Please enable JavaScript.

Coggle requires JavaScript to display documents.

TM: Protozoa (ii) (Giardia lamblia (Tx (oral metronidazole (400mg tid x 3d…

- - - - villi flattening
        
        not enough SA hence fluid stays in bowel
    - - secretion of fluid + electrolytes
        
        watery SI diarrhoea with WBCs
  - - - exam for cysts
      - @ least 3 samples
      - conc + special stains can increase sensitivity
      - trophozoites rarely found
      - antigen detection (ELISA)
    - - vlllous flattening (non-specific - also in HIV + coeliac)
      - deepening of crypts
      - increased inflamm infiltrate in lamina propria
  - - - 400mg tid x 3d
      - 2g/d x 3d
      - paed dose: 15mg/kg/day tid or 40mg/kg qd x 3 d
- - - - 40-90% mortality
      - due to rupture of liver abscess (esp left lobe)
  - - - severe colitis
      - hypovolaemia
      - most liver abscesses
      - peritonitis
    - - for fulimnants colitis, peritonitis, rupture
      - sometimes for liver abscess (not always necessary - catheter drainage instead - interventional radiology)
      - percut catheter drainage may be required for amoebic empyema or amoebic pericarditis
    - - little effect on cysts
      - metronidazole 500-750mg PO tid for 10 d
      - tinidazole
        
        for intestinal amoebiasis: 600mg PO bid for 5 d (or 2g PO qd for 3 d with food)
        
        for hepatic abscess: 2g PO qd for 3-5 d with food
    - - for gut lumen
      - iodoquinol 650 mg PO tid for 20 d
      - paramomycin 25-35 mg/kg/d PO tid for 7 d
      - diloxanide 500mg PO tid for 20 d
    - - may respond to metronidazole 7-10 d
      - cure rate > 90%
      - may rupture, heal or disseminate
      - usually heals without a scar
      - percut drainage (aspiration) may be needed (certain formal indications)...
        
        no response to medical tx after 72 hrs
        
        rupture believed to be imminent
        
        left lobe abscess (more likely to rupture)
        
        if dx hasn't been confirmed