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Extraintestinal Entamoeba histolytica amebiasis

INTRODUCTION

Amebiasis is caused by the protozoan Entamoeba histolytica. The parasite exists in two forms, a cyst stage which is the infective form, and a trophozoite stage which is the form that causes invasive disease. Worldwide, approximately 40 to 50 million people are infected annually [1], with the majority of infections occurring in developing countries due to poorer socioeconomic conditions and sanitation levels. In developed countries such as the United States, amebiasis is mainly seen in migrants from and travelers to endemic countries. Most infection is asymptomatic, but amebic dysentery, amebic liver abscess, and rarely other manifestations such as pulmonary, cardiac or brain involvement can occur [2].

The extraintestinal manifestations of amebiasis will be reviewed here. Gastrointestinal infection with E. histolytica is discussed separately. (See "Intestinal Entamoeba histolytica amebiasis".)

AMEBIC LIVER ABSCESS

Amebic liver abscess is the most common extraintestinal manifestation of amebiasis. Amebae establish hepatic infection by ascending the portal venous system [3].

Epidemiology — There are some epidemiologic features of amebic liver abscess that are strikingly different from intestinal amebiasis.

  • Amebic liver abscess (and other extraintestinal disease) is 7 to 10 times more common in adult men despite an equal gender distribution in children and despite an approximately equal sex distribution of colonic amebic disease [4,5]. Although the reasons for the differences in gender distribution have not been fully explained, some possible mechanisms that have been suggested include: hormonal effects (postmenopausal women have increased rates) and a potential role of alcoholic hepatocellular damage in creating a nidus for portal seeding [6]. The latter is probably more important.
  • Intestinal amebiasis is not common in short term travelers, but amebic liver abscesses can occur after travel exposures as short as four days [7]. In one study, 35 percent of travelers with amebic liver abscess had spent less than six weeks in an endemic area [8].
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