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The E. histolytica life cycle is composed of two main stages: the disease-producing,
invasive trophozoite or the infective cyst. Trophozoites can survive in human stool, and invade
the colonic wall by either binding to epithelial cells on the mucosal surface, whereby they release
cytotoxins, causing cell lysis, or by phagocytosis of red blood cells and polymorphonuclear
neutrophils . Trophozoites can subsequently invade blood vessels and undergo hematogenous
dissemination, sometimes to the liver and lungs. Alternatively, trophozoites can develop into
infective cysts by binary fission. Cysts are then passed in the stool and contaminate food and
water. Following human ingestion, the cysts are capable of surviving the acidic stomach
environment and eventually depositing in the ileum where they once again produce the
trophozoite. However, up to 90% of people infected with E. histolytica are asymptomatic or have
very mild disease . In children, cutaneous amebiasis almost always occurs in the anogenital or
perineal region as a result of direct inoculation from infected stool. This has been reported in
young children because of prolonged contact with fecal material in a child’s diaper. Ninety
percent of reported children with cutaneous amebiasis, including our patient, were associated
with diarrhea or dysentery. Alternatively, direct inoculation of the skin has also been reported
from scratching, anal or vaginal intercourse, and following surgical drainage or spontaneous
rupture of an abscess at a colostomy site or laparotomy incision . A higher incidence of infection
is reported among patients with low socioeconomic status and poor sanitation and hygiene .
Emetine has traditionally been the drug of choice for early diagnosed cutaneous
amebiasis. However, it can cause arrhythmia and thus requires hospitalization with cardiac
monitoring during administration. Dehydroemetine is a less toxic alternative that works well and
is often utilized in conjunction with diiodohydroxyquinolone or iodoquinol . Intestinal amebiasis
(which is usually seen in conjunction with cutaneous amebiasis in children) is treated with a two-
drug regimen. Metronidazole has become the drug of choice, followed by dehydroemetine,
chloroquine, or iodoquinol. No matter what the combination of drugs, the key to cure is early
diagnosis and prompt therapeutic intervention. Surgery may also be required in instances of
rapidly progressive and highly invasive disease.
Daftar pustaka
Tanyuksel M, Petri WA. Laboratory diagnosis of amebiasis. Clin Microbiol Rev 2003;16:713–729.
Kenner, B. M., & Rosen, T. Cutaneous Amebiasis in a Child and Review of the Literature.
Pediatric Dermatology 2006;23(3), 231–234.