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Amebiasis

Human protozoa disease

Amoebiasis, or amoebic dysentery, is an infection of the intestines caused by a parasitic amoeba Entamoeba histolytica. Amoebiasis can be present with no, mild, or severe symptoms. Symptoms may include lethargy, loss of weight, colonic ulcerations, abdominal pain, diarrhea, or bloody diarrhea. Complications can include inflammation and ulceration of the colon with tissue death or perforation, which may result in peritonitis. Anemia may develop if there is prolonged gastric bleeding. Cysts of Entamoeba can survive for up to a month in soil or for up to 45 minutes under fingernails. Invasion of the intestinal lining may result in bloody diarrhea. If the parasite reaches the bloodstream it can spread through the body, most frequently ending up in the liver where it can cause amoebic liver abscesses. Liver abscesses can occur without previous diarrhea. Diagnosis is made by stool examination using microscopy, but it can be difficult to distinguish E. histolytica from other harmless entamoeba species. An increased white blood cell count may be present in severe cases. The most accurate test is finding specific antibodies in the blood, though the antibody test may remain positive following treatment. Bacterial colitis can result in similar symptoms. Prevention of amoebiasis is by improved sanitation, including separating food and water from faeces. There is no vaccine. There are two sets of treatment options depending on the location of the infection: amoebiasis in tissues is treated with either metronidazole, tinidazole, nitazoxanide, dehydroemetine or chloroquine, and luminal infection is treated with diloxanide furoate or iodoquinoline. Effective treatment against all stages of the disease may require a combination of medications. Infections without symptoms may be treated with just one antibiotic, and infections with symptoms are treated with two antibiotics. Amoebiasis is present all over the world, though most cases occur in the developing world. It is estimated that approximately 50 million people worldwide are infected with Entamoeba histolytica each year, with approximately 100,000 deaths among them (i.e. approximately two deaths per thousand cases). The first documented case of amoebiasis was in 1875. In 1891, the disease was described in detail, resulting in the terms amoebic dysentery and amoebic liver abscess. Further evidence from the Philippines in 1913 found that upon swallowing cysts of E. histolytica volunteers developed the disease.