Intestinal Protozoal Diseases Treatment & Management

Updated: Apr 26, 2017
  • Author: Enrique Chacon-Cruz, MD; Chief Editor: Russell W Steele, MD  more...
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Treatment

Medical Care

See the list below:

  • The most important aspect of providing care for children with diarrhea caused by intestinal protozoa includes standard pediatric assessments.

  • Evaluate the child for signs of dehydration, including tachycardia, delayed capillary refill, decreased tears, decreased activity, decreased urine output, and altered mental status.

  • Hypovolemic shock rarely occurs with these infections but must be recognized.

  • The child must be evaluated for the adequacy of the nutritional status. This is particularly important in cases of chronic diarrhea and possible immunodeficiency.

  • Weight must be measured and compared on the growth curve. Appropriate interventions occur following this immediate assessment.

  • Oral rehydration therapy (ORT) is the preferred approach for children with mild-to-moderate dehydration. Intravenous rehydration should rarely be necessary. Current recommendations for pediatric rehydration are outlined best in The Management of Acute Diarrhea in Children: Oral Rehydration, Maintenance, and Nutritional Therapy. [22]

  • Following immediate fluid resuscitation for dehydration, the clinician must address potential nutritional issues and provide adequate nutrition to the child with acute or chronic diarrhea.

  • Protozoal GI infections in immunocompetent patients are usually mild-to-moderate self-limited diseases, and special precautions are not needed.

  • The hallmark for treatment of these diseases is specific antiprotozoal therapy.

  • Patients with severe amebic or balantidic colitis should not receive oral nutrition and should be monitored for potential surgical complications.

  • Consider parenteral nutrition in some patients.

  • Patients with amebic liver abscess should be treated in the hospital until potential complications have been ruled out.

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Surgical Care

Only 2 well-recognized conditions in which surgical therapy is necessary for intestinal protozoal diseases are known: necrotizing colitis, caused by E histolytica or B coli, and complicated amebic liver abscess.

  • Indications for surgery in fulminant amebic colitis include the following:

    • Failure to respond to antiamebic drugs following perforation and localized abscess formation

    • Persistence of abdominal distension and tenderness despite effective antiamebic therapy

    • Toxic megacolon

  • Partial colectomy with colostomy is recommended over primary anastomosis for localized colonic disease because an anastomosis may be incompetent because of the friable condition of the affected intestinal wall.

  • For extensive disease, better surgical results have been obtained with total colectomy with exteriorization of the proximal and distal ends.

  • Indications for needle aspiration in amebic liver abscess include the following:

    • Rupture to pleura, pericardium, or both

    • Left lobe abscesses and proximity to the pericardium

    • As a diagnostic procedure when a pyogenic abscess is highly suspected

    • When surgical drainage is indicated because of imminent rupture of the abscess to the peritoneal cavity or presence of necrotizing colitis

    • When, in some cases, perianal fistulization of intestinal amebic foci is present and necessitates surgical drainage

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Consultations

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  • The primary care physician can manage the vast majority of cases of gastroenteritis associated with protozoal infections. These infections rarely result in complications requiring hospitalization.

  • In patients with chronic diarrhea or amebic liver abscess, consultation with a gastroenterologist along with an infectious-disease specialist may be useful.

  • Surgeons should be consulted when the patient is suspected to have necrotizing colitis, complicated amebic liver abscess, or both.

  • Nutritional support may also be beneficial in severe cases.

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Diet

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  • In immunocompetent patients, effective antiprotozoal therapy results in full recovery.

  • Some patients with severe giardiasis may experience disaccharidase deficiency and may require lactose-free diets, but this is a temporary condition that usually does not last more than 2 weeks.

  • Patients with AIDS and severe spore-forming protozoal infections (chronic diarrhea with wasting syndrome) require hypercaloric diets. This is indicated for the protozoal illness in addition to the wasting syndrome associated with the underlying disease.

  • For amebic liver abscess, some experts recommend a low-fat diet during antiamebic treatment, but no clinical trials have examined the effects of this diet on the patient's outcome.

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Activity

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  • The only limitations for physical activity are in patients with amebic liver abscess who may require hospitalization and patients who require surgery for necrotizing colitis.

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