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.