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PubMed2005

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↗
PubMed1998

Epithelial cell-initiated inflammation plays a crucial role in early tissue damage in amebic infection of human intestine.

BACKGROUND & AIMS: Entamoeba histolytica infection of the intestine can induce severe gut inflammation. The aims of this study were to assess the role of the host inflammatory response in the tissue damage observed with amebiasis and the role of the intestinal epithelial cell in initiating that response. METHODS: E. histolytica infection was established in human intestinal xenografts in severe combined immunodeficient (SCID-HU-INT) mice. Human intestinal epithelial cell inflammatory responses to amebic infection were inhibited by the intraluminal administration of an antisense oligonucleotide to the human p65 subunit of nuclear factor kappaB, and the role of neutrophils in tissue damage observed with amebiasis was studied by depleting neutrophils from SCID-HU-INT mice. RESULTS: Administration of the antisense oligonucleotide blocked the production of human interleukin 1beta and interleukin 8 by intestinal epithelial cells and inhibited neutrophil influx into the E. histolytica-infected intestinal xenografts. Inhibition of the gut inflammatory response by the antisense oligonucleotide or the depletion of neutrophils from SCID-HU-INT mice blocked the increase in intestinal permeability observed with amebic infection. CONCLUSIONS: Intestinal epithelial cells initiate an inflammatory response with resulting neutrophil-mediated tissue damage in response to E. histolytica infection; this inflammatory cascade can be blocked by inhibiting the transcription of genes regulated by nuclear factor kappaB.

Amebiasis↗
PubMed1989

[Invasive amebiasis as a public health problem].

Amebiasis, an infection of humans with the protozoan Entamoeba histolytica, has a wide distribution in Mexico. The lumenal, asymptomatic infection, as measured by the presence of cysts in stools has been recorded from 2.4% at Ometepec, Guerrero to over 55% at Mixquic, D.F., but only a small percentage of those having intestinal infection will develop invasive amebiasis, the main clinical forms being dysentery and liver abscess. In Mexico City, from 0.8 up to 14% of cases of acute diarrhoea in children requiring hospitalization were found to be associated with E. histolytica. Serological surveys for antibodies, suggest that approximately 5.98% of people had intestinal mucosal or liver invasion, but amebic dysentery may be five to 50 times more frequent than liver abscess, namely in children. Amebiasis may cause death when it manifests itself as fulminating colitis or liver abscess. Lethality in adults has been estimated to be around 0.2 to 2%, but in children with liver abscess it may be 1.1 to 26%. In addition to being a potentially lethal disease, it has important socioeconomic consequences, because incapacitating infections are rather frequent in wage-earning adult males requiring several weeks of hospitalization and from two to three months for full recovery. In Mexico, amebiasis has been more closely associated with poverty and low levels of sanitation than to climate, and in view of the high rates of morbidity and mortality caused by E. histolytica, more research into better and cheaper methods of diagnosis, treatment and prevention is clearly necessary plus a substantial improvement in control strategies.

Adolescent↗
PubMedDate not supplied

Illnesses in travelers returning from the tropics: a prospective study of 622 patients.

BACKGROUND: Although between 8 and 19% of travelers consult a doctor after returning from the tropics, the full spectrum of health complaints is unknown. METHODS: We analyzed the relative frequency of travel-associated health complaints in all travelers (immigrants returning from visiting their home countries, expatriates, business travelers, and tourists) consulting our department between November 2002 and May 2003. RESULTS: A total of 622 patients were studied (256 women, 366 men; median age 38 yr; 45.3% tourists, 33.8% immigrants, 14.1% expatriates, 6.7% business travelers). The median duration of travel was 36.9 days. The main destinations were Africa (57.6%) and Asia (26.4%). A total of 637 diseases were diagnosed, distributed as follows: skin diseases (23.4%), gastrointestinal infections (19.1%), respiratory tract infections (11.5%), malaria (8.8%), schistosomiasis (7.2%), viral hepatitis (4.1%), urinary tract infections (3.5%), sexually transmitted infections (3.5%), tuberculosis (2.7%), dengue fever (2.5%), and others (13.8%). Malaria and intestinal tract infections accounted for 21% and 23% of diagnoses in the 257 febrile travelers, respectively. Overall, 230 diagnoses (36.1%) corresponded to imported tropical diseases, the main imported diseases being malaria, schistosomiasis, amebiasis, gastrointestinal disorders caused by intestinal nematodes, and dengue fever. CONCLUSIONS: Tropical diseases are not the leading cause of consultation in travelers returning from the tropics. Immigrants are the travelers most at risk of common tropical diseases, with the noteworthy exceptions of dengue fever and invasive schistosomiasis.

Adolescent↗
PubMed1983

[Comparative results of coprological tests for the detection of intestinal amebae and flagellates in 200 male homosexuals. An appraisal of the risk of amebiasis].

When comparing the results of coprological tests carried out in optimal conditions among 200 male homosexuals (MHS) (1) and 500 male heterosexuals, most of whom were suffering from intestinal disorders, it was found that 52% of MHS and only 3.6% of heterosexuals were Ent. histolytica carriers. The 14 to 1 ratio shows the "uncorrected" relative risk of amoebiasis among MHS, which becomes a 10-12 to 1 corrected relative risk, after taking into account intervening factors. Travelling to the tropics does not increase the incidence of amoebiasis among examined MHS. The occurrence rates of Ent. coli, End. nana, Giardia are higher among MHS, and the rates of two species which are usually rare, Pseudolimax (or Iodamoeba) and Enteromonas (flagellate of the colon), rise sharply in this group, although the occurrence rates of the other protozoa stay at the same level in both groups. Presently, we are unable to explain fully these different behaviors. The highly increased presence of intestinal protozoa and the unusual prevalence of some species among the MHS condition numerous and diversified parasitic associations. Some associations found only among MHS indicate oro-faecal contamination which is the only way for direct transmission of protozoa between individuals.

Adult↗