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Fulminant Amebic Colitis after Corticosteroid Therapy: A Systematic Review
Debbie-Ann Shirley1, Shannon Moonah2
1Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia, United States of America.
Plos Neglected Tropical Diseases
|July 29, 2016
Summary
Corticosteroid use in patients with amebic colitis, often misdiagnosed as inflammatory bowel disease, leads to severe outcomes. Early consideration of Entamoeba histolytica infection is crucial, especially in endemic areas.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Clinical Medicine
Background:
- Amebic colitis, caused by Entamoeba histolytica, is a significant global cause of diarrhea.
- Fulminant amebic colitis represents a severe complication with high mortality and morbidity.
- Corticosteroid administration is a potential risk factor in severe amebic colitis cases.
Purpose of the Study:
- To review literature on fulminant amebic colitis cases linked to corticosteroid exposure.
- To identify risk factors for poor outcomes in these patients.
- To understand diagnostic and treatment challenges.
Main Methods:
- A literature review of English articles from 1991-2016 was conducted.
- 525 records were screened, identifying 24 cases for qualitative analysis.
- Cases associated with corticosteroid use were analyzed.
Main Results:
- Most cases (58%) received corticosteroids after misdiagnosis, primarily of inflammatory bowel disease, accelerating disease progression.
- Nearly half of the patients required surgical intervention.
- Despite metronidazole treatment, 25% of patients died.
Conclusions:
- Entamoeba histolytica infection must be considered before corticosteroid use, particularly in endemic regions or with relevant travel history.
- Early diagnosis and treatment are essential to improve outcomes for fulminant amebic colitis.
- Further research into preventative and therapeutic strategies is needed.
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