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Thoracic amebiasis.
S M Shamsuzzaman1, Y Hashiguchi
1Department of Parasitology, Faculty of Medicine, Kochi Medical School, Nankoku City, Kochi 783-8505, Japan. smszaman@yahoo.com
Clinics in Chest Medicine
|July 3, 2002
Summary
Pleuropulmonary amebiasis, often linked to liver abscesses, presents with chest pain and fever. Early diagnosis and metronidazole treatment are key for recovery, while pericardial involvement requires urgent care.
Area of Science:
- Medical Parasitology
- Infectious Diseases
- Thoracic Medicine
Background:
- Pleuropulmonary amebiasis is a thoracic manifestation of Entamoeba histolytica infection, commonly arising from hepatic abscesses.
- Risk factors include low socioeconomic status, malnutrition, alcoholism, and congenital heart defects.
- While rare in children, it primarily affects adult males aged 20-40.
Purpose of the Study:
- To elucidate the epidemiology, clinical presentation, diagnostic challenges, and management of pleuropulmonary and pericardial amebiasis.
- To differentiate amebic thoracic infections from other conditions like tuberculosis and lung cancer.
- To highlight the diagnostic value of serological tests and imaging.
Main Methods:
- Review of clinical cases and existing literature on thoracic amebiasis.
- Analysis of diagnostic methods including imaging (radiography, ultrasound, CT), serology (ELISA, IFAT, IHA), and direct detection of amebae.
- Evaluation of treatment outcomes with metronidazole and supportive care.
Main Results:
- The lung is the second most common extraintestinal site for amebiasis, typically affecting the right lower lobe.
- Diagnostic indicators include elevated hemidiaphragm, hepatomegaly, pleural effusion, and characteristic "anchovy sauce-like" pus.
- Serological tests are highly valuable; Entamoeba DNA detection shows promise.
- Pericardial amebiasis, often from liver abscess extension, can lead to acute cardiac tamponade.
- Acanthamoeba can cause pulmonary disease in immunocompromised individuals.
Conclusions:
- Pleuropulmonary amebiasis requires a high index of suspicion due to its varied presentation and potential confusion with other diseases.
- Prompt diagnosis via serology and imaging, followed by targeted anti-amebic therapy (metronidazole), leads to favorable outcomes.
- Pericardial amebiasis is a critical condition necessitating urgent intervention, including pericardiocentesis and ambecides.
- Further research into Entamoeba histolytica in HIV-seropositive patients is warranted.