Cryptosporidium parvum Cyclospora cayetanensis Isospora belli Entamoeba histolytica Giardia lamblia cellular immunity humoral immunity microsporidia Trichomonas vaginalis 12 64 http://www.aids-care.org.tw
20 13
100,000 cyst PCR trophozoite trimethoprim-sulfamethoxazole Baktar macrolides azithromycin clarithromycin Acanthoamoeba spp. 14 64 http://www.aids-care.org.tw
E. histolytica E. histolytica 90% 1990 6 12 9% pathogenic amoeba E. histolytica 50% nonpathogenic amoebas E. 10 dispar E. moshkovskii 10% E. histolytica E. dispar E. moshkovskii 10% E. histolytica 1970 Gay 15
Bowel Syndrome dispar indirect hemagglutination IHA 20 E. histolytica and Prevention Centers for Disease Control 5 1980 90 1987 1989 30 40% E. 16 64 http://www.aids-care.org.tw
2000 Seoul 1997 2003 55 50% 1999 18 CD4+ 17
405 7 1.73% 110 14 12.73% 303 43 12.68% 86 1994 2003 854 49 5.33% PCR 43 51 7 18.42% CD4+ 595 IHA 35 5.88% 20 ( 128) 2001 39 2003 12% 12% IHA 0. 18 64 http://www.aids-care.org.tw
12% 2004 148 IHA 4.8% 5 2 3% 90 95% E. histolytica E. dispar the TechLab E. histolytica II ProSpect 5 10% kits 19
PCR the TechLab E. histolytica II PCR 50 80% 90% 2/3 dichloracetanilide derivatives oral aminoglycosides 5-hydroxyquinolines diloxanide furoate Furamide paromomycin Humatin iodoquinol Yodoxin, diiodohydrox- 20 64 http://www.aids-care.org.tw
yquin nitroimidazoles diloxanide furoate paromomycin mycin metronidazole Flagyl tinidazole Fazigyn secnidazole ornidazole Metronidazole disulfuram-like 86% nitroimidazoles 14% Paromo- dispar Diloxanide furoate 1950 chloramphenicol 1977 1990 E. histolytica/e. dispar E. histolytica/e. nitroimidazoles 40 60% 7 Iodoquinol emetine emetine 85% metronidazole 750 64% mg tid 10 tinidazole 5 21
iodoquinol 21 21 iodoquinol Paromomycin metronidazole 7 10 metronidazole < > 1. Haque R, Huston CD, Hughes M, et al. Amebiasis. N Engl J Med 2003;348:1565-73. 2. Stanley SL Jr. Amoebiasis. Lancet 2003 ;361:1025-34. 3. Blessmann J, Ali IK, Ton Nu PA, et al. Longitudinal study of intestinal Entamoeba histolytica infections in asymptomatic adult carriers. J Clin Microbiol 2003 ;41:4745-50. 4. Phillips SC, Mildvan D, William DC, et al.sexual transmission of enteric protozoa and helminths in a venereal-diseaseclinic population. N Engl J Med 1981;305 :603-6. 5. Quinn TC, Stamm WE, Goodell SE, et al. The polymicrobial origin of intestinal infections in homosexual men. N Engl J Med 1983;309:576-82. 6. Markell EK, Hanens RF, Kuritsubo RA, et al. Intestinal protozoa in homosexual men of the San Francisco Bay area: prevalence and correlates of infection. Am J Trop Med Hyg 1984;33:239-45. 7. Allason-Jones E, Mindel A, Sargenunt P 22 64 http://www.aids-care.org.tw
, et al. Entamoeba histolytica as a commensal intestinal parasite in homosexual men. N Engl J Med 1986;315:353-6. 8. Sorvillo FJ, Strassburg MA, Seidel J, et al. Amebic infections in asymptomatic homosexual men: lack of evidence of invasive disease. Am J Public Health 1986; 76:1137-9. 9. Lowther SA, Dworkin MS, Hanson DL, and the Adult and Adolescent Spectrum of Human Immunodeficiency Virus Disease Project. Entamoeba histolytica/entamoeba dispar in human immunodeficiency virus-infected patients in the United States. Clin Infect Dis 2000;30: 955-9. 10.Aceti A, Pennica A, Ippolito G, et al. Antiamebic antibodies in homosexual men. N Engl J Med 1987;316:692. 11.Takeuchi T, Okuzawa E, Nozaki T, et al. High seropositivity of Japanese homosexual men for amebic infection. J Infect Dis 1989;159:808. 12. Ohnishi K, Murata M. Present characteristics of symptomatic amebiasis due to Entamoeba histolytica in the eastsoutheast area of Tokyo. Epidemiol Infect 1997;119:363-7. 13.Ohnishi K, Kato Y, Imamura A, et al. Present characteristics of symptomatic Entamoeba histolytica infection in the big cities of Japan. Epidemiol Infect 2003 ;132:57-60. 14.Nozaki T, Kobayashi S, Takeuchi T, et al. Diversity of clinical isolates of Entamoeba histolytica in Japan. Arch Med Res 2006; 37: 277-9. 15.Oh M, Lee K, Kim E, et al. Amoebic liver abscess in HIV-infected patients. AIDS 2000;14:1872-3. 16.Park WB, Choe PG, Jo JH, et al. Amebic liver abscess in HIV-infected patients, Republic of Korea. Emerg Infect Dis 2007 ;13:516. 17.Stark DJ, Fotedar R, Ellis JT, et al. Locally acquired infection with Entamoeba histolytica in men who have sex with men in Australia. Med J Aust 2006 ;85:417. 18. Hung CC, Chen PJ, Hsieh SM, et al. Invasive amebiasis: an emerging parasitic disease in patients with HIV infection in an endemic area of amebic infection. AIDS 1999;13:2421-8. 19.Liu CJ, Hung CC, Chen MY, et al. Amebic liver abscess and human immunodeficiency virus infection: a report of three cases. J Clin Gastroenterol 2001;33:64-8. 20.Hung CC, Deng HI, Hsiao WH, et al. Invasive amebiasis as an emerging parasitic disease in patients with human immunodeficiency virus type 1 infection in Taiwan. Arch Intern Med 2005;165: 409-15. 21.Tsai JJ, Sun HY, Ke LY, et al. Higher seroprevalence of Entamoeba histolytica infection is associated with human immunodeficiency virus type 1 infection. Am J Trop Med Hyg 2006;74:1016-9. 22.Hung CC, Sun HY, Chang SC. Invasive amebiasis and HIV infection. Am J Trop Med Hyg 2006;75:775. 23.Ko NY, Lee HC, Chang JL, et al. Prevalence of human immunodeficiency virus and sexually transmitted infections and risky sexual behaviors among men visiting gay bathhouses in Taiwan. Sex Transmitted Dis 2006;33:467-73. 24.Hung CC. Amoebiasis, current status in Australia. [Letter to the editor]. Med J Austral 2007;187:372-3. 25.Hung CC, Ji DD, Sun HY, et al. Increased risk for Entamoeba histolytica infection and invasive amebiasis in HIV seropositive men who have sex with men in 23
Taiwan. PLoS NTD 2008;2:e175. 26.Hsu MS, Hsieh SM, Chen MY, et al. Association between amebic liver abscess and human immunodeficiency virus infection in Taiwanese subjects. BMC Infect Dis 2008;8:48. 27.Hung CC, Ko NY, Ko WC, et al. Amebiasis among patrons visiting gay saunas in Taiwan. HIV Med 2008;9: (in press) 28.Chang SY, Sun HY, Ji DD, et al. Costeffectiveness of detection of intestinal amebiasis among persons with or without human immunodeficiency virus infection. J Clin Microbiol 2008;46:3077-9. 24 64 http://www.aids-care.org.tw