Amoebiasis in Pregnancy: A Review and Update of the Literature
Authors: Kodzo-Grey Venyo Anthony 
Published: July 2022

Amoebiasis is a disease which tends to be caused mainly by Entamoeba histolytica. Amoebiasis can affect males, females, children, and adults. Amoebiasis tends to be more commonly encountered in people who live in or travel to developing countries that are amoebiasis endemic area with poor sanitary conditions. Individuals from the developed countries who travel to and back from developing countries or individuals in developed countries who have not travelled to developing countries but have been close to their relatives or friends who have travelled to developing countries could also develop amoebiasis. Individuals who are infected by amoebiasis are not always symptomatic as well as some individuals who have been harbouring entamoeba histolytica may be asymptomatic for many years before they become symptomatic which makes it difficult for the patients and their clinicians to have a high index of suspicion for the possibility of amoebiasis which would contribute to mis-diagnosis or delay in the diagnosis that would tend to be associated with the possible development of complications including amoebic liver abscess and perforation of the abscess with the development of peritonitis when the diagnosis is not established quickly. Amoebiasis could be asymptomatic or it could be associated with mild or severe symptoms. Some of the common symptoms of amoebiasis include lethargy, weight less, abdominal pain, diarrhoea, bloody diarrhoea. Some of the complications of amoebiasis include inflammation as well as perforation with tissue of the colon or peritonitis. Extra-intestinal amoebiasis may also develop leading to amoebiasis of the liver and amoebic liver abscess, amoebic pneumonitis, amoebic infections of the brain and cerebral abscess, amoebic vaginitis, amoebic cervicitis, amoebic endometritis, amoebic salpingitis, amoebiasis of the ovary with or without the development of an abscess, amoebic prostatitis, amoebiasis of the kidney and amoebic emphysematous pyelonephritis and amoebic renal cyst, amoebiasis mimicking fibroid, amoebic peri-carditis, and amoebic cardiac tamponade. Some of the predisposing factors for the development of amoebiasis include: exposure to amoebiasis infected individuals, drinking of unsafe water, alcoholism, ages extremes including the elderly and young children, pregnancy, immunosuppression, recent coital activity with unprotected anal or oral-anal contact, recent travel to developing countries and residence within an amoebiasis endemic developing country or region. Amoebiasis may mimic appendicitis, Crohn’s disease, ulcerative colitis, colonic malignancy and other more common conditions. Globally about 50 million cases of invasive Entamoeba histolytica infection occurs per year leading to as many as many as 100,000 deaths that is believed to be the tip of an iceberg. A high index of suspicion is required to establish quickly a diagnosis of amoebiasis generally as well as amoebiasis in pregnancy. Diagnosis of enteric amoebiasis whether associated with pregnancy in medical establishments in rural hospitals in the developing countries has tended to be based upon microscopy examination of stool samples of patients. Nevertheless, molecular -biology based tests with serology tests by polymerase chain reaction (PCR) tests tend to provide a quick and accurate diagnosis but these tests tend not to be immediately available in small hospitals of some developing countries. In complicated cases like amoebic liver abscess microscopy examination of the abscess fluid aspirate and biopsy of the wall of the abscess would tend to confirm the diagnosis. Few epidemiological data relating to the prevalence of Entamoeba histolytica within Europe and North America do exist; nevertheless, studies that had investigated infectious travel-related gastrointestinal disorders had reported that amoebiasis is the identified pathogen in 1.4% of cases in Europe. Considering that both within the developing countries and developed countries Amoebiasis in pregnancy is not excessively common, without a high index of suspicion for the possibility of a pregnant woman who presents with non-specific symptoms as stated above there would tend to be a delay in the diagnosis of amoebiasis in stool microscopy, PCR studies and ultrasound scan of abdomen and pelvis is not undertaken quickly. If stool microscopy, PCR studies, and quick aspiration and biopsies and pathology examinations of specimens of amoebic liver abscesses / lesions associated with pregnancy are undertaken then a diagnosis of amoebiasis in pregnancy would be made and a quick and appropriate treatment would be provided. Or else complications of amoebiasis including perforation of bowel, perforation of amoebic liver abscess/ amoebic liver abscess related atelectasis and chest infection would develop which would tend to be associated with prolonged morbidity and at times mortality. Treatment of amoebiasis associated with pregnancy entails utilization of anti-amoebic medications (for example metronidazole), treatment of any concurrent bacterial infection with an appropriate antibiotics, supportive care, and treatment of complications including amoebic liver abscess by radiology image-guided (ultrasound scan or magnetic resonance imaging scan) aspiration and drainage of the abscess or at times laparotomy. Regular follow-up clinical and radiology imaging follow-up assessment of patients is important to ascertain there is no recurrence of an abscess and education related to sanitary dietary habits is important to prevent further development of amoebiasis.