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Six months of bloody diarrhea – what is the cause? A mystery patient

Up to 15 times a day, the man must go to the toilet. He suffers from a bloody diarrhea. For three months, he continues this until he visits his family doctor. The doctor can create a bacterial culture that is negative. He still prescribes the patient a broad spectrum antibiotic, which he should take for seven days. However, the 67-year-old will not be good.

He allows another three months to pass before seeking medical help again: he now reports to the Dijon-Bourgogne University Hospital emergency department. In addition to diarrhea, further problems have arisen. The man has had a fever for two days. In addition, his upper abdomen hurts. He has reported that he has lost about five kilograms since the start of his complaint.

Doctors note that the patient is taking medications for chronic hypertension. He is retired and lives with his partner.

The location of abdominal pain causes doctors to report a liver problem. However, the man has no jaundice that can be associated with liver disease. The body is also not pathologically enlarged, reports the team around Capucine Martins in the journal BMJ Case Reports.

A blood test reveals that the number of white blood cells is increasing, as is the so-called C-reactive protein. Both speak for an infection against which his body is struggling.

Abscesses in the liver

With the help of a calculated tomography, doctors look at the stomach and abdomen. His colon shows signs of chronic inflammation. In the liver, they discover two abscesses that are around six to seven centimeters in diameter. From these they suck off a reddish liquid.

At this time, they cannot safely say what caused the abscesses. Most likely, they are the result of a bacterial infection of the gastrointestinal tract.

Less likely, but it is also conceivable that the bacteria attacked their heart and then reached the liver via the bloodstream. And finally, doctors cannot rule out that other pathogens are behind the symptoms instead of bacteria.

Additional tests should clarify this. Consequently, no bacteria can be detected in the blood. There are no traces of typical bacterial diarrhea pathogens in a pallet sample.

The fluid from the liver process appears to be bacterial-free. But the doctor can prove that they have genetic material of a pathogen. It is a unicellular, the amoeba Entamoeba histolytica. Further tests confirm this. The man is suffering from an extremely rare disease in Europe: the so-called amoebic dysentery. The unicellular organisms have colonized his intestines and caused his complaints. In addition, they are responsible for liver pants, this is not an untypical consequence of infection with E. histolytica.

How did the man become infected?

Now doctors want to know where the man was infected with amoeba. As a rule, those affected by Europe were earlier in the tropics or subtropics. But the 67-year-old has never been outside Europe.

However, his partner was in regions where amoebic dysentery occurs – including in India, Vietnam and South America. In addition, she used to have a partner who had an amoebic dysentery. She never suffered from symptoms, but a test shows that she carries the pathogens. This is not uncommon: in 90 percent of people, infection with E. histolytica causes no symptoms, reports the German Tropical Medicine Association in its guideline for the treatment of the disease. However, those affected can eliminate the pathogens and infect others. In most cases, poor hygienic conditions ensure the transmission of amoeba, such as contaminated drinking water. The parasites can also be transmitted during intercourse. It was probably the case with the 67-year-old Frenchman.

The antibiotic, which the man originally received on suspicion of bacterial infection, immediately stops doctors – the drug does not help against amoeba. Instead, he gets a cure for these pathogens. Within 48 hours, liver pain drops, bloody diarrhea disappears and his laboratory values ​​return to normal levels. His partner also takes the drug.

At a follow-up time two months later, the man is good and no traces of the pathogens can be detected.

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