the elderly and immunocompromised pts. , or after inappropriate use of cortocosteroids

common in malnourished infants, the elderly and immunocompromised pts. , or after inappropriate use of cortocosteroids. Features are numerous bloody stools, generalised abdominal pain, rectal tenesmus, high fever, nausea and vomiting. Colonic perforation is a common complication. Toxic megacolon occurs occasionally and is characterised by marked abdominal distension. Diagnosis - Presence of amoebic trophozoites in stools, positive serology, leucocytosis. Abdominal radiographs my reveal a paralytic ileus located in the area of the colon if there is associated perforation. In toxic megacolon generalised distension of the colon with intramural gas may be seen. (b) Bronchitis and bronchopneumonia - sometimes amounting to gangrene. 3. Amoebic pericarditis - Amoebic abscess of left lobe may rupture into pericardium and cause acute cardiac tamponade. 4. Cerebral - Abscess of brain from blood-borne infection. 5. Uro-genital - Subacute cystitis and prostatitis, abscess of kidney, epididymis or testis, ovary or perianal region. Ulcer of urethra in male and cervix in female. E. histolytica may be found in urine if fistula between rectum and bladder. Amoebic vaginitis Amoebic ulceration of glans penis. 6. Abscess of spleen. 7. Cutaneous - Ulceration of skin round anus, at the site of drainage of a liver abscess, round colostomy wound in a case of chronic ulcerative colitis, or sinus of an empyema. PERCUTANEOUS ASPIRATION OF LIVER ABSCESS - with wide bored needle. (a) Indications - (i) Left lobe abscess. (ii) Palpable mass (iii) Massive abscess. (iv) Persistent localized tenderness. (v) Markedly raised hemidiaphragm. (vi) Pleuritic pain suggesting an impending leak. (vii) Failure of symptoms to remit on drug therapy. (viii) When pyogenic or mixed infection is suspected. (b) Site - The needle is introduced into area of maximum tenderness or into 8th or 9th intercostal spaces in midaxillary line. All available pus should be removed If abscess is in left lobe or presenting on lower surface aspiration should be performed through the open abdomen. SURGICAL DRAINAGE - performed under ultrasound or CT guidance. Indications - (i) Rupture of liver abscess. (ii) Imminent rupture of an inaccessible liver abscess (particularly of left lobe). NO When there is risk of peritoneal leakage of necrotic fluid after aspiration. Perforation - Gastric suction, IV fluids and electrolytes together with tetracycline 1 gm. daily and emetine hydrochloride in standard dosage IV metronidazole. Surgery should be avoided. Giardiasis G. intestinalis is a flagellate that exists as a motile trophozoite but can survive outside its mammalian hosts as a cyst. It is found in travellers, children in day-care centres and those with immunoglobulin deficiency states. The mechanism by which Giardia produces disease has not been established, though villous atrophy, mucosal inflammation and inhibition of pancreatic enzymes has been described Clinical features -1. Asymptomatic - in majority. 2. Acute giardiasis - Loose, foul smelling stools; mid-epigastric cramps, nausea, anorexia, flatulence and abdominal distension. After 1 -2 weeks, the watery diarrhoea diminishes and patient is left with increased frequency of bowel movements, passing soft, yellow, offensive stools At this stage the infection may take one of three courses. (a) Progressive resolution of symptoms, with return of normal bowel movement and spontaneous eradication persisting excretion of of Giardia cysts in the stools. (c) Persisting symptomatic infection. 3.Persistent