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Gupta P, Singh KK, Balodhi A, Jain K, Deeba F, Salam N. Prevalence of Amoebiasis and Associated Complications in India: A Systematic Review. Acta Parasitol 2022; 67:947-961. [PMID: 35404011 DOI: 10.1007/s11686-022-00547-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 03/21/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Intestinal protozoan parasites are responsible for diarrheal diseases causing significant morbidity and mortality. Entamoeba histolytica is the principle protozoan parasite associated with diarrheal infections. The infection is often associated with inaccessibility to clean drinking water and poor sanitary conditions in low- and middle-income countries including India. A comprehensive systematic review was performed to evaluate a reliable nationwide estimate for prevalence and geographic distribution of amoebiasis in India and the complications associated with it. METHODS We used the PRISMA guidelines to perform a systematic review and meta-analysis of articles published between the year 2001-2020. Two English language databases PubMed and Web of Science were searched to achieve relevant studies. RESULTS Initial searches resulted in 467 studies out of which 64 eligible articles involving data from 289,659 human subjects from 12 states and 4 union territories were included in the final analysis. Prevalence of amoebiasis ranged from 3-23% in asymptomatic population, 0.64-11% in symptomatic patients and 1-17.5% in HIV-infected patients. Highest prevalence was seen in Tamil Nadu, Andaman Nicobar Island and North East India. Extra intestinal invasion of Entamoeba histolytica leading to complications such as amoebic liver abscess, amoebic colitis, colonic perforation and ameboma were also reported. Such complications have the potential to increase healthcare burden and may prove to be fatal. CONCLUSION Amoebiasis remains a significant public health issue in India responsible for diarrheal diseases causing significant morbidity and mortality. Entamoeba histolytica is the principle protozoan parasite associated with amoebiasis. Public health efforts should be directed towards its control and better diagnostic methods should be employed for distinguishing between pathogenic and non-pathogenic species of Entamoeba.
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Affiliation(s)
- Palak Gupta
- Department of Microbiology, Central University of Punjab, Bathinda, Punjab, 151401, India
| | - Kiran Kumari Singh
- Department of Geography, Central University of Punjab, Bathinda, Punjab, 151401, India
| | - Ashutosh Balodhi
- Department of Microbiology, Central University of Punjab, Bathinda, Punjab, 151401, India
| | - Khushi Jain
- Department of Microbiology, Central University of Punjab, Bathinda, Punjab, 151401, India
| | - Farah Deeba
- Centre for Interdisciplinary Research in Basic Sciences, Jamia Millia Islamia, New Delhi, 110025, India
| | - Nasir Salam
- Department of Microbiology, Central University of Punjab, Bathinda, Punjab, 151401, India.
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Epidemiology of clinically relevant Entamoeba spp. (E. histolytica/dispar/moshkovskii/bangladeshi): A cross sectional study from North India. PLoS Negl Trop Dis 2021; 15:e0009762. [PMID: 34492023 PMCID: PMC8448324 DOI: 10.1371/journal.pntd.0009762] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/17/2021] [Accepted: 08/25/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Entamoeba infections have major impact on millions of the people worldwide. Entamoeba histolytica has long been accepted as the only pathogenic species. However, recent reports of other Entamoeba spp. in symptomatic cases have raised questions on their pathogenicity. METHODOLOGY/PRINCIPAL FINDINGS Total 474 stool samples and 125 liver aspirates from patients with intestinal and extra intestinal manifestations and from community were included. Sewage samples from the hospital and the city were also included. Microscopic examination and molecular detection were performed to detect presence of E. histolytica/ dispar/ moshkovskii/ bangladeshi. The associated demographic and socioeconomic factors were statistically analyzed with the presence of Entamoeba. Microscopy detected Entamoeba spp. in 5.4% stool and 6.4% liver aspirate samples. Through nested multiplex PCR, prevalence of Entamoeba spp. in intestinal and extra-intestinal cases was 6.6% (20/301) and 86.4% (108/125) respectively and in asymptomatic population was 10.5% (13/123). Sewage samples did not show presence of any Entamoeba spp. Uneducated subjects, low economic conditions, untreated drinking water, consumption of raw vegetables and habit of not washing hands before meals were significantly associated with presence of Entamoeba spp. CONCLUSIONS E. histolytica still remains the only Entamoeba spp. in invasive extra intestinal infections. E. dispar was detected in both asymptomatic and symptomatic intestinal infections. Routine identification of Entamoeba spp. should incorporate PCR based detection methods.
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Liver Abscess in Children-experience From a Single Tertiary Care Center of North India: Etiology, Clinical Profile and Predictors of Complications. Pediatr Infect Dis J 2021; 40:e179-e184. [PMID: 33847292 DOI: 10.1097/inf.0000000000003053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Liver abscess (LA), a common problem in children in the tropics, is believed to be mostly pyogenic (PLA), sometimes amebic (ALA). We aimed to analyze the clinical profile, etiology, risk factors for complications, management and outcomes of LA in children. METHODS The details of 81 children with LA managed in a tertiary set up over a period of 3 years were analyzed. A comparison of different parameters was performed with respect to etiology and complications. RESULTS ALA, PLA and mixed infection LA were diagnosed in 40 (49.4%), 32 (39.5%) and 9 (11.1%) children. The triad of fever, hepatomegaly and right upper quadrant tenderness was seen in 65 (80.2%). Coagulopathy was observed in 60 (77%) and jaundice in 12 (14.8%). Majority (71.6%) had a single LA in the right lobe (69%). Conservative, percutaneous needle aspiration, percutaneous catheter drainage and surgical drainage were done in 11.1%, 3.7%, 82.7% and 2.5%, respectively. Forty-three (53.1%) had complicated LA with rupture in 55.8% and vascular thrombosis in 16.2%. Children with complicated LA had higher alanine transaminase, prolonged prothrombin time/international normalized ratio, low serum protein and albumin levels (P < 0.05). Median duration of follow-up was 2 months and mean time to resolution of LA was 48.5 ± 18 days. CONCLUSIONS ALA is the commonest cause of pediatric LA in endemic regions and is difficult to differentiate from PLA clinically. Percutaneous catheter drainage is safe and effective modality for the management of LA in children. A higher alanine transaminase, prolonged prothrombin time/international normalized ratio and low serum albumin levels (<3 g/dL) at presentation identify complicated LA.
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Atabati H, Kassiri H, Shamloo E, Akbari M, Atamaleki A, Sahlabadi F, Linh NTT, Rostami A, Fakhri Y, Khaneghah AM. The association between the lack of safe drinking water and sanitation facilities with intestinal Entamoeba spp infection risk: A systematic review and meta-analysis. PLoS One 2020; 15:e0237102. [PMID: 33147225 PMCID: PMC7641376 DOI: 10.1371/journal.pone.0237102] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Intestinal protozoa infections are responsible for considerable morbidity and mortality, especially where the exposed population suffers from a lack of drinking water and sanitation facilities. In this study, the association between the lack of safe drinking water and sanitation (toilet) facilities with intestinal Entamoeba spp infection in the children (5-11 years), adult (18-55 years), and all age (5-55 years) were assessed. For this purpose, some of the international databases such as Scopus, PubMed, Web of Science, and Embase were screened to up to 7 June 2019 in order to retrieve the related citations. Also, the pooled odds ratios (ORs) following 95% confidence intervals (CIs) were calculated using a random-effects model. Twenty-nine articles with 36 studies were included while the OR extracted or calculated by using 2 × 2 contingency tables. However, the ingestion of contaminated water insignificantly can increase the odds ratio (OR) of Entamoeba spp infection (OR 1.01, (95% confidence interval [CI] 0.58 to 1.43), no access to sanitation (toilet) facilities significantly can increase odds of Entamoeba spp infection (OR 1.18, 95% CI 1.05 to 1.32). The meta-regression analysis showed that over time, odds of intestinal Entamoeba spp infection increased in both lack of safe drinking water (Coefficient: 3.24, P-value < 0.01) and sanitation (toilet) facilities (Coefficient: 2.36, P-value < 0.05) subgroups. Considering the findings, lack of safe drinking water resulted in a further increase in intestinal Entamoeba spp infection among adult (OR: 2.76), children (OR = 0.57) and all age groups (OR: 1.50), and also lack of sanitation (toilet) facilities resulted in further increase intestinal Entamoeba spp infection in children (OR: 1.06), adult (OR: 1.26) and all age (OR: 1.16). In this context, the lack of safe drinking water and sanitation facilities (toilet) was associated with a high risk of intestinal Entamoeba spp infection. Further attempts to providing public health facilities can control the prevalence of intestinal Entamoeba spp.
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Affiliation(s)
- Hamid Atabati
- Department of the environment faculty of fishery and environment, Gorgan University of agriculture and natural resources sciences, Golestan Province, Gorgan, Iran
| | - Hamid Kassiri
- Department of Medical Entomology, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ehsan Shamloo
- Noncommunicable Diseases Research Center, Department of Food Science and Technology, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Mitra Akbari
- Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Science, Rasht, Iran
| | - Ali Atamaleki
- Department of Environmental Health Engineering, Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Sahlabadi
- Department of Environmental Health Engineering, Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nguyen Thi Thuy Linh
- Institute of Research and Development, Duy Tan University, Danang, Vietnam
- Faculty of Environmental and Chemical Engineering, Duy Tan University, Danang, Vietnam
| | - Ali Rostami
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Yadolah Fakhri
- Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Amin Mousavi Khaneghah
- Department of Food Science, Faculty of Food Engineering, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
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Tharmaratnam T, Kumanan T, Iskandar MA, D’Urzo K, Gopee-Ramanan P, Loganathan M, Tabobondung T, Tabobondung TA, Sivagurunathan S, Patel M, Tobbia I. Entamoeba histolytica and amoebic liver abscess in northern Sri Lanka: a public health problem. Trop Med Health 2020; 48:2. [PMID: 31992948 PMCID: PMC6977265 DOI: 10.1186/s41182-020-0193-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 01/16/2020] [Indexed: 12/25/2022] Open
Abstract
Entamoeba histolytica (E. histolytica) is a facultative protozoan parasite implicated in amoebic liver abscesses (ALA), the most common extraintestinal manifestation of this infection. E. histolytica is endemic to sub-tropical and tropical countries and has been a major public health concern in northern Sri Lanka (SLK) for the last three decades. This has been attributed to a multitude of factors such as poor sanitation, hygiene, male sex, middle age, overcrowding, unsanitary practices in the production of indigenous alcoholic beverages, and alcohol consumption. Additionally, while rates of E. histolytica have declined substantially throughout the rest of the island, largely due to better infrastructure, it remains pervasive in the northern peninsula, which is generally less developed. Infection arises primarily from fecal-oral transmission through the consumption of contaminated drinking water containing cysts. Upon ingestion, cysts multiply into trophozoites and colonize the host colonic mucosa using lectin and cysteine proteases as virulence factors, leading to host invasion. Symptoms occur along a spectrum, from asymptomatology, to pyrexia, abdominal cramping, and amoebic dysentery. Colonization of the colon results in the formation of distinct flask-shaped ulcers along the epithelium, and eventual penetration of the lamina propria via the production of matrix metalloproteinases. ALA then develops through trophozoite migration via the mesenteric hepatic portal circulation, where microabscesses coalesce to form a single, large right-lobe abscess, commonly on the posterior aspect. The progression of infection to invasive disease is contingent on the unique interplay between host and pathogen factors, such as the strength of host-immunity to overcome infection and inherent pathogenicity of the Entamoeba species. As a preventable illness, E. histolytica complications such as ALA impose a significant burden on the healthcare system. This mini-review highlights epidemiological trends, risk factors, diagnostic modalities, treatment approaches, and opportunities for prevention of E. histolytica-induced ALA, to help address this endemic problem on the island of SLK.
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Affiliation(s)
- Tharmegan Tharmaratnam
- School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- School of Medicine, Royal College of Surgeons in Ireland-Bahrain, Busaiteen, Bahrain
| | - Thirunavukarasu Kumanan
- Department of Internal Medicine, Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka
- Teaching Hospital Jaffna, Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka
| | - Mina Amin Iskandar
- School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- School of Medicine, Royal College of Surgeons in Ireland-Bahrain, Busaiteen, Bahrain
| | - Katrina D’Urzo
- School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Prasaanthan Gopee-Ramanan
- Department of Diagnostic Radiology, Hamilton Health Sciences Centre, Hamilton, ON Canada
- Department of Radiology, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON Canada
| | - Mayura Loganathan
- Academic Family Health Team, Mount Sinai Hospital, Faculty of Medicine, University of Toronto, Toronto, ON Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON Canada
| | - Tyler Tabobondung
- Department of Family Medicine, Brantford General Hospital, Hamilton, ON Canada
- Department of Family Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON Canada
| | | | - Seyon Sivagurunathan
- Department of Family Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON Canada
- Stonechurch Family Health Clinic, Department of Family Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON Canada
| | - Mitul Patel
- School of Medicine, Royal College of Surgeons in Ireland-Bahrain, Busaiteen, Bahrain
| | - Iqdam Tobbia
- School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- School of Medicine, Royal College of Surgeons in Ireland-Bahrain, Busaiteen, Bahrain
- Department of Pathology and Clinical Microbiology, School of Medicine, Royal College of Surgeons in Ireland-Bahrain, Busaiteen, Bahrain
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Cui Z, Li J, Chen Y, Zhang L. Molecular epidemiology, evolution, and phylogeny of Entamoeba spp. INFECTION GENETICS AND EVOLUTION 2019; 75:104018. [PMID: 31465857 DOI: 10.1016/j.meegid.2019.104018] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 08/20/2019] [Accepted: 08/22/2019] [Indexed: 01/11/2023]
Abstract
Entamoeba histolytica is a protozoan parasite and the causative agent of amoebiasis in humans. The estimations of the worldwide burden of amoebiasis by the WHO indicated that approximately 500 million people were infected with the parasite and 10% of these individuals had invasive amoebiasis. However, our understanding of the disease burden and epidemiology of human amebiasis has undergone dramatic changes over the last two decades based on molecular analyses. The development of Entamoeba genomics has also provided some interesting and valuable information on the evolution and population structure of this parasite. In addition, the use of a number of molecular markers has greatly expanded our understanding of Entamoeba host range and genetic diversity. In this review, we re-assessed Entamoeba prevalence and species in humans, non-human primates, other animals, and the environment in the context of molecular data. Some issues regarding the evolution and phylogeny of different Entamoeba species lineages are also discussed.
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Affiliation(s)
- Zhaohui Cui
- College of Animal Science and Veterinary Medicine, Henan Agricultural University, Zhengzhou 450002, China; National International Joint Research Center for Veterinary Immunology, Zhengzhou, China
| | - Junqiang Li
- College of Animal Science and Veterinary Medicine, Henan Agricultural University, Zhengzhou 450002, China; National International Joint Research Center for Veterinary Immunology, Zhengzhou, China; Scientific Research Experiment Center & Laboratory Animal Center, Henan University of Chinese Medicine, Zhengzhou 450046, China
| | - Yuancai Chen
- College of Animal Science and Veterinary Medicine, Henan Agricultural University, Zhengzhou 450002, China; National International Joint Research Center for Veterinary Immunology, Zhengzhou, China
| | - Longxian Zhang
- College of Animal Science and Veterinary Medicine, Henan Agricultural University, Zhengzhou 450002, China; National International Joint Research Center for Veterinary Immunology, Zhengzhou, China.
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Mushtaque M, Ahamad S, Jahan M, Hussain K, Khan MS. Azole-based compounds as antiamoebic agents: a perspective using theoretical calculations. RSC Adv 2016. [DOI: 10.1039/c5ra20552b] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Diseases caused by protozoal organisms are responsible for significant mortality and morbidity worldwide. Amoebiasis caused byEntamoeba histolyticais an example of such diseases.
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Affiliation(s)
- Md. Mushtaque
- School of Physical and Molecular Sciences (Chemistry)
- Al-Falah University
- Faridabad
- India
| | - Shahzaib Ahamad
- Department of Biotechnology
- College of Engineering & Technology
- IFTM
- Moradabad
- India
| | - Meriyam Jahan
- School of Physical and Molecular Sciences (Chemistry)
- Al-Falah University
- Faridabad
- India
| | - Kakul Hussain
- Medical Lab Science Department
- College of Applied Medical Sciences
- Salmanbin Abdulaziz University
- Wadi Adadawasir
- Saudi Arabia
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Nath J, Ghosh SK, Singha B, Paul J. Molecular Epidemiology of Amoebiasis: A Cross-Sectional Study among North East Indian Population. PLoS Negl Trop Dis 2015; 9:e0004225. [PMID: 26633890 PMCID: PMC4669114 DOI: 10.1371/journal.pntd.0004225] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 10/21/2015] [Indexed: 12/30/2022] Open
Abstract
Background Epidemiological studies carried out using culture or microscopy in most of the amoebiasis endemic developing countries, yielded confusing results since none of these could differentiate the pathogenic Entamoeba histolytica from the non-pathogenic Entamoeba dispar and Entamoeba moshkovskii. The Northeastern part of India is a hot spot of infection since the climatic conditions are most conducive for the infection and so far no systemic study has been carried out in this region. Methodology/Principal Findings Following a cross-sectional study designed during the period 2011–2014, a total of 1260 fecal samples collected from the Northeast Indian population were subjected to microscopy, fecal culture and a sensitive and specific DNA dot blot screening assay developed in our laboratory targeting the Entamoeba spp. Further species discrimination using PCR assay performed in microscopy, culture and DNA dot blot screening positive samples showed E. histolytica an overall prevalence rate of 11.1%, 8.0% and 13.7% respectively. In addition, infection rates of nonpathogenic E. dispar and E. moshkovskii were 11.8% (95% CI = 10.2, 13.8) and 7.8% (95% CI = 6.4, 9.4) respectively. The spatial distributions of infection were 18.2% (107/588) of Assam, 11.7% (23/197) of Manipur, 10.2% (21/207) of Meghalaya, and 8.2% (22/268) of Tripura states. Association study of the disease with demographic features suggested poor living condition (OR = 3.21; 95% CI = 1.83, 5.63), previous history of infection in family member (OR = 3.18; 95% CI = 2.09, 4.82) and unhygienic toilet facility (OR = 1.79; 95% CI = 1.28, 2.49) as significant risk factors for amoebiasis. Children in age group <15 yr, participants having lower levels of education, and daily laborers exhibited a higher infection rate. Conclusions/Significance Despite the importance of molecular diagnosis of amoebiasis, molecular epidemiological data based on a large sample size from endemic countries are rarely reported in the literature. Improved and faster method of diagnosis employed here to dissect out the pathogenic from the nonpathogenic species would help the clinicians to prescribe the appropriate anti-amoebic drug. Most epidemiologic studies in developing countries carried out for amoebiasis is either based on microscopy alone or culture/ microscopy used as a screening tool, have poor sensitivity and specificity and thus fails to figure out its true magnitude. The purpose of this study was to assess the true prevalence of amoebiasis in selected North Eastern states of India using DNA based screening technique followed by PCR assay for species discrimination. In addition, PCR assay confirmed that only 55.8% of the samples, resembling E. histolytica by microscopy, were true E. histolytica, implying that remaining 44.2% of so-called infections were due to other nonpathogenic Entamoeba spp. We found a higher prevalence of amebiasis (13.7%) using DNA dot blot screening compared to conventional microscopy and culture based screening. Poor living condition, previous history of infection in a family member, unhygienic toilet facility, children in age group <15 yr, participants having lower levels of education and daily laborers were identified as significant risk factors for amoebiasis. Thus, the techniques like DNA dot blot hybridization and PCR based detection adopted in the present study over and above the conventional screening methods can reduce misdiagnosis of the disease appreciably from the population living in this endemic area.
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Affiliation(s)
- Joyobrato Nath
- Department of Zoology, Gurucharan College, Silchar, Assam, India
- Department of Biotechnology, Assam University, Silchar, Assam, India
| | | | - Baby Singha
- Department of Zoology, Gurucharan College, Silchar, Assam, India
| | - Jaishree Paul
- School of Life Sciences, Jawaharlal Nehru University, New Delhi, India
- * E-mail:
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