Micrognome » overseas travel http://micrognome.priobe.net Microbes, infectious diseases and the causal relationship that links them Sun, 29 Jan 2012 04:40:31 +0000 en hourly 1 http://wordpress.org/?v=3.2.1 Abdominal pain in an overseas resident http://micrognome.priobe.net/2010/06/abdominal-pain-in-an-overseas-resident/ http://micrognome.priobe.net/2010/06/abdominal-pain-in-an-overseas-resident/#comments Sun, 27 Jun 2010 12:54:20 +0000 micrognome http://micrognome.priobe.net/?p=1347

Clinical case of upper abdominal pain in overseas resident

A 54 year old businessman presents with right upper quadrant pain after spending the last six months living in Java.

An ultrasound scan revealed gallstones. A laparoscopic cholecystectomy was then performed. At this point a lesion was observed on the surface of the liver, but not biopsied.

Four months later, on another return visit to Australia, the patient re-presented with fever, a cough and pain radiating to his shoulder tip. He was admitted to a district hospital and a chest X-ray performed. Changes consistent with right lower lobe consolidation were observed and intravenous antibiotics (i.v. Ticarcillin/Clavulanic acid) commenced. The patient did not improve and was transferred to a larger hospital.

After 7 days of intravenous antibiotics he coughed up a large quantity of viscous, brown phlegm with a paste-like consistency. These CT scan views were obtained at this point:

CT thorax after coughing up 'anchovy paste'

 

CT upper abdomen showing hepatic lesion

 

The patient’s serum was sent to the Microbiology laboratory with the following result:

Entamoeba histolytica titre > 1:4096

This was seen under the microscope in the paste-like sample of phlegm:

Microscope view of patient's sputum, showing microbe with internalised red cells

 

Q1   What do the CT scans show?

  • CT thorax: peri-mediastinal opacity
  • CT upper abdomen: smooth-walled lesion within liver

Q2   What object was seen under the microscope?

  • amoebic trophozoite  (Entamoeba histolytica) containing erythrocytes

Q3   What pathological process explains these observations?

  • amoebic liver abscess with trans-diaphragmatic extension and rupture into a bronchiole or bronchus, probably during coughing

Q4   What treatment would you recommend?

  • 750 mg Metronidazole i.v. x3 doses x 10 days
  • followed by paromomycin x3 doses

]]> http://micrognome.priobe.net/2010/06/abdominal-pain-in-an-overseas-resident/feed/ 1 Barefoot in Brazil http://micrognome.priobe.net/2010/04/barefoot-in-brazil/ http://micrognome.priobe.net/2010/04/barefoot-in-brazil/#comments Wed, 07 Apr 2010 00:03:03 +0000 micrognome http://micrognome.priobe.net/?p=431

A 26 year old fit and well mining engineer returns from working in north-eastern Brazil with an intensely pruritic rash on both feet, present for several weeks.

He has been self treating the rash with over-the-counter creams and tablets from Brazil, and has also self-traumatised the area with a penknife.

 

 

1 What is the diagnosis?

2  What is the treatment?

 

Answers

The Stafinator, 7th April.

 

 

 

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