title: A possible cluster of sexually transmitted Entamoeba histolytica: genetic analysis of a highly virulent strain.
abstract: BACKGROUND
  Transmission of Entamoeba histolytica generally occurs by fecal excretion of cysts followed by oral ingestion of contaminated food or water. However, fecal-oral transmission may occur within households and long-term care institutions, and sexual transmission occurs among men who have sex with men. Epidemiologically linked clusters of E. histolytica infection are rare in industrialized countries. We report such a sexually linked cluster in Canada.
  
  
  METHODS
  An index case involving a young female with an amebic liver abscess led to an epidemiological investigation of sexual contacts. Anti-amebic serological analysis, stool specimen examinations, and abdominal ultrasounds were done for the contacts. Enzyme-linked immunosorbent assay was done for stool antigen specific to E. histolytica. Genotyping and phylogenetic analysis was performed on 1 stool isolate.
  
  
  RESULTS
  By tracing sexual contacts related to the index case, we uncovered a cluster of 7 cases of amebiasis (3 with liver abscesses). Oral-anal sex was common in the group; the 5 female individuals were bisexual (4) or homosexual (1). The outbreak strain was genotyped, and cluster analysis indicated that this virulent strain differed substantially from asymptomatic or diarrheal E. histolytica isolates.
  
  
  CONCLUSIONS
  E. histolytica can be transmitted by heterosexual activity as well as male and female homosexual activity. Patients with amebiasis should be counselled about possible sexual transmission.
authors: Division of Infectious Diseases, Department of Medicine, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada. Irving.salit@uhn.on.ca
authors: Irving E
authors: IE
authors: Salit
authors: Krishna
authors: K
authors: Khairnar
authors: Kevin
authors: K
authors: Gough
authors: Dylan R
authors: DR
authors: Pillai
mesh_terms: D000328:Adult; D000818:Animals; D000913:Antibodies, Protozoan / Q000097:blood; D002170:Canada / Q000453:epidemiology; D016000:Cluster Analysis; D016358:Contact Tracing; D016172:DNA Fingerprinting / Q000379:methods; D004748:Entamoeba histolytica / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D004749:Entamoebiasis / Q000453:epidemiology* / Q000469:parasitology / Q000635:transmission; D005243:Feces / Q000469:parasitology; D005260:Female; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D017422:Sequence Analysis, DNA; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000453:epidemiology* / Q000469:parasitology / Q000635:transmission; D014463:Ultrasonography
chemical_list: D000913:Antibodies, Protozoan