Amoebiasis natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Natural History

Luminal Amoaebiasis (Asymptomatic) - 1 to 3 Weeks

• Following transmission, individuals remain asymptomatic for approximately 1 to 3 weeks, during which the parasite starts to actively destroy to integrity of the intestinal wall.
• The majority of patients with Entamoeba (both E. dispar and E. histolytica) do not develop any clinical manifestations.
• The infection rate of E. histolytica is approximately 20%, whereas the infection rate of E. dispar is approximately 0%.

Invasive Intestinal Amoaebiasis

• As the parasite continues to invade the intestinal wall, the integrity of the wall is compromised, and the host immune cells are activated. The activation of neutrophils, macrophages, lymphocytes, and eosinophils contribute to inflammation and the development of clinical manifestations.
• Early symptoms include profuse, watery diarrhea, abdominal pain, bloating, and nausea.

If left untreated, patients may progress to develop dysentery, colitis, appendicitis, toxic megacolon, and ameboma.

Invasive Extraintestinal Amoebiasis

• As the infection advances, the parasite is able to migrate outside the intestinal lumen into the bloodstream, where it is able to migrate to distant organs.
• If left untreated, the most site of parasitic migration is the liver, whereby the parasite travels in the portal circulation and causes amoebic liver abscess.
• Other organs may also be affected, including the brain (brain abscess), pulmonary system (pleuropulmonary abscess), skin, and genitals.

Complications

Complications of amoebiasis may be either intestinal or extraintestinal:

Intestinal Complications=

• Dysentery
• Colitis
• Appendicitis
• Toxic megacolon
• Ameboma

Extraintestinal Complications

• Amoebic liver abscess
• Amoebic brain abscess
• Pleuropulmonary abscess
• Skin lesions
• Amoebic genital lesions
• Cardiac abscess