by the faeco-oral route. The infection can be an asymptomatic one, that is, the victim could be in good health in-spite of harboring the Entamoeba histolytica infection. In severe cases of infection, Entamoeba histolytica can result in full-fledged frank dysentery along with colonic ulceration. Uncommonly, Entamoeba histolytica can invade organs other than large intestine. Liver is the second common site followed by lungs. The brain, genitals and the skin are other possible sites if infection by the amoeba. The majority of patients do not develop frank-dysentery, i.e. they do not develop diarrhoea with blood or mucus. Vague symptoms, such as discomfort in the tummy, irregularity of bowels, constipation, diarrhoea, griping and tenesmus occur in various combinations. In some cases, low grade fever, loss of weight, pallor, generalized non-specific aches and pains are common. The patient usually carries on his day-to day duties with sub-optimum health and efficiency.

The diagnosis of asymptomatic bowel amoebic infection can be established through repeated fresh stool microscopic examination. The sigmoidoscopic examination of ulcerative lesions of colon and microscopic examination of direct smears obtained from the ulcers would further confirm the diagnosis of amoebic ulcers. Invasion of liver by Entamoeba histolytica is the second commonest form of amoebiasis. The onset is usually insidious but an exceptionally rapid course can be seen during endemics of bowel amoebiasis. The presenting symptoms of liver amoebiasis are pain in the upper right quadrant of tummy, or fever or both. The presence of jaundice is very rare in patients with liver amoebiasis. Fever of uncertain origin is a common problem in many developing countries. One of the causes of the fever of uncertain origin could be amoebic infection of the liver.

The diagnosis of amoebic infection of the lungs and brain requires a high degree of expertise on the part of physician/clinician. The amoebic infection of brain is usually diagnosed at the operation table. Amoebic ulceration of skin is not very rare. Sophisticated techniques like serology and radio-isotopic scan can be of great help in establishing the diagnosis of amoebic abscess of liver, lung or brain. The treatment of amoebiasis is highly effective once a correct diagnosis has been made. Eradication or prevention of amoebiasis in any locality can be achieved only if there are optimum ways of sewage disposal and personal hygiene.

Thursday, February 14, 2013

Effect of Alcohol on Fetus

Thousands of research papers have been published to highlight the hazardous effects of alcohol on the fetus in the womb of drinking mothers. It has been estimated that 60-70% of pregnancies of mothers having 5 to 6 drinks a day may have an abnormal outcome. Even moderate levels of drinking during pregnancy would be detrimental to the fetus. Excessive drinking during pregnancy may lead to fetal alcohol syndrome (FAS). The fetal alcohol syndrome (FAS) includes failure of growth before and after birth, various physical defects and neuro-developmental disorders. The FAS has an incidence of around one percent in live births from such women. The healthcare of alcohol damaged children (ADC) would need extra spending by individuals as well as by governments. Psychiatrists recommend total abstinence from alcohol during pregnancy.

The alcohol abuse and drink trade are subjects of the interest of governments worldwide. Majority of the governments are interested in the wealth than health. The average consumption of alcohol has doubled during the last decade in many developing countries. You would find increased number of outlets of liquor in your area. The alcohol seems to be an ever-expanding scourge, taking a heavy toll of health and wealth due to lack of social alcohol discipline. The drinking habits of female population need to be reliably surveyed to ascertain the damage caused to their infants.