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Amebiasis

(Amoebiasis)

by Richard D. Pearson, MD

Amebiasis is an infection of the large intestine and sometimes the liver and other organs that is caused by the single-celled protozoan parasite Entamoeba histolytica, an ameba.

  • The amebas may be spread from person to person or through food or water.

  • People may have no symptoms or may have diarrhea, constipation, cramping abdominal pain, tenderness in the upper abdomen, and fever.

  • Doctors base the diagnosis on analysis of a stool sample and, if needed, other tests, such as colonoscopy or ultrasonography and blood tests.

  • People are given a drug that kills the amebas, followed by a drug that kills the dormant form of the amebas in the large intestine.

Amebiasis tends to occur in areas where sanitation is inadequate. Most infections occur in areas of Africa, the Indian subcontinent, and parts of Central and South America. In the United States, it is most likely to occur in immigrants and, less commonly, in people who have traveled to developing countries.

Entamoeba histolytica exists in two forms:

  • An active parasite (trophozoite)

  • A dormant parasite (cyst)

Transmission of amebiasis

Infection begins when cysts are swallowed. The cysts hatch, releasing trophozoites that multiply and can cause ulcers in the lining of the intestine. Occasionally, they spread to the liver or other parts of the body. Some trophozoites become cysts, which are excreted in stool (feces) along with trophozoites. Outside the body, the fragile trophozoites die, but the hardy cysts survive.

Cysts can be spread directly from person to person or indirectly through food or water.

In places with poor sanitation, amebiasis is acquired by ingesting food or water that is contaminated with feces. Fruits and vegetables may be contaminated when grown in soil fertilized by human feces, washed in polluted water, or prepared by someone who is infected. Amebiasis may occur and spread in places with adequate sanitation if infected people are incontinent or hygiene is poor (for example, in day care centers or mental institutions). Amebiasis can also be spread through certain sexual practices (such as oral-anal sex).

Symptoms of Amebiasis

Many infected people have few or no symptoms. Amebiasis symptoms that may occur include

  • Increased gas (flatulence)

  • Cramping abdominal pain

  • Intermittent diarrhea, constipation, or both.

In severe cases, the abdomen is tender when touched, and the stool contains mucus and blood. The person may also have a fever. Diarrhea may lead to dehydration. Wasting of the body (emaciation) and anemia can occur in people with chronic infection. Sometimes a large lump (ameboma) forms and blocks the intestine.

Occasionally, trophozoites cause tearing (perforation) of the intestinal wall, resulting in severe abdominal pain and an abdominal infection (peritonitis) that requires immediate medical attention.

In some people, the amebas spread to the liver where they can cause an abscess. Symptoms include fever, sweats, chills, weakness, nausea, vomiting, weight loss, and pain or discomfort in the upper right part of the abdomen over the liver.

Rarely, amebas spread to other organs (including the lungs or brain). The skin may also become infected, especially around the buttocks, genitals, or wounds caused by abdominal surgery or injury.

Diagnosis of Amebiasis

  • Stool tests

  • Possibly examination of a tissue sample from the large intestine

  • Sometimes blood tests to detect antibodies to the amebas

To diagnose amebiasis, a doctor collects stool samples for analysis. The best approach is to test the stool for a protein released by the amebas (antigen testing) or to use the polymerase chain reaction (PCR) technique to check the stool for the ameba's genetic material. The PCR technique produces many copies of the ameba's genetic material and thus makes the ameba easier to identify. These tests are more useful than microscopic examination of stool samples, which is often inconclusive. Also, microscopic examination may require three to six stool samples to find the amebas, and even when they are seen, they cannot be distinguished from other amebas such as Entamoeba dispar, which look the same but are genetically different and do not cause disease.

A flexible viewing tube (colonoscope) may be used to look inside the large intestine and to obtain a tissue sample if ulcers or other signs of infection are found there.

When amebas spread to sites outside the intestine (such as the liver), they may no longer be present in the stool. Ultrasonography, computed tomography (CT), or magnetic resonance imaging (MRI) can be done to confirm an abscess in the liver, but these tests do not indicate the cause. Blood tests are then done to check for antibodies to the amebas. ( Antibodies are proteins produced by the immune system to help defend the body against a particular attack, including that by parasites.) Or, if doctors suspect that a liver abscess is due to amebas, they often simply start a drug that kills amebas (an amebicide). If the person improves, the diagnosis is probably amebiasis.

Prevention of Amebiasis

Preventing food and water from being contaminated with human feces is key to preventing amebiasis. Improving sanitation systems in areas where the infection is common can help.

When traveling to areas where the infection is common, people should avoid eating uncooked foods, including salads and vegetables, and should avoid consuming potentially contaminated water and ice. Boiling water kills cysts. Filtering water through a filter that has the words "absolute 1 micron or less" on it and/or dissolving iodine or chlorine in the water may help. However, the effectiveness of iodine or chlorine depends on many factors, such as on how cloudy or muddy the water is (turbidity) and what its temperature is.

Treatment of Amebiasis

  • An amebicide and/or a drug to kill cysts

If amebiasis is suspected and the person has symptoms, an amebicide (a drug that kills amebas)—either metronidazole or tinidazole—is used. Metronidazole must be taken for several days. Usually, tinidazole is given as a single large dose. Tinidazole has fewer side effects than metronidazole. People should not drink alcohol while taking either of these drugs or for several days after stopping them because doing so may result in nausea, vomiting, flushing, and headaches. Metronidazole and tinidazole are not given to pregnant women.

Neither metronidazole nor tinidazole always kills cysts that are in the large intestine. A second drug (such as paromomycin, iodoquinol, or diloxanide) is used to kill these cysts and thus prevent a relapse. One of these drugs can be used alone to treat people who do not have symptoms but have the amebas in their stool.

People who are dehydrated are given fluids.

Drugs Mentioned In This Article

  • Generic Name
    Select Brand Names
  • YODOXIN
  • FLAGYL
  • No US brand name
  • TINDAMAX