611 Annals of Tropical Medicine and Public Health | Nov-Dec 2012 | Vol 5 | Issue 6
Impaired consciousness revealing a cerebral amebiasis in an immunocompetent adult
Hanane Ezzouine, Boubaker Charra, Abdellatif Benslama, Said Motaouakkil
Department of Anesthesia and Intensive Care, Medical Intensive Care Unit, University Teaching Hospital Ibn Rochd, Casablanca, Morocco
ABSTRACT
Amebiasis is a parasitic infection with manifestations, mainly digestives. It is rarely described extra- gastrointestinal locations including the brain. We report the case of a patient aged 42, made five months earlier for an appendectomy, and was admitted to the ICU after a convalescent stable uncomplicated. At admission, he was 12/15 in Glasgow and had a right hemiplegia. Brain CT revealed a discrete diffuse hypodensities perilesional edema. An abdominal ultrasound found an aspect for multiple hepatic abscesses. Abscess puncture was performed, which was not conclusive, and no seed could be identified. On Ultrasound, no cardiac abnormalities were found, and no endocarditis was present. And since the appearance macroscopic (chocolate-brown), amebic serology is performed and has been highly positive. The therapeutic management included an intubation and ventilation as well as a tri-antibiotic-based ceftriaxon, metronidazol and gentamycin. Confirmation of amebiasis required high doses of metronidazol for an extended period. The replay of the play was an appendectomy for an amebome. Evolution was favorable. Amebiasis can have extraintestinal locations, issues to think about including the cerebral forms.
Key words: Ameboma, cerebral amebiasis, favorable evolution, immunocompetent adult
Introduction
Amebiasis is a parasitic infection cosmopolitan tropic intestinal. It had mainly digestive symptoms (acute dysentery). However, it can have extra-intestinal manifestations (liver, skin, and even brain) and distorting the diagnosis. We report the case of a young adult with cerebral localization, and neurological clinical result was indicative of multifocal amebiasis (ameboma, liver, and brain).
Case Report
We report the case of a patient aged 42, made five months earlier for an appendectomy and admitted to the ICU after a convalescent stable uncomplicated. At admission, clinical examination found a patient with
12/15 in Glasgow and has a right hemiplegia. His hemodynamic status was stable, his blood pressure was 127/56 mmHg and heart rate was 97 beats/minute.
It was fast breathing at 20 cycles/minute and arterial oxygen saturation was 97% in an open air. Examination pleuropulmonary and cardiovascular were normal. In addition, the patient was afebrile, and the rest of the clinical examination found a discrete hepatomegaly.
Capillary blood glucose was 0.97 g/liter.
In blood tests, urea at 0.20 g/l creatinine 12 mg/l in serum; Na 129 mEq/l; serum potassium of 3.8 mEq/l.
Transaminase: ASAT 22 IU/L ALAT to 17 IU/L.
A complete blood count: Hemoglobin 10 g/
dl, leukocytes and platelets 15 000/mm3 in 305000/ mm3. Prothrombin time to 63% fibrinogen 2.1 g/L The CT scan revealed diffuse hypodensities with a discrete perilesional edema. Echocardiography was without faults. The ejection fraction was preserved.
No signs of endocarditis or valvular were present. An abdominal ultrasound supplemented by an abdominal CT scan found multiple liver abscesses. HIV negative serology. The therapeutic management consisted of intubation and ventilation, a tri-antibiotic-based ceftriaxon, metronidazol, and gentamicin.Ultrasound- guided puncture of liver abscesses surface allowed the
Address for correspondence:
Dr. Hanane EZZOUINE Service de Réanimation Médicale-CHU Ibn Rochd 1, Quartier des hopitaux . Casablanca. MOROCCO E-mail: ezzouinehanane@yahoo.fr
C A SE REPOR T
Access this article online Quick Response Code: Website:
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DOI:
10.4103/1755-6783.109316
612 Annals of Tropical Medicine and Public Health | Nov-Dec 2012 | Vol 5 | Issue 6 612
Ezzouine, et al.: Impaired consciousness revealing a cerebral amebiasis in an immunocompetent adult
Conclusion
Amebiasis is a parasitic cosmopolitan related primarily to sanitation. Amebic dysentery is the most common clinical expression; however, the extraintestinal locations including brain and liver are possible and can be revealing.
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evacuation of 200 ml of pus, colored “chocolate-brown.”
The bacteriological and parasitological pus evacuated failed to germ tify and gave the macroscopic appearance (chocolate-brown), amebic serology was performed and has been highly positive. Confirmation of amebiasis involved in therapeutic, high doses of metronidazol (4 grams/day) administered for an extended period (60 days). The outcome was favorable with a marked neurological improvement. In abdominal ultrasound and CT scan, the initial lesions regressed.
A replay of the part of appendicitis had performed 5 months earlier and found a ameboma (a rare form of digestive localization).
Discussion
Amebiasis, caused by human parasite Entamoeba histolytica, is the third most deadly parasitic disease in the world.[1-4] (WHO: 10% of the world population is infected, mainly in the tropics.) Infection is usually asymptomatic. The parasite can, however, crossing the intestinal mucosa, causing painful and bloody diarrhea (amebic dysentery), ulcers, and in more severe forms, lead to abscesses in the liver, lungs, and brain.
Transmission and spread of the ameba involved, aided by poor sanitary conditions of the countries most affected by this neglected disease, is a major public health. The interest of our observation lies in the unique way of revelation or of impaired consciousness and loss motricity signs.[1-9] Major contribution of imaging (abdominal ultrasound with the possibility to perform ultrasound-guided puncture for diagnostic purposes but also the brain scans for diagnostic purposes and monitoring.).[10-12]
Furthermore, it is to raise the contribution of amebic serology very positive that guided diagnosis. Similarly, we stress the vital importance of the analysis careful pathological and its contribution, early diagnosis, and treatment (ameboma).
Cite this article as: Ezzouine H, Charra B, Benslama A, Motaouakkil S.
Impaired consciousness revealing a cerebral amebiasis in an immunocompetent adult. Ann Trop Med Public Health 2012;5:611-2.
Source of Support: Nil, Conflict of Interest: None declared.
