Volume 94, Issue 5
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Amebic liver abscess (ALA) is endemic in developing countries. The epidemiology and clinical characteristics of the disease in developing countries are well described. Travelers from nonendemic countries can serve as a model for the natural history of ALA. Currently, the available literature on travelers is limited. This is a retrospective observational study on Israeli travelers diagnosed with ALA. Data regarding travel history, clinical presentation, imaging, and treatment were collected and analyzed. Among 6,867 ill returning Israeli travelers, amebiasis was diagnosed in 53 travelers (0.77%), of whom 14 were with ALA (0.2%). Twelve ALA cases (86%) had an exposure in the Indian subcontinent. The male to female ratio was 1:1, with no significant clinical differences between the sexes. The average lag period between exposure and onset of symptoms was 17.1 months. The lack of male predominance and the prolonged lag period may imply that behavioral factors are pivotal in the development of ALA. Larger case series of travelers are required.


Article metrics loading...

Loading full text...

Full text loading...



  1. Stanley SL, , 2003. Amoebiasis. Lancet 361: 10251034.[Crossref]
  2. Blessmann J, Van Linh P, Nu PA, Thi HD, Muller-Myhsok B, Buss H, Tannich E, , 2002. Epidemiology of amebiasis in a region of high incidence of amebic liver abscess in central Vietnam. Am J Trop Med Hyg 66: 578583.
  3. Gatti S, Bernuzzi AM, Maserati R, Scaglia M, , 2000. Incidence of Entamoeba histolytica/Entamoeba dispar in international travelers, extracommunitary immigrants, and adopted children. Arch Med Res 31: S47S48.[Crossref]
  4. Cordel H, Prendki V, Madec Y, Houze S, Paris L, Bouree P, Caumes E, Matheron S, Bouchaud O, , 2013. Imported amoebic liver abscess in France. PLoS Negl Trop Dis 7: e2333.[Crossref]
  5. WHO/PAHO/UNESCO, 1997. WHO/PAHO/UNESCO report. A consultation with experts on amoebiasis. Mexico City, Mexico 28–29 January, 1997. Epidemiol Bull 18: 1314.
  6. Ximenez C, Moran P, Rojas L, Valadez A, Gomez A, , 2009. Reassessment of the epidemiology of amebiasis: state of the art. Infect Genet Evol 9: 10231032.[Crossref]
  7. Pritt BS, Clark CG, , 2008. Amebiasis. Mayo Clin Proc 83: 11541159, quiz 1159–1160.[Crossref]
  8. Vallois D, Epelboin L, Touafek F, Magne D, Thellier M, Bricaire F, Caumes E, , 2012. Amebic liver abscess diagnosed by polymerase chain reaction in 14 returning travelers. Am J Trop Med Hyg 87: 10411045.[Crossref]
  9. Djossou F, Malvy D, Tamboura M, Beylot J, Lamouliatte H, Longy-Boursier M, Le Bras M, , 2003. Abcès amibien du foie. Analyse de 20 observations et proposition d'un algorithme thérapeutique. Rev Med Interne 24: 97106.[Crossref]
  10. Verweij JJ, Blange RA, Templeton K, Schinkel J, Brienen EA, van Rooyen MA, van Lieshout L, Polderman AM, , 2004. Simultaneous detection of Entamoeba histolytica, Giardia lamblia, and Cryptosporidium parvum in fecal samples by using multiplex real-time PCR. J Clin Microbiol 42: 12201223.[Crossref]
  11. Khairnar K, Parija SC, Palaniappan R, , 2007. Diagnosis of intestinal amoebiasis by using nested polymerase chain reaction-restriction fragment length polymorphism assay. J Gastroenterol 42: 631640.[Crossref]
  12. Santos HL, Peralta RH, de Macedo HW, Barreto MG, Peralta JM, , 2007. Comparison of multiplex-PCR and antigen detection for differential diagnosis of Entamoeba histolytica . Braz J Infect Dis 11: 365370.[Crossref]
  13. Zengzhu G, Bracha R, Nuchamowitz Y, Cheng IW, Mirelman D, , 1999. Analysis by enzyme-linked immunosorbent assay and PCR of human liver abscess aspirates from patients in China for Entamoeba histolytica . J Clin Microbiol 37: 30343036.
  14. Haque R, Kabir M, Noor Z, Rahman SM, Mondal D, Alam F, Rahman I, Al Mahmood A, Ahmed N, Petri WA, Jr, 2010. Diagnosis of amebic liver abscess and amebic colitis by detection of Entamoeba histolytica DNA in blood, urine, and saliva by a real-time PCR assay. J Clin Microbiol 48: 27982801.[Crossref]
  15. Herbinger KH, Fleischmann E, Weber C, Perona P, Loscher T, Bretzel G, , 2011. Epidemiological, clinical, and diagnostic data on intestinal infections with Entamoeba histolytica and Entamoeba dispar among returning travelers. Infection 39: 527535.[Crossref]
  16. Stienlauf S, Segal G, Sidi Y, Schwartz E, , 2005. Epidemiology of travel-related hospitalization. J Travel Med 12: 136141.[Crossref]
  17. Greenwood Z, Black J, Weld L, O'Brien D, Leder K, Von Sonnenburg F, Pandey P, Schwartz E, Connor BA, Brown G, Freedman DO, Torresi J, , 2008. Gastrointestinal infection among international travelers globally. J Travel Med 15: 221228.[Crossref]
  18. Swaminathan A, Torresi J, Schlagenhauf P, Thursky K, Wilder-Smith A, Connor BA, Schwartz E, Vonsonnenberg F, Keystone J, O'Brien D, , 2009. A global study of pathogens and host risk factors associated with infectious gastrointestinal disease in returned international travellers. J Infect 59: 1927.[Crossref]
  19. Ansart S, Perez L, Vergely O, Danis M, Bricaire F, Caumes E, , 2005. Illnesses in travelers returning from the tropics: a prospective study of 622 patients. J Travel Med 12: 312318.[Crossref]
  20. Bernin H, Marggraff C, Jacobs T, Brattig N, An L, Blessmann J, Lotter H, , 2014. Immune markers characteristic for asymptomatically infected and diseased Entamoeba histolytica individuals and their relation to sex. BMC Infect Dis 14: 621.[Crossref]
  21. Gupta RK, , 1984. Amebic liver abscess: a report of 100 cases. Int Surg 69: 261264.
  22. Hai AA, Singh A, Mittal VK, Karan GC, , 1991. Amoebic liver abscess. Review of 220 cases. Int Surg 76: 8183.
  23. Tony JC, Martin TK, , 1992. Profile of amebic liver abscess. Arch Med Res 23: 249250.
  24. Lotter H, Helk E, Bernin H, Jacobs T, Prehn C, Adamski J, Gonzalez-Roldan N, Holst O, Tannich E, , 2013. Testosterone increases susceptibility to amebic liver abscess in mice and mediates inhibition of IFNγ secretion in natural killer T cells. PLoS One 8: e55694.[Crossref]
  25. Acuna-Soto R, Maguire JH, Wirth DF, , 2000. Gender distribution in asymptomatic and invasive amebiasis. Am J Gastroenterol 95: 12771283.[Crossref]
  26. Rapp C, Valentin C, Verret C, Margery J, Simon F, Ficko C, Carmoi T, , 2013. Imported hepatic amebiasis in adults: retrospective study of 58 cases [in French]. Med Sante Trop 23: 238.
  27. Stienlauf S, Meltzer E, Leshem E, Rendi-Wagner P, Schwartz E, , 2010. The profile of Israeli travelers to developing countries: perspectives of a travel clinic [in Hebrew]. Harefuah 149: 559562, 621.
  28. Yinnon AM, Hadas-Halpern I, Shapiro M, Hershko C, , 1994. The changing clinical spectrum of liver abscess: the Jerusalem experience. Postgrad Med J 70: 436439.[Crossref]
  29. Zurauskas JP, McBride WJ, , 2001. Case of amoebic liver abscess: prolonged latency or acquired in Australia? Intern Med J 31: 565566.[Crossref]
  30. Hoffbrand BI, , 1975. Amoebic liver abscess presenting thirty-two years after acute amoebic dysentery. Proc R Soc Med 68: 593594.
  31. Paulley JW, , 1961. Amoebic liver abscess in Great Britain. BMJ 1: 462463.[Crossref]
  32. Nespola B, Betz V, Brunet J, Gagnard JC, Krummel Y, Hansmann Y, Hannedouche T, Christmann D, Pfaff AW, Filisetti D, Pesson B, Abou-Bacar A, Candolfi E, , 2015. First case of amebic liver abscess 22 years after the first occurrence. Parasite 22: 20.[Crossref]
  33. Mendoza-Macias CL, Barrios-Ceballos MP, de la Pena LP, Rangel-Serrano A, Anaya-Velazquez F, Mirelman D, Padilla-Vaca F, , 2009. Entamoeba histolytica: effect on virulence, growth and gene expression in response to monoxenic culture with Escherichia coli 055. Exp Parasitol 121: 167174.[Crossref]

Data & Media loading...

  • Received : 08 Aug 2015
  • Accepted : 14 Dec 2015

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error