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COMMENTARY
Year : 2018  |  Volume : 11  |  Issue : 4  |  Page : 342-343  

Acute fulminant necrotizing amebic pancolitis


Department of Tropical Medicine, Hainan Medical University, Haikou, China; Department of Community Medicine, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India

Date of Web Publication2-Aug-2018

Correspondence Address:
Viroj Wiwanitkit
Wiwanitkit House, Bangkhae, Bangkok

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mjdrdypu.mjdrdypu_9_18

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How to cite this article:
Wiwanitkit V. Acute fulminant necrotizing amebic pancolitis. Med J DY Patil Vidyapeeth 2018;11:342-3

How to cite this URL:
Wiwanitkit V. Acute fulminant necrotizing amebic pancolitis. Med J DY Patil Vidyapeeth [serial online] 2018 [cited 2019 Oct 22];11:342-3. Available from: http://www.mjdrdypv.org/text.asp?2018/11/4/342/238180



Amebic parasite is an important protozoa that can cause disease in human beings. The amebic infection is an important public health problem in several countries. This parasitic infection has a wide clinical spectrum and can lead to serious fatal clinical problem. The report case of acute fulminant necrotizing amebic pancolitis is a good example of serious clinical manifestation of amebic infection.

[1] In fact, colon is an important affected organ in amebic infection. The diagnosis is usually by the stool examination and identification of the parasite in the stool sample. The endoscopic investigation is also sometimes useful in diagnosis. The gastrointestinal problem is the well-known classical clinical presentation of amebic infection. Nevertheless, there is a wide range of clinical problem in amebic colitis. As noted by Cooper et al. on amebic colitis, “Most patients present with watery or bloody diarrhea. Less common presentations of amebic colitis include abdominal pain, overt gastrointestinal bleeding, exacerbation of inflammatory bowel disease, or the incidental association with colon cancer. Amebic liver abscesses are the most frequent complication.”[2] Fleming et al. also noted that “Physicians should be alert to the less common presentations of amebic colitis, such as overt gastrointestinal bleeding, exacerbation of inflammatory bowel disease, and the incidental finding of association with colon cancer, or a surgical abdomen.”[3] The common findings from colonoscopic investigation are “multiple large ulcers with diffuse inflammation of the intervening mucosa,” and the pathology is common at the left colon.[4]

Focusing on pancolitis, it is a serious form of amebic colitis that there is generalized colonic pathological involvement. This condition is related to severe infection, but there is no evidence that the existence of underlying colon disease increases the chance for occurrence of amebic pancolitis (for example, Vukobrat-Bijedic et al. found that there is no clinical association of underlying ulcerative colitis with severity of colonic pathology).[5] Nevertheless, the clinical problem in pediatric case is usually severe and required good management. Similar to the present published case report, the severe clinical problem due to amebic pancolitis can be seen in pediatric patient. The “necrotizing amebic pancolitis” is the serious clinical presentation. Lami and Moore noted that “Necrotizing amebic colitis appears to be more hazardous in infancy and childhood than in adult years.”[6] Several underlying conditions are proven to be related to the disease severity in pediatric case. The underlying malnutrition and additional illnesses and malformations are believed to be the main contributing factors.[6] In additional, the immunocompromised status is also mentioned as a cause of increased risk for the total colonic necrosis and disintegration in pediatric amebic infection.[6] For management of the case with necrotizing amebic pancolitis, the first suggested option is a conservative treatment by ileostomy and colonic lavage.[7] Béchade et al. noted that this practice could help reduce the death rate.[7] Nevertheless, in the severe affected pediatric case, it sometimes requires colectomy as surgical therapy.[6]

In tropical developing countries, the amebic infection is not uncommon at present. The amebic diarrhea sporadically occurs and it might result in unwanted complications including to liver abscess as well as colitis. It is no doubt that the clinical problem due to amebic pancolitis is more ever than simple amebic infection. The early diagnosis and prompt treatment is the key points for successful clinical management of the patient.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Gupta R, Riyaz S, Soni N. Acute fulminant necrotizing amoebic pancolitis: A lethal entity in children. Med J Dr DY Patil Vidyapeeth 2018;11:338-41. [In press].  Back to cited text no. 1
    
2.
Cooper CJ, Fleming R, Boman DA, Zuckerman MJ. Varied clinical manifestations of amebic colitis. South Med J 2015;108:676-81.  Back to cited text no. 2
    
3.
Fleming R, Cooper CJ, Ramirez-Vega R, Huerta-Alardin A, Boman D, Zuckerman MJ, et al. Clinical manifestations and endoscopic findings of amebic colitis in a United States-Mexico border city: A case series. BMC Res Notes 2015;8:781.  Back to cited text no. 3
    
4.
Sachdev GK, Dhol P. Colonic involvement in patients with amebic liver abscess: Endoscopic findings. Gastrointest Endosc 1997;46:37-9.  Back to cited text no. 4
    
5.
Vukobrat-Bijedic Z, Husic-Selimovic A, Bijedic N, Bjelogrlic I, Djuran A. Intestinal amebiasis in a group of patients with ulcerative colitis: Influence on clinical course of the disease. Med Arch 2013;67:10-2.  Back to cited text no. 5
    
6.
Lami JL, Moore TC. Colectomy for necrotizing amebic pancolitis in early childhood with survival. J Pediatr Surg 1989;24:1174-6.  Back to cited text no. 6
    
7.
Béchade D, Beyssac R, Raymond JM, de Mascarel A, Masson B, Amouretti M, et al. Necrotizing amebic colitis. Gastroenterol Clin Biol 1994;18:657-60.  Back to cited text no. 7
    




 

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