Giant Amoebic Liver Abscess: A Rare Diagnosis in a Rural Setting of Sub-Saharan Africa

Background. Extraintestinal amoebiasis is an uncommon complication of Entamoeba histolytica infection, occurring in about 5-10% of patient. Prompt diagnosis and management is essential to prevent complications. However, diagnosis and management in resource-limited settings is very challenging owing to limited diagnostic tools and nonspecific clinical symptoms. Therefore, our case report underscores the role of incisive clinical evaluation, basic investigation, and nonsurgical management of giant amoebic abscess in resource-limited settings. Case Presentation. A 13-year-old female Cameroonian presented with subacute onset of upper abdominal pain, high fever, and chest pain for one week. Before presentation, she had been on treatment at a local traditional practitioner during which her symptoms worsen. After clinical evaluation and basic investigation, she was diagnosed with a giant amoebic liver abscess. She was resuscitated and placed on nonsurgical management. Follow-up after 1 month was significant for complete recovery. Conclusion. Amoebic liver abscess is a rare complication of Entamoeba histolytica infection with devastating complications. The diagnosis of this disease requires high index of suspicion in resource-limited settings. Good clinical evaluation and timely nonsurgical therapy can provide recovery to some patients.

A RARE CASE OF COMPLICATED LIVER ABSCESS WITH MIDDLE HEPATIC VEIN THROMBOSIS: A CASE REPORT AND REVIEW OF LITERATURE

In developing countries Amoebic liver abscess is commonly encountered disease and it’s also the commonest extraintestinal manifestation of Entamoeba histolytica infection. Usual complication of Amoebic liver abscess arises due to collection of pus in various cavities, like in peritoneal cavity following perforation, in the pleural cavity which is known as empyema thoracis, and rarely it is complicated by life threatening conditions such as venous extension of the disease involving the hepatic veins and IVC, with only few cases reported. Here we describe a case of amoebic liver abscess extending across middle hepatic vein.

A Comparative Analysis of Microscopy, Coproantigen Serology, and Nested Multiplex PCR in the Laboratory Diagnosis of Entamoeba histolytica Infection

Objectives Amoebiasis is caused by the most common intestinal protozoan parasite Entamoeba histolytica. This parasite causes amoebic colitis, which is manifested by diarrhea, followed by dysentery. The laboratory diagnosis of intestinal amoebiasis in most cases is by microscopic examination of stool samples. Other nonroutine methods include coproantigen enzyme-linked immunosorbent assay (ELISA) from stool samples, serum ELISA for antibodies, stool culture, isoenzyme analysis, and polymerase chain reaction (PCR). The present study aimed to comparatively analyze the different diagnostic modalities used for the detection of E. histolytica from the stool sample of patients with intestinal amoebiasis. Materials and Methods This study was undertaken with 631 patients, during a period of 3 years, from January 2017 to December 2019. Stool specimen obtained from each patient was subjected to direct microscopic wet mount examination, coproantigen ELISA, and nested multiplex PCR, respectively. Results Out of all the patients tested, 5.2% were positive for E. histolytica. Among the positive cases, stool microscopy was positive in 3.17%, coproantigen ELISA was positive in 29 (4.6%) cases, and PCR was positive in 30 (4.75%) cases. Statistical Analysis The prevalence of E. histolytica infection was summarized as percentages. The three diagnostic tests done were statistically analyzed, taking microscopy as the gold standard. The agreement between techniques (microscopy, coproantigen ELISA, and PCR) was analyzed with kappa statistics. Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were summarized as percentage with 95% confidence interval. Conclusion In all suspected amoebiasis cases, a combination of stool microscopy, coproantigen testing with molecular detection of the parasite offers the best approach to diagnosis of this parasitic infection.

A Comparative Study of Cattle and Sheep Amoebiasis in Selected Regions of Baghdad City

Entamoeba histolytica (E. histolytica) infection is the third great parasitic disease responsible for death in the world. Cattle and Sheep harboring E. histolytica can be the possible reservoir hosts for human amoebiasis. This study was performed microscopically to detect the infection of E. histolytica in cattle and sheep fecal samples. Our data recorded a total E. histolytica infection rate of (54%) in cattle and (50%) in sheep without any significant differences between them. One hundred fecal samples were collected from cattle and sheep from three completely different areas in Baghdad city (Al-Tarmiyah, Al-Fudhaliyah, and Abu-Ghraib). Males showed higher infection rates than females in cattle and sheep (62.5%) and (57.14) respectively. The difference between age groups with significant difference (P<0.01) was obtained in ages <1 year (72.7%) and (68.75%) in cattle and sheep respectively. This study has demonstrated the widespread of Entamoeba parasite in cattle and sheep in Baghdad city.

The IL-33-ILC2 pathway protects from amebic colitis

Entamoeba histolytica is a pathogenic protozoan parasite that causes intestinal colitis, diarrhea, and in some cases, liver abscess. Through transcriptomics analysis, we observed that E. histolytica infection was associated with increased expression of IL-33 mRNA in both the human and murine colon. IL-33, the IL-1 family cytokine, is released after cell injury to alert the immune system of tissue damage during infection. Treatment with recombinant IL-33 protected mice from amebic infection and colonic tissue damage; moreover, blocking IL-33 signaling made mice more susceptible to infection and weight loss. IL-33 limited the recruitment of inflammatory immune cells and decreased the pro-inflammatory cytokine IL-6 in the colon. Type 2 immune responses, which are known to be involved in tissue repair, were upregulated by IL-33 treatment during amebic infection. Interestingly, administration of IL-33 protected RAG2-/- mice but not RAG2-/-γc-/- mice, demonstrating that IL-33 mediated protection occurred in the absence of T or B cells but required the presence of innate lymphoid cells (ILCs). IL-33 induced recruitment of ILC2 but not ILC1 and ILC3 in RAG2-/- mice. Adoptive transfer of ILC2s to RAG2-/-γc-/- mice restored IL-33 mediated protection. These data reveal that the IL-33-ILC2 pathway is an important host defense mechanism against amebic colitis.

Entamoeba histolytica—Gut Microbiota Interaction: More Than Meets the Eye

Amebiasis is a disease caused by the unicellular parasite Entamoeba histolytica. In most cases, the infection is asymptomatic but when symptomatic, the infection can cause dysentery and invasive extraintestinal complications. In the gut, E. histolytica feeds on bacteria. Increasing evidences support the role of the gut microbiota in the development of the disease. In this review we will discuss the consequences of E. histolytica infection on the gut microbiota. We will also discuss new evidences about the role of gut microbiota in regulating the resistance of the parasite to oxidative stress and its virulence.

Bioactive chemical compounds identified in extracts of Reseda sphenocleoides leaves and evaluation of antiamoebic activity in vitro

Background: Entamoeba histolytica is a causative agent of amoebiasis, estimated to cause more than 100,000 deaths per year. Metronidazole is used to treatment of E. histolytica infection. However, this drug has several untoward side effects, the current study was designed to analysis of the bioactive chemical products in extracts of Reseda sphenocleoides leaves and evaluation of anti-amoebic activity in vitro. Methods: Bioactive chemical compounds were tests by GC-MS and FT-IR. Entamoeba histolytica was cultured under xenic conditions in Locke's egg (LE) medium and different concentrations of extracts of R. sphenocleoides were added to cultivated parasites. Results: 11 and 18 bioactive phytochemical compounds were showed in the ethanolic and aqueous extracts of R. sphenocleoides leaves respectively by GC-MS analysis. FT-IR analysis of extracts of R. sphenocleoides leaves proved the presence many functional groups for various phytocompounds. The ethanolic extract of R. sphenocleoides leaves was showed inhibits the growth of E. histolytica in vitro at concentrations 5 and 10 mg/ml after 96 hrs of incubation. While the highest concentration 20 mg/ml used in this study inhibited the E. histolytica in all times of incubation. The aqueous extract showed there was no growth of E. histolytica at the concentrations of 5 and 10 mg/ml after 72 and 48 hrs respectively. However, the higher concentfrations (15 and 20 mg/ml) of the aqueous extract were on the growth of the E. histolytica parasite during the period of incubation. It was found that the minimum inhibitory concentration (MIC) for ethanolic and aqueous extracts of R. sphenocleoides leaves was <15 mg/ml, <10 mg/ml respectively. Conclusion: The results specify that the extracts of R. sphenocleoides has a higher capacity in reducing of E. histolytica number in vitro. Moreover, these results showed that the extracts of R. sphenocleoides contains various bioactive compounds and therefore has various medicinal properties that can be used for the treatment of various diseases.

PREVALENCE OF Entamoeba histolytica INFECTION AMONG PRIMARY SCHOOL CHILDREN IN FIVE SELECTED COMMUNITIES OF WUSHISHI LOCAL GOVERNMENT AREA, NIGER STATE, NIGERIA

Ameobiasis is an infection caused by Entamoeba histolytica, which is a serious problem especially in developing countries and ranks third among the parasitic infections that lead to death mostly in primary age children.The aim of the present study was to investigate the prevalence of E. histolytical in young children.Three hundred (300) children aged 0-14 years were sampled for E. histolytica infection in five rural communities in Wushishi Local Government Area, Niger State, North Central Nigeria. The stool samples were examined for cysts of E. histolytica using saline and iodine preparations. The prevalence rate of 17 % was recorded. The prevalence by sex had a higher infection rate in males (19.3 %) than females (14.6%) which was not significantly (P>0.05). The prevalence of the infection in relation to age was highest (23%) in 7 to 10 year age group, while the least infection of 12 (12%) was recorded in 11 to 14 year age group A significant association was found between the sources of drinking water and prevalence of E. histolytica (P<0.05). The highest was recorded in those using stream/pond (89.2%) and least recorded from Borehole/Tap (40.3%). Therefore, it become necessary need for improved sanitation, personal hygiene, health education policy and a proper deworming scheme amongst school children in the study areas in order to decrease infections rate.

Detection of Entamoeba histolytica Coproantigen Among Children with Dysentery in Ahvaz, Southwest Iran

: Entamoeba histolytica is one of the important parasitic diseases in many parts of the world, especially the tropical and subtropical regions. The parasite is transmitted through contaminated water and vegetables. The exact diagnosis of infection with the parasite is crucial in many medical laboratories since there are many false positive and negative results in their reports. Therefore, the current study aimed at evaluating and comparing microscopic and coproantigen ELISA (the enzyme-linked immunosorbent assay) results to reach an appropriate test for the correct diagnosis of amoebiasis in children. One hundred stool samples were collected from children under 15 years old with dysenteric diarrhea from April to September 2018. Microscopic tests and coproantigen ELISA were performed on all the samples. The results showed that 5% of the samples had E. histolytica/E. dispar cysts. The findings of ELISA to detect coproantigen did not show any specific E. histolytica antigen in the samples. Hence, all the patients received chemotherapy for shigellosis. E. histolytica infection is not the main causative agent for dysenteric diarrhea in children in the studied area, and laboratory experts should be trained to prevent false-positive reports.