THE MANAGEMENT OF AMEBIASIS

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Abstract
The management of 360 cases of amebiasis in American soldiers in Burma is reviewed. Because of the high incidence among American troops, ranging from 18.3 to 23%, this disease may become a major health problem in the future. So varied was the symptomatology that it became necessary to consider amebiasis in the differential diagnosis of any gastrointestinal complaint. Physical examination may be entirely negative, but colonic tenderness should direct suspicion toward intestinal amebiasis, and compression or percussion tenderness over the liver toward hepatic invelvement. The large tender liver frequently observed in amebiasis, although not necessarily signifying a true amebic hepatitis, is frequently associated with the more severe infections. Clinical differentiation of amebic from bacillary dysentery is not always possible. Stool examination by an experienced laboratory technician is the only reliable means of diagnosis. The combined treatment of subcut. injns. of emetine hydrochloride with oral amebicides is the most satisfactory regimen. The use of either form of treatment alone not only may be unsuccessful, but may actually be harmful by producing a drug-fast strain of parasite. The term "asymptomatic carrier" is dangerous and misleading. It is believed that all cases of amebiasis are diseased and., if treated at all, should be treated vigorously, not only with oral amebicides, but also with injns. of emetine, because emetine is the most effective amebicide for parasites that have penetrated the mucosal wall, more effectively eradicates amebae that have penetrated into the portal system without yet producing symptoms, and is comparatively non-toxic when given properly. Sulfadiazine may sometimes be of value in relieving symptoms that persist after adequate anti-amebic therapy.
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