Intestinal Amebiasis: Diagnosis and Management

Intestinal amebiasis is an infection due to Entamoeba Histolytica and has the highest prevalence in tropical countries, including Indonesia. Amebiasis is responsible for approximately 70,000 deaths annually every year. High prevalence is found especially in endemic area which had poor hygiene and sanitation or crowded population. Human is the main reservoir, while the disease can be transmited by mechanical vector such as cokckroach and flies. Making diagnosis of intestinal amebiasis sometimes can be a problem. Clinical presentation and disease severity may be varied. Complication due to late management of the disease can be fatal. Lifestyle education, early diagnosis and proper management of amebiasis are very important measures to promote by health workers

Nosocomial Clostridium Difficile Diarrhea in Patient with Malignancy

Clostridium difficile (C. difficile) is the main pathogen causing antibiotics associated diarrhea and colitis. This bacterium increases with hospitalization with incidence of 20-60 cases per 100,000 patients/day. C. difficile is gram positive bacilli which produce toxins in 2,700 cases in every 100,000 exposures to particular antibiotics, such as clindamycin, cephalosporin, and ampicillin. These antibiotics disrupt the intestinal normal flora and predispose to colonization of C. difficile. This case described a 53-year old male patient with squamous cell carcinoma in his left ear who came to Department of Internal Medicine, Cipto Mangunkusumo Hospital, with the complain of diarrhea since two weeks after one month hospitalization in Department of Ear, Nose, and Throat. The characteristics of the diarrhea were 10 times per day ± 100 mL, watery consistency, green yellowish in color, and no blood in the feces. Additionally, the patient also complained of pain in all parts of his stomach, especially in the epigastric area. Earlier, patient was given ceftazidime for 30 days of hospitalization. The serology examination of C. difficile in the feces showed positive result (titer = 0.790 and control = 0.190). During the colonoscopy examination, pancolitis was found and the pathologic anatomy result was found appropriate for infective colitis. Thereafter, antibiotic administration was ceased and metronidazole was administered intravenously three times a day. The diarrhea stopped after seven days and the patient was discharged

Candidiasis in Malignancy

Esophageal candidiasis presents with a range of clinical findings and is rarely found among immunocompetent patient without predisposing factors. Between 20-50% of patient may be asymptomatic. One of predisposing factor of candidiasis is immunocompromised condition due to Malignancy. Dysphagia is the most frequently presented feature of esophageal carcinoma. We demonstrated a case of esophageal candidiasis as one of early clinical presentation in patient with esophageal carcinoma

Colonic Tuberculosis: a High Index of Suspicion

Tuberculosis remains to be one of the most common problems in developing countries such as Indonesia. It can involve many organs including gastrointestinal tract. Colonic tuberculosis is an ancient disease and has long been recognized. However, it is sometimes difficult to make early diagnosis due to nonspecific sign and symptoms. In endemic areas, correct diagnoses were made only 50% of the time. Without a high index of suspicion of the disease, it has been rarely diagnosed correctly. We reported a case of colonic tuberculosis in 18 years old female patient with lung tuberculosis.Endoscopic examination showed ulcerative mucosa, ‘halo lesion\u27, and pseudopolyp while PPD skin test, sputum smear and histopathological examination of endoscopic biopsy revealed negative for tuberculosis infection. The presence of lung tuberculosis had made high index of suspicion of colonic tuberculosis. Standard regimen of antituberculosis therapy was given and the patient showed good clinical response