Risk factors for intestinal invasive amebiasis in Japan, 2003-2009.

We determined yearly change in prevalence and risk factors for amebic colitis caused by intestinal invasive amebiasis among persons who underwent endoscopy and assessed differences between HIV-positive and HIV-negative persons in Japan. A total of 10,930 patients were selected for analysis, of whom 54 had amebic colitis. Prevalence was in 2009 (0.88%, 12/1360) compared with 2003 (0.16%, 3/1904). Male sex (odds ratio [OR] 8.39, 95% CI 1.99-35.40), age <50 years (OR 4.73, 95% CI 2.43-9.20), history of syphilis (OR 2.90, 95% CI 1.40-5.99), and HIV infection (OR 15.85, 95% CI 7.93-31.70) were independent risk factors. No differences in risk factors were identified between HIV-positive and HIV-negative patients. Contact with commercial sex workers was a new risk factor among HIV-negative patients. Homosexual intercourse, rather than immunosuppressed status, appears to be a risk factor among HIV-positive patients.

[Transmission of enteropasitosis through currency notes]. / Transmissão de enteroparasitoses através do papel-moeda.

PURPOSE: There are several ways to propagation of parasitary diseases and how there aren't many bibliographic work about this theme, it was realized a study near to the Natal-RN population, to verify the enteroparasites transmission through the paper money. METHODS: In the Laboratório Parasitologia Clínica was analysed 500 bills of several worths gotten in shops and, concomitantly it was examined samples of a water got from the washed hands of the people who held the money. The methods to realize the parasitologic exams were: Ritchie and Faust et al. RESULTS: It was observed the following parasites prevalent in 48 (9.6%) examined bills: Endolimax nana 31 (6.2%), Entamoeba coli 06 (1.2%), Entamoeba histolytica 01 (0.2%), Ascaris lumbricoides 10 (2.0%). In the water, it vas observed that 40 (40.0%) of them had the same kinds of parasites in their hands. CONCLUSIONS: Finally, it is postulated that the paper money is important to the enteroparasites transmission and it is suggested that new researches must be done in this area.

Transmissão de enteroparasitoses através do papel-moeda / Transmission of enteropasitosis through currency notes

PURPOSE: There are several ways to propagation of parasitary diseases and how there aren't many bibliographic work about this theme, it was realized a study near to the Natal-RN population, to verify the enteroparasites transmission through the paper money. METHODS: In the Laboratório Parasitologia Clínica was analysed 500 bills of several worths gotten in shops and, concomitantly it was examined samples of a water got from the washed hands of the people who held the money. The methods to realize the parasitologic exams were: Ritchie and Faust et al. RESULTS: It was observed the following parasites prevalent in 48 (9.6%) examined bills: Endolimax nana 31 (6.2%), Entamoeba coli 06 (1.2%), Entamoeba histolytica 01 (0.2%), Ascaris lumbricoides 10 (2.0%). In the water, it vas observed that 40 (40.0%) of them had the same kinds of parasites in their hands. CONCLUSIONS: Finally, it is postulated that the paper money is important to the enteroparasites transmission and it is suggested that new researches must be done in this area.

[Fatal fulminant acute amebic colitis in metropolitan France]. / Colite amibienne aiguë fulminante mortelle chez un métropolitain.

BACKGROUND: Emergency care is required for patients presenting dysentery and fever. CASE REPORT: A 65-year old patient living in metropolitan France was hospitalized for watery diarrhea that had progressively worsened over the last month. Rectal bleeding was also noted. Serology tests at admission, together with parasitology examination of the fecal matter and colonoscopy led to the diagnosis of intestinal amebiasis a few hours before the patient's rapid death. Serology was positive for amebas and the diagnosis was confirmed by pathology examination of the colonoscopy biopsies. DISCUSSION: The diagnosis of amebiasis should be entertained even in Europe when there is no history of travel to endemic areas in patients who develop suggestive manifestations. Identification of amebas in the fecal matter and serology tests provide certain diagnosis. Clinicians should recall that rapidly fatal outcome is not uncommon in severe forms. Emergency care is mandatory.

Clinical analysis of a dysentery outbreak in Taichung.

In September 1993, we collected 207 patients due to dysentery, who visited the Department of Pediatrics at China Medical College Hospital. In our report, 67.6% of these patients were amebic dysentery, 19.3% were combined infection with amebic and Shigella sonnei dysentery, and 13.1% were Shigella sonnei dysentery. Therefore, amebic dysentery was the predominant cause during this outbreak. The clinical features of this outbreak were, in descending order, watery stool, fever, abdominal pain, mucinous stool and bloody stool. No concurrent liver abscess was discerned. Because there had not been such a clustering of dysentery in Taichung for so many years, we thought that travel to endemic areas might have been the underlying predisposing cause. Most of the school water supplying system was ground water, which might have been contaminated by a few patients returning from endemic areas. We thought that fecal-oral route by contaminated water might have been the primary transmission route.

[Invasive amebiasis at an institution for the mentally retarded in Hyogo Prefecture].

An outbreak of amebiasis caused by Entamoeba histolytica occurred at an institution for mentally retarded persons in Hyogo Prefecture. Twelve out of a total of 49 admitted persons exhibited E. histolytica cysts in their stool, and 13 including persons in whom no cysts had been detected showed positive serological reactions for E. histolytica infection. However, neither the cyst nor the antibody against the organism was detected in the staff members of the institution. Indirect fluorescence antibody test and sandwich enzyme-linked immunosorbent assay with a monoclonal antibody specific for pathogenic strains of E. histolytica revealed that all trophozoite strains grown from cysts in stool samples from five patients were pathogenic. Epidemiological analysis strongly suggested that a patient in the institution had been infected with an organism from a patient outside the institution, and that infection may have spread among the admitted persons due to abnormal behavior. Administration of metronidazole resulted in effective elimination of the cysts from the stool of the cyst-carriers.

Raw wastewater agricultural re-use and risk of protozoal infection in Beni-Mellal, Morocco.

This study was carried out to determine the potential risk of protozoal infection associated with raw wastewater use for agricultural purposes, among children of Beni-Mellal, Morocco. In a randomly-selected sample of 1343 children 740 from 5 regions which use raw wastewater for agriculture (exposed), while 603 were from 4 control regions that do not practice wastewater irrigation (unexposed). A questionnaire-interview with children and parents was used to collect data on demographic, hygienic, and risky water contact risk factors One or more protozoal infection was identified among 276(37.2%) of children living in the wastewater re-use regions, versus only among 22 (3.6%) living in control regions. The overall prevalence of 40.1% was observed among boys, and 33.3% among girls residing in exposed areas. The two identified protozoa were Entaemoeba histolytica and Giardia intestinalis, which infected 34.3% and 5.1% in the exposed population compared to only 3.3% and 0.3% in the control population, respectively. We also noted that the G. intestinalis prevalence was more than 40% among the children under 9 years, but less than 17% for those who were more than 12 years. Also, a significant excess of protozoal infection was observed among children who had risky contact with agricultural lands (p<0.001). In conclusion, raw wastewater use in Beni-Mellal can lead to a high risk of protozoal infections. Adequate treatment of wastewater prior to re-use, as well as public health education are highly recommended.

Invasive amebiasis in a spider monkey (Ateles geoffroyi). Case report and a short review of the literature of amebiasis in non-human primates.

A spider monkey (Ateles geoffroyi) studied at the San Juan de Aragon Zoo died with symptoms of amoebic dysentery verified by coprologic investigation of the parasite, his female partner was cured with conventional antiamoebic treatment. At autopsy widespread ulcerations in the colon and multiple liver abscesses were found, containing trophozoites of Entamoeba histolytica. Both lesions were identical to those observed in human amoebiasis. A short review of the literature in nonhuman primates infections points out that the so-called spontaneous amoebiasis seen in colonies of captive monkeys, and transmission to their newborns within the same species of monkeys, have been in contact with humans. It is proposed that amoebiasis in monkeys should be considered as an excellent model for experimental studies on amoebiasis because other phylogenetically distant species have shown different pathology or are resistant to the infection. Also, it should raise concern that monkeys may become carriers of cysts and trophozoites of virulent strains of E. histolytica. Entamoeba histolytica DNA hybridization techniques should be considered for comparing genomic similarities with other protozoa, including the genera Amoeba to establish its pattern of evolution.

Amebiasis at an evacuation site on the Thai-Cambodian border.

Symptomatic intestinal amebiasis was highly endemic among the Cambodians living at Green Hill, an evacuation site on the Thai-Cambodian border between June 1987 through May 1989. Monthly incidence rates of intestinal amebiasis were determined to be inversely proportional to cumulative monthly rainfall. The highest incidence of amebic dysentery was 63/1000 in children 12-23 months old. Behavioral risk factors were investigated by conducting a case-control study. A questionnaire was administered to 73 families, each having at least one member with confirmed intestinal amebiasis within the past 3 months, and to 95 randomly selected control families having no individual with diarrhea for at least 3 months. Individuals from families with greater than 4 members were at higher risk for acquiring intestinal amebiasis. No significant differences in behavioral risk factors were identified between case and control families. Eighty-six percent of 51 water samples drawn from wells where amebiasis patients obtained their drinking water had greater than 10 coliforms/100 ml. The main route of transmission of E. histolytica was not identified, but was most likely via the fecal-oral route.

[Clinical investigation of 10 patient with amebic dysentery].

Data were obtained in 10 patients with amebic dysentery at Osaka Socio-Medical Center hospital during the period from April 1985, to April 1989. All of the patients were male, and their average age was 41 years old. In the past history, all of them had never gone to foreign country, and 7 patients had the habit of homosexual love. In the serological test, positive rate of antiamebic antibody was 100% (6/6) by agar gel diffusion, that of antibody of Toreponema pallidum was 60% (6/10) by TPHA, but anti AIDS antibody was not detected (0/3) by HIV. Detectability of Entoamoeba hystolitica was 70% (7/10) in stool, 50% (2/4) in liver abscess, 25% (1/4) in biopsied specimens of rectal mucosa. Then, we fund that the serological test for antiamebic antigen was useful for diagnosis of this disease, and suspected that homosexual contact contributed to the infection of E. hystolitica.

Entamoeba polecki and other intestinal protozoa in Papua New Guinea Highland children.

Relatively few cases of humans infected with Entamoeba polecki have been reported world-wide. Where man and pig live in close association and where sanitation is poor, pig to man transmission is considered to be the most likely source of human infection. In our survey of 184 children only fresh faeces were used, thus allowing the identification of trophozoites as well as cysts. Thirty-five children (19%) were found positive for E. polecki, although in one community ten of 23 (43.4%) over five-year olds were infected. Sera from 20 positive children were tested against E. histolytica antigen, but no positive reactions were observed. We propose the possibility of man to man transmission of E. polecki where the prevalence rate and intensity of infection are high.

Etiology and epidemiology of diarrheal diseases in the United States.

Accurate data on the frequency of acute diarrheal illness and the distribution of pathogens are not available for several reasons, including the facts that only a small fraction of cases come to the attention of physicians and that available diagnostic tests establish an etiology in only about half of these. In a survey of three groups of patients in a community (upper-middle class and lower class outpatients and hospitalized infants), a possible cause was found in fewer than 20 percent of outpatients, and rotavirus accounted for the majority. However, asymptomatic colonization with rotavirus is very common in early infancy, and demonstration of the antigen correlates with a causative role in diarrhea in only about one half of cases. Data on cases of shigellosis over a 15-year period in Dallas compared with the Centers for Disease Control national data demonstrate that epidemiologic patterns in any given community can differ substantially from the national data. Day-care centers are important sources of Giardia and Shigella infections in the community. The epidemiologic roles of newly reported causes of diarrhea (Campylobacter laridis, Blastocystis hominis, Cryptosporidium species, and Aeromonas hydrophila) are being explored. Generalizations about etiology and epidemiology of pathogens in diarrheal disease are invalid unless the population group is defined socioeconomically and geographically.

Natural history of intestinal parasites in asymptomatic adults.

The need to treat asymptomatic adults who have intestinal parasites should be based on considerations of potential pathogenicity and transmission risk, but such data are sparse in general and unavailable for countries such as the United States, where reinfection is rare. Opinions of North American physicians about the natural history and treatment of 12 parasites detectable by stool examination were assessed using the Delphi technique. In response to the first questionnaire, majority agreement on pathogenic potential was achieved for only 3 of 12 parasites. When the more expert group was queried a second time, majority agreement was achieved for 8 of 12 parasites. Nevertheless, the predicted risk of subsequent disease still varied widely, from 1:10 to 1:1,000 for most parasites, and was unrelated to the perceived need for treatment. Almost all respondents thought asymptomatic adults with any intestinal parasites should always be treated. Transmission risk was judged to be low and was generally appropriate to the life cycle of the parasite.