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, FACP
Peter F Weller, MD, FACP
- 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 .
- Haque R, Huston CD, Hughes M, et al. Amebiasis. N Engl J Med 2003; 348:1565.
- Bercu TE, Petri WA, Behm JW. Amebic colitis: new insights into pathogenesis and treatment. Curr Gastroenterol Rep 2007; 9:429.
- Peterson KM, Singh U, Petri WA Jr. Enteric Amebiasis. In: Tropical Infectious Diseases: Principles, Pathogens and Practice, 3rd ed, Guerrant R, Walker DH, Weller PF (Eds), Saunders Elsevier, Philadelphia 2011. p.614.
- Heredia RD, Fonseca JA, López MC. Entamoeba moshkovskii perspectives of a new agent to be considered in the diagnosis of amebiasis. Acta Trop 2012; 123:139.
- Caballero-Salcedo A, Viveros-Rogel M, Salvatierra B, et al. Seroepidemiology of amebiasis in Mexico. Am J Trop Med Hyg 1994; 50:412.
- Haque R, Faruque AS, Hahn P, et al. Entamoeba histolytica and Entamoeba dispar infection in children in Bangladesh. J Infect Dis 1997; 175:734.
- Weinke T, Friedrich-Jänicke B, Hopp P, Janitschke K. Prevalence and clinical importance of Entamoeba histolytica in two high-risk groups: travelers returning from the tropics and male homosexuals. J Infect Dis 1990; 161:1029.
- Salit IE, Khairnar K, Gough K, Pillai DR. A possible cluster of sexually transmitted Entamoeba histolytica: genetic analysis of a highly virulent strain. Clin Infect Dis 2009; 49:346.
- Morán P, Ramos F, Ramiro M, et al. Infection by human immunodeficiency virus-1 is not a risk factor for amebiasis. Am J Trop Med Hyg 2005; 73:296.
- Hung CC, Deng HY, Hsiao WH, et al. Invasive amebiasis as an emerging parasitic disease in patients with human immunodeficiency virus type 1 infection in Taiwan. Arch Intern Med 2005; 165:409.
- Padilla-Vaca F, Anaya-Velázquez F. Insights into Entamoeba histolytica virulence modulation. Infect Disord Drug Targets 2010; 10:242.
- Mortimer L, Chadee K. The immunopathogenesis of Entamoeba histolytica. Exp Parasitol 2010; 126:366.
- Stanley SL Jr. Amoebiasis. Lancet 2003; 361:1025.
- Haque R, Duggal P, Ali IM, et al. Innate and acquired resistance to amebiasis in bangladeshi children. J Infect Dis 2002; 186:547.
- Haque R, Mondal D, Duggal P, et al. Entamoeba histolytica infection in children and protection from subsequent amebiasis. Infect Immun 2006; 74:904.
- Lejeune M, Rybicka JM, Chadee K. Recent discoveries in the pathogenesis and immune response toward Entamoeba histolytica. Future Microbiol 2009; 4:105.
- Ximénez C, Cerritos R, Rojas L, et al. Human amebiasis: breaking the paradigm? Int J Environ Res Public Health 2010; 7:1105.
- Graffeo R, Archibusacci CM, Soldini S, et al. Entamoeba dispar: A Rare Case of Enteritis in a Patient Living in a Nonendemic Area. Case Rep Gastrointest Med 2014; 2014:498058.
- Yakoob J, Abbas Z, Beg MA, et al. Entamoeba species associated with chronic diarrhoea in Pakistan. Epidemiol Infect 2012; 140:323.
- Shimokawa C, Kabir M, Taniuchi M, et al. Entamoeba moshkovskii is associated with diarrhea in infants and causes diarrhea and colitis in mice. J Infect Dis 2012; 206:744.
- Ximénez C, Morán P, Rojas L, et al. Reassessment of the epidemiology of amebiasis: state of the art. Infect Genet Evol 2009; 9:1023.
- Gonzales ML, Dans LF, Martinez EG. Antiamoebic drugs for treating amoebic colitis. Cochrane Database Syst Rev 2009; :CD006085.
- Okamoto M, Kawabe T, Ohata K, et al. Amebic colitis in asymptomatic subjects with positive fecal occult blood test results: clinical features different from symptomatic cases. Am J Trop Med Hyg 2005; 73:934.
- Stockinger ZT. Colonic ameboma: its appearance on CT: report of a case. Dis Colon Rectum 2004; 47:527.
- Misra SP, Misra V, Dwivedi M. Ileocecal masses in patients with amebic liver abscess: etiology and management. World J Gastroenterol 2006; 12:1933.
- Kenner BM, Rosen T. Cutaneous amebiasis in a child and review of the literature. Pediatr Dermatol 2006; 23:231.
- Rayan HZ. Microscopic overdiagnosis of intestinal amoebiasis. J Egypt Soc Parasitol 2005; 35:941.
- Gonzalez-Ruiz A, Haque R, Rehman T, et al. A monoclonal antibody for distinction of invasive and noninvasive clinical isolates of Entamoeba histolytica. J Clin Microbiol 1992; 30:2807.
- González-Ruíz A, Haque R, Rehman T, et al. Further diagnostic use of an invasive-specific monoclonal antibody against Entamoeba histolytica. Arch Med Res 1992; 23:281.
- Gonzalez-Ruiz A, Haque R, Rehman T, et al. Diagnosis of amebic dysentery by detection of Entamoeba histolytica fecal antigen by an invasive strain-specific, monoclonal antibody-based enzyme-linked immunosorbent assay. J Clin Microbiol 1994; 32:964.
- Haque R, Kress K, Wood S, et al. Diagnosis of pathogenic Entamoeba histolytica infection using a stool ELISA based on monoclonal antibodies to the galactose-specific adhesin. J Infect Dis 1993; 167:247.
- Haque R, Ali IK, Akther S, Petri WA Jr. Comparison of PCR, isoenzyme analysis, and antigen detection for diagnosis of Entamoeba histolytica infection. J Clin Microbiol 1998; 36:449.
- Petri WA Jr, Singh U. Diagnosis and management of amebiasis. Clin Infect Dis 1999; 29:1117.
- Haque R, Petri WA Jr. Diagnosis of amebiasis in Bangladesh. Arch Med Res 2006; 37:273.
- Roy S, Kabir M, Mondal D, et al. Real-time-PCR assay for diagnosis of Entamoeba histolytica infection. J Clin Microbiol 2005; 43:2168.
- Qvarnstrom Y, James C, Xayavong M, et al. Comparison of real-time PCR protocols for differential laboratory diagnosis of amebiasis. J Clin Microbiol 2005; 43:5491.
- Blessmann J, Buss H, Nu PA, et al. Real-time PCR for detection and differentiation of Entamoeba histolytica and Entamoeba dispar in fecal samples. J Clin Microbiol 2002; 40:4413.
- Fotedar R, Stark D, Beebe N, et al. Laboratory diagnostic techniques for Entamoeba species. Clin Microbiol Rev 2007; 20:511.
- Tanyuksel M, Petri WA Jr. Laboratory diagnosis of amebiasis. Clin Microbiol Rev 2003; 16:713.
- Hamzah Z, Petmitr S, Mungthin M, et al. Development of multiplex real-time polymerase chain reaction for detection of Entamoeba histolytica, Entamoeba dispar, and Entamoeba moshkovskii in clinical specimens. Am J Trop Med Hyg 2010; 83:909.
- Liang SY, Hsia KT, Chan YH, et al. Evaluation of a new single-tube multiprobe real-time PCR for diagnosis of Entamoeba histolytica and Entamoeba dispar. J Parasitol 2010; 96:793.
- Drugs for Parasitic Infections, 3rd Ed, The Medical Letter, New Rochelle, NY 2013.
- Misra NP, Gupta RC. A comparison of a short course of single daily dosage therapy of tinidazole with metronidazole in intestinal amoebiasis. J Int Med Res 1977; 5:434.
- Singh G, Kumar S. Short course of single daily dosage treatment with tinidazole and metronidazole in intestinal amoebiasis: a comparative study. Curr Med Res Opin 1977; 5:157.
- Presutti antiprotozoal agent Tindamax clears FDA; AWP is $18 per dose. In: "The Pink Sheet" vol 66, F-D-C Reports, Inc. Chevy Chase, MD 2004. p.10.
- Mackey-Lawrence NM, Petri WA Jr. Amoebic dysentery. BMJ Clin Evid 2011; 2011.
- Stanley SL Jr. Protective immunity to amebiasis: new insights and new challenges. J Infect Dis 2001; 184:504.
- Lotter H, Tannich E. The current status of an amebiasis vaccine. Arch Med Res 2006; 37:292.