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)

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.

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.

Entamoeba histolytica como causa de diarreia crônica / Entamoeba histolytica as a cause of chronic diarrhea / Entamoeba histolytica como causa de diarrea crónica

A diarreia crônica, caracterizada pela presença de mais de três dejeções de consistência pastosa durante pelo menos quatro semanas, é frequentemente encontrada na prática clínica. Na diarreia crônica, a probabilidade de uma etiologia infecciosa é baixa, sendo as causas funcionais, inflamatórias, osmóticas ou secretórias mais comuns. A amebíase intestinal é uma causa de diarreia crônica, causada pelo protozoário Entamoeba histolytica, sendo comum e prevalente em países em desenvolvimento. Pode ter várias formas de apresentação, sendo na maioria dos casos assintomática. Apresenta-se o caso clínico de um paciente de 27 anos, sexo masculino, raça caucasiana, homem que pratica sexo com homens (HSH), com diarreia crônica com início há cerca de seis anos. O exame objetivo não revelava alterações. Realizou exame parasitológico de fezes, com isolamento de quistos de Entamoeba histolytica. Foi medicado com metronidazol e paromomicina com resolução clínica do quadro. É importante para o Médico de Família equacionar esta etiologia na investigação de pacientes com diarreia, para um correto e atempado diagnóstico e tratamento, de modo a evitar exames desnecessários, possíveis complicações, a transmissão do agente e um grave problema de saúde pública.

Chronic diarrhea, characterized by the presence of more than three loose stools for at least four weeks, is often found in clinical practice. In chronic diarrhea, the probability of an infectious etiology is low, having usually a functional, inflammatory, osmotic or secretory origin. Intestinal amebiasis is a cause of chronic diarrhea, caused by the protozoan Entamoeba histolytica, common and prevalent in developing countries. It can have different presentations but most patients are asymptomatic. We present a 27-year-old Caucasian male, man who have sex with men (MSM), with chronic diarrhea starting six years ago. The physical exam was normal. A parasitological stool examination was performed with isolation of cysts of Entamoeba histolytica. He was treated with metronidazole and paromomycin with clinical resolution. It is important for General Practice to address this etiology in the investigation of patients with diarrhea for a correct and timely diagnosis and treatment, to avoid unnecessary testing, possible complications, transmission of the agent and a serious public health problem.

La diarrea crónica, caracterizada por la presencia de más de tres heces de consistencia blanda durante al menos cuatro semanas, es frecuentemente encontrada en la práctica clínica. En la diarrea crónica, la probabilidad de una etiología infecciosa es baja, siendo las causas funcionales, inflamatorias, osmóticas o secretoras más comunes. La amebiasis intestinal es una causa de diarrea crónica, causada por el protozoario Entamoeba histolytica, siendo común y prevalente en los países en desarrollo. Puede tener varias formas de presentación, siendo en la mayoría de los casos asintomática. Presentamos un paciente de 27 años, sexo masculino, caucásico, hombre que tiene sexo con hombres (HSH), con diarrea crónica con inicio hace cerca de seis años. El examen objetivo no reveló alteraciones. Realizó un examen parasitológico de heces, con aislamiento de quistes de Entamoeba histolytica. Fue medicado con metronidazol y paromomicina con resolución clínica del cuadro. Es importante para el médico de familia considerar esta etiología en la investigación de pacientes con diarrea, para un correcto y oportuno diagnóstico y tratamiento, de modo a evitar, exámenes innecesarios, posibles complicaciones, la transmisión del agente y un grave problema de salud pública.

Detection of intestinal parasites in public transport buses in Belém, Pará State, Northern Brazil

The purpose of this study was to investigate the frequency of intestinal parasites in public transport buses in the city of Belém, Pará, Brazil, as well as to compare the frequency of these enteroparasites according to the bus lines, collection sites within the vehicles, and presence of pathogenic and nonpathogenic parasites in the samples. This is a cross-sectional analytical study carried out between February and April 2019, in which 320 samples were analyzed, from 5 bus lines, 8 buses each, collected from 8 different surfaces inside the vehicles, according to Graham's method. Subsequently, the statistical test was performed to evaluate the differences between the variables, considering p ? 0.05. The results indicated that 7.8% of the samples were parasitized and the right handrail presented the highest prevalence of parasites, namely 2.2%. The pathogenic parasites corresponded to 26.7% and the non-pathogenic 73.3%. The non-pathogenic parasite most commonly found was Entamoeba coli totaling 50%, whereas the only pathogenic parasite was Giardia intestinalis in 26.7%. Thus, the presence of pathogenic and non-pathogenic parasites reflects the precarious hygiene of users of this type of transport, presenting a public health issue which needs to be addressed.

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.

Coccidiosis y amibiasis intestinal en niños de edad escolar de un distrito de Lambayeque, Perú / Intestinal coccidiosis and amebiasis in school age children of a district in Lambayeque, Peru

Objetivos: Determinar la prevalencia y los factores asociados a coccidiosis y amibiasis intestinal en niños de edad escolar del distrito de Chongoyape, Chiclayo, Perú. Material y métodos: Estudio transversal de tipo relacional entre noviembre del 2014 y enero del 2015 en 133 escolares. Para recolectar la información sociodemográfica y de saneamiento se usó un cuestionario estructurado. La detección de los parásitos se realizó en muestras seriadas de heces. Para los coccidios intestinales se realizó examen microscópico directo (EMD), técnica ácido resistente modificada (TARM) y ELISA coproantígenos para Cryptosporidium spp., mientras que para la amibiasis se usó EMD y ELISA coproantígenos para Entamoeba hystolitica. Resultados: El 6,8% (9/133) de la muestra presentó coccidiosis intestinal, 3,8% (5/133) con Cryptosporidium spp., y 3,0% (4/133) con Cyclospora cayetanensis. No se detectó Cystoisospora belli. El 4,5% (6/133) de la muestra presentó E. histolytica. El factor asociado en ambas parasitosis fue el consumo de agua insalubre (p=0,001 y p=0,026 respectivamente), mientras que el contacto con animales se asoció a la coccidiosis intestinal (p=0,013). Conclusiones: La coccidiosis y la amibiasis intestinal son frecuentes en niños de la población estudiada, evidenciando su importancia como problema de salud pública y la necesidad de un diagnóstico específico y rutinario en las instituciones de salud de la región. (AU)

Objectives: To determine the prevalence of and risk factors for intestinal coccidiosis and amebiasis in school-age children in the district of Chongoyape, Chiclayo, Peru. Methods: Cross-sectional study carried-out between November 2014 and January 2015 among 133 school-aged children. A structures questionnaire collected socio-demographic and sanitation information. Serial stool samples were required, which were processed under direct microscopy, modified acid-fast staining and ELISA to detect antigens of Cryptosporidium spp, while direct microscopy and ELISA were used to detect Entamoeba hystolitica. Results: 6.8% (9/133) of the samples were positive for coccidian parasites, 3.8% (5/133) were positive for Cryptosporidium and 3% (4/133) for Cyclospora cayetanensis, no Cystoisospora belli was identified. E. hystolitica was found in 4.5% (6/133) samples. Drinking non-potable water was a risk factor for getting both infections, while animal contact was associated with getting a coccidian parasite (p=0.013). Conclusions: Both coccidian and intestinal amebas are frequent protozoan infections in this population. These parasites are public health problem that require routine and specific diagnostic methods in the region. (AU)

Amebiasis intestinal y hepática / Intestinal and hepatic amebiasis

Amebiasis is the infection by Entamoeba histolytica, a protozoan capable of invading the colonic mucosa causing a diarrheic syndrome, although most of the time is mild, it can lead to a fulminating colitis. Sometimes it can spread to other organs; among extra-intestinal manifestations of this parasite, the most frequent is the amebic liver abscess. In the next pages, general aspects of this protozoan, its epidemiology, clinical findings, diagnosis and treatment are reviewed, emphasizing the possibilities of diagnosis and treatment available in Chile.

La amebiasis corresponde a la infección por Entamoeba histolytica, protozoo capaz de invadir la mucosa del colon provocando un cuadro diarréico que, si bien la mayoría de las veces es leve, puede llegar a una colitis fulminante. En algunas oportunidades puede diseminarse a otros órganos; dentro de las manifestaciones extra-intestinales de este parásito, la más frecuente es el absceso hepático amebiano. A continuación se revisan aspectos generales de este protozoo, su epidemiología, cuadro clínico, diagnóstico y tratamiento, destacando las posibilidades de diagnóstico y tratamiento disponibles en Chile.

Descripción del estado de salud de indígenas Huitoto y Embera de Florencia, Caquetá a través de pruebas de laboratorio, en el primer período de 2012 / Description of the health status of indigenous Huitoto and Embera of Florencia Caquetá trough laboratory tests in the first period of 2012

Objetivo. Describir la presencia de anemia, infecciones y parasitismo intestinal en comunidades indígenas colombianas Huitoto y Embera residentes en Florencia, Caquetá a partir de pruebas de laboratorio como: cuadro hemático, frotis de sangre periférica (FSP), ferritina, proteína C reactiva (PCR), parcial de orina y coprológico. Materiales y métodos. Se recolectaron muestras de sangre, orina y materia fecal, de adultos entre los 18 y 79 años. Resultados. Se encontró que las dos comunidades indígenas presentaban deficiencias en el estado de salud representadas por alto nivel de parasitismo intestinal, presencia de anemia en algunos de los individuos, al igual que una baja prevalencia de infección urinaria. Se sugiere implementar campañas de promoción y prevención de la salud de estas comunidades indígenas.

Objetive. Describe the presence of anemia, infections and intestinal parasitism in Colombian indigenous communities Huitoto and Embera residents in Florencia, Caquetá. Materials and Methods: Laboratory test such as: hemogram, peripheral blood smear (FSP), Ferritin, C-reactive protein (CRP), partial of urine and stool. In the study were collected blood samples, urine and stool, of adults between 18 and 79 years. Results. It was found that the two communities had deficiencies in health status represented by high level of intestinal parasitism, anemia in some individuals, as well as a low prevalence of urinary tract infection. In response to the problems described above, the group of research suggests deploy campaigns of health promotion and disease prevention related to the findings on the health status of these indigenous communities.

Perfuração do colo por colite amebiana invasiva durante terapia anti-TNF para espondiloartrite / Colonic perforation due to invasive amebic colitis during anti-TNF therapy for spondyloarthritis

O bloqueio do TNF tem tido sucesso no tratamento de algumas doenças reumáticas, como a espondiloartrite. Relatam-se muitas complicações infecciosas com a terapia anti-TNF, principalmente infecções bacterianas, micobacterianas, virais e fúngicas. A Entamoeba histolytica é um protozoário extracelular que causa principalmente colite e abscesso hepático, sendo que a perfuração intestinal é uma complicação rara, com alta mortalidade. O TNF é considerado o principal mediador da imunidade celular contra a amebíase. Inicialmente, é quimiotático para a E. histolytica, potencializando sua adesão ao enterócito por meio da lectina galactose-inibível, e depois ativando os macrófagos para matarem a ameba pela liberação de NO; assim, o bloqueio do TNF poderia ser prejudicial, aumentando a virulência amebiana. Descreve-se o caso de uma mulher de 46 anos com espondiloartrite que apresentou uma perfuração do colo por colite amebiana invasiva durante uso de anti-TNF.

TNF blockade has been successful in the treatment of some rheumatic diseases such as spondyloarthritis. Many infectious complications have been reported with anti-TNF therapy, mainly bacterial, mycobacterial, viral and fungal infections. Entamoeba histolytica is an extracellular protozoan parasite that mainly causes colitis and hepatic abscess; bowel perforation is an uncommon complication with high mortality. TNF is considered the principal mediator of cell immunity against amebiasis. Initially, it is chemotactic to E. histolytica, enhancing its adherence to enterocyte via galactose inhibitable lectin, and then activating macrophages to kill ameba though the release of NO, so that TNF blocking could be harmful, increasing amebic virulence. We describe the case of a 46-year-old woman with spondyloarthritis who presented a colonic perforation due to invasive amebic colitis during anti-TNF use.

Diagnóstico parasitológico e molecular de enteroparasitos entre crianças residentes e funcionários de uma institução beneficente para menores no município de Niterói-RJ, Brasil / Parasitological and molecular diagnosis of enteroparasites among resident children and employees of a child care institution at Niterói city, RJ, Brazil

Os enteroparasitos são causa importante de agravos à saúde humana e podem interferir de forma significativa no desenvolvimento infantil. Embora as formas de transmissão sejam bemdocumentadas, a desinformação e as precárias condições socioeconômicas de alguns segmentos da população ainda são fatores que contribuem para a manutenção de parasitos no País, viabilizando a transmissão. Este estudo foi realizado entre crianças residentes e funcionários de uma instituiçãofilantrópica religiosa, situada na cidade de Niterói, Rio de Janeiro, consistindo em um ciclo de palestras educativas, seguido da coleta de amostras fecais para diagnóstico coproparasitológico.Foram coletadas 68 amostras fecais frescas e encontrados enteroparasitos em 41 delas (60 por cento),sendo o Blastocystis hominis o parasito mais prevalente (44 por cento). Adicionalmente, sete amostrasforam positivas para o complexo Entamoeba histolytica/E. dispar, sendo uma confirmada como E. histolytica pelo ELISA para pesquisa de coproantígeno. Em 37 amostras de fezes foi pesquisadaa presença de E. histolytica e E. dispar pela técnica de Nested-PCR. Entre essas, 12 (32 por cento) amplificaram um fragmento de 195 pb quando utilizados primers específicos para E. dispar, não havendo amplificação de qualquer produto com os primers de E. histolytica. Estudo feito no entornoda instituição revelou acúmulo de lixo e a presença de saídas de esgoto no peridomicílio, as quais desembocavam nas proximidades da área de lazer das crianças. É possível que esses pontos sejam responsáveis pela contaminação do solo e mesmo incriminados como uma das possíveis fontes deinfestação para as crianças.

Intestinal parasites are important agents of human diseases, besides being responsible for impairingchildhood development. Although transmission is well known, lack of information and precarioussocial and economic conditions are risk factors that allow maintenance of parasite cycles, favoringtransmission. This study was carried out among resident children and employees of a Catholic Institution, located in Niterói, Rio de Janeiro, and consisted of delivering lectures and collectingfresh stool samples, which were processed through the Willis and Hoffman, Pons and Janermethods. Enteroparasites were found in 41 samples (60 percent) and Blastocystis hominis was the mostprevalent (44 percent). Additionally, in seven samples where microscopic examination was positive forthe E. histolytica/E. dispar complex an ELISA was employed to detect E. histolytica and only onereacted positively in the immunoassay. In 37 samples a Nested-PCR was carried out for detectionof E. histolytica and E. dispar and in 12 samples (32 percent) a product with 195 bp was observed usingE. dispar primers, while there was no amplification product with E. histolytica specific primers. As the Institution has a good pattern of hygiene not related with the results, a superficial analysis of its peripheral area was carried out and showed lots of garbage in the neighborhood and sewage outflowinto the play area of the Institution. We concluded that these points may be responsible for the soil contamination and could be incriminated as one of the sources of infection in the children.

Avaliação epidemiológica das parasitoses intestinais no Parque Oswaldo Cruz, Manguinhos, Rio de Janeiro, RJ / Epidemiological evaluation of intestinal parasites in Parque Oswaldo Cruz, Manguinhos, RJ

A importância das parasitoses intestinais no Brasil não comporta contestação. Estas acometem principalmente a população de baixa renda, sem acesso ao saneamento básico, à assistência médica e às informações adequadas sobre medidas profiláticas. O objetivo do presente trabalho foi realizar um estudo integrado para avaliação epidemiológica das parasitoses intestinais na Comunidade do Amorim - Parque Oswaldo Cruz (POC), localizada no Complexo de Favelas de Manguinhos, RJ, reforçando políticas públicas de prevenção e visando à melhoria da qualidade de vida da população. Realizou se inquéritos socioeconômico e coproparasitológico, através do método desedimentação de Lutz (1919), a fim de verificar a prevalência de parasitoses intestinais. Além disso, foram realizadas oficinas de prevenção e discussões com a comunidade, no âmbito do Curso Saúde Comunitária: Uma Construção de Todos, ministrado no IOC, Fiocruz. Para a análise estatística utilizou-se o teste do qui-quadrado e o cálculo da Odds Ratio. Em relação às condições socioeconômicas, os moradores cadastrados, em sua maioria, apresentavam escolaridade com ensino médio completo, renda mensal de 2 a 4 salários mínimos e cerca de 90 por cento afirmavam possuir água canalizada em seus domicílios. A prevalência das parasitoses intestinais foi de 19,9 por cento. Os parasitos mais frequentes foram os protozoários Endolimax nana e Entamoebacoli. Giardia lamblia apresentou prevalência de 1,8 por cento (p< 0,001). Entre os helmintos, Enterobius vermicularis foi o mais frequente (p< 0,001). Este estudo possibilitou concluir que o perfil epidemiológico das parasitoses intestinais na comunidade do Amorim (POC), foi estabelecido, servindo de base científica para ações governamentais...

The importance of intestinal parasite infections (IPIs) in Brazil does not carry ondefense. These affect mainly the low-income population without access to basicsanitation, health care and adequate information on preventive measures. Theaim of this study was to achieve an integrated epidemiological survey ofintestinal parasites in the Amorim - Parque Oswaldo Cruz (POC) Community,located at Manguinhos complex of slums, RJ, reinforcing public policies forprevention and improvement of the quality of life. It were performedsocioeconomic surveys and stool examination by the Lutz (1919) sedimentationmethod, in order to determine the prevalence of intestinal parasites. In addition,prevention workshops and discussions were conducted with the community,within the course Saúde Comunitária: Uma Construção de Todos, hostedby IOC, Fiocruz. The statistical analysis used the chi-square test and oddsratio. Regarding their socioeconomic features, residents had high schooleducation, monthly income 2-4 minimum salaries and approximately 90 percent claimed to have piped water at their homes. The overall prevalence of IPIs was19.9 percent. The most frequent parasites were protozoa Endolimaxnana and Entamoeba coli. Giardia lamblia showed prevalence 1.8 percent (p <0.001). Among the helminths, Enterobius vermicularis was the most common (p<0.001). This study allowed concluding which the epidemiological profile of IPIsin the Amorim (POC) community was established, serving as a scientific basisfor government actions. Due to environmental conditions and lack surveillanceproviding public policy on sanitation in the locality, there is a need tostandardize the methodology to be used in the SUS, to control the transmissionat vulnerable areas, including Manguinhos, RJ. The course SaúdeComunitária: Uma Construção de Todos, presented by itself as an inclusivemethodology in Manguinhos, RJ, and can be replicated in other areas toprevent IPIs, for the health promotion...

Perforación intestinal secundaria a amebiasis / Amebiasis intestinal perforation secondary

La amebiasis intestinal es una enfermedad frecuente en países en desarrollo, que es común en regiones tropicales y subtropicales, así como en regiones con servicios sanitarios deficientes. Presentamos el caso de un paciente de 74 años de edad, sexo masculino, originario y residente de la ciudad de Guatemala, quién cursó una diarrea y dolor abdominal. Fue intervenido quirúrgicamente por abdomen agudo, con resección intestinal extensa por perforaciones. En el estudio de anatomía patológica se realizó el diagnóstico de colitis amebiana con perforaciones y peritonitis.

Intestinal amoebiasis is a disease common indeveloping countries, which is common in tropicaland subtropical regions, as well as in regions withpoor sanitation. We report the case of a 74-year-oldmale, resident of Guatemala City, who presented withdiarrhea and abdominal pain. He had a laparatomy foracute abdomen, undergoing wide intestinal resectiondue to perforations. The pathology diag-nosis wasamoebic colitis with perforations and peritonitis.

Parasitological Evaluation of Domestic Water Sources in a Rural Community in Nigeria.

Aim: To evaluate the level of safety of water sources in a rural settlement in Nigeria with reference to parasitic infections and to make appropriate recommendations to the government and the community dwellers. Study Design: Investigative study. Place and Duration of Study: Samples were collected in Heipang, Barkin Ladi Local Government Area of Plateau State, Nigeria between October-December, 2012. They were processed at the General Laboratory of National Veterinary Research Institute, Vom, Nigeria. Methodology: 100 water samples were collected from domestic water sources. 10 of the samples were from streams, 60 from ponds, 20 from wells and 10 were from bore holes. Samples were investigated for presence of parasites using standard World Health Organisation approved laboratory techniques. Each sample was subjected to macroscopy, filtration, centrifugation and microscopy. Results: It revealed that 59 out of 100 water sources investigated had parasitic infestation. Ponds had the highest degree of parasitic contamination (78.3%), streams followed closely with 50%, while wells and bore holes had 35% and 0% in that order. Helminths were the leading parasitic genera encountered with Ascaris species accounting for 33.9% of the parasites. Hookworm was the second most common helminth with the prevalence of 20.3%. Strongyloides species accounted for a paltry prevalence of 3.4%. Protozoan cysts of Balanditium coli and Entamoeba histolytica accounted for 18.6% of parasites each. Conclusion: These findings clearly show that most water sources in the study area constitute grave epidemiological threat to public health. Inhabitants of such communities should boil or treat their water before consumption while government authorities should provide safe drinking water to the rural dwellers.

Parasitismo intestinal en niñas y niños mayores de 5 años de Ciudad Bolívar / Parasitismo intestinal en niñas y niños mayores de 5 años de Ciudad Bolívar

Se realizó un estudio descriptivo y transversal de 320 pacientes mayores de 5 años de edad, cuyos exámenes de heces fecales dieron positivos, atendidos en el Centro de Diagnóstico Integral "Cuyuní" de la parroquia La Sabanita en Ciudad Bolívar (Estado Bolívar de Venezuela), desde julio del 2011 hasta marzo del 2012, a fin de caracterizarles según algunas variables de interés: tipos de parásitos, particularidades del abastecimiento y tratamiento del agua de consumo, lugar de deposición, hábitos higiénico-sanitarios y síntomas más frecuentes. Del total de la serie, 58,4 % presentaba poliparasitismo, 73,7 % se abastecía de agua mediante pipas o tanques y 45,3 % no trataba el agua de consumo, mientras que 66,3 % lo hacía por el método de filtración; asimismo, predominaron la defecación en letrinas (53,1 %), el hábito de andar descalzos (24,7 %), el dolor abdominal entre los síntomas referidos (39,4 %) y la Entamoeba histolytica como parásito más hallado (35,3 %).

A descriptive and cross-sectional study was carried out in 320 patients over 5 years of age whose stool tests were positive, treated in "Cuyuní" Comprehensive Diagnosis Center from La Sabanita parish in Bolívar city (Bolívar State of Venezuela), from July 2011 to March 2012, in order to characterize them according to some variables of interest: types of parasites, particularities of supply and treatment of drinking water, stools place, health habits and most frequent symptoms. Of the total of the series, 58.4% had polyparasitism, 73.7% were supplied with water by means of tankers or water tanks and 45.3% did not treat drinking water, while 66.3% did so by the filtration method; also, passage of stools in latrines (53.1%), the habit of walking barefoot (24.7%), abdominal pain between the symptoms reported (39.4%) and Entamoeba histolytica as the most found parasite (35.3%) prevailed.

Randomized trial of secnidazol versus metronidazol in the treatment of intestinal amoebiasis in children

Intestinal amoebiasis of children is an endemic disease in Iraq, and it is one of the leading causes of acute and chronic diarrhea. Noticeable resistance to the usually used antiprotozoal medication, especially in the last years had been repeatedly documented. To determine the effectiveness and safety of [Secnidazol] in the treatment of intestinal amoebiasis in pediatric age group. A study was performed on 200 children aged 10 months -7 years diagnosed as intestinal amoebiasis on the base of clinical ground and microscopical study. The children were allocated at random into one or another equal treatment groups of [100 children for each group]. Therapeutic dose of Metronidazol [40mg/kg/day for 7 days] started for the first group while for the second group, Secnidazol suspension [single dose of 30 mg/Kg/dose] was given. Both groups were followed for one week by clinical assessment and parasitological examination of the stool for the presence of Ent. histolytica [trophozoite and/or cysts]. The study showed that Metronidazol suspension had 18% clinical and 11% parasitological cure at day 1 compared to 83% clinical and 32% parasitological cure when using Secnidazol. These reached 72% clinical and 59% parasitological cure rate after 7 days of using Metronidazol compared to 91% clinical and 89% parasitological cure by effect of Secnidazol suspension. Secnidazol was more effective than Metronidazol for clinical and parasitological treatment of intestinal amoebiasis in children. In addition, Secnidazol is more palatable, and with a shorter duration of treatment [monotherapy] increasing the treatment compliance. Our results recommend to replace Metronidazol with Secnidazol suspension at least in resistant or intransigent cases of intestinal amebiasis

Nuevos métodos para el diagnóstico microbiológico de la amebiasis y de otros protozoarios intestinales / New methods for the microbiological diagnosis of amebiasis and other intestinal protozoa

La Organización Mundial de la Salud (OMS) ubica a las enfermedades diarreicas en segundo lugar como causa de morbi-mortalidad de niños en países en vías de desarrollo, siendo las infecciones por protozoarios intestinales proporcionalmente una causa trascendente en dichas regiones. La mayoría de estos parásitos se transmiten por vía fecal-oral o por contacto interpersonal y exhiben ciclosde vida que, en general se desarrollan en dos estadios: el trofozoíto que coloniza el intestino y el quiste que es excretado con las heces y cuya rígida pared protectora, le confiere resistencia en el ambiente, permitiendo de este modo la propagación de la enfermedad. Entamoeba histolytica es uno de los agentes infecciosos de mayor distribución mundial, y es aproximadamente la causa de 100.000 muertes por año, siendo responsable de uno de los problemas de salud más serios en países en vías de desarrollo. Se reconocen al menos ocho amebas que podrían colonizar el intestino del hombre: E. histolytica, E. dispar, E. moshkovskii, E. coli, E. hartmanni, E. polecki, Iodamoeba butschlii y Endolimax nana. Aunque sólo E. histolytica es considerada como el agente etiológico de la Amebiosis. Su presentación clínica va desde la colonización asintomática, la disentería amebiana, hasta la propagación extraintestinal, originando abscesos en diversos órganos y tejidos. Por este motivo, la correcta identificación de E. histolytica en heces y tejidos y diferenciándola de otras amebas comensales y de otros protozoarios representa un desafío en la práctica médica, a que de ello dependerá el tratamiento y el pronóstico de laenfermedad.

Abstract: The World Health Organization (WHO) includes diarrhea a the second leading cause of morbidity and mortality of children in developing countries. Among these causes, infections by intestinal protozoan parasites represent an important percentage in any place of the world. Most of these parasites are transmitted by the fecal-oral route or by inter personal contact and exhibit simple life cycles, consisting in the disease-causing, proliferating trophozoites and the dormant, resistant cyst responsible for the transmission of the infection among susceptible hosts. Entamoeba histolytica is one of the most frequent of those parasites, causing about 100.000 deaths per year in developing countries, being one of the major health problems in areas where basic sanitation practices are inefficient. At least eight species of Entamoeba have been reported to infect the human large intestine: E. histolytica, E. dispar, E. moshkovskii, E. coli, E. hartmanni, E. polecki, odamoeba butschlii and Endolimax nana, although E. histolytica is the only one considered to cause pathology in humans. Clinical manifestation of this infection varies from asymptomatic infection to dysentery and extraintestinal invasion, producing abscesses in many tissues. Therefore, the correct identification of E. histolytica in stool and tissue samples and its differential diagnostic is an important challenge in parasitology because treatment and prognosis depend of the valid identification of this parasite.The health issue of protozoan intestinal infections, both in developed and developing parts of the world, is of such importance that it is clearly necessary the development of novel, better, cheap, and faster diagnostic methods. The incorporation of new approaches and technology to the efficient and sensitive detection of these infections is significantly relevant.

A Case of Steroid Treated Amebic Colitis Misdiagnosed as Eosinophilic Colitis / 대한소화기내시경학회지

Some cases have reported that amebic colitis leads to serious complications that are caused by a misdiagnosis of an inflammatory bowel disease and consequential ill-managed steroid therapy. Therefore, it should be stressed that the differential diagnosis on such a case is very important. Eosinophilic colitis may reveal its presence as diarrhea, abdominal pain, ascites, and eosinophilic deposits in tissues. Therefore, it is highly necessary to make a differential diagnosis to distinguish eosinophilic colitis from other infectious or inflammatory bowel diseases. We report a case of amebic colitis, which was mistakenly diagnosed as eosinophilic colitis and a liver eosinophilic abscess in a young male who complained of bloody diarrhea and right upper quadrant pain. However, the misdiagnosed steroid therapy did not aggravate the progress of the amebic infection.

Amibiasis: implicaciones del reconocimiento de entamoeba dispar e identificación de entamoeba moshkovskii en humanos: revisión / Amebiasis: implications of the recognition of entamoeba dispar and the identification of entamoeba moshkovskii in humans: revisión

La historia de Entamoeba histolytica es muy confusa y muestra diversos conceptos erróneos acerca del parásito y su relación con el hospedador. La poca correlación entre la prevalencia de la amibiasis asintomática y sintomática originó la propuesta de tres hipótesis explicativas, entre las cuales estaba el concepto de Brumpt de que existían dos especies morfológicamente idénticas, E. dysenteriae y E. dispar. La aplicación de las técnicas moleculares modernas demostró, en forma irrefutable, que lo que se conocía clásicamente como E. histolytica se trataba realmente de dos especies, confirmándose el concepto de Brumpt casi 7 décadas después. Estudios recientes han identificado en humanos E. moshkovskii, morfológicamente indistinguible de E. histolytica y E. dispar, así como una gran diversidad genética de cada una de estas especies y heterogenicidad en virulencia entre las razas de E. histolytica. La redescripción de E. dispar y la identificación de E. moshkovskii en humanos han impactado enormemente el conocimiento de E. histolytica y la amibiasis con importantes implicaciones clínicas y epidemiológicas que han conducido a la necesidad de reevaluar la prevalencia y morbilidad de la infección en la población mundial y estudiar la distribución geográfica, prevalencia y modelo de transmisión de las razas de E. histolytica para detectar aquéllas epidemiológicamente relevantes y predecir el riesgo de la enfermedad amibiana en una población.

The history of Entamoeba histolytica is very confuse and shows several wrong concepts about the parasite and its relationship with the host. The poor correlation between the prevalence of asymptomatic and symptomatic amebiasis originated the proposal of three explicative hypothesis, among them was the concept of Brumpt that E. histolytica comprised two morphologically identical species, E. dysenteriae and E. dispar. The application of modern molecular techniques irrefutably proved that E. histolytica was really a complex of two species, confirming the concept of Brumpt almost 7 decades later. Recent studies have identified in humans E. moshkovskii, morphologically indistinguishable from E. histolytica and E. dispar, a great genetic diversity within each of these species, and heterogeneity in virulence among E. histolytica strains. The redescription of E. dispar, and the recovery of E. moshkovskii from humans have had a major impact in our understanding of E. histolytica and amebiasis with important clinical and epidemiologic implications. This has led to the need of a reevaluation of the infection in terms of prevalence and morbidity in the global population and to study the geographic distribution, prevalence, and transmission pattern of E. histolytica strains in order to detect those with epidemiologic relevance and predict the risk of amebic disease in a population.