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[Comparative study on serological diagnosis of entamoebiasis histolytica].

The practicability of four diagnostic methods for entamoebiasis histolytica including micro-gel diffusion precipitin test (MGDP), indirect immunofluorescent antibody test (IFA), indirect hemagglutination test (IHA) and enzyme-linked immunosorbent assay (ELISA) was evaluated. The serological test methods were compared by using sera obtained from 30 entamoebiasis histolytica patients and 130 normal health individuals. The highest sensitivity was obtained with the method of ELISA, followed by IFA and IHA : the lowest was obtained with MGDP. On the contrary, the high specificity was obtained with IHA, IFA, MGDP : the lowest was obtained with ELISA. Intensity of the antibody titers in IHA was correlated well with that of IFA. In addition, we studied antibodies nonspecifically reactive to Entamoeba histolytica in sera from E. histolytica-negative individuals with high CRP patients with regard to the sensitivity and specificity. Among 101 sera examined, six showed false positive results of which five were the sera with extremely high CRP.

Animals↗

[Anal symptoms of gastro-intestinal diseases].

In most cases the ano-cutaneous clinical symptoms correlated to diseases of the gastro-intestinal tract are not specific (erythema, itching, wounds or scarring). However in the following diseases occasional dermatological lesions may directly contribute to their diagnosis: in Crohn's disease, tuberculosis of bowel, chronic entamoebiasis and bilharziosis, the skin lesions of the anal area have the same histological structure as the gut lesions. Perianal fistulas and ulcers are frequent in Crohn's disease especially if there is a colonic and rectal spreading; they respond badly to steroid therapy and are often correlated with a worse prognosis. Perianal specific lesions occur often in oxyuriasis in children, in candidiasis of the digestive tract, in systemic aphthosis and in some malignancies. In other gastro-intestinal disturbances, the dermatological and features are less specific and can only be suggestive: iatrogenic and microbial diarrheas, side-effects of laxatives, proctological diseases. It has to be emphasized that pruritus ani is only induced by deeper lesions when they spread to the perianal skin. In proctological practice, contact dermatitis by sensitivity to anaesthetics or suppository balsams (Peruvian balsam), itching or burning atrophy by topical steroid abuse, non-diagnosed fungal (candidiasis), bacterial (erythrasma) or psoriatic intertrigos (flexural psoriasis) may sometimes explain the failure of therapy.

Adult↗

Invasive amebiasis as an emerging parasitic disease in patients with human immunodeficiency virus type 1 infection in Taiwan.

BACKGROUND: Whether risk of invasive amebiasis due to Entamoeba histolytica is higher among human immunodeficiency virus (HIV)-infected persons than uninfected persons remains unclear, although intestinal colonization by Entamoeba dispar is common among men who have sex with men. Our objective was to determine the prevalence of invasive amebiasis and intestinal colonization by E histolytica and E dispar in HIV-infected persons and uninfected controls. METHODS: We assessed the prevalence of invasive amebiasis by case review of 951 HIV-infected persons and by serologic studies of 634 of the 951 HIV-infected persons, 429 uninfected controls with gastrointestinal symptoms, and 178 uninfected healthy controls using indirect hemagglutination antibody assay. We assessed the rate of intestinal colonization by E histolytica and E dispar by fecal antigen and polymerase chain reaction tests in 332 asymptomatic HIV-infected persons and 144 of the 178 uninfected healthy controls. RESULTS: Forty-nine (5.2%) of 951 HIV-infected persons had 51 episodes of invasive amebiasis. A high indirect hemagglutination antibody titer was detected in 39 (6.2%) of 634 HIV-infected persons compared with 10 (2.3%) of 429 uninfected controls with gastrointestinal symptoms and 0 of 178 uninfected healthy controls (P<.001). Stool specimens from 40 (12.1%) of 332 HIV-infected persons and 2 (1.4%) of 144 uninfected healthy controls were positive for E histolytica or E dispar antigen (P<.001). Ten (25.0%) of the 40 antigen-positive stool specimens from HIV-infected persons contained E histolytica. CONCLUSION: Persons infected with HIV in Taiwan are at increased risk for invasive amebiasis and exhibit a relatively high frequency of elevated antibody titers and intestinal colonization with E histolytica.

AIDS-Related Opportunistic Infections↗

Spectrum of amebiasis in children.

In 11 patients with childhood amebiasis, only two had dysentery. Additional clinical findings included hematochezia without diarrhea (four patients), dysentery with appendicitis (one patient), exacerbation of ulcerative colitis (two patients), and disseminated infantile amebiasis (two patients). All patients with hematochezia examined by proctosigmoidoscopy had colitis. The diagnosis of amebiasis was confirmed by microscopic examination of fresh stool specimens, pathologic findings, and/or serologic titers. Amebiasis should be considered in the differential diagnosis of infants and children with hematochezia or hepatomegaly, especially in endemic areas.

Adolescent↗

Amebic peritonitis following rupture of an amebic liver abscess. Successful treatment of two patients.

We present two successfully treated cases of amebic peritonitis. Acute peritonitis secondary to intra-abdominal rupture of an amebic liver abscess is an infrequent but serious complication of invasive amebiasis. Its diagnosis should be considered in anyone with a suspected liver abscess, jaundice, or diarrhea in whom peritonitis develops. This diagnosis should be further suggested in the United States if the patient is a male and is of Mexican origin in areas where this racial group constitutes the majority of cases of amebic disease. Use of radioisotope liver scans and the demonstration of serum precipitins to Endamoeba histolytica may provide rapid evidence of invasive disease, although surgical intervention is often necessary to make a specific diagnosis. Emetine hydrochloride alone or followed by metronidazole combined with surgical drainage is the current treatment for amebic peritonitis.

Adult↗

Amebiasis. An increasing problem among homosexuals in New York City.

During a five-year period at The New York Hospital, Entamoeba histolytica was identified in the stools of 20 men who had not traveled outside the New York area. All of the patients were found subsequently to homosexual. During this same period amebiasis was diagnosed in 30 men who had traveled; only two were homosexual. Of ten patients with E histolytica infection seen during the first year of this study, none were homosexual whereas eight of 11 patients in the fifth year were homosexual, suggesting a gradual increase during this period of this disease in the homosexual community.

Adult↗

Inhibition of enteric parasites by emulsified oil of oregano in vivo.

Oil of Mediterranean oregano Oreganum vulgare was orally administered to 14 adult patients whose stools tested positive for enteric parasites, Blastocystis hominis, Entamoeba hartmanni and Endolimax nana. After 6 weeks of supplementation with 600 mg emulsified oil of oregano daily, there was complete disappearance of Entamoeba hartmanni (four cases), Endolimax nana (one case), and Blastocystis hominis in eight cases. Also, Blastocystis hominis scores declined in three additional cases. Gastrointestinal symptoms improved in seven of the 11 patients who had tested positive for Blastocystis hominis.

Adult↗

Effects of parasitic infections in pregnant women.

This review focuses on the parasitic diseases which occur frequently in the tropics and which affect pregnant women. Clinical disease of the mother during pregnancy, vertical transmission of parasites and transplacental passage of soluble parasitic antigens are discussed in relation to their immunopathological significance for the fetus. The incidences of congenital malaria, African trypanosomiasis and Chagas' disease are reviewed, together with vertical transmission of filarial infection, involvement of the female genital tract in schistosomiasis, and fulminant colitis due to Entamoeba histolytica infection during pregnancy.

Animals↗

Interactions between Entamoeba histolytica, bacteria and intestinal cells.

Axenically grown pathogenic and non-pathogenic isolates of Entamoeba histolytica have been shown to adhere to mammalian epithelial cells and bacteria by virtue of carbohydrate-binding proteins present on their cell surfaces. The interaction of amoeba isolates of low pathogenicity with a variety of gram-negative bacteria, mainly Escherichia coli strains which are readily ingested by the amoebae after relatively short periods, significantly increased the ability of the trophozoites to: (a) destroy and ingest intestinal epithelial cells; (b) secrete a cytopathic substance which morphologically affects a variety of tissue-cultured cells; and (c) cause hepatic abscesses in hamsters. Addition of carbohydrates that inhibit the lectin-mediated attachment of bacteria to amoebae prevented the enhancement of virulence. Interaction of the amoebae with bacteria that were heat-inactivated, glutaraldehyde-fixed or disrupted by sonication, as well as with bacteria precoated with antibodies or concanavalin A, did not lead to an increase in virulence. Moreover, short prior treatments of the bacteria with inhibitors of protein synthesis, but not with cell-wall synthesis inhibitors, also prevented the stimulation. The results indicate that interactions of amoebae with certain bacteria may be responsible for the increase in amoebic virulence.

Adhesiveness↗

Encystation of entamoeba parasites.

Entamoeba histolytica is a protozoan parasite of humans, and the causitive agent of intestinal amebiasis. The disease-causing stage of the parasite is an osmotically sensitive ameboid form, which differentiates into a thick-walled cyst for transmission from person to person. The conditions within the human intestine that induce encystment of the amoeba are unknown, but studies using an amoebic parasite of reptiles are now yielding information about the molecules and host:parasite interactions involved in the process. An understanding of the amoeba's obligatory encystment pathway should provide an approach for interrupting the transmission of this parasite, for which there is currently no vaccine.

Amebicides↗

Diagnosis of Meleney's synergistic gangrene.

A retrospective and comparative study of 127 case reports of Meleney's postoperative progressive synergistic gangrene and of 62 examples of postoperative amoebic skin gangrene, showed that these two entities were clinically indistinguishable and that therefore a purely clinical diagnosis of Meleney's gangrene could not be made. Furthermore, a critical appraisal of the bacteriological data indicated that a certain diagnosis of Meleney's gangrene cannot be provided by the clinical bacteriologist. Finally, the histological features were entirely non-specific thus precluding a definitive diagnosis by the histopathologist. If Meleney's entity cannot be diagnosed its existence becomes debatable. The alternative diagnosis of cutaneous amoebiasis is advanced for consideration. Several of the outstanding features of Meleney's progressive gangrene, hitherto unexplained, are better understood if Entamoeba histolytica is accepted as the prime cause rather than bacteria.

Entamoebiasis↗

Rho signaling in Entamoeba histolytica modulates actomyosin-dependent activities stimulated during invasive behavior.

Interaction of Entamoeba histolytica trophozoites with target cells and substrates activates signaling pathways in the parasite. Phosphorylation cascades triggered by phospho-inositide and adenyl-cyclase-dependent pathways modulate reorganization of the actin cytoskeleton to form structures that facilitate adhesion. In contrast, little is known about participation of Rho proteins and Rho signaling in actin rearrangements. We report here the in vivo expression of at least one Rho protein in trophozoites, whose activation induced actin reorganization and actin-myosin interaction. Antibodies to EhRhoA1 recombinant protein mainly localized Rho in the cytosol of nonactivated amoebae, but it was translocated to vesicular membranes and to some extent to the plasma membrane after treatment with lysophosphatidic acid (LPA), a specific agonist of Rho activation. Activated Rho was identified in LPA-treated trophozoites. LPA induced striking polymerization of actin into distinct dynamic structures. Disorganization of these structures by inhibition of Rho effector, Rho-kinase (ROCK), and by ML-7, an inhibitor of myosin light chain kinase dependent phosphorylation of myosin light chain, suggested that the actin structures also contained myosin. LPA stimulated concanavalin-A-mediated formation of caps, chemotaxis, invasion of extracellular matrix substrates, and erythrophagocytosis, but not binding to fibronectin. ROCK inhibition impaired LPA-stimulated functions and to some extent adhesion to fibronectin. Similar results were obtained with ML-7. These data suggest the presence and operation of Rho-signaling pathways in E. histolytica, that together with other, already described, signaling routes modulate actomyosin-dependent motile processes, particularly stimulated during invasive behavior.

Actomyosin↗