Colorectal Parasitic Infections: Invasive Entamoeba histolytica and Its Role in Colonic and Hepatic Disease

  • G. C. Cook
Part of the The Bloomsbury Series in Clinical Science book series (BLOOMSBURY)


In all developing Third World countries — both tropical and subtropical — socioeconomic conditions and standards of hygiene and sanitation are less than perfect. In consequence human infection with a large range of colorectal parasites is common (Cook 1980, 1986a,b, 1988, 1989). Travellers and tourists are also frequently infected and a ‘high index of suspicion’ is required if this group of diseases is to be diagnosed (Walker and Williams 1985). Recently, intestinal parasitic infections have received considerable prominence in relation to immunosuppression (Chaps. 2 and 4) (Cook 1980, 1986b), and this is especially so in patients with HIV infections and in particular those with the end-stage AIDS syndrome (Casemore et al. 1985); active male homosexuals who are HIV-negative are also at a significantly greater risk from some of these infections (Weller 1985).


Male Homosexual Entamoeba Histolytica Protozoan Infection Intestinal Parasitic Infection Eosinophilic Gastroenteritis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Alexander-Williams J (1983) Pruritus ani. Br Med J 287: 159–160CrossRefGoogle Scholar
  2. Allason-Jones E, Mindel A, Sargeaunt P, Katz D (1988) Outcome of untreated infection with Entamoeba histolytica in homosexual men with and without HIV antibody. Br Med J 297: 654–657CrossRefGoogle Scholar
  3. Allen AVH, Ridley DS (1970) Further observations on the formol-ether concentration technique for faecal parasites. J Clin Pathol 23: 545–546PubMedCrossRefGoogle Scholar
  4. Ambroise-Thomas P (1980) Amebiasis and other protozoal diseases. In: Houba V (ed) Immunological investigation of tropical parasitic diseases. Churchill Livingstone, Edinburgh, pp 75–83Google Scholar
  5. Anthony PP, McAdam IWJ (1972) Helminthic pseudotumours of the bowel: thirty-four cases of 116 helminthoma. Gut 13: 8–16PubMedCrossRefGoogle Scholar
  6. Areán VM, Koppisch E (1956) Balantidiasis. A review and report of cases. Am J Pathol 32: 1089–1115Google Scholar
  7. Barker DC, Troup L, Maxwell LE (1976) Nutrition/invasion interaction migration of Entamoeba invadens in response to varied carbohydrate stimuli. In: van den Bosshe H (ed) Biochemistry of parasites and host-parasite relationships. North-Holland, Amsterdam, pp 393–400Google Scholar
  8. Bassily S, Farid Z, El-Masry NA, Mickhail EM (1987) Treatment of intestinal E histolytica and G lamblia with metronidazole, tinidazole and ornidazole: a comparative study. J Trop Med Hyg 90: 9–12PubMedGoogle Scholar
  9. Beaver PC, Kriz JJ, Lau TJ (1973) Pulmonary nodule caused by Enterobius vermicularis. Am J Trop Med Hyg 22: 711–713PubMedGoogle Scholar
  10. Beaver PC, Blanchard JL, Seibold HR (1988) Invasive amebiasis in naturally infected new world and old world monkeys with and without clinical disease. Am J Trop Med Hyg 39: 343–352PubMedGoogle Scholar
  11. Berry AJ, Long EG, Smith JH, Gourley WK, Fine DP (1983) Chronic relapsing colitis due to Strongyloides stercorals. Am J Trop Med Hyg 32: 1289–1293PubMedGoogle Scholar
  12. Bijlmer J (1946) An exceptional case of oxyuriasis of the intestinal wall. J Parasitol 32: 359–366PubMedCrossRefGoogle Scholar
  13. Boreham PFL, Phillips RE, Shepherd RW (1984) The sensitivity of Giardia intestinalis to drugs in vitro. J Antimicrob Chemother 14: 449–461PubMedCrossRefGoogle Scholar
  14. Brumpt ME (1925) Etude sommaire de YEntamoeba dispar a n. sp. amibe a kystes quadrinuclees, parasite de l’homme. Bull Acad Med Paris 94: 943–952Google Scholar
  15. Bundy DAP (1986) Epidemiological aspects of Trichuris and trichuriasis in Caribbean communities. Trans R Soc Trop Med Hyg 80: 706–718PubMedCrossRefGoogle Scholar
  16. Casemore DP, Sands RL, Curry A (1985) Cryptosporidium species: a ‘new’ human pathogen. J Clin Pathol 38: 1321–1336Google Scholar
  17. Chandrasoma PT, Mendis KN (1977) Enterobius vermicularis in ectopic sites. Am J Trop Med Hyg 26: 644–649Google Scholar
  18. Cook GC (1980) Tropical gastroenterology. Oxford University Press, Oxford, pp 158–164, 381–393Google Scholar
  19. Cook GC (1985a) Infective gastroenteritis and its relationship to reduced gastric acidity. Scand J Gastroenterol 20 [Suppl 111]: 17–23CrossRefGoogle Scholar
  20. Cook GC (1985b) Parasitic infection. In: Booth CC, Neale G (eds) Disorders of the small intestine. Blackwell Scientific Publications, Oxford, pp 283–298Google Scholar
  21. Cook GC (1986a) The clinical significance of gastrointestinal helminths - a review. Trans R Soc Trop Med Hyg 80: 675–685PubMedCrossRefGoogle Scholar
  22. Cook GC (1986b) Colorectal parasitic and mycotic infections. Ital J Gastroenterol 18: 338–342Google Scholar
  23. Cook GC (1988) Intestinal parasitic infections. Curr Opin Gastroenterol 4: 113–123CrossRefGoogle Scholar
  24. Cook GC (1989) Parasitic infections of the gastrointestinal tract: a worldwide clinical problem. Curr Opin Gastroenterol 5: 126–139CrossRefGoogle Scholar
  25. Councilman WT, Lafleur HA (1891) Amoebic dysentery. Johns Hopkins Hosp Rep 2: 395–548Google Scholar
  26. Desowitz RS, Barnish G (1986) Entamoeba polecki and other intestinal protozoa in Papua New Guinea highland children. Ann Trop Med Parasitol 80: 399–402Google Scholar
  27. Editorial (1985) Is that amoeba harmful or not? Lancet i:732–734Google Scholar
  28. Ellyson JH, Bezmalinovic Z, Parks SN, Lewis FR (1986) Necrotizing amebic colitis: a frequently fatal complication. Am J Surg 152: 21–26PubMedCrossRefGoogle Scholar
  29. Feingold C, Bracha R, Wexler A, Mirelman D (1985) Isolation, purification, and partial characterization of an enterotoxin from extracts of Entamoeba histolytica trophozoites. Infect Immun 48: 211–218PubMedGoogle Scholar
  30. Felt-Bersma RJF, Meuwissen SGM, Velzen D van (1984) Perforation of the small intestine due to eosinophilic gastroenteritis. Am J Gastroenterol 79: 442–445PubMedGoogle Scholar
  31. Gandhi BM, Irshad M, Acharya SK, Tandon BN (1988) Amebic liver abscess and circulating immune complexes of Entamoeba histolytica proteins. Am J Trop Med Hyg 39: 440–444PubMedGoogle Scholar
  32. Gilman RH, Chong YH, Davis C, Greenberg B, Virik HK, Dixon HB (1983) The adverse consequences of heavy Trichuris infection. Trans R Soc Trop Med Hyg 77: 432–438PubMedCrossRefGoogle Scholar
  33. Gorbach SL (1982) Viral infections and inflammatory bowel disease. Gastroenterology 83: 1318–1319.Google Scholar
  34. Greenwood BM, Whittle HC (1981) Immunology of medicine in the tropics. Edward Arnold, London, pp 178–210Google Scholar
  35. Grundy MS, Voller A, Warhurst D (1987) An enzyme-linked immunosorbent assay for the detection of Entamoeba histolytica antigens in faecel material. Trans R Soc Trop Med Hyg 81: 627–632PubMedCrossRefGoogle Scholar
  36. Harries AD, Myers B, Cook GC (1985) Inflammatory bowel disease: a common cause of bloody diarrhoea in visitors to the tropics. Br Med J 291: 1686–1687CrossRefGoogle Scholar
  37. Healy GR (1986) Immunologic tools in the diagnosis of amebiasis: epidemiology in the United States. Rev Infect Dis 8: 239–246PubMedCrossRefGoogle Scholar
  38. Hurst AF (1934) The clinical importance of achlorhydria. Br Med J 2: 665–669PubMedCrossRefGoogle Scholar
  39. Istre GR, Kreiss K, Hopkins RS, Healy GR, Benziger M, Canfield TM, Dickinson P, Englert TR, Compton RC, Mathews HM, Simmons RA (1982) An outbreak of amebiasis spread by colonic irrigation at a chiropractic clinic. N Engl J Med 307: 339–342PubMedCrossRefGoogle Scholar
  40. Jackson TFHG (1987) Entamoeba histolytica cyst passers — to treat or not to treat? South Afr Med J 72:657–658Google Scholar
  41. Joyce MP, Ravdin JI (1988) Antigens of Entamoeba histolytica recognised by immune sera from liver abscess patients. Am J Trop Med Hyg 38: 74–80PubMedGoogle Scholar
  42. Kan SP (1983) Efficacy of single doses of mebendazole in the treatment of Trichuris trichiura infection. Am J Trop Med Hyg 32: 118–122PubMedGoogle Scholar
  43. Kean BH (1988) A history of amebiasis. In: Ravdin JI (ed) Amebiasis: human infection by Entamoeba histolytica. Churchill Livingstone, New York and Edinburgh, pp 1–10Google Scholar
  44. Köberle F (1968) Chagas’ disease and Chagas’ syndromes: the pathology of American trypanosomiasis. Adv Parasitol 6: 63–116PubMedCrossRefGoogle Scholar
  45. Kovacz JA, Masur H (1986) Protozoan infections of man: other infections. In: Campbell WC, Rew RS (eds) Chemotherapy of parasitic diseases. Plenum Press, New York, pp 139–158Google Scholar
  46. Lalla F de, Rizzardini G, Cairoli GA, Rinaldi E, Santoro D, Ostinelli A (1988) Outbreak of amoebiasis in tourists returning from Thailand. Lancet 2: 847PubMedCrossRefGoogle Scholar
  47. Lee FI, Costello FT, Cowley DJ, Murray SM, Srimankar J (1983) Eosinophilic colitis with perianal disease. Am J Gastroenterol 78: 164–166PubMedGoogle Scholar
  48. Lucas SB, Cruse JP, Lewis AHM (1985) Anisakiasis in the United Kingdom. Lancet 2: 843–844PubMedCrossRefGoogle Scholar
  49. Lushbaugh WB, Hofbauer AF, Pittman FE (1984) Proteinase activities of Entamoeba histolytica cytotoxin. Gastroenterology 87: 17–27PubMedGoogle Scholar
  50. Malebranche R, Arnoux E, Guérin JM, Pierre GD, Laroche AC, Péan-Guichard C, Elie R, Morisset PH, Spira T, Mandeville R, Drotman P, Seemayer T, Dupuy J-M (1983) Acquired immunodeficiency syndrome with severe gastrointestinal manifestations in Haiti. Lancet 2: 873–878PubMedCrossRefGoogle Scholar
  51. Manson P (1898) Abscess of the liver. In: Tropical diseases: a manual of the diseases of warm climates. Cassell, London, pp 343–378Google Scholar
  52. Martínez-Palomo A (ed) (1986) Amebiasis. Elsevier, Amsterdam, p 269Google Scholar
  53. Martínez-Palomo A (1987) The pathogenesis of amoebiasis. Parasitol Today 3: 111–118PubMedCrossRefGoogle Scholar
  54. Mathan MM, Mathan VI (1985) Rectal mucosal morphologic abnormalities in normal subjects in southern India: a tropical colonopathy? Gut 26: 710–717PubMedCrossRefGoogle Scholar
  55. Mirelman D (1987) Effect of culture conditions and bacterial associates on the zymodemes of Entamoeba histolytica. Parasitol Today 3: 37–40PubMedCrossRefGoogle Scholar
  56. Mirelman D (1988) Ameba — bacterial relationship in amebiasis. In: Ravdin JI (ed) Amebiasis: human infection by Entamoeba histolytica. Churchill Livingstone, New York and Edinburgh, pp 351–369Google Scholar
  57. Mirelman D, Bracha R, Chayen A, Aust-Kettis A, Diamond LS (1986a) Entamoeba histolytica: effect of growth conditions and bacterial associates on isoenzyme patterns and virulence. Exp Parasitol 62: 142–148Google Scholar
  58. Mirelman D, Bracha R, Wexler A, Chayen A (1986b) Changes in isoenzyme patterns of a cloned culture of nonpathogenic Entamoeba histolytica during axenization. Infect Immunol 54: 827–832Google Scholar
  59. Mondou EN, Gnepp DR (1989) Hepatic granuloma resulting from Enterobius vermicularis. Am J Clin Pathol 91: 97–100PubMedGoogle Scholar
  60. Nanda R, Baveja U, Anand BS (1984) Entamoeba histolytica cyst passers: clinical features and outcome in untreated subjects. Lancet 2: 301–303PubMedCrossRefGoogle Scholar
  61. Naquira C, Jimenez G, Guerra JG, Bernal R, Nalin DR, Neu D, Aziz M (1989) Ivermectin for human strongyloidiasis and other intestinal helminths. Am J Trop Med Hyg 40: 304–309PubMedGoogle Scholar
  62. Nozaki T, Motta SRN, Takeuchi T, Kobayashi S, Sargeaunt PG (1989) Pathogenic zymodemes of Entamoeba histolytica in Japanese male homosexual population. Trans R Soc Trop Med Hyg 83: 525PubMedCrossRefGoogle Scholar
  63. Parija SC, Kasinathan S, Rao RS (1989) Rapid indirect haemagglutination (rapid-IHA) using sensitized chick cells for serodiagnosis of amoebiasis at primary health centre level. J Trop Med Hyg 92: 221–226PubMedGoogle Scholar
  64. Prasad RN, Virk KJ (1987) Entamoeba histolytica: is it necessary to characterize pathogenic strains? Parasitol Today 3: 352Google Scholar
  65. Ravdin JI (ed) (1988). Amebiasis: human infection by Entamoeba histolytica. Churchill Livingstone, New York and Edinburgh, p 838Google Scholar
  66. Ravdin JI (1989) Entamoeba histolytica: from adherence to enteropathy. J Infect Dis 159:420–429PubMedCrossRefGoogle Scholar
  67. Ravdin JI, Murphy CF, Salata RA, Guerrant RL, Hewlett EL (1985) N-acetyl-D-galactosamine-inhibitable adherence lectin of Entamoeba histolytica. I. Partial purification and relation to amebic virulence in vitro. J Infect Dis 151: 804–815Google Scholar
  68. Rogers L (1912) The rapid cure of amoebic dysentery and hepatitis by hypodermic injections of soluble salts of emetine. Br Med J 1: 1424–1425PubMedCrossRefGoogle Scholar
  69. Rogers L (1922) Amoebic liver abscess: its pathology, prevention and cure. Lancet 1: 463–469CrossRefGoogle Scholar
  70. Rolston KVI, Hoy J, Mansell PWA (1986) Diarrhea caused by ‘nonpathogenic amoebae’ in patients with AIDS. N Engl J Med 315: 192PubMedGoogle Scholar
  71. Ross RA, Gibson DI, Harris EA (1989) Cutaneous oesophagostomiasis in man. Trans R Soc Trop Med Hyg 83: 394–395PubMedCrossRefGoogle Scholar
  72. Rushovich AM, Randell EL, Caprini JA, Westenfelder GO (1983) Omental anisakiasis: a rare mimic of acute appendicitis. Am J Clin Pathol 80: 517–520.PubMedGoogle Scholar
  73. Saffos RO, Rhatigan RM (1977) Unilateral salpingitis due to Enterobius vermicularis. Am J Clin Pathol 67: 296–299PubMedGoogle Scholar
  74. Sandler M (1981) Whipworm infection in the colon and rectum simulating Crohn’s colitis. Lancet 2: 210PubMedCrossRefGoogle Scholar
  75. Sargeaunt PG (1987) The reliability of Entamoeba histolytica zymodemes in clinical diagnosis. Parasitol Today 3: 40–43PubMedCrossRefGoogle Scholar
  76. Sargeaunt PG (1988) Zymodemes of Entamoeba histolytica. In: Ravdin JI (ed) Amebiasis: human infection by Entamoeba histolytica. Churchill Livingstone, New York and Edinburgh, pp 370–387Google Scholar
  77. Sargeaunt PG, Williams JE, Grene JD (1978) The differentiation of invasive and non-invasive Entamoeba histolytica by isoenzyme electrophoresis. Trans R Soc Trop Med Hyg 72: 519–521PubMedCrossRefGoogle Scholar
  78. Sargeaunt PG, Oates JK, Maclennan I, Oriel JD, Goldmeier D (1983) Entamoeba histolytica in male homosexuals. Br J Vener Dis 59: 193–195Google Scholar
  79. Sharma MP, Rai RR, Acharya SK, Ray JCS, Tandon BN (1989) Needle aspiration of amoebic liver abscess. Br Med J 299: 1308–1309CrossRefGoogle Scholar
  80. Sheen IS, Chien CSC, Lin DY, Liaw YF (1989) Resolution of liver abscesses: comparison of pyogenic and amebic liver abscesses. Am J Trop Med Hyg 40: 384–389PubMedGoogle Scholar
  81. Shiraki T, Otsuru M, Kenmotsu M, Kihara T, Hisayasu N, Motoyama N (1974) Invasion of Enterobius vermicularis into the human tissues - a report of 4 cases of eosinophilic granulomas caused by adult Enterobius in the intestines and their adjacent tissues. Jap J Parasit 23: 125–137Google Scholar
  82. Shukla VK, Roy SK, Vaidya MP, Mehrotra ML (1986) Fulminant amebic colitis. Dis Colon Rectum 29: 398–401PubMedCrossRefGoogle Scholar
  83. Speelman P, McGlaughlin R, Kabir I, Butler T (1987) Differential clinical features and stool findings in shigellosis and amoebic dysentery. Trans R Soc Trop Med Hyg 81: 549–551PubMedCrossRefGoogle Scholar
  84. Strachan WD, Chiodini PL, Spice WM, Moody AH, Ackers JP (1988) Immunological differentiation of pathogenic and non-pathogenic isolates of Entamoeba histolytica. Lancet 1: 561–563PubMedCrossRefGoogle Scholar
  85. Sullam PM (1988) Amebiasis and giardiasis in homosexual men. In: Leech JH, Sande MA, Root RK (eds) Parasitic infections. Churchill Livingstone, New York and Edinburgh, pp 147–175Google Scholar
  86. Tannich E, Horstmann RD, Knobloch J, Arnold HH (1989) Genomic DNA differences between pathogenic and nonpathogenic Entamoeba histolytica. Proc Natl Acad Sei USA 86: 5118–5122CrossRefGoogle Scholar
  87. Vinayak VK, Sharma P (1989) Kinetics of the immune responses during the course of hepatic amoebic infection — an experimental study. Trans R Soc Trop Med Hyg 83: 349–353PubMedCrossRefGoogle Scholar
  88. Walker E, Williams G (1985) ABC of healthy travel. British Medical Journal Publications, London, p 39Google Scholar
  89. Walsh JA (1986) Problems in recognition and diagnosis of amebiasis: estimation of the global magnitude of morbidity and mortality. Rev Infect Dis 8: 228–238PubMedCrossRefGoogle Scholar
  90. Wanke C, Butler T, Islam M (1988) Epidemiologic and clinical features of invasive amebiasis in Bangladesh: a case-control comparison with other diarrheal diseases and postmortem findings. Am J Trop Med Hyg 38: 335–341PubMedGoogle Scholar
  91. Weber J (1985) Sexually acquired parasitic infections in homosexual men. Parasitol Today 1: 93–95PubMedCrossRefGoogle Scholar
  92. Weller IVD (1985) The gay bowel. Gut 26: 869–875Google Scholar
  93. Yang S (1989) Detection of Entamoeba histolytica trophozoites in liver pus by the indirect fluorescent antibody test for the aetiological diagnosis of amoebic liver abscess. Ann Trop Med Parasitol 83: 253–255PubMedGoogle Scholar
  94. Yang J, Scholten TO (1977) Dientamoeba fragilis: A review with notes on its epidemiology, pathogenicity, mode of transmission and diagnosis. Am J Trop Med Hyg 26: 16–22Google Scholar

Copyright information

© Springer-Verlag London Limited 1990

Authors and Affiliations

  • G. C. Cook
    • 1
    • 2
    • 3
    • 4
    • 5
  1. 1.Hospital for Tropical DiseasesUniversity College HospitalUK
  2. 2.St Luke’s Hospital for the ClergyUK
  3. 3.London School of Hygiene and Tropical MedicineUK
  4. 4.Royal Nigerian ArmyNigeria
  5. 5.Makerere UniversityUganda

Personalised recommendations