Asymptomatic intestinal colonization by pathogenic Entamoeba histolytica in amebic liver abscess: prevalence, response to therapy, and pathogenic potential

Clin Infect Dis. 1992 Apr;14(4):889-93. doi: 10.1093/clinids/14.4.889.


Since the application of isoenzyme electrophoresis to the study of Entamoeba histolytica, the prevalence and natural history of asymptomatic intestinal colonization in patients with amebic liver abscess (ALA) has not been addressed. We prospectively evaluated this enteric phase in 50 patients with ALA, using two dosage regimens of metronidazole. The overall prevalence of asymptomatic colonization was 72% (36/50). All these isolates, without exception, proved to express pathogenic zymodemes. Despite a 100% clinical response of the hepatic lesions, failure to eradicate the organism from the bowel occurred in 20 of these 36 subjects. During longitudinal posttreatment surveillance, three carriers returned with second bouts of invasive disease: one with dysentery and two with liver abscesses. Thus, in patients with ALA, there is a high prevalence of intestinal colonization with exclusively pathogenic strains, and treatment with metronidazole frequently results in a continued carrier state. These carriers have a propensity for developing recurrent invasive disease and constitute a public health hazard.

Publication types

  • Clinical Trial
  • Controlled Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Animals
  • Carrier State / drug therapy
  • Carrier State / epidemiology*
  • Dysentery, Amebic / drug therapy
  • Dysentery, Amebic / epidemiology
  • Dysentery, Amebic / etiology*
  • Entamoeba histolytica / classification
  • Entamoeba histolytica / isolation & purification
  • Entamoeba histolytica / pathogenicity
  • Female
  • Follow-Up Studies
  • Humans
  • Intestinal Diseases, Parasitic / drug therapy
  • Intestinal Diseases, Parasitic / epidemiology
  • Intestinal Diseases, Parasitic / etiology*
  • Liver Abscess, Amebic / complications*
  • Liver Abscess, Amebic / drug therapy
  • Male
  • Metronidazole / therapeutic use*
  • Middle Aged
  • Prevalence
  • Prospective Studies


  • Metronidazole