Enteric multiplex PCR panels: A new diagnostic tool for amoebic liver abscess?

Weitzel, Thomas; Cabrera, José‐María; Rosas, Reinaldo; Noriega, L.M.; Schiappacasse, Giancarlo; Vollrath, Valeska; Porte, Lorena

doi:10.1016/j.nmni.2017.05.002

Cited by 11 publications

(8 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[ 31 ]). However, there are neither standardized PCR protocols nor commercially available detection kits, resulting in varying degrees of sensitivity and specificity of the often applied in-house protocols [ 32 ]. Further improvement of molecular diagnostic methods as well as enhanced accessibility in developing countries may facilitate diagnosis of invasive amoebiasis in general as well as ALA in particular [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

Development of amoebic liver abscess in early pregnancy years after initial amoebic exposure: a case report

et al. 2020

View full text Add to dashboard Cite

Background Infection with Entamoeba histolytica and associated complications are relatively rare in developed countries. The overall low prevalence in the Western world as well as the possibly prolonged latency period between infection with the causing pathogen and onset of clinical symptoms may delay diagnosis of and adequate treatment for amoebiasis. Amoebic liver abscess (ALA) is the most common extraintestinal manifestation of invasive amoebiasis. Pregnancy has been described as a risk factor for development of invasive amoebiasis and management of these patients is especially complex. Case presentation A 30-year-old Caucasian woman in early pregnancy presented to our emergency department with abdominal pain alongside elevated inflammatory markers and liver function tests. Travel history revealed multiple journeys to tropic and subtropic regions during the past decade and a prolonged episode of intermittently bloody diarrhea during a five month stay in Indonesia seven years prior to admission. Sonographic and magnetic resonance imaging revealed a 5 × 4 cm hepatic abscess. After ultrasound-guided transcutaneous liver drainage, both abscess fluids and blood cultures showed neither bacterial growth nor microscopic signs of parasitic disease. Serological testing confirmed an infection with Entamoeba histolytica, which was treated with metronidazole, followed by eradication therapy with paromomycin. Subsequent clinical, laboratory and imaging follow-up exams showed regression of the ALA. In addition, the pregnancy completed without complications and a healthy baby boy was born 7 months after termination of treatment. Conclusions This case of invasive amoebiasis in early pregnancy outside of endemic regions and several years after exposure demonstrates the importance of broad differential diagnostics in the context of liver abscesses. The complex interdisciplinary decisions regarding the choice of imaging techniques as well as interventional and antibiotic therapy in the context of pregnancy are discussed. Furthermore, we present possible explanations for pregnancy as a risk factor for an invasive course of amoebiasis.

show abstract

Section: Discussionmentioning

confidence: 99%

Development of amoebic liver abscess in early pregnancy years after initial amoebic exposure: a case report

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Supporting this hypothesis, E . histolytica has been recognised by other authors as an emerging sexually transmissible pathogen in MSM, causing sporadic outbreaks in countries where it is not endemic [9–11]. For some time now there has also been agreement that patients with HIV infection tend to have a higher prevalence of E .…”

Section: Discussionmentioning

confidence: 99%

Approach to amoebic colitis: Epidemiological, clinical and diagnostic considerations in a non-endemic context (Barcelona, 2007-2017)

et al. 2019

View full text Add to dashboard Cite

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.

show abstract

“… 1 , 2 Although not widely available, molecular techniques have quickly been recognized as the diagnostic standard and have been used to diagnose amebic liver abscess in several reports. 2 , 3 This case highlights the pitfalls in utilizing conventional diagnostics as well as the utility of multiplex PCR to rapidly diagnose extraintestinal amebiasis.…”

mentioning

confidence: 97%