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==Background==
<languages/>
* Fecal oral transmission of Entamoeba histolytica cyst
 
* Excystation in intestinal lumen
 
* Trophozoites adhere and colonizes large intestine forming new cysts or invade the intestinal mucosa to cause colitis or abscesses
 
* Liver abscess-10x more common in men
==Background== [[File:Amebiasis LifeCycle.gif|thumb|The life-cycle of various intestinal Entamoeba species.]]
==Clinical Features==
*Fecal oral transmission of Entamoeba histolytica cyst
* Asymptomatic vs. dysentery vs. extraintestinal abscesses
*Most infection asymptomatic
* Intestinal- several weeks of crampy abdominal pain, weight loss, watery or bloody diarrhea
*Excystation in intestinal lumen
* Liver abscess-fever, cough, and a constant, dull, RUQ or epigastric pain, right-sided pleural pain or referred shoulder pain +/- GI upset
*Trophozoites adhere and colonizes large intestine forming new cysts or invade the intestinal mucosa to cause colitis or abscesses
** Hepatomegaly with tenderness over the liver a typical finding
*[[Liver abscess|Liver abscess]] - 10x more common in men
*Incubation period usually 2-4 weeks, but may range from a few days to years
 
 
 
==Clinical Features== *Asymptomatic vs. dysentery vs. extraintestinal abscesses
*Intestinal- several weeks of crampy [[abdominal pain|abdominal pain]], weight loss, watery or bloody [[diarrhea|diarrhea]]
*[[Liver abscess|Liver abscess]]-[[fever|fever]], [[cough|cough]], [[RUQ pain|RUQ]] or [[epigastric pain|epigastric pain]], right-sided [[chest pain|pleural pain]] or referred shoulder pain +/- GI upset
**[[Hepatomegaly|Hepatomegaly]] with tenderness over the liver a typical finding
**Abscess rupture can involve associated peritoneum, pericardium, or pleural cavity
**Abscess rupture can involve associated peritoneum, pericardium, or pleural cavity
* Extrahepatic amebic abscesses in the lung, brain, and skin are rare
*Extrahepatic amebic abscesses in the lung, brain, and skin are rare
==Differential Diagnosis==
 
===Dysentery===
 
*Infectious- Shigella, Salmonella, Campylobacter, E.Coli.  
 
*Noninfectious- Inflammatory bowel disease, ischemic colitis, diverticulitis, AV malformation.
==Differential Diagnosis== ===Dysentery=== *Infectious- [[shigella|shigella]], [[salmonella|salmonella]], [[campylobacter|campylobacter]], [[E. Coli|E. Coli]].  
===Liver abscess===
*Noninfectious- [[Inflammatory bowel disease|Inflammatory bowel disease]], [[ischemic colitis|ischemic colitis]], [[diverticulitis|diverticulitis]], AV malformation.
*Pyogenic liver abscess, necrotic hepatoma, Echinococcal cyst
 
==Workup==
 
*CBC
{{Liver abscess DDX}}
 
 
 
{{Fever in Traveler DDX}}
 
 
 
{{Diarrhea DDX}}
 
 
 
 
==Evaluation== ===Labs=== *CBC
*Chem
*Chem
*LFT
*[[LFTs|LFTs]]
*Stool or abscess microscopy
*Stool PCR
**Diagnostic gold standard
**100% sensitive and specific
*Stool or abscess microscopy  
**<60% SN; unreliable diagnostic test<ref>Rayan HZ. Microscopic overdiagnosis of intestinal amoebiasis. J Egypt Soc Parasitol. 2005;35(3):941–951</ref>
*Stool, serum, or abscess fluid antigen
*Stool, serum, or abscess fluid antigen
*Indirect hemagluttination (antibody)
*Indirect hemagglutination (antibody)
==Management==
 
===Asymptomatic colonization===
 
*Paromomycin or Diloxanide
 
===Colitis===
===Imaging=== *Abdominal Ultrasound
*Flagyl
**58-98% SN for liver abscess (depending on size/location)
===Liver abscess===
*Abdominal CT
*Flagyl, Tinidazole, Paromomycin, or Diloxanide
**Alternative to ultrasound; equally effective in identifying abscess
*Consider drainage of abscess if no response to abx in 5 days, abscess >5cm or left lobe involvement
 
==Disposition==
 
*Home if no complications
 
==Sources==
==Management== ===Asymptomatic colonization=== *[[Paromomycin|Paromomycin]] or diloxanide
*Haque R, Huston C, Hughes M, Houpt E, Petri, W. ''Amebiasis''. N Engl J Med 2003; 348:1565-1573
 
 
 
===Colitis===  
*{{AntibioticDose|drug=Metronidazole|dose=750mg PO q8h x 5-10 days|context=Intestinal colitis|disease=Amebiasis|population=Adult}}
 
 
 
===Liver abscess=== *[[Metronidazole]], [[tinidazole|tinidazole]], [[paromomycin|paromomycin]], or diloxanide
*Consider drainage of abscess by IR if no response to antibiotics in 5 days, abscess > 5cm, or left lobe involvement
 
 
 
==Disposition== *'''Admission'''
**Admit if signs of shock, sepsis, or peritonitis
**Patients with toxic megacolon should be admitted for surgical intervention.
*'''Discharge'''
**Patients who are non-toxic and able to tolerate oral hydration/PO meds can be discharged with outpatient follow-up
 
 
 
==External Links== *[https://www.merckmanuals.com/professional/infectious-diseases/intestinal-protozoa-and-microsporidia/amebiasis?query=amebiasis Merk Manual - Amebiasis]
 
 
 
==References== <references/>
 
[[Category:ID]]
[[Category:Tropical Medicine]]
[[Category:GI]]

Revisión actual - 10:47 20 mar 2026

Otros idiomas:


==Background==

The life-cycle of various intestinal Entamoeba species.
  • Fecal oral transmission of Entamoeba histolytica cyst
  • Most infection asymptomatic
  • Excystation in intestinal lumen
  • Trophozoites adhere and colonizes large intestine forming new cysts or invade the intestinal mucosa to cause colitis or abscesses
  • Liver abscess - 10x more common in men
  • Incubation period usually 2-4 weeks, but may range from a few days to years


==Clinical Features== *Asymptomatic vs. dysentery vs. extraintestinal abscesses


==Differential Diagnosis== ===Dysentery=== *Infectious- shigella, salmonella, campylobacter, E. Coli.


Hepatic abscess


Fever in traveler


Acute diarrhea

Infectious

Noninfectious

Watery Diarrhea

Traveler's Diarrhea



==Evaluation== ===Labs=== *CBC

  • Chem
  • LFTs
  • Stool PCR
    • Diagnostic gold standard
    • 100% sensitive and specific
  • Stool or abscess microscopy
    • <60% SN; unreliable diagnostic test[2]
  • Stool, serum, or abscess fluid antigen
  • Indirect hemagglutination (antibody)


===Imaging=== *Abdominal Ultrasound

    • 58-98% SN for liver abscess (depending on size/location)
  • Abdominal CT
    • Alternative to ultrasound; equally effective in identifying abscess


==Management== ===Asymptomatic colonization=== *Paromomycin or diloxanide


Colitis


===Liver abscess=== *Metronidazole, tinidazole, paromomycin, or diloxanide

  • Consider drainage of abscess by IR if no response to antibiotics in 5 days, abscess > 5cm, or left lobe involvement


==Disposition== *Admission

    • Admit if signs of shock, sepsis, or peritonitis
    • Patients with toxic megacolon should be admitted for surgical intervention.
  • Discharge
    • Patients who are non-toxic and able to tolerate oral hydration/PO meds can be discharged with outpatient follow-up


==External Links== *Merk Manual - Amebiasis


==References==

  1. ↑ Marx et al. “Cholera and Gastroenteritis caused by Noncholera Vibrio Species”. Rosen’s Emergency Medicine 8th edition vol 1 pg 1245-1246.
  2. ↑ Rayan HZ. Microscopic overdiagnosis of intestinal amoebiasis. J Egypt Soc Parasitol. 2005;35(3):941–951
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