Acanthamoeba vaginitis

Acanthamoeba vaginitis



[Summary]



Acanthamoeba vaginitis (Amebic vaginitis) secondary to multiple intestinal infection, in patients with fecal Acanthamoeba trophozoites (Amebic trophozoite) with the stool mucus from the direct spread to the vulva and vagina mouth.



[Diagnosis]




Since this disease is a rare, sometimes clinicians will be overlooked, according to diarrhea or dysentery history and the test, the diagnosis can be made. Is the most reliable diagnosis from vaginal secretions (also check with the faeces) found Acanthamoeba trophozoites. Pap smear method can be used directly or culture solution for the organization Acanthamoeba (entamoeba histolylica) protozoa, as well as lesions of the pathological examination. Inspection of negative vaginal secretions chronic ulcer cases, biopsy should be done.


[Treatment]




Treatment of systemic therapy principles with partial treatment. Commonly used drugs: ① hydrochloride ipecac alkali (emetini hydrochloridium), the killing of Acanthamoeba trophozoites strongest role, but the role of the cyst not sure, toxicity, the heart and kidney dysfunction, the elderly and frail patients pregnant women and other prohibited. Common daily dose of 0.06 g (1mg/kg), deep intramuscular injection, for 6 to 9 days for a course of treatment, repeat the treatment in 20 to 30 days; ② Kabbah arsenic, 0.25 g per day 2 , 10 days for a course of treatment; ③ metronidazole 200 ~ 400 mg three times a day, 10 to 14 days of treatment; ④ Brucea javanica (functus bruceae) on Entamoeba effective, can also be used for chronic patients and HIV carriers , oral Brucea javanica-10 to 15, three times a day, seven days for a course of treatment. Local treatment: the drug can be made for vaginal washing solution, or made into powder and vaginal suppository day, a total of 7 to 10 days for a course of treatment.


[Etiology:




In a healthy situation, and generally does, incidence, but if body condition, especially vulvovaginal damaged, local resistance is low, Acanthamoeba trophozoites can take advantage of growth and reproduction, cause amoebic vaginitis.


[Pathological changes:




Acanthamoeba ulcer formation of the basic disease of vaginitis. When the amoeba parasite invasive vaginal mucosa, with the activities of pseudo-foot dissolved organization and secretion of enzymes (histolytic enzyme), the mucosal cell necrosis and ulceration, marginal uplift, lesions around a small number of plasma cells and lymphocytes infiltrating. Ulcer surface coating yellow brown necrotic material containing dissolved cell debris, mucus and Acanthamoeba trophozoites.


[Clinical]




Vaginal secretions were serous or mucus, which can be found the trophozoites. When a vaginal mucosa ulceration, hemorrhage, can be transformed into purulent secretions or blood. Sometimes Zhicui ulcers can occur in the cervix, vulva, integration into large necrosis. Individual cases as serious connective tissue reaction, showed irregular tumor-like proliferation of hardware, ulcers face covered in bloody mucus secretion and easily misdiagnosed as cancer.