Abdominal pain, blood stools repeated attacks, test people "a move to lock the enemy"!

Preface

Intestinal amoebiasis, also known as amoebic dysentery, is a gastrointestinal infectious disease

Case passed

The patient, a 63-year-old male, had abdominal pain and intermittent bowel movements for more than

On July 28, 2022, the patient came to the hospital again for follow-up due to abdominal pain and blood removal, no fever, no nausea and vomiting, no acid reflux belching and other symptoms

Figure 1 Results of "stool routine + OB" on July 28

This stool specimen has a red, soft stool appearance, and a large number of red blood cells and white blood cells can be seen under 40-fold microscopy, as shown in Figure 2

Figure 2 Specimen of stool on July 28 (40×)

We noticed that the patient had visited the patient many times, checked the past medical records, and found that the patient had been treated with drugs based on the results of the colonoscopy (non-infectious enteritis), and the symptoms of abdominal pain and bloody stool had been repeated

On August 2, the patient sent a stool sample again, except for the occasional white blood cells under the microscope, the occult blood test was positive, and the rest were normal, the results were shown in Figure 3

Figure 3 Results of "stool routine + OB" on August 2

This stool specimen is brown, stool in appearance, with a small amount of white blood cells visible under the microscope, as shown in Figure 4

Fig.

On August 4, the patient sent another stool sample, this stool sample is a typical jam-like specimen, red, rotten stool, a large number of red blood cells and white blood cells were seen under high-power microscopy, we saw the cells suspected of amoeba sac under ordinary light microscope, and then we gave the specimen iodine stain, confirmed to be amoeba sac

Figure 5 Characteristics of stool specimens and microscopic view on August 4 (20×)

Figure 6 Downward view of ordinary light microscope (saline smear, 40×)

Fig.

Case studies

Intrahistolytic amoeba is the main pathogen of chronic colitis and amoebic dysentery, and the clinical manifestations of amoebic disease caused by it vary in diversity, which can be divided into asymptomatic insect-carrying infection and symptomatic invasive infection

Less than 10% of people infected with amoeba present with typical acute symptoms of infection: abdominal pain, diarrhea and frequency, jam-like mucus pus and bloody stools, poor antibiotic therapy, laboratory tests for amoebic trophoblasts, and/or posac

Missed diagnosis and misdiagnosis often occur in clinical work, and the reasons may be:

(1) Improper collection and delivery of feces, fresh specimens are not kept warm and sent for inspection

(2) The patient's symptoms are atypical and the clinician is inexperienced

In this case, the patient, several times in a year, abdominal pain, bloody stool symptoms, clinical according to the results of the colonoscopy of colitis, given the corresponding treatment, although the patient's acute symptoms have been alleviated, but the pathogen may always exist, which is also the patient's prolonged year, recurrent attacks may be the cause

Case summary

As one of the three major routines, the routine examination of stool is one

Expert reviews

The relatively rare amoebic disease in the case selection process described the complete diagnosis and treatment process and laboratory tests
of the patients.

Highlighting the importance of clinical testing also suggests that inspectors should strengthen their ability
to test under microscopy morphology.

Clinical should be better combined with testing, and timely examination-doctor-patient communication
should be paid attention to in work.

Reviewer: Guo Zhonghui, Chief Physician, Director of the Department of Clinical Laboratory, Guangzhou Panyu Central Hospital

References

Hou Qiang.
Clinical features of 76 cases of amoebic enteritis in a single center[D].
Dali University, 2022.

Feng Zhen,Gao Yang,Fang Zhen.
One case of enteroabiasis[J].
Journal of Diagnostic Pathology,2018, 25(05):397.

Jin Ke, Feng Meng, Cui Ting, et al.
A case of ulcerative colitis complicated by intestinal amoebiasis[J].
Chinese Journal of Infectious Diseases, 2021, 39(06):369-370.