An unexpected parasitosis in Italy

Background: Amoebiasis is a common disease in tropical areas, such as Africa, Central and South America and India, most related with crowded living conditions and poor sanitation. Methods: A 11-year-old Italian female was admitted in another hospital for persistent fever, unresponsive to beta-lactam antibiotic treatment, after a brief holiday in Sardinia. Patient showed no diarrhea and vomiting. Routine examinations, serology for EBV, CMV, Toxoplasmosis, Salmonella, Brucella, Mycoplasma, Bartonella, Rickettsia as well as protein chain reaction (PCR) for meningococcus, pneumococcus, Adenovirus, Heamophilus influenzae were negative. Tick and thin blood films for malaria and bacterial cultures resulted negative, too. No evidence of Leishmaniasis in bone marrow aspirate was found. Chest radiography and cardiac ultrasonography showed no abnormalities. An abdomen ultrasonography showed celiac and hepatic lymphadenopathies and two hypoechoic lesions, suggestive of liver microabscesses. Patient was admitted to the Infectious Disease Unit at our Pediatric Department. Serology for Ecchinococcus, Schistosoma were negative. Amoeba Indirect Hemagglutination (IHA) resulted highly positive (128 L/tit). A treatment with metronidazole for 10 days was performed and followed by paromomycin for other 10 days, with progressively decreasing antibodies titre until reaching a negative value after 1 month. Moreover, several follow-up abdomen ultrasonographies showed a progressive reduction of hepatic lesions until complete resolution after 3 months. Conclusion: Amebiasis is a tropical disease caused by Entamoeba histolytica. Our case was unusual in its presentation, since patient had no intestinal symptoms and no epidemiological data were suggestive of this parasitosis. Ultrasonography of abdomen was essential for considering the diagnosis.