Serologic Diagnosis of Amebiasis

Juniper, Kerrison; Cl, Worrell; Mc, Minshew; Ls, Roth; Cypert, H.; Re, Lloyd

doi:10.4269/ajtmh.1972.21.157

Cited by 53 publications

(18 citation statements)

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“…However, it is well documented that individuals with ALA may remain seropositive for amebiasis by conventional serologic tests for years following their acute infection. 8,13,14 Furthermore, a high background level of seropositivity in endemic areas can also limit the usefulness of serologic tests in diagnosing acute or invasive amebiasis. An antigen detection test in the stool may provide an effective approach to differentiating current intestinal infection from past amebic infection; however, in Ͼ 65% of the ALA cases the stool was negative for antigen.…”

Section: Discussionmentioning

confidence: 99%

“…The antibody response is greatest in amebic liver abscesses, less in intestinal amebiasis, and least in asymptomatic cyst passers. [12][13][14] Current serologic tests for detecting amebiasis, such as the IHA, are highly sensitive and specific for amebic infection. However, it is well documented that individuals with ALA may remain seropositive for amebiasis by conventional serologic tests for years following their acute infection.…”

Section: Discussionmentioning

confidence: 99%

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Invasive amebiasis: challenges in diagnosis in a non-endemic country (Kuwait).

Hira¹,

Iqbal²,

Al-Ali³

et al. 2001

The American Journal of Tropical Medicine and Hygiene

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Abstract. Invasive zymodemes of the enteric protozoan Entamoeba histolytica infect the large intestine and cause extra-intestinal lesions such as amebic liver abscess (ALA). The clinical manifestations of ALA are protean, particularly in patients presenting in a non-endemic, desert country such as Kuwait, and diagnosis becomes problematic. In this study, we present cases of ALA to illustrate the clinical and diagnostic challenges. For serodiagnosis of ALA, we compared the sensitivity and specificity of the indirect hemagglutination assay (IHA) with the ImmunoTab assay and an enzyme-linked immunosorbent assay (ELISA) for this geographic region. We tested sera of 110 patients with ALA, 1,224 patients suspected of having invasive amebic infection, and 50 Europeans with no travel history to an amebic-endemic area. The IHA was simple, rapid, easy to perform, and reliable (sensitivity ϭ 99%, specificity Ͼ 95%). The performance of the IHA in detecting ALA in suspected cases was significantly better than that of the ELISA and the ImmunoTab test. Compared with the IHA, both the ELISA and ImmunoTab assay detected relatively higher numbers of false-positive cases (4.7% and 3.6%, respectively). With the availability of ultrasound and computed tomography scans, the serology correlates excellently with the clinical presentation. In chronic cases where fibrosis may be present around the abscess, the IHA has limitations, as in the follow-up of treated patients. Pitfalls in diagnosis are highlighted by discussing the differential diagnosis of ALA from bacterial hepatic abscesses and infected hydatid cysts. Most importantly, the IHA in such cases was invariably at a titer that is considered not significant.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Invasive amebiasis: challenges in diagnosis in a non-endemic country (Kuwait).

Hira¹,

Iqbal²,

Al-Ali³

et al. 2001

The American Journal of Tropical Medicine and Hygiene

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“…Imaging techniques such as ultrasound, computed tomography, and magnetic resonance have excellent sensitivities for the detection of liver abscess arising from any cause, but there are no findings specific for ALA (13). Further complicating the diagnosis is the fact that most patients with an ALA do not have coexistent intestinal infection with E. histolytica (11). Therefore, detection of E. histolytica antigen or DNA in stool samples is not very helpful for the diagnosis of ALA (1,6,8,12).…”

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confidence: 99%

Diagnosis of Amebic Liver Abscess and Amebic Colitis by Detection of Entamoeba histolytica DNA in Blood, Urine, and Saliva by a Real-Time PCR Assay

et al. 2010

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The noninvasive diagnosis of amebic liver abscess is challenging, as most patients at the time of diagnosis do not have a concurrent intestinal infection with Entamoeba histolytica. Fecal testing for E. histolytica parasite antigen or DNA is negative in most patients. A real-time PCR assay was evaluated for detection of E. histolytica DNA in blood, urine, and saliva samples from amebic liver abscess as well as amebic colitis patients in Bangladesh. A total of 98 amebic liver abscess and 28 amebic colitis patients and 43 control subjects were examined. The real-time PCR assay detected E. histolytica DNA in 49%, 77%, and 69% of blood, urine, and saliva specimens from the amebic liver abscess patients. For amebic colitis the sensitivity of the real-time PCR assay for detection of E. histolytica DNA in blood, urine, and saliva was 36%, 61%, and 64%, respectively. All blood, urine, and saliva samples from control subjects were negative by the real-time PCR assay for E. histolytica DNA. When the real-time PCR assay results of the urine and saliva specimens were taken together (positive either in urine or saliva), the real-time PCR assay was 97% and 89% sensitive for detection of E. histolytica DNA in liver abscess and intestinal infection, respectively. We conclude that the detection of E. histolytica DNA in saliva and urine could be used as a diagnostic tool for amebic liver abscess.Entamoeba histolytica is a protozoan parasite that causes amebic diarrhea, colitis, and amebic liver abscess (ALA), mostly in developing countries (5,7,22,25). Eighty percent of infected individuals remain asymptomatic carriers, while the other 20% develop clinically overt disease (7,9,22,25). About 50 million symptomatic cases of amebiasis occur worldwide each year, resulting in 40,000 to 100,000 deaths annually (25). Mortality from amebiasis is mainly due to extra-amebic colitis, of which ALA is the most common.It is difficult to differentiate ALA from pyogenic liver abscess or other space-occupying lesions of the liver. Imaging techniques such as ultrasound, computed tomography, and magnetic resonance have excellent sensitivities for the detection of liver abscess arising from any cause, but there are no findings specific for ALA (13). Further complicating the diagnosis is the fact that most patients with an ALA do not have coexistent intestinal infection with E. histolytica (11). Therefore, detection of E. histolytica antigen or DNA in stool samples is not very helpful for the diagnosis of ALA (1,6,8,12).The current means for diagnosis of ALA is the detection of antiamebic antibody by serological tests combined with aspiration of the abscess. The presence of serum antibodies against E. histolytica and the absence of bacteria in the abscess fluid are consistent with an ALA. A drawback of serologic tests is that the serum antibody levels in people from areas of endemicity remain positive for years after infection with E. histolytica (3,16,23). Therefore, antiamebic antibodies in the serum may be due to amebiasis in the past, limiting th...

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“…1989;accepted 6 Nov. 1989. spread to extra-intestinal sites. Conventionally, the immuno-diagnosis of amoebic infection has been based on the demonstration of circulating antibodies to E. histolytica although the presence of antibodies does not differentiate between present and past clinical or subclinical infection (Abioye et al, 1972;Juniper et al, 1972;Healy et al, 1974), and anti-amoebic antibodies are known to persist for years after the successful treatment of an amoebic liver abscess (Abioye et al , 1972 ;Healy et al, 1974;Vinayak, 1975). The level of anti-amoebic antibodies has limited or no correlation with the severity of infection (Vinayak, 1975;Bos and Van den Eijk, 1976;Thomas et al, 1981), and clearly the demonstration of circulating anti-amoebic antibodies has major limitations as a diagnostic test.…”

Section: Introductionmentioning

confidence: 99%

Uses and limitations in the demonstration of specific circulating immune complexes in patients with amoebiasis

Vinayak¹,

Shandil²,

Bansal

et al. 1990

Journal of Medical Microbiology

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Summary.A micro-enzyme linked immuaosorbent assay (micro-ELISA) has been evaluated as a diagnostic test to detect amoebic antigen in polyethylene glycol (PEG) precipitated circulating immune complexes (CIC) in sera from patients with amoebiasis. The immune complexes were captured on rabbit anti-amoebic IgGcoated wells of microtitration plates and the complexed antigen was detected by enzyme linked antihuman immunoglobulins. A titre of > 160 for the immune complexes was considered to be of clinical significance. The immunoassay detected amoebic, antigen-specific CIC in 35 (94.5%) of 37 patients with confirmed amoebic liver abscess. Twenty (55.5%) of 36 clinically suspected cases of amoebic liver abscess had amoebic antigen-specific CIC and responded favourably to anti-amoebic chemotherapy. Only two (20%) of 10 cases of non-dysenteric symptomatic intestinal amoebic infection had amoebic antigen-specific CIC. One (10%) of 10 patients with non-amoebic intestinal disorders also had amoebic antigen in CIC. However, none of 15 cases of non-amoebic hepatic disorders that included hydatid disease, metastatic adenocarcinoma, hepatocellular carcinoma, cholecystitis and choledocal cyst, 13 cases of rheumatoid arthritis and 25 apparently healthy subjects had amoebic antigen in CIC. The levels of the amoebic antigen-specific CIC did not correlate (p>O-O5) with either the number of abscess(es) or lobe(s) of the liver involved. However, the levels of antigen-specific CIC were higher (p < 0.01) in patients with a liver size of more than 5 cm below the right costal margin. Antigen-specific CIC levels tended to decline or disappear during 3-6 months following completion of therapy. In spite of the limitations for diagnosing symptomatic intestinal amoebic disease, the demonstration of specific CIC is recommended as an immuno-diagnostic procedure for patients with suspected amoebic liver abscess.

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Serologic Diagnosis of Amebiasis

Cited by 53 publications

References 0 publications

Invasive amebiasis: challenges in diagnosis in a non-endemic country (Kuwait).

Invasive amebiasis: challenges in diagnosis in a non-endemic country (Kuwait).

Diagnosis of Amebic Liver Abscess and Amebic Colitis by Detection of Entamoeba histolytica DNA in Blood, Urine, and Saliva by a Real-Time PCR Assay

Uses and limitations in the demonstration of specific circulating immune complexes in patients with amoebiasis

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