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PubMed1994

Parasitic gastroenteritis.

Parasitic causes of diarrhea are common in pediatric patients and have important public health implications. Therefore, diagnosis should be pursued vigorously in the appropriate clinical setting. Giardia and Cryptosporidium infections are the most common causes of disease in the United States, and stool examination for ova and parasites is the best way to make the diagnosis. This should be performed three times, on alternate days, in order to rule out parasitic disease with confidence. In treatment of Giardia, it is important to interrupt transmission, particularly in the day-care setting. Because of the potential for major outbreaks, patients with cryptosporidiosis should be kept out of day care until their symptoms resolve. Although amebiasis is not a common problem in the United States, all patients with bloody diarrhea who have traveled to, or are from, endemic areas should be tested for amebiasis by serology and stool examination. If patients with suspected inflammatory bowel disease are being considered for therapy with corticosteroids, mucosal scrapings of colonic lesions should be examined for amoebae, because corticosteroid therapy can lead to more invasive amoebic disease. Acquired immunodeficiency syndrome patients with diarrhea can be infected with a number of pathogens and a specific diagnosis should be pursued aggressively. These patients are often infected with one or more of the parasites described in this article. The approach to diarrhea in these children is described in a separate article of this issue (Deveikis A. 'Gastrointestinal Disease in Immunocompromised Children," pages 562-569).

Amebiasis↗
PubMed1982

Seroepidemiology of amoebiasis in the villagers in Phichit Province and urban slum dwellers in Bangkok, Thailand.

A serological survey was conducted in the villages of Phichit Province, Northern region and in the urban slum communities in Bangkok to determine whether amoebiasis was endemic in the areas and to determine the prevalence rates. Six rural villages, ethnically and culturally alike with a population of 3,019 and two urban slums with a population of 1,510 were surveyed. Sera were tested for indirect hemagglutination antibody (IHA) to Entamoeba histolytica and the stools examined for the parasite by direct smear method. Positive IHA titres (greater than or equal to 1:128) were detected in 482 (11%) and 176 (20%) sera, and E. histolytica found in 639 (2%) and 208 (3%) stool specimens of rural and urban slum populations respectively. Out of a total of 88 persons who showed significant levels of IHA antibodies to E. histolytica antigen, 5 had E. histolytica cysts in their stool specimens. The survey confirmed, serologically and parasitologically, that amoebiasis is endemic in the lower socio-economic areas. Substandard living and sanitary conditions within the areas were considered responsible for the transmission of the disease.

Adolescent↗
PubMed1982

[Useful and superfluous measures in the treatment of infant diarrhea].

In acute diarrhea of infancy we distinguish between infectious and noninfectious causes. In the latter we know some autosomal recessive disorders, e.g. the glucose-galactose-malabsorption, the lactase deficiency as well as the sucrase-isomaltase deficiency. In addition the most frequent acquired disorders like the cow's milk protein intolerance and celiac disease contribute also to the group of noninfectious causes of diarrhea. Here the most effective therapy consists of the elimination of the toxic agent from the diet. In infectious diarrhea we find most frequently rotavirus as the agent but also yersinia, campylobacter fetus, salmonella, shigella, E. coli, lamblia giardia and entameba hystolytica. Generally a conservative treatment with a dietetic regimen is preferred. Only in severe cases with yersinia and campylobacter infection the addition of antibiotic drugs is necessary. Giardia lamblia and amebiasis however have to be treated with metronidazol. As the absorption of glucose is coupled with that of sodium within the small intestine in acute gastroenteritis we find a combined disturbance between salt and carbohydrate absorption. A solution containing glucose and salt is recommended therefore for oral rehydration. The amount administered within the first 24 hours should be between 150-250 ml/kg per day. So called "antidiarrhoic drugs" are questionably effective.

Bacterial Infections↗
PubMed2001

Microbes and microbial toxins: paradigms for microbial-mucosal interactions. VI. Entamoeba histolytica: parasite-host interactions.

The protozoan intestinal parasite Entamoeba histolytica remains a significant cause of morbidity and mortality worldwide. E. histolytica causes two major clinical syndromes, amebic colitis and amebic liver abscess. Recent advances in the development of in vitro and in vivo models of disease, new genetic approaches, the identification of key E. histolytica virulence factors, and the recognition of crucial elements of the host response to infection have led to significant insights into the pathogenesis of amebic infection. E. histolytica virulence factors include 1) a surface galactose binding lectin that mediates E. histolytica binding to host cells and may contribute to amebic resistance to complement, 2) amebapores, small peptides capable of lysing cells, which may play a role in killing intestinal epithelial cells, hepatocytes, and host defense cells, and 3) a family of secreted cysteine proteinases that play a key role in E. histolytica tissue invasion, evasion of host defenses, and parasite induction of gut inflammation. Amebae can both lyse host cells and induce their suicide through programmed cell death. The host response is also an important factor in the outcome of infection, and neutrophils may play a key role in contributing to the tissue damage seen in amebiasis and in controlling amebic infection.

Animals↗
PubMed2005

Vaccine prospects for amebiasis.

Entamoeba histolytica is a eukaryotic protozoan parasite and is the causative agent of amebic colitis and amebic liver abscess. Many insights into the innate and acquired immune responses to infection with E. histolytica have been made in recent years. These findings have provided a foundation for producing a vaccine that could help to prevent the initial establishment of infection in the intestinal wall. The galactose and N-acetyl-D-galactosamine-specific lectin on the surface of the ameba is an immunodominant molecule that is highly conserved and has an integral role in the stimulation of these immune responses. The structure of the lectin has been defined, and the heavy subunit with its cysteine-rich region has been demonstrated in animal models to have some efficacy as a possible vaccine agent for prevention of amebic infection. Finding an ideal animal model of amebic intestinal infection has been difficult, but the C3H mouse and severe combined immunodeficient mouse-human intestinal xenograft models have both provided valuable insights into the first line of immune defense at the mucosal wall of the colon. Providing safe food and water to all people in the developing world is a formidable task that is not achievable in the foreseeable future. However, a vaccine for amebiasis could make a significant impact on the morbidity and mortality from the disease. Many components of the ameba are immunogenic and may serve as targets for a future vaccine, including the galactose and N-acetyl-D-galactosamine lectin, the serine-rich E. histolytica protein, cysteine proteinases, lipophosphoglycans, amebapores and the 29-kDa protein.

Amebiasis↗
PubMed2001

Amebiasis and mucosal IgA antibody against the Entamoeba histolytica adherence lectin in Bangladeshi children.

Amebiasis is the third leading parasitic cause of death worldwide, and it is not known whether immunity is acquired from a previous infection. An investigation was done to determine whether protection from intestinal infection correlated with mucosal or systemic antibody responses to the Entamoeba histolytica GalNAc adherence lectin. E. histolytica colonization was present in 0% (0/64) of children with and 13.4% (33/246) of children without stool IgA anti-GalNAc lectin antibodies (P= .001). Children with stool IgA lectin-specific antibodies at the beginning of the study had 64% fewer new E. histolytica infections by 5 months (3/42 IgA(+) vs. 47/227 IgA(-); P= .03). A stool antilectin IgA response was detected near the time of resolution of infection in 67% (12/18) of closely monitored new infections. It was concluded that a mucosal IgA antilectin antibody response is associated with immune protection against E. histolytica colonization. The demonstration of naturally acquired immunity offers hope for a vaccine to prevent amebiasis.

Animals↗
PubMed1989

Entamoeba histolytica and other parasitic infections in south Kanara district, Karnataka.

Single stool specimens collected from 1,020 apparently healthy people of the South Kanara District, were processed for intestinal parasites using three parasitological methods viz. (a) Direct smear in physiological saline and D'Antoni's iodine, (b) Zinc sulfate concentration method and (c) by culture in modified Boek and Drbolhav medium. Of these 781 (76.51 per cent) were found to be infected with parasites. The prevalence of various intestinal parasites was: Ascaris lumbricoides (48.33 per cent), Necator americanus (46.86 per cent), Trichuris trichiura (42.75 per cent), Entamoeba coli (23.24 per cent), Entamoeba histolytica (7.94 per cent), Enterobius vermicularis (2.84 per cent), Giardia intestinalis (2.45 per cent), Iodamoeba buitschlii (1.57 per cent), Entamoeba hartmanni (1.37 per cent), Trichomonas hominis (0.88 per cent), Strongyloides stercoralis (0.68 per cent), Hymenolepis nana (0.49 per cent), Chilomastis mesnili (0.10 per cent) and Endolimax nana (0.10 per cent). High incidence of parasitic infections was recorded in females and age group of 6-14 years.

Adolescent↗