Amebiasis, which is caused by Entamoeba histolytica, occurs worldwide and is associated with poor sanitation. Outbreaks have been reported in institutions for the mentally retarded and in the homosexual community. Amebae inhabit the cecum and large intestine, where they cause ulcers and diffuse inflammation, which can mimic ulcerative colitis. Rarely, an ameboma develops in the liver and presents as a liver abscess. Approximately half of all infected patients are asymptomatic. Symptoms include nausea and vomiting, anorexia, diarrhea, fever, abdominal pain, and leukocytosis. Protozoan infections, including amebiasis, do not produce eosinophilia. The diagnosis is established with stool testing, including testing of postcathartic stools and concentration and staining techniques. Stool specimens should be fixed in polyvinyl alcohol formalin, or merthiolate-iodine-formalin. Serologic tests (ELISA and indirect hemagglutination reaction) can be helpful in the presence of extraintestinal disease. Treatment is with metronidazole or tinidazole.
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