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Kumar R, Patel R, Priyadarshi RN, Narayan R, Maji T, Anand U, Soni JR. Amebic liver abscess: An update. World J Hepatol 2024; 16:316-330. [PMID: 38577528 PMCID: PMC10989314 DOI: 10.4254/wjh.v16.i3.316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 01/23/2024] [Accepted: 02/21/2024] [Indexed: 03/27/2024] Open
Abstract
Amebic liver abscess (ALA) is still a common problem in the tropical world, where it affects over three-quarters of patients with liver abscess. It is caused by an anaerobic protozoan Entamoeba hystolytica, which primarily colonises the cecum. It is a non-suppurative infection of the liver consisting primarily of dead hepatocytes and cellular debris. People of the male gender, during their reproductive years, are most prone to ALA, and this appears to be due to a poorly mounted immune response linked to serum testosterone levels. ALA is more common in the right lobe of the liver, is strongly associated with alcohol consumption, and can heal without the need for drainage. While majority of ALA patients have an uncomplicated course, a number of complications have been described, including rupture into abdomino-thoracic structures, biliary fistula, vascular thrombosis, bilio-vascular compression, and secondary bacterial infection. Based on clinico-radiological findings, a classification system for ALA has emerged recently, which can assist clinicians in making treatment decisions. Recent research has revealed the role of venous thrombosis-related ischemia in the severity of ALA. Recent years have seen the development and refinement of newer molecular diagnostic techniques that can greatly aid in overcoming the diagnostic challenge in endemic area where serology-based tests have limited accuracy. Metronidazole has been the drug of choice for ALA patients for many years. However, concerns over the resistance and adverse effects necessitate the creation of new, safe, and potent antiamebic medications. Although the indication of the drainage of uncomplicated ALA has become more clear, high-quality randomised trials are still necessary for robust conclusions. Percutaneous drainage appears to be a viable option for patients with ruptured ALA and diffuse peritonitis, for whom surgery represents a significant risk of mortality. With regard to all of the aforementioned issues, this article intends to present an updated review of ALA.
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Affiliation(s)
- Ramesh Kumar
- Department of Gastroenterology, All India Institute of Medical Sciences, Patna 801507, India.
| | - Rishabh Patel
- Department of Gastroenterology, All India Institute of Medical Sciences, Patna 801507, India
| | | | - Ruchika Narayan
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Patna 801507, India
| | - Tanmoy Maji
- Department of Gastroenterology, All India Institute of Medical Sciences, Patna 801507, India
| | - Utpal Anand
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Patna 801507, India
| | - Jinit R Soni
- Department of Gastroenterology, All India Institute of Medical Sciences, Patna 801507, India
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Rodrigues MAM, Miamoto B, Viero RM. Necrotizing amebic colitis in an elder patient: an unexpected autopsy finding. Autops Case Rep 2023; 13:e2023456. [PMID: 38034513 PMCID: PMC10687792 DOI: 10.4322/acr.2023.456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 10/14/2023] [Indexed: 12/02/2023]
Abstract
Necrotizing amebic colitis is an uncommon amebiasis complication associated with high mortality. We present a case of necrotizing amebic colitis in an old patient whose diagnosis was revealed at postmortem examination. An 81-year-old man died at home without medical attention. The postmortem examination revealed ulcers involving the entire colon and intestinal perforation. The ulcers were large, geographic, and necrotizing, extending from the cecum to the rectum. The histological examination disclosed the infectious etiology by showing amebic trophozoites at the base of the ulcers. No extra-intestinal lesions were found. No information about previous episodes of dysentery or travel could be obtained. The potential role of aging or drug-causing immunosuppression and the evolution of chronic and latent intestinal infection to a severe and invasive form of amebiasis is discussed. This case reinforces the value of postmortem examination for diagnosing diseases not clinically identified.
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Affiliation(s)
| | - Bruno Miamoto
- Universidade Estadual Paulista (UNESP), Departamento de Patologia, Faculdade de Medicina de Botucatu, Botucatu, SP
| | - Rosa Marlene Viero
- Universidade Estadual Paulista (UNESP), Departamento de Patologia, Faculdade de Medicina de Botucatu, Botucatu, SP
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Dauny V, Dioguardi-Burgio M, Leflon-Guibout V, Bert F, Roux O, Houzé S, Lefort A, Rossi G. [Clinical and radiological differences between amoebic and pyogenic liver abscess: A case-control study]. Rev Med Interne 2023; 44:472-478. [PMID: 37105864 DOI: 10.1016/j.revmed.2023.03.011] [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: 12/07/2022] [Revised: 02/06/2023] [Accepted: 03/29/2023] [Indexed: 04/29/2023]
Abstract
INTRODUCTION Amoebic liver abscess (ALA) is the fourth cause of mortality by parasitic infection. This study aimed to assess clinical, radiological and therapeutic characteristics of patients admitted for amoebic liver abscess compared to pyogenic abscess in a French digestive tertiary care-centre. MATERIAL AND METHOD The charts of patients hospitalized for a liver abscess between 2010 and 2020 were retrospectively assessed then separated in two groups: amoebic liver abscess and pyogenic liver abscess from portal underlying cause. Clinical and radiological data were collected for univariate comparison. RESULTS Twenty-one patients were hospitalized during the time of the study for ALA, and 21 patients for pyogenic liver abscess with a portal mechanism. All patients hospitalized for ALA lived in and/or had travelled recently in an endemic area. In comparison with patients hospitalized for pyogenic abscess, patients admitted for ALA were younger (44years old vs. 63years old, P<0.001), had less comorbidities (5% vs. 43% of patients with at least one comorbidity, P<0.01), a longer median duration of symptoms (10days vs. 3days, P=0.015), abdominal pain (86% vs. 52%, P=0.019), and a slighter leucocytosis (9600G/L vs. 15,500G/L, P=0.041) were more frequent. On the abdominal tomodensitometry, density of ALA was higher (34 vs. 25 UH, P<0.01), associated with a focal intra-hepatic biliary dilatation and less often multiloculated. CONCLUSION While rare in western countries, amoebic liver abscess care should not be underestimated. The presence of a solitary liver abscess of intermediate density on computed tomography, occurring on a patient returning from an endemic zone should lead the physician to a possible diagnosis of ALA.
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Affiliation(s)
- Vincent Dauny
- Service de médecine interne, hôpital Beaujon, groupe hospitalier AP-HP Nord, université Paris Cité, Clichy, France.
| | - Marco Dioguardi-Burgio
- Service de radiologie, hôpital Beaujon, groupe hospitalier AP-HP Nord, université Paris Cité, Clichy, France; Inserm U1149, « centre de recherche sur l'inflammation » (CRI), université Paris Cité, 75018 Paris, France
| | - Véronique Leflon-Guibout
- Laboratoire de microbiologie, hôpital Beaujon, groupe hospitalier AP-HP Nord, université Paris Cité, Clichy, France
| | - Frédéric Bert
- Laboratoire de microbiologie, hôpital Beaujon, groupe hospitalier AP-HP Nord, université Paris Cité, Clichy, France
| | - Olivier Roux
- Service d'hépatologie, hôpital Beaujon, groupe hospitalier AP-HP Nord, université Paris Cité, Clichy, France
| | - Sandrine Houzé
- Service de parasitologie, hôpital Bichat, AP-HP, 75018 Paris, France; IRD, MERIT, université Paris Cité, 75006 Paris, France
| | - Agnès Lefort
- Service de médecine interne, hôpital Beaujon, groupe hospitalier AP-HP Nord, université Paris Cité, Clichy, France; Inserm, IAME, UMR1137, université Paris Cité, Paris, France
| | - Geoffrey Rossi
- Service de médecine interne, hôpital Beaujon, groupe hospitalier AP-HP Nord, université Paris Cité, Clichy, France
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Fu X, Zhong Y, Chen L, Ge M, Yu M, Sun Y, Shen L. Global burden and trends of the Entamoeba infection-associated diseases from 1990 to 2019: An observational trend study. Acta Trop 2023; 240:106866. [PMID: 36801451 DOI: 10.1016/j.actatropica.2023.106866] [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: 11/30/2022] [Revised: 02/11/2023] [Accepted: 02/15/2023] [Indexed: 02/21/2023]
Abstract
BACKGROUND Entamoeba infection-associated diseases (EIADs) in humans are a worldwide public health problem, but there is a lack of a global picture of EIADs, which is vital to prevention and control. METHODS We applied 2019 Global Burden of Disease (GBD) data collected from multiple sources at global, national and regional levels. The disability-adjusted life years (DALYs) with corresponding 95% uncertainty intervals (95% UIs) were extracted as the main measure of the burden of EIADs. The Joinpoint regression model was used to estimate the trends of age-standardised DALY rates by age, sex, geographical region, and sociodemographic index (SDI). Besides, a generalized linear model was conducted to analyze the influence of sociodemographic factors on the DALY rate of EIADs. RESULTS In 2019, there were 2,539,799 (95% UI 850,865-6,186,972) DALY cases attributable to Entamoeba infection, and the global age-standardised DALY rate of EIADs was 36.77/100,000 (95% UI: 12.03-90.49). Although over the past 30 years, the age-standardised DALY rate of EIADs presented significantly declining trends [average annual percent change (AAPC) = -3.79%, 95% CI: -4.05% - -3.53%], it has remained a heavy burden among the age group of <5 years (257.43/100,000, 95% UI: 67.73-676.78) and the low SDI regions (100.47/100,000, 95% UI: 32.27-249.09). The age-standardized DALY rate in high-income North America and Australia had an increasing trend (AAPC = 0.38%, 95% CI: 0.47% - 0.28% and 0.38%, 95% CI: 0.46% - 0.29%, respectively). Furthermore, the DALY rates in high SDI regions showed statistically significant increasing trends among the age groups of 14-49, 50-69 years and 70+ years, with AAPCs of 1.01% (95% CI: 0.87% - 1.15%), 1.58% (95% CI: 1.43% - 1.73%), and 2.93% (95% CI: 2.58% - 3.29%), respectively. CONCLUSIONS Over the past 30 years, the burden of EIADs has declined significantly. However, it has still caused a high burden in the low SDI regions and the age group of <5 years. At the same time, in adults and the elderly of the high SDI regions, the increasing trends of Entamoeba infection-associated burden should also be given more attention.
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Affiliation(s)
- Xiaofang Fu
- Linping Campus, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yonghong Zhong
- Linping Campus, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Liyan Chen
- Linping Campus, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Minjie Ge
- Linping Campus, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Min Yu
- Linping Campus, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yibo Sun
- Linping Campus, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Linfeng Shen
- Linping Campus, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
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Bello-López JM, Cruz-Cruz C, Loyola-Cruz MÁ, Quiroga-Vargas E, Martínez-Figueroa C, Cureño-Díaz MA, Fernández-Sánchez V, Ibáñez-Cervantes G, Durán-Manuel EM. Epidemiology of the first seven years of national surveillance of amoebic liver abscesses in Mexico. Parasitol Int 2023; 92:102678. [DOI: 10.1016/j.parint.2022.102678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 07/29/2022] [Accepted: 09/06/2022] [Indexed: 10/14/2022]
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Er-Lukowiak M, Hansen C, Lotter H. Sex Difference in Amebiasis. Curr Top Microbiol Immunol 2023; 441:209-224. [PMID: 37695430 DOI: 10.1007/978-3-031-35139-6_8] [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] [Indexed: 09/12/2023]
Abstract
Infection with the protozoan parasite Entamoeba histolytica is much more likely to cause severe, focal liver damage in males than females, although the infection rate is the same in both sexes. The differences in disease susceptibility may be due to modulation of key mechanisms of the innate immune response by sex hormones. Complement-mediated mechanisms and estrogen-dependent activated natural killer T cells lead to early elimination of the parasite in females, whereas a pathological immune axis is triggered in males. Testosterone, which is generally thought to have more immunosuppressive properties on cells of the immune response, leads to overwhelming activation of monocytes and host-dependent destruction of liver tissue in males resulting in worse outcomes.
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Affiliation(s)
- Marco Er-Lukowiak
- Department Interface - RG Molecular Infection Immunology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Charlotte Hansen
- Department Interface - RG Molecular Infection Immunology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Hanna Lotter
- Department Interface - RG Molecular Infection Immunology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.
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Nasrallah J, Akhoundi M, Haouchine D, Marteau A, Mantelet S, Wind P, Benamouzig R, Bouchaud O, Dhote R, Izri A. Updates on the worldwide burden of amoebiasis: A case series and literature review. J Infect Public Health 2022; 15:1134-1141. [PMID: 36155852 DOI: 10.1016/j.jiph.2022.08.013] [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: 04/27/2022] [Revised: 08/17/2022] [Accepted: 08/23/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Amoebiasis is an intestinal and tissue parasitic infection caused by the protozoan Entamoeba histolytica. Despite significant medical importance and worldwide dispersion, little is known about the epidemiology and distinct geographical distribution of various clinical forms of amoebiasis in the world. In this study, we present an amoebiasis case series referred to Avicenne Hospital (Bobigny, France) from 2010 to 2022 followed by an overview of the released literature to explore diverse clinico-pathology of amoebiasis and to update the actual epidemiological situation of this parasitosis worldwide. METHODS The referred patients underwent a combination of clinical and parasitological examinations and imaging. The study was followed by an overview of released literature performed based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline. RESULTS A total of 15 patients with amoebiasis were diagnosed with an average age of 48.5 years old at the occurrence time of infection. Men (78%) were the most affected patients. Most of the cases were reported following a trip to endemic regions, such as Mali, India, Nepal, Algeria, Cameroon or Congo. All of the processed patients exhibited a hepatic amoebiasis. Amoebic abscess was observed in all cases with an average size of 6.3 cm. Of these patients, seven cases (46.7%) benefited from drainage following a risk of rupture or superinfection of the abscess. A compilation of findings extracted from 390 scientific publications via seven major medical databases, allowed us to update the main epidemiological and clinical events that has led to the current worldwide expansion of amoebiasis. We presented a clinical and epidemiological overview of the amoebiasis accompanied with a worldwide illustrative map displaying the current distribution of known amoebiasis foci in each geographical ecozone of Asia, Europe, Africa, Americas, and Australia. CONCLUSIONS Although Metropolitan France is not known as an endemic region of amoebiasis, amoebic liver abscess was the most frequent clinical form observed among our 15 patients processed. Most of infected patients had a history of travel to or lived-in endemic areas before arriving in France.
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Affiliation(s)
- Jade Nasrallah
- Parasitology-Mycology Department, Avicenne Hospital, AP-HP, Sorbonne Paris Nord University, Bobigny, France
| | - Mohammad Akhoundi
- Parasitology-Mycology Department, Avicenne Hospital, AP-HP, Sorbonne Paris Nord University, Bobigny, France.
| | - Djamel Haouchine
- Parasitology-Mycology Department, Avicenne Hospital, AP-HP, Sorbonne Paris Nord University, Bobigny, France
| | - Anthony Marteau
- Parasitology-Mycology Department, Avicenne Hospital, AP-HP, Sorbonne Paris Nord University, Bobigny, France
| | - Stéphane Mantelet
- Parasitology-Mycology Department, Avicenne Hospital, AP-HP, Sorbonne Paris Nord University, Bobigny, France
| | - Philippe Wind
- Digestive Surgery and Surgical Oncology Department, Avicenne Hospital, AP-HP, Sorbonne Paris Nord University, Bobigny, France
| | - Robert Benamouzig
- Hepato-gastroenterology Department, Avicenne Hospital, AP-HP, Sorbonne Paris Nord University, Bobigny, France
| | - Olivier Bouchaud
- Infectious diseases Department, Avicenne Hospital, AP-HP, Sorbonne Paris Nord, Bobigny, France
| | - Robin Dhote
- Internal Medicine Department, Avicenne Hospital, AP-HP, Sorbonne Paris Nord University, Bobigny, France
| | - Arezki Izri
- Parasitology-Mycology Department, Avicenne Hospital, AP-HP, Sorbonne Paris Nord University, Bobigny, France; Unité des Virus Émergents (UVE: Aix-Marseille Univ-IRD 190-Inserm 1207-IHU Méditerranée Infection), Marseille, France
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Giant Amoebic Liver Abscess: A Rare Diagnosis in a Rural Setting of Sub-Saharan Africa. J Parasitol Res 2021; 2021:2825778. [PMID: 34712492 PMCID: PMC8548179 DOI: 10.1155/2021/2825778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 09/07/2021] [Accepted: 09/28/2021] [Indexed: 11/17/2022] Open
Abstract
Background Extraintestinal amoebiasis is an uncommon complication of Entamoeba histolytica infection, occurring in about 5-10% of patient. Prompt diagnosis and management is essential to prevent complications. However, diagnosis and management in resource-limited settings is very challenging owing to limited diagnostic tools and nonspecific clinical symptoms. Therefore, our case report underscores the role of incisive clinical evaluation, basic investigation, and nonsurgical management of giant amoebic abscess in resource-limited settings. Case Presentation. A 13-year-old female Cameroonian presented with subacute onset of upper abdominal pain, high fever, and chest pain for one week. Before presentation, she had been on treatment at a local traditional practitioner during which her symptoms worsen. After clinical evaluation and basic investigation, she was diagnosed with a giant amoebic liver abscess. She was resuscitated and placed on nonsurgical management. Follow-up after 1 month was significant for complete recovery. Conclusion Amoebic liver abscess is a rare complication of Entamoeba histolytica infection with devastating complications. The diagnosis of this disease requires high index of suspicion in resource-limited settings. Good clinical evaluation and timely nonsurgical therapy can provide recovery to some patients.
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Shirley DA, Sharma I, Warren CA, Moonah S. Drug Repurposing of the Alcohol Abuse Medication Disulfiram as an Anti-Parasitic Agent. Front Cell Infect Microbiol 2021; 11:633194. [PMID: 33777846 PMCID: PMC7991622 DOI: 10.3389/fcimb.2021.633194] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 02/18/2021] [Indexed: 01/24/2023] Open
Abstract
Parasitic infections contribute significantly to worldwide morbidity and mortality. Antibiotic treatment is essential for managing patients infected with these parasites since control is otherwise challenging and there are no vaccines available for prevention. However, new antimicrobial therapies are urgently needed as significant problems exist with current treatments such as drug resistance, limited options, poor efficacy, as well as toxicity. This situation is made worse by the challenges of drug discovery and development which is costly especially for non-profitable infectious diseases, time-consuming, and risky with a high failure rate. Drug repurposing which involves finding new use for existing drugs may help to more rapidly identify therapeutic candidates while drastically cutting costs of drug research and development. In this perspective article, we discuss the importance of drug repurposing, review disulfiram pharmacology, and highlight emerging data that supports repurposing disulfiram as an anti-parasitic, exemplified by the major diarrhea-causing parasite Entamoeba histolytica.
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Affiliation(s)
- Debbie-Ann Shirley
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Virginia, Charlottesville, VA, United States
| | - Ishrya Sharma
- Division of Infectious Diseases & International Health, Department of Medicine, University of Virginia, Charlottesville, VA, United States
| | - Cirle A Warren
- Division of Infectious Diseases & International Health, Department of Medicine, University of Virginia, Charlottesville, VA, United States
| | - Shannon Moonah
- Division of Infectious Diseases & International Health, Department of Medicine, University of Virginia, Charlottesville, VA, United States
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Shirley DA, Moonah S. COVID-19 and Corticosteroids: Unfamiliar but Potentially Fatal Infections That Can Arise following Short-Course Steroid Treatment. Am J Trop Med Hyg 2021; 104:790-793. [PMID: 33410395 PMCID: PMC7941796 DOI: 10.4269/ajtmh.20-1471] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 12/07/2020] [Indexed: 12/19/2022] Open
Abstract
Corticosteroid use is increasing worldwide as recent studies confer survival benefit of corticosteroids in the management of patients with severe COVID-19. Strongyloides and amebic infections are neglected diseases that can progress to catastrophic complications in patients exposed to corticosteroids, even with short treatment courses. To prevent lethal outcomes, clinicians should be aware of the threat these two parasitic infections pose to at-risk patients receiving corticosteroids, especially in the era of COVID-19.
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Affiliation(s)
- Debbie-Ann Shirley
- Division of Infectious Diseases and International Health, University of Virginia COVID-19 Clinic, University of Virginia Health System, Charlottesville, Virginia
| | - Shannon Moonah
- Division of Infectious Diseases and International Health, University of Virginia COVID-19 Clinic, University of Virginia Health System, Charlottesville, Virginia
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Vanbrabant P, Damanet B, Maussen C, Van Esbroeck M, Soentjens P. Screening the asymptomatic soldiers after a stay in sub-Saharan Africa. A retrospective observational study. Travel Med Infect Dis 2020; 39:101941. [PMID: 33278608 DOI: 10.1016/j.tmaid.2020.101941] [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: 02/04/2020] [Revised: 11/18/2020] [Accepted: 11/24/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Many tropical clinics offer post-travel screening for parasitic infections in asymptomatic travellers. However, literature on attack rates and incidence rates of parasitic infections is scarce. METHOD All military personnel returning from a tropical region during the year 2018 were tested for the presence of antibodies against Strongyloides stercoralis, Schistosoma and Entamoeba histolytica. Test results were compared with previous results if available to distinguish recent and old infection. RESULTS In total, 949 soldiers were included in the study. The median age was years 31 (IQR: 26-41), 96.3% were male. The median duration of stay in the tropics was 35 days (IQR: 14-90). The destination was predominantly central Africa. Serological tests were positive for S. stercoralis in 10 patients (1.1%), Schistosoma in 3 (0.3%), and E. histolytica in 16 (1.7%). The attack rates were 0.84, 0.32 and 1.69 respectively. The incidence rates were 3.99, 1.49 and 7.97 respectively. CONCLUSIONS The risk for parasitic infection in the asymptomatic returning soldiers is low. However, the potentially serious complications of unrecognised parasitic infection can legitimise systematic screening.
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Affiliation(s)
- Peter Vanbrabant
- Centre for Infectious Diseases, Polyclinic Department. Queen Astrid, Military Hospital, Brussels, Belgium; General Internal Medicine, University Hospitals Leuven, Leuven, Belgium.
| | - Benjamin Damanet
- Centre for Infectious Diseases, Polyclinic Department. Queen Astrid, Military Hospital, Brussels, Belgium; School of Public Health, Free University of Brussels, Brussels, Belgium
| | - Chris Maussen
- Centre for Infectious Diseases, Polyclinic Department. Queen Astrid, Military Hospital, Brussels, Belgium
| | - Marjan Van Esbroeck
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Patrick Soentjens
- Centre for Infectious Diseases, Polyclinic Department. Queen Astrid, Military Hospital, Brussels, Belgium; Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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Ghosh S, Farr L, Singh A, Leaton LA, Padalia J, Shirley DA, Sullivan D, Moonah S. COP9 signalosome is an essential and druggable parasite target that regulates protein degradation. PLoS Pathog 2020; 16:e1008952. [PMID: 32960936 PMCID: PMC7531848 DOI: 10.1371/journal.ppat.1008952] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 10/02/2020] [Accepted: 09/01/2020] [Indexed: 02/06/2023] Open
Abstract
Understanding how the protozoan protein degradation pathway is regulated could uncover new parasite biology for drug discovery. We found the COP9 signalosome (CSN) conserved in multiple pathogens such as Leishmania, Trypanosoma, Toxoplasma, and used the severe diarrhea-causing Entamoeba histolytica to study its function in medically significant protozoa. We show that CSN is an essential upstream regulator of parasite protein degradation. Genetic disruption of E. histolytica CSN by two distinct approaches inhibited cell proliferation and viability. Both CSN5 knockdown and dominant negative mutation trapped cullin in a neddylated state, disrupting UPS activity and protein degradation. In addition, zinc ditiocarb (ZnDTC), a main metabolite of the inexpensive FDA-approved globally-available drug disulfiram, was active against parasites acting in a COP9-dependent manner. ZnDTC, given as disulfiram-zinc, had oral efficacy in clearing parasites in vivo. Our findings provide insights into the regulation of parasite protein degradation, and supports the significant therapeutic potential of COP9 inhibition.
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Affiliation(s)
- Swagata Ghosh
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, United States of America
| | - Laura Farr
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, United States of America
| | - Aditya Singh
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, United States of America
| | - Laura-Ann Leaton
- Division of Biomedical Informatics and Personalized Medicine, University of Colorado, Aurora, CO, United States of America
| | - Jay Padalia
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, United States of America
| | - Debbie-Ann Shirley
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, United States of America
| | - David Sullivan
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Shannon Moonah
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, United States of America
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Madden GR, Shirley DA, Townsend G, Moonah S. Case Report: Lower Gastrointestinal Bleeding due to Entamoeba histolytica Detected Early by Multiplex PCR: Case Report and Review of the Laboratory Diagnosis of Amebiasis. Am J Trop Med Hyg 2020; 101:1380-1383. [PMID: 31674299 DOI: 10.4269/ajtmh.19-0237] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
We report a case of Entamoeba histolytica infection in a young man who presented with cerebral infarction and shortly after admission developed bloody diarrhea with fever. A rapid diagnosis of severe E. histolytica colitis was established through the use of a multiplex polymerase chain reaction enteropathogen stool panel. This result was unexpected in a patient native to the United States without known risk factors for amebiasis and negative stool microscopy examination for ova and parasites. Rapid diagnosis allowed prompt initiation of appropriate anti-amebic therapy and ultimately a good outcome in a condition that otherwise carries high morbidity and fatality.
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Affiliation(s)
- Gregory R Madden
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - Debbie-Ann Shirley
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Virginia, Charlottesville, Virginia
| | - Gregory Townsend
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - Shannon Moonah
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
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Shirley DAT, Watanabe K, Moonah S. Significance of amebiasis: 10 reasons why neglecting amebiasis might come back to bite us in the gut. PLoS Negl Trop Dis 2019; 13:e0007744. [PMID: 31725715 PMCID: PMC6855409 DOI: 10.1371/journal.pntd.0007744] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Debbie-Ann T. Shirley
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia, United States of America
| | - Koji Watanabe
- AIDS Clinical Center, National Center for Global Health and Medicine, Shinjuku, Tokyo, Japan
| | - Shannon Moonah
- Department of Medicine, University of Virginia School of Medicine Charlottesville, Virginia, United States of America
- * E-mail:
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15
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Shirley DAT, Farr L, Watanabe K, Moonah S. A Review of the Global Burden, New Diagnostics, and Current Therapeutics for Amebiasis. Open Forum Infect Dis 2018; 5:ofy161. [PMID: 30046644 PMCID: PMC6055529 DOI: 10.1093/ofid/ofy161] [Citation(s) in RCA: 182] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 07/03/2018] [Indexed: 12/21/2022] Open
Abstract
Amebiasis, due to the pathogenic parasite Entamoeba histolytica, is a leading cause of diarrhea globally. Largely an infection of impoverished communities in developing countries, amebiasis has emerged as an important infection among returning travelers, immigrants, and men who have sex with men residing in developed countries. Severe cases can be associated with high case fatality. Polymerase chain reaction–based diagnosis is increasingly available but remains underutilized. Nitroimidazoles are currently recommended for treatment, but new drug development to treat parasitic agents is a high priority. Amebiasis should be considered before corticosteroid therapy to decrease complications. There is no effective vaccine, so prevention focuses on sanitation and access to clean water. Further understanding of parasite biology and pathogenesis will advance future targeted therapeutic and preventative strategies.
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Affiliation(s)
- Debbie-Ann T Shirley
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Laura Farr
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Koji Watanabe
- AIDS Clinical Center, National Center for Global Health and Medicine, Shinjuku, Tokyo, Japan
| | - Shannon Moonah
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia
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16
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Kannathasan S, Murugananthan A, Kumanan T, de Silva NR, Rajeshkannan N, Haque R, Iddawela D. Epidemiology and factors associated with amoebic liver abscess in northern Sri Lanka. BMC Public Health 2018; 18:118. [PMID: 29316900 PMCID: PMC5761098 DOI: 10.1186/s12889-018-5036-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 01/05/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Clinically diagnosed amoebic liver abscess (ALA) caused by Entamoeba histolytica has been an important public health problem in Jaffna district, northern Sri Lanka for last three decades. In order to draw up a control strategy for elimination of this condition, knowledge of its epidemiology and factors associated with this condition in the local context is vital. METHODS All clinically diagnosed ALA patients admitted to the Teaching Hospital, Jaffna during the study period were included in the study and the data were collected using an interviewer administered questionnaire. One hundred blood samples from randomly selected toddy (a local alcoholic drink consisting of the fermented sap of the Palmyrah palm) consumers and 200 toddy samples were collected. Toddy samples were cultured in Robinson's medium to establish the presence of Entamoeba histolytica in the sample. Climatic data and the total toddy sales in the district were obtained from the Meteorological and Excise Departments respectively. A sub group of randomly selected 100 patients were compared with 100 toddy consumers who were negative for E. histolytica antibody to explore the potential risk factors. RESULTS Between July 2012 and July 2015, 346 of 367 ALA patients were enrolled in this study. Almost all patients (98.6%) were males with a history of heavy consumption of alcohol (100%). Almost all (94.2%) were within the age group 31-50 years. None of the cultured toddy samples grew E. histolytica. The monthly incidence of disease peaked in the dry season, matching the total toddy sales in the district. Age, type of alcohol and frequency of drinking were identified as potential risk factors whereas frequency of alcohol consumption and type of alcohol (consuming toddy and arrack) were identified as the independent risk factors. Moreover, the knowledge, attitude and practices towards ALA were poor among participants and the control group. CONCLUSIONS Though the number of cases has declined in recent years, ALA still remains as an important public health problem in Jaffna district. The transmission route of E. histolytica leading to ALA has to be further explored. Moreover, greater awareness among the public who are at risk would be beneficial in order to eliminate the disease.
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Affiliation(s)
- Selvam Kannathasan
- Department of Pathology, Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka
| | | | | | | | | | - Rashidul Haque
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Devika Iddawela
- Department of Parasitology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
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17
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Smith S, Phillips GE, McBride WJH, Hanson J. Case Report: Endemic Amebiasis in Australia: Implications for Residents, Travelers, and Clinicians. Am J Trop Med Hyg 2017; 97:245-247. [PMID: 28719303 DOI: 10.4269/ajtmh.17-0004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Entamoeba histolytica is considered endemic in Australia; however, cases are rare, occurring almost exclusively in high-risk individuals. We describe a series of locally acquired, complicated cases in low-risk individuals from Far North Queensland in whom the diagnosis was delayed. Amebiasis may pose a greater local threat than is currently recognized.
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Affiliation(s)
- Simon Smith
- Department of Medicine, Cairns Hospital, Cairns, Australia.,James Cook University, Cairns, Australia
| | - Gael E Phillips
- Pathology Queensland, Health Support Queensland, Department of Health, Queensland Government, Australia
| | | | - Josh Hanson
- The Kirby Institute, Sydney, Australia.,Menzies School of Health Research, Darwin, Australia.,Department of Medicine, Cairns Hospital, Cairns, Australia
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18
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Kannathasan S, Murugananthan A, Kumanan T, Iddawala D, de Silva NR, Rajeshkannan N, Haque R. Amoebic liver abscess in northern Sri Lanka: first report of immunological and molecular confirmation of aetiology. Parasit Vectors 2017; 10:14. [PMID: 28061872 PMCID: PMC5219765 DOI: 10.1186/s13071-016-1950-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 12/21/2016] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Since 1985, amoebic liver abscess (ALA) has been a public health problem in northern Sri Lanka. Clinicians arrive at a diagnosis based on clinical and ultrasonographic findings, which cannot differentiate pyogenic liver abscess (PLA) from ALA. As the treatment and outcome of the ALA and PLA differs, determining the etiological agent is crucial. METHODS All clinically diagnosed ALA patients admitted to the Teaching Hospital (TH) in Jaffna during the study period were included and the clinical features, haematological parameters, and ultrasound scanning findings were obtained. Aspirated pus, blood, and faecal samples from patients were also collected. Pus and faeces were examined microscopically for amoebae. Pus was cultured in Robinson's medium for amoebae, and MacConkey and blood agar for bacterial growth. ELISA kits were used for immunodiagnosis of Entamoeba histolytica infection. DNA was extracted from selected pus samples and amplified using nested PCR and the purified product was sequenced. RESULTS From July 2012 to July 2015, 346 of 367 clinically diagnosed ALA patients admitted to Jaffna Teaching Hospital were enrolled in this study. Almost all patients (98.6%) were males with a history of heavy alcohol consumption (100%). The main clinical features were fever (100%), right hypochodric pain (100%), tender hepatomegaly (90%) and intercostal tenderness (60%). Most patients had leukocytosis (86.7%), elevated ESR (85.8%) and elevated alkaline phosphatase (72.3%). Most of the abscesses were in the right lobe (85.3%) and solitary (76.3%) in nature. Among the 221 (63.87%) drained abscesses, 93.2% were chocolate brown in colour with the mean volume of 41.22 ± 1.16 ml. Only four pus samples (2%) were positive for amoeba by culture and the rest of the pus and faecal samples were negative microscopically and by culture. Furthermore, all pus samples were negative for bacterial growth. Antibody against E. histolytica (99.7%) and the E. histolytica antigen were detected in the pus samples (100%). Moreover, PCR and sequencing confirmed these results. CONCLUSION To our knowledge, this is the first report from Sri Lanka that provides immunological and molecular confirmation that Entamoeba histolytica is a common cause of liver abscesses in the region.
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Affiliation(s)
- Selvam Kannathasan
- Department of Pathology, Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka
| | | | | | - Devika Iddawala
- Department of Parasitology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | | | | | - Rashidul Haque
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
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19
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O'connell PR, Sheehan G. Intra-abdominal Sepsis, Peritonitis, Pancreatitis, Hepatobiliary and Focal Splenic Infection. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00041-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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20
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Lachish T, Wieder-Finesod A, Schwartz E. Amebic Liver Abscess in Israeli Travelers: A Retrospective Study. Am J Trop Med Hyg 2016; 94:1015-9. [PMID: 26928829 DOI: 10.4269/ajtmh.15-0576] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 12/14/2015] [Indexed: 01/21/2023] Open
Abstract
Amebic liver abscess (ALA) is endemic in developing countries. The epidemiology and clinical characteristics of the disease in developing countries are well described. Travelers from nonendemic countries can serve as a model for the natural history of ALA. Currently, the available literature on travelers is limited. This is a retrospective observational study on Israeli travelers diagnosed with ALA. Data regarding travel history, clinical presentation, imaging, and treatment were collected and analyzed. Among 6,867 ill returning Israeli travelers, amebiasis was diagnosed in 53 travelers (0.77%), of whom 14 were with ALA (0.2%). Twelve ALA cases (86%) had an exposure in the Indian subcontinent. The male to female ratio was 1:1, with no significant clinical differences between the sexes. The average lag period between exposure and onset of symptoms was 17.1 months. The lack of male predominance and the prolonged lag period may imply that behavioral factors are pivotal in the development of ALA. Larger case series of travelers are required.
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Affiliation(s)
- Tamar Lachish
- Infectious Diseases Unit, Shaare-Zedek Medical Center, Jerusalem, Israel; Infectious Diseases Unit, Sheba Medical Center, Tel Hashomer, Israel; The Center for Geographic Medicine, The Chaim Sheba Medical Center, Tel Hashomer, Israel; The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Wieder-Finesod
- Infectious Diseases Unit, Shaare-Zedek Medical Center, Jerusalem, Israel; Infectious Diseases Unit, Sheba Medical Center, Tel Hashomer, Israel; The Center for Geographic Medicine, The Chaim Sheba Medical Center, Tel Hashomer, Israel; The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eli Schwartz
- Infectious Diseases Unit, Shaare-Zedek Medical Center, Jerusalem, Israel; Infectious Diseases Unit, Sheba Medical Center, Tel Hashomer, Israel; The Center for Geographic Medicine, The Chaim Sheba Medical Center, Tel Hashomer, Israel; The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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21
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Nourse CB, Robson JM, Whitby MR, Francis JR. First report of Entamoeba histolytica infection from Timor-Leste--acute amoebic colitis and concurrent late development of amoebic liver abscess in returned travellers to Australia. J Travel Med 2016; 23:tav027. [PMID: 26858275 DOI: 10.1093/jtm/tav027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/26/2015] [Indexed: 11/13/2022]
Abstract
This communication reports invasive amoebic colitis and late onset amoebic liver abscess in three members of a group of 12 Australian travellers to Timor-Leste (TL). This is the first report of Entamoeba histolytica infection from TL. Clinicians in Australia need to consider amoebiasis in the differential diagnosis in travellers returning with colitis, abdominal pain and fever. Presentation with amoebic liver abscess months after exposure is rare but should be suspected in symptomatic individuals with a relevant history of travel.
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Affiliation(s)
- Clare B Nourse
- Infection Management and Prevention Service, Lady Cilento Children's Hospital, Brisbane, Faculty of Paediatrics and Child Health, University of Queensland, Brisbane,
| | | | | | - Josh R Francis
- Department of Paediatrics, Royal Darwin Hospital, Darwin and Menzies School of Health Research, Charles Darwin University, Darwin, NT
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22
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Pais-Morales J, Betanzos A, García-Rivera G, Chávez-Munguía B, Shibayama M, Orozco E. Resveratrol Induces Apoptosis-Like Death and Prevents In Vitro and In Vivo Virulence of Entamoeba histolytica. PLoS One 2016; 11:e0146287. [PMID: 26731663 PMCID: PMC4701480 DOI: 10.1371/journal.pone.0146287] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 12/15/2015] [Indexed: 11/26/2022] Open
Abstract
Entamoeba histolytica causes amoebiasis, an infection that kills 100,000 individuals each year. Metronidazole and its derivatives are currently used against this protozoan, but these drugs present adverse effects on human health. Here, we investigated the effect of resveratrol (a natural compound) on E. histolytica trophozoites viability, as well as its influence on the parasite virulence. Trophozoites growth was arrested by 72 μM resveratrol and the IC50 was determined as 220 μM at 48 h. Cells appeared smaller, rounded and in clusters, with debris-containing vacuoles and with abnormally condensed chromatin. Resveratrol triggered reactive oxygen species production. It caused lipid peroxidation and produced phosphatidylserine externalization and DNA fragmentation this latter evidenced by TUNEL assays. It also provoked an increase of intracellular Ca2+ concentration, activated calpain and decreased superoxide dismutase activity, indicating that an apoptosis-like event occurred; however, autophagy was not detected. Cytopathic activity, phagocytosis, encystment and in vivo virulence were diminished dramatically by pre-incubation of trophozoites with resveratrol, evidencing that resveratrol attenuated the trophozoite virulence in vitro. Interestingly, after the inoculation of virulent trophozoites, animals treated with the drug did not develop or developed very small abscesses. Our findings propose that resveratrol could be an alternative to contend amoebiasis.
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Affiliation(s)
- Jonnatan Pais-Morales
- Departamento de Infectómica y Patogénesis Molecular, Centro de Investigación y de Estudios Avanzados del IPN, México DF, México
| | - Abigail Betanzos
- Departamento de Infectómica y Patogénesis Molecular, Centro de Investigación y de Estudios Avanzados del IPN, México DF, México
| | - Guillermina García-Rivera
- Departamento de Infectómica y Patogénesis Molecular, Centro de Investigación y de Estudios Avanzados del IPN, México DF, México
| | - Bibiana Chávez-Munguía
- Departamento de Infectómica y Patogénesis Molecular, Centro de Investigación y de Estudios Avanzados del IPN, México DF, México
| | - Mineko Shibayama
- Departamento de Infectómica y Patogénesis Molecular, Centro de Investigación y de Estudios Avanzados del IPN, México DF, México
| | - Esther Orozco
- Departamento de Infectómica y Patogénesis Molecular, Centro de Investigación y de Estudios Avanzados del IPN, México DF, México
- * E-mail:
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23
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Is procalcitonin increased in cases of invasive amoebiasis? A retrospective, observational study. Diagn Microbiol Infect Dis 2015; 83:395-9. [DOI: 10.1016/j.diagmicrobio.2015.08.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 08/19/2015] [Accepted: 08/20/2015] [Indexed: 01/11/2023]
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24
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Nespola B, Betz V, Brunet J, Gagnard JC, Krummel Y, Hansmann Y, Hannedouche T, Christmann D, Pfaff AW, Filisetti D, Pesson B, Abou-Bacar A, Candolfi E. First case of amebic liver abscess 22 years after the first occurrence. Parasite 2015; 22:20. [PMID: 26088504 PMCID: PMC4472968 DOI: 10.1051/parasite/2015020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 06/04/2015] [Indexed: 01/03/2023] Open
Abstract
A 72-year-old man consulted in November 2012 for abdominal pain in the right upper quadrant. The patient had a history of suspected hepatic amebiasis treated in Senegal in 1985 and has not traveled to endemic areas since 1990. Abdominal CT scan revealed a liver abscess. At first, no parasitological tests were performed and the patient was treated with broad-spectrum antibiotics. Only after failure of this therapy, serology and PCR performed after liver abscess puncture established the diagnosis of hepatic amebiasis. The patient was treated with metronidazole and tiliquinol-tilbroquinol. Amebic liver abscess is the most frequent extra-intestinal manifestation. Hepatic amebiasis 22 years after the last visit to an endemic area is exceptional and raises questions on the mechanisms of latency and recurrence of these intestinal protozoan parasites.
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Affiliation(s)
- Benoît Nespola
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Laboratoire de Parasitologie et de Mycologie Médicale, Hôpitaux Universitaires de Strasbourg 67091
Strasbourg France
| | - Valérie Betz
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Service de Néphrologie et Hémodialyse, Hôpitaux Universitaires de Strasbourg 67091
Strasbourg France
| | - Julie Brunet
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Laboratoire de Parasitologie et de Mycologie Médicale, Hôpitaux Universitaires de Strasbourg 67091
Strasbourg France
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Institut de Parasitologie et de Pathologie Tropicale, Université de Strasbourg 67091
Strasbourg France
| | - Jean-Charles Gagnard
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Service de Maladies Infectieuses et Tropicales, Hôpitaux Universitaires de Strasbourg 67091
Strasbourg France
| | - Yves Krummel
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Service de Médecine A, Centre Hospitalier de Sélestat 67600
Sélestat France
| | - Yves Hansmann
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Service de Maladies Infectieuses et Tropicales, Hôpitaux Universitaires de Strasbourg 67091
Strasbourg France
| | - Thierry Hannedouche
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Service de Néphrologie et Hémodialyse, Hôpitaux Universitaires de Strasbourg 67091
Strasbourg France
| | - Daniel Christmann
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Service de Maladies Infectieuses et Tropicales, Hôpitaux Universitaires de Strasbourg 67091
Strasbourg France
| | - Alexander W. Pfaff
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Laboratoire de Parasitologie et de Mycologie Médicale, Hôpitaux Universitaires de Strasbourg 67091
Strasbourg France
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Institut de Parasitologie et de Pathologie Tropicale, Université de Strasbourg 67091
Strasbourg France
| | - Denis Filisetti
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Laboratoire de Parasitologie et de Mycologie Médicale, Hôpitaux Universitaires de Strasbourg 67091
Strasbourg France
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Institut de Parasitologie et de Pathologie Tropicale, Université de Strasbourg 67091
Strasbourg France
| | - Bernard Pesson
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Laboratoire de Parasitologie et de Mycologie Médicale, Hôpitaux Universitaires de Strasbourg 67091
Strasbourg France
| | - Ahmed Abou-Bacar
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Laboratoire de Parasitologie et de Mycologie Médicale, Hôpitaux Universitaires de Strasbourg 67091
Strasbourg France
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Institut de Parasitologie et de Pathologie Tropicale, Université de Strasbourg 67091
Strasbourg France
| | - Ermanno Candolfi
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Laboratoire de Parasitologie et de Mycologie Médicale, Hôpitaux Universitaires de Strasbourg 67091
Strasbourg France
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Institut de Parasitologie et de Pathologie Tropicale, Université de Strasbourg 67091
Strasbourg France
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25
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Norman FF, Monge-Maillo B, Martínez-Pérez Á, Perez-Molina JA, López-Vélez R. Parasitic infections in travelers and immigrants: part I protozoa. Future Microbiol 2015; 10:69-86. [DOI: 10.2217/fmb.14.105] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
ABSTRACT The growth in international commerce, travel and migration contribute to the global emergence of certain parasitic infections. Importation of vectors and food products may contribute to the emergence of protozoan infections in nonendemic countries. Infections such as malaria are potentially fatal, especially in nonimmune patients, and outcome depends largely on timely diagnosis and treatment. Diagnosis/management of imported parasitic infections may be complex especially as some patients may have underlying immunosuppressive conditions such as HIV infection. Major challenges concern the development of improved diagnostic techniques, safer/more effective drug therapies and identification of biological markers of progression and response to treatment. Imported parasitic diseases which may be transmitted vertically or through blood transfusion/organ donation could become a public health priority in the near future. Climate change may affect arthropod distribution and facilitate the spread of protozoan vector-borne diseases. The first part of this review focuses on protozoan infections in travelers and immigrants.
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Affiliation(s)
- Francesca F Norman
- Tropical Medicine & Clinical Parasitology, Infectious Diseases Department, Ramon y Cajal Hospital, Ctra. De Colmenar, Km 9.1, 28034 Madrid, Spain
| | - Begoña Monge-Maillo
- Tropical Medicine & Clinical Parasitology, Infectious Diseases Department, Ramon y Cajal Hospital, Ctra. De Colmenar, Km 9.1, 28034 Madrid, Spain
| | - Ángela Martínez-Pérez
- Tropical Medicine & Clinical Parasitology, Infectious Diseases Department, Ramon y Cajal Hospital, Ctra. De Colmenar, Km 9.1, 28034 Madrid, Spain
| | - Jose A Perez-Molina
- Tropical Medicine & Clinical Parasitology, Infectious Diseases Department, Ramon y Cajal Hospital, Ctra. De Colmenar, Km 9.1, 28034 Madrid, Spain
| | - Rogelio López-Vélez
- Tropical Medicine & Clinical Parasitology, Infectious Diseases Department, Ramon y Cajal Hospital, Ctra. De Colmenar, Km 9.1, 28034 Madrid, Spain
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