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Datta P, Rattan D, Sharma D, Sharma N, Kalra N, Duseja A, Angrup A, Sehgal R. Novel diagnostic approach for amoebic liver abscess using cell free (cf) DNA: a prospective study. Infect Dis (Lond) 2024; 56:259-267. [PMID: 38112684 DOI: 10.1080/23744235.2023.2294119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/07/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Amoebic liver abscess (ALA) is commonly seen in tropical countries and diagnosis of ALA relies mainly on non-specific serological and imaging techniques as well as PCR from pus. OBJECTIVE This study evaluated the potential of using cell free DNA (cfDNA) from serum and urine for diagnosing ALA. METHODS We prospectively evaluated quantitative PCR (qPCR) for detection of cf DNA in serum and urine sample in all liver abscess patients. The samples were collected from patients reporting to emergency ward of Postgraduate Institute of Medical Education and Research, Chandigarh, India with symptoms suggestive of liver abscess. Real time PCR was done to detect cf DNA in serum and urine by targeting 99-bp unit of small subunit rRNA of Entamoeba histolytica and conventional PCR for pus. RESULTS A total 113 samples (serum and urine) and 100 pus samples were analysed. A total of 62 ALA patients were confirmed; with maximum 57 patients detected by qPCR for cfDNA in the serum, 55 patients by PCR on pus aspirate and 50 ALA patients by qPCR for cfDNA in urine sample. Therefore, the sensitivity of qPCR for detection of cf DNA in serum was 91.94% and for urine was 80.65%. CONCLUSION A total of 11.2% of ALA patients were diagnosed only through detection of E. histolytica cf DNA in their serum and urine. Detection of cfDNA from serum, urine of ALA has a potential role in future especially for developing countries as it is a rapid, sensitive and patient friendly diagnostic approach.
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Affiliation(s)
- Priya Datta
- Department of Medical Parasitology, PGIMER, Chandigarh, India
| | - Divya Rattan
- Department of Medical Parasitology, PGIMER, Chandigarh, India
| | - Devyani Sharma
- Department of Medical Parasitology, PGIMER, Chandigarh, India
| | - Navneet Sharma
- Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Naveen Kalra
- Department of Radiodiagnosis & Imaging, PGIMER, Chandigarh, India
| | - Ajay Duseja
- Department of Hepatology, PGIMER, Chandigarh, India
| | - Archana Angrup
- Department of Medical Microbiology, PGIMER, Chandigarh, India
| | - Rakesh Sehgal
- Department of Medical Parasitology, PGIMER, Chandigarh, India
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Kumar R, Patel R, Priyadarshi RN, Narayan R, Maji T, Anand U, Soni JR. Amebic liver abscess: An update. World J Hepatol 2024; 16:316-330. [PMID: 38577528 PMCID: PMC10989314 DOI: 10.4254/wjh.v16.i3.316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 01/23/2024] [Accepted: 02/21/2024] [Indexed: 03/27/2024] Open
Abstract
Amebic liver abscess (ALA) is still a common problem in the tropical world, where it affects over three-quarters of patients with liver abscess. It is caused by an anaerobic protozoan Entamoeba hystolytica, which primarily colonises the cecum. It is a non-suppurative infection of the liver consisting primarily of dead hepatocytes and cellular debris. People of the male gender, during their reproductive years, are most prone to ALA, and this appears to be due to a poorly mounted immune response linked to serum testosterone levels. ALA is more common in the right lobe of the liver, is strongly associated with alcohol consumption, and can heal without the need for drainage. While majority of ALA patients have an uncomplicated course, a number of complications have been described, including rupture into abdomino-thoracic structures, biliary fistula, vascular thrombosis, bilio-vascular compression, and secondary bacterial infection. Based on clinico-radiological findings, a classification system for ALA has emerged recently, which can assist clinicians in making treatment decisions. Recent research has revealed the role of venous thrombosis-related ischemia in the severity of ALA. Recent years have seen the development and refinement of newer molecular diagnostic techniques that can greatly aid in overcoming the diagnostic challenge in endemic area where serology-based tests have limited accuracy. Metronidazole has been the drug of choice for ALA patients for many years. However, concerns over the resistance and adverse effects necessitate the creation of new, safe, and potent antiamebic medications. Although the indication of the drainage of uncomplicated ALA has become more clear, high-quality randomised trials are still necessary for robust conclusions. Percutaneous drainage appears to be a viable option for patients with ruptured ALA and diffuse peritonitis, for whom surgery represents a significant risk of mortality. With regard to all of the aforementioned issues, this article intends to present an updated review of ALA.
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Affiliation(s)
- Ramesh Kumar
- Department of Gastroenterology, All India Institute of Medical Sciences, Patna 801507, India.
| | - Rishabh Patel
- Department of Gastroenterology, All India Institute of Medical Sciences, Patna 801507, India
| | | | - Ruchika Narayan
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Patna 801507, India
| | - Tanmoy Maji
- Department of Gastroenterology, All India Institute of Medical Sciences, Patna 801507, India
| | - Utpal Anand
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Patna 801507, India
| | - Jinit R Soni
- Department of Gastroenterology, All India Institute of Medical Sciences, Patna 801507, India
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3
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Gupta P, Singh KK, Balodhi A, Jain K, Deeba F, Salam N. Prevalence of Amoebiasis and Associated Complications in India: A Systematic Review. Acta Parasitol 2022; 67:947-961. [PMID: 35404011 DOI: 10.1007/s11686-022-00547-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 03/21/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Intestinal protozoan parasites are responsible for diarrheal diseases causing significant morbidity and mortality. Entamoeba histolytica is the principle protozoan parasite associated with diarrheal infections. The infection is often associated with inaccessibility to clean drinking water and poor sanitary conditions in low- and middle-income countries including India. A comprehensive systematic review was performed to evaluate a reliable nationwide estimate for prevalence and geographic distribution of amoebiasis in India and the complications associated with it. METHODS We used the PRISMA guidelines to perform a systematic review and meta-analysis of articles published between the year 2001-2020. Two English language databases PubMed and Web of Science were searched to achieve relevant studies. RESULTS Initial searches resulted in 467 studies out of which 64 eligible articles involving data from 289,659 human subjects from 12 states and 4 union territories were included in the final analysis. Prevalence of amoebiasis ranged from 3-23% in asymptomatic population, 0.64-11% in symptomatic patients and 1-17.5% in HIV-infected patients. Highest prevalence was seen in Tamil Nadu, Andaman Nicobar Island and North East India. Extra intestinal invasion of Entamoeba histolytica leading to complications such as amoebic liver abscess, amoebic colitis, colonic perforation and ameboma were also reported. Such complications have the potential to increase healthcare burden and may prove to be fatal. CONCLUSION Amoebiasis remains a significant public health issue in India responsible for diarrheal diseases causing significant morbidity and mortality. Entamoeba histolytica is the principle protozoan parasite associated with amoebiasis. Public health efforts should be directed towards its control and better diagnostic methods should be employed for distinguishing between pathogenic and non-pathogenic species of Entamoeba.
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Affiliation(s)
- Palak Gupta
- Department of Microbiology, Central University of Punjab, Bathinda, Punjab, 151401, India
| | - Kiran Kumari Singh
- Department of Geography, Central University of Punjab, Bathinda, Punjab, 151401, India
| | - Ashutosh Balodhi
- Department of Microbiology, Central University of Punjab, Bathinda, Punjab, 151401, India
| | - Khushi Jain
- Department of Microbiology, Central University of Punjab, Bathinda, Punjab, 151401, India
| | - Farah Deeba
- Centre for Interdisciplinary Research in Basic Sciences, Jamia Millia Islamia, New Delhi, 110025, India
| | - Nasir Salam
- Department of Microbiology, Central University of Punjab, Bathinda, Punjab, 151401, India.
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4
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Sardar SK, Das K, Maruf M, Haldar T, Saito-Nakano Y, Kobayashi S, Dutta S, Ganguly S. Molecular evidence suggests the occurrence of Entamoeba moshkovskii in pigs with zoonotic potential from eastern India. Folia Parasitol (Praha) 2022; 69. [DOI: 10.14411/fp.2022.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 01/06/2022] [Indexed: 11/19/2022]
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Tharmaratnam T, Kumanan T, Iskandar MA, D’Urzo K, Gopee-Ramanan P, Loganathan M, Tabobondung T, Tabobondung TA, Sivagurunathan S, Patel M, Tobbia I. Entamoeba histolytica and amoebic liver abscess in northern Sri Lanka: a public health problem. Trop Med Health 2020; 48:2. [PMID: 31992948 PMCID: PMC6977265 DOI: 10.1186/s41182-020-0193-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 01/16/2020] [Indexed: 12/25/2022] Open
Abstract
Entamoeba histolytica (E. histolytica) is a facultative protozoan parasite implicated in amoebic liver abscesses (ALA), the most common extraintestinal manifestation of this infection. E. histolytica is endemic to sub-tropical and tropical countries and has been a major public health concern in northern Sri Lanka (SLK) for the last three decades. This has been attributed to a multitude of factors such as poor sanitation, hygiene, male sex, middle age, overcrowding, unsanitary practices in the production of indigenous alcoholic beverages, and alcohol consumption. Additionally, while rates of E. histolytica have declined substantially throughout the rest of the island, largely due to better infrastructure, it remains pervasive in the northern peninsula, which is generally less developed. Infection arises primarily from fecal-oral transmission through the consumption of contaminated drinking water containing cysts. Upon ingestion, cysts multiply into trophozoites and colonize the host colonic mucosa using lectin and cysteine proteases as virulence factors, leading to host invasion. Symptoms occur along a spectrum, from asymptomatology, to pyrexia, abdominal cramping, and amoebic dysentery. Colonization of the colon results in the formation of distinct flask-shaped ulcers along the epithelium, and eventual penetration of the lamina propria via the production of matrix metalloproteinases. ALA then develops through trophozoite migration via the mesenteric hepatic portal circulation, where microabscesses coalesce to form a single, large right-lobe abscess, commonly on the posterior aspect. The progression of infection to invasive disease is contingent on the unique interplay between host and pathogen factors, such as the strength of host-immunity to overcome infection and inherent pathogenicity of the Entamoeba species. As a preventable illness, E. histolytica complications such as ALA impose a significant burden on the healthcare system. This mini-review highlights epidemiological trends, risk factors, diagnostic modalities, treatment approaches, and opportunities for prevention of E. histolytica-induced ALA, to help address this endemic problem on the island of SLK.
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Affiliation(s)
- Tharmegan Tharmaratnam
- School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- School of Medicine, Royal College of Surgeons in Ireland-Bahrain, Busaiteen, Bahrain
| | - Thirunavukarasu Kumanan
- Department of Internal Medicine, Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka
- Teaching Hospital Jaffna, Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka
| | - Mina Amin Iskandar
- School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- School of Medicine, Royal College of Surgeons in Ireland-Bahrain, Busaiteen, Bahrain
| | - Katrina D’Urzo
- School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Prasaanthan Gopee-Ramanan
- Department of Diagnostic Radiology, Hamilton Health Sciences Centre, Hamilton, ON Canada
- Department of Radiology, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON Canada
| | - Mayura Loganathan
- Academic Family Health Team, Mount Sinai Hospital, Faculty of Medicine, University of Toronto, Toronto, ON Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON Canada
| | - Tyler Tabobondung
- Department of Family Medicine, Brantford General Hospital, Hamilton, ON Canada
- Department of Family Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON Canada
| | | | - Seyon Sivagurunathan
- Department of Family Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON Canada
- Stonechurch Family Health Clinic, Department of Family Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON Canada
| | - Mitul Patel
- School of Medicine, Royal College of Surgeons in Ireland-Bahrain, Busaiteen, Bahrain
| | - Iqdam Tobbia
- School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- School of Medicine, Royal College of Surgeons in Ireland-Bahrain, Busaiteen, Bahrain
- Department of Pathology and Clinical Microbiology, School of Medicine, Royal College of Surgeons in Ireland-Bahrain, Busaiteen, Bahrain
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Carrero JC, Reyes-López M, Serrano-Luna J, Shibayama M, Unzueta J, León-Sicairos N, de la Garza M. Intestinal amoebiasis: 160 years of its first detection and still remains as a health problem in developing countries. Int J Med Microbiol 2019; 310:151358. [PMID: 31587966 DOI: 10.1016/j.ijmm.2019.151358] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 08/29/2019] [Accepted: 09/15/2019] [Indexed: 12/22/2022] Open
Abstract
Amoebiasis is a parasitic disease caused by Entamoeba histolytica (E. histolytica), an extracellular enteric protozoan. This infection mainly affects people from developing countries with limited hygiene conditions, where it is endemic. Infective cysts are transmitted by the fecal-oral route, excysting in the terminal ileum and producing invasive trophozoites (amoebae). E. histolytica mainly lives in the large intestine without causing symptoms; however, possibly as a result of so far unknown signals, the amoebae invade the mucosa and epithelium causing intestinal amoebiasis. E. histolytica possesses different mechanisms of pathogenicity for the adherence to the intestinal epithelium and for degrading extracellular matrix proteins, producing tissue lesions that progress to abscesses and a host acute inflammatory response. Much information has been obtained regarding the virulence factors, metabolism, mechanisms of pathogenicity, and the host immune response against this parasite; in addition, alternative treatments to metronidazole are continually emerging. An accesible and low-cost diagnostic method that can distinguish E. histolytica from the most nonpathogenic amoebae and an effective vaccine are necessary for protecting against amoebiasis. However, research about the disease and its prevention has been a challenge due to the relationship between E. histolytica and the host during the distinct stages of the disease is multifaceted. In this review, we analyze the interaction between the parasite, the human host, and the colon microbiota or pathogenic microorganisms, which together give rise to intestinal amoebiasis.
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Affiliation(s)
- Julio C Carrero
- Departamento de Inmunología, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, CdMx, Mexico
| | - Magda Reyes-López
- Departamento de Biología Celular, Centro de Investigación y de Estudios Avanzados del IPN, CdMx, Mexico
| | - Jesús Serrano-Luna
- Departamento de Biología Celular, Centro de Investigación y de Estudios Avanzados del IPN, CdMx, Mexico
| | - Mineko Shibayama
- Departamento de Infectómica y Patogénesis Molecular, Centro de Investigación y de Estudios Avanzados del IPN, CdMx, Mexico
| | - Juan Unzueta
- Departamento de Infectómica y Patogénesis Molecular, Centro de Investigación y de Estudios Avanzados del IPN, CdMx, Mexico
| | - Nidia León-Sicairos
- Departamento de Investigación, Hospital Pediátrico de Sinaloa México, Unidad de Investigación, CIASaP, Facultad de Medicina, Universidad Autónoma de Sinaloa, Culiacán, Sinaloa, Mexico
| | - Mireya de la Garza
- Departamento de Biología Celular, Centro de Investigación y de Estudios Avanzados del IPN, CdMx, Mexico.
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Saidin S, Othman N, Noordin R. Update on laboratory diagnosis of amoebiasis. Eur J Clin Microbiol Infect Dis 2018; 38:15-38. [DOI: 10.1007/s10096-018-3379-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 09/07/2018] [Indexed: 02/06/2023]
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Kumanan T, Sujanitha V, Balakumar S, Sreeharan N. Amoebic Liver Abscess and Indigenous Alcoholic Beverages in the Tropics. J Trop Med 2018; 2018:6901751. [PMID: 30112008 PMCID: PMC6077556 DOI: 10.1155/2018/6901751] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 06/25/2018] [Indexed: 11/17/2022] Open
Abstract
Amoebic liver abscess (ALA) seen commonly in the tropics is predominantly confined to adult males, especially those who consume locally brewed alcohol, although intestinal amoebiasis occurs in all age groups and in both genders. Whether the role of alcohol in the development of ALA is incidental and casual or whether alcohol is causally implicated has been debated. It has been argued that socioeconomic factors and poor sanitary conditions are the primary culprits that casually link alcohol to ALA. However, there has emerged an abundance of data that implicates alcohol in a more causal role in facilitating the extraintestinal invasion of the infective protozoan and the subsequent development of ALA. These factors include the role of alcohol in host immunity, parasitic proliferation, and invasion and in creating a conducive hepatic microenvironment. The contributory role of alcohol-induced increase in hepatic iron stores and lipid content is discussed. Late-stage liver disease with fibrosis seems to be protective for the development of ALA. Further research is necessary to elucidate the many possible mechanisms that predispose to hepatic amoebiasis, so that appropriate individual and population-based preventive measures can be implemented.
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Affiliation(s)
- T. Kumanan
- Department of Medicine, Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka
| | - V. Sujanitha
- Department of Medicine, Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka
| | - S. Balakumar
- Department of Biochemistry, Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka
| | - N. Sreeharan
- Department of Medicine, Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka
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9
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Selecting PCR for the Diagnosis of Intestinal Parasitosis: Choice of Targets, Evaluation of In-House Assays, and Comparison with Commercial Kits. J Parasitol Res 2017; 2017:6205257. [PMID: 29181192 PMCID: PMC5695021 DOI: 10.1155/2017/6205257] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 07/31/2017] [Indexed: 11/17/2022] Open
Abstract
Microscopy of stool samples is a labour-intensive and inaccurate technique for detection of intestinal parasites causing diarrhoea and replacement by PCR is attractive. Almost all cases of diarrhoea induced by parasites over a nine-year period in our laboratory were due to Giardia lamblia, Cryptosporidium species, or Entamoeba histolytica detected by microscopy. We evaluated and selected in-house singleplex real-time PCR (RT-PCR) assays for these pathogens in 99 stool samples from patients suspected of having intestinal parasitosis tested by microscopy. The strategy included a genus-specific PCR assay for C. parvum and C. hominis, with subsequent identification by a PCR that distinguishes between the two species. G. lamblia was detected in five and C. parvum in one out of 68 microscopy-negative samples. The performance of the in-house RT-PCR assays was compared to three commercially available multiplex test (MT-PCR) kit systems in 81 stool samples, collected in 28 microscopy-positive and 27 microscopy-negative samples from individuals suspected of intestinal parasitosis and in 26 samples from individuals without suspicion of parasitic infection. The in-house assays detected parasites in more samples from patients suspected of having parasitosis than did any of the kits. We conclude that commercial kits are targeting relevant parasites, but their performance may vary.
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10
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López-López P, Martínez-López MC, Boldo-León XM, Hernández-Díaz Y, González-Castro TB, Tovilla-Zárate CA, Luna-Arias JP. Detection and differentiation of Entamoeba histolytica and Entamoeba dispar in clinical samples through PCR-denaturing gradient gel electrophoresis. ACTA ACUST UNITED AC 2017; 50:e5997. [PMID: 28380216 PMCID: PMC5423754 DOI: 10.1590/1414-431x20175997] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 01/24/2017] [Indexed: 12/20/2022]
Abstract
Amebiasis is one of the twenty major causes of disease in Mexico; however, the diagnosis is difficult due to limitations of conventional microscopy-based techniques. In this study, we analyzed stool samples using polymerase chain reaction-denaturing gradient gel electrophoresis (PCR-DGGE) to differentiate between Entamoeba histolytica (pathogenic) and E. dispar (non-pathogenic). The target for the PCR amplification was a small region (228 bp) of the adh112 gene selected to increase the sensitivity of the test. The study involved 62 stool samples that were collected from individuals with complaints of gastrointestinal discomfort. Of the 62 samples, 10 (16.1%) were positive for E. histolytica while 52 (83.9%) were negative. No sample was positive for E. dispar. These results were validated by nested PCR-RFLP (restriction fragment length polymorphism) and suggest that PCR-DGGE is a promising tool to differentiate among Entamoeba infections, contributing to determine the specific treatment for patients infected with E. histolytica, and therefore, avoiding unnecessary treatment of patients infected with the non-pathogenic E. dispar.
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Affiliation(s)
- P López-López
- Family Medicine Unit 43, Social Security Mexican Institute, Cardenas, Tabasco, Mexico
| | - M C Martínez-López
- Health Sciences Academic Division, Juarez Autonomous University of Tabasco, Villahermosa, Tabasco, Mexico
| | - X M Boldo-León
- Health Sciences Academic Division, Juarez Autonomous University of Tabasco, Villahermosa, Tabasco, Mexico
| | - Y Hernández-Díaz
- Multidisciplinary Academic Division at Jalpa de Mendez, Juarez Autonomous University of Tabasco, Jalpa de Mendez, Tabasco, Mexico
| | - T B González-Castro
- Multidisciplinary Academic Division at Jalpa de Mendez, Juarez Autonomous University of Tabasco, Jalpa de Mendez, Tabasco, Mexico
| | - C A Tovilla-Zárate
- Multidisciplinary Academic Division at Comalcalco, Juarez Autonomous University of Tabasco, Comalcalco, Tabasco, Mexico
| | - J P Luna-Arias
- Center for Research and Advanced Studies, National Polytechnic Institute, Mexico City, Mexico
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11
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Al-Areeqi MA, Sady H, Al-Mekhlafi HM, Anuar TS, Al-Adhroey AH, Atroosh WM, Dawaki S, Elyana FN, Nasr NA, Ithoi I, Lau YL, Surin J. First molecular epidemiology of Entamoeba histolytica, E. dispar and E. moshkovskii infections in Yemen: different species-specific associated risk factors. Trop Med Int Health 2017; 22:493-504. [PMID: 28151567 DOI: 10.1111/tmi.12848] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To investigate the molecular epidemiology of Entamoeba histolytica, E. dispar and E. moshkovskii infections among rural communities in Yemen. METHODS In a community-based study, faecal samples were collected from 605 participants and examined by wet mount, formalin-ether sedimentation, trichrome staining and nested multiplex PCR techniques. Demographic, socio-economic and environmental information was collected using a pre-tested questionnaire. RESULTS Overall, 324 (53.6%) of the samples were positive for Entamoeba cysts and/or trophozoites by microscopic examination. Molecular analysis revealed that 20.2%, 15.7% and 18.2% of the samples were positive for E. histolytica, E. dispar and E. moshkovskii, respectively. Multivariate analysis showed different sets of species-specific risk factors among these communities. Educational level was identified as the significant risk factor for E. histolytica; age and gender were the significant risk factors for E. moshkovskii; and sources of drinking water and consumption of unwashed vegetables were the significant risk factors for E. dispar. Moreover, living in coastal/foothill areas and presence of other infected family members were risk factors for both E. histolytica and E. moshkovskii infections. CONCLUSION The study reveals that Entamoeba spp. infection is highly prevalent among rural communities in Yemen, with E. histolytica, E. dispar and E. moshkovskii differentiated for the first time. Identifying and treating infected family members, providing health education pertinent to good personal and food hygiene practices and providing clean drinking water should be considered in developing a strategy to control intestinal parasitic infections in these communities, particularly in the coastal/foothill areas of the country.
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Affiliation(s)
- Mona A Al-Areeqi
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Department of Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
| | - Hany Sady
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Department of Medical Laboratories, Faculty of Medical Sciences, Hodeidah University, Hodeidah, Yemen
| | - Hesham M Al-Mekhlafi
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Department of Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen.,Endemic and Tropical Diseases Unit, Medical Research Center, Jazan University, Jazan, Saudi Arabia
| | - Tengku Shahrul Anuar
- Integrative Pharmacogenomics Institute, Universiti Teknologi MARA, Puncak Alam Campus, Selangor, Malaysia.,Department of Medical Laboratory Technology, Faculty of Health Sciences, Universiti Teknologi MARA, Puncak Alam Campus, Selangor, Malaysia
| | - Abdulelah H Al-Adhroey
- Department of Community Medicine, Faculty of Medicine and Health Sciences, Thamar University, Dhamar, Yemen
| | - Wahib M Atroosh
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Salwa Dawaki
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Fatin Nur Elyana
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nabil A Nasr
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Init Ithoi
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yee-Ling Lau
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Johari Surin
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Centre for Research and Innovation, Taylor's University, Selangor, Malaysia
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12
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Hamad I, Raoult D, Bittar F. Repertory of eukaryotes (eukaryome) in the human gastrointestinal tract: taxonomy and detection methods. Parasite Immunol 2016; 38:12-36. [PMID: 26434599 DOI: 10.1111/pim.12284] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 09/23/2015] [Indexed: 12/22/2022]
Abstract
Eukaryotes are an important component of the human gut, and their relationship with the human host varies from parasitic to commensal. Understanding the diversity of human intestinal eukaryotes has important significance for human health. In the past few decades, most of the multitudes of techniques that are involved in the diagnosis of the eukaryotic population in the human intestinal tract were confined to pathological and parasitological aspects that mainly rely on traditionally based methods. However, development of culture-independent molecular techniques comprised of direct DNA extraction from faeces followed by sequencing, offer new opportunities to estimate the occurrence of eukaryotes in the human gut by providing data on the entire eukaryotic community, particularly not-yet-cultured or fastidious organisms. Further broad surveys of the eukaryotic communities in the gut based on high throughput tools such as next generation sequencing might lead to uncovering the real diversity of these ubiquitous organisms in the human intestinal tract and discovering the unrecognized roles of these eukaryotes in modulating the host immune system and inducing changes in host gut physiology and ecosystem.
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Affiliation(s)
- I Hamad
- URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, Aix Marseille Université, Marseille, France
| | - D Raoult
- URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, Aix Marseille Université, Marseille, France
| | - F Bittar
- URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, Aix Marseille Université, Marseille, France
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Molecular testing for clinical diagnosis and epidemiological investigations of intestinal parasitic infections. Clin Microbiol Rev 2016; 27:371-418. [PMID: 24696439 DOI: 10.1128/cmr.00122-13] [Citation(s) in RCA: 146] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Over the past few decades, nucleic acid-based methods have been developed for the diagnosis of intestinal parasitic infections. Advantages of nucleic acid-based methods are numerous; typically, these include increased sensitivity and specificity and simpler standardization of diagnostic procedures. DNA samples can also be stored and used for genetic characterization and molecular typing, providing a valuable tool for surveys and surveillance studies. A variety of technologies have been applied, and some specific and general pitfalls and limitations have been identified. This review provides an overview of the multitude of methods that have been reported for the detection of intestinal parasites and offers some guidance in applying these methods in the clinical laboratory and in epidemiological studies.
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Lachish T, Wieder-Finesod A, Schwartz E. Amebic Liver Abscess in Israeli Travelers: A Retrospective Study. Am J Trop Med Hyg 2016; 94:1015-9. [PMID: 26928829 DOI: 10.4269/ajtmh.15-0576] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 12/14/2015] [Indexed: 01/21/2023] Open
Abstract
Amebic liver abscess (ALA) is endemic in developing countries. The epidemiology and clinical characteristics of the disease in developing countries are well described. Travelers from nonendemic countries can serve as a model for the natural history of ALA. Currently, the available literature on travelers is limited. This is a retrospective observational study on Israeli travelers diagnosed with ALA. Data regarding travel history, clinical presentation, imaging, and treatment were collected and analyzed. Among 6,867 ill returning Israeli travelers, amebiasis was diagnosed in 53 travelers (0.77%), of whom 14 were with ALA (0.2%). Twelve ALA cases (86%) had an exposure in the Indian subcontinent. The male to female ratio was 1:1, with no significant clinical differences between the sexes. The average lag period between exposure and onset of symptoms was 17.1 months. The lack of male predominance and the prolonged lag period may imply that behavioral factors are pivotal in the development of ALA. Larger case series of travelers are required.
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Affiliation(s)
- Tamar Lachish
- Infectious Diseases Unit, Shaare-Zedek Medical Center, Jerusalem, Israel; Infectious Diseases Unit, Sheba Medical Center, Tel Hashomer, Israel; The Center for Geographic Medicine, The Chaim Sheba Medical Center, Tel Hashomer, Israel; The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Wieder-Finesod
- Infectious Diseases Unit, Shaare-Zedek Medical Center, Jerusalem, Israel; Infectious Diseases Unit, Sheba Medical Center, Tel Hashomer, Israel; The Center for Geographic Medicine, The Chaim Sheba Medical Center, Tel Hashomer, Israel; The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eli Schwartz
- Infectious Diseases Unit, Shaare-Zedek Medical Center, Jerusalem, Israel; Infectious Diseases Unit, Sheba Medical Center, Tel Hashomer, Israel; The Center for Geographic Medicine, The Chaim Sheba Medical Center, Tel Hashomer, Israel; The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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López MC, León CM, Fonseca J, Reyes P, Moncada L, Olivera MJ, Ramírez JD. Molecular Epidemiology of Entamoeba: First Description of Entamoeba moshkovskii in a Rural Area from Central Colombia. PLoS One 2015; 10:e0140302. [PMID: 26465744 PMCID: PMC4605823 DOI: 10.1371/journal.pone.0140302] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 09/23/2015] [Indexed: 12/02/2022] Open
Abstract
Background Entamoeba histolytica, E. dispar and E. moshkovskii are the most frequent species described in human infection where E. histolytica is the only true pathogen. The epidemiology of this infection is complex due to the absence of a routine exam that allows a correct discrimination of the Entamoeba species complex. Therefore, molecular methods appear as the unique epidemiological tool to accomplish the species discrimination. Herein, we conducted a cross-sectional study to determine the frequency of Entamoeba species infections in a group of asymptomatic individuals from a rural area in central Colombia. Methodology/Principal Findings A total of 181 fecal samples from asymptomatic children under 16 years old from the hamlet La Vírgen, Cundinamarca (Colombia) that voluntarily accepted to participate in the study were collected. The fecal samples were examined by light microscopy and DNA-extracted, subsequently submitted to molecular discrimination of E. dispar/E. histolytica/E. moshkovskii infection based on a multiplex PCR assay targeting the 18S rRNA fragment. To confirm the species description, twenty samples were randomly submitted to DNA sequencing of the aforementioned fragment. By direct microscopic examination, frequency of the complex E. histolytica/E. dispar/E. moshkovskii was 18.8% (34/181). PCR showed a frequency of 49.1% (89/181), discriminated as 23.2% (42/181) that were positive for E. dispar, 25.4% (46/181) for E. moshkovskii and 0.55% (1/ 181) for E. histolytica. Also, mixed infections were detected between E. dispar and E. moshkovskii at 4.42% (8/181) of the samples. Molecular barcoding confirmed the diagnosis depicted by the multiplex PCR assay. Conclusions/Significance This is the first description of E. moshkovskii in Colombia and the second report in South-America to our knowledge. Our results suggest the need to unravel the true epidemiology of Entamoeba infections around the world, including the real pathogenic role that E. moshkovskii may have.
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Affiliation(s)
- Myriam Consuelo López
- Departamento de Salud Pública, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Cielo M. León
- Grupo de Investigaciones Microbiológicas–UR (GIMUR), Facultad de Ciencias Naturales y Matemáticas, Universidad del Rosario, Bogotá, Colombia
| | - Jairo Fonseca
- Departamento de Salud Pública, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Patricia Reyes
- Departamento de Salud Pública, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Ligia Moncada
- Departamento de Salud Pública, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Mario J. Olivera
- Grupo de Investigaciones Microbiológicas–UR (GIMUR), Facultad de Ciencias Naturales y Matemáticas, Universidad del Rosario, Bogotá, Colombia
| | - Juan David Ramírez
- Grupo de Investigaciones Microbiológicas–UR (GIMUR), Facultad de Ciencias Naturales y Matemáticas, Universidad del Rosario, Bogotá, Colombia
- * E-mail:
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Mohanty S, Sharma N, Deb M. Microscopy versus enzyme linked immunosorbent assay test for detection of Entamoeba histolytica infection in stool samples. Trop Parasitol 2014; 4:136-8. [PMID: 25250240 PMCID: PMC4166803 DOI: 10.4103/2229-5070.138547] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 08/12/2014] [Indexed: 11/28/2022] Open
Affiliation(s)
- Srujana Mohanty
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India ; Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India E-mail:
| | - Nisha Sharma
- Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India E-mail:
| | - Monorama Deb
- Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India E-mail:
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Systematic detection and association of Entamoeba species in stool samples from selected sites in India. Epidemiol Infect 2014; 143:108-19. [PMID: 24703238 DOI: 10.1017/s0950268814000715] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
This study developed a fast and high throughput dot-blot technique to evaluate the presence of Entamoeba in stool samples (n = 643) followed by a PCR-based method to validate and differentiate the two species E. histolytica and E. dispar. The prevalence rate of the parasite has been detected in a cross-sectional study carried out in the population of the Eastern and Northern parts of India. Of the various demographic features, prevalence was highest in the monsoon season (P = 0·017), in the <15 years age group (P = 0·015). In HIV-positive individuals, the prevalence rate was significantly high (P = 0·008) in patients with a CD4 cell count <200 as well as in patients without antiretroviral therapy (ART) (P = 0·011). Our analysis further confirmed that risk factors such as toilet facilities, living conditions, hygienic practices, drinking water source, occupation and level of education are important predictors as they were found to contribute significantly in the prevalence of the parasite.
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Hartmeyer GN, Høgh SV, Chen M, Holt H, Skov MN, Kemp M. Need for species-specific detection for the diagnosis of amoebiasis in a non-endemic setting. ACTA ACUST UNITED AC 2013; 45:868-71. [DOI: 10.3109/00365548.2013.816440] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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LUMINEX®: a new technology for the simultaneous identification of five Entamoeba spp. commonly found in human stools. Parasit Vectors 2013; 6:69. [PMID: 23497666 PMCID: PMC3622617 DOI: 10.1186/1756-3305-6-69] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 02/21/2013] [Indexed: 11/24/2022] Open
Abstract
Background Six species of the genus Entamoeba, i.e., E. histolytica, E. dispar, E. moshkovskii, E. polecki, E. coli, and E. hartmanii can be found in human stools. Among these, only E. histolytica is considered to be pathogenic, causing intestinal and extra-intestinal disease, but it is morphologically identical to E. dispar and E. moshkovskii. In general, E. polecki, E. coli, and E. hartmanii can be differentiated morphologically from E. histolytica, but some of their diagnostic morphologic features may overlap creating issues for the differential diagnosis. Moreover, the previous inability to differentiate among Entamoeba species has limited epidemiologic information on E histolytica. The objective of this study was to develop a rapid, high-throughput screening method using Luminex technique for the simultaneous detection and differentiation of Entamoeba species. Methods PCR amplification was performed with biotinylated Entamoeba sp 18S rRNA gene primers, designed to amplify a fragment ranging from 382 to 429 bp of the Entamoeba spp studied. Regions of this fragment that could differentiate among E. histolytica, E. moshkovskii, E. dispar, E. hartmanii and E. coli were selected to design hybridization probes to link to Luminex beads. The assay was standardized with cloned DNA samples of each species and evaluated with 24 DNA extracts from samples obtained from individuals diagnosed with these amebas in their stools. Results Using this approach we were able to correctly identify E. histoltyica, E. dispar, E hartmanni, E. coli and E. moshkovskii in all specimens studied. From twenty four samples tested by microscopy, PCR/DNA Sequencing and real-time PCR, 100% agreed with PCR-Luminex assay for identification of E. dispar, E. moshkovskii, E. hartmanni, E. histolytica, and E. coli. Conclusion These results show that this method could be used in the diagnostic detection of Entamoeba spp in fecal samples. This diagnostic test was useful to clearly distinguish E histolytica from other species and also to strengthen epidemiologic data on Entamoeba spp.
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Molecular epidemiology of amoebiasis in Malaysia: highlighting the different risk factors of Entamoeba histolytica and Entamoeba dispar infections among Orang Asli communities. Int J Parasitol 2012; 42:1165-75. [PMID: 23123168 DOI: 10.1016/j.ijpara.2012.10.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 10/04/2012] [Accepted: 10/05/2012] [Indexed: 11/23/2022]
Abstract
Currently, species-specific information on Entamoeba infections is unavailable in Malaysia and is restricted worldwide due to the re-description of pathogenic Entamoeba histolytica and non-pathogenic Entamoeba dispar and Entamoeba moshkovskii. Therefore, this cross-sectional study was conducted to provide the first known documented data on the true prevalence of these three species in western Malaysia using a molecular method. Another aim of this study was to determine the association of potential risk factors associated with each Entamoeba sp. A total of 500 stool samples from three Orang Asli tribes were randomly collected. The overall prevalence of E. histolytica, E. dispar and E. moshkovskii determined by microscopy was 18.6% (93/500). Molecular analysis revealed that while most Entamoeba-positive individuals were infected with E. dispar (13.4%), followed by E. histolytica (3.2%) and E. moshkovskii (1.0%), the present findings show low prevalence rates of mixed infections with E. histolytica and E. dispar (2%), E. dispar and E. moshkovskii (1.2%) and association infections of E. histolytica, E. dispar and E. moshkovskii (0.4%). Logistical regression analysis indicates that the dynamics of the transmission of the three Entamoeba spp. was different. Of six statistically significant variables observed in the univariate analysis, three were retained as significant risk factors for E. histolytica infection in the logistical regression model. These factors were (i) not washing hands after playing with soil or gardening (Odds ratio (OR)=4.7; 95% confidence level (CI)=1.38, 16.14; P=0.013), (ii) indiscriminate defecation in the river or bush (OR=5.7; 95% CI=1.46, 21.95; P=0.012) and (iii) close contact with domestic animals (OR=5.4; 95% CI=1.36, 2.51; P=0.017). However, subjects with family members who were infected with E. histolytica/E. dispar/E. moshkovskii (OR=3.8; 95 CI=2.11, 6.86; P<0.001) and those who consumed raw vegetables (OR=1.8; 95% CI=1.01, 3.23; P=0.047) were more likely to be infected with E. dispar. On the other hand, no associated factor was identified with E. moshkovskii infection. Nevertheless, diarrhoea (P=0.002) and other gastroenteritis symptoms (P<0.001) were only associated with E. histolytica infection. The present study provides new insight into the distribution and risk factors of E. histolytica, E. dispar and E. moshkovskii infections among Orang Asli communities in Malaysia. Identifying the different risk factors of E. histolytica and E. dispar infections will help in the planning specific strategies in the control and prevention of each infection in the communities. Moreover, it emphasises the need for molecular methods to determine the species-specific prevalence of Entamoeba spp.
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Heredia RD, Fonseca JA, López MC. Entamoeba moshkovskii perspectives of a new agent to be considered in the diagnosis of amebiasis. Acta Trop 2012; 123:139-45. [PMID: 22664420 DOI: 10.1016/j.actatropica.2012.05.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Revised: 05/25/2012] [Accepted: 05/26/2012] [Indexed: 10/28/2022]
Abstract
During the last decade Entamoeba moshkovskii has become relevant given its capacity to infect humans, especially when considering that it is morphologically indistinguishable from E. histolytica. For a long time, E. moshkovskii was considered as a free living amoeba, but in the last decade it has been demonstrated that E. moshkovskii can infect humans and can be found more frequently in regions where amebiasis shows high prevalence values, becoming a challenge to differentiate it from the E. histolytica/E. dispar complex. Recently there have been studies that raise the possibility that E. moshkovskii could be a pathogenic species, as there are reports in different countries that associated this infection with gastrointestinal symptoms even though others have described it as a non pathogenic species. For this reasons, both clinical and epidemiological studies are required.
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Shimokawa C, Kabir M, Taniuchi M, Mondal D, Kobayashi S, Ali IKM, Sobuz SU, Senba M, Houpt E, Haque R, Petri WA, Hamano S. Entamoeba moshkovskii is associated with diarrhea in infants and causes diarrhea and colitis in mice. J Infect Dis 2012; 206:744-51. [PMID: 22723640 DOI: 10.1093/infdis/jis414] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Entamoeba moshkovskii is prevalent in developing countries and morphologically indistinguishable from pathogenic Entamoeba histolytica and nonpathogenic Entamoeba dispar. It is not known if E. moshkovskii is pathogenic. METHODS Mice were intracecally challenged with the trophozoites of each Entamoeba spp. to test the ability to cause diarrhea, and infants in Bangladesh were prospectively observed to see if newly acquired E. moshkovskii infection was associated with diarrhea. RESULTS E. moshkovskii and E. histolytica caused diarrhea and weight loss in susceptible mice. E. dispar infected none of the mouse strains tested. In Mirpur, Dhaka, Bangladesh, E. moshkovskii, E. histolytica, and E. dispar were identified in 42 (2.95%), 66 (4.63%), and 5 (0.35%), respectively, of 1426 diarrheal episodes in 385 children followed prospectively from birth to one year of age. Diarrhea occurred temporally with acquisition of a new E. moshkovskii infection: in the 2 months preceding E. moshkvskii-associated diarrhea, 86% (36 of 42) of monthly surveillance stool samples were negative for E. moshkovskii. CONCLUSIONS E. moshkovskii was found to be pathogenic in mice. In children, the acquisition of E. moshkovskii infection was associated with diarrhea. These data are consistent with E. moshkovskii causing disease, indicating that it is important to reexamine its pathogenicity.
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Affiliation(s)
- Chikako Shimokawa
- Department of Parasitology, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
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Sard BG, Navarro RT, Esteban Sanchis JG. [Non-pathogenic intestinal amoebae: a clinical-analytical overview]. Enferm Infecc Microbiol Clin 2011; 29 Suppl 3:20-8. [PMID: 21458707 DOI: 10.1016/s0213-005x(11)70023-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Human beings can be parasitized by various species of intestinal amoebae. Entamoeba histolytica is the only intestinal amoeba recognized to be pathogenic, while other amoeba species, E. dispar, E. moshkovskii, E. hartmanni, E. coli, E. polecki, Endolimax nana and Iodamoeba buetschlii are considered to be non-pathogenic. The aim of this review is to synthesize the main morphological characteristics of the trophozoite and cyst stages of each amoeba as the basis for precise microscopical diagnosis. The difficulty of morphological differentiation among species included in the so-called "Entamoeba complex" entails the use of immunological and molecular diagnoses. In addition, a summary of basic epidemiological, therapeutic and prophylactic aspects of these non-pathogenic amoebae is provided. All of these aspects are crucial since these amoebae are usually found to be present in human coproparasitological analyses and must be differentiated from the pathogenic species E. histolytica. Furthermore, they can be used as suitable biological tags of the hygienic state of the environment and the health and hygiene measures of the population.
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Identification and delineation of members of the Entamoeba complex by pyrosequencing. Mol Cell Probes 2010; 24:403-6. [DOI: 10.1016/j.mcp.2010.07.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 06/22/2010] [Accepted: 07/22/2010] [Indexed: 11/19/2022]
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Hosoe N, Kobayashi T, Kanai T, Bessho R, Takayama T, Inoue N, Imaeda H, Iwao Y, Kobayashi S, Mukai M, Ogata H, Hibi T. In vivo visualization of trophozoites in patients with amoebic colitis by using a newly developed endocytoscope. Gastrointest Endosc 2010; 72:643-6. [PMID: 20579647 DOI: 10.1016/j.gie.2010.04.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Accepted: 04/19/2010] [Indexed: 12/15/2022]
Abstract
BACKGROUND The endocytoscopy system (ECS) is a new method to provide real-time super-magnifying microscopic imaging in vivo. Routine diagnosis of amebic colitis requires multiple tests that are both time consuming and costly. OBJECTIVE To determine the feasibility of ECS to directly detect the amebic parasites in vivo. DESIGN Prospective, single-center, pilot study. SETTING Tertiary-care university hospital. PATIENTS This study involved 5 patients who were suspected to have amebic colitis by conventional colonoscopy in our institute. INTERVENTIONS A super-magnifying ECS with 450 x magnification. MAIN OUTCOME MEASUREMENTS We compared ECS findings with those of conventional methods-serum antibody tests and histology of colon biopsy specimens. RESULTS We successfully visualized the amebic trophozoites in all 5 cases. In contrast, 3 specimens had positive results on serology, and 3 had positive histology results on hematoxylin and eosin staining. LIMITATIONS Pilot study with a limited number of patients. Findings were compared only with serology and histology findings. CONCLUSIONS ECS would be a useful tool for the prompt diagnosis of amebic colitis via the real-time in vivo visualization of amebic trophozoites.
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Affiliation(s)
- Naoki Hosoe
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Keio University, Shinjuku, Tokyo, Japan
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Entamoeba histolytica and E. dispar infections in captive macaques (Macaca fascicularis) in the Philippines. Primates 2009; 51:69-74. [PMID: 19862480 DOI: 10.1007/s10329-009-0174-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2009] [Accepted: 10/05/2009] [Indexed: 10/20/2022]
Abstract
Entamoeba histolytica is a protozoan parasite that infects man and animals. This parasite has a global distribution and the disease it causes is usually characterized by diarrhea. In order to detect the parasite, it is necessary to differentiate it from Entamoeba dispar. E. dispar appears morphologically similar to E. histolytica but does not cause disease and tissue invasion. This study reports on the prevalence of E. histolytica and E. dispar among captive macaques in a primate facility in the Philippines. PCR was used to correctly identify both Entamoeba species. Indirect fluorescent antibody test (IFAT) was also performed to determine the seroprevalence of amebiasis in the captive macaques. Based on PCR targeting of the peroxiredoxin gene, of the 96 stool samples collected, 23 (24%) contained E. histolytica while 32 (33%) contained E. dispar. IFAT revealed 26 (27%) serum samples positive for antibodies against E. histolytica. Sequence analysis of the 18S rRNA gene showed that the 23 E. histolytica isolates were identical to human E. histolytica isolates deposited in the GenBank and not Entamoeba nuttalli as found in macaques in other recent reports. The Philippines is a major exporter of monkeys for biomedical research purposes, so screening animals before transporting them to other locations lessens the risk of spreading zoonoses to a wider area. This is the first report of the molecular detection of E. histolytica and E. dispar among macaques in the Philippines. This study complements the limited information available on the animal hosts of E. histolytica in the Philippines.
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Ximénez C, Morán P, Rojas L, Valadez A, Gómez A. Reassessment of the epidemiology of amebiasis: state of the art. INFECTION GENETICS AND EVOLUTION 2009; 9:1023-32. [PMID: 19540361 DOI: 10.1016/j.meegid.2009.06.008] [Citation(s) in RCA: 133] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2009] [Revised: 05/25/2009] [Accepted: 06/08/2009] [Indexed: 10/20/2022]
Abstract
The epidemiology of amebiasis has dramatically changed since the separation of Entamoeba histolytica and Entamoeba dispar species, and the worldwide prevalence of these species has not been estimated until recently. The most cited data regarding prevalence, morbidity, or mortality due to amebiasis is the 1986 Walsh report, in which 100,000 deaths are reported to occur worldwide each year due to medical complications of invasive amebiasis. However, the prevalence values of Entamoeba histolytica infection could be completely erroneous since the estimations were performed prior to the molecular characterization of E. histolytica and E. dispar species. Moreover, Entamoeba moshkovskii, another morphologically indistinguishable human parasitic Entamoeba, was not mentioned or considered as a contributor to the prevalence figures in endemic areas. However, recent available prevalence and morbidity data obtained through molecular techniques allow the construction of a more reliable map of endemic regions of amebiasis all over the world [the Asian subcontinent (India, Bangladesh), Africa, Asian Pacific Countries (Thailand, Japan), South and Central America (Mexico, Colombia)]. The epidemiology of infectious diseases focuses on identification of factors that determine disease distribution in time and space, transmission factors responsible for the disease, clinical manifestations, and progression in the host, with the goal being the design of realistic intervention and prevention strategies in a reasonable period of time. In the present review, we will describe how molecular tools have made actual knowledge regarding the epidemiology of amebiasis possible. We will also analyze the most relevant available data on prevalence, morbidity, geographic distribution, patterns of transmission, exposure, and risk factors for infection in the human host. Our intention is to emphasize the recent molecular typing methods applied in genotyping Entamoeba species and strains, and to assess their value and limitations. Finally, we will discuss those areas of the host-parasite relationship that are still not fully understood, and the scientific challenges to approach this important public health problem in the future.
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Affiliation(s)
- Cecilia Ximénez
- Departamento de Medicina Experimental, Facultad de Medicina, Universidad Nacional Autónoma de México, México DF, Mexico.
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Utzinger J, Botero-Kleiven S, Castelli F, Chiodini PL, Edwards H, Köhler N, Gulletta M, Lebbad M, Manser M, Matthys B, N'Goran EK, Tannich E, Vounatsou P, Marti H. Microscopic diagnosis of sodium acetate-acetic acid-formalin-fixed stool samples for helminths and intestinal protozoa: a comparison among European reference laboratories. Clin Microbiol Infect 2009; 16:267-73. [PMID: 19456836 DOI: 10.1111/j.1469-0691.2009.02782.x] [Citation(s) in RCA: 105] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The present study aimed to compare the diagnostic performance of different European reference laboratories in diagnosing helminths and intestinal protozoa, using an ether-concentration method applied to sodium acetate-acetic acid-formalin (SAF)-preserved faecal samples. In total, 102 stool specimens were analysed during a cross-sectional parasitological survey in urban farming communities in Côte d'Ivoire. Five SAF-preserved faecal samples were prepared from each specimen and forwarded to the participating reference laboratories, processed and examined under a microscope adhering to a standard operating procedure (SOP). Schistosoma mansoni (cumulative prevalence: 51.0%) and hookworm (cumulative prevalence: 39.2%) were the predominant helminths. There was excellent agreement (kappa > 0.8; p < 0.001) among the reference laboratories for the diagnosis of S. mansoni, hookworm, Trichuris trichiura and Ascaris lumbricoides. Moderate agreement (kappa = 0.54) was found for Hymenolepis nana, and lesser agreement was observed for other, less prevalent helminths. The predominant intestinal protozoa were Entamoeba coli (median prevalence: 67.6%), Blastocystis hominis (median prevalence: 55.9%) and Entamoeba histolytica/Entamoeba dispar (median prevalence: 47.1%). Substantial agreement among reference laboratories was found for E. coli (kappa = 0.69), but only fair or moderate agreement was found for other Entamoeba species, Giardia intestinalis and Chilomastix mesnili. There was only poor agreement for B. hominis, Isospora belli and Trichomonas intestinalis. In conclusion, although common helminths were reliably diagnosed by European reference laboratories, there was only moderate agreement between centres for pathogenic intestinal protozoa. Continued external quality assessment and the establishment of a formal network of reference laboratories is necessary to further enhance both accuracy and uniformity in parasite diagnosis.
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Affiliation(s)
- J Utzinger
- Department of Public Health and Epidemiology, Swiss Tropical Institute, Basel, Switzerland.
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Ali IKM, Clark CG, Petri WA. Molecular epidemiology of amebiasis. INFECTION GENETICS AND EVOLUTION 2008; 8:698-707. [PMID: 18571478 DOI: 10.1016/j.meegid.2008.05.004] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2008] [Revised: 04/18/2008] [Accepted: 05/01/2008] [Indexed: 12/13/2022]
Abstract
Entamoeba histolytica, the causative agent of human amebiasis, remains a significant cause of morbidity and mortality in developing countries and is responsible for up to 100,000 deaths worldwide each year. Entamoeba dispar, morphologically indistinguishable from E. histolytica, is more common in humans in many parts of the world. Similarly Entamoeba moshkovskii, which was long considered to be a free-living ameba, is also morphologically identical to E. histolytica and E. dispar, and is highly prevalent in some E. histolytica endemic countries. However, the only species to cause disease in humans is E. histolytica. Most old epidemiological data on E. histolytica are unusable as the techniques employed do not differentiate between the above three Entamoeba species. Molecular tools are now available not only to diagnose these species accurately but also to study intra-species genetic diversity. Recent studies suggest that only a minority of all E. histolytica infections progress to the development of clinical symptoms in the host and there exist population level differences between the E. histolytica strains isolated from the asymptomatic and symptomatic individuals. Nevertheless the underlying factors responsible for variable clinical outcome of infection by E. histolytica remain largely unknown. We anticipate that the recently completed E. histolytica genome sequence and new molecular techniques will rapidly advance our understanding of the epidemiology and pathogenicity of amebiasis.
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Affiliation(s)
- Ibne Karim M Ali
- Division of Infectious Diseases and International Health, University of Virginia Health System, MR4 Building Room 2115, Lane Road, Charlottesville, VA 22908, USA.
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