Edited by Mike Sharland

in Manual of Childhood Infections

Fourth edition

Published on behalf of © Royal College of Paediatrics & Child Health & European Society of Paediatric Infectious Diseases

Published in print April 2016 | ISBN: 9780198729228
Published online June 2016 | e-ISBN: 9780191796142 | DOI:

Series: Oxford Specialist Handbooks in Paediatrics


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Amoebiasis, caused by Entamoeba histolytica, only occurs in humans and primates. E. histolytica is indistinguishable from the non-pathogenic dispar and moshkovskii. E. histolytica occurs worldwide, but the majority of cases occur in developing countries—approximately 500 million infected. The true incidence of asymptomatic carriage is unclear. Paediatric amoebiasis accounts for less than 10% of all cases, probably higher in resource-poor countries. E. histolytica is spread by the faecal–oral route. Cysts persist in soil for months and are resistant to chlorination and gastric acid. Ingested cysts develop into trophozoites in the small intestine, then pass to the colon. Trophozoites cannot survive outside the body. Ninety per cent of carriers remain asymptomatic and eliminate the organism without treatment. Four to 10% develop colitis, with diarrhoea progressing to dysentery. Fulminant colitis with perforation is rare. Amoebic liver abscess is the commonest systemic manifestation (0.5–1.5%). Very rarely, disease disseminates further by rupture of the amoebic liver abscess or intestinal perforation. A good travel history, often going back years, is vital. Stool microscopy is the mainstay of diagnosis; however, differentiation between Entamoeba species is difficult. If dysentery is present, then fresh warm stool needs to be sent urgently for microscopy to look for trophozoites with ingested red blood cells.Antigen detection has high sensitivity and specificity in dysentery and amoebic liver abscess. Ninety per cent of symptomatic patients develop E. histolytica antibodies. Treatment for invasive bowel or systemic disease includes metronidazole or tinidazole; a recent Cochrane review concluded that tinidazole is superior. Metronidazole is not an effective therapy to remove luminal carriage.

Chapter.  2194 words. 

Subjects: Paediatrics ; Infectious Diseases

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