Renal amoebic abscess detected on grey-scale ultrasonography. A case report

Ultrasound scanning performed on a patient to exclude a liver abscess was negative, but demonstrated a fluid-filled lesion situated at the lower pole of the right kidney. This was confirmed on excretory urography and angiography, and aspiration produced typical amoebic pus. THe evidence for this diagnosis and the probably route of infection are discussed. The literature on renal amoebiasis is reviewed.

Enteric diseases

This paper focuses on the growing incidence of the "new" sexually transmitted parasitic enteric diseases: amebiasis and giardiasis. Two major behavioral factors influence transmission of these diseases in the gay community: 1) oral-rectal and oral-genital sexual contact and 2) multiple sexual partners. Pathogenesis, clinical signs and symptoms and complications associated with these diseases are also discussed. Although many patients present with severe symptoms, approximately 50 percent of infected patients are asymptomatic. The diagnostic procedures include a fresh purged stool examination, nonpurged warm stool examinations, and/or cold stool specimens. The serologic tests (serum precipitin and hemagglutination) are of value only in severely symptomatic invasive disease. Different treatment regimens and their side effects are discussed. Drugs used in the treatment of the enteric diseases include diiodohydroxyquin, metronidazole, furamide, and paromomycin. Only 60 to 70 percent of patients with the disease are cured, and 30 to 40 percent of patients require multiple courses of therapy. Test-of-cure examinations, ideally consisting of one or two purged stool specimens, are necessary in follow-up management.

[Diagnosis of intestinal amebiasis]

Three cases of intestinal amebiasis with varying clinical pictures are presented. One patient developed an amebic liver abscess and also amebic colitis, which was mistaken for Crohn's disease. A second patient with amebic dysentery had no Entamoeba histolytica trophozoites in fecal material because of previous therapy with an antiprotozoal drug. The third patient, who had colitis and severe constitutional symptoms, had trophozoites in the stool but negative serological tests. The diagnostic value of radiology and endoscopy, of examinations of stool and exsudate, and of histopathology and serology is discussed.

Primary amoebic meningoencephalitis: a report of two cases and antibiotic and immunologic studies

In the summer of 1978, two children who had recently been swimming in freshwater lakes in Florida died from primary amoebic meningoencephalitis. Despite early and intensive treatment with amphotericin B, both patients died three to five days after the onset of illness. Amoebae were observed in wet preparations of cerebrospinal fluid and in sections of cerebral tissue and were identified as Naegleria fowleri by the indirect immunofluorescent antibody technique. The amoebae were highly virulent in mice. The isolate of N. fowleri was extremely sensitive in vitro to amphotericin B (minimal inhibitory concentration [MIC], 0.15 microgram/ml), somewhat sensitive to miconazole (MIC, 25 micrograms/ml), and resistant to rifampin (MIC, less than or equal to 100 micrograms/ml). Treatment with amphotericin B (7.5 mg/kg of body weight per day) administered intraperitoneally protected 60% of the mice. Lower doses of amphotericin B alone or in combination with miconazole (100 mg/kg) or rifampin (220 mg/kg) were not protective. These results suggest that amphotericin B remains the single effective agent in treatment of primary amoebic meningoencephalitis.

Amoebiasis: a surgeon's view

A small series of patients with amoebiasis presenting to the surgical service in Seychelles is described. The varied nature of the symptomatology indicates that this may be a local pattern of the disease process. The value of specific clinical features and the use of a therapeutic trial for diagnosis is emphasised. The features of common 'Third-World' diseases should be well known to all surgeons wherever they practise in view of the rapidity with which people can now travel from country to country.

A case of Acanthamoeba keratitis in The Netherlands

A severe kerato-iritis of the right eye of a 36-year-old healthy man constituted a diagnostic and therapeutic problem. More than seven months after the onset of his complaints a cornea transplantation was carried out because a large abscess had developed in the stroma of the cornea and perforation was feared. Amoebae, belonging to the free-living genus Acanthamoeba, were found in the excised corneal disc. Similar infections have been described earlier in the USA, in England and in Germany. The case described here is the first well documented one in the Netherlands. The case history and identification of the amoeba are described. Data from the literature on epidemiology, pathogenicity and treatment are discussed.

Assessment of the sensitivity, specificity, and reproducibility of the indirect immunofluorescent technique for the diagnosis of amebiasis

The indirect immunofluorescence (IIF) test was used to study antibody titers to Entamoeba histolytica in various manifestations of clinical amebiasis by comparing the results with parasitological and clinical data from confirmed cases. The sensitivity, specificity, and reproducibility of this test for diagnosis were also studied. A high degree of correlation was found between reactivity in the IIF test and confirmed cases of amebic liver abscess. A positivity rate of 96% in sera of confirmed cases of amebic liver abscess in the present study compares favorably with the results of other workers. The IIF test is very useful in the diagnosis of hepatic amebiasis but is less sensitive for amebic dysentery. The test could not be used to differentiate between hepatic amebiasis and amebic dysentery. The IIF test was insensitive for amebic colitis and of no diagnostic value. Specificity and reproducibility of the test were good, as shown by results obtained with sera from patients with parasitic infections other than amebiasis.