Fulminant Amebic Colitis after Corticosteroid Therapy: A Systematic Review

• Published in: PLoS neglected tropical diseases Vol. 10; no. 7; p. e0004879
• Main Authors: Shirley, Debbie-Ann, Moonah, Shannon
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 28.07.2016; Public Library of Science (PLoS)
• Subjects: Acquisitions & mergers; Adrenal Cortex Hormones - adverse effects; Biology and Life Sciences; Care and treatment; Colitis; Complications and side effects; Corticosteroid drugs; Developing countries; Development and progression; Diarrhea; Dysentery, Amebic - etiology; Dysentery, Amebic - pathology; English literature; Entamoeba histolytica; Fatalities; Food contamination & poisoning; Funding; Gangrene; Humans; Immunosuppression; Infections; Inflammatory bowel disease; Intervention; LDCs; Medical diagnosis; Medicine and Health Sciences; Morbidity; Mortality; Parasites; Risk factors; Travel; Tropical diseases
• ISSN: 1935-2735; 1935-2727; 1935-2735
• DOI: 10.1371/journal.pntd.0004879

Amebic colitis, caused by intestinal infection with the parasite, Entamoeba histolytica, is a common cause of diarrhea worldwide. Fulminant amebic colitis is the most devastating complication of this infection, associated with both high mortality and morbidity. We conducted a review of the English literature to describe cases of fulminant amebic colitis associated with exposure to corticosteroid medications in order to identify the risk factors for poor outcome and determine difficulties in diagnosis and treatment. Articles reporting severe and fulminant forms of amebic colitis between 1991 and 2016 were collected. 525 records were screened to identify 24 cases for qualitative analysis associated with corticosteroid use. Cases arose from areas of high endemicity or travel to such areas. Most cases (14 of 24, 58%) were given corticosteroids for initially misdiagnosed colitis, mainly inflammatory bowel, resulting in rapid progression of disease. Nearly half of all cases underwent surgical intervention, and 25% of cases died, despite all patients eventually receiving treatment with metronidazole. The odds of death did not differ significantly by prior misdiagnosis, co-morbidities, bowel perforation or need for surgery. Infection with E. histolytica should be considered prior to the administration of corticosteroids, in particular for patients residing in endemic areas or those with appropriate travel history, especially prior to the diagnosis of inflammatory bowel disease. The development of preventative and treatment interventions are needed to improve outcomes of fulminant disease.