Hepatitis G Virus Infection in Hemodialysis Patients: Fact or Fancy?

TO THE EDITOR: A 50-yr-old white male attorney presented to my office complaining of vague, generalized, cramping abdominal pain following a scuba diving trip that he and his lady friend and her two children took to Cabo San Lucas in Mexico several months before. He had also consulted a urologist because of lessened libido, and unsatisfactory orgasms. The urologist made a clinical diagnosis of prostatitis and prescribed ciprofloxin. The patient had been depressed because of the death of his father and another close family member. On examination it was noted that he had a 10-lb weight loss from the time of his previous visit, 6 months earlier. His abdomen was mildly diffusely tender in all quadrants. A hemoccult test done on stool from a rectal exam was positive for blood. The exam was otherwise unremarkable. Three repeat stool exams revealed two that were positive for blood. A stool culture was negative for pathogens. One of three stools for O&P disclosed Entameba Hartmanii . The patient was referred to a gastroenterologist and concurrently started on metronidazole and tetracycline. A colonoscopy was performed revealing two polyps, which were biopsied and were non malignant. After completion of treatment, the stools were negative for parasites. Upon learning of the presence of the parasite in her man friend’s stool, the lady friend and her two children, who were experiencing similar symptoms, went to their physician who subsequently identified E. Hartmanii from one of their stool specimens. The lady friend was also experiencing decreased interest in sex, diminished vaginal sensation, and unsatisfactory orgasms. These three patients were also placed on metronidazole and tetracycline. All four of the patients had resolution of their abdominal symptoms. The sexual complaints disappeared in both individuals following metronidazole and tetracycline (there had not been any change in the male following two weeks of ciprofloxin alone). I call this to your attention because Entameba Hartmanii is not thought to be a human pathogen and is not usually treated. In these individuals, all gastrointestinal and libidinal symptoms had resolved. Perhaps we should rethink E. Hartmanii and its role in human disease.