Pathophysiology

E. histolytica invades mucosal cells of colonic epithelium, producing the classic flask-shaped ulcer in the submucosa. The trophozoite toxin has a cytocidal effect on cells. If the trophozoite gets into the portal circulation, it will be carried to the liver, where it produces abscess and periportal fibrosis. Liver abscesses are more common in men than women and are rarely seen in children. Amebic ulcerations can affect the perineum and genitalia, and abscesses may occur in the lung and brain.

Erosion of liver abscesses can result in peritonitis. Liver abscesses that are located in the right lobe can spread to the lungs and pleura. Pericardial infection, although

Pharmacologic Therapy

Metronidazole (Flagyl), dehydroemetine, and chloroquine (Aralen) are tissue-acting agents, and iodoquinol (Yodoxin), diloxanide furoate (Furamide), and paromomycin (Humatin) are luminal amebicides. A systemic or tissue-acting agent may be so well absorbed that the amounts of the drug remaining in the bowel may be insufficient to have luminal or local effects. A luminally-active agent, on the other hand, may not attain effective enough levels in the tissue to be efficacious. Asymptomatic cyst passers (identified by stool examinations, and who may develop invasive disease) and patients with mild intestinal amebiasis should receive a luminal agent: paromomycin 25 to 35 mg/kg/day three times daily for 7 days, or iodoquinol 650 mg three times daily for 20 days, or diloxanide furoate 500 mg three times daily for 10 days. These regimens have cure rates of between 84% and 96%. Dilox anide furoate is available from

Ponorama Compounding Pharmacy (6744 Balboa Blvd., Lake Balboa, CA 91406; 12

[800] 247-9767). The pediatric dose of paromomycin is the same as that used in adults, whereas the pediatric dose of iodoquinol is 30 to 40 mg/kg (maximum: 2 g) per day in three doses for 20 days, and the pediatric dose of diloxanide furoate is 20 in three doses for 10 days. Paromomycin is the preferred agent in pregnant rare, may be associated with extension of the amebic abscesses from the liver.

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