Amoebiasis

Most infected people, about 90%, are asymptomatic, but this disease has the potential to become serious. It is estimated that about 40,000 to 100,000 people worldwide die annually due to amoebiasis.

Infections can sometimes last for years if there is no treatment. Symptoms, if present, can take anywhere from days to years to develop,{{cite web|title=Amebiasis Clinical Presentation|vauthors=Dhawan VK, Cleveland KO, Cantey RJ|website=Medscape|veditors=Bronze MS|date=12 December 2024|access-date=17 March 2025|url=https://emedicine.medscape.com/article/212029-clinical}} but usually it is about two to four weeks.{{cite book|url=https://www.ncbi.nlm.nih.gov/books/NBK519535/|title=StatPearls|chapter=Amebiasis|vauthors=Zulfiqar H, Mathew G, Horrall S|date=25 June 2023|access-date=16 March 2025|publisher=StatPearls Publishing LLC|location=Treasure Island, Florida|via=National Library of Medicine|pmid=30137820|id=Bookshelf ID No. NBK519535}} Symptoms can range from mild diarrhea to dysentery with blood, coupled with intense abdominal pains. Extra-intestinal complications might also arise as a result of invasive infection which includes colitis, liver, lung, or brain abscesses. The blood comes from bleeding lesions created by the amoebae invading the lining of the colon. 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, as this is where blood from the intestine reaches first, but they can end up almost anywhere in the body.{{citation needed|date=June 2021}}

Onset time is highly variable and the average asymptomatic infection persists for over a year. It is theorized that the absence of symptoms or their intensity may vary with such factors as strain of amoeba, immune response of the host, and perhaps associated bacteria and viruses.{{cn|date=June 2022}}

In asymptomatic infections, the amoeba lives by eating and digesting bacteria and food particles in the gut, a part of the gastrointestinal tract. It does not usually come in contact with the intestine itself due to the protective layer of mucus that lines the gut. 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. This process can lead to penetration and digestion of human tissues, resulting first in flask-shaped ulcerations in the intestine. Entamoeba histolytica ingests the destroyed cells by phagocytosis and is often seen with red blood cells (a process known as erythrophagocytosis) inside when viewed in stool samples. Especially in Latin America,{{Citation needed|date=July 2008}} a granulomatous mass (known as an amoeboma) may form in the wall of the ascending colon or rectum due to long-lasting immunological cellular response, and is sometimes confused with cancer.{{cite book|last=Day|first=David W.|author2=Basil C. Morson |author3=Jeremy R. Jass |author4=Geraint Williams |author5=Ashley B. Price |title=Morson and Dawson's Gastrointestinal Pathology|year=2003| publisher=John Wiley & Sons, Inc.| isbn=978-0-632-04204-3}}

The ingestion of one viable cyst may cause an infection.{{cite web|url=https://www.fda.gov/Food/FoodSafety/FoodborneIllness/FoodborneIllnessFoodbornePathogensNaturalToxins/BadBugBook/ucm070739.htm|title=Foodborne Pathogenic Microorganisms and Natural Toxins Handbook: Entamoeba histolytica |work=Bad Bug Book|publisher=United States Food and Drug Administration: Center for Food Safety & Applied Nutrition |date=2007-12-28|access-date=2009-07-13| archive-url=https://web.archive.org/web/20090709183421/https://www.fda.gov/Food/FoodSafety/FoodborneIllness/FoodborneIllnessFoodbornePathogensNaturalToxins/BadBugBook/ucm070739.htm|archive-date= 9 July 2009 | url-status= dead}}

Steroid therapy can occasionally provoke severe amoebic colitis in people with any E. histolytica infection.{{cite journal | vauthors = Shirley DA, Moonah S | title = Fulminant Amebic Colitis after Corticosteroid Therapy: A Systematic Review | journal = PLOS Neglected Tropical Diseases | volume = 10 | issue = 7 | pages = e0004879 | date = July 2016 | pmid = 27467600 | pmc = 4965027 | doi = 10.1371/journal.pntd.0004879 | doi-access = free }} This bears high mortality: on average more than 50% with severe colitis die.

Amoebiasis is an infection caused by the amoeba Entamoeba histolytica.

Image:Entamoeba histolytica life cycle-en.svg]]

Amoebiasis is usually transmitted by the fecal-oral route, but it can also be transmitted indirectly through contact with dirty hands or objects as well as by anal-oral contact. Infection is spread through ingestion of the cyst form of the parasite, a semi-dormant and hardy structure found in feces. Any non-encysted amoebae, or trophozoites, die quickly after leaving the body but may also be present in stool: these are rarely the source of new infections. Since amoebiasis is transmitted through contaminated food and water, it is often endemic in regions of the world with limited modern sanitation systems, including México, Central America, western South America, South Asia, and western and southern Africa.{{cite book | veditors = Ryan KJ, Ray CG | title = Sherris Medical Microbiology | url = https://archive.org/details/sherrismedicalmi00ryan | url-access = limited | edition = 4th | publisher = McGraw Hill | year = 2004 | pages=[https://archive.org/details/sherrismedicalmi00ryan/page/n750 733]–8 | isbn = 978-0-8385-8529-0}}

Amoebic dysentery is one form of traveler's diarrhea.{{cite web |url= http://www.safewateronline.com/travelers_d.htm |title= safewateronline.com: Travelers' Diarrhea |access-date=2020-06-28| archive-url=https://web.archive.org/web/20080606032848/http://www.safewateronline.com/travelers_d.htm| archive-date= 6 June 2008 | url-status= dead}} It is more prevalent in long-term travelers with stays of longer than six months as opposed to travelers who spend less than one month in an endemic area.{{cite web|url=https://wwwnc.cdc.gov/travel/yellowbook/2024/infections-diseases/amebiasis|access-date=16 March 2025|date=31 January 2025|website=CDC Yellow Book 2024|publisher=U.S. Centers for Disease Control and Prevention|vauthors=Cope JR, Ali IK|title=Amebiasis}} Diarrhea is more likely to be caused by a parasite, such as E. histolytica, if it has subacute or chronic characteristics.{{cite journal|title=TRAVELLER'S DIARRHEA|vauthors=Larson SC|journal=Emergency Medicine Clinics of North America|volume=15|issue=1|pages=179-189|doi=10.1016/S0733-8627(05)70290-X|doi-access=free|pmid=9056575|year=1997}}

File:Tissue damage caused by E. histolytica is a result of three main events, host cell death, inflammation, and parasite invasion.png

Amoebiasis results from tissue destruction induced by the E. histolytica parasite.

E. histolytica causes tissue damage by three main events: direct host cell killing, inflammation, and parasite invasion.{{cite journal | vauthors = Ghosh S, Padalia J, Moonah S | title = Cell Death, Inflammation, Invasion, and the Gut Microbiome | journal = Current Clinical Microbiology Reports | volume = 6 | issue = 1 | pages = 51–57 | date = 21 January 2019 | pmid = 31008019 | pmc = 6449278 | doi = 10.1007/s40588-019-0113-6 }}

The pathogenesis of amoebiasis involves interplay of various molecules secreted by E. histolytica such as LPPG, lectins, cysteine proteases, and amoebapores. Lectins help in the attachment of the parasite to the mucosal layer of the host during invasion. The amoebapores destroy the ingested bacteria present in the colonic environment. Cysteine proteases lyse the host tissues. Other molecules such as PATMK, myosins, G proteins, C2PK, CaBP3, and EhAK1 play an important role in the process of phagocytosis.{{cite book |doi=10.1016/S0065-308X(08)60286-9 |chapter=Metabolism of Entamoeba histolytica Schaudinn, 1903 |title=Advances in Parasitology |date=1985 |volume=23 |pages=105–142 |pmid=6085216 |isbn=978-0-12-031723-3 | vauthors = Reeves RE }}

With colonoscopy it is possible to detect small ulcers of between 3–5mm, but diagnosis may be difficult as the mucous membrane between these areas can look either healthy or inflamed.

Trophozoites may be identified at the ulcer edge or within the tissue, using immunohistochemical staining with specific anti-E. histolytica antibodies.

Asymptomatic human infections are usually diagnosed by finding cysts shed in the stool. Various flotation or sedimentation procedures have been developed to recover the cysts from fecal matter and stains help to visualize the isolated cysts for microscopic examination. Since cysts are not shed constantly, a minimum of three stools are examined. In symptomatic infections, the motile form (the trophozoite) is often seen in fresh feces. Serological tests exist, and most infected individuals (with symptoms or not) test positive for the presence of antibodies. The levels of antibody are much higher in individuals with liver abscesses. Serology only becomes positive about two weeks after infection. More recent developments include a kit that detects the presence of amoeba proteins in the feces, and another that detects amoeba DNA in feces. These tests are not in widespread use due to their expense.{{citation needed|date=May 2021}}

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 important to distinguish the E. histolytica cyst from the cysts of nonpathogenic intestinal protozoa such as Entamoeba coli by its appearance. E. histolytica cysts have a maximum of four nuclei, while the commensal Entamoeba coli cyst has up to 8 nuclei. Additionally, in E. histolytica, the endosome is centrally located in the nucleus, while it is usually off-center in Entamoeba coli. Finally, chromatoidal bodies in E. histolytica cysts are rounded, while they are jagged in Entamoeba coli. However, other species, Entamoeba dispar and E. moshkovskii, are also commensals and cannot be distinguished from E. histolytica under the microscope. As E. dispar is much more common than E. histolytica in most parts of the world this means that there is a lot of incorrect diagnosis of E. histolytica infection taking place. The WHO recommends that infections diagnosed by microscopy alone should not be treated if they are asymptomatic and there is no other reason to suspect that the infection is actually E. histolytica. Detection of cysts or trophozoites stools under microscope may require examination of several samples over several days to determine if they are present, because cysts are shed intermittently and may not show up in every sample.{{citation needed|date=June 2021}}

Typically, the organism can no longer be found in the feces once the disease goes extra-intestinal.{{Citation needed|date=September 2008}} Serological tests are useful in detecting infection by E. histolytica if the organism goes extra-intestinal and in excluding the organism from the diagnosis of other disorders. 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. A negative serological result, however, can be equally important in excluding suspected tissue invasion by E. histolytica.{{Citation needed|date=September 2008}}

Stool antigen detection tests have helped to overcome some of the limitations of stool microscopy. Antigen detection tests are easy to use, but they have variable sensitivity and specificity, especially in low-endemic areas.

Polymerase chain reaction (PCR) is considered the gold standard for diagnosis but remains underutilized.{{cite journal |last1=Madden |first1=Gregory R. |last2=Shirley |first2=Debbie-Ann |last3=Townsend |first3=Gregory |last4=Moonah |first4=Shannon |title=Lower Gastrointestinal Bleeding due to Entamoeba histolytica Detected Early by Multiplex PCR: Case Report and Review of the Laboratory Diagnosis of Amebiasis |journal=The American Journal of Tropical Medicine and Hygiene |volume=101 |issue=6 |pages=1380–1383 |date=28 October 2019 |doi=10.4269/ajtmh.19-0237|pmid=31674299 |pmc=6896859 }}

Image:Ehistdisp cyst wtmt.jpg|Immature E. histolytica/E. dispar cyst in a concentrated wet mount stained with iodine. This early cyst has only one nucleus and a glycogen mass is visible (brown stain).

Image:Amoebic dysentery in colon biopsy (1).jpg|Amoebae in a colon biopsy from a case of amoebic dysentery.

File:Immunohistochemical staining of trophozoites (brown) using specific anti–Entamoeba histolytica macrophage migration inhibitory factor antibodies in a patient with amebic colitis.jpg|Immunohistochemical staining of trophozoites (brown) using specific anti–Entamoeba histolytica macrophage migration inhibitory factor antibodies in a patient with amoebic colitis.

File:Amoebic Ulcer Intestine.jpg

To help prevent the spread of amoebiasis around the home :{{citation needed|date=May 2021}}

• Wash hands thoroughly with soap and hot running water for at least 10 seconds after using the toilet or changing a baby's diaper, and before handling food.
• Clean bathrooms and toilets often; pay particular attention to toilet seats and taps.
• Avoid sharing towels or face washers.

To help prevent infection:{{cn|date=June 2022}}

• Avoid raw vegetables when in endemic areas, as they may have been fertilized using human feces.
• Boil water or treat with iodine tablets.
• Avoid eating street foods especially in public places where others are sharing sauces in one container

Good sanitary practice, as well as responsible sewage disposal or treatment, are necessary for the prevention of E. histolytica infection on an endemic level. E.histolytica cysts are usually resistant to chlorination, therefore sedimentation and filtration of water supplies are necessary to reduce the incidence of infection.

E. histolytica cysts may be recovered from contaminated food by methods similar to those used for recovering Giardia lamblia cysts from feces. Filtration is probably the most practical method for recovery from drinking water and liquid foods. E. histolytica cysts must be distinguished from cysts of other parasitic (but nonpathogenic) protozoa and from cysts of free-living protozoa as discussed above. Recovery procedures are not very accurate; cysts are easily lost or damaged beyond recognition, which leads to many falsely negative results in recovery tests.{{cite web | title = FDA Bacteriological Analytical Manual | url = http://www.foodinfonet.com/publication/fdaBAM.htm | access-date = 2008-03-26 | archive-url = https://web.archive.org/web/20080406032216/http://www.foodinfonet.com/publication/fdaBAM.htm | archive-date = 2008-04-06 | url-status = dead }}

{{main|Amoebicide}}

E. histolytica infections occur in both the intestine and (in people with symptoms) in tissue of the intestine and/or liver. Those with symptoms require treatment with two medications, an amoebicidal tissue-active agent and a luminal cysticidal agent. Individuals that are asymptomatic only need a luminal cysticidal agent.

File:Significance of Amebiasis.png

In the majority of cases, amoebas remain in the gastrointestinal tract of the hosts. Severe ulceration of the gastrointestinal mucosal surfaces occurs in less than 16% of cases. In fewer cases, the parasite invades the soft tissues, most commonly the liver.{{cite journal | vauthors = 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 | display-authors = 6 | title = First case of amebic liver abscess 22 years after the first occurrence | journal = Parasite | volume = 22 | pages = 20 | year = 2015 | pmid = 26088504 | pmc = 4472968 | doi = 10.1051/parasite/2015020 | url = }} Only rarely are masses formed (amoebomas) that lead to intestinal obstruction.(Mistaken for Ca caecum and appendicular mass) Other local complications include bloody diarrhea, pericolic and pericaecal abscess.{{citation needed|date=May 2021}}

Complications of hepatic amoebiasis includes subdiaphragmatic abscess, perforation of diaphragm to pericardium and pleural cavity, perforation to abdominal cavital (amoebic peritonitis) and perforation of skin (amoebiasis cutis).{{citation needed|date=May 2021}}

Pulmonary amoebiasis can occur from liver lesions by spread through the blood or by perforation of pleural cavity and lung. It can cause lung abscess, pulmono pleural fistula, empyema lung and broncho pleural fistula. It can also reach the brain through blood vessels and cause amoebic brain abscess and amoebic meningoencephalitis. Cutaneous amoebiasis can also occur in skin around sites of colostomy wound, perianal region, region overlying visceral lesion and at the site of drainage of liver abscess.{{citation needed|date=May 2021}}

Urogenital tract amoebiasis derived from intestinal lesion can cause amoebic vulvovaginitis (May's disease), rectovesicle fistula and rectovaginal fistula.{{cn|date=June 2022}}

Entamoeba histolytica infection is associated with malnutrition and stunting of growth in children.{{cite journal | vauthors = Mondal D, Petri WA, Sack RB, Kirkpatrick BD, Haque R | title = Entamoeba histolytica-associated diarrheal illness is negatively associated with the growth of preschool children: evidence from a prospective study | journal = Transactions of the Royal Society of Tropical Medicine and Hygiene | volume = 100 | issue = 11 | pages = 1032–8 | date = November 2006 | pmid = 16730764 | doi = 10.1016/j.trstmh.2005.12.012 | display-authors = etal }}

An estimated 500 million people worldwide are infected with Entamoeba, the majority of whom are infected with E. dispar and an estimated 10% are infected with E. histolytica{{cite book |doi=10.1002/9781119600206.ch146 |chapter=Parasitic diseases: Protozoa |title=Yamada's Textbook of Gastroenterology |date=2022 |pages=3022–3038 |isbn=978-1-119-60016-9 | vauthors = Beiting DP, John AR }}{{Cite book | last=Rosenthal | first=Philip J. | chapter=Amebiasis | editor-last=Papadakis | editor-first=Maxine A. | editor2-last=McPhee | editor2-first=Stephen J. | editor3-last=Rabow | editor3-first=Michael W. | editor4-last=McQuaid | editor4-first=Kenneth R. | title=Current Medical Diagnosis & Treatment 2023 | publisher=McGraw-Hill Education | year=2023 | url=https://accessmedicine.mhmedical.com/content.aspx?bookid=3212§ionid=269150095 | access-date=2025-05-25 }}. Mortality from invasive E. histolytica infection is estimated at 100,000 per year. Amoebiasis caused about 55,000 deaths worldwide in 2010, down from 68,000 in 1990.{{cite journal |last1=Shirley |first1=DT |last2=Watanabe |first2=K |last3=Moonah |first3=S |title=Significance of amebiasis: 10 reasons why neglecting amebiasis might come back to bite us in the gut. |journal=PLOS Neglected Tropical Diseases |date=November 2019 |volume=13 |issue=11 |pages=e0007744 |doi=10.1371/journal.pntd.0007744 |pmid=31725715|pmc=6855409 |doi-access=free }}{{cite journal | vauthors = Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, Abraham J, Adair T, Aggarwal R, Ahn SY, Alvarado M, Anderson HR, Anderson LM, Andrews KG, Atkinson C, Baddour LM, Barker-Collo S, Bartels DH, Bell ML, Benjamin EJ, Bennett D, Bhalla K, Bikbov B, Bin Abdulhak A, Birbeck G, Blyth F, Bolliger I, Boufous S, Bucello C, Burch M, Burney P, Carapetis J, Chen H, Chou D, Chugh SS, Coffeng LE, Colan SD, Colquhoun S, Colson KE, Condon J, Connor MD, Cooper LT, Corriere M, Cortinovis M, de Vaccaro KC, Couser W, Cowie BC, Criqui MH, Cross M, Dabhadkar KC, Dahodwala N, De Leo D, Degenhardt L, Delossantos A, Denenberg J, Des Jarlais DC, Dharmaratne SD, Dorsey ER, Driscoll T, Duber H, Ebel B, Erwin PJ, Espindola P, Ezzati M, Feigin V, Flaxman AD, Forouzanfar MH, Fowkes FG, Franklin R, Fransen M, Freeman MK, Gabriel SE, Gakidou E, Gaspari F, Gillum RF, Gonzalez-Medina D, Halasa YA, Haring D, Harrison JE, Havmoeller R, Hay RJ, Hoen B, Hotez PJ, Hoy D, Jacobsen KH, James SL, Jasrasaria R, Jayaraman S, Johns N, Karthikeyan G, Kassebaum N, Keren A, Khoo JP, Knowlton LM, Kobusingye O, Koranteng A, Krishnamurthi R, Lipnick M, Lipshultz SE, Ohno SL, Mabweijano J, MacIntyre MF, Mallinger L, March L, Marks GB, Marks R, Matsumori A, Matzopoulos R, Mayosi BM, McAnulty JH, McDermott MM, McGrath J, Mensah GA, Merriman TR, Michaud C, Miller M, Miller TR, Mock C, Mocumbi AO, Mokdad AA, Moran A, Mulholland K, Nair MN, Naldi L, Narayan KM, Nasseri K, Norman P, O'Donnell M, Omer SB, Ortblad K, Osborne R, Ozgediz D, Pahari B, Pandian JD, Rivero AP, Padilla RP, Perez-Ruiz F, Perico N, Phillips D, Pierce K, Pope CA, Porrini E, Pourmalek F, Raju M, Ranganathan D, Rehm JT, Rein DB, Remuzzi G, Rivara FP, Roberts T, De León FR, Rosenfeld LC, Rushton L, Sacco RL, Salomon JA, Sampson U, Sanman E, Schwebel DC, Segui-Gomez M, Shepard DS, Singh D, Singleton J, Sliwa K, Smith E, Steer A, Taylor JA, Thomas B, Tleyjeh IM, Towbin JA, Truelsen T, Undurraga EA, Venketasubramanian N, Vijayakumar L, Vos T, Wagner GR, Wang M, Wang W, Watt K, Weinstock MA, Weintraub R, Wilkinson JD, Woolf AD, Wulf S, Yeh PH, Yip P, Zabetian A, Zheng ZJ, Lopez AD, Murray CJ, AlMazroa MA, Memish ZA | s2cid = 1541253 | display-authors = 6 | title = Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010 | journal = Lancet | volume = 380 | issue = 9859 | pages = 2095–128 | date = December 2012 | pmid = 23245604 | doi = 10.1016/S0140-6736(12)61728-0 | pmc = 10790329 | hdl = 10536/DRO/DU:30050819 | url = https://zenodo.org/record/2557786 | hdl-access = free }}

Although usually considered a tropical parasite, the first case reported (in 1875) was actually in St Petersburg in Russia, near the Arctic Circle.{{cite journal |last1=Lösch |first1=F. |title=Massenhafte Entwickelung von Amöben im Dickdarm |trans-title=Massive development of amoebas in the large intestine |language=de |journal=Archiv für pathologische Anatomie und Physiologie und für klinische Medicin |date=November 1875 |volume=65 |issue=2 |pages=196–211 |doi=10.1007/BF02028799 |url=https://zenodo.org/record/1428378 }} Infection is more common in warmer areas, but this is because of both poorer hygiene and the parasitic cysts surviving longer in warm moist conditions.

Amoebiasis was first described by Fedor A. Lösch in 1875, in northern Russia.{{cite journal |last1=Rawat |first1=Aadish |last2=Singh |first2=Parikshit |last3=Jyoti |first3=Anupam |last4=Kaushik |first4=Sanket |last5=Srivastava |first5=Vijay Kumar |title=Averting transmission: A pivotal target to manage amoebiasis |journal=Chemical Biology & Drug Design |date=August 2020 |volume=96 |issue=2 |pages=731–744 |doi=10.1111/cbdd.13699 |pmid=32356312 |s2cid=218475533 }} The most dramatic incident in the US was the Chicago World's Fair outbreak in 1933, caused by contaminated drinking water. There were more than a thousand cases, with 98 deaths.{{cite journal | vauthors = Markell EK | title = The 1933 Chicago outbreak of amebiasis | journal = The Western Journal of Medicine | volume = 144 | issue = 6 | pages = 750 | date = June 1986 | pmid = 3524005 | pmc = 1306777 }}{{cite web |title=Water and Waste Systems |url=http://www4.ncsu.edu/~rifki/arc414/Water%20and%20Waste/WaterWaste_09.htm |archive-url=https://web.archive.org/web/20170119121357/http://www4.ncsu.edu/~rifki/arc414/Water%20and%20Waste/WaterWaste_09.htm |archive-date=2017-01-19 |url-status=dead |access-date=2017-01-19 }}{{MEDRS|date=March 2024}} It has been known since 1897 that at least one non-disease-causing species of Entamoeba existed (Entamoeba coli), but it was first formally recognized by the WHO in 1997 that E. histolytica was two species, despite this having first been proposed in 1925. In addition to the now-recognized E. dispar, evidence shows there are at least two other species of Entamoeba that look the same in humans: E. moshkovskii and Entamoeba bangladeshi. The reason these species haven't been differentiated until recently is because of the reliance on appearance.

Joel Connolly of the Chicago Bureau of Sanitary Engineering brought the outbreak to an end when he found that defective plumbing permitted sewage to contaminate drinking water. In 1998 there was an outbreak of amoebiasis in the Republic of Georgia.{{cite journal | vauthors = Kreidl P, Imnadze P, Baidoshvili L, Greco D | title = Investigation of an outbreak of amoebiasis in Georgia | journal = Euro Surveillance | volume = 4 | issue = 10 | pages = 103–104 | date = October 1999 | pmid = 12631887 | doi = 10.2807/esm.04.10.00040-en | doi-access = free }} Between 26 May and 3 September 1998, 177 cases were reported, including 71 cases of intestinal amoebiasis and 106 probable cases of liver abscess.{{citation needed|date=May 2021}}

The Nicobarese people have attested to the medicinal properties found in Glochidion calocarpum, a plant common to India, saying that its bark and seed are most effective in curing abdominal disorders associated with amoebiasis.See p. 412 in: {{cite journal |last=Hammer |first=K |title=Barilla (Salsola soda, Chenopodiaceae) |journal=Economic Botany |volume=44 |issue=3 |pages=410–412 |date=1990 |doi=10.1007/bf03183925 |jstor=4255259 |bibcode=1990EcBot..44..410H |s2cid=32113455 }}

An outbreak of amoebic dysentery occurs in Diana Gabaldon's novel A Breath of Snow and Ashes.{{cite web|title=Outlandish Observations|date=17 January 2014 |url=http://www.outlandishobservations.com/2014/01/friday-fun-facts-1172014.html|access-date=2020-11-24}}{{MEDRS|date=March 2024}}

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| eMedicine_mult = {{eMedicine2|article|996092}}

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• [https://www.cdc.gov/parasites/amebiasis/ Amoebiasis] - Centers for Disease Control and Prevention

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