eMedicine Specialties > Pediatrics: General Medicine > Parasitology

Amebiasis: Follow-up

Author: Vinod K Dhawan, MD, FACP, FRCP(C), Professor, Department of Clinical Medicine, University of California at Los Angeles; Professor of Medicine, Charles R Drew University of Medicine and Science; Chief, Division of Infectious Diseases, MLK-Harbor Hospital
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
Contributor Information and Disclosures

Updated: Aug 11, 2008

Follow-up

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.5,6,7  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.

Complications

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

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.

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.

Miscellaneous

Medicolegal Pitfalls

  • Failure to suspect and treat amebiasis in a returning traveler may cause legal liability.
  • Intestinal amebiasis may be mistakenly treated as chronic ulcerative colitis.

Special Concerns

  • Intestinal amebiasis may be mistakenly treated as inflammatory bowel disease. Perform lower GI endoscopy in all patients in whom inflammatory bowel disease is suspected before treating with steroids.
 
Acknowledgments

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



More on Amebiasis

Overview: Amebiasis
Differential Diagnoses & Workup: Amebiasis
Treatment & Medication: Amebiasis
Follow-up: Amebiasis
Multimedia: Amebiasis
References
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Further Reading

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Keywords

amebiasis, intestinal amebiasis, Entamoeba histolytica, E histolytica, Amoeba coli, A coli, amebic colitis, Entamoeba dispar, E dispar, dysentery, amebic dysentery, acute amebic colitis, fulminant amebic colitis, chronic amebic colitis, ameboma, amebic liver abscess, pleuropulmonary amebiasis, amebic peritonitis, amebic pericarditis, cerebral amebiasis, proctocolitis, dysentery, colitis, megacolon, ameboma, peritonitis, pericarditis, brain abscess, toxic megacolon, peritonitis, hepatic necrosis, portal venous obstruction, HIV, AIDS, diarrhea, bacterial dysentery, inflammatory bowel disease, carcinoma, tuberculosis, Crohn disease, actinomycosis, lymphoma, jaundice, fallopian tube amebiasis, ulcers, empyema, basilar atelectasis, pneumonia, lung abscess, heart failure

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Contributor Information and Disclosures

Author

Vinod K Dhawan, MD, FACP, FRCP(C), Professor, Department of Clinical Medicine, University of California at Los Angeles; Professor of Medicine, Charles R Drew University of Medicine and Science; Chief, Division of Infectious Diseases, MLK-Harbor Hospital
Vinod K Dhawan, MD, FACP, FRCP(C) 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 None None

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.

Medical Editor

Michael D Nissen, MBBS, BMedSc, 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, BMedSc, 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.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

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.

CME Editor

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: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Consulting; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching; sanofi pasteur Grant/research funds Unrestricted research grant; sanofi pasteur  Consulting; sanofi pasteur Honoraria Speaking and teaching; Tap 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: None None None

 
 
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