Amoebiasis

Amoebiasis, or Amebiasis refers to infection caused by the amoeba Entamoeba histolytica. The term Entamoebiasis is occasionally seen but is no longer in use; it refers to the same infection. Likewise amoebiasis is sometimes incorrectly used to refer to infection with other amoebae, but strictly speaking it should be reserved for Entamoeba histolytica infection. Other amoebae infecting humans include

A gastrointestinal infection that may or may not be symptomatic and can remain latent in an infected person for several years, amoebiasis is estimated to cause 70,000 deaths per year world wide. Symptoms can range from mild diarrhea to dysentery with blood and mucus in the stool. E. histolytica is usually a commensal organism. Severe amoebiasis infections (known as invasive or fulminant amoebiasis) occur in two major forms. Invasion of the intestinal lining causes amoebic dysentery or amoebic colitis. If the parasite reaches the bloodstream it can spread through the body, most frequently ending up in the liver where it causes amoebic liver abscesses. Liver abscesses can occur without previous development of amoebic dysentery. When no symptoms are present, the infected individual is still a carrier, able to spread the parasite to others through poor hygienic practices. While symptoms at onset can be similar to bacillary dysentery, amoebiasis is not bacteriological in origin and treatments differ, although both infections can be prevented by good sanitary practices

E. histolytica infections occur in both the intestine and (in people with symptoms) in tissue of the intestine and/or liver. As a result, two different classes of drugs are needed to treat the infection, one for each location. Such anti-amoebic drugs are known as amoebicides or amebicides. Metronidazole, or a related drug such as Tinidazole, Secnidazole or Ornidazole, is used to destroy amoebae that have invaded tissue. These are rapidly absorbed into the bloodstream and transported to the site of infection. Because they are rapidly absorbed there is almost none remaining in the intestine. Since most of the amoebae remain in the intestine when tissue invasion occurs, it is important to get rid of those also or the patient will be at risk of developing another case of invasive disease. Several drugs are available for treating intestinal infections, the most effective of which has been shown to be Paromomycin (also known as Humatin); Diloxanide Furoate (also known as Furamide) is used in the US and Iodoquinol (also known as Yodoxin) is used in certain other countries. Both tissue and lumenal drugs must be used to treat infections, with Metronidazole usually being given first, followed by Paromomycin or Diloxanide. E. dispar does not require treatment, but many laboratories (even in the developed world) do not have the facilities to distinguish this from E. histolytica.
For amebic dysentery a multi-prong approach must be used, starting with one of:
Metronidazole 500-750mg three times a day for 5-10 days
Tinidazole 2g once a day for 3 days is an alternative to metronidazole
In addition to the above, one of the following luminal amebicides should be prescribed as an adjunctive treatment, either concurrently or sequentially, to destroy E. histolytica in the colon:
Paromomycin 500mg three times a day for 10 days
Diloxanide furoate 500mg three times a day for 10 days
Iodoquinol 650mg three times a day for 20 days