<<Disclaimer: Verify this information before applying it to your situation.>>
NOTE: I am not a physician
> 1) What is amoebic dysentery and could CD be mistaken for it?
Amoebic dysentary is an infection by a pathogen protazoa (Entamoeba
histolytica). It is primairily intestinal (although it can, it untreated,
migrate to the liver, brain and lungs) and can cause ulceration of the
intestinal mucosa. (This could presmueably lead to malabsorption. If
she had permanent damage to the mucosa, it might have been compensated for
earlier but, with a normal decline in absorption due to aging, have later
resulted in malabsorption. E. histolytica is also known to recurr many
years later after apparently having been cured (possibly due to
encapsulation in cysts which later ruptured or due to subclinial chronic
infection which later flared up). E. histolytica also "likes" iron -
those with high levels of iron are much more susceptible to infection and
it is more serious in them. I have not seen a reference to it as such,
but it seems logical to me that if it uses a lot of iron, it might cause an
iron deficiency anemia. Anyway, the point is that E. hystolytica should
certainly be checked for. The stool test is somewhat tricky (unless it
has been improved in the years since I dealt with it) - it is not
constantly present in the stool, so a number of tests must be taken AND
they must be delivered FRESH to the lab within a few hours, AND the lab
must be very experienced in doing the test (this usually means a public
health lab at the state level) (again, this is as of about 86, so things
may have changed.) NOTE: Just because a lab DOES a test does NOT
mean that it is proficient at it. The accuracy (sensitivity and
specificity) of many tests can vary quite a bit depending on which
laboratory does them.
Both CD and amoebic dysentary can cause malabsorption (with similar
symptoms) and a mild, chronic case of E. h. might have a lot of
similarities to CD. I was diagnosed with CD about 18 years after a
case of probable E. h.*1. Some of the medical literature I read stressed
that it very often recurrs years later and should always be considered as
a possiblity in any future diagnosis where symptoms are compatable with it.
> 2) If so, if she were your aunt, would you say something to her at this
>point in her life, or would you just let it go?
If other symptoms are compatable (and, of course, depending on her
personality and on the nature of her relationship*2 with you) you might
suggest that she get an endomesial antibody test done for CD as well as an
ELISA test done for E. h. Earlier posts on this list have stated that
diagnosis and treatment of CD is worthwhile even at advanced ages (although
the intestinal biopsy might well be skipped - a postive AB test would
probably be considered sufficient considered the hardships of an IB at 80).
Regardless of the CD and E h. tests, her iron should certainly be checked
(anemia should never be ASSUMED to be due to iron deficiency as there are
other causes and INAPPROPRIATE iron supplementation may cause serious
problems in some cases.
Jim Barron
Chapel Hill NC
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*1 althought, since the diagnosis was only clinical (lab tests were
"inconclusive") and I now know I have iron overload (as well as CD) AND as
I had eaten a VERY large number of raw oysters just prior to the
infections, it may well have been a case of Vibrio fulnivicus misdiagnosed
as E. h. (no one else out of the 150+ people at the clambake became ill)
*2 I have found out the hard way that sometimes the most difficult person
to try to give advice (or even make suggestions to) is a family member!
Remember that you can make suggestions and try to inform her a little, but
she knows more than anyone else what she has experienced and when and the
final decision is, of course, up to her. Just inform her to the extent
that she is willing to be informed.
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