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1.
J Infect Chemother ; 23(11): 778-781, 2017 Nov.
Article in English | MEDLINE | ID: mdl-28527648

ABSTRACT

A 23-year-old Japanese woman presented with abdominal distention following fever, diarrhea, and abdominal pain during a stay in Taiwan. Serology for the detection of amebic-antibodies and stool microscopic examination were both negative. A computed tomography scan showed a 13 cm diameter abscess spreading from the lower abdominal wall to the pelvic retroperitoneal space. Needle aspiration of the abscess was done under computed tomography guidance, and microscopy of the aspirated fluid revealed trophozoites of Entamoeba. The patient was diagnosed as amebiasis with negative serologic markers that caused intra-abdominal abscess. Intravenous metronidazole treatment for two weeks did not result in any improvement of the abscess. After irrigation and drainage of the abscess, her symptoms resolved. This case report highlights that amebiasis should be considered when indicated by patient history, including travelers returning from endemic areas, and that further evaluation is necessary for diagnosis, even if the serology and stool test are negative.


Subject(s)
Abdominal Abscess/parasitology , Abdominal Pain/parasitology , Amebicides/therapeutic use , Entamoebiasis/complications , Fever/parasitology , Abdominal Abscess/blood , Abdominal Abscess/pathology , Abdominal Abscess/therapy , Abdominal Pain/blood , Abdominal Pain/pathology , Abdominal Pain/therapy , Anti-Bacterial Agents/therapeutic use , Biomarkers/blood , Biopsy, Fine-Needle/methods , C-Reactive Protein/analysis , Colonoscopy , Drainage , Entamoeba histolytica/immunology , Entamoeba histolytica/isolation & purification , Entamoebiasis/blood , Entamoebiasis/parasitology , Entamoebiasis/therapy , Female , Fever/blood , Fever/pathology , Fever/therapy , Humans , Magnetic Resonance Imaging , Serologic Tests , Taiwan , Therapeutic Irrigation , Tomography, X-Ray Computed/methods , Trophozoites/isolation & purification , Young Adult
2.
Mol Microbiol ; 98(2): 208-17, 2015 Oct.
Article in English | MEDLINE | ID: mdl-26173474

ABSTRACT

The development of molecular microbiology has made it possible for us to deepen our understanding of the pathogenesis of amebiasis. Research using the trophozoite form of Entamoeba histolytica has clearly shown us the importance of the interface between the parasite and host cells in vitro. Immuno-pathogenesis after excystation was similarly well advanced by the use of a novel murine model of amebic colitis. However, it is still challenging to apply these findings to clinical and epidemiological settings. This is mainly because of the lack of a complete infection animal model of amebiasis by oral-fecal infection. Moreover, in vitro experiments have predominantly been performed using the same axenic cultured strain HM-1: IMSS isolated about 50 years ago, whereas highly diverse strains are prevalent all over the world. Translational research informed by clinical observations has the greatest potential for the development of effective interventions. Here, we highlight discoveries of the experiments designed from cohort observation and discuss remaining problems to be solved.


Subject(s)
Biomedical Research , Entamoeba histolytica/pathogenicity , Entamoebiasis , Animals , Disease Models, Animal , Entamoebiasis/parasitology , Entamoebiasis/prevention & control , Entamoebiasis/therapy , Host-Parasite Interactions/genetics , Humans , Mice , Molecular Biology/methods , Virulence
3.
Trop Gastroenterol ; 36(4): 251-5, 2015.
Article in English | MEDLINE | ID: mdl-27509703

ABSTRACT

BACKGROUND: Amebic liver abscess (ALA) is a common and serious problem in our country. There are only a few controlled trials on the efficacy and advantages of combination therapy with percutaneous needle aspiration and pharmacotherapy, over pharmacotherapy alone for amebic liver abscess. MATERIAL AND METHODS: This study was conducted to compare the efficacy of two different treatment modalities i.e. drug treatment alone vs. drug treatment and aspiration of abscess cavity in patients with small (up to 5 cm) and large (5 cm to 10 cm) size ALA. This is one of the largest single center, prospective, randomized studies comparing the efficacy of aspiration in ALA. RESULTS: (i) Mean body temperature, liver tenderness, total leukocyte count (TLC), serum alanine aminotransferase (ALT) and liver span were significantly decreased in the aspiration group on days 8 and 15 as compared to non-aspiration group especially in large abscess (5 cm to 10 cm). (ii) Abscess cavity maximum diameter decreased significantly in aspiration group on days 8 and 15, and 1 month & 3 months in large abscess (5cm to 10 cm). CONCLUSIONS: (i) Needle aspiration along with metronidazole hastens clinical improvement especially in large (5 cm up to 10 cm) cavities in patients with ALA. (ii) Aspiration is safe and no major complications occurred. (iii) Hence, combination therapy should be the first choice especially in large ALA (5 cm to 10 cm).


Subject(s)
Antiprotozoal Agents/therapeutic use , Entamoebiasis/therapy , Liver Abscess, Amebic/therapy , Metronidazole/therapeutic use , Paracentesis/methods , Alanine Transaminase/blood , Combined Modality Therapy , Entamoebiasis/blood , Entamoebiasis/pathology , Fever , Humans , India , Leukocyte Count , Liver/pathology , Liver Abscess, Amebic/blood , Liver Abscess, Amebic/pathology , Organ Size , Treatment Outcome
4.
ScientificWorldJournal ; 2014: 364264, 2014.
Article in English | MEDLINE | ID: mdl-24605052

ABSTRACT

Entamoeba histolytica is a protozoan parasite that presents a risk to the health of millions of people worldwide. Due to the existence of different clinical forms caused by the parasite and also different virulence levels presented by one strain, one would expect differences in the profile of gene transcripts between virulent and nonvirulent cultures. In this study we used the differential display to select gene segments related to invasiveness of amoeba. One Brazilian strain of E. histolytica in two conditions, able or not to cause lesions in experimental animals, was used. RNA from this strain, was used to study the differential expression of genes. 29 specific gene fragments differentially expressed in the virulent strain were selected. By real-time PCR, six of these genes had confirmed their differential expression in the virulent culture. These genes may have important roles in triggering invasive amoebiasis and may be related to adaptation of trophozoites to difficulties encountered during colonization of the intestinal epithelium and liver tissue. Future studies with these genes may elucidate its actual role in tissue invasion by E. histolytica generating new pathways for diagnosis and treatment of amoebiasis.


Subject(s)
Entamoeba histolytica/metabolism , Entamoebiasis/metabolism , Gene Expression Regulation , RNA, Protozoan/biosynthesis , Animals , Entamoeba histolytica/genetics , Entamoeba histolytica/pathogenicity , Entamoebiasis/genetics , Entamoebiasis/therapy , Humans , Mice , RNA, Protozoan/genetics , Rats
5.
Semin Cutan Med Surg ; 33(3): 133-5, 2014 Sep.
Article in English | MEDLINE | ID: mdl-25577853

ABSTRACT

In today's world, many people can travel easily and quickly around the globe. Most travel travel-related illnesses include fever, diarrhea, and skin disease, which are relatively uncommon in returning travelers. We review four of the most common emerging infestations and skin infections in the Americas, which are important to the clinical dermatologist, focusing on the clinical presentation and treatment of cutaneous larva migrans, gnathostomiasis, cutaneous amebiasis, and trombiculiasis.


Subject(s)
Entamoebiasis/diagnosis , Gnathostomiasis/diagnosis , Larva Migrans/diagnosis , Travel , Trombiculiasis/diagnosis , Tropical Climate , Diagnosis, Differential , Entamoebiasis/parasitology , Entamoebiasis/therapy , Entamoebiasis/transmission , Gnathostomiasis/parasitology , Gnathostomiasis/therapy , Gnathostomiasis/transmission , Humans , Larva Migrans/parasitology , Larva Migrans/therapy , Larva Migrans/transmission , Trombiculiasis/parasitology , Trombiculiasis/therapy , Trombiculiasis/transmission
6.
Semin Pediatr Surg ; 21(2): 142-50, 2012 May.
Article in English | MEDLINE | ID: mdl-22475120

ABSTRACT

Parasitic infestation is common in developing countries especially in Africa. Children are often more vulnerable to these infections. Many health problems result from these infestations, including malnutrition, iron-deficiency anemia, surgical morbidities, and even impaired cognitive function and educational achievement. Surgical intervention may be needed to treat serious complications caused by some of these parasites. Amoebic colitis and liver abscess caused by protozoan infections; intestinal obstruction, biliary infestation with cholangitis and liver abscess, and pancreatitis caused by Ascaris lumbricoides; biliary obstruction caused by Faschiola; hepatic and pulmonary hydatid cysts caused by Echinococcus granulosus and multilocularis are examples. Expenditure of medical care of affected children may cause a great burden on many African governments, which are already suffering from economic instability. The clinical presentation, investigation, and management of some parasitic infestations of surgical relevance in African children are discussed in this article.


Subject(s)
Parasitic Diseases/surgery , Africa/epidemiology , Ascariasis/diagnosis , Ascariasis/epidemiology , Ascariasis/surgery , Ascariasis/therapy , Child , Dracunculiasis/diagnosis , Dracunculiasis/epidemiology , Dracunculiasis/surgery , Dracunculiasis/therapy , Echinococcosis/diagnosis , Echinococcosis/epidemiology , Echinococcosis/surgery , Echinococcosis/therapy , Entamoebiasis/diagnosis , Entamoebiasis/epidemiology , Entamoebiasis/surgery , Entamoebiasis/therapy , Enterobiasis/diagnosis , Enterobiasis/epidemiology , Enterobiasis/surgery , Helminthiasis/epidemiology , Helminthiasis/surgery , Humans , Myiasis/diagnosis , Myiasis/epidemiology , Myiasis/surgery , Myiasis/therapy , Parasitic Diseases/diagnosis , Parasitic Diseases/epidemiology , Parasitic Diseases/therapy , Schistosomiasis/diagnosis , Schistosomiasis/epidemiology , Schistosomiasis/surgery , Schistosomiasis/therapy
7.
Adv Exp Med Biol ; 712: 62-83, 2011.
Article in English | MEDLINE | ID: mdl-21660659

ABSTRACT

Cysteine proteases of the protozoan parasite Entamoeba histolytica are key virulence factors involved in overcoming host defences. These proteases are cathepsin-like enzymes with a cathepsin-L like structure, but cathepsin-B substrate specificity. In the host intestine, amoeba cysteine proteases cleave colonic mucins and degrade secretory immunoglobulin (Ig) A and IgG rendering them ineffective. They also act on epithelial tight junctions and degrade the extracellular matrix to promote Cell death. They are involved in the destruction of red blood cells and the evasion of neutrophils and macrophages and they activate pro-inflammatory cytokines IL- 1ß and IL-18. In short, amoeba cysteine proteases manipulate and destroy host defences to facilitate nutrient acquisition, parasite colonization and/or invasion. Strategies to inhibit the activity of amoeba cysteine proteases could contribute significantly to host protection against E. histolytica.


Subject(s)
Cathepsins/metabolism , Entamoeba histolytica/enzymology , Gastrointestinal Tract/parasitology , Host-Parasite Interactions , Cathepsins/chemistry , Entamoeba histolytica/pathogenicity , Entamoebiasis/parasitology , Entamoebiasis/therapy , Humans
10.
Curr Gastroenterol Rep ; 9(5): 429-33, 2007 Oct.
Article in English | MEDLINE | ID: mdl-17991346

ABSTRACT

Amebiasis, caused by the protozoan parasite Entamoeba histolytica, affects more than 50 million people worldwide, with over 100,000 deaths annually. The majority of cases are asymptomatic; however, significant morbidity and mortality are associated with illness in the remaining 10% of cases. Recent advances in the understanding of the mechanism of infection by E. histolytica, the role of the innate immune system, and the role of genetic disposition to infection will allow the development of novel detection and treatment methods. The disease mechanisms, clinical findings, therapeutic strategies, and important developments regarding amebiasis are discussed here.


Subject(s)
Dysentery, Amebic/diagnosis , Dysentery, Amebic/therapy , Entamoeba histolytica/isolation & purification , Entamoebiasis/diagnosis , Tinidazole/therapeutic use , Adolescent , Adult , Age Distribution , Animals , Bangladesh/epidemiology , Child , Child, Preschool , Developing Countries , Dysentery, Amebic/epidemiology , Entamoeba histolytica/drug effects , Entamoebiasis/epidemiology , Entamoebiasis/prevention & control , Entamoebiasis/therapy , Humans , Incidence , Male , Prognosis , Protozoan Vaccines/administration & dosage , Risk Assessment , Severity of Illness Index , Sex Distribution
11.
World J Gastroenterol ; 13(42): 5659-61, 2007 Nov 14.
Article in English | MEDLINE | ID: mdl-17948943

ABSTRACT

A 54-year-old man presented with rectal pain and bleeding secondary to ulcerated, necrotic rectal and cecal masses that resembled colorectal carcinoma upon colonoscopy. These masses were later determined to be benign amebomas caused by invasive Entamoeba histolytica, which regressed completely with medical therapy. In Western countries, the occurrence of invasive protozoan infection with formation of amebomas is very rare and can mistakenly masquerade as a neoplasm. Not surprisingly, there have been very few cases reported of this clinical entity within the United States. Moreover, we report a patient that had an extremely rare occurrence of two synchronous lesions, one involving the rectum and the other situated in the cecum. We review the current literature on the pathogenesis of invasive E. histolytica infection and ameboma formation, as well as management of this rare disease entity at a western medical center.


Subject(s)
Entamoeba histolytica , Entamoebiasis/diagnosis , Rectal Diseases/diagnosis , Animals , Colorectal Neoplasms/diagnosis , Diagnosis, Differential , Entamoebiasis/pathology , Entamoebiasis/therapy , Humans , Male , Middle Aged
12.
Pediatr Dermatol ; 23(3): 231-4, 2006.
Article in English | MEDLINE | ID: mdl-16780468

ABSTRACT

Cutaneous amebiasis is a rare manifestation of infection with the parasite Entamoeba histolytica. We describe this infestation in a 9-year-old Mexican immigrant who presented with diarrhea and perianal ulcers. To our knowledge, this is only the tenth child with cutaneous amebiasis reported in the literature, and only the second from the United States. We review previous reports and emphasize the importance of a high index of clinical suspicion for early diagnosis and treatment to prevent potentially serious morbidity and even mortality.


Subject(s)
Entamoeba histolytica , Entamoebiasis/diagnosis , Skin Diseases, Parasitic/diagnosis , Anal Canal , Animals , Child , Entamoebiasis/therapy , Humans , Male , Skin Diseases, Parasitic/therapy
13.
Chirurgia (Bucur) ; 101(5): 539-42, 2006.
Article in English | MEDLINE | ID: mdl-17278650

ABSTRACT

Digestive amoebiasis with his invasive form is an unusual pathology encountered in the temperate zone. This could lead to a life threatening complication: systemic amoebiasis. A 55-year-old male was treated successfully of systemic amoebiasis in a third referral hospital. The diagnosis was established based on epidemiology data and microscopical identification of trophozoites of Entamoeba histolytica. The amoebicidal, antibiotic and supportive treatments was firstly administrated. The clinical picture of intestinal amoebiasis raised from dysenteric syndrome to necrotizing enteritis. The bowel perforation with localized peritonitis was followed by chronic enteric fistula. Amoebic liver abscess, as the most frequent extraintestinal complication, was concomitantly diagnosed and treated. Urinary amoebiasis was considered as complication in the context of systemic dissemination: any other location could become a site of an amoebic abscess. Multidisciplinary approach was the successful key in the management of the patient, including antiparasitic therapy and antibiotic prophylaxis, intensive care and multiple surgical approaches. The diagnosis of digestive amoebiasis and systemic complication may be delayed in nonendemic areas, leading to advanced and complicated stages of the disease. The surgical approach is most efficiently to treat a large liver amoebic abscess and intraperitoneal collections.


Subject(s)
Entamoebiasis/therapy , Ileitis/therapy , Intestinal Fistula/therapy , Liver Abscess, Amebic/therapy , Amebicides/therapeutic use , Animals , Anti-Bacterial Agents/therapeutic use , Antifungal Agents/therapeutic use , Antiprotozoal Agents/therapeutic use , Drug Therapy, Combination , Entamoeba histolytica/isolation & purification , Entamoebiasis/diagnosis , Entamoebiasis/parasitology , Humans , Ileitis/diagnosis , Ileitis/parasitology , Intestinal Fistula/diagnosis , Intestinal Fistula/parasitology , Liver Abscess, Amebic/diagnosis , Liver Abscess, Amebic/parasitology , Male , Middle Aged , Reoperation , Suction , Treatment Outcome
14.
J Assoc Physicians India ; 52: 251-2, 2004 Mar.
Article in English | MEDLINE | ID: mdl-15636321

ABSTRACT

A patient of cerebral amoebiasis due to Entamoeba histolytica with no evidence of disease elsewhere is described. He made a complete recovery after surgical excision of the abscess along with metronidazole therapy.


Subject(s)
Brain Abscess/parasitology , Entamoeba histolytica/isolation & purification , Entamoebiasis/complications , Animals , Brain Abscess/diagnosis , Brain Abscess/therapy , Child , Craniotomy , Diagnosis, Differential , Entamoebiasis/diagnosis , Entamoebiasis/therapy , Humans , Male , Metronidazole/therapeutic use
16.
Clin Chest Med ; 23(2): 479-92, 2002 Jun.
Article in English | MEDLINE | ID: mdl-12092041

ABSTRACT

Pleuropulmonary amebiasis is the common and pericardial amebiasis the rare form of thoracic amebiasis. Low socioeconomic conditions, malnutrition, chronic alcoholism, and ASD with left to right shunt are contributing factors to the development of pulmonary amebiasis. Although no age is exempt, it commonly occurs in patients aged 20 to 40 years, with an adult male to female ratio of 10:1. Children rarely develop thoracic amebiasis: when it does occur there is an equal sex distribution. The infection usually spreads to the lungs by extension of an amebic liver abscess. Infection may pass to the thorax directly from the primary intestinal lesion through hematogenous spread, however. Lymphatic spread is one possible route. Inhalation of dust containing cysts and aspiration of cysts or trophozoites of E histolytica in the lungs are some other hypothetical routes. The lung is the second most common extraintestinal site of amebic involvement after the liver. Usually the lower lobe, and sometimes the middle lobe of the right lung, are affected, but it may affect any lobe of the lungs. The patient develops fever and right upper quadrant pain that is referred to the tip of the right shoulder or in between the scapula. Hemophtysis is common. The diagnosis of thoracic amebiasis is suggested by the combination of an elevated hemidiaphragm (usually right), hepatomegaly, pleural effusion, and involvement of the right lung base in the form of haziness and obliteration of costophrenic and costodiaphragmatic angles. Infection is usually extended to the thorax by perforation of a hepatic abscess through the diaphragm and across an obliterated pleural space, producing pulmonary consolidation, abscesses, or broncho-hepatic fistula. Empyema develops when a liver abscess ruptures into the pleural space. Rarely, a posterior amebic liver abscess can burst into the inferior vena cava and develop an embolism of the inferior vena cava and thromboembolic disease of the lungs with congestive cardiac failure or corpulmonale. Diagnosis by finding E histolytica in stool specimens is of limited value. In a limited number of cases amebae might be found in aspirated pus or expectorated sputum. "Anchovy sauce-like" pus or sputum may be found. Presence of bile in sputum indicates that the pus is of liver origin. Serological tests are of immense value in diagnosis. Liver enzymes are usually normal and neutrophilic leucocytosis may or may not be found. ESR is invariably elevated. Anti-amebic antibodies can be detected by ELISA, IFAT, and IHA. Amebic antigen can be detected from serum and pus by ELISA. Detection of Entamoeba DNA in pus or sputum may be a sensitive and specific method. Pleuropulmonary amebiasis is easily confused with other illnesses and is treated as pulmonary TB, bacterial lung abscesses, and carcinoma of the lung. A single drug regimen with metronidazole with supportive therapy usually cures patients without residual anomalies. Aspiration of pus from empyema thoracis may be needed for confirmation and therapeutic purposes. The pericardium is usually involved by direct extension from the amebic abscess of the left lobe of the liver, sometimes from the right lobe of the liver, and rarely from the lungs or pleura. An initial accumulation of serous fluid due to reactive pericarditis followed by intrapericardial rupture may develop either (1) acute onset of severe symptoms with chest pain, dyspnea, and cardiac tamponade, shock, and death, or (2) progressive effusion with thoracic cage pain, progressive dyspnea, and fever. Chest radiograph, ultrasound examination, and CT scan usually confirm the presence of a liver abscess in continuity with the pericardium and fluid within the pericardial sac with or without the fistulous tract. Echocardiography may demonstrate fluid in the pericardial cavity. Patients should be cared for in the ICU and ambecides should be started without delay. Pericardiocentesis usually confirms the diagnosis and improves the general condition of the patient. Aspiration of the accumulated fluid should be performed urgently in cardiac tamponade; repeated aspiration may be needed. Surgical drainage should be done if needed. Acanthamoeba, a free-living ameba, may also infect the lungs in the form of pulmonary nodular infiltration and pulmonary edema in association with amebic meningoencephalitis in immunocompromised patients. It usually spreads to the meninges of the brain by way of the blood from its primary lesion in the lung or skin. Early diagnosis and institution of treatment may be life saving for these patients. A literature review shows that HIV/AIDS patients are not prone to infection with E histolytica. It is now clear that there are an increasing number of HIV-seropositive patients among amebic liver abscess patients, however, which suggests that although the incidence of intestinal infection is not high among HIV-seropositive or AIDS patients they are more susceptible to an invasive form of the disease.


Subject(s)
Entamoebiasis , Lung Diseases, Parasitic , Animals , Entamoeba histolytica/pathogenicity , Entamoebiasis/diagnosis , Entamoebiasis/epidemiology , Entamoebiasis/parasitology , Entamoebiasis/therapy , Humans , Lung Diseases, Parasitic/diagnosis , Lung Diseases, Parasitic/epidemiology , Lung Diseases, Parasitic/parasitology , Lung Diseases, Parasitic/therapy
17.
Jpn J Infect Dis ; 53(6): 229-37, 2000 Dec.
Article in English | MEDLINE | ID: mdl-11227020

ABSTRACT

Amebiasis is epidemic in two major populations in Japan: male homosexuals and institutionalized people. Currently available diagnostic, chemotherapeutic, and prophylactic measures and their problems are discussed. Recent advances in basic research on amebiasis are also described with new findings of unique metabolisms and intracellular structures and organization. Discoveries and analyses of the unique features presented by this parasitic protist help in our elucidation of the pathogenic mechanisms of the parasite and may eventually lead to the development of new drugs and vaccines against amebiasis.


Subject(s)
Entamoeba histolytica , Entamoebiasis/epidemiology , Animals , Antiprotozoal Agents/therapeutic use , Endemic Diseases , Entamoeba histolytica/growth & development , Entamoeba histolytica/pathogenicity , Entamoebiasis/parasitology , Entamoebiasis/therapy , Humans , Japan/epidemiology , Male , Microscopy, Electron , Protozoan Vaccines/immunology
18.
Semin Respir Infect ; 12(2): 106-12, 1997 Jun.
Article in English | MEDLINE | ID: mdl-9195675

ABSTRACT

Amebiasis is the third leading parasitic cause of death in the world. Approximately 500 million people worldwide are infected with Entamoeba histolytica. Invasive disease is more common in the immunosuppressed, pregnant women, children, and alcoholics. Amebic colitis and liver abscess are the most common intestinal and extraintestinal manifestations of E. histolytica infection. Pleuropulmonary complications occur almost exclusively in individuals with a liver abscess. Common pleuropulmonary complications include right-sided sympathetic effusions, empyema, basilar atelectasis, lung infiltration, and lung abscess. Bronchohepatic fistula is an unusual and distinctive problem characterized by expectoration of sputum that may resemble anchovy paste. Left hepatic lobe abscesses occasionally produce left-sided pleuropulmonary complications and may result in lethal rupture into the pericardium. Diagnosis is based on demonstration of the organism in clinical specimens; however, false-negative microbiological study results commonly occur even with active infection. Serological studies can confirm the diagnosis in the appropriate clinical setting, and newer immunological tests on blood, fluid, and tissue specimens show promise. Metronidazole remains the treatment of choice, and although surgical drainage is contraindicated, percutaneous drainage of abscesses and empyema may occasionally be indicated.


Subject(s)
Entamoeba histolytica , Entamoebiasis , Lung Diseases, Parasitic , Pleural Diseases , Animals , Antiprotozoal Agents/therapeutic use , Diagnosis, Differential , Drainage , Entamoebiasis/diagnosis , Entamoebiasis/epidemiology , Entamoebiasis/therapy , Female , Humans , Lung Diseases, Parasitic/diagnosis , Lung Diseases, Parasitic/epidemiology , Lung Diseases, Parasitic/therapy , Male , Metronidazole/therapeutic use , Pleural Diseases/diagnosis , Pleural Diseases/epidemiology , Pleural Diseases/therapy , Pregnancy , Prognosis
19.
Wkly Epidemiol Rec ; 72(14): 97-9, 1997 Apr 04.
Article in English, French | MEDLINE | ID: mdl-9100475
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