Abstract
BackgroundAmebic colitis, caused by intestinal infection with the parasite, Entamoeba histolytica, is a common cause of diarrhea worldwide. Fulminant amebic colitis is the most devastating complication of this infection, associated with both high mortality and morbidity. We conducted a review of the English literature to describe cases of fulminant amebic colitis associated with exposure to corticosteroid medications in order to identify the risk factors for poor outcome and determine difficulties in diagnosis and treatment.Methodology and Principal FindingsArticles reporting severe and fulminant forms of amebic colitis between 1991 and 2016 were collected. 525 records were screened to identify 24 cases for qualitative analysis associated with corticosteroid use. Cases arose from areas of high endemicity or travel to such areas. Most cases (14 of 24, 58%) were given corticosteroids for initially misdiagnosed colitis, mainly inflammatory bowel, resulting in rapid progression of disease. Nearly half of all cases underwent surgical intervention, and 25% of cases died, despite all patients eventually receiving treatment with metronidazole. The odds of death did not differ significantly by prior misdiagnosis, co-morbidities, bowel perforation or need for surgery.Conclusions and SignificanceInfection with E. histolytica should be considered prior to the administration of corticosteroids, in particular for patients residing in endemic areas or those with appropriate travel history, especially prior to the diagnosis of inflammatory bowel disease. The development of preventative and treatment interventions are needed to improve outcomes of fulminant disease.
Highlights
Amebic colitis, caused by the protozoan parasite Entamoeba histolytica, is a leading cause of severe diarrhea worldwide, killing more than 55,000 people globally each year [1]
Infection with E. histolytica should be considered prior to the administration of corticosteroids, in particular for patients residing in endemic areas or those with appropriate travel history, especially prior to the diagnosis of inflammatory bowel disease
In the largest global study of childhood diarrheal illness conducted to date, E. histolytica was shown to be a top cause of severe diarrhea among infants and children living in Africa and Asia, and was the leading cause of unadjusted mortality in the 12 to 24 month age group [3]
Summary
Amebic colitis, caused by the protozoan parasite Entamoeba histolytica, is a leading cause of severe diarrhea worldwide, killing more than 55,000 people globally each year [1]. In the largest global study of childhood diarrheal illness conducted to date, E. histolytica was shown to be a top cause of severe diarrhea among infants and children living in Africa and Asia, and was the leading cause of unadjusted mortality in the 12 to 24 month age group [3]. Trophozoite invasion of the intestinal mucosa leading to mucosal inflammation is a hallmark of amebic colitis. Amebic colitis, caused by intestinal infection with the parasite, Entamoeba histolytica, is a common cause of diarrhea worldwide. Fulminant amebic colitis is the most devastating complication of this infection, associated with both high mortality and morbidity. PLoS Negl Trop Dis 10(7): e0004879. doi:10.1371/journal.pntd.0004879
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