Management of Entamoeba histolytica Infection: Treatment Strategies and Possible New Drug Targets

Abstract

Entamoeba histolytica infection, amoebiasis, is a major cause of morbidity and mortality in developing countries. It is also a significant causative agent of traveler’s diarrhea. It has been estimated that amoebiasis may affect 10% of the global population. The most common infection route is via ingestion of contaminated food and water. About 90% of infected individuals are asymptomatic, but the infection may also lead to severe complications, such as colitis with bloody diarrhea, liver abscesses, and colonic perforation. The classical gold standard for diagnosis is the detection of trophozoites from stool samples by microscopy, although this method is labor-intensive and has low sensitivity. Several other diagnostic methods, based on parasite culture, serologic tests, antigen detection, and polymerase chain reaction, have been developed. In the future, multiplex PCR methods will be widely used for the simultaneous detection of various pathogenic microorganisms including E. histolytica. Treatment of amoebic colitis typically involves a combination therapy with the so-called luminal agents (paromomycin, diloxanide furoate, iodoquinol) combined with tissue amoebicides (metronidazole, tinidazole). Even though the present treatment options are mostly effective, new drugs are needed to treat all patients with amoebiasis, and different vaccine candidates are under development to eradicate E. histolytica from population.