The Case of Mistaken Identity: Entamoeba histolytica presenting as Community Acquired Pneumonia

Ha, Kai; Gorshein, Elan; Skole, Kevin

doi:10.14309/00000434-201510001-00894

Cited by 2 publications

(4 citation statements)

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“…This was followed by European countries (6 of 24 cases, 25%), including Spain [ 26 , 27 ], Sweden [ 28 ], Denmark [ 29 ], Portugal [ 30 ] and Italy [ 31 ]. There were three reports (12%) originating from the USA [ 32 – 34 ] and a fourth (4%) from the USA territory American Samoa [ 35 ]. Two cases (8%) from a single case series were from Chile [ 36 ].…”

Section: Resultsmentioning

confidence: 99%

“…In all, 14 of 24 (58%) cases were given corticosteroid medications for initially misdiagnosed colitis ( Table 1 ), including misdiagnosed inflammatory bowel disease (11 of 24 cases, 46%) [ 18 – 20 , 22 , 26 , 28 – 30 , 33 , 37 ], intestinal vasculitis (2 of 24 cases, 8%) [ 23 , 25 ], and abdominal tuberculosis (1 of 24 cases, 4%) [ 24 ]. The remainder were given corticosteroid medications for the indication of prevention or treatment of graft-versus-host disease (GVHD) following transplantation (5 of 24, 21%) [ 16 , 31 , 34 , 36 ], respiratory illness (3 of 24 cases, 12.5%) [ 21 , 32 , 35 ], multiple myeloma (1 of 24, 4%) [ 17 ] and thrombocytopenic purpura (1 of 24, 4%) [ 27 ].…”

Section: Resultsmentioning

confidence: 99%

“…The odds of perforation did not differ significantly by prior misdiagnosis, CMV co-infection or treatment with additional immune modulating therapies. Associated amebic liver abscesses were found in three (12.5%) cases [ 30 , 32 , 33 ]. Central nervous system dissemination occurred in one case (4%), a one-year-old child with jejenal perforation, liver abscess and seizures secondary to meningoencephalitis (trophozoites demonstrated by microscopy in the cerebrospinal fluid) [ 35 ].…”

Section: Resultsmentioning

confidence: 99%

“…Most cases (13 of 24, 54%) had involvement of multiple areas of bowel, including pancolitis in seven cases (29%) [ 18 , 20 , 22 , 23 , 25 , 26 , 33 ]. Proctosigmoid involvement was documented in four cases (17%) [ 15 , 16 , 28 , 31 ], descending colon in two cases (8%)[ 16 , 28 ], transverse colon in five cases (21%)[ 16 , 28 , 29 , 31 , 34 ], ascending colon in five cases (21%) [ 29 – 32 , 34 ], cecal/ ileo-cecal in five cases (21%) [ 21 , 24 , 27 , 30 , 31 ], jejenal in one case (4%) [ 35 ] and exact location of colitis not specified in two cases (8%) [ 17 , 19 ].…”

Section: Resultsmentioning

confidence: 99%

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Fulminant Amebic Colitis after Corticosteroid Therapy: A Systematic Review

Shirley

Moonah

2016

PLoS Negl Trop Dis

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BackgroundAmebic colitis, caused by intestinal infection with the parasite, Entamoeba histolytica, is a common cause of diarrhea worldwide. Fulminant amebic colitis is the most devastating complication of this infection, associated with both high mortality and morbidity. We conducted a review of the English literature to describe cases of fulminant amebic colitis associated with exposure to corticosteroid medications in order to identify the risk factors for poor outcome and determine difficulties in diagnosis and treatment.Methodology and Principal FindingsArticles reporting severe and fulminant forms of amebic colitis between 1991 and 2016 were collected. 525 records were screened to identify 24 cases for qualitative analysis associated with corticosteroid use. Cases arose from areas of high endemicity or travel to such areas. Most cases (14 of 24, 58%) were given corticosteroids for initially misdiagnosed colitis, mainly inflammatory bowel, resulting in rapid progression of disease. Nearly half of all cases underwent surgical intervention, and 25% of cases died, despite all patients eventually receiving treatment with metronidazole. The odds of death did not differ significantly by prior misdiagnosis, co-morbidities, bowel perforation or need for surgery.Conclusions and SignificanceInfection with E. histolytica should be considered prior to the administration of corticosteroids, in particular for patients residing in endemic areas or those with appropriate travel history, especially prior to the diagnosis of inflammatory bowel disease. The development of preventative and treatment interventions are needed to improve outcomes of fulminant disease.

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