Intestinal Entamoeba histolytica amebiasis
- Karin Leder, MBBS, FRACP, PhD, MPH, DTMH
Karin Leder, MBBS, FRACP, PhD, MPH, DTMH
- Section Editor — Travel Medicine
- Head of Infectious Diseases Unit
- Monash University, Australia
- Peter F Weller, MD, MACP
Peter F Weller, MD, MACP
- Editor-in-Chief — Infectious Diseases
- Section Editor — Tropical Medicine
- William Bosworth Castle Professor of Medicine
- Harvard Medical School
- Professor of Immunology and Infectious Diseases
- Harvard T. H. Chan School of Public Health
Intestinal amebiasis is caused by the protozoan Entamoeba histolytica. Most infection is asymptomatic; clinical manifestations include amebic dysentery and extraintestinal disease . Worldwide, approximately 50 million people develop colitis or extraintestinal disease, with over 100,000 deaths annually . Extraintestinal manifestations include amebic liver abscess and other more rare manifestations such as pulmonary, cardiac, or brain involvement; these are discussed separately. (See "Extraintestinal Entamoeba histolytica amebiasis".)
There are three species of intestinal amebae with identical morphologic characteristics: E. histolytica, E. dispar, and E. moshkovskii . Most symptomatic disease is caused by E. histolytica; E. dispar is generally considered nonpathogenic. Reported infections with E. moshkovskii are becoming more frequent; its pathogenic potential remains unclear .
Issues related to intestinal E. histolytica infection will be reviewed here; issues related to extraintestinal E. histolytica infection are discussed separately. (See "Extraintestinal Entamoeba histolytica amebiasis".)
Amebiasis occurs worldwide; the prevalence is disproportionately increased in developing countries because of poor socioeconomic conditions and sanitation levels. Infection with E. dispar occurs approximately 10 times more frequently than infection with E. histolytica . Areas with high rates of amebic infection include India, Africa, Mexico, and parts of Central and South America. The overall prevalence of amebic infection may be as high as 50 percent in some areas . The seroprevalence of E. histolytica in one Mexican study was 8.4 percent . In another series from urban Bangladesh, children had a 4.2 percent prevalence rate of E. histolytica infection .
In developed countries, amebiasis is generally seen in migrants from and travelers to endemic areas. E. histolytica is not a common cause of travelers' diarrhea, and gastrointestinal infection is uncommon in travelers who have spent less than one month in endemic areas. In one prospective study of German travelers to the tropics, only 0.3 percent had pathogenic E. histolytica infection . Institutionalized patients and sexually active homosexuals are also at increased risk of infection .
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