- Tunisia. A 9-year-old child has diarrhoea. You find lots of cysts with 8 nuclei in the faeces. What do you think?
- Venezuela. A 34-year-old man has had fever for 3 weeks and pain at the lower right ribs. There is clearly pain upon percussion of the liver. On the lateral side a painful bulge is observed between the ribs. He has had Furamide® for two weeks without improvement. The faeces contain no amoebic cysts, or trophozoites. What do you think, and what do you do?
- Peru. A 14-year-old child has bloody diarrhoea. He has fever (38.9°
C). What enquiries do you make and what do you do?
- Iraq. A man exhibits a painful skin ulcer on his abdomen which is rapidly growing larger. There is a small lateral fistula at the level of the lower right ribs. His general condition is very poor. What do you do?
- Java. A shopkeeper has dysentery. Amoebiasis is suspected and he is started on metronidazole. After taking the first tablets he has severe nausea. What enquiries need to be made?
- Honduras. A patient receives surgery for appendicitis. Five days later he develops fever and pain over the liver region. His general condition is poor and becomes progressively worse. A liver aspiration produces 40 ml of stinking pus. What do you think?
- Ghana. A man has had loose, bloody stools for 10 days. Upon rectoscopy several ulcers are observed on the rectal mucosa. The ulcers have an eroded undermined edge. A rectal smear is taken and the material is placed on a slide. A number of other patients are still waiting to be seen. Afterwards all the material is taken to the lab. You eat lunch. In the afternoon you are told that the sample contained no amoebae. What now?
- Draw an Entamoeba histolytica trophozoite and cyst and indicate the important characteristics.
- Moçambique. You have 1000 tablets of diloxanide (500 mg) in your supplies. Each day 50 people consult you (6 days a week). 10% of these people have Entamoeba histolytica cysts in their faeces. If you are going to treat everyone (10 days therapy), how long will your supplies last?
- Indonesia. A man has progressive bloody diarrhoea. At another hospital, cysts of Entamoeba histolytica have never been found after repeated faecal analysis. Suggest some possibilities.
