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[3 cases of hematogenous lung abscess of amebic origin]
J A García Uribe1, A Padua Gabriel, O Quintana
1Unidad de Cuidados Intensivos Respiratorios, División de Neumología Adultos, México, D.F.
Abstract:
Invasive amebiasis is a very serious health problem in Mexico as it is presumably related to the presence of virulent strains of Entamoeba histolytica and poor hygienic and sanitary conditions; other factors related to invasive amebiasis are undernutrition, alcoholism, and homosexuality. We present three patients with pulmonary amebic hematogenous abscess. Clinically all patients had the typical "chocolate" exudate. The three patients had pulmonary consolidations by chest roentgenogram; one of them had multiple opacities with air fluid level, and the others had an isolated opacity with air fluid level. The ultrasound and hepatogammagram were negative for diaphragmatic communication in all; in one of them the pneumoperitoneum was negative for diaphragmatic communication. The transthoracic needle biopsy of the lesions was positive to ameba in two patients. The serologic tests were positive in all. We treated the patients with metronidazole and emetine during 10 days; since the clinical picture and the radiologic findings did not remit completely, we gave a second course of metronidazole during 10 days more and achieved complete resolution.
Insights
Invasive amebiasis, a severe health issue in Mexico, can manifest as pulmonary abscesses. Prompt diagnosis and a two-course metronidazole treatment effectively resolved these serious Entamoeba histolytica infections.
Area of Science:
- Infectious Diseases
- Medical Parasitology
- Pulmonology
Background:
- Invasive amebiasis poses a significant public health challenge in Mexico, linked to virulent Entamoeba histolytica strains and poor sanitation.
- Associated risk factors include malnutrition, alcoholism, and specific population behaviors.
Observation:
- Three cases of pulmonary amebic hematogenous abscess are presented, characterized by clinical "chocolate" exudate.
- Radiographic findings included pulmonary consolidations, with some showing multiple opacities and air-fluid levels.
- Diagnostic methods like ultrasound, hepatogammagram, and pneumoperitoneum ruled out diaphragmatic communication; transthoracic needle biopsy confirmed amebiasis in two patients, and serology was positive in all.
Findings:
- All patients presented with pulmonary consolidations and positive serologic tests for amebiasis.
- Transthoracic needle biopsy confirmed Entamoeba histolytica in two of the three patients.
- Initial treatment with metronidazole and emetine was insufficient, necessitating a second course of metronidazole for complete resolution.
Implications:
- This case series highlights the importance of considering invasive amebiasis in pulmonary presentations, especially in endemic regions.
- A two-course metronidazole regimen appears effective for treating pulmonary amebic abscesses.
- Improved diagnostics and treatment strategies are crucial for managing invasive amebiasis complications.