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Kawashima A, Yanagawa Y, Shimogawara R, Yagita K, Gatanaga H, Watanabe K. Amebiasis as a sexually transmitted infection: A re-emerging health problem in developed countries. Glob Health Med 2023; 5:319-327. [PMID: 38162428 PMCID: PMC10730925 DOI: 10.35772/ghm.2023.01064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/21/2023] [Accepted: 10/23/2023] [Indexed: 01/03/2024]
Abstract
Amebiasis, which is caused by Entamoeba histolytica (E. histolytica), is the second leading cause of parasite-related death worldwide. It manifests from asymptomatic carriers to severe clinical conditions, like colitis and liver abscesses. Amebiasis is commonly seen in developing countries, where water and food are easily contaminated by feces because of the poor sanitation. However, a recently challenge in many developed countries is the increase in domestic cases of invasive amebiasis as a sexually transmitted infection (STI amebiasis). In contrast to food-/ waterborne transmission of E. histolytica in developing countries, transmission of STI amebiasis occurs directly through human-to-human sexual contact (e.g., men who have sex with men and people who engage in oral-anal sex); in this setting, asymptomatic infected individuals are the main reservoir of E. histolytica. The Development of screening methods for the early diagnosis of asymptomatic E. histolytica infection is the key to epidemiologic control. Moreover, delay in diagnosis of severe cases (e.g., fulminant amebiasis) leads to death even in developed countries. It is also important to increase clinical awareness of domestically transmitted STI amebiasis in the clinical settings. This review considers the changing epidemiology and clinical manifestations of STI amebiasis, and finally discusses the future strategies for the better practice.
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Affiliation(s)
- Akira Kawashima
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
- Department of Parasitology, National Institute of Infectious Diseases, Tokyo, Japan
- The Joint Research Center for Human Retrovirus Infection Kumamoto University Campus, Kumamoto, Japan
| | - Yasuaki Yanagawa
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
- Department of Parasitology, National Institute of Infectious Diseases, Tokyo, Japan
- Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, CA, USA
| | - Rieko Shimogawara
- Department of Parasitology, National Institute of Infectious Diseases, Tokyo, Japan
| | - Kenji Yagita
- Department of Parasitology, National Institute of Infectious Diseases, Tokyo, Japan
| | - Hiroyuki Gatanaga
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
- The Joint Research Center for Human Retrovirus Infection Kumamoto University Campus, Kumamoto, Japan
| | - Koji Watanabe
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
- Department of Parasitology, National Institute of Infectious Diseases, Tokyo, Japan
- The Joint Research Center for Human Retrovirus Infection Kumamoto University Campus, Kumamoto, Japan
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Pal S, Biswas P, Ghosh R, Dam S. In silico analysis and molecular identification of an anaphase-promoting complex homologue from human pathogen Entamoeba histolytica. J Genet Eng Biotechnol 2021; 19:133. [PMID: 34468883 PMCID: PMC8410921 DOI: 10.1186/s43141-021-00234-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 08/22/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Amoebiasis, being endemic worldwide, is the second leading cause of parasite-associated morbidity and mortality after malaria. The human parasite Entamoeba histolytica is responsible for the disease. Metronidazole is considered as the gold standard for the treatment of amoebiasis, but this antibiotic is carcinogenic and the development of antibiotic resistance against E. histolytica is a major health concern. Chromosome segregation is irregular in this parasite due to the absence of a few cell cycle checkpoint proteins. Anaphase-promoting complex (APC/C or cyclosome) is an E3 ubiquitin ligase that synchronizes chromosome segregation and anaphase progression via the ubiquitin-proteasome system. Proteasome is considered to be an attractive drug target for protozoan parasites. For the present study, EhApc11 from E. histolytica, a homologue of Apc11 in humans, is selected for elucidating its structural and functional aspects by detailed in silico analysis and molecular methods. Its physicochemical characteristics, identification of probable interactors, 3D model and quality analysis are done using standard bioinformatics tools. cDNA sequence of EhAPC11 has been further cloned for molecular characterization. RESULT Conserved domain analysis revealed that EhApc11 belongs to the RING (really interesting new gene) superfamily and has ligand binding capacity. Expression study in Escherichia coli BL21 (DE3) revealed that the molecular weight of glutathione S-transferase (GST)-tagged protein is ~ 36 kDa. CONCLUSION EhApc11 is a hydrophilic, thermostable, extracellular protein with potent antigenicity. The study will serve as a groundwork for future in-depth analysis regarding the validation of protein-protein interaction of EhApc11 with its substrates identified by STRING analysis and the potential of EhApc11 to serve as an anti-amoebic drug target.
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Affiliation(s)
- Suchetana Pal
- Department of Microbiology, The University of Burdwan , Burdwan, West Bengal, 713104, India
| | - Pinaki Biswas
- Department of Microbiology, The University of Burdwan , Burdwan, West Bengal, 713104, India
| | - Raktim Ghosh
- Department of Microbiology, The University of Burdwan , Burdwan, West Bengal, 713104, India
| | - Somasri Dam
- Department of Microbiology, The University of Burdwan , Burdwan, West Bengal, 713104, India.
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Pu LH, Li Z, Wu J, Zhang YL, Chen JQ, Yang JF, Zou FC. Prevalence, molecular epidemiology and zoonotic risk of Entamoeba spp. from experimental macaques in Yunnan Province, southwestern China. Parasitol Res 2020; 119:2733-2740. [PMID: 32617726 DOI: 10.1007/s00436-020-06762-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 06/07/2020] [Indexed: 02/06/2023]
Abstract
Amebiasis is a worldwide parasitic zoonosis, with symptoms of abdominal discomfort, indigestion, diarrhea, and even death. However, limited information about the prevalence of Entamoeba spp. in experimental nonhuman primates (NHPs) in southwestern China is available. The objective of the current study was to investigate the frequency and species identity of Entamoeba to evaluate potential zoonotic risk factors for Entamoeba spp. infection in experimental NHPs. A total of 505 fecal samples were collected from NHPs (macaques) and analyzed by PCR analysis the small subunit rRNA (SSU rRNA) gene of Entamoeba spp. Forty-seven specimens were positive for Entamoeba spp., and the prevalence of Entamoeba spp. was 9.31% (47/505). Significant differences in the prevalence rates among the three breeds (P = 0.002 < 0.01, df = 2, χ2 = 12.33) and feed types (P = 0.001 < 0.01, df = 1, χ2 = 10.12) were observed. Altogether, four Entamoeba species, including E. dispar (57.44%), E. chattoni (29.78%), E. histolytica (6.38%), and E. coli (6.38%), were identified by DNA sequence analysis. The results suggested a low prevalence but high diversity of Entamoeba species in experimental NHPs in Yunnan Province, southwestern China. Results of this study contribute to the knowledge of the genetic characteristics of Entamoeba spp. in NHPs.
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Affiliation(s)
- Li-Hua Pu
- Key Laboratory of Veterinary Public Health of Yunnan Province, College of Veterinary Medicine, Yunnan Agricultural University, Kunming, 650201, Yunnan Province, People's Republic of China
| | - Zhao Li
- Key Laboratory of Veterinary Public Health of Yunnan Province, College of Veterinary Medicine, Yunnan Agricultural University, Kunming, 650201, Yunnan Province, People's Republic of China
| | - Jie Wu
- Key Laboratory of Veterinary Public Health of Yunnan Province, College of Veterinary Medicine, Yunnan Agricultural University, Kunming, 650201, Yunnan Province, People's Republic of China
| | - Yu-Lin Zhang
- Kunming Primate Research Center of the Chinese Academy of Sciences, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, 650223, Yunnan Province, People's Republic of China
| | - Jia-Qi Chen
- Kunming Primate Research Center of the Chinese Academy of Sciences, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, 650223, Yunnan Province, People's Republic of China
| | - Jian-Fa Yang
- Key Laboratory of Veterinary Public Health of Yunnan Province, College of Veterinary Medicine, Yunnan Agricultural University, Kunming, 650201, Yunnan Province, People's Republic of China.
| | - Feng-Cai Zou
- Key Laboratory of Veterinary Public Health of Yunnan Province, College of Veterinary Medicine, Yunnan Agricultural University, Kunming, 650201, Yunnan Province, People's Republic of China.
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Vakamacawai E, McCaig E, Waqainabete I, Cox MR. Amoebic Liver Abscesses in Fiji: Epidemiology, Clinical Presentation and Comparison of Percutaneous Aspiration and Percutaneous Catheter Drainage. World J Surg 2019; 44:665-672. [PMID: 31712845 DOI: 10.1007/s00268-019-05274-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Amoebic liver abscess (ALA) is a common clinical problem in tropical countries related to poor sanitation. The epidemiology and clinical presentation of ALA in Fiji has not been previously described. It is unclear whether percutaneous aspiration (PA) or percutaneous catheter drainage (PCD) has better outcomes. PURPOSE The aims were to describe the epidemiology and clinical presentation of ALA in Fiji and to compare the outcomes of PA and PCD for treatment of ALA. METHODS A retrospective case note review of patients treated with either PA or PCD between 2010 and 2015 was performed. Indications for intervention were ALA > 5 cm, ALA in the left lateral lobe, risk of imminent rupture and failure to respond to medical treatment. RESULTS There were 262 patients, 90% were male, 92.9% I-Taukei ethnicity and 86.2% regular recreational kava drinkers. Most presented with upper abdominal pain and fevers. The majority (90.3%) had a single abscess with 87.8% being in the right lobe. 174 (66.4%) had LA and 88 (33.6%) had PCD. There was an unintended selection bias for PA in abscess with a volume of <1 litre. PA was associated with a more rapid resolution of fever and shorter hospital stay, more rapid resolution of the cavity and no morbidity. PCD had five complications, one bleed and four bile leaks. There was no mortality in either group. CONCLUSIONS ALA in Fiji occurs in I-Taukei males who drink kava. PA appears to offer equivalent if not better outcomes for treatment of ALA.
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Affiliation(s)
- Esala Vakamacawai
- Department of Surgery, College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji
| | - Eddie McCaig
- Department of Surgery, College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji
| | - Ifereimi Waqainabete
- Department of Surgery, College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji
| | - Michael R Cox
- Department of Surgery, College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji. .,Nepean Clinical School, Nepean Hospital, The University of Sydney, Clinical Sciences Building, P. O. Box 67, Penrith, NSW, 2751, Australia.
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Ögren J, Dienus O, Matussek A. Optimization of routine microscopic and molecular detection of parasitic protozoa in SAF-fixed faecal samples in Sweden. Infect Dis (Lond) 2019; 52:87-96. [DOI: 10.1080/23744235.2019.1682188] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Jessica Ögren
- Clinical Microbiology, Region Jönköping County, Jönköping, Sweden
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Olaf Dienus
- Clinical Microbiology, Region Jönköping County, Jönköping, Sweden
| | - Andreas Matussek
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Laboratory Medicine, Region Jönköping County, Jönköping, Sweden
- Karolinska University Laboratory, Stockholm, Sweden
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Soares NM, Azevedo HC, Pacheco FTF, de Souza JN, Del-Rei RP, Teixeira MCA, Santos FLN. A Cross-Sectional Study of Entamoeba histolytica/dispar/moshkovskii Complex in Salvador, Bahia, Brazil. BIOMED RESEARCH INTERNATIONAL 2019; 2019:7523670. [PMID: 31428644 PMCID: PMC6681611 DOI: 10.1155/2019/7523670] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 07/02/2019] [Accepted: 07/14/2019] [Indexed: 11/22/2022]
Abstract
Epidemiological studies on species-specific Entamoeba infections are scarce due to the morphological similarity of pathogenic Entamoeba histolytica and nonpathogenic E. dispar and E. moshkovskii. The diagnosis of E. histolytica is frequently based on coproantigen (E. histolytica-Gal/GalNAc lectin specific) detection by immunoassays. However, specific E. histolytica-lectin is not expressed in cysts, which are eliminated by asymptomatic individuals leading to false-negative results and an underestimation of amebiasis prevalence. Molecular techniques based on the amplification of parasite DNA have been shown to be a highly sensitive and specific method that allows the detection of different Entamoeba species. This study aimed to assess the frequency of the species from E. histolytica/dispar/moshkovskii complex by molecular and immunological techniques in individuals attended at a public health system in Salvador-Bahia, Brazil. A cross-sectional study involving 55,218 individuals was carried out. The diagnosis was based on microscopy revealing E. histolytica/dispar/moshkovskii complex. The species differentiation was performed by E. histolytica-specific antigen, serological evaluation and by molecular technique. The overall prevalence of E. histolytica/dispar/moshkovskii complex determined by microscopy was approximately 0.49% (273/55,218). E. histolytica-specific antigen detection and molecular characterization returned 100% negativity for E. histolytica. However, serological evaluation returned an 8.9% positivity (8/90). In the stool samples analysed by PCR, it was not possible to identify E. histolytica and E. moshkovskii, although circulating IgG anti-E. histolytica has been detected.
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Affiliation(s)
- Neci M. Soares
- Pharmacy College, Federal University of Bahia, UFBA, Salvador-BA 40170-115, Brazil
| | - Helen C. Azevedo
- Pharmacy College, Federal University of Bahia, UFBA, Salvador-BA 40170-115, Brazil
| | - Flávia T. F. Pacheco
- Pharmacy College, Federal University of Bahia, UFBA, Salvador-BA 40170-115, Brazil
| | - Joelma N. de Souza
- Pharmacy College, Federal University of Bahia, UFBA, Salvador-BA 40170-115, Brazil
| | - Rodrigo P. Del-Rei
- Faculty of Technology and Sciences of Bahia, FATEC-BA, Salvador-BA 40280-901, Brazil
| | | | - Fred L. N. Santos
- Advanced Public Health Laboratory, Gonçalo Moniz Institute, FIOCRUZ-BA, Salvador-BA 40296-710, Brazil
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Molecular identification of Entamoeba histolytica from stool samples of Ilam, Iran. Comp Immunol Microbiol Infect Dis 2019; 63:145-147. [PMID: 30961811 DOI: 10.1016/j.cimid.2019.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 01/09/2019] [Accepted: 01/10/2019] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Amoebiasis is a multifactorial, life-threatening public health issue and the third parasitic disease cause of mortality in worldwide, particularly in low- and mid-income countries. The aim of this study was to attempt to explore genetic encoding differences of CP8 (conserved gene) of Entamoeba histolytica/Entamoeba dispar in its various infectious properties isolated from Ilam located at a southwest part of Iran. MATERIALS AND METHODS A total of 2023 stool samples were collected between 2016 and 2018 from the hospital in Ilam, of which only 30 isolates were identified as E. histolytica/E. dispar. These isolates were collected from the intensive care unit, infectious disease, and surgery settings. The isolates were identified and the polymerase chain reaction (PCR) was performed to detect the CP8 gene. In all stages, Entamoeba histolytica HM1: IMSS was used as a positive control. RESULTS In genotype confirmation, only two isolates had the CP8 gene found in the PCR technique. The sequencing results confirmed the mentioned gene with 99%-100% specificity. CONCLUSION It is concluded that PCR is highly sensitive to detect E. histolytica and indicating this important role as screening tools in direct DNA extraction from stool samples and valuable technique in early detection of symptomatic and asymptomatic E. histolytica patients.
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Evaluation of a new multiplex PCR assay (ParaGENIE G-Amoeba Real-Time PCR kit) targeting Giardia intestinalis, Entamoeba histolytica and Entamoeba dispar/Entamoeba moshkovskii from stool specimens: evidence for the limited performances of microscopy-based approach for amoeba species identification. Clin Microbiol Infect 2018; 24:1205-1209. [DOI: 10.1016/j.cmi.2018.02.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 02/04/2018] [Accepted: 02/06/2018] [Indexed: 11/19/2022]
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Van Den Broucke S, Verschueren J, Van Esbroeck M, Bottieau E, Van den Ende J. Clinical and microscopic predictors of Entamoeba histolytica intestinal infection in travelers and migrants diagnosed with Entamoeba histolytica/dispar infection. PLoS Negl Trop Dis 2018; 12:e0006892. [PMID: 30372434 PMCID: PMC6233926 DOI: 10.1371/journal.pntd.0006892] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 11/13/2018] [Accepted: 10/02/2018] [Indexed: 12/31/2022] Open
Abstract
Background Amebiasis is a protozoal infection caused by Entamoeba histolytica, while the morphologically indistinguishable E. dispar is considered as non-pathogenic. Polymerase chain reaction (PCR) assays are necessary to differentiate both species. The most common clinical presentations of E. histolytica disease are amebic colitis and amebic liver abscess, but asymptomatic infection is also possible. We assessed the frequency and pattern of clinical symptoms and microscopic features in travelers/migrants associated with E. histolytica intestinal infection and compared them to those found in individuals with E. dispar infection. Methods We conducted a retrospective study at the travel clinic of the Institute of Tropical Medicine, Antwerp, Belgium on travelers/migrants found from 2006 to 2016 positive for Entamoeba histolytica/dispar through antigen detection and/or through microscopy confirmed by PCR. All files of individuals with a positive PCR for E. histolytica (= cases) and a random selection of an equal number of Entamoeba dispar carriers (= controls) were reviewed. We calculated the sensitivity, specificity and likelihood ratios (LRs) of clinical symptoms (blood in stool, mucus in stool, watery diarrhea, abdominal cramps, fever or any of these 5 symptoms) and of microscopic features (presence of trophozoites in direct and in sodium acetate-acetic acid-formalin (SAF)-fixed stool smears) to discriminate between E. histolytica and E. dispar infection. Results Of all stool samples positive for Entamoeba histolytica/dispar for which PCR was performed (n = 810), 30 (3.7%) were true E. histolytica infections, of which 39% were asymptomatic. Sensitivity, specificity and positive LRs were 30%, 100% and 300 (p 0.007) for presence of blood in stool; 22%, 100% and 222 (p 0.03) for mucus in stool; 44%, 90% and 4.7 (p 0.009) for cramps and 14%, 97% and 4.8 (p = 0.02) for trophozoites in direct smears. For watery diarrhea, fever and for trophozoites in SAF fixated smears results were non-significant. Conclusions E. histolytica infection was demonstrated in a small proportion of travelers/migrants with evidence of Entamoeba histolytica/dispar infection. In this group, history of blood and mucus in stool and cramps had good to strong confirming power (LR+) for actual E. histolytica infection. Trophozoites were also predictive for true E. histolytica infection but in direct smears only. In the present work, we found that E. histolytica intestinal infections are rarely diagnosed among travelers and migrants presenting in a national reference travel clinic in Europe. Microscopic finding of cysts or trophozoites and antigen testing cannot discriminate between Entamoeba histolytica/dispar infection, which leads to overdiagnosis of E. histolytica infections in low resource settings where PCR is not available. We found visualization of trophozoites under the microscope helpful in discriminating between E. histolytica and E. dispar infection in direct smears. Hematophagy is a very rare finding but in our experience was always associated with E. histolytica infection. In a context where only microscopy is available, a patient presenting with blood or mucus in stool or cramps should anyhow be treated as amoebiasis if Entamoeba histolytica/dispar cysts/trophozoites are found. Nevertheless it is worth noting that a sizeable proportion of E. histolytica cases were asymptomatic. Last, our study suggests that E. dispar might be pathogenic but symptoms in E. histolytica infected patients were clearly more often suggestive of intestinal tissue invasion.
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Affiliation(s)
- Steven Van Den Broucke
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- * E-mail:
| | - Jacob Verschueren
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Marjan Van Esbroeck
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Jef Van den Ende
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Faculty of Medicine and Health Sciences, University Antwerp, Belgium
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Saidin S, Othman N, Noordin R. Update on laboratory diagnosis of amoebiasis. Eur J Clin Microbiol Infect Dis 2018; 38:15-38. [DOI: 10.1007/s10096-018-3379-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 09/07/2018] [Indexed: 02/06/2023]
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Berglund B, Dienus O, Sokolova E, Berglind E, Matussek A, Pettersson T, Lindgren PE. Occurrence and removal efficiency of parasitic protozoa in Swedish wastewater treatment plants. THE SCIENCE OF THE TOTAL ENVIRONMENT 2017; 598:821-827. [PMID: 28458199 DOI: 10.1016/j.scitotenv.2017.04.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 04/03/2017] [Accepted: 04/03/2017] [Indexed: 06/07/2023]
Abstract
Giardia intestinalis, Cryptosporidium spp., Entamoeba histolytica and Dientamoeba fragilis are parasitic protozoa and causative agents of gastroenteritis in humans. G. intestinalis and Cryptosporidium spp. in particular are the most common protozoa associated with waterborne outbreaks in high-income countries. Surveillance of protozoan prevalence in wastewater and evaluation of wastewater treatment removal efficiencies of protozoan pathogens is therefore imperative for assessment of human health risk. In this study, influent and effluent wastewater samples from three wastewater treatment plants in Sweden were collected over nearly one year and assessed for prevalence of parasitic protozoa. Quantitative real-time PCR using primers specific for the selected protozoa Cryptosporidium spp., G. intestinalis, E. histolytica, Entamoeba dispar and D. fragilis was used for protozoan DNA detection and assessment of wastewater treatment removal efficiencies. Occurrence of G. intestinalis, E. dispar and D. fragilis DNA was assessed in both influent (44, 30 and 39 out of 51 samples respectively) and effluent wastewater (14, 9 and 33 out of 51 samples respectively) in all three wastewater treatment plants. Mean removal efficiencies of G. intestinalis, E. dispar and D. fragilis DNA quantities, based on all three wastewater treatment plants studied varied between 67 and 87%, 37-75% and 20-34% respectively. Neither E. histolytica nor Cryptosporidium spp. were detected in any samples. Overall, higher quantities of protozoan DNA were observed from February to June 2012. The high prevalence of protozoa in influent wastewater indicates the need for continued monitoring of these pathogens in wastewater-associated aquatic environments to minimise the potential risk for human infection.
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Affiliation(s)
- Björn Berglund
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
| | - Olaf Dienus
- County Hospital Ryhov, Division of Medical Services, Clinical Microbiology Laboratory, Jönköping, Sweden
| | - Ekaterina Sokolova
- Department of Civil and Environmental Engineering, Water Environment Technology, Chalmers University of Technology, Gothenburg, Sweden
| | - Emma Berglind
- County Hospital Ryhov, Division of Medical Services, Clinical Microbiology Laboratory, Jönköping, Sweden
| | - Andreas Matussek
- County Hospital Ryhov, Division of Medical Services, Clinical Microbiology Laboratory, Jönköping, Sweden; Karolinska University Laboratory, Stockholm, Sweden
| | - Thomas Pettersson
- Department of Civil and Environmental Engineering, Water Environment Technology, Chalmers University of Technology, Gothenburg, Sweden
| | - Per-Eric Lindgren
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; County Hospital Ryhov, Division of Medical Services, Clinical Microbiology Laboratory, Jönköping, Sweden
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Formenti F, Valerio M, Guerriero M, Perandin F, Pajola B, Mistretta M, Tais S, Degani M, Bisoffi Z. Molecular Biology Can Change the Classic Laboratory Approach for Intestinal Protozoan Infections. Front Microbiol 2017; 8:2191. [PMID: 29163458 PMCID: PMC5681914 DOI: 10.3389/fmicb.2017.02191] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 10/25/2017] [Indexed: 12/30/2022] Open
Abstract
For many years microscopy has been considered the mainstay of the diagnosis of parasitic infections. In our laboratory, before the advent of molecular biology, the approach for the identification of parasitic infections in stools was the microscopic exam of three samples. Once we adopted molecular biology, a real-time PCR on one single sample was added to the classical coproparasitological exam of three samples. Given the high sensitivity of real-time PCR (Rt-PCR), we then decided to evaluate if a change of our routine was justified. In detail, we intended to assess if a much more practical routine, based on the analysis of a single fecal sample, was sufficiently sensitive to replace the routine described above. The new approach to be evaluated included, on the same and unique fecal sample, a classical coproparasitological exam plus Rt-PCR. The data obtained showed that the sensitivity of the new proposed approach remains very high, despite the reduction of coproparasitological exams from three to one, with the advantage of reducing costs and saving time, both for patients and for the laboratory.
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Affiliation(s)
- Fabio Formenti
- Centre for Tropical Diseases, Sacro Cuore Don Calabria Hospital, Verona, Italy
| | - Matteo Valerio
- Medical Oncology, Sacro Cuore Don Calabria Hospital, Verona, Italy
| | - Massimo Guerriero
- Centre for Tropical Diseases, Sacro Cuore Don Calabria Hospital, Verona, Italy.,Department of Computer Science, University of Verona, Verona, Italy
| | - Francesca Perandin
- Centre for Tropical Diseases, Sacro Cuore Don Calabria Hospital, Verona, Italy
| | - Barbara Pajola
- Centre for Tropical Diseases, Sacro Cuore Don Calabria Hospital, Verona, Italy
| | - Manuela Mistretta
- Centre for Tropical Diseases, Sacro Cuore Don Calabria Hospital, Verona, Italy
| | - Stefano Tais
- Centre for Tropical Diseases, Sacro Cuore Don Calabria Hospital, Verona, Italy
| | - Monica Degani
- Centre for Tropical Diseases, Sacro Cuore Don Calabria Hospital, Verona, Italy
| | - Zeno Bisoffi
- Centre for Tropical Diseases, Sacro Cuore Don Calabria Hospital, Verona, Italy
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Dong H, Li J, Qi M, Wang R, Yu F, Jian F, Ning C, Zhang L. Prevalence, molecular epidemiology, and zoonotic potential of Entamoeba spp. in nonhuman primates in China. INFECTION GENETICS AND EVOLUTION 2017; 54:216-220. [PMID: 28698157 DOI: 10.1016/j.meegid.2017.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 05/23/2017] [Accepted: 07/03/2017] [Indexed: 12/11/2022]
Abstract
Amebiasis is a major public-health concern. It has a global distribution, and is listed as the third leading parasitic cause of human mortality. To survey the prevalence and assess the potential zoonotic transmission of Entamoeba spp. in nonhuman primates (NHPs) in China, 2688 fresh fecal specimens were collected from NHPs reared in farms or zoos/parks or free ranging in 13 districts. The overall prevalence of Entamoeba spp. infection determined with microscopy analysis was 39.4% (1059/2688). Higher infection rates were detected in the free ranging group (41.1%, 169/411) and in animals <1year old (58.7%, 556/947). Gene fragments were successfully amplified 463 (87.2%) out of the 531 selected specimens (approximately half of the total microscopy-positive specimens). Polymerase chain reaction (PCR) amplification identified 386 (83.4%) Entamoeba dispar and 287 (62.0%) E. coli infections, and among these, 210 (45.4%) were mixed infections. And that the E. dispar and E. coli had also been detected in humans. In phylogenetic analysis, the E. dispar and E. coli sequences clustered with reference E. dispar and E. coli, respectively. In conclusion, nonhuman primates infected with Entamoeba species, with high prevalence and zoonotic potential, should be considered when evaluating the maintenance of Entamoeba spp. and its transmission between animal reservoirs and humans.
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Affiliation(s)
- Haiju Dong
- College of Animal Science and Veterinary Medicine, Henan Agricultural University, Zhengzhou 450002, Henan, PR China
| | - Junqiang Li
- College of Animal Science and Veterinary Medicine, Henan Agricultural University, Zhengzhou 450002, Henan, PR China
| | - Meng Qi
- College of Animal Science and Veterinary Medicine, Henan Agricultural University, Zhengzhou 450002, Henan, PR China
| | - Rongjun Wang
- College of Animal Science and Veterinary Medicine, Henan Agricultural University, Zhengzhou 450002, Henan, PR China
| | - Fuchang Yu
- College of Animal Science and Veterinary Medicine, Henan Agricultural University, Zhengzhou 450002, Henan, PR China
| | - Fuchun Jian
- College of Animal Science and Veterinary Medicine, Henan Agricultural University, Zhengzhou 450002, Henan, PR China
| | - Changshen Ning
- College of Animal Science and Veterinary Medicine, Henan Agricultural University, Zhengzhou 450002, Henan, PR China
| | - Longxian Zhang
- College of Animal Science and Veterinary Medicine, Henan Agricultural University, Zhengzhou 450002, Henan, PR China.
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Mwendwa F, Mbae CK, Kinyua J, Mulinge E, Mburugu GN, Njiru ZK. Stem loop-mediated isothermal amplification test: comparative analysis with classical LAMP and PCR in detection of Entamoeba histolytica in Kenya. BMC Res Notes 2017; 10:142. [PMID: 28359328 PMCID: PMC5374617 DOI: 10.1186/s13104-017-2466-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 03/24/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Entamoeba histolytica, the causative agent for amoebiasis is a considerable burden to population in the developing countries where it accounts for over 50 million infections. The tools for detection of amoebiasis are inadequate and diagnosis relies on microscopy which means a significant percent of cases remain undiagnosed. Moreover, tests formats that can be rapidly applied in rural endemic areas are not available. METHODS In this study, a loop-mediated isothermal test (LAMP) based on 18S small subunit ribosomal RNA gene was designed with extra reaction accelerating primers (stem primers) and compared with the published LAMP and PCR tests in detection of E. histolytica DNA in clinical samples. RESULTS The stem LAMP test indicated shorter time to results by an average 11 min and analytical sensitivity of 10-7 (~30 pg/ml) compared to the standard LAMP and PCR which showed sensitivities levels of 10-5 (~3 ng/ml) and 10-4 (~30 ng/ml) respectively using tenfold serial dilution of DNA. In the analysis of clinical specimens positive for Entamoeba spp. trophozoites and cysts using microscopy, the stem LAMP test detected E. histolytica DNA in 36/126, standard LAMP test 20/126 and PCR 17/126 cases respectively. There was 100% agreement in detection of the stem LAMP test product using fluorescence of SYTO-9 dye in real time machine, through addition of 1/10 dilution of SYBR® Green I and electrophoresis in 2% agarose gel stained with ethidium bromide. CONCLUSION The stem LAMP test developed in this study indicates potential towards detection of E. histolytica.
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Affiliation(s)
- Fridah Mwendwa
- Institute of Tropical Medicine and Infectious Diseases, Jomo Kenyatta University of Agriculture and Technology, P.O Box 62000-0200, Nairobi, Kenya.
| | - Cecilia K Mbae
- Centre for Microbiology Research, Kenya Medical Research Institute, P.O Box 19464-00202, Nairobi, Kenya
| | - Johnson Kinyua
- Department of Biochemistry, Jomo Kenyatta University of Agriculture and Technology, P.O Box 62000-0200, Nairobi, Kenya
| | - Erastus Mulinge
- Centre for Microbiology Research, Kenya Medical Research Institute, P.O Box 19464-00202, Nairobi, Kenya
| | | | - Zablon K Njiru
- Meru University of Science and Technology, P. O. Box 972-60200, Meru, Kenya.,School of Health Professions, Mandurah Campus, Murdoch University, Murdoch, WA, 6210, Australia
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15
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Saidin S, Yunus MH, Othman N, Lim YAL, Mohamed Z, Zakaria NZ, Noordin R. Development and initial evaluation of a lateral flow dipstick test for antigen detection of Entamoeba histolytica in stool sample. Pathog Glob Health 2017; 111:128-136. [PMID: 28335696 DOI: 10.1080/20477724.2017.1300421] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Entamoeba histolytica infection remains a public health concern in developing countries. Early diagnosis of amoebiasis can avoid disease complications, thus this study was aimed at developing a test that can rapidly detect the parasite antigens in stool samples. Rabbits were individually immunized with recombinant pyruvate phosphate dikinase (rPPDK) and E. histolytica excretory-secretory antigens to produce polyclonal antibodies. A rapid dipstick test was produced using anti-rPPDK PAb lined on the dipstick as capture reagent and anti-EhESA PAb conjugated to colloidal gold as the detector reagent. Using E. histolytica-spiked in stool sample of a healthy individual, the detection limit of the dipstick test was found to be 1000 cells ml-1. Meanwhile when rPPDK was spiked in the stool sample, the minimum concentration detected by the dipstick test was 0.1 μg ml-1. The performances of the dipstick, commercial Techlab E. histolytica II enzyme-linked immunosorbent assays (ELISA) and real-time PCR were compared using 70 stool samples from patients infected with Entamoeba species (n = 45) and other intestinal pathogens (n = 25). When compared to real-time PCR, the diagnostic sensitivity of the dipstick for detection of E. histolytica was 65.4% (n = 17/26); while the diagnostic specificity when tested with stool samples containing other intestinal pathogens was 92% (23/25). In contrast, Techlab E. histolytica II ELISA detected 19.2% (5/26) of the E. histolytica-positive samples as compared to real-time PCR. The lateral flow dipstick test produced in this study enabled rapid detection of E. histolytica, thus it showed good potential to be further developed into a diagnostic tool for intestinal amoebiasis.
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Affiliation(s)
- Syazwan Saidin
- a Institute for Research in Molecular Medicine , Universiti Sains Malaysia , Penang , Malaysia
| | - Muhammad Hafiznur Yunus
- a Institute for Research in Molecular Medicine , Universiti Sains Malaysia , Penang , Malaysia
| | - Nurulhasanah Othman
- a Institute for Research in Molecular Medicine , Universiti Sains Malaysia , Penang , Malaysia
| | - Yvonne Ai-Lian Lim
- b Faculty of Medicine, Department of Parasitology , University of Malaya , Kuala Lumpur , Malaysia
| | - Zeehaida Mohamed
- c Department of Medical Microbiology and Parasitology, School of Medical Sciences , Universiti Sains Malaysia , Kubang Kerian , Malaysia
| | - Nik Zairi Zakaria
- c Department of Medical Microbiology and Parasitology, School of Medical Sciences , Universiti Sains Malaysia , Kubang Kerian , Malaysia
| | - Rahmah Noordin
- a Institute for Research in Molecular Medicine , Universiti Sains Malaysia , Penang , Malaysia
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16
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Archaeological occurrences and historical review of the human amoeba, Entamoeba histolytica, over the past 6000years. INFECTION GENETICS AND EVOLUTION 2016; 42:34-40. [DOI: 10.1016/j.meegid.2016.04.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 04/20/2016] [Accepted: 04/24/2016] [Indexed: 11/15/2022]
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17
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Molecular testing for clinical diagnosis and epidemiological investigations of intestinal parasitic infections. Clin Microbiol Rev 2016; 27:371-418. [PMID: 24696439 DOI: 10.1128/cmr.00122-13] [Citation(s) in RCA: 146] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Over the past few decades, nucleic acid-based methods have been developed for the diagnosis of intestinal parasitic infections. Advantages of nucleic acid-based methods are numerous; typically, these include increased sensitivity and specificity and simpler standardization of diagnostic procedures. DNA samples can also be stored and used for genetic characterization and molecular typing, providing a valuable tool for surveys and surveillance studies. A variety of technologies have been applied, and some specific and general pitfalls and limitations have been identified. This review provides an overview of the multitude of methods that have been reported for the detection of intestinal parasites and offers some guidance in applying these methods in the clinical laboratory and in epidemiological studies.
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18
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Ögren J, Van Nguyen S, Nguyen MK, Dimberg J, Matussek A. Prevalence of Dientamoeba fragilis, Giardia duodenalis, Entamoeba histolytica/dispar, and Cryptosporidium spp in Da Nang, Vietnam, detected by a multiplex real-time PCR. APMIS 2016; 124:529-33. [PMID: 27102222 DOI: 10.1111/apm.12535] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 02/23/2016] [Indexed: 11/30/2022]
Abstract
We surveyed the prevalence of Dientamoeba fragilis, Giardia duodenalis, Entamoeba histolytica, Entamoeba dispar, and Cryptosporidium spp in individuals with and without gastrointestinal (GI) symptoms residing in and around Da Nang city, Vietnam. Fecal samples were collected from children (n = 100) and adults (n = 80) with GI symptoms and from healthy individuals (n = 88) reporting no GI symptoms. Parasite detection was performed by multiplex real-time PCR. Overall, except for G. duodenalis, we found a low prevalence (<5%) of D. fragilis and E. dispar and no detection of E. histolytica and C. spp in all participants with GI symptoms. Specifically for D. fragilis this contrasts with findings in European populations of children with GI symptoms showing prevalence up to 73%. Moreover, our results indicate that the prevalence of G. duodenalis is higher in patients with GI symptoms compared to asymptomatic individuals and this difference is most obvious in young patients.
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Affiliation(s)
- Jessica Ögren
- Division of Medical Diagnostics, Clinical Microbiology Laboratory, County Hospital Ryhov, Region Jönköping County, Sweden
| | - Song Van Nguyen
- Department of Medical Laboratory, Da Nang University of Medical Technology and Pharmacy, Da Nang, Vietnam
| | - Minh Khac Nguyen
- Department of Medical Laboratory, Da Nang University of Medical Technology and Pharmacy, Da Nang, Vietnam
| | - Jan Dimberg
- Department of Natural Science and Biomedicine, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Andreas Matussek
- Division of Medical Diagnostics, Clinical Microbiology Laboratory, County Hospital Ryhov, Region Jönköping County, Sweden
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19
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Molecular identification of Entamoeba species in savanna woodland chimpanzees (Pan troglodytes schweinfurthii). Parasitology 2016; 143:741-8. [PMID: 26935395 DOI: 10.1017/s0031182016000263] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
To address the molecular diversity and occurrence of pathogenic species of the genus Entamoeba spp. in wild non-human primates (NHP) we conducted molecular-phylogenetic analyses on Entamoeba from wild chimpanzees living in the Issa Valley, Tanzania. We compared the sensitivity of molecular [using a genus-specific polymerase chain reaction (PCR)] and coproscopic detection (merthiolate-iodine-formaldehyde concentration) of Entamoeba spp. We identified Entamoeba spp. in 72 chimpanzee fecal samples (79%) subjected to species-specific PCRs for six Entamoeba species/groups (Entamoeba histolytica, Entamoeba nuttalli, Entamoeba dispar, Entamoeba moshkovskii, Entamoeba coli and Entamoeba polecki ST2). We recorded three Entamoeba species: E. coli (47%), E. dispar (16%), Entamoeba hartmanni (51%). Coproscopically, we could only distinguish the cysts of complex E. histolytica/dispar/moshkovskii/nuttalli and E. coli. Molecular prevalence of entamoebas was higher than the prevalence based on the coproscopic examination. Our molecular phylogenies showed that sequences of E. dispar and E. coli from Issa chimpanzees are closely related to sequences from humans and other NHP from GenBank. The results showed that wild chimpanzees harbour Entamoeba species similar to those occurring in humans; however, no pathogenic species were detected. Molecular-phylogenetic methods are critical to improve diagnostics of entamoebas in wild NHP and for determining an accurate prevalence of Entamoeba species.
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20
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Yimer M, Zenebe Y, Mulu W, Abera B, Saugar JM. Molecular prevalence of Entamoeba histolytica/dispar infection among patients attending four health centres in north-west Ethiopia. Trop Doct 2016; 47:11-15. [PMID: 26834117 DOI: 10.1177/0049475515627236] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The prevalence of amoebiasis is often overestimated owing to its epidemiological overlap with the non-pathogenic Entamoeba dispar To provide evidence for this conjecture, a cross-sectional study was conducted from November 2013 to January 2015. A range of 180-200 µg of semi-solid and formed stools and 200 µL of diarrhoeic stool samples were used for DNA extraction from microscopically E. histolytica/dispar positive samples using the QIAamp® DNA Stool Mini Kit according to manufacturers' instructions. Nested PCR targeting 18S ribosomal RNA gene was used. In 422 microscopically positive E. histolytica/dispar stools, molecular prevalence revealed that E. histolytica infestation was present in only 1.7% (95% confidence interval [CI], 0.47-2.93) and E. dispar was found in 42.2% (95% CI, 37.49-46.91), while 56.2% (95% CI, 51.47-60.93) had neither E. histolytica nor E. dispar (P < 0.001). We conclude that infestation with E. histolytica is rarer in our study areas than was previously believed. Hence, accurate differentiation of E. histolytica and E. dispar is crucial.
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Affiliation(s)
- Mulat Yimer
- Medical Parasitologist; Lecturer, College of Medicine and Health Sciences, Bahir Dar University
| | - Yohannes Zenebe
- Lecturer, College of Medicine, Bahir Dar University and Health Sciences and tropical infectious diseases
| | - Wondemagegn Mulu
- Medical Microbiologist; Lecturer, College of Medicine, Bahir Dar University and Health Sciences
| | - Bayeh Abera
- Medical Microbiologist; Lecturer, College of Medicine and Health Sciences
| | - José M Saugar
- Carlos III Institute of health, Madrid, Spain, Laboratory officer at Department of amoebiasis
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21
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Llewellyn S, Inpankaew T, Nery SV, Gray DJ, Verweij JJ, Clements ACA, Gomes SJ, Traub R, McCarthy JS. Application of a Multiplex Quantitative PCR to Assess Prevalence and Intensity Of Intestinal Parasite Infections in a Controlled Clinical Trial. PLoS Negl Trop Dis 2016; 10:e0004380. [PMID: 26820626 PMCID: PMC4731196 DOI: 10.1371/journal.pntd.0004380] [Citation(s) in RCA: 124] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 12/18/2015] [Indexed: 11/18/2022] Open
Abstract
Background Accurate quantitative assessment of infection with soil transmitted helminths and protozoa is key to the interpretation of epidemiologic studies of these parasites, as well as for monitoring large scale treatment efficacy and effectiveness studies. As morbidity and transmission of helminth infections are directly related to both the prevalence and intensity of infection, there is particular need for improved techniques for assessment of infection intensity for both purposes. The current study aimed to evaluate two multiplex PCR assays to determine prevalence and intensity of intestinal parasite infections, and compare them to standard microscopy. Methodology/Principal Findings Faecal samples were collected from a total of 680 people, originating from rural communities in Timor-Leste (467 samples) and Cambodia (213 samples). DNA was extracted from stool samples and subject to two multiplex real-time PCR reactions the first targeting: Necator americanus, Ancylostoma spp., Ascaris spp., and Trichuris trichiura; and the second Entamoeba histolytica, Cryptosporidium spp., Giardia. duodenalis, and Strongyloides stercoralis. Samples were also subject to sodium nitrate flotation for identification and quantification of STH eggs, and zinc sulphate centrifugal flotation for detection of protozoan parasites. Higher parasite prevalence was detected by multiplex PCR (hookworms 2.9 times higher, Ascaris 1.2, Giardia 1.6, along with superior polyparasitism detection with this effect magnified as the number of parasites present increased (one: 40.2% vs. 38.1%, two: 30.9% vs. 12.9%, three: 7.6% vs. 0.4%, four: 0.4% vs. 0%). Although, all STH positive samples were low intensity infections by microscopy as defined by WHO guidelines the DNA-load detected by multiplex PCR suggested higher intensity infections. Conclusions/Significance Multiplex PCR, in addition to superior sensitivity, enabled more accurate determination of infection intensity for Ascaris, hookworms and Giardia compared to microscopy, especially in samples exhibiting polyparasitism. The superior performance of multiplex PCR to detect polyparasitism and more accurately determine infection intensity suggests that it is a more appropriate technique for use in epidemiologic studies and for monitoring large-scale intervention trials. Gastrointestinal parasites including soil-transmitted helminths cause considerable morbidity worldwide, especially in resource-poor communities. Large-scale epidemiologic and treatment efficacy studies are regularly undertaken to determine the optimum ways to reduce or eliminate parasites from endemic communities, thereby reducing the burden of disease. Accurate and sensitive tests for detection of soil transmitted helminths and protozoa are of great importance to the success of such trials. Increasingly recognised is the importance of accurately determine the infection intensity, as morbidity and transmission pressure of helminth infections are directly related this and not just to prevalence. A vast majority of studies use standard microscopy methods which, although well accepted, may not be as accurate as more recently developed molecular techniques such as multiplex PCR. Therefore, there is need for further evaluation of multiplex PCR techniques and their ability to detect infections and provide infection intensity data. In the current study real-time PCR showed a higher sensitivity for the detection of intestinal helminths and protozoa especially in cases of mixed infections as well as more accurate determination of infection intensity compared to microscopy.
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Affiliation(s)
- Stacey Llewellyn
- Clinical Tropical Medicine Laboratory, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Tawin Inpankaew
- Department of Veterinary Disease Biology, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark; Department of Parasitology, Faculty of Veterinary Medicine, Kasetsart University, Bangkok, Thailand
| | - Susana Vaz Nery
- Research School of Population Health, College of Medicine, Biology and Environment, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Darren J. Gray
- Research School of Population Health, College of Medicine, Biology and Environment, The Australian National University, Canberra, Australian Capital Territory, Australia
- Molecular Parasitology Laboratory, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
- School of Public Health, University of Queensland, Herston, Queensland, Australia
| | - Jaco J. Verweij
- Laboratory for Medical Microbiology and Immunology, St Elisabeth Hospital, Tilburg, the Netherlands
| | - Archie C. A. Clements
- Research School of Population Health, College of Medicine, Biology and Environment, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Santina J. Gomes
- Laboratorio Nacional da Saúde, Ministério da Saúde, Dili, Timor-Leste
| | - Rebecca Traub
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - James S. McCarthy
- Clinical Tropical Medicine Laboratory, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
- School of Medicine, University of Queensland, Queensland, Australia
- * E-mail:
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23
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Molecular Diagnosis of Gastrointestinal Infections. Mol Microbiol 2016. [DOI: 10.1128/9781555819071.ch27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Vaidyanathan R, Rauf S, Grewal YS, Spadafora LJ, Shiddiky MJA, Cangelosi GA, Trau M. Enhancing Protein Capture Using a Combination of Nanoyeast Single-Chain Fragment Affinity Reagents and Alternating Current Electrohydrodynamic Forces. Anal Chem 2015; 87:11673-81. [DOI: 10.1021/acs.analchem.5b02490] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Ramanathan Vaidyanathan
- Centre
for Personalized NanoMedicine, Australian Institute for Bioengineering
and Nanotechnology (AIBN), Corner College and Cooper Roads (Bldg 75), The University of Queensland, Brisbane, Queensland 4072, Australia
| | - Sakandar Rauf
- Centre
for Personalized NanoMedicine, Australian Institute for Bioengineering
and Nanotechnology (AIBN), Corner College and Cooper Roads (Bldg 75), The University of Queensland, Brisbane, Queensland 4072, Australia
| | - Yadveer S. Grewal
- Centre
for Personalized NanoMedicine, Australian Institute for Bioengineering
and Nanotechnology (AIBN), Corner College and Cooper Roads (Bldg 75), The University of Queensland, Brisbane, Queensland 4072, Australia
| | - Lauren J. Spadafora
- School
of Public Health, University of Washington, Seattle, Washington 98195, United States
| | - Muhammad J. A. Shiddiky
- Centre
for Personalized NanoMedicine, Australian Institute for Bioengineering
and Nanotechnology (AIBN), Corner College and Cooper Roads (Bldg 75), The University of Queensland, Brisbane, Queensland 4072, Australia
| | - Gerard A. Cangelosi
- School
of Public Health, University of Washington, Seattle, Washington 98195, United States
| | - Matt Trau
- Centre
for Personalized NanoMedicine, Australian Institute for Bioengineering
and Nanotechnology (AIBN), Corner College and Cooper Roads (Bldg 75), The University of Queensland, Brisbane, Queensland 4072, Australia
- School
of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland 4072, Australia
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Efunshile MA, Ngwu BAF, Kurtzhals JAL, Sahar S, König B, Stensvold CR. Molecular Detection of the Carriage Rate of Four Intestinal Protozoa with Real-Time Polymerase Chain Reaction: Possible Overdiagnosis of Entamoeba histolytica in Nigeria. Am J Trop Med Hyg 2015; 93:257-62. [PMID: 26101274 PMCID: PMC4530744 DOI: 10.4269/ajtmh.14-0781] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 04/11/2015] [Indexed: 12/17/2022] Open
Abstract
Diarrhea remains the second largest killer of children worldwide, and Nigeria ranks number two on the list of global deaths attributable to diarrhea. Meanwhile, prevalence studies on potentially diarrheagenic protozoa in asymptomatic carriers using molecular detection methods remain scarce in sub-Saharan countries. To overcome sensitivity issues related to microscopic detection and identification of cysts in stool concentrates, real-time polymerase chain reaction (PCR) was used to analyze genomic DNAs extracted from stool samples from 199 healthy school children for Entamoeba histolytica, E. dispar, Giardia intestinalis, and Cryptosporidium. Questionnaires were administered for epidemiological data collection. E. histolytica was not detected in any of the samples, whereas Giardia (37.2%), E. dispar (18.6%), and Cryptosporidium (1%) were found. Most of the children sourced their drinking water from community wells (91%), while the majority disposed of feces in the bush (81.9%). Our study is the first to use real-time PCR to evaluate the epidemiology of E. histolytica, Giardia, and Cryptosporidium in Nigeria where previous studies using traditional diagnostic techniques have suggested higher and lower carriage rates of E. histolytica and Giardia, respectively. It is also the first study to accurately identify the prevalence of common potentially diarrheagenic protozoa in asymptomatic carriers in sub-Saharan Africa.
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Affiliation(s)
- Michael A Efunshile
- Institute of Medical Microbiology and Infectious Disease Epidemiology, Medical Faculty, University of Leipzig, Leipzig, Germany; Ebonyi State University, Abakaliki, Nigeria; Department of Clinical Microbiology, Centre for Medical Parasitology, Copenhagen University Hospital Copenhagen, Denmark; Department of International Health, Immunology, and Microbiology, University of Copenhagen, Denmark; Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - Bethrand A F Ngwu
- Institute of Medical Microbiology and Infectious Disease Epidemiology, Medical Faculty, University of Leipzig, Leipzig, Germany; Ebonyi State University, Abakaliki, Nigeria; Department of Clinical Microbiology, Centre for Medical Parasitology, Copenhagen University Hospital Copenhagen, Denmark; Department of International Health, Immunology, and Microbiology, University of Copenhagen, Denmark; Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - Jørgen A L Kurtzhals
- Institute of Medical Microbiology and Infectious Disease Epidemiology, Medical Faculty, University of Leipzig, Leipzig, Germany; Ebonyi State University, Abakaliki, Nigeria; Department of Clinical Microbiology, Centre for Medical Parasitology, Copenhagen University Hospital Copenhagen, Denmark; Department of International Health, Immunology, and Microbiology, University of Copenhagen, Denmark; Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - Sumrin Sahar
- Institute of Medical Microbiology and Infectious Disease Epidemiology, Medical Faculty, University of Leipzig, Leipzig, Germany; Ebonyi State University, Abakaliki, Nigeria; Department of Clinical Microbiology, Centre for Medical Parasitology, Copenhagen University Hospital Copenhagen, Denmark; Department of International Health, Immunology, and Microbiology, University of Copenhagen, Denmark; Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - Brigitte König
- Institute of Medical Microbiology and Infectious Disease Epidemiology, Medical Faculty, University of Leipzig, Leipzig, Germany; Ebonyi State University, Abakaliki, Nigeria; Department of Clinical Microbiology, Centre for Medical Parasitology, Copenhagen University Hospital Copenhagen, Denmark; Department of International Health, Immunology, and Microbiology, University of Copenhagen, Denmark; Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - Christen R Stensvold
- Institute of Medical Microbiology and Infectious Disease Epidemiology, Medical Faculty, University of Leipzig, Leipzig, Germany; Ebonyi State University, Abakaliki, Nigeria; Department of Clinical Microbiology, Centre for Medical Parasitology, Copenhagen University Hospital Copenhagen, Denmark; Department of International Health, Immunology, and Microbiology, University of Copenhagen, Denmark; Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
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Ögren J, Dienus O, Löfgren S, Einemo IM, Iveroth P, Matussek A. Dientamoeba fragilis prevalence coincides with gastrointestinal symptoms in children less than 11 years old in Sweden. Eur J Clin Microbiol Infect Dis 2015; 34:1995-8. [PMID: 26173693 PMCID: PMC4565872 DOI: 10.1007/s10096-015-2442-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 06/26/2015] [Indexed: 12/31/2022]
Abstract
Dientamoeba fragilis is a protozoan with a debated role in gastrointestinal (GI) disease. Although correlated to GI symptoms, no virulence factors have been described. In this study, we evaluated the cause of GI symptoms in children at two schools, with children aged 1 to 10 years, in the county of Jönköping, Sweden. D. fragilis infection correlated to GI symptoms in children and Enterobius vermicularis correlated to D. fragilis infection.
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Affiliation(s)
- J Ögren
- Clinical Microbiology Laboratory, County Hospital Ryhov, 55185, Region Jönköping County, Sweden
| | - O Dienus
- Clinical Microbiology Laboratory, County Hospital Ryhov, 55185, Region Jönköping County, Sweden
| | - S Löfgren
- Clinical Microbiology Laboratory, County Hospital Ryhov, 55185, Region Jönköping County, Sweden
| | - I-M Einemo
- Department for Control of Communicable Diseases, Region Jönköping County, Sweden
| | - P Iveroth
- Department for Control of Communicable Diseases, Region Jönköping County, Sweden
| | - A Matussek
- Clinical Microbiology Laboratory, County Hospital Ryhov, 55185, Region Jönköping County, Sweden.
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Abstract
Among the Entamoeba species that infect humans, Entamoeba histolytica causes diseases, Entamoeba dispar is a harmless commensal, Entamoeba moshkovskii seems to be a pathogen, and the pathogenicity of Entamoeba bangladeshi remains to be investigated. Species-specific detection needed for treatment decisions and for understanding the epidemiology and pathogenicity of these amebae. Antigen-based detection methods are needed for E dispar, E moshkovskii, and E bangladeshi; and molecular diagnostic test capable of detecting E histolytica, E dispar, E moshkovskii, and E bangladeshi simultaneously in clinical samples. Next-generation sequencing of DNA from stool is needed to identify novel species of Entamoeba.
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Affiliation(s)
- Ibne Karim M Ali
- Division of Foodborne Waterborne and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road Northeast, Mailstop D-66, Atlanta, GA 30329, USA.
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Ibrahim SS, El-Matarawy OM, Ghieth MA, Abu Sarea EY, El-Badry AA. Copro prevalence and estimated risk of Entamoeba histolytica in Diarrheic patients at Beni-Suef, Egypt. World J Microbiol Biotechnol 2014; 31:385-90. [PMID: 25542044 DOI: 10.1007/s11274-014-1791-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 12/20/2014] [Indexed: 10/24/2022]
Abstract
Amoebiasis diagnosis is usually based on microscopy that cannot differentiate pathogenic E. histolytica from morphologically identical non-pathogenic species. 194 fecal samples were collected from diarrheic &/or dysenteric patients and examined for Entamoeba complex microscopically, E. histolytica/E. dispar coproantigen using ICT and E. histolytica coproantigen using Tech lab E. histolytica II ELISA test. Entamoeba complex trophozoites/cysts, E. histolytica/E. dispar coproantigen and E. histolytica coproantigen were detected in 22.2, 14.4 and 3.6 % of samples, respectively. Microscopy and ICT method had limited sensitivity with poor PPV (9.3 and 7.1 %, respectively) and both slightly agree with ELISA test. The prevalence of E. histolytica was low (3.6 %) in studied individuals and was 14 times lower than non-pathogenic amoebae. E. histolytica detection studied individuals was positively associated with mucoid and bloody stool, which makes them disease predictors. E. histolytica fecal ELISA assay for E. histolytica detection surpassed microscopy and E. histolytica/E. dispar ICT assay. This has highlighted the need for practical non-microscopic detection methods that can differentiate between amoeba infections to avoid unnecessary and possibly harmful therapies and to determine the true prevalence and epidemiology of E. histolytica.
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Affiliation(s)
- Shimaa S Ibrahim
- Department of Medical Parasitology, Faculty of Medicine, Beni Suef University, Beni Suef, Egypt
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29
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Application of PCR-based methods for diagnosis of intestinal parasitic infections in the clinical laboratory. Parasitology 2014; 141:1863-72. [DOI: 10.1017/s0031182014000419] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
SUMMARYFor many years PCR- and other DNA-based methods of pathogen detection have been available in most clinical microbiology laboratories; however, until recently these tools were not routinely exploited for the diagnosis of parasitic infections. Laboratories were initially reluctant to implement PCR as incorporation of such assays within the algorithm of tools available for the most accurate diagnosis of a large variety of parasites was unclear. With regard to diagnosis of intestinal parasitic infections, the diversity of parasites that one can expect in most settings is far less than the parasitological textbooks would have you believe, hence developing a simplified diagnostic triage is feasible. Therefore the classical algorithm based on population, patient groups, use of immuno-suppressive drugs, travel history etc. is also applicable to decide when to perform and which additional techniques are to be used, if a multiplex PCR panel is used as a first-line screening diagnostic.
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Taniuchi M, Sobuz SU, Begum S, Platts-Mills JA, Liu J, Yang Z, Wang XQ, Petri WA, Haque R, Houpt ER. Etiology of diarrhea in Bangladeshi infants in the first year of life analyzed using molecular methods. J Infect Dis 2013; 208:1794-802. [PMID: 24041797 DOI: 10.1093/infdis/jit507] [Citation(s) in RCA: 147] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Diarrhea causes enormous morbidity and mortality in developing countries, yet the relative importance of multiple potential enteropathogens has been difficult to ascertain. METHODS We performed a longitudinal cohort study from birth to 1 year of age in 147 infants in Dhaka, Bangladesh. Using multiplex polymerase chain reaction, we analyzed 420 episodes of diarrhea and 1385 monthly surveillance stool specimens for 32 enteropathogen gene targets. For each infant we examined enteropathogen quantities over time to ascribe each positive target as a probable or less-likely contributor to diarrhea. RESULTS Multiple enteropathogens were detected by the first month of life. Diarrhea was associated with a state of overall pathogen excess (mean number of enteropathogen gene targets (± SE), 5.6 ± 0.1 vs 4.3 ± 0.1 in surveillance stool specimens; P < .05). After a longitudinal, quantitative approach was applied to filter out less-likely contributors, each diarrheal episode still had an average of 3.3 probable or dominant targets. Enteroaggregative Escherichia coli, Campylobacter, enteropathogenic E. coli, rotavirus, and Entamoeba histolytica were the most frequent probable contributors to diarrhea. Rotavirus was enriched in moderate to severe diarrheal episodes. CONCLUSIONS In this community-based study diarrhea seemed to be a multipathogen event and a state of enteropathogen excess above a high carriage baseline.
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Affiliation(s)
- Mami Taniuchi
- Division of Infectious Diseases and International Health, Department of Medicine
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31
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Sánchez-Aguilar M, Morán-Mendoza O, Herrera-Hernández MF, Hernández-Sierra JF, Mandeville PB, Tapia-Pérez JH, Sánchez-Reyna M, Sánchez-Rodríguez JJ, Gordillo-Moscoso A. Prognostic indications of the failure to treat amoebic liver abscesses. Pathog Glob Health 2013; 106:232-7. [PMID: 23265424 DOI: 10.1179/2047773212y.0000000021] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVES To identify the variables that predict the failure to treat amoebic liver abscesses. METHODS We prospectively carried out a case-control study on a cohort of patients who had been diagnosed with amoebic liver abscesses using clinical, ultrasonic, and serologic methods. Patients with pyogenic abscesses, negative ELISA tests for amoebiasis, immunosuppression status, or previous abdominal surgery were excluded. All patients received metronidazole, and those who demonstrated 4 days of unfavorable clinical responses received percutaneous or surgical draining of the abscess. Demographic, laboratory, and ultrasonographic characteristics were assessed as prognostic indications of failure. RESULTS Of 40 patients with amoebic liver abscess, 24 (mean age: 36·7±11·2 years) responded to medical treatment and 16 (41·8±11·6 years) required drainage, including 14 patients who underwent percutaneous drainage and two patients who required surgery. The albumin level, abscess volume, abscess diameter, and alkaline phosphatase level were all statistically significant (P<0·05) on the bivariate analysis. The highest (>99%) sensitivity and negative predictive value were observed for an abscess volume >500 ml and diameter >10 cm, while the best specificity and positive predictive value were achieved with the combination of low serum albumin level, high alkaline phosphatase level, and large abscess volume or diameter. CONCLUSIONS The prognostic indications of the failure to treat amoebic liver abscesses include low albumin, high alkaline phosphatase, and large abscess volume or diameter. The combination of these variables is a useful and easy tool for determining appropriate therapy.
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Affiliation(s)
- Martín Sánchez-Aguilar
- Department of Experimental Surgery, Faculty of Medicine, Universidad Autónoma de San Luis Potosí, Mexico.
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Anuar TS, Al-Mekhlafi HM, Abdul Ghani MK, Azreen SN, Salleh FM, Ghazali N, Bernadus M, Moktar N. Different clinical outcomes of Entamoeba histolytica in Malaysia: does genetic diversity exist? THE KOREAN JOURNAL OF PARASITOLOGY 2013; 51:231-6. [PMID: 23710093 PMCID: PMC3662069 DOI: 10.3347/kjp.2013.51.2.231] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 01/23/2013] [Accepted: 02/10/2013] [Indexed: 11/23/2022]
Abstract
The present study was conducted to investigate the clinical outcomes of Entamoeba histolytica infection in symptomatic and asymptomatic Orang Asli (aborigine) communities in Malaysia. Examination was performed on 500 stool samples obtained from Orang Asli communities in 3 different states using formalin-ether concentration, trichrome staining, and single-round PCR techniques. Out of 500 stool samples, single infection of E. histolytica, Entamoeba dispar, and Entamoeba moshkovskii was identified in 3.2%, 13.4%, and 1%, respectively. In addition, 10 samples had mixed infections with E. histolytica and E. dispar. Six samples containing E. dispar were also positive for E. moshkovskii, and only 2 samples had E. histolytica in association with E. dispar and E. moshkovskii. Seventeen E. histolytica-positive samples were from symptomatic subjects, whereas the remaining 11 samples came from asymptomatic subjects. These findings suggest a predominant distribution of pathogenic potential of E. histolytica strains in this community. Therefore, further studies on genotyping of E. histolytica is required, to find out association between E. histolytica genotype and the outcome of the infection.
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Affiliation(s)
- Tengku Shahrul Anuar
- Department of Parasitology & Medical Entomology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, Malaysia
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33
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Molecular epidemiology of amoebiasis in Malaysia: highlighting the different risk factors of Entamoeba histolytica and Entamoeba dispar infections among Orang Asli communities. Int J Parasitol 2012; 42:1165-75. [PMID: 23123168 DOI: 10.1016/j.ijpara.2012.10.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 10/04/2012] [Accepted: 10/05/2012] [Indexed: 11/23/2022]
Abstract
Currently, species-specific information on Entamoeba infections is unavailable in Malaysia and is restricted worldwide due to the re-description of pathogenic Entamoeba histolytica and non-pathogenic Entamoeba dispar and Entamoeba moshkovskii. Therefore, this cross-sectional study was conducted to provide the first known documented data on the true prevalence of these three species in western Malaysia using a molecular method. Another aim of this study was to determine the association of potential risk factors associated with each Entamoeba sp. A total of 500 stool samples from three Orang Asli tribes were randomly collected. The overall prevalence of E. histolytica, E. dispar and E. moshkovskii determined by microscopy was 18.6% (93/500). Molecular analysis revealed that while most Entamoeba-positive individuals were infected with E. dispar (13.4%), followed by E. histolytica (3.2%) and E. moshkovskii (1.0%), the present findings show low prevalence rates of mixed infections with E. histolytica and E. dispar (2%), E. dispar and E. moshkovskii (1.2%) and association infections of E. histolytica, E. dispar and E. moshkovskii (0.4%). Logistical regression analysis indicates that the dynamics of the transmission of the three Entamoeba spp. was different. Of six statistically significant variables observed in the univariate analysis, three were retained as significant risk factors for E. histolytica infection in the logistical regression model. These factors were (i) not washing hands after playing with soil or gardening (Odds ratio (OR)=4.7; 95% confidence level (CI)=1.38, 16.14; P=0.013), (ii) indiscriminate defecation in the river or bush (OR=5.7; 95% CI=1.46, 21.95; P=0.012) and (iii) close contact with domestic animals (OR=5.4; 95% CI=1.36, 2.51; P=0.017). However, subjects with family members who were infected with E. histolytica/E. dispar/E. moshkovskii (OR=3.8; 95 CI=2.11, 6.86; P<0.001) and those who consumed raw vegetables (OR=1.8; 95% CI=1.01, 3.23; P=0.047) were more likely to be infected with E. dispar. On the other hand, no associated factor was identified with E. moshkovskii infection. Nevertheless, diarrhoea (P=0.002) and other gastroenteritis symptoms (P<0.001) were only associated with E. histolytica infection. The present study provides new insight into the distribution and risk factors of E. histolytica, E. dispar and E. moshkovskii infections among Orang Asli communities in Malaysia. Identifying the different risk factors of E. histolytica and E. dispar infections will help in the planning specific strategies in the control and prevention of each infection in the communities. Moreover, it emphasises the need for molecular methods to determine the species-specific prevalence of Entamoeba spp.
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34
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Ngui R, Angal L, Fakhrurrazi SA, Lian YLA, Ling LY, Ibrahim J, Mahmud R. Differentiating Entamoeba histolytica, Entamoeba dispar and Entamoeba moshkovskii using nested polymerase chain reaction (PCR) in rural communities in Malaysia. Parasit Vectors 2012; 5:187. [PMID: 22947430 PMCID: PMC3453490 DOI: 10.1186/1756-3305-5-187] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Accepted: 08/17/2012] [Indexed: 11/10/2022] Open
Abstract
Background In this study, a total of 426 human faecal samples were examined for the presence of Entamoeba histolytica, Entamoeba dispar, Entamoeba moshkovskii infection via a combination of microscopic examination and nested polymerase chain reaction (PCR) targeting 16S ribosomal RNA of Entamoeba species. Methods Faecal sample were collected from 426 participants in five rural villages in Peninsular Malaysia. The faecal samples were processed by direct wet smear and formalin ethyl acetate concentration technique followed by iodine staining and examined via microscopy for the presence of Entamoeba species and other intestinal parasites. Microscopically positive samples for Entamoeba species cysts were further characterized using a Nested Polymerase Chain Reaction (Nested-PCR) targeting 16S-like ribosomal RNA gene. The data entry and analysis was carried out using the SPSS software (Statistical Package for the Social Sciences) program for Windows version 17 (SPSS, Chicago, IL, USA). Results Based on single faecal examination, overall prevalence of Entamoeba infection was 17.6% (75/426). Females (19.1%) were more commonly infected compared to males (15.9%). Comparison by age groups showed that adults (23.9%) had higher infection rates than children (15.3%). The PCR results showed that 52 out of 75 microscopy positive samples successfully generated species-specific amplicons. The infection with E. histolytica (75.0%; 39/52) was the most common, followed by E. dispar (30.8%; 18/52) and E. moshkovskii (5.8%; 3/52). Of these, 33 (63.5%) were shown to contain only E. histolytica, 10 (19.2%) contained E. dispar and 3 (5.8%) contained only E. moshkovskii. Mixed infection with E. histolytica and E. dispar was found in 6 (11.5%) samples. Conclusions The present study essentially emphasized the benefit of molecular techniques in discriminating the pathogenic Entamoeba species from the non-pathogenic for accurate diagnosis and better management of amoebiasis. The presence of E. moshkovskii is of great public health concern as it was the first time it has been reported in Malaysia.
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Affiliation(s)
- Romano Ngui
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
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35
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Fletcher SM, Stark D, Harkness J, Ellis J. Enteric protozoa in the developed world: a public health perspective. Clin Microbiol Rev 2012; 25:420-49. [PMID: 22763633 PMCID: PMC3416492 DOI: 10.1128/cmr.05038-11] [Citation(s) in RCA: 241] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Several enteric protozoa cause severe morbidity and mortality in both humans and animals worldwide. In developed settings, enteric protozoa are often ignored as a cause of diarrheal illness due to better hygiene conditions, and as such, very little effort is used toward laboratory diagnosis. Although these protozoa contribute to the high burden of infectious diseases, estimates of their true prevalence are sometimes affected by the lack of sensitive diagnostic techniques to detect them in clinical and environmental specimens. Despite recent advances in the epidemiology, molecular biology, and treatment of protozoan illnesses, gaps in knowledge still exist, requiring further research. There is evidence that climate-related changes will contribute to their burden due to displacement of ecosystems and human and animal populations, increases in atmospheric temperature, flooding and other environmental conditions suitable for transmission, and the need for the reuse of alternative water sources to meet growing population needs. This review discusses the common enteric protozoa from a public health perspective, highlighting their epidemiology, modes of transmission, prevention, and control. It also discusses the potential impact of climate changes on their epidemiology and the issues surrounding waterborne transmission and suggests a multidisciplinary approach to their prevention and control.
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Affiliation(s)
| | - Damien Stark
- School of Medical and Molecular Biosciences, University of Technology Sydney, Sydney, NSW, Australia
- St. Vincent's Hospital, Sydney, Division of Microbiology, SydPath, Darlinghurst, NSW, Australia
| | - John Harkness
- School of Medical and Molecular Biosciences, University of Technology Sydney, Sydney, NSW, Australia
- St. Vincent's Hospital, Sydney, Division of Microbiology, SydPath, Darlinghurst, NSW, Australia
| | - John Ellis
- The ithree Institute, University of Technology Sydney, Sydney, NSW, Australia
- School of Medical and Molecular Biosciences, University of Technology Sydney, Sydney, NSW, Australia
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36
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Prim N, Escamilla P, Solé R, Llovet T, Soriano G, Muñoz C. Risk of underdiagnosing amebic dysentery due to false-negative Entamoeba histolytica antigen detection. Diagn Microbiol Infect Dis 2012; 73:372-3. [PMID: 22683092 DOI: 10.1016/j.diagmicrobio.2012.04.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 04/25/2012] [Accepted: 04/30/2012] [Indexed: 11/26/2022]
Abstract
Entamoeba histolytica antigen assays on stool are widely used to diagnose amebiasis. We report a case of confirmed amebic colitis with a false-negative antigen detection that became positive after treatment. Our results indicate that these assays may underdiagnose acute amebic infection when used alone and should be used cautiously.
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Affiliation(s)
- Núria Prim
- Servei de Microbiologia, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain
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37
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Foo PC, Chan YY, See Too WC, Tan ZN, Wong WK, Lalitha P, Lim BH. Development of a thermostabilized, one-step, nested, tetraplex PCR assay for simultaneous identification and differentiation of Entamoeba species, Entamoeba histolytica and Entamoeba dispar from stool samples. J Med Microbiol 2012; 61:1219-1225. [PMID: 22556327 DOI: 10.1099/jmm.0.044552-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Entamoeba histolytica is the only Entamoeba species that causes amoebiasis in humans. Approximately 50 million people are infected, with 100, 000 deaths annually in endemic countries. Molecular diagnosis of Entamoeba histolytica is important to differentiate it from the morphologically identical Entamoeba dispar to avoid unnecessary medication. Conventional molecular diagnostic tests require trained personnel, cold-chain transportation and/or are storage-dependent, which make them user-unfriendly. The aim of this study was to develop a thermostabilized, one-step, nested, tetraplex PCR assay for the detection of Entamoeba histolytica, Entamoeba dispar and Entamoeba species in cold-chain-free and ready-to-use form. The PCR test was designed based on the Entamoeba small subunit rRNA (SSU-rRNA) gene, which detects the presence of any Entamoeba species, and simultaneously can be used to differentiate Entamoeba histolytica from Entamoeba dispar. In addition, a pair of primers was designed to serve as an internal amplification control to help identify inhibitors in the samples. All PCR reagents together with the designed primers were thermostabilized by lyophilization and were stable at 24 °C for at least 6 months. The limit of detection of the tetraplex PCR was found to be 39 pg DNA or 1000 cells for Entamoeba histolytica and 78 pg DNA or 1000 cells for Entamoeba dispar, and the specificity was 100 %. In conclusion, this cold-chain-free, thermostabilized, one-step, nested, multiplex PCR assay was found to be efficacious in differentiating Entamoeba histolytica from other non-pathogenic Entamoeba species.
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Affiliation(s)
- Phiaw Chong Foo
- School of Health Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Yean Yean Chan
- Department of Medical Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Wei Cun See Too
- School of Health Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Zi Ning Tan
- School of Health Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Weng Kin Wong
- School of Health Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Pattabhiraman Lalitha
- Department of Biotechnology, Faculty of Applied Sciences, AIMST University, Semeling, 08100 Bedong, Kedah, Malaysia
| | - Boon Huat Lim
- School of Health Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
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38
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Intestinal parasitic infections in an industrialized country; a new focus on children with better DNA-based diagnostics. Parasitology 2011; 138:1492-8. [PMID: 21859503 DOI: 10.1017/s0031182011001211] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
In recent years, the isolation of parasitic DNA from faecal samples and PCR techniques, have been improved and simplified. Moreover, the introduction of real-time PCR has made it possible to multiplex different targets into one reaction. These new technical possibilities make it feasible to introduce PCR with its unsurpassed sensitivity and specificity in a routine laboratory setting for the diagnosis of intestinal parasites. Detection rates of the parasitic infections included in the PCR are increased significantly compared with microscopy. Molecular diagnostics, especially in children, reveal a possible cause of the gastrointestinal complaints in many more cases compared with conventional methods. Usually in GP patients no other pathogenic parasites are detected using microscopy and in the returning travellers additional parasites are found with microscopy in a minority of cases only. Multiplex real-time PCR offers a highly sensitive and specific diagnostic alternative for labour intensive microscopy in clinical laboratory practice. Additional diagnostic methods for the detection of parasitic infections that are not included as PCR target can be limited to a selected group of patients.
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39
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Molecular Diagnosis of Gastrointestinal Infections. Mol Microbiol 2011. [DOI: 10.1128/9781555816834.ch48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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40
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Ximénez C, Morán P, Rojas L, Valadez A, Gómez A, Ramiro M, Cerritos R, González E, Hernández E, Oswaldo P. Novelties on amoebiasis: a neglected tropical disease. J Glob Infect Dis 2011; 3:166-74. [PMID: 21731305 PMCID: PMC3125031 DOI: 10.4103/0974-777x.81695] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
In accordance with the 1997 documents of the World Health Organization (WHO), amoebiasis is defined as the infection by the protozoan parasite Entamoeba histolytica with or without clinical manifestations. The only known natural host of E. histolytica is the human with the large intestine as major target organ. This parasite has a very simple life cycle in which the infective form is the cyst, considered a resistant form of parasite: The asymptomatic cyst passers and the intestinal amoebiasis patients are the transmitters; they excrete cysts in their feces, which can contaminate food and water sources. E. histolytica sensu stricto is the potentially pathogenic species and E. dispar is a commensal non-pathogenic Entamoeba. Both species are biochemical, immunological and genetically distinct. The knowledge of both species with different pathogenic phenotypes comes from a large scientific debate during the second half of the 20(th) century, which gave place to the rapid development of diagnostics technology based on molecular and immunological strategies. During the last ten years, knowledge of the new epidemiology of amoebiasis in different geographic endemic and non-endemic areas has been obtained by applying mostly molecular techniques. In the present work we highlight novelties on human infection and the disease that can help the general physician from both endemic and non-endemic countries in their medical practice, particularly, now that emigration is undoubtedly a global phenomenon that is modifying the previous geography of infectious diseases worldwide.
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Affiliation(s)
- Cecilia Ximénez
- Department of Experimental Medicine, Faculty of Medicine, National Autonomous University of Mexico (UNAM), Mexico City, Mexico
| | - Patricia Morán
- Department of Experimental Medicine, Faculty of Medicine, National Autonomous University of Mexico (UNAM), Mexico City, Mexico
| | - Liliana Rojas
- Department of Experimental Medicine, Faculty of Medicine, National Autonomous University of Mexico (UNAM), Mexico City, Mexico
| | - Alicia Valadez
- Department of Experimental Medicine, Faculty of Medicine, National Autonomous University of Mexico (UNAM), Mexico City, Mexico
| | - Alejandro Gómez
- Unit of Medical Researches in Infection and Parasite Diseases, Pediatric Hospital, Mexican Institute of Social Security (IMSS), Mexico City, Mexico
| | - Manuel Ramiro
- Unit of Education, Scientific Research and Health Policy; Direction of Medical Benefits, Mexican Institute of Social Security (IMSS), Mexico City, Mexico
| | - René Cerritos
- Department of Experimental Medicine, Faculty of Medicine, National Autonomous University of Mexico (UNAM), Mexico City, Mexico
| | - Enrique González
- Department of Experimental Medicine, Faculty of Medicine, National Autonomous University of Mexico (UNAM), Mexico City, Mexico
| | - Eric Hernández
- Department of Experimental Medicine, Faculty of Medicine, National Autonomous University of Mexico (UNAM), Mexico City, Mexico
| | - Partida Oswaldo
- Department of Experimental Medicine, Faculty of Medicine, National Autonomous University of Mexico (UNAM), Mexico City, Mexico
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Taniuchi M, Verweij JJ, Noor Z, Sobuz SU, Lieshout LV, Petri WA, Haque R, Houpt ER. High throughput multiplex PCR and probe-based detection with Luminex beads for seven intestinal parasites. Am J Trop Med Hyg 2011; 84:332-7. [PMID: 21292910 DOI: 10.4269/ajtmh.2011.10-0461] [Citation(s) in RCA: 144] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Polymerase chain reaction (PCR) assays for intestinal parasites are increasingly being used on fecal DNA samples for enhanced specificity and sensitivity of detection. Comparison of these tests against microscopy and copro-antigen detection has been favorable, and substitution of PCR-based assays for the ova and parasite stool examination is a foreseeable goal for the near future. One challenge is the diverse list of protozoan and helminth parasites. Several existing real-time PCR assays for the major intestinal parasites-Cryptosporidium spp., Giardia intestinalis, Entamoeba histolytica, Ancylostoma duodenale, Ascaris lumbricoides, Necator americanus, and Strongyloides stercoralis-were adapted into a high throughput protocol. The assay involves two multiplex PCR reactions, one with specific primers for the protozoa and one with specific primers for the helminths, after which PCR products are hybridized to beads linked to internal oligonucleotide probes and detected on a Luminex platform. When compared with the parent multiplex real-time PCR assays, this multiplex PCR-bead assay afforded between 83% and 100% sensitivity and specificity on a total of 319 clinical specimens. In conclusion, this multiplex PCR-bead protocol provides a sensitive diagnostic screen for a large panel of intestinal parasites.
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Affiliation(s)
- Mami Taniuchi
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA22908, USA.
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Identification and delineation of members of the Entamoeba complex by pyrosequencing. Mol Cell Probes 2010; 24:403-6. [DOI: 10.1016/j.mcp.2010.07.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 06/22/2010] [Accepted: 07/22/2010] [Indexed: 11/19/2022]
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Abstract
PURPOSE OF REVIEW To update the reader on the latest developments in the laboratory diagnosis of intestinal protozoa. RECENT FINDINGS Correct identification of a diarrhoea causing pathogens is essential for the choice of treatment in an individual patient as well as to map the aetiology of diarrhoea in a variety of patient populations. Classical diagnosis of diarrhoea causing protozoa by microscopic examination of a stool sample lacks both sensitivity and specificity. Alternative diagnostic platforms are discussed. SUMMARY Recent literature on the diagnosis of intestinal protozoa has focused mainly on nucleic acid-based assays, in particular the specific detection of parasite DNA in stool samples using real-time PCR. In addition, the trend has been moving from single pathogen detection to a multiplex approach, allowing simultaneous identification of multiple parasites. Different combinations of targets can be used within a routine diagnostic setting, depending on the patient population, such as children, immunocompromised individuals and those who have been travelling to tropical regions. Large-scale monitoring and evaluation of control strategies become feasible due to automation and high-throughput facilities. Improved technology also has become available for differentiating protozoa subspecies, which facilitates outbreak investigations and extensive research in molecular epidemiology.
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Gutiérrez-Cisneros MJ, Cogollos R, López-Vélez R, Martín-Rabadán P, Martínez-Ruiz R, Subirats M, Merino FJ, Fuentes I. Application of real-time PCR for the differentiation of Entamoeba histolytica and E. dispar in cyst-positive faecal samples from 130 immigrants living in Spain. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 2010; 104:145-9. [PMID: 20406581 DOI: 10.1179/136485910x12607012373759] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In an effort to improve the diagnosis of intestinal amoebiasis, a real-time PCR has been used for the detection and differentiation of Entamoeba histolytica and E. dispar infections in African or South American immigrants who live in Spain. Faecal samples from all of the 130 subjects had apparently been found to contain E. histolytica/E. dispar cysts by microscopical examination. Using the real-time PCR, E. histolytica DNA was detected in faecal samples from only 10 (7.7%) of the immigrants, with E. dispar DNA detected in the samples from another 117 (90.0%) of the subjects. The use of such PCR in the routine investigation of patients found positive for E. histolytica/E. dispar cysts (by microscopy) is recommended, especially in non-endemic areas.
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Affiliation(s)
- M J Gutiérrez-Cisneros
- Servicio de Parasitología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain.
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Cnops L, Esbroeck MV. Freezing of stool samples improves real-time PCR detection of Entamoeba dispar and Entamoeba histolytica. J Microbiol Methods 2010; 80:310-2. [DOI: 10.1016/j.mimet.2010.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Revised: 12/30/2009] [Accepted: 01/04/2010] [Indexed: 10/20/2022]
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Rivero Z, Bracho A, Calchi M, Díaz I, Acurero E, Maldonado A, Chourio G, Arráiz N, Corzo G. [Detection and differentiation of Entamoeba histolytica and Entamoeba dispar by polymerase chain reaction in a community in Zulia State, Venezuela]. CAD SAUDE PUBLICA 2009; 25:151-9. [PMID: 19180297 DOI: 10.1590/s0102-311x2009000100016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2008] [Accepted: 07/01/2008] [Indexed: 11/22/2022] Open
Abstract
Differential identification of Entamoeba histolytica and Entamoeba dispar is essential for both appropriate patient treatment and epidemiological purposes. To determine the prevalence of these amoeba infections in Santa Rosa de Agua (Maracaibo, Zulia State, Venezuela), a PCR assay using specific primers for each species was standardized and applied. 204 stool samples were analyzed through direct microscopic examination with SSF (0.85%) and lugol, formol-ether concentration, and PCR. Under direct microscopy, 42 individuals (20.58%) presented the E. histolytica/E. dispar complex. Meanwhile PCR showed 47 positive cases for these amoebas: 22 E. histolytica (10.78%), 16 E. dispar (7.84%), and 9 (4.41%) mixed infections. There was no significant difference in the presence of E. histolytica and/or E. dispar according to either gender or age. There were no cases of these amoebas in children under 2 years of age. Observed frequency of E. histolytica (31/204) shows the endemic nature of amoeba infection in this community.
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Affiliation(s)
- Zulbey Rivero
- Escuela de Bioanálisis, Universidad del Zulia, Maracaibo, Venezuela.
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Singh A, Houpt E, Petri WA. Rapid Diagnosis of Intestinal Parasitic Protozoa, with a Focus on Entamoeba histolytica. Interdiscip Perspect Infect Dis 2009; 2009:547090. [PMID: 19584941 PMCID: PMC2703877 DOI: 10.1155/2009/547090] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2009] [Accepted: 03/30/2009] [Indexed: 11/18/2022] Open
Abstract
Entamoeba histolytica is an invasive intestinal pathogenic parasitic protozoan that causes amebiasis. It must be distinguished from Entamoeba dispar and E. moshkovskii, nonpathogenic commensal parasites of the human gut lumen that are morphologically identical to E. histolytica. Detection of specific E. histolytica antigens in stools is a fast, sensitive technique that should be considered as the method of choice. Stool real-time PCR is a highly sensitive and specific technique but its high cost make it unsuitable for use in endemic areas where there are economic constraints. Serology is an important component of the diagnosis of intestinal and especially extraintestinal amebiasis as it is a sensitive test that complements the detection of the parasite antigens or DNA. Circulating Gal/GalNac lectin antigens can be detected in the serum of patients with untreated amoebic liver abscess. On the horizon are multiplex real-time PCR assays which permit the identification of multiple enteropathogens with high sensitivity and specificity.
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Affiliation(s)
- Anjana Singh
- University of Virginia, Charlottesville, P.O. Box 801340, VA 22908-1340, USA
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Eric Houpt
- University of Virginia, Charlottesville, P.O. Box 801340, VA 22908-1340, USA
| | - William A. Petri
- University of Virginia, Charlottesville, P.O. Box 801340, VA 22908-1340, USA
- Infectious Diseases and International Health, University of Virginia, MR4 Building, Health System, Charlottesville, VA 22908-1340, USA
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ten Hove RJ, van Esbroeck M, Vervoort T, van den Ende J, van Lieshout L, Verweij JJ. Molecular diagnostics of intestinal parasites in returning travellers. Eur J Clin Microbiol Infect Dis 2009; 28:1045-53. [PMID: 19415354 PMCID: PMC2758195 DOI: 10.1007/s10096-009-0745-1] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Accepted: 03/31/2009] [Indexed: 11/15/2022]
Abstract
A new diagnostic strategy was assessed for the routine diagnosis of intestinal parasites in returning travellers and immigrants. Over a period of 13 months, unpreserved stool samples, patient characteristics and clinical data were collected from those attending a travel clinic. Stool samples were analysed on a daily basis by microscopic examination and antigen detection (i.e. care as usual), and compared with a weekly performed multiplex real-time polymerase chain reaction (PCR) analysis on Entamoeba histolytica, Giardia lamblia, Cryptosporidium and Strongyloides stercoralis. Microscopy and antigen assays of 2,591 stool samples showed E. histolytica, G. lamblia, Cryptosporidium and S. stercoralis in 0.3, 4.7, 0.5 and 0.1% of the cases, respectively. These detection rates were increased using real-time PCR to 0.5, 6.0, 1.3 and 0.8%, respectively. The prevalence of ten additional pathogenic parasite species identified with microscopy was, at most, 0.5%. A pre-selective decision tree based on travel history or gastro-intestinal complaints could not be made. With increased detection rates at a lower workload and the potential to extend with additional parasite targets combined with fully automated DNA isolation, molecular high-throughput screening could eventually replace microscopy to a large extent.
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Affiliation(s)
- R J ten Hove
- Department of Parasitology, Leiden University Medical Centre, P.O. Box 9600, Leiden 2300 RC, The Netherlands
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Graillet R, Sánchez-Aguilar M, Morán-Mendoza AO, Hernández-Sierra JF, Gordillo-Moscoso A, Tapia-Pérez JH. [Analysis of factors associated to failure of medical treatment of amoebic liver abscess]. Cir Esp 2009; 84:83-6. [PMID: 18682186 DOI: 10.1016/s0009-739x(08)72139-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION To identify the laboratory and ultrasound factors that could predict the response to medical treatment of amoebic liver abscess. MATERIAL AND METHOD Retrospective study of patients diagnosis with amoebic liver abscess in Hospital Central in San Luis Potosí, Mexico. We included patients greater than 15 years of both sexes. We excluded those with probable pyogenic abscess, immunosupression, history of abdominal or biliary surgery, abdominal neoplasm abdominal or sepsis. We identified patients with good response to medical treatment and patients who needed the abscess drained. We studied the ultrasound findings, plasma levels of albumin, alkaline phosphatase and bilirubin. RESULTS We analysed 45 patients, 31 had a good response (controls) and 14 needed drainage (cases). The medians of the variables with statistical significance in bivariate analysis were: albumin 2.65 g/dl and 1.7 g/dl (p < 0.001); alkaline phosphatase 133 U and 259 U (p = 0.02) and diameter of absences 5.9 cm and 9.95 cm (p < 0.001), controls and cases respectively. By logistic regression the diameter of the abscess showed a determination coefficient of 0.447 (p < 0.05) and OR = 14.85 (95% CI, 2.11-104.9) for drain if it was > or = 8 cm. CONCLUSIONS A diameter bigger than 8 cm in hepatic amoebic abscess is associated with failure of medical treatment. Low albumin could be related to malnutrition and increased alkaline phosphatase with extrinsic compression of extrahepatic conducts due to big abscesses.
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Affiliation(s)
- Rogelio Graillet
- Cirugía Experimental. Facultad de Medicina. Universidad Autónoma de San Luis Potosí. San Luis Potosí. SLP. México
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Tan KSW. New insights on classification, identification, and clinical relevance of Blastocystis spp. Clin Microbiol Rev 2008; 21:639-65. [PMID: 18854485 PMCID: PMC2570156 DOI: 10.1128/cmr.00022-08] [Citation(s) in RCA: 443] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
SUMMARY Blastocystis is an unusual enteric protozoan parasite of humans and many animals. It has a worldwide distribution and is often the most commonly isolated organism in parasitological surveys. The parasite has been described since the early 1900s, but only in the last decade or so have there been significant advances in our understanding of Blastocystis biology. However, the pleomorphic nature of the parasite and the lack of standardization in techniques have led to confusion and, in some cases, misinterpretation of data. This has hindered laboratory diagnosis and efforts to understand its mode of reproduction, life cycle, prevalence, and pathogenesis. Accumulating epidemiological, in vivo, and in vitro data strongly suggest that Blastocystis is a pathogen. Many genotypes exist in nature, and recent observations indicate that humans are, in reality, hosts to numerous zoonotic genotypes. Such genetic diversity has led to a suggestion that previously conflicting observations on the pathogenesis of Blastocystis are due to pathogenic and nonpathogenic genotypes. Recent epidemiological, animal infection, and in vitro host-Blastocystis interaction studies suggest that this may indeed be the case. This review focuses on such recent advances and also provides updates on laboratory and clinical aspects of Blastocystis spp.
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Affiliation(s)
- Kevin S W Tan
- Department of Microbiology, Laboratory of Molecular and Cellular Parasitology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore.
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