Amebiasis Clinical Presentation

  • Author: Alexandre Lacasse, MD, MSc; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Jan 10, 2012
 

History

  • Amebic colitis
    • The most common presentation of amebic colitis is gradual onset of bloody diarrhea, abdominal pain, and tenderness spanning several weeks’ duration.
    • Rectal bleeding without diarrhea can occur, especially in children.
    • Only approximately 10-30% of patients with amebic colitis develop fever.
    • Weight loss and anorexia may occur.
    • Fulminant or necrotizing colitis usually manifests as severe bloody diarrhea and widespread abdominal pain with evidence of peritonitis and fever.
    • Predisposing factors for fulminant colitis include poor nutrition, pregnancy, corticosteroid use, and very young age.
  • Amebic liver abscess
    • The most typical presentation of amebic liver abscess is fever, right upper quadrant pain, and tenderness of less than 10 days’ duration.
    • Unlike amebic colitis, amebic liver abscess is associated with fever in 85-90% of cases.
    • A more subacute presentation can be seen, with concomitant weight loss and anorexia.
    • Cough can occur. Jaundice is unusual.
    • Acute abdominal symptoms and signs should prompt rapid investigation for intraperitoneal rupture.
    • Sixty to 70% of patients with amebic liver abscess do not have concomitant colitis, although a history of dysentery within the previous year may be obtained.
    • Amebic liver abscess may manifest years after travel to or residency in an endemic area.
    • A history of alcohol abuse is common, but a clear causal relationship is unclear.
  • Pleuropulmonary amebiasis: Cough, pleuritic chest pain, and respiratory distress may be clues to rupture through the diaphragm, a rare but serious complication of amebic liver abscess.
  • Cerebral amebiasis
    • Occurring in 0.6% of amebic liver abscess cases, abrupt onset of nausea, vomiting, headache, and mental status change should prompt rapid investigation for CNS involvement.
    • Progression can be very rapid.
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Physical

  • Amebic colitis
    • Fever (10-30%)
    • Weight loss (40%)
    • Diffuse abdominal tenderness (12-85%)
    • Heme-positive stools (70-100%)
    • Abdominal pain, distension, and rebound tenderness likely in fulminant colitis
  • Amebic liver abscess
    • Fever (85-90%)
    • Right upper quadrant abdominal tenderness (84-90%)
    • Weight loss (33-50%)
    • Hepatomegaly (30-50%)
    • Jaundice (6-10%)
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Causes

  • Amebiasis is an infection caused by the protozoal organism E histolytica, which can cause colitis and other extraintestinal manifestations, including liver abscess (most common) and pleuropulmonary, cardiac, and cerebral dissemination.
  • E histolytica is transmitted primarily through the fecal-oral route. Infective cysts can be found in fecally contaminated food and water supplies and contaminated hands of food handlers. Sexual transmission is possible, especially in the setting of oral-anal practices.
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Contributor Information and Disclosures
Author

Alexandre Lacasse, MD, MSc  Internal Medicine Faculty, Assistant Director, Medicine Clinic, Infectious Disease Consultant, St Mary's Health Center

Alexandre Lacasse, MD, MSc is a member of the following medical societies: American College of Physicians, American Medical Association, Association of Program Directors in Internal Medicine, Infectious Diseases Society of America, and Society for Healthcare Epidemiology of America

Disclosure: Nothing to disclose.

Coauthor(s)

Kerry O Cleveland, MD  Associate Professor of Medicine, University of Tennessee College of Medicine; Consulting Staff, Department of Internal Medicine, Division of Infectious Diseases, Methodist Healthcare of Memphis

Kerry O Cleveland, MD is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America, and Society for Healthcare Epidemiology of America

Disclosure: Nothing to disclose.

J Robert Cantey, MD  Professor, Department of Medicine, Division of Infectious Diseases, Medical University of South Carolina

J Robert Cantey, MD is a member of the following medical societies: Alpha Omega Alpha, American Society for Clinical Investigation, American Society for Microbiology, Infectious Diseases Society of America, International Society of Travel Medicine, Musculoskeletal Infection Society, Phi Beta Kappa, and Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Specialty Editor Board

Klaus-Dieter Lessnau, MD, FCCP  Clinical Associate Professor of Medicine, New York University School of Medicine; Medical Director, Pulmonary Physiology Laboratory; Director of Research in Pulmonary Medicine, Department of Medicine, Section of Pulmonary Medicine, Lenox Hill Hospital

Klaus-Dieter Lessnau, MD, FCCP is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Medical Association, American Thoracic Society, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Michael Stuart Bronze, MD  Professor, Stewart G Wolf Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Medical Association, Association of Professors of Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, and Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Eleftherios Mylonakis, MD  Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Robert Swords, MD, to the development and writing of this article.

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Trichrome stain of Entamoeba histolytica trophozoites in amebiasis. Two diagnostic characteristics are observed. Two trophozoites have ingested erythrocytes, and all 3 have nuclei with small, centrally located karyosomes.
Trichrome stain of an Entamoeba histolytica cyst in amebiasis. Each cyst has 4 nuclei with characteristically centrally located karyosomes. Cysts measure 12-15 mm.
 
 
 
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