AMEBIASIS IN A MENTAL INSTITUTION: SEROLOGIC AND EPIDEMIOLOGIC STUDIES1

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Abstract
Sexton, D. J., D. J. Krogstad, H. C. Spencer, Jr. (CDC, Atlanta, Ga. 30333), G. R. Healy, S. Sinclair, C. E. Sledge and M. G. Schultz. Amebiasis in a mental institution: serologic and epidemiologic studies. Am J Epidemiol 100: 414–423, 1974. Serologic and stool surveys were done during the fall of 1972 at a 3500-patient Mississippi mental institution. In the 20-year period from 1953–1972 the hospital had reported 127 deaths due to amebiasis. Trophozoites of Entamoeba histolytica were demonstrated at autopsy or pre-mortem biopsy in 67 (53%) of the cases. A random serologic survey of 351 (10%) of the patients revealed positive indirect hemagglutination (IHA) titers to E. histolytica in 27.6%. Higher rates of seropositivity were found among the mentally retarded patients than among geriatric, psychotic, or other diagnostic categories. Surveys of 2 wards of mentally retarded patients revealed that 73% of 108 were seropositive, and 17% had either cysts or trophozoites of E. histolytica in their stools. The distribution of seropositivity among patients did not correlate with patterns of food or water distribution. Seropositivity rates of employees were lower than those of patients. Patient-contact employees had a higher proportion (8.0% of 174) of positive IHA titers when compared with employees without patient contact (5.1% of 389). Stool examination of dietary and patient-contact employees failed to reveal any cysts or trophozoites of E. histolytica. The probable importance of person-to-person transmission is suggested by deviation from a predicted random distribution of seropositivity among patients and by the significantly increased number of high IHA titers among patient-contact employees. The absence of evidence for transmission by food or water and the presence of unsanitary conditions which would facilitate fecal-oral spread further support this hypothesis.

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