Clinical Brief
Neonatal Amoebiasis Pushpendra Magon Department of Pediatrics, Vinayaka Mission Medical College, Karaikal, Pondicherry, India
ABSTRACT The authors report a case of neonatal amebiasis presenting with vomiting, refusal to feeds, abdominal distension and mucoid stools. The diagnosis was made on the basis of clinical appearance of stools and the presence of Entameba Histolytica. The purpose of this report is to alert to the possibility of amoebiasis in newborns, if baby presents with NEC like picture in an endemic area and to send the stool sample immediately to examine for trophozoites, especially because the diarrheal stool starts autolyzing within 30 min of defecation. This 14-day-old newborn, who was possibly infected with orally given jaggery solution is presented. He was successfully treated with intravenous tinidazole. [Indian J Pediatr 2010; 77 (8) : 903-904] E-mail:
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Key words: Neonatal amebiasis; Entameba histolytica; NEC
REPORT OF CASE Amebiasis is a parasitic disease caused by Entamoeba histolytica. Only few cases of symptomatic infection have yet been reported in neonates, but mortality in fulminant amebic colitis is notably high in infants.1-4 A 14-day-old full term girl born in an endemic area, to a primigravida at 37 wk of gestation by normal vaginal delivery with no antenatal or natal problems, was brought with history of mucoid stools. Source of the infection was evaluated and was found possibly to be the water supply, as the child was given tap water soon after the birth. On physical examination weight was 2.7 kg and the vital signs were stable. However, the abdomen was distended with decreased bowel sounds, with no evidence of organomegaly. Examination of chest, central nervous system and skin were normal. Investigations at admission revealed (Hb 15 g/dL, Hct. 45%, Platelets 157000/mm 3, WBCs -10900/mm 3 with neutrophils 65%, band forms 8%, lymphocytes 22% and monocytes 5%). Biochemistry tests revealed sugar (108 mg/dL), BUN (12.4 mg/dL), serum total protein (5.3 g/ dL), Na (134 mEq/L), K (5.1 mEq/L), Ca (9.3mg/dL), P (6.5 mg/dL), PT/PTT were prolonged (15.6/46.7sec) and CRP was positive. The urine test and chest radiographs were normal. Abdominal radiographs showed distended Correspondence and Reprint requests : Dr. Pushpendra Magon, K1, Staff Quarters, Vinayaka Mission Medical College, Keezha Kasakudimedu, Karaikal-609609, Pondicherry, India. [DOI-10.1007/s12098-010-0140-z] [Received December 6, 2009; Accepted March 22, 2010]
Indian Journal of Pediatrics, Volume 77—August, 2010
loops gas in the colon. Nurses were instructed to collect fresh stools and send it to the laboratory for immediate examination. Naked eye examination of the stools revealed mucoid stools. Examination using the concentration method demonstrated amebiasis (E. histolytica). Stool examination revealed positive occult blood with many leukocytes and showed trophozoites of E. histolytica. Blood culture was negative. In view of mucoid stools, decreased bowel sounds, abdominal distension and stool occult blood, the baby was not given anything orally and was administered fluids with antibiotics and Vitamin K. The baby was treated with tinidazole intravenously from the fifth day of hospital stay. Her abdomen regained normal contour on the tenth day. Repeat stool examination was negative for occult blood, leukocytes, and ameba. The patient was discharged on 25th day, without complications and was followed up for 3 months, with no relapse. DISCUSSION Amebiasis was first reported in 1875 by the St. Petersburg's physician, Fedor Aleksandrovich Lösch, who described amebic trophozoites in the stool and colonic ulcerations of a farmer who died of dysentery. 1 The infection of E. histolytica usually occurs through the ingestion of the cyst form, which change to trophozoites and attach to the colon wall (minimum latent period is two days). Once attached to the colonic epithelia, the trophozoites release a proteinase that allows the organisms to penetrate beneath the submucosal tissue producing flask-shaped ulcers of amoebic colitis.2-3 903
Pushpendra Magon The parasite infects approximately 10% of the world population, annually. In endemic areas like Indian subcontinent about 25% of population has antibodies to E.histolytica from previous sub-clinical infections via fecaloral route. 4-6 However, amoebic infection is not often suspected in newborn age group, even in the endemic areas The purpose of this report is to alert to the possibility of amoebiasis in newborns on oral feeds other than breast milk, if baby presents with NEC like picture. REFERENCES 1. Lesh FA. Massive development of amebiasis in the large intestine. Am J Trop Med Hyg 1975; 24: 383-392.
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2. Seydel KB, Li E, Swanson PE, Stanley SL Jr. Human in-testinal epithelial cells produce proinflammatory cytokinesin response to infection in a SCID mouse-human intestinal xenograft model of amebiasis. Infect Immun 1997; 65: 1631-1639. 3. Gathiram V, Jackson TF. A longitudinal study of asymptomatic carriers of pathogenic zymodemes of Entamoeba histolytica. S Afr Med J 1987; 72: 669-672. 4. Berhman RE, Kliegaman RM, Jensom HB. Nelson Textbookof Pediatrics. 17th ed. Philadelphia; WB Saunders Co, 2002; 11231125. 5. Petri WA Jr, Singh U. Diagnosis and management of amebiasis. Clin Infect Dis 1999; 29: 1117-1125. 6. Haque R, Mondal D, Kirkpatrick BD et al. Epidemiologic and Clinical characteristics of acute diarrhea with emphasis on Entamoeba histolytica infections in preschool children in urban slum of Dhaka, Bangladesh. Am J Trop Med Hyg 2003; 69: 398-405.
Indian Journal of Pediatrics, Volume 77—August, 2010
