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Amoebiasis: Symptoms, causes, diagnosis and treatment
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Amoebiasis: Symptoms, causes, diagnosis and treatment

The infection is usually caused when a person consumes food or water which have been contaminated by human faeces
Illustration of a gut containing infection-causing bacteria
Representational image | Shutterstock

Amoebiasis or amoebic dysentery is an infection in humans caused by the protozoan parasite Entamoeba histolytica. It is a common infection of the intestinal tract, but less than 20 percent of infected people become sick.

The main risk groups for acute infection and mortality are children, pregnant women, people who are malnourished or have a history of alcoholism.

While these infections are generally limited to the gastro-intestinal tract, they can spread to other organs. The liver is usually affected, resulting in an abscess. Rarely, amoebiasis can spread to the lungs, heart, and brain.

Amoebiasis affects men and women equally, except when it invades the liver, in which case men are vulnerable. This is likely as alcoholism is seen much more among men than women.

It is endemic in countries like India, China, Mexico, and other developing countries which have poor sanitation facilities.

Symptoms

Common symptoms of mild amoebiasis include

  • Loose stools, pain, and cramps in the stomach
  • Severe or acute infection can cause increased pain, fever and frequent stools with blood
  • Chronic amoebiasis is associated with stomach pain, loose stools and complaints of fatigue and loss of weight

Causes

Infection is usually transmitted when a person consumes food and water which have been contaminated by human faeces – which is in turn due to poor hygiene practices. The single-celled protozoan parasite Entamoeba histolytica which is responsible for the contamination exists in two forms:

  • Cysts, which are present in the faeces of infected persons, can survive for several days in faeces and contaminated water. Infection can spread easily through people who do not follow proper sanitary hygiene. When such people handle food with unwashed hands, infection is caused by this faecal-oral route. This is commonly observed with road-side vendors and eateries operating in unclean premises.
  • Trophozoites arise from the cysts in the small intestine and further divide in the large intestine to form cysts. Trophozoites are easily destroyed by gastric juices, cannot survive for long outside the human body and are generally non-infective.
  • Transmission can also occur through house flies, cockroaches, and rats as vectors.
  • Amoebiasis can spread rapidly among people living in hostels, prisons, and other institutions with shared toilet facilities.
  • Usage of night soil as manure for agriculture is also a contributing factor in South Asian countries.
  • Incidents of sewage mixing with community water supply can lead to sudden outbreaks or epidemics of amoebiasis.

Diagnosis

Microscopy:

  • Histolytica can be identified microscopically from stool samples of infected persons. Sometimes multiple stool samples may be required.
  • However, it is difficult to microscopically differentiate histolytica from similar parasites like E. dispar and E. moshkovskii which are relatively less harmful.

Serum:

  • Antigen detection using ELISA, radioimmunoassay, or immunofluorescence.
  • Antibody detection is done using Enzyme Immunoassay (EIA) for extra-intestinal disease.
  • Indirect Haemagglutination (IHA) is the most sensitive test. But only a negative result can be used to exclude infection. This is because a current infection or a past infection both give a positive result.
  • If there is an extra-intestinal infection, a blood sample can be used to make the diagnosis. But again, this will show up a positive result with someone who has a history of amoebiasis, even if no current infection exists.
  • Polymerase Chain Reaction (PCR) tests can help to differentiate between E. histolytica and other parasites. However, these are expensive.

CT scans and MRI can be used in case of amoebic liver abscess and cerebral infection. Colonoscopy can be used to take biopsies and confirm intestinal amoebiasis.

Treatment

The drug of choice to treat amoebiasis is an antibiotic nitroimidazole such as metronidazole which is given for:

  • Tissue infections and invasive disease
  • Both prevention and treatment

As a follow-up to metronidazole, luminal agents such as Paromycin are usually given to a patient for:

  • Lumen infections
  • Eliminating cysts
  • Asymptomatic carriers

Severe infections require the use of broad-spectrum antibiotics. Amoebic liver abscess (pus formation) requires surgical drainage if the abscess is large and threatening to rupture.

Persons with amoebiasis recover well with treatment, provided it is given on time. Most patients will recover in a period of 2 weeks, but if left untreated, it can lead to serious consequences.

Amoebiasis can be prevented by:

  • Thoroughly washing hands with soap after using the toilet
  • Cleaning fruits and vegetables before consuming them
  • Not eating cut or peeled fruits sold by street vendors
  • Drinking water that is boiled or bottled
  • Avoiding road-side eateries

Sources:

https://www.nhp.gov.in/disease/digestive/amoebiasis

https://www.cdc.gov/parasites/amebiasis/general-info.html

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6304615/

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