Amebiasis

Also called amoebic dysentery, amebiasis can cake the form of either an acute or a chronic protozoal infection. Extraintestinal amebiasis can induce hepatic abscess and infection of the lungs, pleural cavity, pericardium, peritoneum and, rarely, the brain.

Amebiasis occurs worldwide; about 90% of infections are asymptomatic and the rest produce symptoms ranging from amoebic dysentery to abscesses of the liver and other organs. It's the third most common cause of death from paralytic disease, after schistosomiasis and malaria. It's most common in the tropics, subtropics, and other areas with poor sanitation and health practices.

Causes

Transmission generally occurs through ingestion of cysts from food or water contaminated by feces. All household members should have their stools examined because person to person transmission can occur.

Symptoms and Signs

Few strains of amebae are harmless but others, for unknown reasons, invade the intestinal wall, causing mucus secretion into the intestines and diarrhea - an illness called amebic dysentery. Additional symptoms may include fever, and abdominal cramping and pain.

In severe cases, ulcers may form in the intestinal wall; the amebae gain access to the bloodstream and travel to the liver to form abscesses.

The symptoms often are quite mild and can include

• loose stools
• stomach pain
• stomach cramping.

Diagnostic tests

Isolating E. histolytica in fresh stool or in aspirates ,from abscesses, ulcers, or tissue confirms acute amebiasis. Endoscopy can aid in diagnosis, unless it's contraindicated by fulminant disease.

Other tests that support the diagnosis include:

• indirect hemagglutination test (positive with current or previous infection)
• complement fixation (usually positive only during active disease)
• liver scan, which may reveal abscesses.

Treatment

The patient with amebiasis is treated with metronidazole, the preferred amebicide for intestinal and extraintestinal infection that causes symptoms of acute colitis or liver abscess. Other agents for asymptomatic carriers include diloxamine furoate, iodoquinol, or paromomysin. For liver abscess without intestinal infections, the patient receives metronidazole, tinidazole, imidazole, plus the other agents as listed above for the asymptomatic carrier.

Exploratory surgery is hazardous because it can lead to peritonitis, perforation, and pericecal abscess. Percutaneous drainage of abscesses of the liver may be necessary, but surgery is usually reserved for patients with a perforation or rupture.

Prevention

• Drinking only water that has been bottled in sanitary conditions or boiled.
• Eating only cooked or peeled vegetables or fruits

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