Amebiasis cutánea por ameba de vida libre, heraldo ignorado de encefalitis letal. Reporte de caso / Free-living cutaneous amebiasis, ignored herald of lethal encephalitis. Case report

Introducción: Las enfermedades por amebas de vida libre (AVL) son poco frecuentes pero con letalidad mayor al 90% cuando comprometen el sistema nerviosos central (SNC). El cuadro clínico puede confundirse con enfermedades más prevalentes. Reporte de caso: Agricultor de 32 años procedente de Poroto-Trujillo-La Libertad-Perú, inicia enfermedad con una placa eritematosa centrofacial que se diagnosticó como tuberculosis cutánea (TBC), sin mejoría pese a recibir esquema completo de quimioterapia antituberculosa. Siete meses después presenta encefalitis severa falleciendo a los tres días de su ingreso al hospital. En la biopsia de piel se encontraron trofozoitos de AVL. Se plantea el diagnóstico de dermatitis cutánea por AVL complicada con encefalitis granulomatosa amebiana (EGA). No se han documentado casos similares en su lugar de procedencia. Conclusión: En el norte del Perú, las placas cutáneas en personas expuestas al suelo o agua estancada, deben considerarse señales de alerta ante la probabilidad de infección por AVL.

ABSTRACT Introduction: Diseases caused by free-living amoebas (FLA) are rare but with a lethality greater than 90% when they affect the central nervous system (CNS). The clinical picture can be confused with more prevalent diseases. Case report: A 32-year-old farmer from Poroto-Trujillo-La Libertad-Peru, started the disease with a central facial erythematous plaque that was diagnosed as cutaneous tuberculosis (CTB), without improvement despite receiving a complete regimen of anti-tuberculous chemotherapy. Seven months later, he presented severe encephalitis and died three days after his admission to the hospital. FLA trophozoites were found in the skin biopsy. A diagnosis of cutaneous dermatitis due to FLA complicated with granulomatous amebic encephalitis (GAE) is proposed. Similar cases have not been documented in his place of origin. Conclusion: In northern Peru, skin plaques in people exposed to the ground or stagnant water should be considered warning signs of the probability of AVL infection.

Fatal and disseminated infection by Entamoeba invadens in a red-footed tortoise (Chelonoidis carbonaria)

Amebiasis is an important parasitosis that can affect reptiles, specially caused by protozoas of the genus Entamoeba, which include pathogenic or commensal species. Entamoeba invadens is the most common amoeba to cause serious disease and death in reptiles. This paper aims to report a case of a sudden death due to a disseminated infection by Entamoeba invadens in a red-footed tortoise (Chelonoidis carbonaria). The animal was brought to the Center for Management and Conservation of Wild Animals of the Fauna Division and found dead after being kept in an enclousure with other captive tortoises for 11 months. Macroscopic findings evidenced necrotizing typhlitis and proctitis and round yellow areas in the right lobe of liver parenchyma. In the histological examination, necrotizing and heterophilic enteritis and necrotizing hepatitis with macrovesicular degeneration of hepatocytes, associated with mixed inflammatory infiltrate were present. Both organs revealed numerous amoebic trophozoites, morphologically suggestive of the genus Entamoeba, and bacterial colonies. The agent was confirmed by PCR and Sanger DNA sequencing, which leads this study to be the first confirmed case report of E. invadens infection in Brazil in a red-footed tortoise.(AU)

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.

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

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.

Molecular diagnosis of amoebiasis.

Amoebiasis is an intestinal parasitosis caused by the protozoan Entamoeba histolytica that represents the third leading cause of mortality due to parasitosis. It is a prevalent disease in tropical climate regions with poor or absent sanitary services. Microscopy and antigen detection techniques are routinely used to diagnose amoebiasis because of their low cost and ease of application. However, these techniques do not differentiate E. histolytica infections and other potentially pathogenic species such as Entamoeba moshkovskii or Entamoeba bangladeshi. Therefore, in the last decades, molecular tests that allow correct identification of the causal agent of amoebiasis and the establishment of the prevalence of the infecting species have been developed. Techniques based on nucleic acids, such as conventional, multiplex, or real-time polymerase chain reaction (PCR), are being seriously considered in clinical laboratories, because they detect the etiologic agent directly from the sample without the need for previous prolonged culture, thus reducing diagnostic time. Also, the nested PCR test and the sequencing of ribosomal markers have allowed the identification of new parasitic species in humans, such as E. moshkovskii and E. bangladeshi, and an improved characterization of the known infecting species. The application of multiplex platforms allows the simultaneous identification of infecting species, increasing the sensitivity and specificity of these techniques. Therefore, the molecular diagnosis of amoebiasis is projected as an innovative tool in the fight against this parasitosis.

La amebiasis es una parasitosis intestinal causada por el protozoario Entamoeba histolytica y representa la tercera causa de mortalidad por parasitosis. Es una enfermedad prevalente en regiones de clima tropical con deficientes o nulos servicios sanitarios. Las técnicas de microscopía y detección de antígenos se emplean sistemáticamente para el diagnóstico de la amebiasis por su bajo costo y fácil aplicación. Sin embargo, no permiten diferenciar entre infecciones por E. histolytica y otras especies de potencial patogenicidad como Entamoeba moshkovskii o Entamoeba bangladeshi. Ante ello, en las últimas décadas se han desarrollado pruebas moleculares que permiten una correcta identificación del agente causal de la amebiasis y el establecimiento de la prevalencia de la especie infectante. Las técnicas basadas en ácidos nucleicos, como la reacción en cadena de la polimerasa (PCR) convencional, múltiple o en tiempo real, están siendo seriamente consideradas en los laboratorios clínicos, porque detectan al agente etiológico de manera directa en la muestra sin necesidad de cultivo prolongado previo, disminuyendo de esta forma el tiempo del diagnóstico. Asimismo, la PCR anidada sumada a la secuenciación de marcadores ribosomales ha permitido la identificación de nuevas especies parasitarias, como E. moshkovskii y E. bangladeshi en humanos, y una mejor caracterización de las especies infectantes ya conocidas. La aplicación de las plataformas multiplex permite la identificación simultánea de especies infectantes, aumentando la sensibilidad y la especificidad de estas técnicas. Por esto, el diagnóstico molecular de la amebiasis se proyecta como una verdadera herramienta innovadora en la lucha contra las parasitosis.

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.

Diversity, geographical distribution, and prevalence of Entamoeba spp. in Brazil: a systematic review and meta-analysis.

The genus Entamoeba includes a variety of widely distributed species adapted to live in the digestive tracts of humans and a large variety of animals of different classes. The objective of this study was to investigate the prevalence, distribution, and molecular epidemiology of Entamoeba spp. in different classes of hosts in Brazil. Studies that analyzed hosts from several classes, including humans and domestic, wild, or captive animals, were considered. The pooled prevalence of Entamoeba spp. was calculated using the random-effects model. A total of 166 studies on humans and 16 on animals were included. The prevalence of Entamoeba spp. in the Brazilian population was 22% (95% CI: 21-24). The state with the highest prevalence was Paraiba with 72%, followed by Federal District with 53%, and Rondonia with 50%. In immunocompromized patients, the prevalence was 18%, and cancer (36%) was the most prevalent cause of immunosuppression. The prevalence of Entamoeba spp. in animal hosts was 12% (95% CI: 7-17). Captive wild animals and domestic farm animals showed the highest prevalence, with 16% and 15%, respectively. The species found more often were E. coli (86.5%), E. dispar (7.9%), and E. histolytica (3.1%). In conclusion, a high prevalence (22%) of Entamoeba spp. was found in the Brazilian population, with a prevalence of up to 50% mainly in the northern, northeastern, and central-western regions. The pathogenic species E. histolytica is distributed in most Brazilian regions, with significant prevalence percentages. Among animals, unidentified Entamoeba species were most prevalent in mammals.

TITLE: Diversité, répartition géographique et prévalence d'Entamoeba spp. au Brésil : revue systématique et méta-analyse. ABSTRACT: Le genre Entamoeba comprend une variété d'espèces largement distribuées, adaptées à vivre dans le tube digestif des humains et une grande variété d'animaux de différentes classes. L'objectif de cette étude était d'étudier la prévalence, la distribution et l'épidémiologie moléculaire d'Entamoeba spp. dans différentes classes d'hôtes au Brésil. Les études qui ont analysé les hôtes de plusieurs classes, y compris les humains et les animaux domestiques, sauvages ou captifs, ont été prises en compte. La prévalence combinée d'Entamoeba spp. a été calculée à l'aide du modèle à effets aléatoires. Au total, 166 études sur l'homme et 16 sur les animaux ont été incluses. La prévalence d'Entamoeba spp. dans la population brésilienne était de 22 % (IC à 95 % : 21­24). L'état avec la prévalence la plus élevée était Paraiba avec 72 %, suivi du District fédéral avec 53 % et Rondonia avec 50 %. Chez les patients immunodéprimés, la prévalence était de 18 % et le cancer (36 %) était la cause la plus fréquente d'immunosuppression. La prévalence d'Entamoeba spp. chez les hôtes animaux était de 12 % (IC à 95 % : 7­17). Les animaux sauvages en captivité et les animaux domestiques d'élevage ont affiché la prévalence la plus élevée, avec respectivement 16 % et 15 %. Les espèces trouvées le plus souvent étaient E. coli (86,5 %), E. dispar (7,9 %) et E. histolytica (3,1 %). En conclusion, une prévalence élevée (22 %) d'Entamoeba spp. a été trouvée dans la population brésilienne, allant jusqu'à 50 % principalement dans les régions du nord, du nord-est et du centre-ouest. L'espèce pathogène E. histolytica est répartie dans la plupart des régions du Brésil, avec des pourcentages de prévalence importants. Parmi les animaux, les espèces d'Entamoeba non identifiées étaient les plus répandues chez les mammifères.

Encefalitis letal por amebas de vida libre en tres miembros de una familia, Tumbes, Perú / Lethal encephalitis due to free-living amoebae in three members of a family, Tumbes, Peru

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.

Ascariasis, Amebiasis and Giardiasis in Mexican children: distribution and geographical, environmental and socioeconomic risk factors.

The aim of this study is to provide an overview of the geographical distribution of Ascariasis, Amebiasis and Giardiasis, and to identify specific geographical, socioeconomic and environmental factors that are associated with the incidence of these infections in Mexican children. We made use of publicly available data that was reported by federal organizations in Mexico for the year 2010. The contribution of geographical, socioeconomic and environmental factors to the incidence of infections was assessed by a multivariable regression model using a backwards selection procedure. A. lumbricoides incidence was associated with mean minimum temperature of the state, the state-wide rate of households without access to piped water and toilet, explaining 77% of the incidence of A. lumbricoides infections. Mean minimum precipitation in the state, the rate of households without access to a toilet, piped water and sewage system best explained (73%) the incidence of E. histolytica infections. G. lamblia infections were only explained by the latitude of the state (11%). In addition to the well-known socioeconomic factors contributing to the incidence of A. lumbricoides and E. histolytica we found that temperature and precipitation were associated with higher risk of infection.

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

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.

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).  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 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.

Identification of descriptors for structure-activity relationship in ruthenium (II) mixed compounds with antiparasitic activity.

Herein is presented the synthesis, characterization, electrochemical studies, DFT calculations and in vitro evaluation of amoebicidal activity in trophozoites of Entamoeba histolytica of twenty ruthenium (II) mixed compounds with general formulae: [Ru(pdto)(E-E)]Clx (E-E bidentate, either neutral or negatively charged ligands). For compounds under study, O-O, N-O and N-N auxiliary donor ligands demonstrate to have a crucial impact on the electronic properties and that it is possible to modulate the antiparasitic activity. Among analyzed complexes, only four present a better performance compared to typically used metronidazole drug (IC50 < 6.80 µmol/L) to treat amebiasis disease. For studied compounds, structure-activity relationships are strongly determined by either the redox potential (E1/2) of RuII/RuIII and calculated molar volume (V) of the complexes.

Acetylcholine Upregulates Entamoeba histolytica Virulence Factors, Enhancing Parasite Pathogenicity in Experimental Liver Amebiasis.

Entamoeba histolytica is an invasive enteric protozoan, whose infections are associated to high morbidity and mortality rates. However, only less than 10% of infected patients develop invasive amebiasis. The ability of E. histolytica to adapt to the intestinal microenvironment could be determinant in triggering pathogenic behavior. Indeed, during chronic inflammation, the vagus nerve limits the immune response through the anti-inflammatory reflex, which includes acetylcholine (ACh) as one of the predominant neurotransmitters at the infection site. Consequently, the response of E. histolytica trophozoites to ACh could be implicated in the establishment of invasive disease. The aim of this study was to evaluate the effect of ACh on E. histolytica virulence. Methods include binding detection of ACh to plasma membrane, quantification of the relative expression of virulence factors by RT-PCR and western blot, evaluation of the effect of ACh in different cellular processes related to E. histolytica pathogenesis, and assessment of the capability of E. histolytica to migrate and form hepatic abscesses in hamsters. Results demonstrated that E. histolytica trophozoites bind ACh on their membrane and show a clear increase of the expression of virulence factors, that were upregulated upon stimulation with the neurotransmitter. ACh treatment increased the expression of L220, Gal/GalNAc lectin heavy subunit (170 kDa), amebapore C, cysteine proteinase 2 (ehcp-a2), and cysteine proteinase 5 (ehcp-a5). Moreover, erythrophagocytosis, cytotoxicity, and actin cytoskeleton remodeling were augmented after ACh treatment. Likewise, by assessing the formation of amebic liver abscess, we found that stimulated trophozoites to develop greater hamster hepatic lesions with multiple granulomas. In conclusion, ACh enhanced parasite pathogenicity by upregulating diverse virulence factors, thereby contributing to disease severity, and could be linked to the establishment of invasive amebiasis.

Tinidazole efficacy for amebic colitis therapeutic prophylaxis in patients with de novo acute leukemia receiving intensive chemotherapy.

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.

Entamoeba histolytica Interaction with Enteropathogenic Escherichia coli Increases Parasite Virulence and Inflammation in Amebiasis.

Epidemiological studies suggest frequent association of enteropathogenic bacteria with Entamoeba histolytica during symptomatic infection. In this study, we sought to determine if the interaction with enteropathogenic (EPEC) or nonpathogenic Escherichia coli (strain DH5α) could modify the virulence of E. histolytica to cause disease in animal models of amebiasis. In vitro studies showed a 2-fold increase in CaCo2 monolayer destruction when E. histolytica interacted with EPEC but not with E. coli DH5α for 2.5 h. This was associated with increased E. histolytica proteolytic activity as revealed by zymogram analysis and degradation of the E. histolytica CP-A1/5 (EhCP-A1/5) peptide substrate Z-Arg-Arg-pNC and EhCP4 substrate Z-Val-Val-Arg-AMC. Additionally, E. histolytica-EPEC interaction increased EhCP-A1, -A2, -A4, and -A5, Hgl, Apa, and Cox-1 mRNA expression. Despite the marked upregulation of E. histolytica virulence factors, nonsignificant macroscopic differences in amebic liver abscess development were observed at early stages in hamsters inoculated with either E. histolytica-EPEC or E. histolytica-E. coli DH5α. Histopathology of livers of E. histolytica-EPEC-inoculated animals revealed foci of acute inflammation 3 h postinoculation that progressively increased, producing large inflammatory reactions, ischemia, and necrosis with high expression of il-1ß, ifn-γ, and tnf-α proinflammatory cytokine genes compared with that in livers of E. histolytica-E. coli DH5α-inoculated animals. In closed colonic loops from mice, intense inflammation was observed with E. histolytica-EPEC manifested by downregulation of Math1 mRNA with a corresponding increase in the expression of Muc2 mucin and proinflammatory cytokine genes il-6, il-12, and mcp-1 These results demonstrate that E. histolytica/EPEC interaction enhanced the expression and production of key molecules associated with E. histolytica virulence, critical in pathogenesis and progression of disease.

[Eficacia del tinidazol en la profilaxis terapéutica de la colitis amebiana en pacientes con leucemia aguda de novo que reciben quimioterapia intensiva].

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.

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.

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)

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.