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@article{dd584dac2bed4f9cbd4487a5d9b3adcd,
title = "Clinical and microscopic predictors of Entamoeba histolytica intestinal infection in travelers and migrants diagnosed with Entamoeba histolytica/dispar infection",
abstract = "BackgroundAmebiasis is a protozoal infection caused by Entamo histolytica, while the morphologically indistinguishable E. dispar is considered as non-pathogenic. Polymerase chain reaction (PCR) assays are necessary to differentiate both species. The most common clinical presentations of E. histolytica disease are amebic colitis and amebic liver abscess, but asymptomatic infection is also possible. We assessed the frequency and pattern of clinical symptoms and microscopic features in travelers/migrants associated with E. histolytica intestinal infection and compared them to those found in individuals with E. dispar infection.MethodsWe conducted a retrospective study at the travel clinic of the Institute of Tropical Medicine, Antwerp, Belgium on travelers/migrants found from 2006 to 2016 positive for Entamoeba histolytica/disparth rough antigen detection and/or through microscopy confirmed by PCR. All files of individuals with a positive PCR for E. histolytica (= cases) and a random selection of an equal number of Entamoeba disparcarriers (= controls) were reviewed. We calculated the sensitivity, specificity and likelihood ratios (LRs) of clinical symptoms (blood in stool, mucus in stool, watery diarrhea, abdominal cramps, fever or any of these 5 symptoms) and of microscopic features (presence of trophozoites in direct and in sodium acetate -acetic acid-formalin (SAF)-fixed stool smears) to discriminate between E. histolytica and E. dispar infection.ResultsOf all stool samples positive for Entamoeba histolytica/dispar for which PCR was performed (n = 810), 30 (3.7{\%}) were true E. histolytica infections, of which 39{\%} were asymptomatic. Sensitivity, specificity and positive LRs were 30{\%}, 100{\%} and 300 (p 0.007) for presence of blood in stool; 22{\%}, 100{\%} and 222 (p 0.03) for mucus in stool; 44{\%}, 90{\%} and 4.7 (p 0.009) for cramps and 14{\%}, 97{\%} and 4.8 (p = 0.02) for trophozoites in direct smears. For watery diarrhea, fever and for trophozoites in SAF fixated smears results were non-significant.ConclusionsE. histolytica infection was demonstrated in a small proportion of travelers/migrants with evidence of Entamoeba histolytica/dispar infection. In this group, history of blood and mucus in stool and cramps had good to strong confirming power (LR+) for actual E. histolytica infection. Trophozoites were also predictive for true E. histolytica infection but in direct smears only.",
keywords = "AMEBIASIS, EPIDEMIOLOGY, DISPAR, DIFFERENTIATION, PREVALENCE, ZYMODEMES, CARRIERS",
author = "{Van den Broucke}, Steven and Jacob Verschueren and {Van Esbroeck}, Marjan and Emmanuel Bottieau and {Van den Ende}, Jef",
note = "CPDF",
year = "2018",
doi = "10.1371/journal.pntd.0006892",
language = "English",
volume = "12",
journal = "PLoS Negl Trop Dis",
issn = "1935-2727",
publisher = "Public Library of Science",
number = "10",

}

RIS

TY - JOUR

T1 - Clinical and microscopic predictors of Entamoeba histolytica intestinal infection in travelers and migrants diagnosed with Entamoeba histolytica/dispar infection

AU - Van den Broucke, Steven

AU - Verschueren, Jacob

AU - Van Esbroeck, Marjan

AU - Bottieau, Emmanuel

AU - Van den Ende, Jef

N1 - CPDF

PY - 2018

Y1 - 2018

N2 - BackgroundAmebiasis is a protozoal infection caused by Entamo histolytica, while the morphologically indistinguishable E. dispar is considered as non-pathogenic. Polymerase chain reaction (PCR) assays are necessary to differentiate both species. The most common clinical presentations of E. histolytica disease are amebic colitis and amebic liver abscess, but asymptomatic infection is also possible. We assessed the frequency and pattern of clinical symptoms and microscopic features in travelers/migrants associated with E. histolytica intestinal infection and compared them to those found in individuals with E. dispar infection.MethodsWe conducted a retrospective study at the travel clinic of the Institute of Tropical Medicine, Antwerp, Belgium on travelers/migrants found from 2006 to 2016 positive for Entamoeba histolytica/disparth rough antigen detection and/or through microscopy confirmed by PCR. All files of individuals with a positive PCR for E. histolytica (= cases) and a random selection of an equal number of Entamoeba disparcarriers (= controls) were reviewed. We calculated the sensitivity, specificity and likelihood ratios (LRs) of clinical symptoms (blood in stool, mucus in stool, watery diarrhea, abdominal cramps, fever or any of these 5 symptoms) and of microscopic features (presence of trophozoites in direct and in sodium acetate -acetic acid-formalin (SAF)-fixed stool smears) to discriminate between E. histolytica and E. dispar infection.ResultsOf all stool samples positive for Entamoeba histolytica/dispar for which PCR was performed (n = 810), 30 (3.7%) were true E. histolytica infections, of which 39% were asymptomatic. Sensitivity, specificity and positive LRs were 30%, 100% and 300 (p 0.007) for presence of blood in stool; 22%, 100% and 222 (p 0.03) for mucus in stool; 44%, 90% and 4.7 (p 0.009) for cramps and 14%, 97% and 4.8 (p = 0.02) for trophozoites in direct smears. For watery diarrhea, fever and for trophozoites in SAF fixated smears results were non-significant.ConclusionsE. histolytica infection was demonstrated in a small proportion of travelers/migrants with evidence of Entamoeba histolytica/dispar infection. In this group, history of blood and mucus in stool and cramps had good to strong confirming power (LR+) for actual E. histolytica infection. Trophozoites were also predictive for true E. histolytica infection but in direct smears only.

AB - BackgroundAmebiasis is a protozoal infection caused by Entamo histolytica, while the morphologically indistinguishable E. dispar is considered as non-pathogenic. Polymerase chain reaction (PCR) assays are necessary to differentiate both species. The most common clinical presentations of E. histolytica disease are amebic colitis and amebic liver abscess, but asymptomatic infection is also possible. We assessed the frequency and pattern of clinical symptoms and microscopic features in travelers/migrants associated with E. histolytica intestinal infection and compared them to those found in individuals with E. dispar infection.MethodsWe conducted a retrospective study at the travel clinic of the Institute of Tropical Medicine, Antwerp, Belgium on travelers/migrants found from 2006 to 2016 positive for Entamoeba histolytica/disparth rough antigen detection and/or through microscopy confirmed by PCR. All files of individuals with a positive PCR for E. histolytica (= cases) and a random selection of an equal number of Entamoeba disparcarriers (= controls) were reviewed. We calculated the sensitivity, specificity and likelihood ratios (LRs) of clinical symptoms (blood in stool, mucus in stool, watery diarrhea, abdominal cramps, fever or any of these 5 symptoms) and of microscopic features (presence of trophozoites in direct and in sodium acetate -acetic acid-formalin (SAF)-fixed stool smears) to discriminate between E. histolytica and E. dispar infection.ResultsOf all stool samples positive for Entamoeba histolytica/dispar for which PCR was performed (n = 810), 30 (3.7%) were true E. histolytica infections, of which 39% were asymptomatic. Sensitivity, specificity and positive LRs were 30%, 100% and 300 (p 0.007) for presence of blood in stool; 22%, 100% and 222 (p 0.03) for mucus in stool; 44%, 90% and 4.7 (p 0.009) for cramps and 14%, 97% and 4.8 (p = 0.02) for trophozoites in direct smears. For watery diarrhea, fever and for trophozoites in SAF fixated smears results were non-significant.ConclusionsE. histolytica infection was demonstrated in a small proportion of travelers/migrants with evidence of Entamoeba histolytica/dispar infection. In this group, history of blood and mucus in stool and cramps had good to strong confirming power (LR+) for actual E. histolytica infection. Trophozoites were also predictive for true E. histolytica infection but in direct smears only.

KW - AMEBIASIS

KW - EPIDEMIOLOGY

KW - DISPAR

KW - DIFFERENTIATION

KW - PREVALENCE

KW - ZYMODEMES

KW - CARRIERS

U2 - 10.1371/journal.pntd.0006892

DO - 10.1371/journal.pntd.0006892

M3 - A1: Web of Science-article

VL - 12

JO - PLoS Negl Trop Dis

T2 - PLoS Negl Trop Dis

JF - PLoS Negl Trop Dis

SN - 1935-2727

IS - 10

M1 - 0006892

ER -

ID: 2813398