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1.
Cesk Patol ; 56(2): 95-98, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32493026

RESUMO

Amoebic colitis represents a common parasitic infection in developing countries. In western world, it is encountered only sporadically. The clinical presentation is usually non-specific, non-invasive laboratory tests are often false negative and endoscopic and histopathological appearance may mimic other illnesses, especially Crohns disease. The disease therefore harbours a huge risk of misdiagnosing and a proper diagnosis is usually challenging. We present a case of an amoebic colitis with Crohn-like features and negative parasitological testing in a 53-years-old woman, in which the final diagnosis was established on the basis of its histopathological examination.


Assuntos
Doença de Crohn , Disenteria Amebiana , Doença de Crohn/complicações , Doença de Crohn/diagnóstico , Doença de Crohn/patologia , Diagnóstico Diferencial , Disenteria Amebiana/complicações , Disenteria Amebiana/diagnóstico , Disenteria Amebiana/patologia , Feminino , Humanos , Pessoa de Meia-Idade
2.
J Postgrad Med ; 66(2): 99-101, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32134005

RESUMO

Amebiasis caused by protozoa Entamoeba histolytica (EH) is the third leading parasitic cause of human mortality. Although amebiasis is endemic in India, only about 10% of the infected individuals manifest disease. Clinical spectrum of amebiasis ranges from asymptomatic colonization to amebic colitis to hemorrhagic and fulminant colitis. Factors causing an invasive infection are not completely understood. Pathogen virulence, host immunity, and ability of the pathogen to evade host immune response play vital role in determining the disease course. Host factors such as immunocompromised states may make an individual susceptible to develop symptomatic infection. Malignancies usually result in chronic debilitation which may make the individual prone to develop invasive amebiasis with rapid progression. We report two cases of invasive amebiasis which developed a fulminant course in the immediate postoperative period after abdominal surgeries for visceral malignancies.


Assuntos
Carcinoma/cirurgia , Colecistectomia/efeitos adversos , Disenteria Amebiana/diagnóstico , Entamoeba histolytica/isolamento & purificação , Neoplasias da Vesícula Biliar/cirurgia , Gastrectomia/efeitos adversos , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia/efeitos adversos , Complicações Pós-Operatórias/parasitologia , Amebíase/diagnóstico , Amebíase/tratamento farmacológico , Anti-Infecciosos/uso terapêutico , Disenteria Amebiana/tratamento farmacológico , Feminino , Humanos , Masculino , Metronidazol/uso terapêutico , Pessoa de Meia-Idade , Complicações Pós-Operatórias/tratamento farmacológico , Resultado do Tratamento
4.
Pathol Res Pract ; 216(1): 152608, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31564573

RESUMO

Amoebiasis, caused by the intestinal protozoan Entamoeba histolytica, though a relatively common parasitic disease in the tropical and subtropical regions, is uncommon in the developed countries. In these countries, as amoebic colitis shares similar clinical symptoms and endoscopic features with inflammatory bowel disease (IBD), these cases can be easily unrecognized and misdiagnosed. In this case report, we discuss the case of an adult patient with invasive intestinal amoebiasis, who was initially managed as Crohn's disease on corticosteroid treatment and subsequently rapidly deteriorated and developed multiple perforations in the colon and ileum. Despite total colectomy followed by resection of the small bowel, he died of multiple organ failure and sepsis within two months of his initial clinical presentation of diarrhea with abdominal pain. The learning point of this case is that invasive intestinal amoebiasis should be considered as a differential diagnosis at the first clinical adult presentation of IBD-like symptoms despite suggestive endoscopic findings of Crohn's like ulcers. Regardless of negative endoscopic biopsies, due to the low sensitivity of microscopic examination, serology test for antibody and molecular test for Entamoeba DNA are recommended for accurate detection and identification of Entamoeba species, especially in the high risk populations with recent travel to endemic zones and for patients with immunosuppression and comorbidities such as diabetes mellitus, tuberculosis, alcoholism, HIV/AIDS and in pregnant women. Amoebiasis should be completely ruled out prior to corticosteroid administration, to avoid severe complications such as fulminant intestinal amoebiasis which is associated with an inherently high mortality.


Assuntos
Colo/cirurgia , Disenteria Amebiana/cirurgia , Entamoeba histolytica/patogenicidade , Perfuração Intestinal/cirurgia , Doença de Crohn/complicações , Disenteria Amebiana/diagnóstico , Humanos , Doenças Inflamatórias Intestinais/complicações , Doenças Inflamatórias Intestinais/diagnóstico , Doenças Inflamatórias Intestinais/cirurgia , Perfuração Intestinal/etiologia , Masculino , Pessoa de Meia-Idade
5.
Rev Chilena Infectol ; 37(5): 599-603, 2020 Nov.
Artigo em Espanhol | MEDLINE | ID: mdl-33399810

RESUMO

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.


Assuntos
Colite , Idoso , Disenteria Amebiana/diagnóstico , Disenteria Amebiana/tratamento farmacológico , Entamoeba histolytica , Feminino , Humanos
6.
Nihon Shokakibyo Gakkai Zasshi ; 116(10): 833-841, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31597882

RESUMO

A 65-year-old man was admitted complaining of high fever and pain in the right lower abdomen. An ileocolonic side-to-end anastomosis had been performed 38 years previously for an abscess in a colonic diverticulum. On the current admission, findings on contrast-enhanced computed tomography suggested an amebic liver abscess and intestinal amebiasis. Colonoscopy revealed an irregularly shaped ulcer and false membrane in the ileal blind end of the ileocolonic anastomosis. Amebic trophozoites were seen by rapid microscopy. Amebiasis in the blind end of the ileum has rarely been reported. This case is of particular interest because the intestinal amebiasis also led to a liver abscess.


Assuntos
Amebíase , Disenteria Amebiana/diagnóstico , Abscesso Hepático Amebiano/diagnóstico , Idoso , Anastomose Cirúrgica , Colonoscopia , Humanos , Masculino
7.
Am J Trop Med Hyg ; 101(6): 1384-1387, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31595870

RESUMO

Recent data show that the gut microbiome plays a role in determining the clinical outcome of Entamoeba histolytica infection. We report the case of a patient who developed recurrent acute amebic colitis (second episode of acute colitis) after colonoscopy. Genotyping of E. histolytica revealed that she developed a second episode of acute amebic colitis with the same genotype as that of the first episode, indicating chronic infection had persisted asymptomatically for > 10 months between the first and second episodes. Analysis of the gut microbiome, in addition to the clinical findings, suggested that dysbiosis at colonoscopy induced the change in the clinical form of E. histolytica infection from asymptomatic chronic infection to symptomatic colitis.


Assuntos
Infecções Assintomáticas , Colonoscopia/efeitos adversos , Disbiose , Disenteria Amebiana/diagnóstico , Exacerbação dos Sintomas , Doença Aguda , Adulto , Entamoeba histolytica/genética , Feminino , Microbioma Gastrointestinal , Genótipo , Humanos , Abscesso Hepático Amebiano
8.
J Assoc Physicians India ; 67(4): 79-81, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31299848

RESUMO

Acute fulminant necrotizing amebic colitis rarely presents with massive lifethreatening lower gastrointestinal bleeding without diarrhea. Diagnosis is difficult as colonoscopy is suboptimal due to active bleeding, stool testing is often negative and a positive serology cannot confirm the diagnosis. We herein report a case of a 39-year-old male who presented with profuse bleeding per rectum, without associated significant antecedent history of fever or diarrhea. Colonoscopy was inconclusive as active bleeding obscured the vision. Computed tomography of abdomen revealed non-specific thickening of the caecum. Emergency laparotomy with right hemicolectomy and temporary ileostomy was performed. Microscopic examination of colonic mucosa revealed Entamoeba histolytica trophozoites with erythrophagocytosis suggestive of fulminant amebic colitis. Intravenous metronidazole was given subsequently and patient recovered completely. Ileocolonic anastomosis was done after closing the ileostomy three months later. This case highlights this exceedingly rare presentation of fulminant amebic colitis which poses a diagnostic challenge and can be life threatening without early surgical intervention.


Assuntos
Disenteria Amebiana/diagnóstico , Hemorragia Gastrointestinal/diagnóstico , Adulto , Colo , Colonoscopia , Diarreia , Disenteria Amebiana/terapia , Hemorragia Gastrointestinal/microbiologia , Hemorragia Gastrointestinal/terapia , Humanos , Masculino
10.
PLoS One ; 14(2): e0212791, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30789955

RESUMO

BACKGROUND: Amoebic colitis is the most frequent clinical manifestation of invasive intestinal infection due to Entamoeba histolytica and a common cause of diarrhoea worldwide. Since higher transmission rates are usually related to poor health and exposure to unhygienic conditions, cases reported in Europe usually involve immigrants and international travellers. The goal of this study was to characterise both the clinical and the epidemiological features of a European population diagnosed with amoebic colitis and then to evaluate the diagnostic tools and therapeutic options applied. METHODS AND RESULTS: This was a retrospective observational study in which data from all patients diagnosed with amoebic colitis attending at the International Health Units of two tertiary referral hospitals, Germans Trias i Pujol University Hospital (Badalona, North Barcelona Metropolitan Area) and Vall d'Hebron University Hospital (Barcelona city) between 2007 and 2017 were analysed. During the study period 50 patients were diagnosed with amoebic colitis. Thirty-six (72%) were men, and immigrants accounted for 46% of all cases. Antecedents of any international travel were reported for 28 (56%), the most frequent destinations having been the Indian subcontinent, South and Central America and sub-Saharan Africa. Preexisting pathological conditions or any kind of immunosuppression were identified in 29 (58%) patients; of these, 13 (26%) had HIV infection-all of them men who have sex with men-and 5 (10%) had inflammatory bowel disease. Diarrhoea, abdominal pain and dysentery were the most frequently recorded symptoms of invasive amoebae. Diagnosis was made through microbiological study in 45 (90%) and/or histological identification of amoebae in colon biopsies in 10 (20%). After treatment with metronidazole (82%) or tinidazole (8%), all patients had good outcomes. Post-acute intraluminal treatment was indicated in 28 (56%). CONCLUSIONS: Amoebic colitis should be suspected in patients with diarrhoea and compatible epidemiological risk factors (immigration, travelling abroad or men who have sex with men), especially if some degree of immunosuppression concurs. These risk factors must be taken into account in any diagnostic approach to inflammatory bowel disease (IBD), and active searches for stool parasites should be performed in such cases to rule out misdiagnosis or simultaneous amoebic infection. Treatment should include intraluminal anti-amoebic treatment in order to avoid relapse and prevent further spread of the disease.


Assuntos
Disenteria Amebiana/diagnóstico , Disenteria Amebiana/epidemiologia , Entamoeba histolytica/isolamento & purificação , Adulto , Idoso , Diarreia/diagnóstico , Diarreia/epidemiologia , Diarreia/terapia , Disenteria Amebiana/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Espanha/epidemiologia , Adulto Jovem
11.
Acta Gastroenterol Belg ; 82(4): 539-541, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31950812

RESUMO

A 50-year-old patient was admitted to our department after developing severe abdominal cramps, watery diarrhea and fever, during four days whilst travelling abroad. Imaging identified a mass in the ascending colon with simultaneous liver lesions. Initially a diagnosis of metastatic colorectal cancer was suggested, however colonoscopy showed a large lesion with a central ulcer and surrounding inflammation in the ascending colon. Biopsies confirmed our clinical suspicion of amoebic colitis, complicated by development of an amoeboma and simultaneous liver abscesses. Amoeboma formation is a rare complication of amoebiasis, however a simultaneous presentation with liver abscesses, amoebic colitis and an amoeboma might even be less frequent. Despite its rarity physicians should maintain a high index of suspicion of patients presenting with synchronous liver and colon lesions, especially as travel to endemic areas has increased.


Assuntos
Amebíase , Colonoscopia/métodos , Disenteria Amebiana/diagnóstico , Entamoeba histolytica/isolamento & purificação , Abscesso Hepático Amebiano/diagnóstico , Dor Abdominal/parasitologia , Biópsia , Disenteria Amebiana/parasitologia , Disenteria Amebiana/cirurgia , Humanos , Abscesso Hepático Amebiano/parasitologia , Abscesso Hepático Amebiano/cirurgia , Neoplasias Hepáticas/diagnóstico , Pessoa de Meia-Idade
13.
Eur J Clin Microbiol Infect Dis ; 38(1): 15-38, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30255429

RESUMO

Amoebiasis, an enteric protozoan disease caused by Entamoeba histolytica, is a public health problem in many developing countries, causing up to 100,000 fatal cases annually. Detection of the pathogenic E. histolytica and its differentiation from the non-pathogenic Entamoeba spp. play a crucial role in the clinical management of patients. Laboratory diagnosis of intestinal amoebiasis in developing countries still relies on labour-intensive and insensitive methods involving staining of stool sample and microscopy. Newer and more sensitive methods include a variety of antigen detection ELISAs and rapid tests; however, their diagnostic sensitivity and specificity seem to vary between studies, and some tests do not distinguish among the Entamoeba species. Molecular detection techniques are highly sensitive and specific and isothermal amplification approaches may be developed into field-applicable tests; however, cost is still a barrier for their use as a routine laboratory test method in most endemic areas. Laboratory diagnosis of extraintestinal amoebiasis faces challenges of lack of definitive detection of current infection and commercially available point-of-care tests. For both types of amoebiasis, there is still a need for highly sensitive and specific tests that are rapid and cost-effective for use in developing countries where the disease is prevalent. In recent years, new molecules of diagnostic value are being discovered and new tests developed. The advances in 'omics' technologies are enabling discoveries of new biomarkers that may help distinguish between different infection stages.


Assuntos
Disenteria Amebiana , Entamoeba histolytica , Técnicas Microbiológicas , Técnicas de Diagnóstico Molecular , Disenteria Amebiana/diagnóstico , Disenteria Amebiana/parasitologia , Entamoeba histolytica/genética , Entamoeba histolytica/isolamento & purificação , Humanos , Reação em Cadeia da Polimerase
14.
Paediatr Int Child Health ; 39(1): 73-75, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-29737935

RESUMO

Entamoeba histolytica is a protozoan parasite that affects a large proportion of the world's population and causes amoebic dysentery and extra-intestinal disease. Many individuals remain asymptomatic during colonisation; in 10% of individuals, the parasite breaks through the mucosal barrier and leads to invasive disease. An eight-month-old girl who was evaluated for hypo-albuminaemia and was diagnosed with amoebic colitis is reported. To the best of our knowledge, this is the first report of hypo-albuminaemia owing to amoebic colitis in any age group.


Assuntos
Disenteria Amebiana/diagnóstico , Disenteria Amebiana/patologia , Entamoeba histolytica/isolamento & purificação , Entamebíase/diagnóstico , Entamebíase/patologia , Hipoalbuminemia/etiologia , Hipoalbuminemia/patologia , Aleitamento Materno , Disenteria Amebiana/complicações , Entamebíase/complicações , Feminino , Humanos , Lactente
15.
Scand J Gastroenterol ; 53(9): 1085-1088, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30256685

RESUMO

Entamoeba histolytica colitis can mimic Crohn's disease. However, a fulminant infection can be life-threatening, especially after exposure to systemic steroids. We present a case of the patient who was initially diagnosed with ileocolonic Crohn's disease, but developed a hepatic E histolytica abscess while undergoing anti-TNF therapy. After revision of the initial diagnostic biopsies, the diagnosis was questioned and E histolytica was confirmed using PCR and histopathology. As intestinal amoebiasis is the most common form of amoebic infection, care should be taken in case of refractory IBD or at initial diagnosis in patients who travelled to endemic areas. We therefore discuss the epidemiology, clinical features, diagnostic tools and pathophysiology of E Histolytica in order to raise awareness among gastroenterologists treating patients with inflammatory bowel disease.


Assuntos
Colo/patologia , Disenteria Amebiana/diagnóstico , Entamoeba histolytica/isolamento & purificação , Abscesso Hepático Amebiano/diagnóstico por imagem , Colo/parasitologia , Doença de Crohn , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
17.
Niger J Clin Pract ; 21(6): 812-815, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29888733

RESUMO

Type II enteropathy-associated T-cell lymphoma (Type II EATL) is a rare peripheral T-cell lymphoma of the gastrointestinal tract. Here, we report a case of Type II EATL, in which the patient with repeated diarrhea was diagnosed as ulcerative colitis and amebic infection at the beginning, but her symptom had no improvement after therapy. The diagnosis of Type II EATL was confirmed by the repeated biopsies and immunohistochemistry. This case suggests that Type II EATL is difficult to diagnose due to lack of specific symptoms and endoscopic features. It reminds us that for patients with increased intraepithelial lymphocytes and thickened bowel wall, lymphoma should be highly suspected and biopsy should be repeated if necessary.


Assuntos
Linfoma de Células T Associado a Enteropatia/patologia , Neoplasias Gastrointestinais/patologia , Biópsia , Colite Ulcerativa/diagnóstico , Diagnóstico Diferencial , Diarreia/complicações , Diarreia/diagnóstico , Disenteria Amebiana/diagnóstico , Feminino , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade
18.
Parasitology ; 145(14): 1890-1895, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-29739480

RESUMO

We have previously shown that the C-terminal region of the intermediate subunit of Entamoeba histolytica galactose- and N-acetyl-D-galactosamine-inhibitable lectin (C-Igl) is a useful antigen for serodiagnosis of amebiasis. An immunochromatographic kit was developed using fluorescent silica nanoparticles coated with C-Igl prepared in Escherichia coli. Samples for examination were added to the freeze-dried particles and then applied to the immunochromatographic device, in which a test line on the membrane was also coated with C-Igl. Fluorescent intensity was measured using a hand-held reader. In an evaluation of the kit using a human monoclonal antibody, the minimum amount of C-Igl specific antibody showing positive results was 100 pg. In the evaluation of serum samples with different antibody titers in indirect immunofluorescent antibody tests in the kit, 20 µL of serum was sufficient to obtain positive results at 30 min. Serum samples from symptomatic patients with amebic colitis and amebic liver abscess and those from asymptomatic E. histolytica-cyst carriers showed positive results in the kit. Based on evaluation using sera from healthy controls and patients with other infectious diseases, the sensitivity and specificity of the kit were 100 and 97.6%, respectively. Therefore, we conclude that the newly developed kit is useful for rapid serodiagnosis of amebiasis.


Assuntos
Amebíase/diagnóstico , Anticorpos Antiprotozoários/sangue , Cromatografia de Afinidade/instrumentação , Kit de Reagentes para Diagnóstico , Testes Sorológicos/instrumentação , Anticorpos Monoclonais/imunologia , Antígenos de Protozoários/sangue , Disenteria Amebiana/diagnóstico , Entamoeba histolytica , Entamebíase/diagnóstico , Humanos , Abscesso Hepático Amebiano/diagnóstico , Nanopartículas , Sensibilidade e Especificidade , Dióxido de Silício
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