Amebiasis and Amebic Liver Abscess in Children.

Although rare in the developed world, amebiasis continues to be a leading cause of diarrhea and illness in developing nations with crowding, poor sanitation, and lack of clean water supply. Recent immigrants or travelers returning from endemic regions after a prolonged stay are at high risk of developing amebiasis. A high index of suspicion for amebiasis should be maintained for other high-risk groups like men having sex with men, people with AIDS/HIV, immunocompromised hosts, residents of mental health facility or group homes. Clinical presentation of intestinal amebiasis varies from diarrhea to colitis and dysentery. Amebic liver abscess (ALA) is the most common form of extraintestinal amebiasis. Various diagnostic tools are available and when amebiasis is suspected, a combination of stool tests and serology should be sent to maximize the yield of testing. Treatment with an amebicidal drug such as metronidazole/tinidazole and a luminal cysticidal agent such as paromomycin for clinical disease is indicated. However, for asymptomatic disease treatment with a luminal cysticidal agent to decrease chances of invasive disease and transmission is recommended.

[Autochthonous amebic liver abscess in Spain: an emerging disease? Case report and description of a PCR-based diagnostic test]. / Absceso hepático amebiano autóctono en España: una enfermedad emergente? Descripción de 2 nuevos casos clínicos y de una técnica diagnóstica basada en la reacción en cadena de la polimerasa.

INTRODUCTION: In Spain an increase in cases of amebiasis has been detected in patients with no history of traveling to, or immigration from, endemic areas. MATERIAL AND METHODS: This study describes two new cases of amebic hepatic abscess due to native protozoa and reviews 21 more cases of amebic hepatic abscess reported in Spanish patients who had never left the Iberian Peninsula. In addition, a new PCR-based technique for diagnosing Entamoeba histolytica is described. RESULTS: Twenty cases (87%) occurred in men. The age range of the affected patients was 26 to 77 years. Two of the 3 women with extraintestinal amebiasis were HIV-positive. There was no history of exposure to the parasite in 17 cases. In the remaining 6 cases, direct contact with patients affected with amebiasis or with individuals or foods from endemic areas was recorded. CONCLUSION: Entamoeba histolytica infection is becoming an emerging disease in our country. Amebiasis should be included in the differential diagnosis of consistent clinical entities even when there is no background of traveling or immigration. New molecular diagnostic tools can help to characterize this infection and should be considered reference techniques in combination with serological methods.

[Amoebosis: May sexual transmission be an underestimated way of contamination?] / Amibiase : au cours de rapports sexuels, un mode de transmission sous-estimé ?

INTRODUCTION: Amoebiasis is a cosmopolitan disease and the third most deadly of parasitic diseases. Entamoeba histolytica is the only one to be pathogenic. Its transmission is not only related to the faecal peril but also sexual, with cases described among men who have sex with men. A case of unusual sexual transmission is described in this article, aiming to discuss the impact of these ways of transmitting amoebiasis on patient management. CASE REPORT: We describe the case of an amebic liver abscess in a 27-years-old man who did not travel in endemic areas. After patient interrogation, it seems that the contamination mode was sexual, related to a heterosexual relationship with a new female partner 4 months before the diagnosis. HIV and hepatitis B serologies were negative. CONCLUSION: The diagnosis of amoebiasis should be suspected in case of dysentery or liver abscess even if there is no history of travel in endemic areas or of sexual intercourse between men.

[Imported diseases]. / Importierte Erkrankungen.

With continuing worldwide growth in travel, timely information about the epidemiology of post-travel illness is important. Various travel-related surveillance systems have been established that provide these data. Knowledge about prevalences of important diseases in travelers and migrants can help in the differential diagnosis. On the other hand it has be kept in mind that also rare, but life-threatening diseases can be imported like leptospirosis, viral hemorrhagic fever or amebic liver abcess.

Amebic liver abscess in children: clinical and epidemiologic features.

Amebiasis, that is, infection with Entameba histolytica, continues to be endemic in the United States, with liver abscess occurring as an infrequent but constant complication. Seven cases are reported, with epidemiologic investigation of two. Reliable findings in hepatic abscess include fever, abdominal pain, respiratory distress, tender abdomen, and large, tender liver. Anemia, elevated white count with left shift, and the radiographic findings of an elevated right hemidiaphragm are constant. Epidemiologically, amebiasis occurs in clusters in the United States with person-to-person transmission predominant in spread. Infection is associated with poor sanitation and crowding. Investigation of the families of two patients documented 9/21 carriers and an additional 3/21 who were seropositive, as well as crowding and poor sanitation. In this country, treatment of a patient with amebic disease should include investigation of his home and family.

Endemic amebiasis in an extended family.

Two cousins from a large Spanish-American family were simultaneously diagnosed as having amebic liver abscesses. Survey of 183 extended-family members revealed that 45.7% of 162 had a positive amebiasis indirect hemagglutination test and 12.6% of 111 had cysts or trophozoites of Entamoeba histolytica demonstrated in a single stool examination. A total of five family members had had liver abscesses; two deaths had occurred. In a random sample survey of the remainder of the community, only one person (0.3%) had a positive serologic test. Within the extended family, person-to-person appeared to be the predominant mode of transmission. Water supplies were not contaminated. Both community and extended family homes had the same source of water. Type and source of food supply were not correlated with infection and there was no evidence to implicate an infected food handler. Clustering of seropositivity occurred in homes without indoor toilets. Homes of the extended family were more crowded and significantly fewer of them had indoor toilets. Endemic foci of amebiasis continue to exist in the United States. Follow-up family and other close contacts of persons with amebiasis will frequently identify other cases.

Amebic liver abscess.

We report eight cases of amebic liver abscess. All patients were men, and four were homosexual. Five of the eight patients had syphilis, but the four homosexual patients who were tested for HIV infection were negative. Ultrasonography (US), with or without needle aspiration, is the best method for diagnosing amebic liver abscess, and the treatment of choice is US-guided needle aspiration of the abscess followed by metronidazole therapy. Complication by other sexually transmitted diseases is another important factor affecting the treatment of this disease.

[Hepatic amebiasis. Apropos of two cases]. / L'amebiasi epatica. A proposito di due casi.

The authors report 2 cases of amebic hepatic abscess, through to their observation with a little interval of time one from another and both coming from the same small town. Transmission modalities, the diagnostic approach and the therapeutic possibilities are discussed on the basis of personal experience.

[Conservative treatment of hepatic amebic abscesses]. / Leczenie zachowawcze ropni amebowych watroby.

A case is presented of hepatic amebic abscesses in a young man after return from India. After establishing of the aetiology of the disease conservative treatment was started which was completed with success. The authors point to the possibility of transmission of amoeba dysentery to Poland due to journeys to tropical or subtropical countries.

[Autochthonous amebiasis in the region of Nantes]. / Amibiase autochtone dans la région nantaise.

A retrospective study on amoebiasis observed in the central hospital in Nantes since twenty years, shows that, at least, 16 % of the intestinal cases and 1/6, 5 of 30 cases of hepatic amoebiasis are autochthonous.

Amebic liver abscess in a homosexual man.

A case report of a 36-year-old black homosexual man with right upper- and lower-quadrant abdominal pain is presented. When exploratory surgery for appendicitis was performed, an abscess, consistent with an amebic abscess, was encountered in the right lobe of the liver. This abscess was evacuated, and a drain was placed. A serum sample taken at the time of surgery showed high titers of antibody to Entamoeba histolytica; metronidazole therapy was instituted, and the patient made an uneventful recovery. Since amebiasis is epidemic in the gay community, health care personnel should be aware of the various modes of transmission, as well as of the diagnoses, optimal management, and indications for surgery in patients with amebic liver abscess. It is noted that amebic liver abscess appears to be a less frequent complication of amebiasis among the male homosexual population than among other groups.

Present characteristics of symptomatic amebiasis due to Entamoeba histolytica in the east-southeast area of Tokyo.

Admitted medical records, from January 1988 to December 1995, of 28 symptomatic amebic patients who lived in the east-southeast area of Tokyo were studied retrospectively, in order to find the present characteristics of symptomatic amebiasis due to Entamoeba histolytica in this area. Categorized by disease, there were 14 cases of colitis, 9 cases of liver abscess, 4 cases of colitis with liver abscess, and 1 case of liver abscess with brain abscess. Patients consisted of 26 Japanese males, 0 Japanese females, 1 non-Japanese male and 1 non-Japanese female. The mean age of colitis patients and liver abscess patients was 55.4 years old and 41.3 years old, respectively. The presumed place of contraction was Japan in 64% of the patients. Forty-eight percent of male patients indicated that they engaged in homosexual or bisexual practices, and 36% of male patients who denied such sexual practices or did not answer the question had no history of marriage. Positive rate of serum titre for Treponema pallidum hemagglutination test (TPHA) and human immunodeficiency virus antibody was 42.9% and 0%, respectively. Sixty-seven percent of TPHA-positive patients indicated that they engaged in male homosexual or bisexual practices. Zymodeme patterns of E. histolytica isolated from 4 colitis patients were XIV in 1 case and II in 3 cases. Symptomatic amebiasis in the east-southeast area of Tokyo is a disease which predominantly afflicts males, especially those in their middle age, and most patients contract the disease in Japan. The high rates of patients who engaged in male homosexual or bisexual practices and the high rates of patients with positive TPHA suggest that amebiasis is likely to be sexually transmitted disease in homosexual and bisexual men in the east-southeast area of Tokyo, and zymodeme II may be the predominant type in symptomatic amebic colitis in this area.

[Complicated amebic liver abscess--course and therapy]. / Der komplizierte Amöben-Leberabszess--Verlauf und Therapie.

We report on a case of an amoebic liver abscess acquired during a holiday in Bali. Transdiaphragmatic migration and consecutive atelectasis of the right lung caused respiratory insufficiency, requiring immediate surgical intervention. Complications consisted of massive bleeding into the colon concomitant with a reactivated CMV-infection. In addition, toxins of Clostridium difficile and enterohaemorrhagic E. coli were seen in the faeces. In contrast to the majority of uncomplicated cases of amoebic liver abscess, usually treated with amoebicidal drugs only, surgical intervention was clearly indicated in our patient.

Estudo epidemiológico dos pacientes com diagnóstico clínico de necrose amebiana hepática internados no Hospital Universitário de Belém-Pa-Brasil, no período de Janeiro de 1992 a Julho de 2000 / Study epidemiologist of the patients with clinical diagnosis of hepática mebiana necrosis interned in the University Hospital of Belém-Pará-Brazil, the period of January of 1992 the July of 2000

Trabalho apresentado no Congresso da Sociedade Brasileira de Medicina Tropical, 37., 2001, Salvador.