Gastrointestinal Amebiasis

Medically reviewed on Jun 11, 2018

 Health Guide
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What Is It?

Gastrointestinal amebiasis is an infection of the large intestine caused by

microscopic one-celled parasites commonly known as amoebas (Entamoeba
histolytica). Because these parasites live in the large intestine, they travel in the
feces of infected people, and can contaminate water supplies in places where
sanitation is poor. The parasite can contaminate fruits and vegetables grown in
areas where human feces are used as fertilizer. They can be transferred on the
dirty hands of infected people who don't wash their hands often or correctly.

Once amoebas enter the mouth, they travel through the digestive system and
settle in the large intestine. Harmless strains of the parasite (Entamoeba dispar)
live there without causing damage. E. histolytica can live in the intestine without
causing symptoms, but it also can cause severe disease. These amoebas may
invade the wall of the intestine, leading to amoebic dysentery, an illness that
causes intestinal ulcers, bleeding, increased mucus production and diarrhea.
These amoebas also may pass into the bloodstream and travel to the liver or,
infrequently, to the brain, where they form pockets of infection (abscesses).

About 10% of the world's population is infected with amoebas, particularly

people who live in Mexico, India, Central America, South America, Africa and the
tropical areas of Asia. In industrialized countries, amebiasis is most common in
recent immigrants and travelers who visit countries where amoebas are prevalent.

Symptoms

In more than 90% of cases, the infecting strain of amoeba does not cause any
symptoms. When symptoms do occur, they usually begin within months after
amoebas first enter the body. In some people, the symptoms are mild, consisting
of mild pain and gurgling sounds in the lower abdomen, along with two or three
loose stools daily. In other people, however, there can be full-blown symptoms of
amoebic dysentery, including high fever, severe abdominal pain and 10 or more
episodes of diarrhea daily. Typically, this diarrhea is watery or contains blood and
mucus.

When amoebas spread to the liver and cause liver abscess, symptoms can include
fever, nausea, vomiting, and pain in the upper right portion of the abdomen,
weight loss and an enlarged liver. It is possible for a person to develop symptoms
of an amoebic liver abscess without ever having had the diarrhea typical of
infection.

Diagnosis

Your doctor will ask about your exposure to amoebas, especially about any
recent trips to areas where amoebas are common. Your doctor will look for
specific symptoms of amoebic infection, especially frequent diarrhea or loose
stools and the presence of blood and mucus in your bowel movements. Because
other conditions can cause bloody diarrhea, and because there are other types of
infectious diarrhea, information about bowel disease in your family and details of
your travels are particularly important.

Usually, a series of three stool samples will be checked in the laboratory for the
presence of E. histolytica. In many cases, this stool test can confirm the diagnosis.
Several different blood tests that can make a diagnosis with a high degree of
accuracy are also available. In special cases, when the diagnosis is not clear after
stool and blood tests, proctosigmoidoscopy or colonoscopy may be needed to
allow your doctor to examine the intestinal wall directly and to take tissue
samples for laboratory examination. In these tests, a doctor inserts a thin, lighted
instrument into the rectum and colon to view them directly.

When symptoms of fever and abdominal pain, especially on the right upper side,
suggest a possible liver abscess, you may need an ultrasound or CT scan of the
liver. Because people who have a liver abscess but no longer have parasites in the
intestines, stool tests may be less helpful. In these situations, doctors confirm the
diagnosis with a blood test or a needle aspiration or biopsy. In a needle
aspiration or biopsy, a small piece of tissue from the abscess is removed and
examined in a laboratory.

Expected Duration

Harmless amoebas can live in the intestines for years without causing symptoms.
When invasive amoebas cause symptoms of amoebic dysentery, attacks can last
from a few days to several weeks. Unless you are treated, you can have another
attack.

Prevention

There is no immunization to protect against gastrointestinal amebiasis. If you

travel to areas where amebiasis is common, you can decrease your risk of
infection by drinking only canned or bottled drinks or water that has been boiled.
Eat only foods that have been cooked thoroughly. Drink only pasteurized milk
and dairy products. If you eat raw fruit, eat only those that you have freshly
peeled.

Treatment

Gastrointestinal amebiasis is treated with nitroimidazole drugs, which kill

amoebas in the blood, in the wall of the intestine and in liver abscesses. These
drugs include metronidazole(Flagyl) and tinidazole (Tindamax, Fasigyn).
Metronidazole usually is given for 10 days, either by mouth or directly into the
veins (intravenously). To kill amoebas and cysts confined to the intestine, three
drugs called luminal drugs are available: iodoquinol (Diquinol and
others), paromomycin (Humatin) and diloxanide furoate (Furamide). One of these
drugs is used along with metronidazole when gastrointestinal symptoms are
present. In people who pass amoebas in their stools without having symptoms of
amebiasis, the luminal drugs alone can clear the amoebas from the bowel.

When To Call a Professional

Call your doctor whenever you have continuing diarrhea, especially if it contains
blood and mucus. If you have severe abdominal pain, especially in the right
upper side, and a fever, visit a doctor the same day. When you have non-bloody
diarrhea that is frequent and symptoms of dehydration such as dizziness, call
your doctor.

Prognosis

Drug treatment can cure amebiasis within a few weeks. However, because
medication cannot keep you from getting infected again, repeat episodes of
amebiasis may occur if you continue to live in or travel to areas where amoebas
are found. Among children in developing countries, especially infants and those
younger than 5, gastrointestinal amebiasis can be fatal. Worldwide, amebiasis is
the third most common cause of death from parasitic infections.

External resources

Centers for Disease Control and Prevention 1600 Clifton Road Atlanta, GA 30333
Toll-Free: 1-888-232-3228 TTY: 1-888-232-6348http://www.cdc.gov

Further information

Always consult your healthcare provider to ensure the information displayed on

this page applies to your personal circumstances.

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