Urogenital amebiasis
Introduction
Introduction to genitourinary amebiasis The genitourinary amebiasis is a disease caused by the infection of E. histolytica and is rarely seen clinically. Mainly in homosexual (anal) and heterosexual (oral sex), manifested as penile amebiasis, and amebiasis can also affect the kidney, bladder, testis, epididymis and seminal vesicles, causing local inflammation, kidney Miba disease is usually caused by perforation of the amoebic liver abscess to the right kidney to form an adenoma abscess around the kidney, and then penetrate the renal pelvis, or it can be infected with the blood circulation or lymphatic system. basic knowledge The proportion of illness: the incidence rate is about 0.004% - 0.005% Susceptible people: no special people Mode of transmission: contact transmission, blood transmission Complications: acute diffuse peritonitis abdominal pain appendicitis amoebic liver abscess
Cause
Etiology of genitourinary amebiasis
(1) Causes of the disease
The amebic trophozoites in the lysate can spread directly through the primary lesion or spread throughout the body through the bloodstream. There is a clinically rare amebiasis. The urinary amebiasis includes urethritis and prostatitis. More secondary to amoebic dysentery, may be caused by intestinal blood flow - lymphatic spread or retrograde infection.
The life history of E. histolytica is divided into two phases, that is, the trophozoite period that can cause disease and the cystic period that can spread. When the living environment is suitable, the trophozoite escapes from the cyst and is parasitic in the human colon cavity. On the inner or intestine wall, and splitting and breeding, the size of the trophozoite varies from 15 to 30 cm in diameter. The trophozoite moves from the upper and middle colon to the lower colon. If the living conditions are unfavorable, the cyst wall is formed. The sac, the volume is similar to the size of the trophozoite, and the cyst is excreted with the feces. If a person swallows water or food contaminated by the cyst, it may be infected, the capsule reaches the colon, and when the environment is suitable, it is converted into a trophozoite. It is possible to cause illness.
The trophozoites are discharged into the human body and do not turn into capsules outside the human body. The trophozoites do not have the ability to spread. Once they leave the body, they will soon die. Even if the trophozoites are swallowed into the stomach, they will be killed by stomach acid. The ability of the capsule to withstand adverse environmental conditions is strong. The capsule can survive for more than 2 weeks in the feces, survive in water for 5 weeks, survive in the soil at 25-34 °C for 8 days, and survive at 2-6 °C. In the day, it can survive for 60 days at 0 °C. The chlorine concentration generally used for disinfection and drinking cannot kill the capsule, but when heated to 50 °C, the capsule can be killed.
(two) pathogenesis
The routes of infection of the genitourinary amebiasis are:
Direct infection
It can be infected around the kidney by the ulcerated surface of the amoebic liver abscess, forming a peri-renal abscess, penetrating the renal pelvis causing kidney amebiasis, and then infecting the bladder with the urine, the perianal and scrotal amebic disease is also more It spreads from intestinal amoebiasis.
2. Menstrual circulation and lymphatic system infection
E. histolytica can be infected into the urinary organs such as the kidney through the blood or lymphatic system, and the amoeba is attacked by the tissue. The kidney is the fifth most common part, and the right kidney is the most.
Patients may have chills, high fever, frequent urination, dysuria, urgency and other symptoms like acute pyelonephritis, urine can be rice soup-like, can also be jam-like, there is fashion can be discharged from the urine rotten fish intestinal-like spoilage tissue.
3. Contact infection
Male homosexuals can cause illness through anal sex. When there is a small abrasion on the skin of the penis, it can be contaminated by feces and cause disease. It is characterized by irregular superficial ulcer of the penis skin, edge elevation, bloody, purulent secretion or brownish yellow. Necrotic tissue, easy to bleed, tender.
Prevention
Urogenital amebiasis prevention
Drinking water must be boiled, do not eat lettuce, prevent diet from being polluted, prevent flies from breeding and killing flies, inspect and treat platoons and chronic patients in the catering industry, and change jobs during treatment, usually pay attention to personal hygiene before and after meals. .
Complication
Urogenital amebiasis complications Complications Acute diffuse peritonitis Abdominal pain Appendicitis Amoebic liver abscess
Intestinal complication
(1) Intestinal hemorrhage: Deep ulcers can erode blood vessels and cause intestinal bleeding of varying degrees. Sometimes it becomes the main symptom of this disease, and a large amount of bleeding is rare.
(2) Intestinal perforation: mostly occurs in patients with fulminant and deep ulcers. The perforation is common in the cecum, appendix and ascending colon. Perforation can cause localized or diffuse peritonitis. Acute perforation is rare. Chronic perforation More, most of them have no severe abdominal pain. The time of perforation is often difficult to determine, but the general condition is gradually worsened. X-ray examination can be confirmed by free gas. Sometimes, due to the formation of adhesion, a local abscess can be formed after perforation, or penetrate into the vicinity. Organs form internal hemorrhoids.
(3) Amoebic appendicitis: cecal lesions easily spread to the appendix. The clinical symptoms are similar to those of general appendicitis, but they are prone to perforation. It is said that in the tropical and subtropical regions due to appendicitis, about 1/3 are amoeba. Caused by infection.
(4) colon granuloma: chronic cases due to mucosal hyperplasia, granuloma, the formation of large lumps, very similar to tumors, known as amoebia, easily misdiagnosed as intestinal cancer, more common in the cecum, sigmoid colon and rectum.
2. Extraintestinal complications
The amoeba trophozoite can be spread from the intestinal wall vein, lymphatic vessels or directly to the liver, abdominal cavity, lung, pleura, pericardium, brain, genitourinary tract or adjacent skin, forming an abscess or ulcer. Miba liver abscess is most common.
Symptom
Urinary genital amebia disease symptoms common symptoms urinary pain urgency urinary frequency frequent painful purulent secretions tension abscess dull pain chills
There is a history of suspicious illness or amoebic liver abscess, a history of amoebic dysentery.
1. Kidney, bladder amebiasis
There may be dull pain in the kidney area, chills, fever, frequent urination, urgency, dysuria and other symptoms, persistent dull pain or severe pain in the kidney area, accompanied by lumbar muscle tension and rigidity, may appear rice soup-like urine or jam-like urine. Sometimes rotten fish gut-like spoilage tissue can occur, which is a characteristic symptom of cystic smear of amoeba.
2. Penis amebic disease
Irregular superficial ulcers may appear on the surface of the penis skin, the edges are raised, and the surface is covered with bloody or purulent secretions.
Examine
Examination of genitourinary amebiasis
1. A trophozoite containing red blood cells can be found in the secretions.
2. Red blood cells, white blood cells, tissue debris, and fresh urine sediment can be found in the urine to find amoeba trophozoites and cysts.
3. The serum test is the most sensitive and most specific to indirect hemagglutination and immunofluorescence tests, but only responds to active infections and does not respond to carriers.
4. Cystoscopy in the acute phase of diffuse congestive edema of the bladder mucosa, chronic mucosa with polypoid or superficial ulcers, biopsy can find amoeba trophozoites.
5. X-ray examination showed that there was a filling defect in the lesion; sometimes the perirenal abscess was seen with blurred lumbar muscle.
Diagnosis
Diagnosis and identification of urogenital amebiasis
diagnosis
For patients with a history of typical amoebic infections with genitourinary symptoms, the disease should be highly suspected, and laboratory and serological tests are an important basis for determining the diagnosis.
Differential diagnosis
Acute pyelonephritis
There are also low back pain, fever and frequent urination, urgency, urinary pain symptoms, and symptoms similar to kidney and bladder amebiasis, but this disease is a common disease in women, no history of amoebic dysentery and liver abscess, no rice soup-like urine Or jam-like urine symptoms, lumbar and abdomen did not touch the mass, urine sediment smear and bacterial culture are pathogenic bacteria, and no amoeba trophozoites were found.
Pus kidney
Mainly manifested as recurrent low back pain, often accompanied by frequent urination, urgency, dysuria, sometimes pyuria, urine routine examination has a large number of pus cells, urine culture positive, but no jam-like urine, no rot in the urine, urine The liquid and abscess puncture the abscess without amebic trophozoites or cysts, which can be distinguished from renal amebiasis.
3. kidney tuberculosis
Also manifested as repeated frequent urination, urgency, pyuria, hematuria accompanied by low fever and weight loss, but also rice soup-like urine, but patients often have a history of tuberculosis, urinary sediment smear acid-fast staining can be found acid-fast bacilli but no jam-like Urine, no amoeba trophozoites or cysts, no carrion-like tissue, IVU visible pyelonephritis edge blurred, worm-like changes, increased erythrocyte sedimentation rate (erythrocyte sedimentation rate), can be distinguished from renal amebiasis .
4. Peri-renal inflammation and peri-renal abscess
Also manifested as fever, low back pain, lumbar vertebrae to the affected side, limited limb activity, sometimes with frequent urination, urgency, dysuria, similar symptoms to kidney, bladder amebiasis, but the patient has no history of amebiasis infection There is no jam-like urine, no rotted meat-like tissue in the urine, and there is no amoebic trophozoite or cyst in the pus.
5. Kidney tumor
Sometimes it can be expressed as fever, low back pain and gross hematuria. It can be licked and kidney lumps during physical examination, but the patient has no jam-like urine, no rotted meat-like tissue in the urine, no amebic trophozoites in the urine and abscess puncture. Or cysts, B-ultrasound and CT examinations are helpful for diagnosis and can be distinguished from renal amebiasis.
6. Penile cancer
There are also penile head ulcers, and there are pus and bloody secretions on the surface, similar to the performance of penile amebiasis, but penile cancer has many phimosis or prepuce, and the early stage of the disease is papule head, sputum, later It develops into a cauliflower shape, followed by local erosion to form an ulcer, and biopsy can confirm the diagnosis.
7. Penile actinomycosis
Visible multiple ulcers and bloody secretions in the penis, similar to penile amebiasis, but the penis head ulcer is shallower, the surface granules are purple-red, the edge is uplifted, the bottom is serum exudation, and the secretion is mirrored. The test found "sulphur granules", local biopsy showed granulomatous structure, granular granules, but no amoeba trophozoites could be found.
8. Acute cystitis
It also manifests as urinary frequency, urgency, dysuria and other bladder irritation symptoms, but no rice soup-like urine, jam-like urine, no rotted meat-like tissue in the urine, no amoebic trophozoites and amoeba can be found in urine examination. The sac can be distinguished from the kidney and bladder amebiasis.
9. bladder tuberculosis
It also manifests as urinary frequency, urgency, dysuria and other symptoms of bladder irritation, but patients often have a history of lung or kidney tuberculosis, no jam-like urine, no carrion-like tissue in the urine, and no amoebic cysts in the urine test. Destructive changes in renal parenchyma can be seen in the IVU.
