Megacolon tóxico: peritonitis fecaloidea por colitis amebiana. Reporte de un caso y revisión de literatura / Toxic megacolon: fecaloid peritonitis caused by amebic colitis. Report of a case and literature review

Introducción: La amebiasis es una enfermedad causada por el parásito Entamoeba histolytica, y condiciona importantes tasas de afectación a escala global. Una de las complicaciones de la colitis amebiana es el megacolon tóxico, el cual se caracteriza por la dilatación colónica y signos de toxicidad sistémica. Aunque poco frecuente, el megacolon tóxico es considerado letal.Caso clínico : se trata de paciente femenino de 26 años, quien consulta por presentar dolor abdominal generalizado, de fuerte intensidad, tipo cólico, acompañado de náuseas y múltiples episodios eméticos. Al examen físico se precisó hemodinámicamente estable, sin signos de irritación peritoneal, por lo que es ingresada con diagnóstico de colitis amebiana. Se instaura manejo médico y es egresada por mejoría clínica. Luego de 7 días, es readmitida por deterioro clínico y distensión abdominal, realizándose diagnóstico de megacolon tóxico. Mediante laparotomía de emergencia se observa peritonitis fecaloidea difusa y perforación del ciego, se realiza hemicolectomía derecha e ileostomía terminal. Posteriormente, presenta absceso intraabdominal que fue drenado por vía percutánea. Conclusión : el megacolon tóxico es una patología infrecuente que surge como complicación de entidades como la colitis amebiana. En la actualidad, a pesar de los avances tecnológicos que han desencadenado importantes progresos en el ámbito sanitario, el diagnóstico del megacolon tóxico continúa representando un desafío para el profesional médico, por lo que la sospecha clínica es ineludible y determinante en el diagnóstico acertado y oportuno, que permiten la instauración de la terapéutica apropiada y reducción de la morbilidad y mortalidad que de esta se derivan(AU)

Introduction: Amebiasis is a disease caused by the parasite Entamoeba histolytica, and causes significant rates of infection on a global scale. One of the complications of amoebic colitis is toxic megacolon, which is characterized by colonic dilation and signs of systemic toxicity. Although rare, toxic megacolon is considered lethal. Clinical case: this is a 26-year-old female patient, who consults due to generalized abdominal pain, of strong intensity, colic type, accompanied by nausea and multiple emetic episodes. On physical examination she was found to be hemodynamically stable, with no signs of peritoneal irritation, so she was admitted with a diagnosis of amoebic colitis. Medical management was established and she was discharged due to clinical improvement. After 7 days, she was readmitted due to clinical deterioration and abdominal distention, and a diagnosis of toxic megacolon was made. Through emergency laparotomy, diffuse fecaloid peritonitis and perforation of the cecum were observed; right hemicolectomy and terminal ileostomy were performed. Subsequently, she developed an intra-abdominal abscess that was drained percutaneously. Conclusion: toxic megacolon is a rare pathology that arises as a complication of entities such as amoebic colitis. Currently, despite the technological advances that have triggered important progress in the healthcare field, the diagnosis of toxic megacolon continues to represent a challenge for the medical professional, which is why clinical suspicion is unavoidable and decisive in an accurate and timely diagnosis, which allow the establishment of appropriate therapy and reduction of the morbidity and mortality that arise from it(AU)

Inhibition of choline kinase as an antiamoebic approach in Entamoeba histolytica infection

@#Entamoeba histolytica is the parasite responsible for amoebiasis, which can result in amoebic colitis or amoebic liver abscess. Metronidazole has been the conventional treatment for intestinal amoebiasis, but concerns regarding resistance have emerged due to the identification of resistance pathways in E. histolytica. This study investigates a novel anti-amoebic approach targeting the CDP-choline pathway. Inhibition studies were conducted using potential choline kinase (CK) inhibitors to inhibit the EhCK enzyme, and RNA interference was employed to knock down the EhCK gene. Km and Vmax of purified EhCK and hCKa2 proteins were determined by pyruvate kinase-lactate dehydrogenase (PK-LDH) coupled assay. The IC50 values for EhCK and hCKa2 were determined with several commercial CK inhibitors. Selected inhibitors were incubated with E. histolytica trophozoites for 48 hours to determine the EC50 for each inhibitor. Silencing of gene encoding EhCK was carried out using duplex siRNA and the gene expression level was measured by real-time qPCR. Based on the IC50 values, three of the inhibitors, namely CK37, flavopiridol and H-89 were more potent against EhCK than hCKa2. Trophozoites growth inhibition showed that only HDTAB, H-89 and control drug metronidazole could penetrate and induce cell death after 48-hour incubation. siRNA concentration of 10 µg/mL was used for the transfection of positive control GAPDH, EhCK, and non-targeting GFP siRNAs. RNAi experiment concluded with positive control GAPDH downregulated by 99% while the level of EhCK mRNA was downregulated by 47%. In this study, potential inhibitors of EhCK and siRNA have been identified, paving the way for further refinement and testing to enhance their potency against EhCK while sparing hCK. The utilization of these specific inhibitors and siRNA targeting EhCK represents a novel approach to impede the growth of E. histolytica by disrupting its phospholipid synthesis pathway.

Cerebrospinal fluid inflammatory cytokine profiles of patients with neurotropic parasitic infections

@#The pathogenesis of chronic parasitic central nervous system (CNS) infections, including granulomatous amoebic meningoencephalitis (GAE), cerebral toxoplasmosis (CT), and neurocysticercosis (NCC), is primarily due to an inflammatory host reaction to the parasite. Inflammatory cytokines produced by invading T cells, monocytes, and CNS resident cells lead to neuroinflammation which underlie the immunopathology of these infections. Immune molecules, especially cytokines, can therefore emerge as potential biomarker(s) of CNS parasitic infections. In this study, cerebral spinal fluid (CSF) samples from suspected patients with parasitic infections were screened for pathogenic free-living amoebae by culture (n=2506) and PCR (n=275). Six proinflammatory cytokines in smear and culture-negative CSF samples from patients with GAE (n = 2), NCC (n = 7), and CT (n = 23) as well as control (n = 7) patients were measured using the Multiplex Suspension assay. None of the CSF samples tested was positive for neurotropic free-living amoebae by culture and only two samples showed Acanthamoeba 18S rRNA by PCR. Of the six cytokines measured, only IL-6 and IL-8 were significantly increased in all three infection groups compared to the control group. In addition, TNFa levels were higher in the GAE and NCC groups and IL-17 in the GAE group compared to controls. The levels of IL-1b and IFNg were very low in all the infection groups and the control group. There was a correlation between CSF cellularity and increased levels of IL-6, IL-8, and TNFa in 11 patients. Thus, quantifying inflammatory cytokine levels in CSF might help with understanding the level of neuroinflammation in patients with neurotropic parasitic diseases. Further studies with clinico-microbiological correlation in the form of reduction of cytokine levels with treatment and the correlation with neurological deficits are needed.

A Rare Case Of Peritonitis Due To Ulcerative Amoebic Colitis - Case Report

ULCERATIVE AMOEBIC COLITIS is a rare complication of amoebiasis that is associated with high mortality. Only 1 to 4 cases are seen per year in India & only few such cases have been reported. This requires early diagnosis and surgical intervention. We recently cared for a patient who presented with acute abdomen with history of Abdominal pain,Fever,Obstipation. Before presenting to our institution he was admitted at outside private hospital for 2 days in view of Left Diabetic FOOT with ACUTE KIDNEY INJURY with SEPSIS and was treated conservatively.On emergency exploration, MULTIPLE CAECAL PERFORATIONS with extensive necrosis of Ascending COLON were seen. SEGMENTAL RESECTION OF 5 CM TERMINAL ILEUM,CAECUM,ASCENDING COLON and 5 CM TRANSVERSE COLON was performed. Postoperative course was marked by septicaemia and multi-organ failure followed by death. This case report emphasizes the importance of early diagnosis and treatment of acute AMOEBIC COLITIS and associated high mortality.

Diagnostic approach of liver abscess

Liver abscess is an infection of parasitic or bacteria into the liver parenchyma which causes encapsulation of suppurative material surrounded by inflammatory tissue. Liver abscess is an important health problem especially in low-middle income countries. It is not easy to diagnose liver abscess due to non-specific clinical signs. This case report, we presenteda 46-year-old man who was hospitalized with suspected pulmonary infection. However, in the course of the patient's disease, we found a liver abscess.

A Comparative Study on Outcome of Amoebic Liver Abscess in Patients With and Without Alcoholic Liver Disease

Background: Amoebic liver abscesses (ALA) in the presence of Alcoholic liver disease (ALD) constitutes a high-risk group of patients who are prone to complications and may need more aggressive treatment. This study was aimed at evaluating disease course and outcomes in patients of ALA with ALD, in comparison to those without ALD. Material & Methods: This prospective observational study was conducted on 60 consecutive patients of ALA without ALD (Group-I) and 60 consecutive patients of ALA with ALD (Group II). Result: The patients ALA with ALD were older (47.2 ±13.3 years) than those without ALD (34.1±14 years). Mean size of the abscess cavity was significantly larger in patients with ALD (391.2± 208.7 cc in Group I and 594.3 ± 297.9 cc in Group II). In Group I, conservative management was most common (43.3%); while in Group II pigtail catheter insertion was the most frequently used modality of treatment (45%). Complications like empyema (6.6%), acute on chronic liver failure (8.3%) and impending liver failure (23.3%) manifesting as ascites and oedema were seen only in patients in Group II and they also had longer hospital stay. (4.87 days in Group I vs 8.37 in Group II). Conclusion: Patients of ALA with ALD have a more aggressive course of disease and should be managed with a lower threshold for abscess drainage.

Demographic, Clinical, Laboratory and Management Profile in Patients of Amoebic Liver Abscess from Northern India

Background: Amoebic liver abscess (ALA) is a serious extra-intestinal manifestation of amoebiasis and a major problem in developing countries. Due to rapid urbanization, improved sanitation and hygiene in India, there has been a shift in disease epidemiology towards non-communicable disease, but recent changes in epidemiological and clinical pattern in ALA are not well studied. Aim: To evaluate recent demographic, clinical, laboratory and management profile in patient with ALA. Methods: It is a prospective observational study conducted in the Department of Gastroenterology, SMS medical college, Jaipur, Rajasthan from June 2018 to December 2020. A predesigned semi structured questionnaire consisting of socio-demographic factors, risk factors, clinical, laboratory and management profile was used to collect data. Result: A total 508 patients of amoebic liver abscess were analysed. Median age of presentation was 40 years, majority were males (90.4%) with chronic alcoholism (44.1%) and belonging to lower socio-economic class. Abdominal pain, fever and anorexia were the most common symptoms. A majority had right lobe involvement (77.6%) and solitary abscess in 67.5%. Most of the small liver abscesses (68%) were managed by medical treatment alone. Percutaneous needle aspiration was done in 62.6% patients, mostly for abscess size 5-10 cm (93%) with 90% success. A total of 24.6% patients underwent percutaneous catheter drainage, all successfully done. Intraperitoneal rupture was seen in 10% patient. Mortality was 1.5%. Conclusion: This is one of the largest cohorts of ALA which shows that a majority of cases are males from lower socioeconomic status with history of significant alcohol intake. Early initiation of a combined therapeutic approach leads to early symptomatic improvement, fewer complications and better outcomes.

Primary amoebic meningoencephalitis in children: a case report and literature review / 中华实用儿科临床杂志

A case of primary amoebic meningoencephalitis (PAM) treated in the First Affiliated Hospital of Xinxiang Medical University in March 6, 2022 was reported.The proband was a 14-year-old boy, who was admitted to the hospital because of " fever, headache and vomiting for 2 days" . Metagenomic next-generation sequencing (mNGS) was consequently conducted to examine the pathogens in cerebrospinal fluid.Naegleria infection was detected, so the child was diagnosed with PAM.The disease developed rapidly, and the patient died 29 hours after admission.In the paper, a total of 13 studies were reviewed, and 15 children with PAM were reported.Of the reported cases, only 1 case survived, 14 cases died.PAM had a low incidence, a dangerous condition, and high mortality.Most cases were diagnosed by autopsy or pathogen diagnosis in cerebrospinal fluid.This case is confirmed by mNGS of pathogens, and it is rarely reported at home and abroad.

Transmission characteristics and prevention measures of Naegleria fowleri： a review / 上海预防医学

Objective To review the Naegleria fowleri and primary amoebic meningoencephalitis caused by the naegleria fowleri， so as to strengthen the public awareness of the disease and its prevention. Methods We reviewed the literatures and reports， and summarized the following information： epidemic status， life cycle and characteristics， environmental distribution and infection routes， pathogenesis and clinical manifestations， diagnosis and treatment， prevention and control measures. Results Primary amoeba meningoencephalitis is a water-borne disease caused by the Naegleria fowleri， which enters human body through the nose and arrives at the central nervous system through olfactory nerve， leading to hemorrhagic and necrotic meningitis. Although the disease is rare， it has a fatality rate of 95%. Most of the patients reported were healthy children or young adults who had nasal contact with water contaminated with Naegleria fowleri a week before symptoms appeared. At present， its pathology can be divided into contact mechanism and non-contact mechanism. In contact mechanism， the Naegleria fowleri relies on the phagocytosis of food cup on its surface and the release of cytolytic molecules that directly destroy host cells. In non-contact mechanism， the Naegleria fowleri has toxic effects by secreting proteins. The clinical symptoms are episodic， with an average time of five days from illness to death. At beginning， the symptoms may include headache， vomiting， fever and other influenza-like symptoms， followed by central nervous system symptoms， such as stiff neck， drowsiness， anorexia， fear and so on. Intravenous or intrathecal injection of amphotericin B is considered to be the basic treatment of this disease， which can be combined with other adjunct therapies such as ventricular shunt and cooling to reduce encephaledema. Conclusion Primary amoebic meningoencephalitis is a rare but highly fatal disease. We should strengthen the public awareness of the disease and its prevention， especially to avoid nasal contact with contaminated water. We should also strengthen scientific research， improve the level of diagnosis， and develop effective drugs to prevent the disease before it happens.

Clinical features of amoebic enteritis patients with acquired immunodeficiency syndrome / 中华传染病杂志

Objective:To investigate the clinical features of amoebic enteritis with acquired immunodeficiency syndrome (AIDS) patients.Methods:The clinical data of patients diagnosed of amoebic enteritis in Beijing Ditan Hospital, Capital Medical University from April 2011 to October 2019 were collected. They were divided into amoebic enteritis group and amoebic enteritis with AIDS group. The laboratory indexes, pathological examination and colonoscopic appearance of the two groups were analyzed retrospectively. The clinical characteristics of amoeba enteritis with AIDS patient were summarized. Pearson chi-square test, continuous calibration chi-square test, Fisher′s exact test, independent sample t test and Mann-Whitney U test were used for statistical analysis. Results:A total of 53 patients with amoebic enteritis were included, including 31 cases in amoebic enteritis group and 22 cases in amoebic enteritis with AIDS group. The detection rate of amoebic trophozoite in cases feces in amoebic enteritis with AIDS group was lower than that in amebic enteritis group (68.2%(15/22) vs 96.8%(30/31)) with statistical significance ( χ2=6.13, P=0.013). The detection rate of amoebic trophozoite by colonoscopy in amoebic enteritis with AIDS was higher than that in amebic enteritis group (7/15 vs 1/16) with statistical significance (Fisher′s exact test, P=0.015). Amoebic enteritis with AIDS cases had lower levels of red blood cell count ((3.48±0.80)×10 12/L vs (4.11±0.81)×10 12/L), hemoglobin ((102.40±25.74) g/L vs (121.52±22.73) g/L), albumin ((29.07±5.94) g/L vs (35.48±6.92) g/L), CD4 + T-lymphocyte counts (76.00 (26.25, 228.50)/μL vs 514.50 (444.00, 752.25)/μL) than patients with amoebic enteritis, which were all statistically significant ( t=2.80, 2.86, 3.52 and Z=-5.27, respectively, all P<0.050). And amoebic enteritis with AIDS cases had higher level of alanine aminotransferase (ALT) (21.00 (12.85, 41.33) U/L vs 13.40 (9.40, 22.40) U/L, Z=-2.32, P=0.020). The results of colonoscopy showed that amoebic enteritis with AIDS cases had higher rate of intestinal mucosa ulcer than amoebic enteritis cases ((11/15 vs 5/16) Fisher′s exact test, P=0.032). Conclusions:Amoebic enteritis with AIDS cases have lower levels of red blood cells, hemoglobin, albumin and CD4 + T-lymphocyte counts and higher levels of ALT. Amoebic enteritis with AIDS cases have higher rate of intestinal mucosa ulcer detected by colonoscopy. Colonoscopy combined with biopsy play an important role in the diagnosis of amoebic enteritis with AIDS patients.

Sociodemographic and Clinical Profile of Amoebic Liver Abscess observed at a Tertiary Referral Hospital over 10 Years

Aim: To study the sociodemographic factors, clinical features and treatment outcome of patients with amebic liver abscess. Methods: Prospective analysis of 163 consecutive patients with liver abscesses (mean age 39.5 years, 140 males). Amoebic aetiology was determined by various combinations of history of dysentery, radiological appearance, aspirated pus study, amebic serology, colonoscopy findingsand response to treatment. Sociodemographic factors associated with amoebic liver abscess included education, income, eating hygiene and alcohol consumption. All patients were treated with fine needle pus aspiration and intravenous metronidazole for at least 7 days. Results: 109(63.9%) abscesses were treated in the first 5 years. Antecedent diarrhoea was present in 27 (16.6%). 146 patients (89.6%) took nitroimidazoles frequently. Jaundice, mostly mild, occurred in 35%.E. histolytica was demonstrated in stool in 11 patients (6.7%) and in aspirated pus in 35 patients (21.5%). Serology was positive (>1:160) in 53(32.5%) patients and was related to abscess size > 10 cm, presence of amoeba in pus and stool and positive colonoscopy findingsbut not to the number of abscesses. Colonoscopy revealed colitis in 21(12.9%) and caecal mass in 7(4.3%). All patients had prompt symptom relief with treatment without recurrence. 80% belonged to the lower middle class hailing from rural areas. 128(78.5%), all males, consumed 60 – 80 ml indigenously brewed liquor daily and they had poor personal and eating hygiene with higher antibody levels. 32 patients (19.6%) drank potable water. Conclusion: Though decreasing, amebic liver abscess continues to afflict heavy alcohol drinkers of lower socioeconomic strata, living in unhygienic conditions. Alcohol might influence seropositivity. Aspiration irrespective of size gives a lasting cure.

Encefalitis por ameba de vida libre: reporte de caso / Free-living amoeba encephalitis: case report

La encefalitis amebiana granulomatosa es una enfermedad considerada atípica debido a la baja incidencia desde que fue descubierta. Sin embargo, conforme han avanzando los métodos diagnósticos, en retrospectiva, se ha descrito la presencia de esta enfermedad desde principios del siglo XX, identificando a Acanthamoeba spp y Balamuthia mandrillaris como agentes más comunes.Es una enfermedad de difícil diagnóstico debido al amplio abanico clínico que puede presentar, siendo el sitio anatómico dentro del sistema nervioso central quien determinará estas características. El conocimiento y sospecha de la misma permitirá un abordaje terapéutico oportuno aunque, en la mayoría de los casos, con un desenlace fatal para el paciente.A continuación se presenta el caso clínico de un paciente masculino de 26 años de edad originario de la ciudad de Durango, México, sin antecedentes de importancia, de ocupación ladrillero, quien sufre golpe con ladrillo en región naso-orbitaria, ingresando al hospital al tercer día del evento con diagnóstico de celulitis periorbitaria izquierda y nasal, cefalea de leve intensidad, rinorrea abundante, hemiparesia fasciocorporal izquierda, parestesia de extremidad superior izquierda, diplopía y vértigo postural. Los estudios imagenológicos revelaron lesiones heterogéneas en el lóbulo occipital, hemisferio cerebeloso izquierdo y tallo cerebral. Se realizó escisión de lesión tumoral cerebelar, con estudio anatomopatológico, reportando encefalitis granulomatosa por presencia de ameba de vida libre. El paciente evolucionó hacia deterioro rostro-caudal declarándose su fallecimiento a los 16 días de su estancia intrahospitalaria.En el Estado de Durango, México, no se cuenta con casos reportados por infección de ameba de vida libre

Granulomatous amoebic encephalitis is a disease considered atypical due to the low incidence since it was discovered. However, as diagnostic methods have progressed, in retrospect, the presence of this disease has been described since the beginning of the 20th century, identifying Acanthamoeba spp. and Balamuthia mandrillaris as the most common agents.A disease that is difficult to diagnose due to the wide clinical range that it can present, being the anatomical site within the central nervous system that will determine these characteristics. The knowledge and suspicion of it will allow a timely therapeutic approach although, in most cases, with a fatal outcome for the patient.The clinical case is presented below of a 26 year old male patient from the city of Durang, México, with no significant history, of brick occupation, who suffers a blow with a brick in the naso-orbital region, follows, entering our hospital on the third day of the event with a diagnosis of left periorbital and nasal cellulitis, mild headache, profuse rhinorrhea, left fasciocorporeal hemiparesis, left upper limb parestesia, diplopia, and postural vertigo.Imaging studies were performed observing heterogeneous lesions in the occipital lobe, left cerebellar hemisphere and brain stem; excision of the cerebellar tumor lesion being carried out, with pathological study, reporting granulomatous encephalitis due to the presence of free-living amoeba. The patient progresses to face-caudal deterioration, declaring his death after 16 days of hospital stay.Within the state of Durango, Mexico, there are no reported cases of free-living amoeba infection

Primer informe clínico de Balamuthia mandrillaris en el distrito de Camaná, Arequipa, Perú / First case report of the Balamuthia mandrillaris in the Camaná district of Arequipa, Peru

Resumen Las infecciones por amebas de vida libre causan compromiso cutáneo y neurológico. Estas afecciones presentan una baja frecuencia pero una alta letalidad, mayor al 98%. Gene ralmente el cuadro clínico es inespecífico y los exámenes de laboratorio no son de gran ayuda, por lo que representa un reto diagnóstico y terapéutico. En este informe presentamos el caso de un paciente de 21 años que fue hospitalizado por un síndrome convulsivo con tumoraciones cerebrales, además de una lesión cutánea en el muslo derecho. El análisis histopatológico, PCR y el cuadro clínico permitieron el diagnóstico de encefalitis amebiana granulomatosa. A pesar del tratamiento, el paciente tuvo un desenlace fatal.

Abstract Infections by free-living amoebas cause cutaneous and neurological compromise. These conditions have a low frequency, but a high lethality more than 98%. Generally, the clinical picture is nonspecific; the laboratory tests dont help, so it represents a diagnostic and therapeutic challenge. In this report, we present the case of a 21-year-old patient, who was hospitalized for a convulsive syndrome with brain tumors, in addition to a cutaneous lesion on the right thigh. Histopathological analysis, PCR and the clinical picture allowed the diagnosis of granulomatous amebic encephalitis. Despite the treatment, the patient had a fatal outcome.

TREATMENT DIFFICULTIES WITH LIVER ABSCESS IN PREGNANCY A RARE CASE REPORTTREATMENT DIFFICULTIES WITH LIVER ABSCESS IN PREGNANCY A RARE CASE REPORT

Liver abscess in pregnancy is a rare entity and can be a life threatening condition. Here we present A case of amoebic liver abscess in 25 years old lady in of pregnancy, with highlights on treatmentthird trimester difficulties which we had faced in the management and timely intervention leads to good fetomaternal outcome

Occurrence of The Pathogenic Amoeba Naegleria fowleri, Pathogenesis, Diagnosis, and Treatment Options

@#Naegleria fowleri is the causative agent of primary amoebic meningoencephalitis (PAM) that infects the central nervous system (CNS). The amoeba is present ubiquitously. The infection is rare but has a high mortality rate. The pathogenic amoeba reaches the host through the nasal passage and migrates along the olfactory nerves to reach the human brain and cause severe destruction of the CNS. As Malaysia has a large population that practising ablutions in daily routine, the risk of infection increases. Two mechanisms associated with the infection include contact-dependent and contact-independent. Signs and symptoms vary from early stage to later stage of infection. CSF and brain biopsy are the common specimens collected used to diagnose the PAM infection and usually detect and identify by PCR method. As for treatment, the CDC of United States America has recommended the usage of miltefosine that provides promising in vitro therapy against N. fowleri. This review will discuss more on the occurrence of N. fowleri, pathogenicity, diagnostic tools, and pharmacotherapy approach against N. fowleri infection.

Various brain-eating amoebae: the protozoa, the pathogenesis, and the disease / 医学前沿

Among various genera of free-living amoebae prevalent in nature, some members are identified as causative agents of human encephalitis, in which Naegleria fowleri followed by Acanthamoeba spp. and Balamuthia mandrillaris have been successively discovered. As the three dominant genera responsible for infections, Acanthamoeba and Balamuthia work as opportunistic pathogens of granulomatous amoebic encephalitis in immunocompetent and immunocompromised individuals, whereas Naegleria induces primary amoebic meningoencephalitis mostly in healthy children and young adults as a more violent and deadly disease. Due to the lack of typical symptoms and laboratory findings, all these amoebic encephalitic diseases are difficult to diagnose. Considering that subsequent therapies are also affected, all these brain infections cause significant mortality worldwide, with more than 90% of the cases being fatal. Along with global warming and population explosion, expanding areas of human and amoebae activity in some regions lead to increased contact, resulting in more serious infections and drawing increased public attention. In this review, we summarize the present information of these pathogenic free-living amoebae, including their phylogeny, classification, biology, and ecology. The mechanisms of pathogenesis, immunology, pathophysiology, clinical manifestations, epidemiology, diagnosis, and therapies are also discussed.

Encefalitis amebiana granulomatosa por Amebas de Vida Libre en un paciente pediátrico / Granulomatous amoebic encephalitis due to free-living amebas in a pediatric patient

Introducción: Las amebas de vida libre (AVL) Naegleria fowleri, Acanthamoeba spp., Balamuthia mandrillaris, son protozoos ampliamente distribuidos en la naturaleza. Son microorganismos oportunistas, que afectan preferentemente al sistema nervioso central causando cuadros de meningoencefalitis amebiana primaria o de encefalitis granulomatosa amebiana (EGA), ambas patologías de alta mortalidad. Descripsión del Caso: Paciente femenina de 10 años, que ingresa a nuestro hospital por presentar hemiparesia braquiocrural izquierda, vómitos y cefalea de 72 horas de evolución. Se realiza tomografía computada y Resonancia Magnética en la que se identifica una lesión expansiva, sólido-quística ubicada en la región fronto derecha. Se realiza exéresis completa de la misma y se implementa tratamiento farmacológico lográndose la restitución ad-integrum de la función motora y la resolución de la EGA a 30 meses de seguimiento. Discusión: La encefalitis granulomatosa amebiana es una patología causada por amebas de vida libre. Su presentacíon clínica puede ser indistinguible de otras causas de leptomeningitis o encefalitis, como las de origen bacteriano, viral o por micobacterias lo que impide conocer su real incidencia. Su tratamiento antiparasitario es muy complejo y su evolución es habitualmente fatal. Conclusión: Reportamos un caso de Encefalitis Amebiana Granulomatosa en una paciente pediátrica inmunocompetente, con excelente evolución.

Introduction: Free-living amoebas (FLA) Naegleria fowleri, Acanthamoeba spp., and Balamuthia mandrillaris, are protist widely distributed in nature. Are opportunistic microorganisms, preferentially affect the central nervous system causing primary amoebic meningoencephalitis or amoebic granulomatous encephalitis (AGE), both with high mortality. Case report: A 10 year-old female patient was admitted with a three-day history of left hemiparesis accompanied with headaches and vomiting. Computed tomography and magnetic resonance were performed, in which an expansive solid cystic mass was observed in the right fronto-parietal region. Complete resection was performed and pharmacological treatment was started, achieving complete restitution of motor function and resolution of AGE after 30 months of follow-up. Discussion: AGE is a desease caused by free-living amoebas. Its clinical presentation is similar to other leptomeningitis or encephalitis of different etiology such as bacterial, viral or by mycobacterial, which cannot know its real incidence. Its pharmacological treatment is complex and its evolution is usually fatal. Conclusion: We report a case of Amoebic Granulomatous Encephalitis in an immunocompetent pediatric patient with good outcome.

Colitis amebiana necrosante, presentación de un caso / Necrotizing amebian colitis, case report

Resumen Introducción: La Organización Mundial de la Salud (OMS) y la Organización Panamericana de la Salud (OPS) han definido la amebiasis como la infección por Entamoeba histolytica, independientemente de los síntomas. La colitis amebiana necrosante es una forma rara de amebiasis que se asocia con una alta morbilidad y mortalidad. Caso clínico: Presentamos a un paciente femenino de 68 años, con antecedentes de diabetes mellitus tipo 2, con colitis amebiana necrosante con múltiples perforaciones, que fue sometida a una hemicolectomía derecha con íleo-transverso anastomosis. Conclusiones: Se necesitan intervenciones efectivas para prevenir la colitis amebiana y terapias adicionales para tratar la colitis amebiana fulminante y mejorar los resultados.

Abstract Background: Amebiasis has been defined by World Health Organization (WHO) and Pan American Health Organization (PAHO) as the infection with Entamoeba histolytica regardless of symptoms. Necrotizing amoebic colitis is a rare clinical form of amebosis that is associated with high morbidity and mortality. Case Report: We present a 68-years-old-female patient with necrotizing amoebic colitis with multiple perforations who survived after right hemicolectomy with ileus-transverse anastomosis. Conclusions: Effective interventions to prevent amebic colitis, and additional therapies to treat fulminant amebic colitis are needed to improve outcomes.

Prospective study of etiology of liver abscess and comparison of different ways of its management

Background: Liver abscess is a collection of purulent material in the liver parenchyma which can be due to bacterial, parasitic, fungal or mixed infection. It has become one of the most common communicable disease with much more prevalence in underdeveloped and developing countries. Two most common type of liver abscess are amoebic and pyogenic. Pyogenic liver abscess is more common in western world while amoebic liver abscess is more commonly found in third world countries, which are under developed, and more people living under lower socio economic conditions.Methods: A prospective study of 50 patients with clinical diagnosis of liver abscess admitted in the department of surgery B. R. D. Medical College Gorakhpur during a period of one year.Results: There was male predominance (98%) and most of the patient belongs to younger age group and low socio economics status. In amoebic liver abscess there was strong correlation with alcohol intake (66%).Conclusions: In our study most of the patients were group 21-30 years and the most common presenting symptom was right upper quadrant pain and fever. In most of the patients, the common hematological finding was mild anaemia with leucocytosis with altered LFT.

Epidemiological characteristics of amoebic dysentery in China, 2015-2018 / 中华流行病学杂志

Objective@#To understand the characteristics and changes of the incidence of amoebic dysentery in China during 2015-2018, explore the causes of high incidence in some areas and provide a data base for the development of national prevention and control strategies and measures.@*Methods@#Data were collected from the infectious disease reporting management information system from Chinese Disease Control and Prevention. To understand the seasonal, population and area distributions of amoebic dysentery, descriptive epidemiological method and software SPSS 16.0 were used to analyze the amoebic dysentery data.@*Results@#A total of 4 366 amoebic dysentery cases were reported without death in China during 2015-2018. The reported average annual incidence was 0.08/100 000, and the overall proportion of laboratory confirmed cases was 68.23%(2 979/4 366). Amoeba dysentery mainly occurred during May to October. One seasonal peak was observed in 2015 and 2017 (July and June, respectively), and two seasonal peaks were observed in 2016 and 2018 (June and October). The patients were mainly children aged under 5 years (42.28%, 1 846/4 366), and the incidence rate decreased with age in children aged under 10 years. Of these, children under 1 years of age had the highest incidence rate (1.28/100 000). The number of cumulative reported cases in Guangxi, Henan, Guangdong, Heilongjiang and Jiangxi provinces ranked top five from 2015-2018, accounting for 64.50% (2 816/4 366) of the total. The cumulative cases in Dongxing county, Guangxi, in Suixian county, Henan and in Ranghulu district, Heilongjiang, respectively accounted for more than 50.00% of the total number of cases in their provinces.@*Conclusions@#The incidence rate of amoebic dysentery reported in China during 2015-2018 showed a decreasing trend, with a higher incidence in children under 5 years old and a higher number of cases in some areas. It is suggested to further investigate and analyze the diagnosis and reporting of amoeba dysentery in key areas and promote the update of the diagnostic standards for amoeba dysentery.