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Amoebiasis (parasites)

Category: Illness or disabilities

Type

Involuntary

Introduction and description

Amoebiasis, or Amebiasis, refers to infection caused in part by the amoeba Entamoeba histolytica.

Entamoeba histolytica is an anaerobic parasitic protozoan, part of the genus Entamoeba. Predominantly infecting humans and other primates, mammals such as dogs and cats can become infected transiently, but are not thought to contribute significantly to transmission.

E. histolytica is estimated to infect about 50 million people worldwide. Previously, it was thought that 10% of the world population was infected, but these figures predate the recognition that at least 90% of these infections were due to a second species, E. dispar.  The word histolytic literally means "tissue destroyer".

As there is now recognition that more than one species of Entamoeba can result in this illness we have described the illness under the heading of amoebiasis rather than a single parasite.

Superficially amoebiasis is a gastrointestinal infection often confused with ‘traveller’s diarrhoea’ which is bacterial rather than parasitic in origin.  But as we shall see the parasites have the potential to do far more damage.

It is estimated that about 40,000 to 100,000 people worldwide die annually due to amoebiasis, but these figures can only be estimates, as the disease can be asymptomatic and result in complications that appear to be other diseases.  These parasites may be causing more deaths than we think.

It should be noted that cells infected with HIV are often consumed by E. histolytica. Infective HIV remains viable within the amoeba, according to Wikipedia "there has been no proof of human reinfection from amoeba carrying this virus", but that does not mean it has not happened.  In other words, this amoeba may be an HIV carrier.

See also the more generic description of illnesses and diseases caused by Parasites.

Causes

E. histolytica is usually a ‘commensal’ organism. Infection is spread through ingestion of the cyst form of the parasite, a semi-dormant and hardy structure found in faeces.  

Symptoms

Amoebiasis may or may not be symptomatic. 

Symptomatic

 

In the 10% of people where symptoms do occur they can take from a few days to a few weeks to develop and manifest themselves.  The norm is about two to four weeks.  Symptoms can range from mild diarrhoea to dysentery with blood and mucus. Severe amoebiasis infections (known as invasive or fulminant amoebiasis) occur in two major forms.

  • Amoebic dysentry - Invasion of the intestinal lining causes amoebic dysentery or amoebic colitis.  Disease occurs when amoeba comes in contact with the cells lining the intestine. It then secretes the same substances it uses to digest bacteria, which include enzymes that destroy cell membranes and proteins. The blood comes from amoebae invading the lining of the intestine.  This process can lead to penetration and digestion of human tissues, resulting in flask-shaped ulcers in the intestine.
  • Amoebic liver absesses -  In about 10% of invasive cases the amoebae enter the bloodstream and may travel to other organs in the body. Most commonly this means the liver, where it causes amoebic liver abscesses, as this is where blood from the intestine reaches first, but they can end up almost anywhere. Liver abscesses can occur without previous development of amoebic dysentery.

Asymptomatic

 

Most infected people, about 90%, are asymptomatic, but this disease still has the potential to make the sufferer dangerously ill. The disease can remain latent in an infected person for several years. When no symptoms are present, the infected individual is still a carrier, able to spread the parasite to others through poor hygienic practices.

Where no initial symptoms have developed there may still be signs of the disease.

  • Weight loss and stunted growth - Entamoeba histolytica infection is associated with malnutrition and stunting of growth thus this may be a sign of an infected person.
  • Pain - The person may still experience pain.
  • Ulceration - Severe ulceration of the gastrointestinal mucosal surfaces occurs in less than 16% of cases.
  • Intestinal obstruction - In rare cases ‘masses’ are  formed (amoebomas) that lead to intestinal obstruction.  This  can be mistaken for Ca caecum and appendicitus.

The spread of the amoeba round the body

In about 10% of invasive cases the amoebae enter the bloodstream and may travel to other organs in the body.  The amoebias may spread to other parts of the body, using the blood stream or simply by tunnelling their way through tissues.  They then cause symptoms which appear to be other diseases like TB. 

  • Liver disease -  the amoeba can cause amoebic liver abscesses.  As this is where blood from the intestine reaches first, abscesses may be the first noticeable damage, but they can end up almost anywhere. Liver abscesses can occur without previous development of amoebic dysentery
  • Skin disease - the amoebas can find their way round the body and perforate the skin (amoebic cutis).
  • Stomach disease - Complications of hepatic amoebiasis includes perforation to the abdominal cavital (amoebic peritonitis)
  • Heart disease - The pericardium (from the Greek περί, "around" and κάρδιον, "heart") is a double-walled sac containing the heart and the roots of the great vessels.  Complications of hepatic amoebiasis, for example,  can include perforation of diaphgram to pericardium, or the amoebas may simply reach the heart via the blood stream
  • Lung disease - Pulmonary amoebiasis can occur from hepatic lesion by haemotagenous spread and also by perforation of pleural cavity and lung.
  • Vaginal and urinary system disease - Urogenital tract amoebiasis derived from intestinal lesion can cause amoebic vulvovaginitis (May's disease), rectovesicle fistula and rectovaginal fistula.
  • Brain damage - Finally, the amoebas can also reach the brain through blood vessels and cause amoebic brain abscesses and amoebic meningoencephalitis. 

This list is not complete, as via the blood stream and via its tunnelling activities, Entamoeba can get to any organ in the body.

Diagnosis

Human infections are usually diagnosed by finding cysts shed in the stool. Various flotation and sedimentation procedures have been developed to recover the cysts from fecal matter and stains help to visualize the isolated cysts for microscopic examination.

Microscopy is still by far the most widespread method of diagnosis around the world. However it is not as sensitive or accurate in diagnosis as the other tests available. It is possible to distinguish the E. histolytica cyst from the cysts of nonpathogenic intestinal protozoa such as Entamoeba coli by its appearance.  But other species, Entamoeba dispar and E. moshkovskii, cannot be distinguished from E. histolytica under the microscope.

An Ova & Parasite (O&P) test or an E. histolytica fecal antigen assay is “the proper assay for intestinal infections”. Since antibodies may persist for years after clinical cure, a positive serological result may not necessarily indicate an active infection.

Prevention

Amoebiasis can be transmitted through

  • contaminated food and water - it is often endemic in regions of the world with limited modern sanitation systems, including México, Central America, South America, South Asia, and western and southern Africa
  • the fecal oral route  - where both contact with dirty hands or objects and anal-oral contact can be the cause

As such the best form of prevention is to ensure there is an adequate sanitation system in place and that drinking water and water used for washing and preparing food is safe.

Always wash your hands before eating and preparing food.

Treatment

Unless the disease is spotted by its other manifestations, the asymptomatic cases often go untreated.
There are two types of treatment that can be used to treat amoebiasis:

  •  Symptom based treatments  notably Amoebicide drugs - Two different classes of drugs are used to treat the infection. Such anti-amoebic drugs are known as amoebicides
  • Cause based treatments - Eating foods and plants with the ability to fight the parasites.  There are also other options - see the observations - all aimed at killing the parasite.  See also Healing yourself.

How it works

Spiritual experience is rare, but causes as can be seen can be multiple.

The most persistent forms of spiritual experience are often caused by Brain damage.  Less frequent or one off experiences may be caused by the effects of Hypoxia caused by lung damage or liver damage.  The liver damage produces hypoxia via pernicious anaemia [see separate entry].
Some experiences are simply caused by the Extreme pain.  Some via Nutritional deprivation.

Related observations