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from fly contamination; handwashing; and, in endemic areas, avoidance of foods that cannot be cooked or peeled Water supplies can be boiled, treated with iodine (05 mL tincture of iodine per liter for 20 minutes; cysts are resistant to standard concentrations of chlorine) or filtered

Blessman J et al Ultrasound patterns and frequency of focal liver lesions after successful treatment of amoebic liver abscess Trop Med Int Health 2006 Apr;11(4):504 8 [PMID: 16553933] Haque R et al Amebiasis N Engl J Med 2003 Apr 17;348 (16):1565 73 [PMID: 12700377] Stanley SL Jr Amoebiasis Lancet 2003 Mar 22;361(9362):1025 34 [PMID: 12660071] Tinidazole (Tindamax) a new anti-protozoal drug Med Lett Drugs Ther 2004 Aug 30;46(1190):70 2 [PMID: 15375353]

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droxyquin; 650 mg three times daily for 21 days), and paromomycin (30 mg/kg base, maximum 3 g, in three divided doses after meals daily for 7 days) Side effects associated with luminal agents are flatulence with diloxanide furoate, mild diarrhea with iodoquinol, and gastrointestinal symptoms with paromomycin Relative contraindications are thyroid disease for iodoquinol and renal disease for iodoquinol or paromomycin Treatment of intestinal amebiasis requires metronidazole (750 mg three times daily for 10 days) or tinidazole (2 g once daily for 3 days for mild disease and 5 days for serious disease) plus a luminal agent (Table 35 2) Metronidazole has most commonly been used in the United States, but tinidazole, which is now available, offers simpler dosing and less side effects Metronidazole often induces transient nausea, vomiting, epigastric discomfort, headache, or a metallic taste A disulfram-like reaction may occur if alcohol is coingested Drug interactions with cimetidine, some anticoagulants, phenytoin, phenobarbital, lithium, and other drugs have been reported Metronidazole is carcinogenic in mice; it should be avoided in pregnant or nursing mothers if possible The same toxicities and concerns probably apply for tinidazole, although it appears to be better tolerated Fluid and electrolyte replacement is also important for patients with significant diarrhea Surgical management of acute complications of intestinal amebiasis is best avoided whenever possible Successful therapy of severe amebic colitis may be followed by postdysenteric colitis, with continued diarrhea without persistent infection; this syndrome generally resolves in weeks to months An alternative for the treatment of intestinal amebiasis is tetracycline (250 500 mg four times daily for 10 days) plus chloroquine (500 mg daily for 7 days) Tetracycline should be avoided in children and pregnant women Emetine or dehydroemetine can be given subcutaneously (preferred) or intravenously in a dose of 1 15 mg/kg/d; the maximum daily dose for dehydroemetine is 90 mg and 65 mg for emetine) Although these agents are effective, they are highly toxic; specifically, they are cardiotoxic, with a narrow therapeutic range Therefore, they are generally used only until severe disease is controlled These drugs cause nausea, vomiting, and pain at the injection site Emetine is not available in the United States and dehydroemetine is only available from the Centers for Disease Control and Prevention Drug Service Amebic liver abscess is also treated with metronidazole or tinidazole plus a luminal agent (even if intestinal infection is not documented; Table 35 2) Metronidazole can be used intravenously when necessary With failure of initial response to metronidazole or tinidazole, chloroquine, emetine or dehydroemetine may be added Needle aspiration may be helpful for large abscesses (over 5 10 cm), in particular if the diagnosis remains uncertain, if there is an initial lack of response, or if a patient is very ill, suggesting imminent abscess rupture With successful therapy, abscesses disappear slowly (over months).

Acute meningoencephalitis or chronic granulomatous encephalitis after contact with warm fresh water Keratitis, particularly in contact lens users The free-living amebas that cause disease in humans are of the genera Acanthamoeba, Naegleria, and Balamuthia The organisms are widely distributed in soil and fresh and brackish water Acanthamoeba and Naegleria species have been found to harbor Legionella, Vibrio cholerae, and other endosymbiotic bacteria and may serve as a reservoir for these organisms

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