The protozoan parasite Entamoeba histolytica , possibly other Entamoeba spp.
Fecal–oral route, either by eating or drinking fecally contaminated food or water or person-to-person contact (such as by diaper changing or sexual activity).
Amebiasis is distributed worldwide, particularly in the tropics, most commonly in areas of poor sanitation. Long-term travelers (duration >6 months) are significantly more likely than short-term travelers (duration <1 month) to develop E. histolytica infection. Recent immigrants and refugees from these areas are also at risk. Outbreaks among men who have sex with men have been reported. People at higher risk for severe disease are those who are pregnant, immunocompromised, or receiving corticosteroids; associations with diabetes and alcohol use have also been reported.
Most patients have a gradual illness onset days or weeks after infection. Symptoms include cramps, watery or bloody diarrhea, and weight loss, and may last several weeks. Occasionally, the parasite may spread to other organs (extraintestinal amebiasis), most commonly the liver. Amebic liver abscesses may be asymptomatic, but most patients present with fever, right upper quadrant abdominal pain, and weight loss, usually in the absence of diarrhea. Men are at higher risk of developing amebic liver abscess than are women for reasons not fully understood.
Microscopy does not distinguish between E. histolytica (known to be pathogenic), E. bangladeshi, E. dispar , and E. moshkovskii. E. dispar and E. moshkovskii have historically been considered nonpathogenic, but evidence is mounting that E. moshkovskii can cause illness; E. bangladeshi has only recently been identified, so its pathogenic potential is not well understood. More specific tests such as enzyme immunoassay or PCR are needed to confirm the diagnosis of E. histolytica . Additionally, serologic tests can help diagnose extraintestinal amebiasis.
CDC’s Free-Living and Intestinal Amebas laboratory can make a specific diagnosis by using a duplex real-time PCR capable of detecting and distinguishing E. histolytica and E. dispar in stool and liver aspirate samples. More information about this testing and the CDC point of contact can be found at www.cdc.gov/laboratory/specimen-submission/detail.html?CDCTestCode=CDC-10478.
For symptomatic intestinal infection and extraintestinal disease, treatment with metronidazole or tinidazole should be followed by treatment with iodoquinol or paromomycin. Asymptomatic patients infected with E. histolytica should also be treated with iodoquinol or paromomycin, because they can infect others and because 4%–10% develop disease within a year if left untreated.
Food and water precautions (see Chapter 2, Food & Water Precautions) and hand hygiene. Avoid fecal exposure during sexual activity.
CDC website: www.cdc.gov/parasites/amebiasis
- Choudhuri G, Rangan M. Amebic infection in humans. Indian J Gastroenterol. 2012 Jul;31(4):153–62. [PMID:22903366]
- Escolà-Vergé L, Arando M, Vall M, Rovira R, Espasa M, Sulleiro E, et al. Outbreak of intestinal amoebiasis among men who have sex with men, Barcelona (Spain), October 2017 and January 2017. Euro Surveill. 2017 Jul 27;22(30):pii:30581. [PMID:28797327]
- Heredia RD, Fonseca JA, Lopez MC. Entamoeba moshkovskii perspectives of a new agent to be considered in the diagnosis of amebiasis. Acta Trop. 2012 Sep;123(3):139–45.
- Lachish T, Wieder-Finesod A, Schwartz E. Amebic liver abscess in Israeli travelers: a retrospective study. Am J Trop Med Hyg. 2016 May 4;94(5):1015–19. [PMID:26928829]
- Shimokawa C, Kabir M, Taniuchi M, Mondal D, Kobayashi S, Ali IK, et al. Entamoeba moshkovskii is associated with diarrhea in infants and causes diarrhea and colitis in mice. J Infect Dis. 2012 Sep 1;206(5):744–51. [PMID:22723640]
- Shirley D, Moonah S. Fulminant amebic colitis after corticosteroid therapy: a systematic review. PLoS Negl Trop Dis. 2016 Jul 28;10(7):e0004879. [PMID:27467600]
- Ximenez C, Moran P, Rojas L, Valadez A, Gomez A, Ramiro M, et al. Novelties on amoebiasis: a neglected tropical disease. J Glob Infect Dis. 2011 Apr;3(2):166–74.
Jennifer R. Cope, Ibne K. Ali