Metronidazole in amoebiasis 1. The use of metronidazole on the treatment of hepatic and pulmonary amoebiasis

, Cho, Kee Mok; , Hong, Soon Ok; , Lee, Jun Young; , Choi, Yong Kyu; , Soh, Chin Thack

doi:1970.8.2.58

Korean J Parasito > Volume 8(2):1970 > Article

Original Article


Korean J Parasitol. 1970 Aug;8(2):58-62. English. Published online Mar 20, 1994. http://dx.doi.org/10.3347/kjp.1970.8.2.58
Copyright © 1970 by The Korean Society for Parasitology


Metronidazole in amoebiasis 1. The use of metronidazole on the treatment of hepatic and pulmonary amoebiasis
Kee Mok Cho,Soon Ok Hong,Jun Young Lee,Yong Kyu Choi and Chin Thack Soh
Department of Parasitology, Yonsei University College of Medicine, Seoul, Korea.



Abstract
Total 9 cases of extraintestinal amoebiasis, amebic liver abscess and amebic lung abscess, were treated with metronidazole. The diagnosis and progress check were done by (1) stool examination, (2) size and pain of liver, (3) hematological examination, (4) urinanalysis, (5) X-ray or liver scanning (6) examination of aspirated pus from liver and (7) immobilization test of E. histolytica. Results are summarized as follows: 1. Amebic hepatitis: Metronidazole was given to 3 cases with daily dose of 0.9-1.2 gm for 3-7 days. Clinical symptoms were completely restored by the treatment. 2. Amebic lung abscess: One case was treated with metronidazole for 3 days with the daily dose 1.2 gm. X-ray findings showed remarkable improvement by the treatment. An additional administration of the drug for 6 days resulted complete resolution of the pneumonic changes. 3. Amebic liver abscess: Four cases were treated with metronidazole. The daily doses were 0.4-2.4 gm and continued for 2-10 days. Aspiration of the abscess for 1-10 times or continuous drainage of pus were performed during the course supplementarily. All cases were recovered to normal by the combining treatment. No remarkable side effect was noticed by the drug administration, and no relapse was experienced up to date.

Figures


	Fig. 1 X-Ray film of lung abscess before treatment; Case No. 4- C.B. Moon, 42, Male. The film shows homogenouse increased of density at the right base suggesting pneumonic consolidation or abscess. Dome of diaphragm on the same side is also elevated probably due to liver involvement.


	Fig. 2 X-Ray film of Case No. 4, 16 days after the 1st treatment. The previouse pneumonic changes are almost disappeard.


	Fig. 3 X-Ray film of Case No. 4, 2 weeks after the 2nd treatment. Slight linea scarring with complete resolution of pneumonic changes are recognized.


	Fig. 4 X-Ray film of Case No. 4, 2 months after the 2nd treatment. It still shows complete resolution of the pneumonic changes.


	Fig. 5 Photograph of liver abscess patient; Case No. 5- S.K.Ko, 7, Male. Curved line indicates enlarged liver, and dotted line is the right costal arch.


	Fig. 6 photograph (seated view) of Case No. 5 (Fig. 5).


	Fig. 7 photograph of liver abscess patient; Case No. 6- S.B. Kim, 54, Male. Curved line indicates enlarged liver.


	Fig. 8 photograph (seated view) of Case No. 6(Fig. 7).


	Fig. 9 X-Ray film of liver abscess patient before the treatment; Case No, 7- J.C. Kim, 36, Male. The film shows elevation of rght dome of diaphragm up to level of 8th rib, probably due to liver involvement.


	Fig. 10 X-Ray film (A-p view) of Case No. 7, which 950ml and 450ml of pus were aspirated within 2 days interval and 50% "Hypaque" was injected as a contrast media after removal of abscess fluid. Irregular walled abscess cavities in liver are observed.


	Fig. 11 X-Ray film (lateral view) of Case No. 7(Fig. 10).


	Fig. 12 X-Ray film of Case No. 7, 7 days after the treatment. Marked depression of diaphragm to 7th rib level indicates remarkable improvement of liver abscess.


	Fig. 13 Color scan(A-p view) of liver abscess before the treatment; Case No.8- S.H.Kim, 31 Male. It shows markedly enlarged liver in size with large cold area of radio activity in the right lobe. The mottled densities in the remaining are is obsewed.


	Fig. 14 Liver color scan (lateral view) of Case No.8(Fig. 13).


	Fig. 15 Liver color scan (A-p view) of Case No. 7, 1 month after the treatment. The size of liver and the cold area in the right lateral side of the liver is apparently reduced, showing improved funtioning.


	Fig. 16 Liver color scan (lateral view) of Case No. 8(Fig. 15). Findings are suggestive of fairimprovement of the space occupying lesion.

Tables


	Table 1 Treatment of hepatic & pulmonary amoebiasis with Metronidazole (1-β-hydroxyethyl-2-methyl-5-nitroimidazole)

References


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3.	Powell SJ, et al. Am J Trop Med Hyg 1966;15:300–302.

4.	Powell SJ, Wilmot AJ, Elsdon-Dew R. Single and low dosage regimens of metronidazole in amoebic dysentery and amoebic liver abscess. Ann Trop Med Parasitol 1969;63(2):139–142.