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Principles and Practice of Clinical Parasitology. Edited by S. Gillespie & Richard D. Pearson Copyright © 2001 John Wiley & Sons Ltd Print ISBN 0-471-97729-2 Online ISBN 0-470-84250-4
Upinder Singh and William A. Petri Jr
University of Virginia Health Sciences Center, Charlottesville, VA, USA
This chapter will discuss the parasites Entamoeba histolytica, E. dispar, E. coli, E. polecki and E. nana and their clinical importance, disease
presentations and contribution to human illness. Of these amoeba species, E. histolytica is the most medically relevant parasite and causes the greatest human disease, and therefore will receive the greatest emphasis.
E. histolytica has recently been separated from E. dispar on the basis of genetic differences. Both protozoa are morphologically identical but have genetic, and functional differences; E. histolytica is invasive and causes disease such as colitis and liver abscess, and E. dispar causes a asymptomatic colonization which does not need to be medically treated (WHO/PAHO/UNESCO,
1997). In 1828, James Annesley wrote in Prevalent Diseases of India, ‘. . . hepatic disease seems to be induced by the disorder of the bowels, more particularly when this disorder is of a subacute or chronic kind’, recognizing for the first time a link between dysentery and liver abscess. Approximately 30 years later, in 1855, Lambl described amebae in the stool of a child who had diarrhea (Stillwell, 1955). Fedor Losch described amebae in the stool of a young farmer with dysentery from his first evaluation in November 1873 until his death in April 1874. The amebae causing the ultimate demise of the
farmer were described as ‘round, pear-shaped or irregular form and which are in a state of almost continuous motion’, and autopsy studies ultimately revealed colonic ulcerations. Koch’s postulates were fulfilled when the patient’s stool inoculated orally and rectally into a dog caused dysentery, with amebic ulcers (Stillwell, 1955; Kean, 1988). The first North American case of amebiases was reported in 1890 by Sir William Osler, when he described a young physician in Baltimore with dysentery. Osler wrote: ‘Dr B, aged 29, resident in Panama for nearly 6 years, where he had had several attacks of dysentery, or more correctly speaking a chronic dysentery, came north in May, 1889 . . .’. Subsequently, in 1890, the patient developed tender hepatosple-nomegaly and amebae were observed in the stool and abscess fluid: ‘The general character of the amoebae (found in the stool) correspond in every particular with those found in the liver’ (Osler, 1890). A year later, Osler’s colleagues Councilman and Lafleur (1891) proceeded through a classic investigation of 14 cases of amebic dysentery to