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Abstract
Amoebiasis is the second leading cause of death from parasitic disease worldwide.
The causative protozoan parasite, Entamoeba histolytica, is a potent pathogen. Secreting
proteinases that dissolve host tissues, killing host cells on contact, and engulfing
red blood cells, E histolytica trophozoites invade the intestinal mucosa, causing
amoebic colitis. In some cases amoebas breach the mucosal barrier and travel through
the portal circulation to the liver, where they cause abscesses consisting of a few
E histolytica trophozoites surrounding dead and dying hepatocytes and liquefied cellular
debris. Amoebic liver abscesses grow inexorably and, at one time, were almost always
fatal, but now even large abscesses can be cured by one dose of antibiotic. Evidence
that what we thought was a single species based on morphology is, in fact, two genetically
distinct species--now termed Entamoeba histolytica (the pathogen) and Entamoeba dispar
(a commensal)--has turned conventional wisdom about the epidemiology and diagnosis
of amoebiasis upside down. New models of disease have linked E histolytica induction
of intestinal inflammation and hepatocyte programmed cell death to the pathogenesis
of amoebic colitis and amoebic liver abscess.