Intended for healthcare professionals

Rapid response to:

Clinical Review

Management of travellers’ diarrhoea

BMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a1746 (Published 06 October 2008) Cite this as: BMJ 2008;337:a1746

Rapid Response:

Entamoeba histolytica and travelers' diarrhoea

Travelers' diarrhoea is the most common illness affecting travelers,
it can be caused by bacteria, viruses and parasites. In the causative
organisms are found in about half the cases of travellers' diarrhoea, this
is possibly because the sudden change in the environment, especially the
diet, can expose you to a new variety of bacteria or "normal flora" in
your intestine which may trigger off an attack of diarrhoea. However you
may experience difficulty in the diagnosis too. For example, Entamoeba
histolytica is not always found in every stool sample, may be necessary
several stool samples from several different days. One problem is that
other parasites and cells can look very similar to E. histolytica when
seen under a microscope. So while the scientific literature did not find
many reports of the E. histolytica as cause the travelers' diarrhoea, it
is possible that an agent is more important than may seem. There are few
reports in the literature, among the few reports there is a case with E.
histolytica were identified in 17 patients with inflammatory diarrhoea
(KORZENIOWSKI et al. 1994). Another study was undertaken to learn the
prevalence of amoebiasis and to assess the clinical importance of E.
histolytica in high-risk groups: 2700 travelers returning from the tropics
4.0% of the travelers had E. histolytica infections (WEINKE et al., 1990).

The CDC (Centers for Disease Control and Prevention) recommends that
when traveling to a country that has poor sanitary conditions:

What should
I eat and drink there so I will not become infected with E. histolytica or
other such germs?

Drink only bottled or Boiled (for 1 minute) water or carbonated (bubbly)
drinks in cans or bottles.

Do not drink fountain drinks or any drinks with ice cubes. Another way to
make water safe is by filtering it through an "absolute 1 micron or less"
filter and Dissolving chlorine, chlorine dioxide, or iodine tablets in the
filtered water. "Absolute 1 micron" filters can be found in camping /
outdoor supply stores.

Do not eat fresh fruit or vegetables that you did not peel yourself.

Do not eat or drink milk, cheese, or dairy products that may not have been
pasteurized.

Do not eat or drink anything sold by street vendors.

These recommendations also confirm the importance of E. histolytica as
agent of travelers' diarrhoea.

REFERENCES

1)CDC. Centers for Disease Control and Prevention (2009).
http://www.cdc.gov/ncidod/dpd/parasites/Amebiasis/factsht_Amebiasis.htm
[Accessed 30 June 2009]

2)Korzeniowski O.M., Dantas W., Trabulsi L.R., Guerrant R.L. (1984) A
controlled study of endemic sporadic diarrhoea among adult residents of
southern Brazil. Trans R Soc Trop Med Hyg 78:363-9.

3)Weinke T., Friedrich-Jänicke B., Hopp P., Janitschke K. (1990)
Prevalence and clinical importance of Entamoeba histolytica in two high-
risk groups: travelers returning from the tropics and male homosexuals. J
Infect Dis 161:1029-31.

Competing interests:
None declared

Competing interests: No competing interests

03 July 2009
Aline do Carmo França-Botelho
PhD student (UFMG, Belo Horizonte, Brazil)
Maria A. Gomes
Federal University of Minas Gerais, Dept Parasitologia ICB/UFMG Av. Antonio Carlos, 6627, 31270-901,