Pediatric Amebiasis Follow-up

  • Author: Vinod K Dhawan, MD, FACP, FRCP(C), FIDSA; Chief Editor: Russell W Steele, MD   more...
 
Updated: May 10, 2012
 

Deterrence/Prevention

  • Improved sanitation is critical to preventing orofecal transmission of organisms such as E histolytica. Travelers to developing countries should be advised to avoid consumption of unsafe food and water and sexual practices that may lead to fecal-oral transmission. Eating only cooked food or self-peeled fruits in endemic areas minimizes the risk. Travelers should avoid eating raw fruits and salads, which are difficult to sterilize. The amount of chlorine normally used to purify water is inadequate in killing the cysts. Drinking water can be rendered safe by boiling, 0.22 µm filtration, or iodination with tetraglycine hydroperiodide. Bottled water may be used for drinking when traveling to endemic areas.
  • Disease transmission can be reduced by early treatment of carriers in nonendemic areas.
  • Development of a vaccine for invasive amebiasis is still in its infancy.[46, 47, 48] Many components of the ameba are immunogenic and may serve as targets for a future vaccine, including the galactose and N-acetyl-D-galactosamine lectin, the serine-rich E histolytica protein, cysteine proteinases, lipophosphoglycans, amebapores, and the 29-kDa protein. Progress in vaccine development has been facilitated by new animal models that allow better testing of potential vaccine candidates and by the application of recombinant technology to vaccine design. Oral vaccines using amebic antigens that are coadministered with some form of cholera toxin or expressed in attenuated strains of Salmonella or Vibrio cholera have been developed and tested in animals for mucosal immunogenicity.
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Complications

Several complications due to amebiasis have been reported, as follows[26, 49] :

  • Bowel perforation
  • GI bleeding
  • Stricture formation
  • Fistula formation
  • Intussusception
  • Secondary bacterial infection of amebic liver abscess (uncommon)
  • Peritonitis
  • Pericarditis
  • Empyema
  • Brain abscess
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Prognosis

  • Intestinal infections due to amebiasis generally respond well to appropriate therapy. The severity of amebiasis is increased in the following individuals:
    • Children, especially neonates
    • Pregnant and postpartum women
    • Those using corticosteroids
    • Those with malignancies
    • Malnourished individuals
  • The mortality rate in patients with uncomplicated amebic liver abscess is less than 1%.
  • Fulminant amebic colitis has a mortality rate of more than 50%.
  • Pleuropulmonary amebiasis has a 15-20% mortality rate.
  • Amebic pericarditis has a case fatality rate of 40%.
  • Cerebral amebiasis is highly fatal, with a 90% death rate.
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Patient Education

  • Educate patients about the prevention of amebiasis during travel to endemic areas. This includes avoiding drinking contaminated water and avoiding eating raw fruits and salads, which are difficult to sterilize. Bottled water may be used during such travel. Eating only cooked food or self-peeled fruits in endemic areas minimizes risk.
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Contributor Information and Disclosures
Author

Vinod K Dhawan, MD, FACP, FRCP(C), FIDSA  Professor, Department of Clinical Medicine, University of California, Los Angeles, David Geffen School of Medicine; Chief, Division of Infectious Diseases, Rancho Los Amigos National Rehabilitation Center

Vinod K Dhawan, MD, FACP, FRCP(C), FIDSA is a member of the following medical societies: American College of Physicians, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, and Royal College of Physicians and Surgeons of Canada

Disclosure: Pfizer Inc Honoraria Speaking and teaching

Coauthor(s)

Thomas R Naparst, MD  Clinical Instructor in Emergency Medicine, New York University School of Medicine; Consulting Staff, Department of Emergency Medicine, New York Downtown Hospital

Thomas R Naparst, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael D Nissen, MBBS, FRACP, FRCPA  Associate Professor in Biomolecular, Biomedical Science & Health, Griffith University; Director of Infectious Diseases and Unit Head of Queensland Paediatric Infectious Laboratory, Sir Albert Sakzewski Viral Research Centre, Royal Children's Hospital

Michael D Nissen, MBBS, FRACP, FRCPA is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, Pediatric Infectious Diseases Society, Royal Australasian College of Physicians, and Royal College of Pathologists of Australasia

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Martin Weisse, MD  Program Director, Associate Professor, Department of Pediatrics, West Virginia University

Martin Weisse, MD is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Robert W Tolan Jr, MD  Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: Novartis Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author Maria A Horga, MD, to the development and writing of this article.

References

  1. Pritt BS, Clark CG. Amebiasis. Mayo Clin Proc. Oct 2008;83(10):1154-9; quiz 1159-60. [Medline].

  2. Grecu F, Bulgariu T, Blanaru O, et al. Invasive amebiasis. Chirurgia (Bucur). Sep-Oct 2006;101(5):539-42. [Medline].

  3. Haque R, Huston CD, Hughes M, Houpt E, Petri WA Jr. Amebiasis. N Engl J Med. Apr 17 2003;348(16):1565-73. [Medline].

  4. Stanley SL Jr. Amoebiasis. Lancet. Mar 22 2003;361(9362):1025-34. [Medline].

  5. Freedman DO, Weld LH, Kozarsky PE, et al. Spectrum of disease and relation to place of exposure among ill returned travelers. N Engl J Med. Jan 12 2006;354(2):119-30. [Medline]. [Full Text].

  6. Valenzuela O, Moran P, Gomez A, et al. Epidemiology of amoebic liver abscess in Mexico: the case of Sonora. Ann Trop Med Parasitol. Sep 2007;101(6):533-8. [Medline].

  7. van Hal SJ, Stark DJ, Fotedar R, Marriott D, Ellis JT, Harkness JL. Amoebiasis: current status in Australia. Med J Aust. Apr 16 2007;186(8):412-6. [Medline].

  8. Ximénez C, Morán P, Rojas L, Valadez A, Gómez A. Reassessment of the epidemiology of amebiasis: state of the art. Infect Genet Evol. Dec 2009;9(6):1023-32. [Medline].

  9. Stauffer W, Abd-Alla M, Ravdin JI. Prevalence and incidence of Entamoeba histolytica infection in South Africa and Egypt. Arch Med Res. Feb 2006;37(2):266-9. [Medline].

  10. Blessmann J, Van Linh P, Nu PA, et al. Epidemiology of amebiasis in a region of high incidence of amebic liver abscess in central Vietnam. Am J Trop Med Hyg. May 2002;66(5):578-83. [Medline].

  11. Bowley DM, Loveland J, Omar T, Pitcher GJ. Human immunodeficiency virus infection and amebiasis. Pediatr Infect Dis J. Dec 2006;25(12):1192-3. [Medline].

  12. Brindicci G, Picciarelli C, Fumarola L, et al. Amoebic hepatic abscesses in an HIV-positive patient. AIDS Patient Care STDS. Sep 2006;20(9):606-11. [Medline].

  13. Chen Y, Zhang Y, Yang B, et al. Seroprevalence of Entamoeba histolytica infection in HIV-infected patients in China. Am J Trop Med Hyg. Nov 2007;77(5):825-8. [Medline]. [Full Text].

  14. Hsu MS, Hsieh SM, Chen MY, Hung CC, Chang SC. Association between amebic liver abscess and human immunodeficiency virus infection in Taiwanese subjects. BMC Infect Dis. Apr 16 2008;8:48. [Medline]. [Full Text].

  15. Karp CL, Auwaerter PG. Coinfection with HIV and tropical infectious diseases. I. Protozoal pathogens. Clin Infect Dis. Nov 1 2007;45(9):1208-13. [Medline].

  16. Park WB, Choe PG, Jo JH, Kim SH, Bang JH, Kim HB, et al. Amebic liver abscess in HIV-infected patients, Republic of Korea. Emerg Infect Dis. Mar 2007;13(3):516-7. [Medline]. [Full Text].

  17. Infection by human immunodeficiency virus-1 is not a risk factor for amebiasis. Am J Trop Med Hyg. Nov 2006;75(5):1023. [Medline].

  18. Hung CC, Ji DD, Sun HY, Lee YT, Hsu SY, Chang SY, et al. Increased risk for Entamoeba histolytica infection and invasive amebiasis in HIV seropositive men who have sex with men in Taiwan. PLoS Negl Trop Dis. Feb 27 2008;2(2):e175. [Medline].

  19. Hung CC, Ji DD, Sun HY, Lee YT, Hsu SY, Chang SY, et al. Increased risk for Entamoeba histolytica infection and invasive amebiasis in HIV seropositive men who have sex with men in Taiwan. PLoS Negl Trop Dis. Feb 27 2008;2(2):e175. [Medline]. [Full Text].

  20. Muzaffar J, Madan K, Sharma MP, Kar P. Randomized, single-blind, placebo-controlled multicenter trial to compare the efficacy and safety of metronidazole and satranidazole in patients with amebic liver abscess. Dig Dis Sci. Dec 2006;51(12):2270-3. [Medline].

  21. Hung CC, Wu PY, Chang SY, et al. Amebiasis among persons who sought voluntary counseling and testing for human immunodeficiency virus infection: a case-control study. Am J Trop Med Hyg. Jan 2011;84(1):65-9. [Medline]. [Full Text].

  22. Gunther J, Shafir S, Bristow B, Sorvillo F. Short report: Amebiasis-related mortality among United States residents, 1990-2007. Am J Trop Med Hyg. Dec 2011;85(6):1038-40. [Medline]. [Full Text].

  23. Acuna-Soto R, Maguire JH, Wirth DF. Gender distribution in asymptomatic and invasive amebiasis. Am J Gastroenterol. May 2000;95(5):1277-83. [Medline].

  24. Andrade JE, Mederos R, Rivero H, et al. Amebiasis presenting as acute appendicitis. South Med J. Nov 2007;100(11):1140-2. [Medline].

  25. Hardin RE, Ferzli GS, Zenilman ME, Gadangi PK, Bowne WB. Invasive amebiasis and ameboma formation presenting as a rectal mass: An uncommon case of malignant masquerade at a western medical center. World J Gastroenterol. Nov 14 2007;13(42):5659-61. [Medline].

  26. Rao S, Solaymani-Mohammadi S, Petri WA Jr, Parker SK. Hepatic amebiasis: a reminder of the complications. Curr Opin Pediatr. Feb 2009;21(1):145-9. [Medline]. [Full Text].

  27. Loulergue P, Mir O. Pleural empyema secondary to amebic liver abscess. Int J Infect Dis. May 2009;13(3):e135-6. [Medline].

  28. Dhawan VK, Malik SK. Acute pneumonia in the right lower lobe. Chest. Mar 1975;67(3):346-7. [Medline]. [Full Text].

  29. Abd-Alla MD, Jackson TF, Gathiram V, el-Hawey AM, Ravdin JI. Differentiation of pathogenic Entamoeba histolytica infections from nonpathogenic infections by detection of galactose-inhibitable adherence protein antigen in sera and feces. J Clin Microbiol. Nov 1993;31(11):2845-50. [Medline]. [Full Text].

  30. Haque R, Mollah NU, Ali IK, Alam K, Eubanks A, Lyerly D, et al. Diagnosis of amebic liver abscess and intestinal infection with the TechLab Entamoeba histolytica II antigen detection and antibody tests. J Clin Microbiol. Sep 2000;38(9):3235-9. [Medline]. [Full Text].

  31. Helmy MM, Rashed LA, Abdel-Fattah HS. Detection and differentiation of Entamoeba histolytica and Entamoeba dispar isolates in clinical samples by PCR. J Egypt Soc Parasitol. Apr 2007;37(1):257-74. [Medline].

  32. Singh A, Houpt E, Petri WA. Rapid Diagnosis of Intestinal Parasitic Protozoa, with a Focus on Entamoeba histolytica. Interdiscip Perspect Infect Dis. 2009;2009:547090. [Medline]. [Full Text].

  33. Tanyuksel M, Petri WA Jr. Laboratory diagnosis of amebiasis. Clin Microbiol Rev. Oct 2003;16(4):713-29. [Medline]. [Full Text].

  34. Fotedar R, Stark D, Beebe N, Marriott D, Ellis J, Harkness J. PCR detection of Entamoeba histolytica, Entamoeba dispar, and Entamoeba moshkovskii in stool samples from Sydney, Australia. J Clin Microbiol. Mar 2007;45(3):1035-7. [Medline]. [Full Text].

  35. Khairnar K, Parija SC. A novel nested multiplex polymerase chain reaction (PCR) assay for differential detection of Entamoeba histolytica, E. moshkovskii and E. dispar DNA in stool samples. BMC Microbiol. May 24 2007;7:47. [Medline]. [Full Text].

  36. Stark D, van Hal S, Fotedar R, Butcher A, Marriott D, Ellis J, et al. Comparison of stool antigen detection kits to PCR for diagnosis of amebiasis. J Clin Microbiol. May 2008;46(5):1678-81. [Medline]. [Full Text].

  37. Ahmad N, Khan M, Hoque MI, Haque R, Mondol D. Detection of Entamoeba histolytica DNA from liver abscess aspirate using polymerase chain reaction (PCR): a diagnostic tool for amoebic liver abscess. Bangladesh Med Res Counc Bull. Apr 2007;33(1):13-20. [Medline].

  38. Shamsuzzaman SM, Haque R, Hasin SK, Hashiguchi Y. Evaluation of indirect fluorescent antibody test and enzyme-linked immunosorbent assay for diagnosis of hepatic amebiasis in Bangladesh. J Parasitol. Jun 2000;86(3):611-5. [Medline].

  39. Nagata N, Shimbo T, Akiyama J, et al. Predictive value of endoscopic findings in the diagnosis of active intestinal amebiasis. Endoscopy. Apr 2012;44(4):425-8. [Medline].

  40. Gonzales ML, Dans LF, Martinez EG. Antiamoebic drugs for treating amoebic colitis. Cochrane Database Syst Rev. Apr 15 2009;CD006085. [Medline].

  41. Petri WA Jr, Singh U. Diagnosis and management of amebiasis. Clin Infect Dis. Nov 1999;29(5):1117-25. [Medline].

  42. Salles JM, Salles MJ, Moraes LA, Silva MC. Invasive amebiasis: an update on diagnosis and management. Expert Rev Anti Infect Ther. Oct 2007;5(5):893-901. [Medline].

  43. Kimura M, Nakamura T, Nawa Y. Experience with intravenous metronidazole to treat moderate-to-severe amebiasis in Japan. Am J Trop Med Hyg. Aug 2007;77(2):381-5. [Medline].

  44. Moon TD, Oberhelman RA. Antiparasitic therapy in children. Pediatr Clin North Am. Jun 2005;52(3):917-48, viii. [Medline].

  45. Athié-Gutiérrez C, Rodea-Rosas H, Guízar-Bermúdez C, Alcántara A, Montalvo-Javé EE. Evolution of surgical treatment of amebiasis-associated colon perforation. J Gastrointest Surg. Jan 2010;14(1):82-7. [Medline].

  46. Chaudhry OA, Petri WA Jr. Vaccine prospects for amebiasis. Expert Rev Vaccines. Oct 2005;4(5):657-68. [Medline].

  47. Snow MJ, Stanley SL Jr. Recent progress in vaccines for amebiasis. Arch Med Res. Feb 2006;37(2):280-7. [Medline].

  48. Stanley SL Jr. Vaccines for amoebiasis: barriers and opportunities. Parasitology. 2006;133 Suppl:S81-6. [Medline].

  49. Sodhi KS, Ojili V, Sakhuja V, Khandelwal N. Hepatic and inferior vena caval thrombosis: vascular complication of amebic liver abscess. J Emerg Med. Feb 2008;34(2):155-7. [Medline].

 
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Entamoeba histolytica trophozoite. Courtesy of Centers for Disease Control and Prevention.
Entamoeba histolytica cyst. Courtesy of Centers for Disease Control and Prevention.
Life cycle of Entameba histolytica.
Gross pathology of intestinal ulcers due to amebiasis. Courtesy of Centers for Disease Control and Prevention.
Histopathology of typical flask-shaped ulcer of intestinal amebiasis. Courtesy of Centers for Disease Control and Prevention.
Entamoeba histolytica in liver aspirate, trichrome stain. Courtesy of Centers for Disease Control and Prevention.
Histopathology of amebiasis. Courtesy of Centers for Disease Control and Prevention.
 
 
 
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