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Pleuropulmonary Amebiasis in Iraq
Pleuropulmonary Amebiasis in Iraq* ABDUL jABBAR lMARI, M.D ., F .C.C.P.*
Baghdad, Iraq
P
All were men. Their ages ranged from 22 to 46 years old. Ten of them were in a debilitated and malnourished condition. The patients were assessed by the usual clinical methods, fluoroscopy, radiography and diagnostic pneumoperitoneum. Amebae could not be demonstrated in the sputum nor in the empyema pus. The stool examination showed E. histolytica cysts in 14 patients. Sigmoidoscopy revealed normal colonic mucosa.
ULMONARY AMEBIASIS IS USUALLY THE
result of the rupture of an amebic abscess of the liver through the diaphragm, but sometimes the amebae may be carried to the lung by the blood stream and cause pneumonia. Abscesses may form later in the involved areas. Pleural involvement may be the only clinical and radiologic intrathoracic complication. A dry pleurisy may occur in a large proportion of amebic pneumonitis where the lesion spreads to involve the pleura. A serofibrinous effusion may follow. Empyema results from rupture of liver abscess into the pleural space. The exact incidence of amebiasis and the pleuropulmonary manifestations in Iraq are unknown, but are much less than 15 years ago. We believe that the drop in incidence of this disease is due to better sanitation and hygienic conditions and frequent use of antibiotics. The purpose of this paper is to emphasize that in regions where amebiasis is endemic, pleuropulmonary amebiasis should be suspected when there is evidence of disease, clinical or radiologic, in the lower right chest whether or not amebae have been demonstrated in the stool.
CLINICAL FEATURES
The symptoms of pleuropulmonary amebiasis are variable and may be those of lung abscess, consolidation, pleurisy, pleural effusion or empyema. The systemic symptoms were fatigue, abdominal pain and weight loss in the rna jority of cases. M yalgia in 15 cases; anorexia, flatulence and constipation in ten cases; diarrhea, or blood and mucus in the stool in a few cases. TABLE 2-RESPIRATORY SYMPTOMS IN THE PRESENT SERIES
Symptoms Fever Pain in the right lower chest (anterior or posterior) Cough
MATERIAL AND METHODS
Chill Dyspnea Sputum Hemoptysis
This series includes 20 cases with amebiasis manifested in the chest in the following forms (Table 1). TABLE I-THE AMEBIC MANIFESTATIOSS IN THE RIGHT CHEST IS THE PRESENT SERIES
Number of Patients 20
19 12 9
7 4
2
Hepatic symptoms were overshadowed by the pulmonary disease, but in one fatal case with severe jaundice not included in this series, a closed pulmonary abscess was overlooked but was discovered at necropsy. The liver was enlarged and tender in 19 cases. Signs of fluid in the right chest in seven cases including the empyema cases. A pleural rub over the right lower chest was audible early in two cases. A few crepi-
Number of Lesions Patients Pneumonitis with serofibrinous effusion 8 Large empyema 5 Pneumonitis with dry pleurisy 3 Moderate pleural effusion 2 Lung abscess 2 *Professor of Medicine, Medical College, Baghdad University. At present, Research Associate in Medicine, Harvard Medical School and Peter Bent Brigham Hospital, Boston, Massachusetts.
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Baghdad, Iraq
P
All were men. Their ages ranged from 22 to 46 years old. Ten of them were in a debilitated and malnourished condition. The patients were assessed by the usual clinical methods, fluoroscopy, radiography and diagnostic pneumoperitoneum. Amebae could not be demonstrated in the sputum nor in the empyema pus. The stool examination showed E. histolytica cysts in 14 patients. Sigmoidoscopy revealed normal colonic mucosa.
ULMONARY AMEBIASIS IS USUALLY THE
result of the rupture of an amebic abscess of the liver through the diaphragm, but sometimes the amebae may be carried to the lung by the blood stream and cause pneumonia. Abscesses may form later in the involved areas. Pleural involvement may be the only clinical and radiologic intrathoracic complication. A dry pleurisy may occur in a large proportion of amebic pneumonitis where the lesion spreads to involve the pleura. A serofibrinous effusion may follow. Empyema results from rupture of liver abscess into the pleural space. The exact incidence of amebiasis and the pleuropulmonary manifestations in Iraq are unknown, but are much less than 15 years ago. We believe that the drop in incidence of this disease is due to better sanitation and hygienic conditions and frequent use of antibiotics. The purpose of this paper is to emphasize that in regions where amebiasis is endemic, pleuropulmonary amebiasis should be suspected when there is evidence of disease, clinical or radiologic, in the lower right chest whether or not amebae have been demonstrated in the stool.
CLINICAL FEATURES
The symptoms of pleuropulmonary amebiasis are variable and may be those of lung abscess, consolidation, pleurisy, pleural effusion or empyema. The systemic symptoms were fatigue, abdominal pain and weight loss in the rna jority of cases. M yalgia in 15 cases; anorexia, flatulence and constipation in ten cases; diarrhea, or blood and mucus in the stool in a few cases. TABLE 2-RESPIRATORY SYMPTOMS IN THE PRESENT SERIES
Symptoms Fever Pain in the right lower chest (anterior or posterior) Cough
MATERIAL AND METHODS
Chill Dyspnea Sputum Hemoptysis
This series includes 20 cases with amebiasis manifested in the chest in the following forms (Table 1). TABLE I-THE AMEBIC MANIFESTATIOSS IN THE RIGHT CHEST IS THE PRESENT SERIES
Number of Patients 20
19 12 9
7 4
2
Hepatic symptoms were overshadowed by the pulmonary disease, but in one fatal case with severe jaundice not included in this series, a closed pulmonary abscess was overlooked but was discovered at necropsy. The liver was enlarged and tender in 19 cases. Signs of fluid in the right chest in seven cases including the empyema cases. A pleural rub over the right lower chest was audible early in two cases. A few crepi-
Number of Lesions Patients Pneumonitis with serofibrinous effusion 8 Large empyema 5 Pneumonitis with dry pleurisy 3 Moderate pleural effusion 2 Lung abscess 2 *Professor of Medicine, Medical College, Baghdad University. At present, Research Associate in Medicine, Harvard Medical School and Peter Bent Brigham Hospital, Boston, Massachusetts.
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