Fatal Balamuthia mandrillaris infection with red plaques on the nasal dorsum as the first presentation

Abstract Balamuthia mandrillaris infection is a rare infectious disease around the world, with high rates of morbidity and mortality. Its early and correct diagnosis is a big challenge for us, and without it the delay in starting effective treatment can lead to the development of encephalitis. This is a report of a case of Balamuthia mandrillaris infection in a Chinese boy, with red plaques on the nasal dorsum as the first presentation, who finally developed into fatal encephalitis. The authors have reviewed the related literature and share the special skin features in order to favor the early diagnosis of the disease and increase the chances of survival.

From fatal bacterial granuloma after trauma to Balamuthia mandrillaris infection: clinical experience over 20 years / 中华皮肤科杂志

From 1960 to 1990, some Chinese dermatologists noticed that a small number of patients presenting with granulomatous inflammation on the face eventually died of encephalitis. In 2001, Dr. Tianwen Gao summarized clinical and pathological characteristics of these patients and proposed the disease name "fatal bacterial granuloma after trauma", and Propionibacterium acnes was assumed to be the most probable pathogen at that time. In 2018, the disease was confirmed to be Balamuthia mandrillaris infection involving the skin and brain tissues. This review summarized the history of research on Balamuthia mandrillaris infection in China, as well as its clinical, pathological characteristics and treatment methods.

Colitis amebiana fulminante con desenlace fatal en un paciente con probable infección por SARS-CoV-2 / Fulminant amebic colitis with fatal outcome in a patient with probable SARS-CoV-2 infection

RESUMEN Se reporta el caso de un varón de 62 años quien presentó tos y dolor abdominal por dos semanas, con hallazgos tomográficos pulmonares compatibles con probable infección por SARS-CoV-2, que recibió tempranamente corticoterapia a dosis altas y de manera ambulatoria. El paciente presentó evolución tórpida, fue hospitalizado y falleció en el posoperatorio inmediato por un cuadro de abdomen agudo quirúrgico. El estudio anatomopatológico mostró estructuras parasitarias con características compatibles con amebas, como causa de una colitis aguda fulminante complicada, con perforación múltiple y peritonitis aguda. La colitis aguda fulminante por amebiasis intestinal en el contexto de un paciente con probable COVID-19 no había sido reportada en el Perú. Resulta importante resaltar la presentación fulminante con desenlace fatal de esta infección parasitaria prevalente en nuestro medio, en el contexto del uso de corticoides ante una probable infección pulmonar por COVID-19.

ABSTRACT We report the case of a 62-year-old male with cough and abdominal pain for two weeks, associated with pulmonary tomographic findings compatible with probable infection by SARS-CoV-2, and who received high doses of early corticotherapy as an outpatient. The patient showed clinical deterioration, was hospitalized and died in the immediate postoperative period due to acute surgical abdomen. The anatomopathological study showed parasitic structures with characteristics compatible with amebae, which was pointed to as the cause of a complicated acute fulminant colitis, with multiple perforations and acute peritonitis. Acute fulminant colitis due to intestinal amebiasis in the context of a patient with probable COVID-19 had not been previously reported in Peru. It is important to highlight the fulminant presentation with fatal outcome of this prevalent parasitic infection, in the context of corticosteroids use in a probable SARS-CoV-2 pulmonary infection.

Encefalitis letal por amebas de vida libre en tres miembros de una familia, Tumbes, Perú

Las amebas de vida libre (AVL) son parásitos protozoarios que ocasionalmente causan enfermedad en humanos luego del contacto con alguna fuente de aguas o suelo contaminado. Se describe una serie de tres casos de encefalitis con desenlace fatal en un grupo familiar, que tuvo lugar en el departamento de Tumbes entre diciembre de 2019 y febrero de 2020. En la muestra de líquido cefalorraquídeo del primer caso se identificó Acanthamoeba sp. Los tres casos presentaron como antecedente haber entrado a una piscina meses antes de la enfermedad. En Tumbes no hay registro previo de casos de encefalitis por AVL y no se han reportado a nivel mundial su ocurrencia en un conglomerado familiar.

Free-living amoebas (FLA) are protozoan parasites that occasionally cause disease in humans after contact with contaminated water or soil. We describe a series of three cases of encephalitis in a family group with a fatal outcome that occurred in the Tumbes region between December 2019 and February 2020. Acanthamoeba sp. was identified in the cerebrospinal fluid sample from case 1. All three cases had a history of entering a swimming pool months before the disease. In the Tumbes region there is no previous record of encephalitis due to FLA and its occurrence in a family cluster has never been reported before.

Los aptámeros como novedosa herramienta diagnóstica y terapéutica y su potencial uso en parasitología / Aptamers as a novel diagnostic and therapeutic tool and their potential use in parasitology

Los aptámeros son secuencias de ADN o ARN de cadena sencilla que adoptan la forma de estructuras tridimensionales únicas, lo cual les permite reconocer un blanco específico con gran afinidad. Sus usos potenciales abarcan, entre otros, el diagnóstico de enfermedades, el desarrollo de nuevos agentes terapéuticos, la detección de riesgos alimentarios, la producción de biosensores, la detección de toxinas, el transporte de fármacos en el organismo y la señalización de nanopartículas. El pegaptanib es el único aptámero aprobado para uso comercial por la Food and Drug Administration (FDA). Otros aptámeros para el tratamiento de enfermedades están en la fase clínica de desarrollo. En parasitología, se destacan los estudios que se vienen realizando en Leishmania spp., con la obtención de aptámeros que reconocen la proteína de unión a poliA (LiPABP) y que pueden tener potencial utilidad en la investigación, el diagnóstico y el tratamiento de la leishmaniasis. En cuanto a la malaria, se han obtenido aptámeros que permiten identificar eritrocitos infectados e inhiben la formación de rosetas, y otros que prometen ser alternativas para el diagnóstico al detectar de forma específica la proteína lactato deshidrogenasa (PfLDH). Para Cryptosporidium parvuum se han seleccionado aptámeros que detectan ooquistes a partir de alimentos o aguas contaminadas. Para Entamoeba histolytica se han aislado dos aptámeros llamados C4 y C5, que inhiben la proliferación in vitro de los trofozoítos y tienen potencial terapéutico. Los aptámeros contra Trypanosoma cruzi inhiben la invasión de células LLC-MK2 (de riñón de mono) en un 50 a 70 % y aquellos contra T. brucei transportan moléculas tóxicas al lisosoma parasitario como una novedosa estrategia terapéutica. Los datos recopilados en esta revisión destacan los aptámeros como una alternativa para la investigación, el diagnóstico y el tratamiento contra parásitos de interés nacional.

Aptamers are single-stranded DNA or RNA sequences that adopt unique three-dimensional structures that allow them to recognize a specific target with high affinity. They can potentially be used for the diagnosis of diseases, as new therapeutic agents, for the detection of food risks, as biosensors, for the detection of toxins, and as drug carriers and nanoparticle markers, among other applications. To date, an aptamer called pegaptanib is the only aptamer approved by the Food and Drug Administration (FDA) for commercial use. Other aptamers are in different clinical stages of development for the treatment of different diseases. In parasitology, investigations carried out with parasites such as Leishmania spp. allowed the acquisition of aptamers that recognize the polyA-binding protein LiPABP and may have potential applications in research and diagnosis and even as therapeutic agents. Regarding malaria, aptamers have been obtained that allow the identification of infected erythrocytes or inhibit the formation of rosettes, along with those that provide promising alternatives for diagnosis by specifically detecting the protein lactate dehydrogenase (PfLDH). In Cryptosporidium parvum allow the detection of oocysts in contaminated food or water. In Entamoeba histolytica, two aptamers called C4 and C5, which inhibit the proliferation of trophozoites in vitro and have potential use as therapeutic agents, have been isolated. Aptamers obtained against Trypanosoma cruzi inhibit the invasion of LLC-MK2 (from monkey kidney) cells by 50-70%, and in T. brucei, aptamers with the potential to transport toxic molecules to the parasitic lysosome were identified as a novel therapeutic strategy. The data collected in this review highlight aptamers as a novel alternative in the research, diagnosis, and treatment of parasites of national interest.

Amebíase no contexto da emergência: análise do perfil de internações e morbimortalidade nos Estados brasileiros em 5 anos / Amebiasis in the context of emergency: an analysis of the profile of hospitalizations and morbidity/mortality in the states of Brazil in 5 years

Objetivo: Trazer um panorama atualizado acerca dos índices de internações e mortalidade por amebíase nos últimos 5 anos pelo sistema de saúde público brasileiro. Métodos: As informações analisadas foram pesquisadas no banco de dados do Departamento de Informática do Sistema Único de Saúde, considerandose as seguintes variáveis: amebíase; internações e mortalidade; sexo; faixa etária; e período de 2012 a 2016. Resultados: De 14.268 internações por amebíase em todo o Brasil, 4.252 foram em 2012, 3.248 em 2013, 2.552 em 2014, 2.033 em 2015 e 2.183 em 2016. Na Região Norte, encontraram-se os dois Estados com maior e menor número de internações da região e do país: o Pará, com 4.379 casos, e Roraima, com 5. Na Região Nordeste, o Maranhão foi o Estado com mais notificações (4.114) e o segundo maior do Brasil. Na Região Sudeste, Minas Gerais apresentou maior número de registros (793); no Sul, foi o Paraná (325) e, no Centro-Oeste, Goiás (731). Dos Estados com registro de mortalidade, na Região Norte, o Amazonas obteve maior valor (1,02); no Nordeste, foi o Sergipe (5,26); no Sudeste, o Rio de Janeiro (7,81); no Sul, o Rio Grande do Sul (5,26); e, no Centro-Oeste, o Mato Grosso (1,22). Conclusão: Apesar de uma redução no número de internações, as estatísticas para a amebíase ainda continuam altas, principalmente, considerando- se que se trata de uma patologia que poderia ser evitada. É necessário investir em mais medidas educativas, que ensinem a população a evitar a contaminação pelo Entamoeba spp., bem como que seja promovidas ações de saneamento básico e abastecimento de água potável adequados para todas as regiões do Brasil. (AU)

Objective: To provide an updated picture of the hospitalization rates, and mortality due to amebiasis in the last 5 years in the Brazilian public health system. Methods: The information analyzed was searched in the Informatics Department of the Unified Health System database, considering the following variables: amebiasis; hospitalizations and mortality; gender; age group; and period from 2012-2016. Results: Of 14,268 hospitalizations for amebiasis throughout Brazil, 4,252 were in 2012, 3,248 in 2013, 2,552 in 2014, 2,033 in 2015, and 2,183 in 2016. In the North Region, there were the two states with the highest and lowest number of hospitalizations in the region and in the country: the state of Pará, with 4,379 cases, and of Roraima with 5. In the Northeast region, the state of Maranhão was the one with more notifications (4,114), and the second largest one in Brazil. In the Southeast region, the stat of Minas Gerais presented the highest number of records (793); in the South region, it was the state of Paraná (325); and in Center-West, Goiás (731). Of the states with mortality records, in the North region Amazonas reached the highest value (1.02); in the Northeast, Sergipe (5,26); in the Southeast, Rio de Janeiro (7.81); in the South, Rio Grande do Sul (5.26); and in the Center-West region, Mato Grosso (1,22). Conclusion: Despite a reduction in the number of hospitalizations, the statistics for amebiasis are still high, mainly considering that it is a pathology that could be avoided. It is necessary to invest in more educational measures, which teach the population how to avoid contamination by Entamoeba spp., as well as to promote basic sanitation actions, and drinking water supply suitable for all regions of Brazil. (AU)

Eficacia del tinidazol en la profilaxis terapéutica de la colitis amebiana en pacientes con leucemia aguda de novo que reciben quimioterapia intensiva / Efficacy of tinidazole in the therapeutic prophylaxis of amoebic colitis in patients with de novo acute leukemia receiving intensive chemotherapy

Resumen Introducción: En México la seroprevalencia de la Entamoeba histolytica es del 8.4%. La amebiasis intestinal en pacientes con leucemia aguda de novo posterior al inicio de quimioterapia (QT), en el Servicio de Hematología del CMN 20 de Noviembre, es del 12%, aún si muestran test coprológico negativo basal. Objetivo: Averiguar si la administración de tinidazol, en pacientes con leucemia aguda y coprológico negativo, al principio de la QT, disminuye la incidencia de colitis amebiana durante la inducción a la remisión. Método: Prospectivo y no comparativo. Enfermos con diagnóstico de leucemia aguda de novo que inician QT de inducción y coprológico inicial. Se indicó tinidazol, 2 g/día durante 5 días en la primera semana de comenzada QT. Se vigilaron hasta que la inducción concluyó y se inició la recuperación hematopoyética. Resultados: 38 pacientes, 15 mujeres y 23 hombres con edad media de 44 años (16-72). Con leucemia aguda linfoblástica 19, con mieloblástica 16 y con promielocítica 3. Casos sin y con amebiasis intestinal, 35 y 3, respectivamente. Los pacientes con amebiasis solo recibieron tinidazol durante 3 días y se dio después de 2 días de empezada la QT. Conclusión: El tinidazol, en pacientes con leucemia aguda de novo que inician QT de inducción, es efectivo en la prevención de la amebiasis intestinal, durante la etapa de inducción, si se administra a 2 g/día, durante cinco días, a partir del día 1 de la QT.

Abstract Introduction: In Mexico, seroprevalence of Entamoeba histolytica is 8.4%. The intestinal amebiasis in patients with acute leukemia of novo, after the start of chemotherapy (CT) in the Hematology Service of the CMN 20 de Noviembre is 12%, even if patients show a negative baseline coprological test. Objective: To find out if the administration of tinidazole, in patients with acute leukemia and negative coprological test, at the beginning of the CT, decreases the incidence of amoebic colitis during the induction to remission. Method: Prospective and not comparative study. Patients with de novo diagnosis of acute leukemia who initiate induction and initial coprological CT. Tinidazole was indicated, 2 g/day for 5 days in the first week of CT started. They were monitored until the induction was concluded and hematopoietic recovery started. Results: 38 patients, 15 women and 23 men with a mean age of 44 years (16-72), with acute lymphoblastic leukemia 19, myeloblastic 16 and promyelocytic 3. Cases without and with intestinal amebiasis were 35 and 3, respectively. Patients with amebiasis only received tinidazole for 3 days and it was given 2 days after the CT started. Conclusion: Tinidazole, in patients with acute de novo leukemia who initiate induction CT, is effective in the prevention of intestinal amebiasis, during the induction stage, if administered at 2 g/day, for five days, starting on day 1 of the CT.

Manifestaciones clínicas bucales detectadas en pacientes con diagnóstico de amebiasis, giardiasis en el Centro de Salud de Yauri. Cusco / Clinical manifestations detectedin patients with diagnosis of amebiasis, giardiasis in the Center of Health of Yauri. Espinar, Cusco

Objetivos: Determinar el tipo de manifestaciones bucales en los pacientes con diagnóstico de Amebiasis y giardiasis. Material y métodos: La presente investigación es de campo de tipo descriptivo, observacional, la técnica utilizada fue observación clínica, y documental. El instrumento utilizado fue una ficha de observación estructurada; para realizar esta investigación se examinaron 90 pacientes de ambos sexos mayores de 16 años que presenten como diagnóstico Amebiasis, Giardiasis el cual fue confirmado utilizando como método de diagnóstico el examen parasitológico. Los pacientes fueron ordenados en dos grupos de trabajo: Grupo A: Constituido por 45 pacientes con diagnóstico de Amebiasis, Grupo B: Constituido por 45 pacientes con diagnóstico de Giardiasis. Resultados: En el Grupo A: 28 pacientes presentaron manifestaciones bucales de esto, el 38% de pacientes presentaron solamente una manifestación bucal siendo estas las Úlceras aftosas 18%; Glositis 11% y Queilitis 9%; el 24% de pacientes presentaron más de una manifestación bucal asociada. En el Grupo B: 24 pacientes presentaron solamente una manifestación bucal, siendo estas las úlceras aftosas 31,1%, queilitis 15,6% y glositis 6,6%,el 13,3% de pacientes presentaron más de una manifestación bucal asociada. La prueba estadística de Chi2 = 0,000, nos dice que hay una diferencia significativa entre la presencia de amebiasis y giardiasis con la presencia de lesiones bucales. (AU)

Objectives: To determine the type of oral manifestations in patients diagnosed with Amebiasis and giardiasis. Material and methods: The present investigation is of field of descriptive, observational type, the used technique was clinical observation, and documentary. The instrument used was a structured observation card; In order to carry out this investigation, 90 patients of both sexes older than 16 years were examined who presented as diagnosis Amebiasis, Giardiasis, which was confirmed using parasitological examination as diagnostic method. The patients were ordered into two working groups: Group A: Consisting of 45 patients diagnosed with Amebiasis, Group B: Consisting of 45 patients diagnosed with Giardiasis. Results: In group A: 28 patients presented oral manifestations of this, 38% of patients presented only one oral manifestation, these being aphthous ulcers 18%; Glositis 11% and Cheilitis 9%; 24% of patients presented more than one associated oral manifestation. In Group B: 24 patients presented only one oral manifestation, these being aphthous Ulcers 31.1%, Queilitis 15.6% and Glositis 6.6%. 13.3% of patients presented more than one associated oral manifestation. The Chi2 statistical test = 0.000, tells us that there is a significant difference between the presence of amebiasis and giardiasis with the presence of oral lesions. (AU)

Surveillance Study of Acute Gastroenteritis Etiologies in Hospitalized Children in South Lebanon (SAGE study) / 대한소아소화기영양학회지

PURPOSE: Acute gastroenteritis (AGE) is a major cause of morbidity and remains a major cause of hospitalization. Following the Syrian refugee crisis and insufficient clean water in the region, this study reviews the etiological and epidemiological data in Lebanon. METHODS: We prospectively analyzed demographic, clinical and routine laboratory data of 198 children from the age of 1 month to 10 years old who were admitted with the diagnosis of AGE to a private tertiary care hospital located in the district of Nabatieh in south Lebanon. RESULTS: Males had a higher incidence of AGE (57.1%). Pathogens were detected in 57.6% (n=114) of admitted patients, among them single pathogens were found in 51.0% (n=101) of cases that consisted of: Entamoeba histolytica 26.3% (n=52), rotavirus 18.7% (n=37), adenovirus 6.1% (n=12) and mixed co-pathogens found in 6.6% (n=13). Breast-fed children were significantly less prone to rotavirus (p=0.041). Moreover, children who had received the rotavirus vaccine were significantly less prone to rotavirus (p=0.032). CONCLUSION: Our findings highlight the high prevalence of E. histolytica infection as the major cause of pediatric gastroenteritis in hospitalized children, during the summer period likely reflecting the insanitary water supplies and lack of hygiene. Moreover the 42.4% of unidentified causative pathogens should prompt us to widen our diagnostic laboratory arsenal by adopting new diagnostic technologies.

Serodiagnosis of Extraintestinal Amebiasis: Retrospective Evaluation of the Diagnostic Performance of the Bordier® ELISA Kit

Soluble antigens from an axenic culture of Entamoeba histolytica were used to develop a commercial ELISA kit to quantify anti-E. histolytica antibodies in sera of patients with extraintestinal amebiasis in non-endemic settings. The diagnostic specificity and sensitivity of the test were assessed retrospectively using 131 human serum samples with amoebic serologic status available. They were selected according to their results in immunofluorescence (IFAT) and were separated in 2 sample categories: 64 sera with positive results by IFAT and 67 with negative results by IFAT. The sensitivity and specificity of the ELISA kit were assessed at 95.0% and 94.0% compared to the IFAT. The test can be useful to exclude a potential diagnosis of amebiasis and could be used as a screening method since ELISA is an automated technique.

Detection and differentiation of Entamoeba histolytica and Entamoeba dispar in clinical samples through PCR-denaturing gradient gel electrophoresis

Amebiasis is one of the twenty major causes of disease in Mexico; however, the diagnosis is difficult due to limitations of conventional microscopy-based techniques. In this study, we analyzed stool samples using polymerase chain reaction-denaturing gradient gel electrophoresis (PCR-DGGE) to differentiate between Entamoeba histolytica (pathogenic) and E. dispar (non-pathogenic). The target for the PCR amplification was a small region (228 bp) of the adh112 gene selected to increase the sensitivity of the test. The study involved 62 stool samples that were collected from individuals with complaints of gastrointestinal discomfort. Of the 62 samples, 10 (16.1%) were positive for E. histolytica while 52 (83.9%) were negative. No sample was positive for E. dispar. These results were validated by nested PCR-RFLP (restriction fragment length polymorphism) and suggest that PCR-DGGE is a promising tool to differentiate among Entamoeba infections, contributing to determine the specific treatment for patients infected with E. histolytica, and therefore, avoiding unnecessary treatment of patients infected with the non-pathogenic E. dispar.

Systemic acanthamoebiasis associated with canine distemper in dogs in the semiarid region of Paraíba, Brazil

Infections by free-living amoebae can cause systemic disease in animals and humans. We describe the epidemiological, clinical and pathological aspects of disseminated acanthamoebiasis associated with canine distemper in three dogs of the semiarid region of Paraíba, Northeastern Brazil. Affected dogs developed progressive neurological and respiratory signs that progressed to death within in two to 20 days. Gross lesions were irregular and with yellow-reddish nodules randomly distributed in the lungs, heart, kidneys, spleen, lymph nodes, adrenals, and intestine. One dog had foci of malacia in the parietal cortex and another one in nucleus of brain basis. Histologically, pyogranulomas with areas of necrosis and hemorrhage in all organs affected were observed, associated with myriads of intralesional amoebic trophozoites. All three cases were concomitant canine distemper, that possibly triggered immunosuppression in the dogs. The diagnosis was performed through microscopic findings of infection by free-living amoebae and confirmed Acanthamoeba sp. by immunohistochemistry.

Infecções por amebas de vida livre podem causar doença sistêmica nos animais e no homem. Descrevem-se os aspectos epidemiológicos, clínicos e patológicos de acanthamoebíase disseminada associada com cinomose em três cães na região semiárida da Paraíba, Nordeste do Brasil. Os cães afetados desenvolveram sinais respiratórios e neurológicos progressivos, que evoluíram para a morte em dois a 20 dias. Na necropsia havia áreas nodulares, irregulares e amarelo-avermelhadas distribuídas aleatoriamente em pulmões, coração, rins, fígado, baço, linfonodos, adrenal e intestino. Em um caso havia foco de malácia no córtex parietal e outro em núcleo da base encefálica. Histologicamente, foram observados piogranulomas com áreas de necrose e hemorragia em todos os órgãos afetados, associados a miríades de amebas intralesionais. Nos três casos havia cinomose concomitante, que possivelmente desencadeou imunossupressão nos cães. O diagnóstico foi realizado através dos achados microscópicos de infecção por amebas de vida livre e confirmado Acanthamoeba sp. pela imuno-histoquímica.

Amibiasis vulvar: caso clínico / Vulvar amebiasis: clinical case

La amibiasis genital causada por Entamoeba histolytica es una entidad clínica poco frecuente, aun en zonas donde la enfermedad es endémica, es por ello que informamos el caso de una mujer de 74 años de edad ingresada en el servicio de Ginecología de nuestro centro con lesión exofítica ulcerada cubierta por una secreción amarillo verdosa fétida que afectaba labios mayores, labios menores y pliegues genito crurales, con diagnóstico por biopsia de amibiasis vulvar. Recibió tratamiento con metronidazol con resolución completa de la lesión genital. El objetivo de la publicación de este caso es por lo poco frecuente de la patología y la escasa literatura sobre la misma que se puede encontrar(AU)

The genital amebiasis caused by histolytic Entamoeba is a rare clinical entity, even in areas where the disease is endemic, that is which is why report the case of a 74-year-old woman, admitted to the gynecology service medical center, ulcerated exophytic lesion, covered by a fetid greenish yellow discharge that affected labia majora, labia minora and genito crural folds with vulvar biopsy diagnosis of amebiasis. She was treated with metronidazole with complete resolution of genital injury. The aim of the publication is so little frequent of pathology and the scarce literature on it that can be found(AU)

Absceso hepático amebiano: Presentación de caso / Amebic liver abscess: Case report

El absceso hepático amebiano (AHA) es la manifestación extraintestinal más frecuente de la amebiasis. El AHA es resultado de la invasión de Entamoeba histolytica al hígado. Es una infección que está asociada a las malas condiciones de saneamiento ambiental y a los deficientes hábitos higiénicos. Es una patología que aún sigue presentado una alta morbilidad. En este artículo se informa un caso clínico y seguimiento de un paciente de 23 años con AHA, quien presenta la sintomatología típica a quien se suministra tratamiento etiológico adecuado. Adicionalmente, se realiza una revisión sobre el tema abordando los aspectos epidemiológicos más relevantes.

Amebic liver abscess (ALA) is the most common extraintestinal manifestation of amebiasis. The AlA is a result of the invasion of Entamoeba histolytica in the liver. It is an infection that is associated with poor environmental sanitation and poor hygiene. It is a disease that is still presented a high morbidity. This article presents a case report and track a patient aged 23 with ALA, who has the typical symptoms who provided adequate etiological treatment is reported. Additionally, a review of the subject is done by addressing the most relevant epidemiological aspects.

Hypocholesterolemia in Patients with an Amebic Liver Abscess

BACKGROUND/AIMS: Many parasites induce changes in the lipid profiles of the host. Cholesterol increases the virulence of Entamoeba histolytica in animal models and in vitro culture. This study aimed to determine, in patients with an amebic liver abscess, the correlation between cholesterol and other features, such as the size and number of abscesses, standard hematological and serum chemistry profiles, liver tests, and duration of hospital stay. METHODS: A total of 108 patients with an amebic liver abscess and 140 clinically healthy volunteers were investigated. Cholesterol and triglycerides were measured in the sera. The data from medical observations and laboratory tests were obtained from the clinical records. RESULTS: A total of 93% of patients with an amebic liver abscess showed hypocholesterolemia not related to any of the studied parameters. Liver function tests correlated with the size of the abscess. The most severe cases of amebic liver disease or death were found in patients whose cholesterol levels continued to decrease despite receiving antiamebic treatment and hospital care. CONCLUSIONS: Our results show that the hypocholesterolemia observed in patients with an amebic liver abscess is not related to any of the clinical and laboratory features analyzed. This is the first study relating hypocholesterolemia to severity of hepatic amebiasis.

Amebiasis: aspectos clínicos, terapéuticos y de diagnóstico de la infección / An update on amebiasis

The description of Entamoeba dispar, and the recovery of Entamoeba moshkovskii from humans had a major impact in the epidemiology and clinical management of amebiasis. Infections range from asymptomatic colonization to hemorrhagic colitis and extra-intestinal diseases. Only a minority of amebiasis patients progress to the development of disease. Recent studies suggest that susceptibility to infection, and its outcome is influenced by the host, parasite genotype, and environment. The identification of Entamoeba histolytica is based on the detection of specific antigens by ELISA and DNA in stool and other clinical samples. Several diagnostic tests have been developed, including polymerase chain reaction, the technique of choice, for the detection and differentiation of E. histolytica, E. dispar, and E. moshkovskii. Combination of serologic tests with detection of the parasite DNA by PCR or antigen by ELISA offers the best approach to diagnosis. However, these techniques are impractical for clinical laboratories of developing countries. Clinicians must follow the guidelines of the World Health Organization to avoid unnecessary treatments. This review describes and discusses recent advances in amebiasis with emphasis in the clinical aspects and management of infection.

Prevalencia de infección por Entamoeba histolytica en escuelas públicas de la ciudad de Maceió, Alagoas, Brasil / Prevalence of infection caused by Entamoeba histolytica in public schools of Maceio city, Alagoas, Brazil

Introducción: la prevalencia de amebiasis ha tenido que ser reevaluada desde que fue demostrada la existencia de dos especies de Entamoeba indistinguibles morfológicamente, pero diferentes en cuanto a su capacidad de producir enfermedad: Entamoeba histolytica (patógena) y Entamoeba dispar (no patógena). Con el empleo de procedimientos capaces de identificar características antigénicas específicas es posible hacer la diferenciación y evaluar la prevalencia real de amebiasis (es decir, de infecciones producidas por Entamoeba histolytica). Objetivo: determinar la prevalencia de infección por el complejo E. histolytica/E. dispar y, más tarde, de infección por la especie Entamoeba histolytica en muestras fecales de estudiantes de escuelas públicas de Maceió, Alagoas, Brasil. Métodos: primero se realizó la detección microscópica de infección por el complejo E. histolytica/E. dispar en muestras fecales de 1 798 estudiantes (para ello, se empleó la técnica de concentración en formol-éter). A continuación, se confirmó la infección por el mencionado complejo mediante el empleo del ensayo inmunoenzimático ENZYMEBA. Posteriormente, a las muestras confirmadas positivas al complejo E. histolytica/E. dispar se les aplicó el procedimiento inmunoenzimático E. histolytica II®, que detecta de modo específico una adhesina de la especie Entamoeba histolytica. Resultados: el empleo de la observación microscópica de heces y del ensayo ENZYMEBApermitió demostrar una prevalencia de infección por el complejo E. histolytica/E. dispar de 3,8 %. La utilización del procedimiento E. histolytica II® condujo al hallazgo de una prevalencia de infección por la especie Entamoeba histolytica de 1,0 %. La observación microscópica de heces presentó un bajo valor predictivo positivo (26,4 %) para la detección de Entamoeba histolytica respecto al ensayo E. histolytica II®. Conclusiones: aunque las cifras de prevalencia encontradas son bajas, este estudio demuestra por primera vez la ocurrencia de infección por Entamoeba histolytica en Maceió, Alagoas, Brasil. A pesar de que el examen microscópico de heces no es un procedimiento apropiado para el diagnóstico de amebiasis, puede ser utilizado como prueba de descarte en estudios epidemiológicos. La demostración de infección por Entamoeba histolytica en muestras positivas a infección por el complejo E. histolytica/E. dispar puede ser realizada mediante ensayos para la detección específica de coproantígenos del parásito, como Entamoeba histolytica II®.

Introduction: distribution of amebiasis has been reevaluated since it was demonstrated that two morphologically indistinguishable species of Entamoeba exist, but they differ in their capacity to cause disease: Entamoeba histolytica (pathogenic) and Entamoeba dispar (nonpathogenic). The use of techniques to identify specific antigenic characteristics makes it possible to establish differential diagnosis and to assess the actual prevalence of amebiasis cases (caused only by Entamoeba histolytica). Objective: to determine the prevalence of infection by Entamoeba histolytica/Entamoeba dispar complex and, in a second phase, the prevalence of infection by Entamoeba histolytica in stool samples of students from public schools in Maceió, Alagoas, Brazil. Methods: screening of Entamoeba histolytica/Entamoeba dispar complex infection cases was carried out by formol-ether concentration technique on stool samples of 1 798 students. The infection caused by this complex was confirmed with an enzyme linked immunosorbent assay (ENZYMEBA). Positive samples were then analyzed with a specific ELISA (Entamoeba histolytica II®) in order to detect an adesin only present in Entamoeba histolytica. Results: the microscopic observation of feces and the Enzymeba test allowed demonstrating the prevalence of Entamoeba histolytica/Entamoeba dispar infection amounting to 3.8 %. The Entamoeba histolytica II procedure showed the prevalence of infection by Entamoeba histolytica of 1.0%. Therefore, the microscopy presented a low predictive positivity value (26.4%) for detection of Entamoeba histolytica compared to Entamoeba histolytica II® method. Conclusions: although the prevalence figures are not high, the study shows for the first time the occurrence of Entamoeba histolytica in Maceió, Alagoas, Brazil. In spite of the fact that the optical microscopic test of feces is not the appropriate technique for amebiasis diagnosis, it can be used as a screening method in epidemiological studies. Cases of Entamoeba histolytica infection in positive samples by microscopy can be confirmed by using a specific test for detection of the parasite coproantigen like Entamoeba histolytica II®.

Prevalencia de parasitosis intestinal en mujeres embarazadas del Centro de Salud Jaihuayco Julio-Septiembre 2012 / Prevalence of intestinal parasites in pregnant women from Jaihuayco's Health Center july-september 2012

Las parasitosis intestinales afectan de manera especial a poblaciones con bajos recursos económicos, con una alta prevalencia en países en vías de desarrollo, probablemente debido a la falta educación (higiene o de manipulación de alimentos), poca accesibilidad a recursos básicos (agua potable, alcantarillado, etc.) y la pobreza. Los extremos de vida como niños y ancianos, al igual que las mujeres embarazadas son grupos poblacionales vulnerables a las parasitosis, siendo importante la repercusión en la salud de cada uno de estos grupos poblacionales pero, en este caso nos centraremos en los efectos negativos que traen consigo estas enfermedades en las mujeres embarazadas (anemia, desnutrición, niños con bajo peso al nacer, etc.). Se realizó un estudio descriptivo, de corte transversal, el universo fue de 111 mujeres embarazadas que acudieron a consulta del Centro de Salud Jaihuayco ubicado en la zona sud de la ciudad de Cochabamba - Bolivia; se encontró que 25 mujeres de las 111 mujeres embarazadas tenían parasitosis intestinal determinando una prevalencia de 22,5%. Los parásitos más frecuentes hallados fueron: Entamoeba histolitica/coli con 15,3% y Giardia lamblia con 3,6%; de las 25 mujeres con parasitosis; 10 presentaron anemia, a pesar de que en su visita de control se les proporciono las tabletas de hierro para evitar la anemia producida por su estado fisiológico.

Intestinal parasites affect especially low-income populations with a high prevalence in developing countries, probably due to the lack of education (hygiene or food handling), poor accessibility to basic resources (water supply, sewerage, etc.) and poverty. The extreme ages like children and old people as the pregnant women are a sensitive population group to this kind of affection but, in this case the purpose of this work is to show the negative effects of this condition in pregnant women (anemia, malnutrition, children with low birth weight, etc.). It was realized a quantitative, descriptive and cross-sectional study, the universe was 111 pregnant women who attended to the consultation service in Jaihuayco's health center located in the south of Cochabamba's city, where it was achieved the following main results: 25 from the 111 pregnant women have intestinal parasites determining a prevalence of 22,5%. The most prevalent parasites were Entamoeba histolytica/coli with 15,3% and Giardia lamblia with 3,6%; in the 25 women with parasitosis; 10 of them presented anemia despite they were provided with iron tablets to prevent anemia caused by physiological state.

Farmacoterapia actual de la amibiasis, avances en nuevas drogas y diseño de una vacuna / Current pharmacotherapy of amebiasis, advances in new drugs, and design of a vaccine

Aunque existe una gran cantidad de fármacos amebicidas que actúan en la luz intestinal, las drogas de acción tisular usadas para tratar la amibiasis invasiva son aún relativamente limitadas. El advenimiento del metronidazol (MTZ), que es el fármaco de elección para la amibiasis invasiva, y otros nitroimidazoles en el tratamiento de la amibiasis, ha simplificado enormemente la quimioterapia de la infección. No obstante, la erradicación de ésta después de la administración del MTZ requiere terapia adicional con un amebicida de acción luminal como la paramomicina. Después de décadas desde la introducción de estas drogas en la terapia de la infección, se han hecho pocas innovaciones. Mientras tanto, esta parasitosis continúa siendo una causa importante de morbilidad y mortalidad en el mundo contemporáneo. Debido a los efectos tóxicos y los recientes fracasos en el tratamiento de algunos protozoos intestinales con el MTZ, es necesaria la búsqueda de nuevos compuestos amebicidas. Un avance reciente es la nitazoxanida que tiene una actividad de amplio espectro contra diversos agentes infecciosos y se ha demostrado recientemente su acción contra E. histolytica. Este fármaco podría ser clave como amebicida por su efectividad contra el parásito en la luz intestinal y en los tejidos. Sin embargo, el diseño de una vacuna protectora contra la infección sigue siendo deseable. Los estudios experimentales recientes en animales modelo son alentadores. El objetivo de esta revisión es examinar y discutir los aspectos más importantes de la farmacoterapia actual de la amibiasis, así como de los prospectos para el desarrollo de nuevas drogas y una vacuna protectora contra la infección.

Although many drugs destroy Entamoeba histolytica within the colonic lumen, the number of tissue amebicides used to treat invasive amebiasis is still relatively limited. Metronidazole (MTZ), which is the drug of choice for invasive amebiasis, and other nitroimidazoles have greatly simplified the chemotherapy of this disease. However, eradication of E. histolytica infection after completion of MTZ therapy requires additional treatment with luminal amebicides, such as paramomycin. After decades of the introduction of MTZ and other nitroimidazoles in the therapy of amebiasis, there have been few innovations in treating amebic infections. Meanwhile, amebiasis remains among the leading causes of morbidity and mortality in the contemporary world. The toxic effects of MTZ and recent failures in the treatment of several intestinal protozoan parasites, has led to a search for other amebicidal drugs. A recent advance is the demonstration of the effect of nitazoxanide, which has broad spectrum of antiparasitic activity, against E. histolytica. This compound could be the key in the therapy of amebiasis by its action against both luminal and invasive parasite forms. However, the design of an effective vaccine against the infection is still being desirable. Work is underway to develop a vaccine and recent experimental studies are promising. The aim of this review is to examine and discuss the most important aspects of current antiamebic pharmacotherapy and the prospects for development of new drugs and a vaccine.

Absceso esplénico amebiano / Amebic splenetic abscess

La localización extraintestinal es una complicación temible de la amebiasis intestinal, con una elevada mortalidad, que oscila entre el 4 al 14 por ciento de los casos diagnosticados. La forma de presentación más común es el absceso hepático amebiano, y aunque se han reportado localizaciones pulmonares, peritoneales, y hasta cerebrales, la localización esplénica es extremadamente infrecuente. Se reporta un caso de amebiasis esplénica que evolucionó tórpidamente, a pesar del tratamiento específico con metronidazol desde su admisión al Departamento de Emergencia, y que fue intervenido quirúrgicamente al séptimo día, con evolución favorable después de la resección del bazo. Se realiza una revisión de la literatura actualizada sobre el tema(AU)

The extraintestinal location is a fearsome complication of the intestinal amebiasis, with a high mortality fluctuating between the 4 and the 14 percent of cases diagnosed. The commonest presentation way is the amebic hepatic abscess and although others have reported pulmonary, peritoneal and up to cerebral locations, the splenetic one is extremely infrequent. A case of splenetic amebiasis is reported which evolved in a torpid way despite the specific treatment with metronidazole from its admission to Emergence Department and that was operated on at seventh day with a favorable evolution after spleen resection. Authors made a review of the updated literature on this subject(AU)