Beruflich Dokumente
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by Sara Jones
Disease Etiology:
Disease Transmission:
Reservoirs
Human beings are the reservoirs for the protozoa, Entamoeba histolytica. 90% of
patients who become infected with Entamoeba histolytica will remain asymptomatic.[6]
Immunosuppression with steroids or due to other reasons increase the risk of invasive disease.
[7] Incubation of the disease may be from 2 days to years, although it usually from within days
to months.
The trophozoites are 10-60 mm in diameter and are motile amoeba. The pathogenic
Entamoeba histolytica is characterized by ingested erythrocytes in the trophozoite. It is the
trophozoite which is responsible for the invasive disease in the colon. The lecithin of the
trophozoite, galactose/N-acetylgalactosamine facilitates adherence of the amoeba to the colon
wall. This lecithin is a surface protein which contains 2 main subunits. It is the larger, 170-kd
subunit with the glactose-binding activity. This lecithin also has at least 6 different antigenic
characteristics which differentiate it from E. dispar. [8] Colonic cells without N-terminal
galactose or N-acetylgalactosamine residues are resistant to this adherence. Immune mediated
mucosal immunity to the lecithin, galactose/N-acetylgalactosamine plays a significant role in
preventing the development of invasive disease. Serum IgA anti-lecthin provides host resistance
to disease while anti-lecithin IgG increases the risk of adherence.[10] Once adherence occurs,
cell death occurs due to formation of pores in the target cell lipid bilayers, apoptosis, secretion of
proteases, changing intestinal permeability and also by a contact dependant mechanism.[9]
Serologic tests do not distinguish new versus past infections and even in patients with
amebic liver abcesses, these tests may be falsely negative initially for the first week when
symptomatic. The indirect hemagglutination assay measures antibody titers for the galactose-
inhibitable adherence lectin It is no more sensitive than the enzyme immunoassay test. Either
one of these two tests takes about 2 hours to perform.[11]
One of the mainstays of diagnosis is checking the stool for ova and parasites. Specimens
must be fresh (within 15 minutes) to show motile trophozoites. If this cannot be done, specimens
are placed in a fixative to prevent degradation.[3]
While in most, the disease is asymptomatic, symptoms often start with a mild diarrhea
and lower abdominal pain. This may progress to malaise, weight loss and increasing abdominal
pain. The pain may mimic acute appendicitis. The diarrhea will progress to frank dysentery
with bloody mucus like watery diarrhea passing up to 20 times daily as infiltration of the colon
wall increases. As opposed to bacterial enteritis, less than 40% of patients will become febrile
unless fulminate intestinal infection occurs which may cause high fevers, severe abdominal pain
with profuse diarrhea. The patient may develop a toxic megacolon.[7] Patients with chronic
disease may present like those with inflammatory bowel disease or may present with an
asymptomatic abdominal mass which is intraluminal and may be difficult to distinguish from a
carcinoma.[3]. They may have diarrhea every few days alternating with constipation as well as
weakness and weight loss.[12]
Extra-intestinal disease most often presents in the liver. Spread to the liver is through the
portal circulation. Abcesses are solitary in around 2/3rds of cases and 80% of the time, these
abscesses are found in the right lobe of the liver. Jaundice is present in up to 1/3rd of patients and
is usually mild. The liver is usually enlarged and tender. Aspiration rarely shows the
trophozoites or white blood cells. Spread to the liver is more common in males than females for
an unknown reason [3], [4],[7]
Historical Information:
In 1875, Fedor Losch first described amebiasis in St. Petersburg, Russia. 11 years later,
Kartulus, showed that the amoeba were a pathogen for the diarrhea and liver disease in patients
with amebiasis. In 1891, doctors at Johns Hopkins differentiated amoebic from bacterial
dysentery. Over 20 years later, Walker and Sellards, working in the Phillipines were able to
document the pathogenesis of the amebae. There may be up to 100,000 persons worldwide who
die annually from amebic infections[8]
Control/Treatment
The WHO recommends treating all patients with proven Entamoeba histolytica
infections. In places with limited resources and positive stool samples, they recommend only
treating symptomatic patients to limit the development of resistant strains of Entamoeba
histolytica. Prophylaxis is never recommended.
Prevention/ Vaccines
References
[1]Center for Disease Control. Division of Parasitic Disease. Amebiais. last reviewed
September 3, 2008
.http://www.cdc.gov/ncidod/dpd/parasites/Amebiasis/factsht_Amebiasis.htm#what 03/14/10
[2] Petri, WA, Singh, U. Enteric Amebiasis. In: Tropical Infectious Diseases: Principles,
pathogens, and practice. Second edition, Guerrant, R, Walker, DH, Weller, PF (eds). Elsevier,
Philadelphia 2006. p. 967.
C. Graham Clark, PhD, Mayo Clinic Proceedings October 2008 vol. 83 no. 10 1154-1160
http://www.mayoclinicproceedings.com/content/83/10/1154.full 03/14/10
[4] Journal of the Royal Society of Medicine, Amoebiasis: a review James Harris; JRSM 75:
190-197, 1982 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1437583/pdf/jrsocmed00251-
0056.pdf 03/14/10
[5] Emedicine, from WebMD Amebiasis Vinod K Dhawan, MD and Thomas R Naparst, MD,
Updated August 11, 2008 http://emedicine.medscape.com/article/996092-media
03/14/10
03/14/10
[9] Update for Patients; Intestinal Entamoeba histolytica amebiasis Karin Leder, MBBS,
FRACP, PhD, MPH, DTMH and Peter F Weller, MD, FACP; Updated 2010
http://www.utdol.com/patients/content/topic.do?topicKey=~xgxgkbDEMr.rOv 03/14/10
[10] Haque, R, Duggal, P, Ali, IM, et al. Innate and acquired resistance to amebiasis in
Bangladeshi children. J Infect Dis 2002; 186:547. http://www.jstor.org/pss/30084484 03/14/10
[11] Emedicine, from WebMD Amebiasis Vinod K Dhawan, MD and Thomas R Naparst, MD,
Updated August 11, 2008 http://emedicine.medscape.com/article/996092-diagnosis
03/14/10
[12] CDC Yellow Book for Travelers Amebiasis Sharon Roy, Barbara L. Herwaldt,
Stephanie P. Johnston Last updated July 27, 2009
http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-5/amebiasis.aspx 03/14/10
[13] Catherine P. A. Ivory and Kris Chadee; Intranasal Immunization with Gal-Inhibitable
Lectin plus an Adjuvant of CpG Oligodeoxynucleotides Protects againstEntamoeba
histolytica Challenge Infection and Immunity, October 2007, 75: 4917-4922
http://iai.asm.org/cgi/content/abstract/75/10/4917 03/14/10