Amebiasis Health Article

Definition

Amebiasis is an infectious disease caused by a parasitic one-celled microorganism (protozoan) called Entamoeba histolytica. Persons with amebiasis may experience a wide range of symptoms, including diarrhea, fever, and cramps. The disease may also affect the intestines, liver, or other parts of the body.

Description

Amebiasis, also known as amebic dysentery, is one of the most common parasitic diseases occurring in humans, with an estimated 500 million new cases each year. It occurs most frequently in tropical and subtropical areas where living conditions are crowded, with inadequate sanitation. Although most cases of amebiasis occur in persons who carry the disease but do not exhibit any symptoms (asymptomatic), as many as 100, 000 people die of amebiasis each year. In the United States, between 1 and 5% of the general population will develop amebiasis in any given year, while male homosexuals, migrant workers, institutionalized people, and recent immigrants develop amebiasis at a higher rate.

Human beings are the only known host of the amebiasis organism, and all groups of people, regardless of age or sex, can become affected. Amebiasis is primarily spread in food and water that has been contaminated by human feces but is also spread by person-to-person contact. The number of cases is typically limited, but regional outbreaks can occur in areas where human feces are used as fertilizer for crops, or in cities with water supplies contaminated with human feces.

Causes and symptoms

Recently, it has been discovered that persons with symptom-causing amebiasis are infected with Entamoeba histolytica, and those individuals who exhibit no symptoms are actually infected with an almost identical-looking ameba called Entamoeba dispar. During their life cycles, the amebas exist in two very different forms: the infective cyst or capsuled form, which cannot move but can survive outside the human body because of its protective covering, and the disease-producing form, the trophozoite, which although capable of moving, cannot survive once excreted in the feces and, therefore, cannot infect others. The disease is most commonly transmitted when a person eats food or drinks water containing E. histolytica cysts from human feces. In the digestive tract the cysts are transported to the intestine where the walls of the cysts are broken open by digestive secretions, releasing the mobile trophozoites. Once released within the intestine, the trophozoites multiply by feeding on intestinal bacteria or by invading the lining of the large intestine. Within the lining of the large intestine, the trophozoites secrete a substance that destroys intestinal tissue and creates a distinctive bottle-shaped sore (ulcer). The trophozoites may remain inside the intestine, in the intestinal wall, or may break through the intestinal wall and be carried by the blood to the liver, lungs, brain, or other organs. Trophozoites that remain in the intestines eventually form new cysts that are carried through the digestive tract and excreted in the feces. Under favorable temperature and humidity conditions, the cysts can survive in soil or water for weeks to months, ready to begin the cycle again.

Although 90% of cases of amebiasis in the United States are mild, pregnant women, children under two years of age, the elderly, malnourished individuals, and people whose immune systems may be compressed, such as cancer or AIDS patients and those individuals taking prescription medications that suppress the immune system, are at a greater risk for developing a severe infection.

The signs and symptoms of amebiasis vary according to the location and severity of the infection and are classified as follows:

Intestinal amebiasis

Intestinal amebiasis can be subdivided into several categories:

ASYMPTOMATIC INFECTION. Most persons with amebiasis have no noticeable symptoms. Even though these individuals may not feel ill, they are still capable of infecting others by person-to-person contact or by contaminating food or water with cysts that others may ingest, for example, by preparing food with unwashed hands.

CHRONIC NON-DYSENTERIC INFECTION. Individuals may experience symptoms over a long period of time during a chronic amebiasis infection and experience recurrent episodes of diarrhea that last from one to four weeks and recur over a period of years. These patients may also suffer from abdominal cramps, fatigue, and weight loss.

AMEBIC DYSENTERY. In severe cases of intestinal amebiasis, the organism invades the lining of the intestine, producing sores (ulcers), bloody diarrhea, severe abdominal cramps, vomiting, chills, and fevers as high as 104-105°F (40-40.6°C). In addition, a case of acute amebic dysentery may cause complications, including inflammation of the appendix (appendicitis), a tear in the intestinal wall (perforation), or a sudden, severe inflammation of the colon (fulminating colitis).

AMEBOMA. An ameboma is a mass of tissue in the bowel that is formed by the amebiasis organism. It can result from either chronic intestinal infection or acute amebic dysentery. Amebomas may produce symptoms that mimic cancer or other intestinal diseases.

PERIANAL ULCERS. Intestinal amebiasis may produce skin infections in the area around the patient's anus (perianal). These ulcerated areas have a "punched-out" appearance and are painful to the touch.