• 1.

    Gunther J, Shafir S, Bristow B, Sorvillo F, 2011. Short report: amebiasis-related mortality among United States residents, 1990–2007. Am J Trop Med Hyg 85: 10381040.

    • Search Google Scholar
    • Export Citation
  • 2.

    Phillips SC, Mildvan D, William DC, Gelb AM, White MC, 1981. Sexual transmission of enteric protozoa and helminths in a venereal-disease-clinic population. N Engl J Med 305: 603606.

    • Search Google Scholar
    • Export Citation
  • 3.

    Quinn TC, Stamm WE, Goodell SE, Mkrtichian E, Benedetti J, Corey L, Schuffler MD, Holmes KK, 1983. The polymicrobial origin of intestinal infections in homosexual men. N Engl J Med 309: 576582.

    • Search Google Scholar
    • Export Citation
  • 4.

    Allason-Jones E, Mindel A, Sargeaunt P, Williams P, 1986. Entamoeba histolytica as a commensal intestinal parasite in homosexual men. N Engl J Med 315: 353356.

    • Search Google Scholar
    • Export Citation
  • 5.

    Sorvillo FJ, Strassburg MA, Seidel J, Visvesvara GS, Mori K, Todd A, Portigal L, Finn M, Agee BA, 1986. Amebic infections in asymptomatic homosexual men, lack of evidence of invasive disease. Am J Public Health 76: 11371139.

    • Search Google Scholar
    • Export Citation
  • 6.

    Lowther SA, Dworkin MS, Hanson DL; Adult and Adolescent Spectrum of Human Immunodeficiency Virus Disease Project, 2000. Entamoeba histolytica/Entamoeba dispar in human immunodeficiency virus-infected patients in the United States. Clin Infect Dis 30: 955959.

    • Search Google Scholar
    • Export Citation
  • 7.

    Weber R, Ledergerber B, Zbinden R, Altwegg M, Pfyffer GE, Spycher MA, Briner J, Kaiser L, Opravil M, Meyenberger C, Flepp M, 1999. Enteric infections and diarrhea in human immunodeficiency virus-infected persons: prospective community-based cohort study. Swiss HIV Cohort Study. Arch Intern Med 159: 14731480.

    • Search Google Scholar
    • Export Citation
  • 8.

    Hung CC, Ji DD, Sun HY, Lee YT, Hsu SY, Chang SY, Wu CH, Chan YH, Hsiao CF, Liu WC, Colebunders R, 2008. Increased risk for Entamoeba histolytica infection and invasive amebiasis in HIV seropositive men who have sex with men in Taiwan. PLoS Negl Trop Dis 2: e175.

    • Search Google Scholar
    • Export Citation
  • 9.

    Watanabe K, Gatanaga H, Escueta-de Cadiz A, Tanuma J, Nozaki T, Oka S, 2011. Amebiasis in HIV-1-infected Japanese men: clinical features and response to therapy. PLoS Negl Trop Dis 5: e1318.

    • Search Google Scholar
    • Export Citation
  • 10.

    Hung CC, Wu PY, Chang SY, Ji DD, Sun HY, Liu WC, Wu CH, Chang SC, 2011. Amebiasis among persons who sought voluntary counseling and testing for human immunodeficiency virus infection: a case-control study. Am J Trop Med Hyg 84: 6569.

    • Search Google Scholar
    • Export Citation
  • 11.

    Takeuchi T, Miyahira Y, Kobyash S, Nozaki T, Motta S, Matsuda L, 1990. High seropositivity for Entamoeba histolytica infection in Japanese homosexual men: further evidence for occurrence of pathogenic strains. Trans R Soc Trop Med Hyg 84: 250251.

    • Search Google Scholar
    • Export Citation
  • 12.

    Stark D, van Hal SJ, Matthews G, Harkness J, Marriott D, 2008. Invasive amebiasis in men who have sex with men, Australia. Emerg Infect Dis 14: 11411143.

    • Search Google Scholar
    • Export Citation
  • 13.

    Salit IE, Khairnar K, Gough K, Pillai DR, 2009. A possible cluster of sexually transmitted Entamoeba histolytica: genetic analysis of a highly virulent strain. Clin Infect Dis 49: 346353.

    • Search Google Scholar
    • Export Citation
  • 14.

    Moran P, Ramos F, Ramiro M, Curiel O, González E, Valadez A, Gómez A, García G, Melendro EI, Ximénez C, 2005. Entamoeba histolytica and/or Entamoeba dispar : infection frequency in HIV+/AIDS patients in Mexico City. Exp Parasitol 110: 331334.

    • Search Google Scholar
    • Export Citation
  • 15.

    Chen Y, Zhang Y, Yang B, Qi T, Lu H, Cheng X, Tachibana H, 2007. Seroprevalence of Entamoeba histolytica infection in HIV-infected patients in China. Am J Trop Med Hyg 77: 825828.

    • Search Google Scholar
    • Export Citation
  • 16.

    Samie A, Barrett LJ, Bessong PO, Ramalivhana JN, Mavhandu LG, Njayou M, Guerrant RL, 2010. Seroprevalence of Entamoeba histolytica in the context of HIV and AIDS: the case of Vhembe district, in South Africa's Limpopo province. Ann Trop Med Parasitol 104: 5563.

    • Search Google Scholar
    • Export Citation
  • 17.

    James R, Barratt J, Marriott D, Harkness J, Stark D, 2010. Seroprevalence of Entamoeba histolytica infection among men who have sex with men in Sydney, Australia. Am J Trop Med Hyg 83: 914916.

    • Search Google Scholar
    • Export Citation

 

 

 

 

 

Amebiasis Deaths in the United States

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  • 1 Department of Internal Medicine
  • 2 National Taiwan University Hospital and National Taiwan University College of Medicine
  • 3 Taipei, Taiwan
  • 4 E-mail: hcc0401@ntu.edu.tw
  • 5 Department of Laboratory Medicine
  • 6 National Taiwan University Hospital and National Taiwan University College of Medicine
  • 7 Taipei, Taiwan, and
  • 8 Department of Clinical Laboratory Sciences and Medical Biotechnology
  • 9 National Taiwan University College of Medicine
  • 10 Taipei, Taiwan
  • 11 Research and Diagnostic Center
  • 12 Centers for Disease Control, Department of Health
  • 13 Taipei, Taiwan

Dear Sir:

We read with great interest the article published by Gunther and others1 that describes the amebiasis-related mortality among United States residents from 1990 to 2007. Of 134 amebiasis deaths during the study period, human immunodeficiency virus (HIV) infection was a co-existing condition in 14 (10.4%), which was statistically significantly more common than in the control, non-amebiasis group with a matched odds ratio of 7.7 (95% confidence interval, 3.16–18.77). Although more studies are warranted to identify the causes of the higher association between HIV infection and amebiasis deaths in the United States, the findings of several previous studies between the 1980s and 2000s26 concluded infection with Entamoeba histolytica that is pathogenic was rare in men who have sex with men (MSM). Regardless of HIV serostatus, this may hinder health care providers from considering invasive amebiasis high in the list of differential diagnosis when HIV-infected patients present with symptoms of amebic colitis or abscesses that are difficult to be differentiated from other competing causes of colitis or liver abscess.7 Although the spectrum of amebiasis is similar between HIV-infected patients and the general population,8,9 the amebiasis-related mortality rate is low in developed countries where HIV-infected MSM have long been recognized as a high risk group for amebiasis.8,10,11 In the two largest case series of invasive amebiasis in HIV-infected men in Taiwan and Japan, Hung and others8 and Watanabe and others9 retrospectively reviewed 67 and 170 cases of invasive amebiasis, respectively, and the amebiasis-related mortality rate was 0% and 1.2%, respectively, despite a high percentage of amebic abscess and complications. Recent studies that report cases of invasive amebiasis in MSM and bisexuals in other developed countries12,13 and a higher frequency of amebiasis, detected by specific antigen assays for E. histolytica and serologies, in both developed and developing countries1417 should raise concerns and warrant reevaluation of amebiasis in patients with HIV infection, especially in MSM.

  • 1.

    Gunther J, Shafir S, Bristow B, Sorvillo F, 2011. Short report: amebiasis-related mortality among United States residents, 1990–2007. Am J Trop Med Hyg 85: 10381040.

    • Search Google Scholar
    • Export Citation
  • 2.

    Phillips SC, Mildvan D, William DC, Gelb AM, White MC, 1981. Sexual transmission of enteric protozoa and helminths in a venereal-disease-clinic population. N Engl J Med 305: 603606.

    • Search Google Scholar
    • Export Citation
  • 3.

    Quinn TC, Stamm WE, Goodell SE, Mkrtichian E, Benedetti J, Corey L, Schuffler MD, Holmes KK, 1983. The polymicrobial origin of intestinal infections in homosexual men. N Engl J Med 309: 576582.

    • Search Google Scholar
    • Export Citation
  • 4.

    Allason-Jones E, Mindel A, Sargeaunt P, Williams P, 1986. Entamoeba histolytica as a commensal intestinal parasite in homosexual men. N Engl J Med 315: 353356.

    • Search Google Scholar
    • Export Citation
  • 5.

    Sorvillo FJ, Strassburg MA, Seidel J, Visvesvara GS, Mori K, Todd A, Portigal L, Finn M, Agee BA, 1986. Amebic infections in asymptomatic homosexual men, lack of evidence of invasive disease. Am J Public Health 76: 11371139.

    • Search Google Scholar
    • Export Citation
  • 6.

    Lowther SA, Dworkin MS, Hanson DL; Adult and Adolescent Spectrum of Human Immunodeficiency Virus Disease Project, 2000. Entamoeba histolytica/Entamoeba dispar in human immunodeficiency virus-infected patients in the United States. Clin Infect Dis 30: 955959.

    • Search Google Scholar
    • Export Citation
  • 7.

    Weber R, Ledergerber B, Zbinden R, Altwegg M, Pfyffer GE, Spycher MA, Briner J, Kaiser L, Opravil M, Meyenberger C, Flepp M, 1999. Enteric infections and diarrhea in human immunodeficiency virus-infected persons: prospective community-based cohort study. Swiss HIV Cohort Study. Arch Intern Med 159: 14731480.

    • Search Google Scholar
    • Export Citation
  • 8.

    Hung CC, Ji DD, Sun HY, Lee YT, Hsu SY, Chang SY, Wu CH, Chan YH, Hsiao CF, Liu WC, Colebunders R, 2008. Increased risk for Entamoeba histolytica infection and invasive amebiasis in HIV seropositive men who have sex with men in Taiwan. PLoS Negl Trop Dis 2: e175.

    • Search Google Scholar
    • Export Citation
  • 9.

    Watanabe K, Gatanaga H, Escueta-de Cadiz A, Tanuma J, Nozaki T, Oka S, 2011. Amebiasis in HIV-1-infected Japanese men: clinical features and response to therapy. PLoS Negl Trop Dis 5: e1318.

    • Search Google Scholar
    • Export Citation
  • 10.

    Hung CC, Wu PY, Chang SY, Ji DD, Sun HY, Liu WC, Wu CH, Chang SC, 2011. Amebiasis among persons who sought voluntary counseling and testing for human immunodeficiency virus infection: a case-control study. Am J Trop Med Hyg 84: 6569.

    • Search Google Scholar
    • Export Citation
  • 11.

    Takeuchi T, Miyahira Y, Kobyash S, Nozaki T, Motta S, Matsuda L, 1990. High seropositivity for Entamoeba histolytica infection in Japanese homosexual men: further evidence for occurrence of pathogenic strains. Trans R Soc Trop Med Hyg 84: 250251.

    • Search Google Scholar
    • Export Citation
  • 12.

    Stark D, van Hal SJ, Matthews G, Harkness J, Marriott D, 2008. Invasive amebiasis in men who have sex with men, Australia. Emerg Infect Dis 14: 11411143.

    • Search Google Scholar
    • Export Citation
  • 13.

    Salit IE, Khairnar K, Gough K, Pillai DR, 2009. A possible cluster of sexually transmitted Entamoeba histolytica: genetic analysis of a highly virulent strain. Clin Infect Dis 49: 346353.

    • Search Google Scholar
    • Export Citation
  • 14.

    Moran P, Ramos F, Ramiro M, Curiel O, González E, Valadez A, Gómez A, García G, Melendro EI, Ximénez C, 2005. Entamoeba histolytica and/or Entamoeba dispar : infection frequency in HIV+/AIDS patients in Mexico City. Exp Parasitol 110: 331334.

    • Search Google Scholar
    • Export Citation
  • 15.

    Chen Y, Zhang Y, Yang B, Qi T, Lu H, Cheng X, Tachibana H, 2007. Seroprevalence of Entamoeba histolytica infection in HIV-infected patients in China. Am J Trop Med Hyg 77: 825828.

    • Search Google Scholar
    • Export Citation
  • 16.

    Samie A, Barrett LJ, Bessong PO, Ramalivhana JN, Mavhandu LG, Njayou M, Guerrant RL, 2010. Seroprevalence of Entamoeba histolytica in the context of HIV and AIDS: the case of Vhembe district, in South Africa's Limpopo province. Ann Trop Med Parasitol 104: 5563.

    • Search Google Scholar
    • Export Citation
  • 17.

    James R, Barratt J, Marriott D, Harkness J, Stark D, 2010. Seroprevalence of Entamoeba histolytica infection among men who have sex with men in Sydney, Australia. Am J Trop Med Hyg 83: 914916.

    • Search Google Scholar
    • Export Citation
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