[Intestinal parasitosis (amebiasis excepted) in the Provencal].
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Disease↗
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Results for “AMEBIASIS, INTESTINAL”
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Paromomycin therapy of endemic amebiasis in homosexual men.
A prospective evaluation was made of the therapeutic efficacy of paromomycin, an orally administered, nonabsorbable aminoglycoside, in 114 homosexual men with mild-to-moderate (nondysenteric) intestinal amebiasis. All patients received 25-35 mg/kg daily in three divided doses for seven days. Of the 80 patients with gastrointestinal complaints at the onset of therapy, 55 (80%) of 69 were asymptomatic within four to six weeks after completion of treatment; 11 patients were lost to follow-up. Paromomycin produced long-term eradication of intestinal Entameba histolytica infection in 92% of all men evaluated. The rate of microbiologic cure among patients with symptoms at the onset of therapy was comparable to that among asymptomatic individuals. Paromomycin was well tolerated, with mild diarrhea during therapy the only frequent adverse effect (67% of patients). Thus, paromomycin is an effective alternative to conventional multi-drug therapy for intestinal amebiasis, and it has the advantages of low toxicity, brief duration of therapy, and a high rate of patient compliance.
Adult↗
Atypical clinical manifestations of amebic colitis.
Amebic colitis is a disease revealing diverse clinical manifestations and endoscopic gross features and often confused with other types of colitis. In case of misdiagnosis as an idiopathic inflammatory bowel disease or delayed recognition of intestinal amebiasis, an undesirable outcome may occur resulting from erroneous administration of steroids or delayed antiamebic treatment. To demonstrate the pitfalls in the diagnosis and treatment of intestinal amebiasis, 3 cases of amebic colitis with atypical clinical manifestations are presented in this paper. In conclusion, despite the low sensitivities of routine stool examination for parasite and histopathologic confirmation in biopsy specimen, every effort must be made to find amebic trophozoites either in fresh stool or biopsy specimens for prompt and correct diagnosis of amebic colitis when we manage patients with chronic intestinal ulcerations, even though their clinical course and endoscopic findings are not typical of amebiasis. Moreover, following initial successful anti-amebic therapy, more careful clinical, endoscopical, and parasitological follow-up should be done for the early detection of recurrence.
Adult↗
Development of a diagnostic test for Entamoeba histolytica using idiotype expression in human.
The protozoan parasite Entamoeba histolytica is the etiological agent of human amebiasis. The pathology of the disease starts with the cytolysis of the host target cells by amoebae. It is initiated by the adhesion of trophozoites to the host cells, through surface lectin via specific receptors. These adherence lectins have been demonstrated to be highly conserved, and can be recognised by serum antibodies from patients with invasive amebiasis. Some of these molecules have been used as antigens in serologic studies, which has been very helpful in the diagnosis of invasive intestinal amebiasis. However, false-positive serologic reactivity can occur using E. histolytica extracts and purified antigens. Additional problems are because the extracts display a great enzymatic activity. Several diagnostic methods, using different molecules and techniques, have been described. However, the problem still remains since these tests are not capable of differentiating between amoebic liver abscess (ALA) and intestinal amebiasis.Here, the research has been addressed to the 66-kDa antigen, which is a part of the outer membrane proteins from the E. histolytica strain HM1-IMSS trophozoites. First of all, we characterized the 66-kDa antigen in order to prove the relevance. We found that the 66-kDa antigen is a part of the plasma membranes and is distributed rather homogeneously on the cell surface of trophozoites. Apparently, the 66-kDa antigen is a glycoprotein. Using a monoclonal antibody (MAb), we found 25% of inhibition in the erythrophagocytosis by the trophozoites. Starting form one monoclonal antibody, we prepared an anti-idiotype (anti-Id) antibody reagent, with the purpose of searching for the different expressions of the idiotype between the sera from ALA and the intestinal amebiasis patients. Moreover, we produced the antibody Ab3 that is capable of recognising the 66-kDa antigen; it means that the Ab2 displays the internal image of the antigen. We found that 91.6% of the serum from ALA patients displayed the expression of the Id. In contrast, 15.7% of the E. histolytica asymtomatic cyst carriers displayed the Id expression, 6.6% of the patients with another parasite infection, and 11% of the negative controls (serum from umbilical cords of newborn babies). Our results showed that the expression of the Id could be differentiated among the AHA patients from the other groups with a 91.6% sensibility and 88.3% specificity.
Animals↗
IgA reactivity in patients with intestinal or hepatic amebiasis.
The antigens of E. histolytica recognized by IgA antibodies in sera from patients with either amebic liver abscess or intestinal amebiasis, as well as saliva from the latter, were determined in immunoblots of whole native trophozoite proteins. Results show that sera of patients with amebic liver abscess reacted mainly with amebic proteins of more than 200 kDa, whereas those of individuals with intestinal amebiasis recognized a protein of 145 kDa. The saliva of the latter detected a protein of 210 kDa which is not always seen when using the sera of patients with intestinal or hepatic amebiasis.
Animals↗
[Amebiasis and intestinal inflammatory disease].
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Adult↗
Risk factors associated with fulminant amebic colitis.
Amebic colitis is associated with serious complications and a high fatality rate if it progresses to its fulminant form. The purpose of this retrospective study was to determine the risk factors associated with fulminant amebic colitis. From February 1978 to February 1993, 60 adults were diagnosed with intestinal amebiasis at Chang Gung Memorial Hospital. Sixteen patients with massive bloody diarrhea, persistent systemic toxicity or signs of peritonitis were classified as having fulminant colitis, five of whom progressed to fulminant colitis after admission to the hospital. Forty-four patients with good responses to amebicides and without complications were classified as having moderate colitis. There was no amebiasis-related mortality among patients with moderate colitis. In contrast, five patients with fulminant colitis died. Early diagnosis and surgical treatment significantly decreased mortality when compared with conservative treatment. Significant factors associated with the development of fulminant intestinal amebiasis in univariate analyses were being male, age over 60 years, having an associated liver abscess, progressive abdominal pain, signs of peritonitis, leukocytosis, hyponatremia, hypokalemia and hypoalbuminemia. Only the factors of being over 60 years of age and hypokalemia were important in multivariate analyses. We conclude that early and extensive surgical treatment is mandatory for patients with typical presentations of fulminant amebic colitis on admission to the hospital, such as progression to peritonitis, persistent systemic toxemia and explosive bloody diarrhea. For other patients, especially the elderly and those with low serum potassium levels, close monitoring and observation for signs of fulminant colitis is important.
Adult↗
[Hemorrhagic rectocolitis or ulcerative colitis in the black Senegalese. Apropos of 14 cases].
Ulcerative colitis is exceptional in Africa South of the Sahara. The first case was described in 1964: up to 1982, 46 cases were reported. We report on 14 cases (6 females and 8 males) observed in black Senegalese for three years and a half. The medium age of patients was 30 years. All of them had a high social standard of living. Four patients showed intestinal amebiasis in their previous medical history. Clinical and evolutive patterns of ulcerative colitis in Africa present few differences in comparison with the classical ones. The diagnosis is established by endoscopy (rectosigmoidoscopy and/or colonoscopy) and histopathology. Cryptic abscesses were found in only 2 out of 14 cases. Rectal dysplasia was noted in 2 cases. The course of the disease developed on a fulminating acute mode in one case, on a continuous chronic mode in another case and on a chronic mode with relapses in 11 cases. Irrespective to the clinical form observed, intestinal amebiasis represents the most pressing differential diagnosis. Treatment appears to be difficult in severe acute forms out of an intensive care department, as well as in advanced extensive chronic forms. For the later in black Africa endoscopic and histopathological surveillance appears to be preferable to a total colectomy, made necessary by the important rectal lesions, because the functional sequelae of an ileostomy.
Adrenal Cortex Hormones↗
[Validation in Havana City, Cuba of ENZYMEBA, an immunoassay for detecting Entamoeba histolytica in feces].
Parasitologists from different medical institutions in Havana City carried out the external validation of ENZYMEBA, a diagnostic procedure of intestinal amebiasis developed at the "Pedro Kourí" Institute of Tropical Medicine. To this end, serial faeces specimens from 212 individuals were collected and observed on the microscope (reference test). The ENZYMEBA immunoassay (validation test) was also made. On comparing ENZYMEBA with the microscopic examination, satisfactory indexes of sensitivity and specificity were found. No cross-reactions were detected in faeces specimens, where found other parasites were present, too. Taking into account that only one faeces specimen per patient is enough for the diagnosis of intestinal amebiasis with ENZYMEBA, this procedure may be useful in studies of therapeutical efficacy and prevalence.
Animals↗
Intragastric immunization of rats with Entamoeba histolytica trophozoites induces cecal mucosal IgE, eosinophilic infiltration, and type I hypersensitivity.
We have investigated the role of IgE in the local immunity of intestinal amebiasis, a parasitic infection known to induce specific antibody-forming cells (AFC) and IgA antibodies in rodents and humans. We found that intragastric immunization of rats with glutaraldehyde-fixed Entamoeba histolytica trophozoites significantly increased antiameba AFC in the Peyer's patches and spleen and that the lamina propria of the cecum from immunized animals was infiltrated by eosinophils armed with IgE antibodies. Morphometric analysis showed that IgE-containing cells and eosinophils were nearly three times more abundant in the cecum of immunized rats. Antigenic challenge with amebal lysates provoked an increase in the short-circuit current and in the transepithelial potential difference in Ussing-chambered cecum preparations from immunized rats. Although eosinophilia and the increase of IgE are common consequences of infection by parasitic worms, our results indicate that local immunity in intestinal amebiasis also involves IgE deposition, eosinophil infiltration, and type I hypersensitivity, which may explain some symptoms of amebic dysentery such as colic, abdominal tension, tenesmus, and bloody stools.
Amebiasis↗
[Antiamebic effect of metronidazole proved in a study conducted in Cienfuegos province].
Three studies were conducted in Cienfuegos province to prove that intestinal amebiasis in Cuba could be an overestimated health problem. The first two studies showed two components of this overestimation: microscopical overdiagnosis and lack of knowledge about Entamoeba dispar, a non-pathogenic species, in most cases in which microscopical examination was correct. This paper reported the third study that showed the third component: the wrong belief that Entamoeba histolytica is resistant to metronidazole. Thirty-five individuals infected with one or both species of E-histolytica-E. dispar combination were given metronidazole at a dose of 250 mg three times daily for 10 days. Stool samples taken immediately after the treatment were tested by ENZYMEBA to detect one or both species and by a multiplex polymerase chain reaction procedure to determine the existing species. The results of these assays revealed that E. histolytica infection disappeared in all the cases, therefore, we may conclude that in Cienfuegos province and probably in the rest of the country, metronidazol remains an effective drug in the treatment of intestinal amebiasis
Antiprotozoal Agents↗
Entamoeba histolytica: the serine-rich gene polymorphism-based genetic variability of clinical isolates from Georgia.
It is generally accepted that a majority of individuals infected by Entamoeba histolytica do not develop symptomatic disease. However, the parasite and the host factors contributing to the development of the disease, remain undetermined. It is also unclear why certain individuals develop extra-intestinal amebiasis without exhibiting apparent intestinal symptoms. An outbreak of amebic liver abscess in Tbilisi, Georgia in 1998-1999 suggested that the causative E. histolytica strain had an unusual propensity for extra-intestinal spread. To correlate the genetic differences with pathogenic potential of the parasite, we have examined the SREHP gene polymorphisms among Georgian E. histolytica isolates. Comparison of polymorphic patterns revealed the presence of several different genotypes of E. histolytica, thus preventing an association of a single genotype with hepatic disease, but supporting the previous finding of extensive genetic diversity among E. histolytica isolates from the same geographic origin.
Animals↗
[The organization of dispensary observation for persons with a history of infectious diseases in Afghanistan].
Outpatient control over the patients who went through infectious diseases in Afghanistan is determined by a structure of the dominant nosological forms of infectious diseases: typhoid, paratyphoid, intestinal amebiasis and other acute intestinal infections, viral hepatitis, malaria. A considerable number of servicemen who went through infectious diseases had led to a re-enforcement of "infections service" inside the organic structure of the 40th Army, as well as to elaboration of a rational system of outpatient control, including regular medical examinations by organic physicians, and infectionists, laboratory, functional and instrumental methods of examination by organic medical units and specialized health care establishments and sanitary-epidemiological units.
Afghanistan↗
Entamoeba histolytica encephalitis diagnosed by PCR of cerebrospinal fluid.
Extra-intestinal amebiasis is secondary to invasive intestinal infections and usually results in an amebic liver abscess. Other organs, including lungs, brain, skin, spleen and kidneys, may be involved. Diagnosis of the cerebral infection is of the utmost importance and is most often made by detection of the organism at the time of brain biopsy or at autopsy. We report the first case of Entamoeba histolytica encephalitis diagnosed by PCR of the cerebrospinal fluid. The patient was treated successfully with metronidazole. PCR is an increasingly useful tool for the diagnosis of central nervous system infection and can provide rapid diagnosis.
Adult↗
[Clinical and therapeutic study of a group of 217 patients with intestinal giardiasis and amebiasis].
In 15 months of the years 1979-1980, 158 patients with giardiasis and 69 patients with intestinal amebiasis were diagnosed and treated in the outpatient department of the Swiss Tropical Institute. Repeated examination of merthiolate-iodine-formol-fixed stools was the method of choice for detecting intestinal protozoa. Parasitological investigation of duodenal fluid (Enterotest) was less effective. Fewer than 30% of the cases were symptomatic, usually mentioning diarrhea (73-85%) or abdominal discomfort (20-44%). Treatment was by ornidazole single dose (2 g in adults; 40 mg/kg in children) for asymptomatic cases and a five-day treatment schedule (2 X 500 mg/day in adults, 20 mg/day in children) for symptomatic cases. In amebiasis a luminal amebicide (diloxanide furoate) was prescribed in all instances after the first stool examination. Parasitological cure rates were excellent (95%) in all cases of giardiasis but only 59 and 65% respectively in cases of asymptomatic and symptomatic amebiasis. Drug tolerance was excellent. Ornidazole is the drug of choice for all forms of giardiasis, even in a single dose. As a luminal amebicide, however, its efficacy is not superior to other nitroimidazole derivatives.
Drug Administration Schedule↗
Detection of Entamoeba histolytica antigens in stool in amebiasis.
BACKGROUND: Stool microscopy, the conventional method of diagnosing intestinal amebiasis, fails to detect Entamoeba histolytica in more than 30-40% of clinically suspected cases. Demonstration of parasite products in clinical specimens has been suggested as an alternative. However, the usefulness of demonstrating amebic antigen in the stools of clinical cases needs to be assessed. METHODS: A double-antibody sandwich enzyme linked immunosorbent assay (ELISA) using anti-trophozoite antibodies to capture E histolytica specific coproantigen(s) was carried out on stools obtained from 31 patients with microscopically confirmed non-dysenteric amebic colitis, 18 patients with intestinal parasites other than E histolytica and 41 apparently healthy subjects. RESULTS: The assay detected E histolytica specific coproantigen(s) in stools of 23 (74.2%) of 31 subjects with non-dysenteric amebic colitis, none of 18 with other parasitic infections and 1 (2.4%) of 41 apparently healthy subjects. CONCLUSION: Our results provide evidence for the presence of E histolytica specific coproantigen(s) in stool eluates from patients with amebic infection; this finding can be exploited for confirming ongoing amebic infection. However, the sensitivity of the assay needs to be improved by the use of relevant monospecific/monoclonal antibodies.
Animals↗
[Colonic amebiasis due to venereal transmission. Apropos of 2 cases].
Intestinal amebiasis is an ubiquitous disease which is hyperendemic among high promiscuity homosexual males living under temperate climates. Sexual behaviour, especially oroanal contacts which are common in this population, as well as the multiplicity and sometimes anonymity of partners are responsible for this high prevalence. Individual prophylaxis involves local hygiene before intercourse and a decrease in the number of sexual contacts with different partners. Community prophylaxis is essential and consists in information of general practitioners and "gays" about the different means of transmission of amebiasis, its clinical manifestations and the necessity of routine parasitological stool examinations at regular intervals. We report on two cases and discuss these various considerations in the light of data from the literature.
Adult↗
[Extra-intestinal manifestations of amebiasis].
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Amebiasis↗