A CASE PRESENTATION ON ACUTE INFECTIVE

GASTROENTERITIS -AMEBIASIS

PRESENTED BY -
M.AKANKSHA
256517882008
PHARM.D 5TH YEAR
ST.PAULS COLLEGE OF PHARMACY

PRESENTED TO:
THE DEPARTMENT OF CLINICAL PHARMACY
KIMS HOSPITALS,SECUNDERABAD
ABOUT DISEASE
• Amebiasis is an infection of the gastrointestinal tract &sometimes liver and other organs that is caused by the
single celled protozoan parasite entamoeba histolytica ,an ameba
• Amebiasis tends to occur in areas where sanitation is inadequate ,parasite is present worldwide ,but
most infections occur in areas of Africa ,the Indian subcontinent ,and parts of central and south America .
• Worldwide each year , about 50 million people develop amebiasis ,and as many as 1,00,000 of them die .
• Entamoeba species exist in two forms :
AN ACTIVE PARASITE - TROPHOZITE
A DORMANT PARASITE - CYST
SYMPTOMS

• Amebiasis symptoms typically develop over one to three weeks and may include :
Dysentary
Cramping abdominal pain.
Weight loss and fever.
In some people , amebas spread to the liver where they can cause abscess-symptoms include fever,
sweats, chills , weakness, nausea ,vomiting ,weight loss, and pain or discomfort in the upper right
part of the abdomen over the liver .
Rarely , amebas spread to other organs (including lungs and brain).the skin may also become infected
, especially around the buttocks ,genitals .
 DIAGNOSIS

• Stool tests
• Blood test
• Biopsy of large intetsine .
• Endoscopy of large intestine
• USG ,CT ,MRI scannings .

TREATMENT
• An amebicide /a drug to kill cysts .
• If amebiasis is suspected and the person has symptoms ,an amebicide a drug that kill amebas – either
metronidazole or tinidazole is used .
• Metronidazole must be taken for 5-10 days ,Tinidazole must be given for 3-5 days Nitazoxanide has been
proposed as an alternative for treating amebiasis .
TREATMENT
• Metronidazole
• AMEBIC DYSENTARY -750mg orally TID for 5-10 days .
• AMEBIC LIVER ABSCESS-500-750 mg orally TID for 5-10 days .
• Tinidazole
• INFECTION DUE TO E.HISTOLYTICA- 2g orally every day for 3 days
• Along with Antibacterials which kill the cysts like Aminoglycosides, Penicillins , Quinolones .
SUBJECTIVE EVIDENCE

• IP.NO : 32331
• UNIT: INTERNAL MEDICINE
• AGE –37Yr
• GENDER-MALE
• DOA-10-12-21
• DOD-15-12-21
CHIEF COMPLAINTS
• LOOSE STOOLS, FEVER FROM 3 DAYS ASSOCIATED WITH ABDOMINAL PAIN ON AND OFF
GRIPPING TYPE .
• H/O -OUTSIDE FOOD INTAKE
• NO C/ OF VOMITING ,COLD ,COUGH .
• O/E : CVS-S1S2+
CNS –NAD
P/A-SOFT
R/S-BAE+
OTHERS – BP : 120/80mmhg
PR- 75b/min
TEMP.- 98F
RR-14/min
SPO2 -100
PROVISIONAL DIAGNOSIS
• ??GASTROENTERITIS
OBJECTIVE EVIDENCE
CBP-
• HB-13.5g/dl
• RBC- 4.71 cells/ cumm
• WBC-3,710 cells/cumm
• PLATELETS- 1.99 cells/cumm
URINE ANALYSIS
• Straw colour ,clear ,protein trace ,urobilinogen normal , pus cells 4/hpf .
LFT
• AST –28
• ALT- 32
• BILURUBIN –T : 0.58
• BILURUBIN –D: 0.08
• ALBUMIN : 3.6
CONT....

• MICROBIOLOGY –
Stool culture –microorganisms protozoa –E. histolytica

FINAL DIAGNOSIS

ACUTE INFECTIVE GASTROENTERITIS -AMEBIASIS

GOALS OF THE TREATMENT
• To reduce the infection by killing the protozoan E. histolytica .
• To maintain his fluid balance .
• Reduce the abdominal pain ,fever ,vomiting and dysentery.
• Prevent from other infections by maintaining patient hygiene .
 ASSESSMENT
CURRENT DOSE ROA F DA DS COMMENTS
DRUGS
IV FLUIDS 75ml IV 1ml/hr 10/12/21 15/12/21
INJ.TICARNIC 3.1g IV BD 01/12/21 15/12/21 With NS 100ml

INJ.PAN 40mg IV OD 10/12/21 15/12/21

INJ.PCM 1g IV SOS 10/12/21 15/12/21

T.VIBACT DS - P/O BD 10/12/21 15/12/21

T.RIFAGUT 40mg P/O OD 11/12/21 15/12/21

SYP.MUCAINE 10ml P/O TID 12/12/21 15/12/21

GEL
INJ.ZOFER 4mg IV STAT 10/12/21 15/12/21

INJ.METROGYL 400mg P/O TID 10/12/21 15/12/21

DAILY PROGRESS

• DAY 02
• Loose stools present ,myalgia ,afebrile
• BP-10/80mmhg
• Adv :T.RIFAGUT -40mg
• DAY 03
• Loose stools 3 episodes since midnight ,generalized weakness, afebrile
• BP-100/70 mmhg
• Advised –inj.Amikacin 750 mg BD, Syp.Mucaine gel -10ml
• DAY 04
• Clinically better
• DAY 05
• clinically stable
• DAY 06
• Discharge
GOALS ACHEIVED

• THE PATIENT IS HEMODYNAMICALLY STABLE

• INFECTION OF E.HISTOLYTICA IS DECREASED .
• SYMPTOMS ARE SUBSIDED WITH THE SUPPORTIVE TREATMENT .
INTERVENTIONS

• Inj. Amikacin 750mg BD was advised on 12/12/21 but was not given to the patient .
PLANNING
• DISCHARGE MEDICATION :

DOSAGE NAME OF THE DOSE ROA FREQUENCY DURATION

FORM MEDICATION

TABLET SOMPRAZ 40mg P/O OD 14 DAYS

TABLET ACEF.F 500mg P/O BD 5 DAYS

TABLET METROGYL 400mg P/O TID 5 DAYS

TABLET VIBACT DS 1tab P/O BD 3 DAYS

TABLET ESTAR 1tab P/O OD 1 MONTH

REVIEW AFTER 5 DAYS WITH CBP REPORT

Patient counselling
DISEASE RELATED -
• GE is also known as stomach flu ,is an inflammation of the GI tract involving both stomach and intestines .
• It may be caused due to food/water poisonings .
• Symptoms include -fatigue ,lack of appetite ,abdominal pain ,cramping, nausea ,vomiting,diarrhea.

DRUG RELATED -
• Patient was advised to adhere to the prescribed medication.
• The patient was explained about the dose ,administration method ,frequency and time at which drug should
be taken .
• Take them as a whole with glass water .
• If a dose is missed take it as soon as possible ,if not leave the dose and continue the rest as prescribed .
• Tablet Vibact DS and Estar may cause bloating , flatulence and stomach ache will be resolved after course of
treatment hence tablet Sompraz is prescribed to comfort the side effects of the patient .
• Tablet metrogyl may cause abnormal taste and abdominal discomfort will be resolved after the course of the
treatment.
• Tablet ACEF and METROGYL are the antibiotics so you have to take the medication as prescribed at same
time every day .
• Drink plenty of fluids as tablet sompraz may cause drymouth for instant relief take a sugar candy.s
Cont......

• LIFE STYLE MODIFICATIONS :

• Patient was counselled with the following points .
• Drink fluids and get plenty of rest
• Drink clear liquids
• Sanitize your hands before and after eating
• Sanitize the surface of your food items and utensils
• Personal hygiene is necessary
• Drink luke warm water and eat properly cooked foods .