Amebic Liver Abscess in Israeli Travelers: A Retrospective Study

Tamar Lachish Infectious Diseases Unit, Shaare-Zedek Medical Center, Jerusalem, Israel; Infectious Diseases Unit, Sheba Medical Center, Tel Hashomer, Israel; The Center for Geographic Medicine, The Chaim Sheba Medical Center, Tel Hashomer, Israel; The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

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Anat Wieder-Finesod Infectious Diseases Unit, Shaare-Zedek Medical Center, Jerusalem, Israel; Infectious Diseases Unit, Sheba Medical Center, Tel Hashomer, Israel; The Center for Geographic Medicine, The Chaim Sheba Medical Center, Tel Hashomer, Israel; The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

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Eli Schwartz Infectious Diseases Unit, Shaare-Zedek Medical Center, Jerusalem, Israel; Infectious Diseases Unit, Sheba Medical Center, Tel Hashomer, Israel; The Center for Geographic Medicine, The Chaim Sheba Medical Center, Tel Hashomer, Israel; The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

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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.

Author Notes

* Address correspondence to Eli Schwartz, The Center for Geographic Medicine, The Chaim Sheba Medical Center, 52621, Tel-Hashomer, Israel. E-mail: elischwa@post.tau.ac.il

Authors' addresses: Tamar Lachish, Infectious Diseases Unit, Shaare-Zedek Medical Center, Jerusalem, Israel, E-mail: lachisht@yahoo.com. Anat Wieder-Finesod, Infectious Diseases Unit, Sheba Medical Center, Tel Hashomer, Israel, E-mail: anat.wieder@sheba.health.gov.il. Eli Schwartz, The Center for Geographic Medicine, The Chaim Sheba Medical Center, Tel Hashomer, Israel, and the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel, E-mail: elischwa@post.tau.ac.il.

  • 1.

    Stanley SL, 2003. Amoebiasis. Lancet 361: 1025–1034.

  • 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: 578–583.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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: S47–S48.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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.

  • 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: 13–14.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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: 1023–1032.

  • 7.

    Pritt BS, Clark CG, 2008. Amebiasis. Mayo Clin Proc 83: 1154–1159, quiz 1159–1160.

  • 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: 1041–1045.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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: 97–106.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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: 1220–1223.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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: 631–640.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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: 365–370.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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: 3034–3036.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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: 2798–2801.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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: 527–535.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Stienlauf S, Segal G, Sidi Y, Schwartz E, 2005. Epidemiology of travel-related hospitalization. J Travel Med 12: 136–141.

  • 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: 221–228.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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: 19–27.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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: 312–318.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Gupta RK, 1984. Amebic liver abscess: a report of 100 cases. Int Surg 69: 261–264.

  • 22.

    Hai AA, Singh A, Mittal VK, Karan GC, 1991. Amoebic liver abscess. Review of 220 cases. Int Surg 76: 81–83.

  • 23.

    Tony JC, Martin TK, 1992. Profile of amebic liver abscess. Arch Med Res 23: 249–250.

  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Acuna-Soto R, Maguire JH, Wirth DF, 2000. Gender distribution in asymptomatic and invasive amebiasis. Am J Gastroenterol 95: 1277–1283.

  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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: 559–562, 621.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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: 436–439.

  • 29.

    Zurauskas JP, McBride WJ, 2001. Case of amoebic liver abscess: prolonged latency or acquired in Australia? Intern Med J 31: 565–566.

  • 30.

    Hoffbrand BI, 1975. Amoebic liver abscess presenting thirty-two years after acute amoebic dysentery. Proc R Soc Med 68: 593–594.

  • 31.

    Paulley JW, 1961. Amoebic liver abscess in Great Britain. BMJ 1: 462–463.

  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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: 167–174.

    • PubMed
    • Search Google Scholar
    • Export Citation
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