Nontravel-related invasive Entamoeba histolytica infection with probable heterosexual transmission

Abstract

Introduction: In industrialized countries, amebiasis usually occurs in migrants and travelers returning from areas where the disease is endemic, primarily by ingestion of contaminated food or water. Person-to-person transmission can occur, mainly by fecal-oral contact, but sexual transmission has also been described [1,3–5]. Presentation of case: We report a man with Entamoeba histolytica colitis and a large liver abscess (16.5 × 14 cm) in Portugal, who had no relevant travel history and whose only risk factor was his heterosexual partner. The abscess required drainage of 1950 mL of “chocolate-milk” purulent fluid, with rapid symptomatic improvement. The diagnosis was established by real-time reverse transcription PCR for Entamoeba histolytica in the liver aspirate, with positive IgG antibodies. He received a total of 16 days of ceftriaxone and metronidazole followed by 7 days of paromomycin. Conclusion: As enteric infections may be sexually transmitted, in industrialized countries, even in the absence of travel, sexual history should not be neglected. Keywords: Amebiasis, Entamoeba histolytica, Sexually Transmitted Diseases, Liver abscess