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Vilela da Silva CA, Costa Dos Santos CE, de Paula Cortezzi MF, Moura CDSS, Cruz RE, Almeida Lopes CD, Costa K, Souza LTD, Silva PCLD, Neumann E, Nunes ÁC, Gomes MA, Silva Oliveira FM, Caliari MV. Enteropathogenic Escherichia coli modulates the virulence and pathogenicity of Entamoeba dispar. Exp Parasitol 2024; 261:108750. [PMID: 38614222 DOI: 10.1016/j.exppara.2024.108750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/28/2023] [Accepted: 04/06/2024] [Indexed: 04/15/2024]
Abstract
Amoebiasis is a disease caused by Entamoeba histolytica, affecting the large intestine of humans and occasionally leading to extra-intestinal lesions. Entamoeba dispar is another amoeba species considered commensal, although it has been identified in patients presenting with dysenteric and nondysenteric colitis, as well as amoebic liver abscess. Amoebic virulence factors are essential for the invasion and development of lesions. There is evidence showing that the association of enterobacteria with trophozoites contributes to increased gene expression of amoebic virulence factors. Enteropathogenic Escherichia coli is an important bacterium causing diarrhea, with high incidence rates in the world population, allowing it to interact with Entamoeba sp. in the same host. In this context, this study aims to evaluate the influence of enteropathogenic Escherichia coli on ACFN and ADO Entamoeba dispar strains by quantifying the gene expression of virulence factors, including galactose/N-acetyl-D-galactosamine-binding lectin, cysteine proteinase 2, and amoebapores A and C. Additionally, the study assesses the progression and morphological aspect of amoebic liver abscess and the profile of inflammatory cells. Our results demonstrated that the interaction between EPEC and ACFN Entamoeba dispar strains was able to increase the gene expression of virulence factors, as well as the lesion area and the activity of the inflammatory infiltrate. However, the association with the ADO strain did not influence the gene expression of virulence factors. Together, our findings indicate that the interaction between EPEC, ACFN, and ADO Entamoeba dispar strains resulted in differences in vitro and in vivo gene expression of Gal/GalNAc-binding lectin and CP2, in enzymatic activities of MPO, NAG, and EPO, and consequently, in the ability to cause lesions.
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Affiliation(s)
| | | | | | - César da Silva Santana Moura
- Department of Genetics, Ecology, and Evolution, Institute of Biological Sciences, Federal University of Minas Gerais, Brazil
| | - Ruth Elizabeth Cruz
- Department of Parasitology, Institute of Biological Sciences, Federal University of Minas Gerais, Brazil
| | - Camila de Almeida Lopes
- Department of Parasitology, Institute of Biological Sciences, Federal University of Minas Gerais, Brazil
| | - Karen Costa
- Department of Microbiology, Institute of Biological Sciences, Federal University of Minas Gerais, Brazil
| | - Lucas Teixeira de Souza
- Department of Microbiology, Institute of Biological Sciences, Federal University of Minas Gerais, Brazil
| | - Patrícia Costa Lima da Silva
- Department of Genetics, Ecology, and Evolution, Institute of Biological Sciences, Federal University of Minas Gerais, Brazil
| | - Elisabeth Neumann
- Department of Microbiology, Institute of Biological Sciences, Federal University of Minas Gerais, Brazil
| | - Álvaro Cantini Nunes
- Department of Genetics, Ecology, and Evolution, Institute of Biological Sciences, Federal University of Minas Gerais, Brazil
| | - Maria Aparecida Gomes
- Department of Parasitology, Institute of Biological Sciences, Federal University of Minas Gerais, Brazil
| | | | - Marcelo Vidigal Caliari
- Department of General Pathology, Institute of Biological Sciences, Federal University of Minas Gerais, Brazil
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Datta P, Rattan D, Sharma D, Sharma N, Kalra N, Duseja A, Angrup A, Sehgal R. Novel diagnostic approach for amoebic liver abscess using cell free (cf) DNA: a prospective study. Infect Dis (Lond) 2024; 56:259-267. [PMID: 38112684 DOI: 10.1080/23744235.2023.2294119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/07/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Amoebic liver abscess (ALA) is commonly seen in tropical countries and diagnosis of ALA relies mainly on non-specific serological and imaging techniques as well as PCR from pus. OBJECTIVE This study evaluated the potential of using cell free DNA (cfDNA) from serum and urine for diagnosing ALA. METHODS We prospectively evaluated quantitative PCR (qPCR) for detection of cf DNA in serum and urine sample in all liver abscess patients. The samples were collected from patients reporting to emergency ward of Postgraduate Institute of Medical Education and Research, Chandigarh, India with symptoms suggestive of liver abscess. Real time PCR was done to detect cf DNA in serum and urine by targeting 99-bp unit of small subunit rRNA of Entamoeba histolytica and conventional PCR for pus. RESULTS A total 113 samples (serum and urine) and 100 pus samples were analysed. A total of 62 ALA patients were confirmed; with maximum 57 patients detected by qPCR for cfDNA in the serum, 55 patients by PCR on pus aspirate and 50 ALA patients by qPCR for cfDNA in urine sample. Therefore, the sensitivity of qPCR for detection of cf DNA in serum was 91.94% and for urine was 80.65%. CONCLUSION A total of 11.2% of ALA patients were diagnosed only through detection of E. histolytica cf DNA in their serum and urine. Detection of cfDNA from serum, urine of ALA has a potential role in future especially for developing countries as it is a rapid, sensitive and patient friendly diagnostic approach.
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Affiliation(s)
- Priya Datta
- Department of Medical Parasitology, PGIMER, Chandigarh, India
| | - Divya Rattan
- Department of Medical Parasitology, PGIMER, Chandigarh, India
| | - Devyani Sharma
- Department of Medical Parasitology, PGIMER, Chandigarh, India
| | - Navneet Sharma
- Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Naveen Kalra
- Department of Radiodiagnosis & Imaging, PGIMER, Chandigarh, India
| | - Ajay Duseja
- Department of Hepatology, PGIMER, Chandigarh, India
| | - Archana Angrup
- Department of Medical Microbiology, PGIMER, Chandigarh, India
| | - Rakesh Sehgal
- Department of Medical Parasitology, PGIMER, Chandigarh, India
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Marak JR, Raj G, Narayan S, Gara H, Das P. Liver abscess with extension into the Inferior Vena Cava: Case series of a rare complication. Radiol Case Rep 2024; 19:594-599. [PMID: 38111551 PMCID: PMC10726337 DOI: 10.1016/j.radcr.2023.10.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/21/2023] [Accepted: 10/26/2023] [Indexed: 12/20/2023] Open
Abstract
Liver abscess is a common disease, however, it is a rare cause of venous thrombosis. The incidence of amoebic and pyogenic liver abscess in developing countries is high, however, the occurrence of inferior vena cava thrombosis secondary to liver abscess is a very rare and life-threatening complication. Computed tomography (CT) scan is an ideal investigation tool for diagnosing the various complications associated with liver abscess. Here we describe 3 cases of liver abscess in patients who developed a rare vascular complication of inferior vena cava. Liver abscesses should be considered as a rare cause of IVC thrombosis in the correct clinical context. All the patients were managed with ultrasound-guided pigtail insertion and antimicrobial agents.
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Affiliation(s)
- James R. Marak
- Department of Radiodiagnosis, Dr RMLIMS, Lucknow, Uttar Pradesh, 226010, India
| | - Gaurav Raj
- Department of Radiodiagnosis, Dr RMLIMS, Lucknow, Uttar Pradesh, 226010, India
| | - Shamrendra Narayan
- Department of Radiodiagnosis, Dr RMLIMS, Lucknow, Uttar Pradesh, 226010, India
| | - Harsha Gara
- Department of Radiodiagnosis, Dr RMLIMS, Lucknow, Uttar Pradesh, 226010, India
| | - Priya Das
- Department of Radiodiagnosis, Dr RMLIMS, Lucknow, Uttar Pradesh, 226010, India
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Sardar SK, Ghosal A, Haldar T, Das K, Saito-Nakano Y, Kobayashi S, Dutta S, Nozaki T, Ganguly S. Investigating genetic polymorphism in E. histolytica isolates with distinct clinical phenotypes. Parasitol Res 2023; 122:2525-2537. [PMID: 37642770 DOI: 10.1007/s00436-023-07952-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/18/2023] [Indexed: 08/31/2023]
Abstract
Amoebiasis is an infection caused by enteric protozoa, most commonly Entamoeba histolytica, and is globally considered a potentially severe and life-threatening condition. To understand the impact of the parasite genome on disease outcomes, it is important to study the genomes of infecting strains in areas with high disease prevalence. These studies aim to establish correlations between parasite genotypes and the clinical presentation of amoebiasis. We employ a strain typing approach that utilizes multiple loci, including SREHP and three polymorphic non-coding loci (tRNA-linked array N-K2 and loci 1-2 and 5-6), for high-resolution analysis. Distinct clinical phenotype isolates underwent amplification and sequencing of studied loci. The nucleotide sequences were analysed using Tandem Repeats Finder to detect short tandem repeats (STRs). These patterns were combined to assign a genotype, and the correlation between clinical phenotypes and repetitive patterns was statistically evaluated. This study found significant polymorphism in the size and number of PCR fragments at SREHP and 5-6 locus, while the 1-2 locus and NK2 locus showed variations in PCR product sizes. Out of 41 genotypes, two (I6 and I41) were significantly associated with their respective disease outcomes and were found in multiple isolates. We observed that I6 was linked with a symptomatic outcome, with a statistically significant p-value of 0.0183. Additionally, we found that I41 was associated with ALA disease outcome, with a p-value of 0.0089. Our study revealed new repeat units not previously reported, unveiling the genetic composition of E. histolytica strains in India, associated with distinct disease manifestations.
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Affiliation(s)
- Sanjib K Sardar
- Division of Parasitology, ICMR-National Institute of Cholera and Enteric Diseases (ICMR-NICED), Kolkata, India
| | - Ajanta Ghosal
- Division of Parasitology, ICMR-National Institute of Cholera and Enteric Diseases (ICMR-NICED), Kolkata, India
| | - Tapas Haldar
- Division of Parasitology, ICMR-National Institute of Cholera and Enteric Diseases (ICMR-NICED), Kolkata, India
| | - Koushik Das
- Division of Parasitology, ICMR-National Institute of Cholera and Enteric Diseases (ICMR-NICED), Kolkata, India
- Faculty of Science, Assam Downtown University, Guwahati, Assam, 781026, India
| | - Yumiko Saito-Nakano
- Department of Parasitology, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8640, Japan
| | - Seiki Kobayashi
- Department of Parasitology, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8640, Japan
| | - Shanta Dutta
- Division of Bacteriology, ICMR-National Institute of Cholera and Enteric Diseases (ICMR-NICED), Kolkata, India
| | - Tomoyoshi Nozaki
- Department of Biomedical Chemistry, School of International Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sandipan Ganguly
- Division of Parasitology, ICMR-National Institute of Cholera and Enteric Diseases (ICMR-NICED), Kolkata, India.
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Jesrani G, Kaur J, Gupta S, Cheema YS, Ahlawat P. Mediastinal extension of amoebic liver abscess: A case report on the rare thoracic complication of Entamoeba histolytica. Turk J Emerg Med 2023; 23:250-253. [PMID: 38024189 PMCID: PMC10664199 DOI: 10.4103/tjem.tjem_294_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/07/2022] [Accepted: 11/22/2022] [Indexed: 12/01/2023] Open
Abstract
Amoebic liver abscess is one frequently encountered intra-abdominal infection, caused by Entamoeba histolytica and has various abdominal and thoracic life-threatening complications. Herein, describe a case of a 30-year-old female, who suffered from multiple amoebic liver abscesses and presented with massive right-sided pleural effusion. She was managed with recommended antibiotics and pigtail catheter for liver abscess and an intercostal drainage tube for massive pleural effusion. However, postintercostal drainage, her chest X-ray demonstrated a right mediastinal shadow, which was confirmed as an intrathoracic extension of the hepatic liver abscess on computed tomography. An ultrasound-guided pigtail catheter was manipulated and placed at the site of thoracic communication. This led to clinical and radiological improvement, but unfortunately, she developed ventilator-acquired pneumonia and died due to her illness. The case represents an uncommon complication of amoebic liver abscess, which is rarely described and adds more knowledge on the thoracic complexities of this infectious disease.
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Affiliation(s)
- Gautam Jesrani
- Department of General Medicine, Government Medical College and Hospital, Chandigarh, India
| | - Jaspreet Kaur
- Department of General Medicine, Government Medical College and Hospital, Chandigarh, India
| | - Samiksha Gupta
- Department of General Medicine, Government Medical College and Hospital, Chandigarh, India
| | - Yuvraj Singh Cheema
- Department of General Medicine, Government Medical College and Hospital, Chandigarh, India
| | - Prashant Ahlawat
- Department of General Medicine, Government Medical College and Hospital, Chandigarh, India
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Flores MS, Tamez E, Rangel R, Monjardin J, Bosques F, Obregón A, Trejo-Avila L, Quintero I, Gandarilla F, Arevalo K, Alemán E, Galán L. UBIQUITIN OF Entamoeba histolytica INDUCE ANTIBODY RESPONSE IN PATIENTS WITH INVASIVE AMOEBIASIS. Parasite Immunol 2022; 44:e12919. [PMID: 35366008 DOI: 10.1111/pim.12919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 03/21/2022] [Accepted: 03/28/2022] [Indexed: 12/31/2022]
Abstract
Entamoeba histolytica causes amoebic liver abscess (ALA) in humans. The injury of target cells by Entamoeba histolytica includes processes controlled by the ubiquitin Ehub. Previously, we found immunodominance of Ehub glycan moieties using immunized rabbits. In this work, we analyzed dominance of antibodies to the glycoprotein Ehub in the sera from 52 patients with ALA. Controls were sera from 20 healthy people living in endemic areas with high seroprevalence of antibodies to amoebas, and 20 patients with alcoholic hepatitis (AH) to rule out the cross-reaction of Ehub with autoantibodies induced by liver damage. Antigens were trophozoite extract, glycoprotein Ehub and the recombinant protein rEhub. The sera from healthy volunteers and patients with AH do not have antibodies to glycoprotein Ehub. Surprisingly, only the antibodies from patients with ALA recognized the glycoprotein Ehub, and some sera gave a faint reaction with the recombinant protein, especially because evolutionarily, the ubiquitin is conserved between species. This is the first report demonstrating that antibodies to ubiquitin Ehub are induced exclusively in patients with invasive amoebiasis, and the antibody response is mainly to the glycoprotein, indicating glycans are immunodominant. Inhibitors of the Ehub glycans could be potential treatment for amoebiasis by selectively damaging trophozoites. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- María S Flores
- Universidad Autónoma de Nuevo León, Facultad de Ciencias Biológicas, Instituto de Biotecnología. San Nicolás de los Garza, Nuevo León, Mexico
| | - Eva Tamez
- Universidad Autónoma de Nuevo León, Facultad de Medicina, Monterrey, Nuevo León, Mexico
| | - Roberto Rangel
- Universidad Autónoma de Nuevo León, Facultad de Ciencias Biológicas, Instituto de Biotecnología. San Nicolás de los Garza, Nuevo León, Mexico
| | | | - Francisco Bosques
- Universidad Autónoma de Nuevo León, Facultad de Medicina, Monterrey, Nuevo León, Mexico
| | - Adriana Obregón
- Universidad Autónoma de Nuevo León, Facultad de Ciencias Biológicas, Instituto de Biotecnología. San Nicolás de los Garza, Nuevo León, Mexico
| | - Laura Trejo-Avila
- Universidad Autónoma de Nuevo León, Facultad de Ciencias Biológicas, Instituto de Biotecnología. San Nicolás de los Garza, Nuevo León, Mexico
| | - Isela Quintero
- Universidad Autónoma de Nuevo León, Facultad de Ciencias Biológicas, Instituto de Biotecnología. San Nicolás de los Garza, Nuevo León, Mexico
| | - Fátima Gandarilla
- Universidad Autónoma de Nuevo León, Facultad de Ciencias Biológicas, Instituto de Biotecnología. San Nicolás de los Garza, Nuevo León, Mexico
| | - Katiushka Arevalo
- Universidad Autónoma de Nuevo León, Facultad de Ciencias Biológicas, Instituto de Biotecnología. San Nicolás de los Garza, Nuevo León, Mexico
| | - Elizabeth Alemán
- Universidad Autónoma de Nuevo León, Facultad de Ciencias Biológicas, Instituto de Biotecnología. San Nicolás de los Garza, Nuevo León, Mexico
| | - Luis Galán
- Universidad Autónoma de Nuevo León, Facultad de Ciencias Biológicas, Instituto de Biotecnología. San Nicolás de los Garza, Nuevo León, Mexico
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da Silva CAV, de Oliveira IMC, Cruz RE, Silva Prado GK, Santos FV, Neves NCV, Gomes MA, Silva Oliveira FM, Caliari MV. South American Entamoeba dispar strains produce amoebic liver abscesses with different pathogenicities and evolutionary kinetics. Acta Trop 2021; 224:106114. [PMID: 34450059 DOI: 10.1016/j.actatropica.2021.106114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/15/2021] [Accepted: 08/16/2021] [Indexed: 11/25/2022]
Abstract
Amoebiasis is a protozoan disease caused by Entamoeba histolytica, and presents a geographic distribution of worldwide amplitude, high incidence, sometimes accompanied by severe clinical manifestations such as amoebic colitis and Amoebic Liver Abscess (ALA), remaining as a public health problem in developing countries. Entamoeba dispar is another species of amoeba that infects approximately 12% of the world's population, and it has previously been classified as noninvasive. However, E. dispar has already been isolated from patients with symptomatic non-dysenteric colitis, as well as its DNA sequences were detected and genotyped in samples from patients with dysenteric colitis, and patients with ALA, suggesting that this species could also be involved in the development of lesions in the large intestine and liver of human beings. In this context, this study aims to evaluate the ability of isolated strains of Entamoeba dispar in South America to cause liver damage, and to better characterize histopathological findings in 3, 8, 12 and 16 days after infection (DAI). Firstly, we assessed whether trophozoites from MCR, ACFN, ICS, ADO and VEJ E. dispar strains, and EGG Entamoeba histolytica strain differed in their in vitro phagocytosis ability, being related to greater ability to phagocyte with greater virulence. Then, we investigate and characterize histopathological changes present in the liver of mice induced by different strains of E. dispar. Our results demonstrated that trophozoites from E. dispar strains are capable of phagocyting human erythrocytes, but in lower amounts than Entamoeba histolytica. In addition, we described and characterized the lesions in different periods after infection by different E. dispar strains, and identified ACFN as the most pathogenic strain, followed by MCR. The large areas of necrosis produced by the ACFN strain as the eighth DAI, which also show high parasitism, led to 100% mortality. On the other hand, the ICS, ADO and VEJ strains did not produce mortality, and this was correlated with the presence of well-developed chronic granulomatous inflammation, necrosis absorption throughout the infection, and regeneration of the liver parenchyma. The greater pathogenicity of the ACFN strain strongly suggests that this strain could be producing higher levels of virulence factors. As the experimental infection, the heterogeneity of biological behavior of different Entamoeba dispar strains could be involved in the development of undiagnosed human clinical conditions.
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Dhali A, Sarkar A, Ray S, Biswas DN, Dhali GK, Mahajan A. Hepatic artery pseudo-aneurysm rupturing into hepato-gastric fistula, a rare cause of massive upper gastrointestinal hemorrhage: Case report. Radiol Case Rep 2022; 17:133-6. [PMID: 34820036 DOI: 10.1016/j.radcr.2021.10.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 10/10/2021] [Indexed: 11/21/2022] Open
Abstract
Hepatic artery pseudo-aneurysm and hepato-fastric fistula are extremely rare clinical entities, which can be caused as complications of amoebic liver abscess. Herein, we report a 45- year old man, who presented with history of hematemesis since last 1 day, melena since last 3 days and fever since last 5 days. On physical examination, he was hemodynamically stable, pallor was noted. Abdominal examination revealed tenderness over the right-upper quadrant. Per-rectal examination showed evidences of melena. Esophagogastroduodenoscopy revealed stomach communicating anteriorly with the abscess cavity from the surrounding, possibly from liver. There was no evidence of fresh bleed during the procedure. The abscess was drained and sent for microbiological evaluation. Computed tomographic angiography revealed a well defined saccular outpouching arising from common hepatic artery with surrounding ill-defined hypodensity around segment V and IVb of liver. Patient underwent transfemoral endovascular coil embolization. Post embolisation, DSA showed complete occlusion of pseudo-aneurysm. He was discharged on oral metronidazole and was doing well on 8-month follow-up with no episodes of rebleed.
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11
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Maricuto AL, Velásquez VL, Pineda J, Flora-Noda DM, Rodríguez I, Rodríguez-Inés CA, Noya-González ÓO, Contreras R, Omaña-Ávila ÓD, Escalante-Pérez IA, Camejo-Ávila NA, Kuffaty-Akkou NA, Carrión-Nessi FS, Carballo M, Landaeta ME, Forero-Peña DA. Amoebic liver abscess in a COVID-19 patient: a case report. BMC Infect Dis 2021; 21:1134. [PMID: 34736397 PMCID: PMC8567734 DOI: 10.1186/s12879-021-06819-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/26/2021] [Indexed: 02/07/2023] Open
Abstract
Background Amoebiasis is a parasitic disease caused by Entamoeba histolytica, which affects people living in low- and middle-income countries and has intestinal and extraintestinal manifestations. To date, knowledge on coronavirus disease 2019 (COVID-19) coinfection with enteric parasites is limited, and E. histolytica coinfection has not been previously described. Here we present the case of a patient with COVID-19 who, during hospitalisation, presented a clinical picture consistent with an amoebic liver abscess (ALA). Case presentation A 54-year-old man, admitted as a suspected case of COVID-19, presented to our hospital with dyspnoea, malaise, fever and hypoxaemia. A nasopharyngeal swab was positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by reverse-transcription polymerase chain reaction. After 7 days, he developed diarrhoea, choluria and dysentery. An abdominal ultrasound showed a lesion compatible with a liver abscess; stool examination revealed E. histolytica trophozoites, and additional serology for E. histolytica was positive. After 12 days of treatment with metronidazole, ceftazidime and nitazoxanide, the patient reported acute abdominal pain, and an ultrasound examination revealed free liquid in the abdominal cavity. An emergency exploratory laparotomy was performed, finding 3000 mL of a thick fluid described as “anchovy paste”. Computed tomography scan revealed a second abscess. He ended up receiving 21 days of antibiotic treatment and was discharged with satisfactory improvement. Conclusion Here we present, to the best of our knowledge, the first report of ALA and COVID-19 co-presenting. Based on their pathophysiological similarities, coinfection with SARS-CoV-2 and E. histolytica could change the patient’s clinical course; however, larger studies are needed to fully understand the interaction between these pathogens.
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Affiliation(s)
- Andrea L Maricuto
- Infectious Diseases Department, University Hospital of Caracas, Caracas, Venezuela
| | - Viledy L Velásquez
- Infectious Diseases Department, University Hospital of Caracas, Caracas, Venezuela
| | - Jacinto Pineda
- "Dr. José Antonio O'Daly" Anatomopathological Institute, Central University of Venezuela, Caracas, Venezuela
| | - David M Flora-Noda
- Infectious Diseases Department, University Hospital of Caracas, Caracas, Venezuela
| | - Isaac Rodríguez
- Radiodiagnosis Department, University Hospital of Caracas, Caracas, Venezuela
| | | | - Óscar O Noya-González
- "Dr. Félix Pifano" Tropical Medicine Institute, Central University of Venezuela, Caracas, Venezuela
| | - Rosa Contreras
- "Dr. Félix Pifano" Tropical Medicine Institute, Central University of Venezuela, Caracas, Venezuela
| | - Óscar D Omaña-Ávila
- "Luis Razetti" School of Medicine, Central University of Venezuela, Caracas, Venezuela.,Biomedical Research and Therapeutic Vaccines Institute, Ciudad Bolivar, Venezuela
| | - Iván A Escalante-Pérez
- "Luis Razetti" School of Medicine, Central University of Venezuela, Caracas, Venezuela.,Biomedical Research and Therapeutic Vaccines Institute, Ciudad Bolivar, Venezuela
| | | | - Nicolle A Kuffaty-Akkou
- "Luis Razetti" School of Medicine, Central University of Venezuela, Caracas, Venezuela.,Biomedical Research and Therapeutic Vaccines Institute, Ciudad Bolivar, Venezuela
| | - Fhabián S Carrión-Nessi
- Biomedical Research and Therapeutic Vaccines Institute, Ciudad Bolivar, Venezuela.,"Dr. Francisco Battistini Casalta" Health Sciences School, University of Oriente - Bolivar Nucleus, Ciudad Bolivar, Venezuela
| | - Martín Carballo
- Infectious Diseases Department, University Hospital of Caracas, Caracas, Venezuela
| | - María E Landaeta
- Infectious Diseases Department, University Hospital of Caracas, Caracas, Venezuela
| | - David A Forero-Peña
- Infectious Diseases Department, University Hospital of Caracas, Caracas, Venezuela. .,Biomedical Research and Therapeutic Vaccines Institute, Ciudad Bolivar, Venezuela.
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12
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Juwita PM, Yudhawati R. Secondary pleuropulmonary amoebiasis due to liver abscess rupture: A complication case report in low resource setting. Int J Surg Case Rep 2021; 85:106231. [PMID: 34314973 PMCID: PMC8326431 DOI: 10.1016/j.ijscr.2021.106231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 07/18/2021] [Accepted: 07/20/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Pleuropulmonary amoebiasis caused by complications of amoebic liver abscess (ALA) is rare. CASE PRESENTATION A 23 years old male, presented with shortness of breath, cough with yellowish phlegm, right chest pain, fever, bulging stomach, yellow eyes, and swelling of both legs. Abdominal ultrasound and CT scan thorax and abdomen revealed right fluidopneumothorax and liver abscess. Serological testing leads to Entamoeba histolytica infection, which was treated with metronidazole but no significant improvement on empyema and abscess liver size. Surgery was performed after percutaneous aspiration drainage failed to evacuate the abscess. HE and PAS staining from surgical tissue showed Entamoeba hystolitica infection. DISCUSSION Serological testing and radiological examination will be more useful in the early detection of cases of Entamoeba hystolitica infection. Surgery may be considered when purulent drainage does not show improvement in the patient's condition. CONCLUSION ALA complication that causes pulmonary empyema can be surgically treated if the pus cannot be drained.
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Affiliation(s)
- Putri Mega Juwita
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.
| | - Resti Yudhawati
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.
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13
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Mousa H, Al-Bluwi GSM, Al Drini ZFM, Gasmelseed HI, Alkoteesh JA, Babiker ZOE. Importation of Entamoeba histolytica and predominance of Klebsiella pneumoniae in liver abscesses: a 7-year retrospective cohort study from the United Arab Emirates. Trop Dis Travel Med Vaccines 2021; 7:17. [PMID: 34118991 PMCID: PMC8196433 DOI: 10.1186/s40794-021-00140-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 05/10/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND There is a dearth of information on liver abscesses in the United Arab Emirates. Herein, we describe the clinical features of liver abscesses and determine their incidence rates and clinical outcomes. METHODS We retrospectively reviewed the clinical charts of adult patients with a primary diagnosis of liver abscess at a major hospital over a 7-year period. RESULTS Amongst 45 patients, 82.2% (37/45) had a pyogenic liver abscess (PLA) and 17.8% (8/45) had amoebic liver abscesses (ALA). Overall, patients were young (median age 42 years, IQR 35-52), mostly males (77.8%, 35/45) from the Indian subcontinent (55.6%, 25/45), presented with fever (88.9%, 40/45) and abdominal pain (88.9%, 40/45), and had a solitary abscess on imaging (71.1% (32/45). Crude annual incidence rates were 35.9/100,000 hospital admissions (95% CI 26.2-48.0) and 5.9/100,000 inhabitants (95% CI 4.3-7.9). All ALA patients were from the Indian subcontinent (100%, 8/8). Klebsiella pneumoniae was the most frequent pathogen in PLA (43.2% [16/37], 95% CI 27.1-60.5%). The hospital stay was shorter in ALA (7.5 days, IQR 7-8.5) than in PLA (14 days, IQR 9-17). No deaths were recorded within 30 days of hospitalisation. CONCLUSIONS ALA was exclusively seen in migrants from the Indian subcontinent, suggesting importation. Further research to characterise K. pneumoniae isolates and assess potential risk factors is needed.
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Affiliation(s)
- Hussam Mousa
- Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.,Surgical Institute, Al Ain Hospital, Al Ain, United Arab Emirates
| | - Ghada Salameh Mohammed Al-Bluwi
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Zainab Fathi Mohammed Al Drini
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | | | | | - Zahir Osman Eltahir Babiker
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates. .,Division of Infectious Diseases, Al Ain Hospital, Al Ain, United Arab Emirates. .,Present Address: Division of Infectious Diseases, Sheikh Shakhbout Medical City in Partnership with Mayo Clinic, Abu Dhabi, United Arab Emirates.
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14
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Goyal A, Dhaliwal HS, Nampoothiri RV, Singh R, Abraham J, Sharma R, Soloman R, Lahan S, Kaur P, Bansal P, Gill CS. Percutaneous catheter drainage of uncomplicated amoebic liver abscess: prospective evaluation of a clinical protocol for catheter removal and the significance of residual collections. Abdom Radiol (NY) 2021; 46:2855-2864. [PMID: 33469690 DOI: 10.1007/s00261-021-02949-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 12/27/2020] [Accepted: 01/02/2021] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Patients with amoebic liver abscess (ALA) may require percutaneous catheter drainage (PCD). Once the PCD output is substantially reduced or has ceased along with clinical recovery, residual collections on radiological evaluation may concern the treating physicians. The prevalence and significance of such collections is unknown, and the subsequent approach how to tackle them is unclear. METHODS Consecutive patients with one or more uncomplicated ALAs requiring drainage were prospectively enrolled from 3 hospitals and managed based on a standard approach. Catheter removal was attempted after the patients fulfilled all 4 of the following criteria: disappearance of abdominal pain, absence of fever for at least 48 h, an improving trend of TLC (documented on 2 consecutive reports), and catheter drain output of < 10 ml/day for at least 2 consecutive days. RESULTS A total of 110 patients (mean age 46.6 ± 10.5 years, 93.6% males, 89.1% alcoholics) underwent PCD placement; 69 patients (69/110; 62.7%) met all 4 criteria within 5 days of PCD placement (optimal response) and had an uncomplicated course. Patients with suboptimal responses (41/110; 37.3%) were evaluated for local and systemic complications; the appearance of fresh collections (5/110; 4.5%), abscess rupture (2/110; 1.8%), bile leakage (3/110; 2.7%), cholangitis (2/110; 1.8%), thrombophlebitis (2/110; 1.8%) and hospital-acquired infections (2/110; 1.8%) were diagnosed and treated accordingly. Ultimately, PCD removal (based on the fulfilment of all 4 criteria) was universally successful after a median of 5 days (IQR, 4-9 days). None of the patients had symptom recurrence after PCD removal, although residual collections were still seen in 97.3% of patients at the time of PCD removal and in 92.1% and 84.9% of patients available for follow-up at 1 and 3 months, respectively. CONCLUSION Based on our clinical protocol, PCD removal in ALA can be successfully expedited even in the presence of residual collections. An inability to fulfill all 4 criteria within 5 days of PCD placement warrants further evaluations for local and systemic complications that require additional therapeutic measures.
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Affiliation(s)
- Amandeep Goyal
- Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Harpal S Dhaliwal
- Department of Gastroenterology, GTBS (C) Hospital, Ludhiana, Punjab, 141002, India.
| | - Ram V Nampoothiri
- Department of Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ripudaman Singh
- Department of Internal Medicine, Christian Medical College and Hospital, Ludhiana, Punjab, India
| | - John Abraham
- Department of Internal Medicine, Christian Medical College and Hospital, Ludhiana, Punjab, India
| | - Rajan Sharma
- Department of Internal Medicine, GTBS (C) Hospital, Ludhiana, Punjab, India
| | - Rajat Soloman
- Department of Internal Medicine, Christian Medical College and Hospital, Ludhiana, Punjab, India
| | - Shubham Lahan
- Department of Internal Medicine, University College of Medical Sciences, New Delhi, India
| | - Preetraj Kaur
- Department of Internal Medicine, GTBS (C) Hospital, Ludhiana, Punjab, India
| | - Pankaj Bansal
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic School of Medicine and Science, Eau Claire, WI, 54702, USA
| | - Chiranjiv Singh Gill
- Department of Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
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15
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Francis C, Soni S, Gupta A, Agstam S. A case report of ruptured amoebic liver abscess causing cardiac tamponade and requiring pericardial window. Eur Heart J Case Rep 2021; 4:1-4. [PMID: 33426455 PMCID: PMC7780479 DOI: 10.1093/ehjcr/ytaa182] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/08/2020] [Accepted: 05/29/2020] [Indexed: 01/20/2023]
Abstract
Background Amoebiasis is a prevalent infection in the tropics. Amoebic liver abscess is the most common extraintestinal manifestation. Cardiac tamponade is an uncommon complication of amoebic liver abscess that may need urgent pericardiocentesis. Case summary A 25-year-old man presented with abdominal pain and fever for 1 month. Abdominal ultrasound revealed a 4.7 × 4.7 cm abscess in the left lobe of the liver. Percutaneous pigtail drainage was performed to evacuate the abscess. After 2 days, the patient developed signs of cardiac tamponade and bilateral pleural effusion, requiring urgent pericardiocentesis and chest drain insertion. Persistent posterior collection of thick abscess in pericardium needed pericardial window for complete drainage. The patient recovered completely after pericardial window. There was no evidence of chronic constrictive pericarditis after 1 year of follow-up. Discussion A rare complication of the amoebic liver abscess was observed in this young adult who developed cardiac tamponade, requiring an urgent pericardiocentesis, and later requiring pericardial window. Management includes amoebicidal and luminicidal drugs for complete eradication of Entamoeba histolytica.
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Affiliation(s)
- Cliojis Francis
- Department of Cardiology, VMMC and Safdarjung Hospital, New Delhi, India
| | - Swati Soni
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Anunay Gupta
- Department of Cardiology, VMMC and Safdarjung Hospital, New Delhi, India
| | - Sourabh Agstam
- Department of Cardiology, VMMC and Safdarjung Hospital, New Delhi, India
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16
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Kaiser RWJ, Allgeier J, Philipp AB, Mayerle J, Rothe C, Wallrauch C, Op den Winkel M. Development of amoebic liver abscess in early pregnancy years after initial amoebic exposure: a case report. BMC Gastroenterol 2020; 20:424. [PMID: 33317457 PMCID: PMC7734812 DOI: 10.1186/s12876-020-01567-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 12/01/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Infection with Entamoeba histolytica and associated complications are relatively rare in developed countries. The overall low prevalence in the Western world as well as the possibly prolonged latency period between infection with the causing pathogen and onset of clinical symptoms may delay diagnosis of and adequate treatment for amoebiasis. Amoebic liver abscess (ALA) is the most common extraintestinal manifestation of invasive amoebiasis. Pregnancy has been described as a risk factor for development of invasive amoebiasis and management of these patients is especially complex. CASE PRESENTATION A 30-year-old Caucasian woman in early pregnancy presented to our emergency department with abdominal pain alongside elevated inflammatory markers and liver function tests. Travel history revealed multiple journeys to tropic and subtropic regions during the past decade and a prolonged episode of intermittently bloody diarrhea during a five month stay in Indonesia seven years prior to admission. Sonographic and magnetic resonance imaging revealed a 5 × 4 cm hepatic abscess. After ultrasound-guided transcutaneous liver drainage, both abscess fluids and blood cultures showed neither bacterial growth nor microscopic signs of parasitic disease. Serological testing confirmed an infection with Entamoeba histolytica, which was treated with metronidazole, followed by eradication therapy with paromomycin. Subsequent clinical, laboratory and imaging follow-up exams showed regression of the ALA. In addition, the pregnancy completed without complications and a healthy baby boy was born 7 months after termination of treatment. CONCLUSIONS This case of invasive amoebiasis in early pregnancy outside of endemic regions and several years after exposure demonstrates the importance of broad differential diagnostics in the context of liver abscesses. The complex interdisciplinary decisions regarding the choice of imaging techniques as well as interventional and antibiotic therapy in the context of pregnancy are discussed. Furthermore, we present possible explanations for pregnancy as a risk factor for an invasive course of amoebiasis.
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Affiliation(s)
- Rainer W J Kaiser
- Department of Medicine I, LMU Klinikum, Ludwig-Maximilians-University, Munich, Germany. .,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
| | - Julian Allgeier
- Department of Medicine II, LMU Klinikum, Ludwig-Maximilians-University, Munich, Germany
| | - Alexander B Philipp
- Department of Medicine II, LMU Klinikum, Ludwig-Maximilians-University, Munich, Germany
| | - Julia Mayerle
- Department of Medicine II, LMU Klinikum, Ludwig-Maximilians-University, Munich, Germany
| | - Camilla Rothe
- Department of Tropical Medicine, LMU Klinikum, Ludwig-Maximilians-University, Munich, Germany
| | - Claudia Wallrauch
- Department of Tropical Medicine, LMU Klinikum, Ludwig-Maximilians-University, Munich, Germany
| | - Mark Op den Winkel
- Department of Medicine II, LMU Klinikum, Ludwig-Maximilians-University, Munich, Germany
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17
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Goel R, Roy A, Ray D, Chaluvashetty SB, De A. A case of amoebic liver abscess complicated by bilhaemia and venous thrombosis. Trop Doct 2020; 51:249-250. [PMID: 33283676 DOI: 10.1177/0049475520975948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Amoebic liver abscess is the most common extra-intestinal manifestation of amoebiasis. It usually responds well to treatment with metronidazole together with drainage, if indicated. Uncommonly, the abscess may rupture into the pleura, peritoneum or pericardium, bile duct at its hilum, or produce septic emboli. We present a patient with two rare complications: venous thrombosis and jaundice secondary to bilhaemia.
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Affiliation(s)
- Rohan Goel
- Junior Resident, Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Akash Roy
- Senior Resident, Department of Hepatology, PGIMER, Chandigarh, India
| | - Debadrita Ray
- Senior Resident, Department of Laboratory Oncology, 28730AIIMS, New Delhi, India
| | | | - Arka De
- Assistant Professor, Department of Hepatology, PGIMER, Chandigarh, India
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18
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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19
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Rangel-Castañeda IA, Carranza-Rosales P, Guzmán-Delgado NE, Hernández-Hernández JM, González-Pozos S, Pérez-Rangel A, Castillo-Romero A. Curcumin Attenuates the Pathogenicity of Entamoeba histolytica by Regulating the Expression of Virulence Factors in an Ex-Vivo Model Infection. Pathogens 2019; 8:pathogens8030127. [PMID: 31443160 PMCID: PMC6789811 DOI: 10.3390/pathogens8030127] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 08/08/2019] [Accepted: 08/10/2019] [Indexed: 12/12/2022] Open
Abstract
Infection with the enteric protozoan Entamoeba histolytica is still a serious public health problem, especially in developing countries. Amoebic liver abscess (ALA) is the most common extraintestinal manifestation of the amoebiasis, and it can lead to serious and potentially life-threatening complications in some people. ALA can be cured by metronidazole (MTZ); however, because it has poor activity against luminal trophozoites, 40–60% of treated patients get repeated episodes of invasive disease and require repeated treatments that can induce resistance to MTZ, this may emerge as an important public health problem. Anti-virulence strategies that impair the virulence of pathogens are one of the novel approaches to solving the problem. In this study, we found that low doses of curcumin (10 and 50 μM) attenuate the virulence of E. histolytica without affecting trophozoites growth or triggering liver injury. Curcumin (CUR) decreases the expression of genes associated with E. histolytica virulence (gal/galnac lectin, ehcp1, ehcp5, and amoebapore), and is correlated with significantly lower amoebic invasion. In addition, oxidative stress is critically involved in the etiopathology of amoebic liver abscess; our results show no changes in mRNA expression levels of superoxide dismutase (SOD) and catalase (CAT) after E. histolytica infection, with or without CUR. This study provides clear evidence that curcumin could be an anti-virulence agent against E. histolytica, and makes it an attractive potential starting point for effective treatments that reduce downstream amoebic liver abscess.
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Affiliation(s)
- Itzia Azucena Rangel-Castañeda
- Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico
| | - Pilar Carranza-Rosales
- Centro de Investigación Biomédica del Noreste, Instituto Mexicano del Seguro Social, Monterrey 64720, Mexico
| | | | - José Manuel Hernández-Hernández
- Departamento de Biología Celular, Centro de Investigación y Estudios Avanzados del Instituto Politécnico Nacional, Ciudad de México 07360, Mexico
| | - Sirenia González-Pozos
- Unidad de Microscopía Electrónica LaNSE, Centro de Investigación y Estudios Avanzados del Instituto Politécnico Nacional, Ciudad de México 07360, Mexico
| | - Armando Pérez-Rangel
- Departamento de Biología Celular, Centro de Investigación y Estudios Avanzados del Instituto Politécnico Nacional, Ciudad de México 07360, Mexico
| | - Araceli Castillo-Romero
- Departamento de Microbiología y Patología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico.
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Neill L, Edwards F, Collin SM, Harrington D, Wakerley D, Rao GG, McGregor AC. Clinical characteristics and treatment outcomes in a cohort of patients with pyogenic and amoebic liver abscess. BMC Infect Dis 2019; 19:490. [PMID: 31159769 PMCID: PMC6547479 DOI: 10.1186/s12879-019-4127-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 05/23/2019] [Indexed: 02/06/2023] Open
Abstract
Background We describe the clinical features of a cohort of patients with liver abscesses and investigate relationships between clinical, radiological and microbiological findings and mortality. Methods Retrospective review of pyogenic (PLA) or amoebic liver abscesses (ALA) diagnosed and treated at a major infectious diseases department in London over 9 years. Results One hundred forty-one patient records were identified; 132 (93.6%) had PLA and 9 (6.4%) ALA. No organism was identified in 38.6% (51/132); a single bacterial species was isolated in 47.0% (62/132) of PLA, ≥ 2 in 14.4% (19/132). There was weak evidence of variation in abscess size by type of microorganism, with streptococcal PLA typically larger (p = 0.03 for Streptococcus milleri group, p = 0.05 for non-milleri streptococci). Patients with ALA were younger (median 41, IQR 37–51 years) than those with PLA (median 68, IQR 50.5–78 years) (p = 0.003) and all were male (9/9, 100%, (p = 0.03)), with a history of recent travel in the majority (6/9, 66.7% (p = 0.003)). C-reactive protein was higher in ALA than in PLA (p = 0.06). In the entire cohort, loculation (HR = 2.51 (95% CI 1.00–6.32), p = 0.04) and baseline ALP (HR = 4.78 (95% CI 1.19–19.2) per log10 increase, p = 0.03) were associated with mortality. 16S ribosomal RNA (rRNA) analysis was used in a subset of culture-negative cases and increased the diagnostic yield by 13%. Conclusions Clinical or radiological features cannot be used to distinguish between PLA and ALA, or help identify the bacterial cause of PLA. However, ALA is more common in young, male patients with a history of travel. 16S rRNA analysis of abscess fluid has a role in improving microbiological diagnosis in culture-negative cases. Electronic supplementary material The online version of this article (10.1186/s12879-019-4127-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lorna Neill
- Department of Infectious Diseases and Tropical Medicine, London North West Healthcare NHS Trust, Northwick Park Hospital, Middlesex, Harrow, HA1 3UJ, UK.
| | - Frances Edwards
- Department of Infectious Diseases and Tropical Medicine, London North West Healthcare NHS Trust, Northwick Park Hospital, Middlesex, Harrow, HA1 3UJ, UK
| | - Simon M Collin
- Healthcare-Associated Infection & Antimicrobial Resistance Division, National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - David Harrington
- Department of Infectious Diseases and Tropical Medicine, London North West Healthcare NHS Trust, Northwick Park Hospital, Middlesex, Harrow, HA1 3UJ, UK
| | - Dominic Wakerley
- Department of Infectious Diseases and Tropical Medicine, London North West Healthcare NHS Trust, Northwick Park Hospital, Middlesex, Harrow, HA1 3UJ, UK
| | - Guduru Gopal Rao
- Department of Microbiology, London North West Healthcare NHS Trust, Northwick Park Hospital, Middlesex, Harrow, HA1 3UJ, UK.,Department of Medicine, Imperial College London, London, UK
| | - Alastair C McGregor
- Department of Infectious Diseases and Tropical Medicine, London North West Healthcare NHS Trust, Northwick Park Hospital, Middlesex, Harrow, HA1 3UJ, UK.,Department of Microbiology, London North West Healthcare NHS Trust, Northwick Park Hospital, Middlesex, Harrow, HA1 3UJ, UK.,Department of Medicine, Imperial College London, London, UK
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Kumar Jha A, Jha P, Chaudhary M, Kumar S, Prakash V, Mohan Dayal V. The relation of toddy (palm wine) intake to amoebic liver abscess in a predominantly toddy-drinking population: a cross-sectional study. Trop Doct 2019; 49:197-200. [PMID: 30939997 DOI: 10.1177/0049475519840242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The role of toddy (palm wine) as an independent risk factor for amoebic liver abscess (ALA) is not clear. In a cross-sectional study, the clinico-demographic profiles of inpatients with ALA were examined. Microscopy examination of toddy (n = 43) samples was performed. A total of 198 patients with ALA were enrolled, most of whom were: admitted during the May-August months (48%); chronic alcoholic (85% [70% toddy]); malnourished (85%); and of low socioeconomic status (88%). Clinical and laboratory parameters were comparable between toddy and distilled alcohol drinkers. None of the toddy samples revealed presence of cysts and trophozoites of Entamoeba histolytica.
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Affiliation(s)
- Ashish Kumar Jha
- 1 Department of Gastroenterology, Indira Gandhi Institute of Medical Sciences, Patna, India
| | - Praveen Jha
- 1 Department of Gastroenterology, Indira Gandhi Institute of Medical Sciences, Patna, India
| | - Madhur Chaudhary
- 1 Department of Gastroenterology, Indira Gandhi Institute of Medical Sciences, Patna, India
| | - Shailesh Kumar
- 2 Department of Microbiology, Indira Gandhi Institute of Medical Sciences, Patna, India
| | - Vidyut Prakash
- 2 Department of Microbiology, Indira Gandhi Institute of Medical Sciences, Patna, India
| | - Vishwa Mohan Dayal
- 1 Department of Gastroenterology, Indira Gandhi Institute of Medical Sciences, Patna, India
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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] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [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. Electronic supplementary material The online version of this article (10.1186/s12889-018-5036-2) contains supplementary material, which is available to authorized users.
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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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Wong WK, Foo PC, Olivos-Garcia A, Noordin R, Mohamed Z, Othman N, Few LL, Lim BH. Parallel ELISAs using crude soluble antigen and excretory-secretory antigen for improved serodiagnosis of amoebic liver abscess. Acta Trop 2017; 172:208-212. [PMID: 28506795 DOI: 10.1016/j.actatropica.2017.05.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 05/08/2017] [Accepted: 05/11/2017] [Indexed: 12/31/2022]
Abstract
Crude soluble antigen (CSA) produced from Entamoeba histolytica trophozoite is conventionally used for serodiagnosis of invasive amoebiasis. However, high background seropositivities by CSA-assay in endemic areas complicate the interpretation of positive result in clinical settings. Instead, incorporating a second assay which indicates active or recent infection into the routine amoebic serology could possibly complement the limitations of CSA-assay. Hence, the present study aimed to evaluate the diagnostic efficacies of indirect ELISAs using CSA and excretory-secretory antigen (ESA) for serodiagnosis of amoebic liver abscess (ALA). Reference standard for diagnosis of ALA at Hospital Universiti Sains Malaysia is based on clinical presentation, radiological imaging and positive indirect haemagglutination assay (titer ≥256). Five groups of human serum samples collected from the hospital included Group I - ALA diagnosed by the reference standard and pus aspirate analysis using real-time PCR (n=10), Group II - ALA diagnosed by the reference standard only (n=41), Group III - healthy control (n=45), Group IV - other diseases control (n=51) and Group V - other infectious diseases control (n=31). For serodiagnosis of ALA serum samples (Group I and II), CSA-ELISA showed sensitivities of 100% for both groups, while ESA-ELISA showed sensitivities of 100% and 88%, respectively. For serodiagnosis of non-ALA serum samples (Group III, IV and V), CSA-ELISA showed specificities of 91%, 75% and 100%, respectively; while ESA-ELISA showed specificities of 96%, 98% and 100%, respectively. Indirect ELISAs using CSA and ESA have shown distinct strength for serodiagnosis of ALA, in terms of sensitivity and specificity, respectively. In conclusion, parallel analysis by both assays improved the overall efficacies of amoebic serology as compared to either single assay.
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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] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [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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Parghane RV, Phulsunga RK, Gupta R, Basher RK, Bhattacharya A, Mittal BR. Usefulness of Tc99m-mebrofenin Hepatobiliary Scintigraphy and Single Photon Emission Computed Tomography/Computed Tomography in the Diagnosis of Bronchobiliary Fistula. World J Nucl Med 2017; 16:317-319. [PMID: 29033682 PMCID: PMC5639450 DOI: 10.4103/1450-1147.215490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Bronchobiliary fistula (BBF), a rare complication of liver disease, is an abnormal communication between the biliary tract and bronchial tree. BBF may occur as a consequence of local liver infections such as hydatid or amebic disease, pyogenic liver abscess or trauma to the liver, obstruction of biliary tract, and tumor. As such management of liver disease with BBF is very difficult and often associated with a high rate of morbidity and mortality. Therefore, timely diagnosis of BBF is imperative. Hepatobiliary scintigraphy along with hybrid single photon emission computed tomography/computed tomography using Tc99m-mebrofenin is a very useful noninvasive imaging modality, in the diagnosis of BBF.
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Affiliation(s)
- Rahul Vithalrao Parghane
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rohit Kumar Phulsunga
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajesh Gupta
- Department of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajender Kumar Basher
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anish Bhattacharya
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Bhagwant Rai Mittal
- Department of Nuclear Medicine and PET, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Kedia S, Rampal R, Paul J, Ahuja V. Gut microbiome diversity in acute infective and chronic inflammatory gastrointestinal diseases in North India. J Gastroenterol 2016; 51:660-71. [PMID: 26994772 DOI: 10.1007/s00535-016-1193-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 02/23/2016] [Indexed: 02/04/2023]
Abstract
The disease profile in the Indian population provides a unique opportunity for studying the host microbiome interaction in both infectious (amebiasis) and autoimmune diseases like inflammatory bowel disease (IBD) from a similar environment and genetic background. Analysis of fecal samples from untreated amebic liver abscess (ALA) patients, Entamoeba histolytica (Eh)-negative and -positive asymptomatic individuals, and pus samples from naive ALA patients revealed a significant reduction in Lactobacillus in asymptomatic individuals (Eh +ve) and ALA patients. Two anaerobic genera, namely Bacteroides and Peptostreptococcus, were detected in naive ALA pus samples. Analysis of fecal samples from amoebic colitis patients showed a significant decline in population of Bacteroides, Clostridium coccoides and leptum subgroup, Lactobacillus, Campylobacter, and Eubacterium, whereas a significant increase in Bifidobacterium was observed. Mucosa-associated bacterial flora analysis from IBD patients and healthy controls revealed a significant difference in concentration of bacteria among predominating and subdominating genera between ulcerative colitis (UC), Crohn's disease (CD) patients, and controls. In contrast to the mucosal studies, we found a significant increase in lactobacilli population in fecal samples of active UC patients. Another study revealed a significant decrease of Clostridium coccoides and leptum clusters in fecal samples of active UC patients along with decreased concentrations of fecal SCFAs, especially of n-butyrate, iso-butyrate, and acetate. We therefore found similar perturbations in gut microbiome in both infectious and autoimmune diseases, indicating inflammation to be the major driver for changes in gut microbiome.
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Affiliation(s)
- Saurabh Kedia
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Ritika Rampal
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Jaishree Paul
- School of Life Sciences, Jawaharlal Nehru University, New Delhi, India
| | - Vineet Ahuja
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
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Ng KF, Tan KK, Ngui R, Lim YA, Amir A, Rajoo Y, Hassan H, Mahmud R. Fatal case of amoebic liver abscess in a child. ASIAN PAC J TROP MED 2015; 8:878-80. [PMID: 26522307 DOI: 10.1016/j.apjtm.2015.09.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 08/20/2015] [Accepted: 09/15/2015] [Indexed: 11/21/2022] Open
Abstract
We reported a case of amoebic liver abscess (ALA) in a 6-year-old Malaysian boy who presented with fever, lethargy, diarrhoea and right hypochondriac pain. On admission he was diagnosed with perforated acute appendicitis and a laparotomy was done. After surgery he developed acute respiratory distress. Ultrasonography, chest X-Ray and CT scan revealed two ALAs in the posterior segment of right lobe of liver, pleural effusion and collapsed consolidation of lungs bilaterally. Percutaneous liver abscesses drainage was done and intravenous Metronidazole was started. PCR carried out on the pus from the abscess was positive for Entamoeba histolytica. Patient however succumbed to the infection one week after admission.
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Jha AK, Das A, Chowdhury F, Biswas MR, Prasad SK, Chattopadhyay S. Clinicopathological study and management of liver abscess in a tertiary care center. J Nat Sci Biol Med 2015; 6:71-5. [PMID: 25810638 PMCID: PMC4367072 DOI: 10.4103/0976-9668.149091] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Liver abscess is a burning problem in tropical nations, with often lethal consequences and diagnostic/therapeutic challenges. We have determined etiopathology, clinical, radiological, and bacteriological characteristics of this condition and review its management strategies. Materials and Methods: During the period of the month from May 2007 to September 2009, a prospective study was performed involving 125 patients admitted to the in-patient ward of the Department of General Surgery of N.R.S Medical College their diagnosis was made on the basis of clinical features (such as right upper abdomen pain, and fever), laboratory investigations and radiological evidence of liver abscess. Results: Amoebic liver abscess was the most common (88%) type of liver abscess among the study groups. There was a strong correlation with the occurrence of liver abscesses and addiction to alcohol, history of diabetes mellitus and low socioeconomic status. The most common etiology of pyogenic liver abscess was Escherichia coli. Ultrasonography (USG) of the abdomen was accurate and cost-effective in diagnosis of liver abscesses. Percutaneous catheter drainage was the most effective method of treatment (with a 100% success rate). Conclusion: Most patients in our study had liver abscess of amoebic origin and had temporal relationship with diabetes, alcoholism, and staggering socioeconomic status. We suggest early recognition of clinical features and prompt abdominal USG as cost-effective means for treatment initiation and reducing complications.
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Affiliation(s)
- Amitesh Kumar Jha
- Department of General Surgery, College of Medicine and Sagore Dutta Hospital, Kolkata, India
| | - Anjan Das
- Department of Anaesthesiology, College of Medicine and Sagore Dutta Hospital, Kolkata, India
| | - Firoz Chowdhury
- Department of General Surgery, College of Medicine and Sagore Dutta Hospital, Kolkata, India
| | - Madhuri Ranjana Biswas
- Department of Anaesthesiology, College of Medicine and Sagore Dutta Hospital, Kolkata, India
| | - Sanjay Kumar Prasad
- Department of General Surgery, College of Medicine and Sagore Dutta Hospital, Kolkata, India
| | - Surajit Chattopadhyay
- Department of Anaesthesiology, Bankura Sammilani Medical College, Bankura, West Bengal, India
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Ning TZ, Kin WW, Mustafa S, Ahmed A, Noordin R, Cheong TG, Alfonso OG, Huat LB. Detection of Entamoeba histolytica in experimentally induced amoebic liver abscess: comparison of three staining methods. Asian Pac J Trop Biomed 2015; 2:61-5. [PMID: 23569836 DOI: 10.1016/s2221-1691(11)60191-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2011] [Revised: 06/27/2011] [Accepted: 07/13/2011] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To compare the efficacy of three different tissue stains, namely haematoxylin and eosin (H&E), periodic-acid Schiff (PAS) and immunohistochemical (IHC) stains for detection of Entamoeba histolytica (E. histolytica) trophozoites in abscessed liver tissues of hamster. METHODS Amoebic liver abscess was experimentally induced in a hamster by injecting 1 × 10(6) of axenically cultured virulent E. histolytica trophozoites (HM1-IMSS strain) into the portal vein. After a week post-inoculation, the hamster was sacrificed and the liver tissue sections were stained with H&E, PAS and IHC stains to detect the amoebic trophozoite. RESULTS The three stains revealed tissue necrosis and amoebic trophozoites, but with varying clarity. H&E and PAS stained the trophozoites pink and magenta, respectively, however it was difficult to differentiate the stained trophozoites from the macrophages because of their similarity in size and morphology. On the other hand, IHC stain revealed distinct brown appearance of the trophozoites in the infected liver tissues. CONCLUSIONS It can be concluded that out of the three stains, IHC is the best for identification of E. histolytica trophozoites in tissue sections.
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Affiliation(s)
- Tan Zi Ning
- School of Health Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
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Huat LB, Garcia AO, Ning TZ, Kin WW, Noordin R, Azham SSA, Jie LZ, Ching GC, Chong FP, Dam PC. Entamoeba histolytica acetyl-CoA synthetase: biomarker of acute amoebic liver abscess. Asian Pac J Trop Biomed 2014; 4:446-50. [PMID: 25182945 DOI: 10.12980/apjtb.4.2014c1169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 04/29/2014] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To characterize the Entamoeba histolytica (E. histolytica) antigen(s) recognized by moribound amoebic liver abscess hamsters. METHODS Crude soluble antigen of E. histolytica was probed with sera of moribund hamsters in 1D- and 2D-Western blot analyses. The antigenic protein was then sent for tandem mass spectrometry analysis. The corresponding gene was cloned and expressed in Escherichia coli BL21-AI to produce the recombinant E. histolytica ADP-forming acetyl-CoA synthetase (EhACS) protein. A customised ELISA was developed to evaluate the sensitivity and specificity of the recombinant protein. RESULTS A ∼75 kDa protein band with a pI value of 5.91-6.5 was found to be antigenic; and not detected by sera of hamsters in the control group. Tandem mass spectrometry analysis revealed the protein to be the 77 kDa E. histolytica ADP-forming acetyl-CoA synthetase (EhACS). The customised ELISA results revealed 100% sensitivity and 100% specificity when tested against infected (n=31) and control group hamsters (n=5) serum samples, respectively. CONCLUSIONS This finding suggested the significant role of EhACS as a biomarker for moribund hamsters with acute amoebic liver abscess (ALA) infection. It is deemed pertinent that future studies explore the potential roles of EhACS in better understanding the pathogenesis of ALA; and in the development of vaccine and diagnostic tests to control ALA in human populations.
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Affiliation(s)
- Lim Boon Huat
- Biomedicine Programme, School of Health Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Alfonso Olivos Garcia
- Departmento de Medicina Experimental, Facultad de Medicina, Universidad Nacional Autonoma de Mexico, 04510 Mexico D.F., Mexico
| | - Tan Zi Ning
- Department of Medicine, Allianze University College of Medical Sciences, Pulau Pinang, Malaysia
| | - Wong Weng Kin
- Biomedicine Programme, School of Health Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Rahmah Noordin
- Institute for Research in Molecular Medicine, 11800 Universiti Sains Malaysia, Penang, Malaysia
| | - Siti Shafiqah Anaqi Azham
- Biomedicine Programme, School of Health Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Lee Zhi Jie
- Biomedicine Programme, School of Health Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Guee Cher Ching
- Biomedicine Programme, School of Health Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Foo Phiaw Chong
- Biomedicine Programme, School of Health Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Pim Chau Dam
- Biomedicine Programme, School of Health Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
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EL-SHAMY M, EMARA M, ATTIA A, ABD-ALLAH M, SAID S. Huge amoebic liver abscess presented with massive right empyema: a case report. Iran J Parasitol 2014; 9:141-4. [PMID: 25642272 PMCID: PMC4289874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 10/14/2013] [Indexed: 11/23/2022]
Abstract
Amoebic liver abscess is a complication of amoebiasis that needs early diagnosis and proper treatment before further complications occur. We report a-35 year old female presented by fever and dyspnea due to huge liver abscess complicated by massive right side empyema. The patient was effectively treated by percutaneous drainage for both the right lobe abscess and empyema together with pharmacologic agents.
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Affiliation(s)
- Mostafa EL-SHAMY
- Dept. of Tropical Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed EMARA
- Dept. of Tropical Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt,Correspondence
| | - Ahmad ATTIA
- Dept. of Tropical Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed ABD-ALLAH
- Dept. of Tropical Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Sameh SAID
- Dept. of Cardiothoracic Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Abstract
Pulmonary complications occur in 7-20% of patients with amoebic liver abscess(ALA) and may present as pleural effusion, empyema, lung abscess or a bronchohepatic fistula. Rupture into a bronchus presents as sudden coughing with expectoration of chocolate-coloured sputum and is usually managed by postural drainage, bronchodilators and anti-amoebic drugs. A young boy presented with a large amoebic liver abscess of about 1 L volume which ruptured into the lung. He required surgical drainage of the liver abscess as even after intubation he was not able to maintain adequate ventilation. Following this he developed a broncho-hepatico-cutaneous fistula with drainage of 400-500 mL bile per day and bubbling of air in the abdominal drain. He underwent selective right hepatic duct cannulation with endo-papillotomy, following which the fistula closed gradually.
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Affiliation(s)
- Navneet Kaur
- Professor, Department of Surgery, UCMS & GTB Hospital, University of Delhi, Delhi, India
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Siddiqui M, Gupta A, Kazmi A, Chandra D, Grover V, Gupta V. Inferior vena caval and right atrial thrombus complicating amoebic liver abscess. Interact Cardiovasc Thorac Surg 2013; 17:872-4. [PMID: 23929899 DOI: 10.1093/icvts/ivt350] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
We present the result of right atrial thrombectomy in a paediatric patient suffering from a right atrial thrombus due to amoebic liver abscess under total circulatory arrest. A 2-year old boy with amoebic liver abscess complicated by inferior vena cava (IVC) thrombus extending up to the right atrium (RA) was operated on in our institute. During the surgery, the thrombus was removed from the IVC and the RA under deep hypothermic circulatory arrest. After chest closure, open drainage of the abscess was performed. Metronidazole was given postoperatively for 2 weeks. The postoperative period was uneventful. There was rapid convalescence with complete resolution of the abscess. Anticoagulation with warfarin was started on the day following surgery and continued for 6 weeks. There was no recurrence of thrombosis or embolic events in the follow-up period. Extension of thrombus into the right atrium mandates an aggressive surgical approach which may prove life saving. It is crucial in the prevention of pulmonary embolism or Budd-Chiari syndrome, which may have an overall poor outcome.
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Affiliation(s)
- Mansoor Siddiqui
- Department of Cardiothoracic and Vascular Surgery, Postgraduate Institute of Medical Education and Research and Dr RML Hospital, New Delhi, India
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Abstract
A middle aged, non-addict male presented with right upper abdominal pain and swelling with respiratory distress. Examination revealed central cyanosis, bipedal pitting edema with prominent epigastric and back veins. Liver was enlarged, tender, spanned 20 cm without any splenomegaly or ascites. Other systems were clinically normal. Laboratory investigations showed polymorphonuclear leucocytosis with slightly deranged liver function. Abdominal ultrasonography showed an abscess in the right lobe of the liver with compressed inferior vena cava (IVC), middle and left hepatic veins. Arterial blood gas (ABG) documented hypoxia with orthodeoxia and air-contrast echocardiography was suggestive of an intrapulmonary shunt. A diagnosis of hepato-pulmonary syndrome (HPS) was made with near normal liver function secondary to amebic liver abscess. It reversed completely following successful treatment of the liver abscess.
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