Entamoeba histolytica liver abscess case: could stool PCR avoid it?
-
Albert Bernet Sánchez
,
Alba Bellés Bellés
Abstract
Background
Liver abscess is the most common extraintestinal manifestation of Entamoeba histolytica. Clinical manifestations could appear after returning from an endemic area or several years after the exposure. The diagnosis usually requires microbiological confirmation.
Case presentation
We present a case of a 55-year-old woman diagnosed with Crohn’s disease treated with immunosuppressive drugs, who was admitted to the Emergency Service with liver parenchyma abscesses. Computed tomography (CT)-guided puncture showed pus, and both Gram staining and fresh parasite visualization were negative. Hepatic pus bacteriological culture was reported as negative and parasite multiplex polymerase chain reaction (PCR) was performed, being positive for E. histolytica. The same PCR was performed on blood, pleural fluid and stool samples, all of them being positive for E. histolytica.
Conclusions
Reviewing the clinical history of this patient, it was observed that parasite detection in three stool samples was negative 2 months before the current admission. Due to the lack of sensitivity of the microscopy techniques, we propose to routinely perform parasite detection in stools using molecular techniques, especially in immunocompromised patients.
Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: None declared.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interprion of data; in the writing of the report; or in the decision to submit the report for publication.
Conflict of interest: The authors declare not to have any interest conflicts.
References
1. Lichtenstein A, Kondo AT, Visvesvara GS, Fernandez A, Paiva EF, Mauad T, et al. Pulmonary amoebiasis presenting as superior vena cava syndrome. Thorax 2005;60:350–2.10.1136/thx.2004.021014Search in Google Scholar PubMed PubMed Central
2. Fleta J, Bueno O, Bueno M. Amebiasis intestinal y absceso hepático amebiano. Med Integr 2000;36:96–101.Search in Google Scholar
3. Gutiérrez-Cisneros MJ, Martín-Rabadán P, Menchén L, García-Lechuz JM, Fuentes I, Gárate T, et al. Absceso hepático amebiano autóctono en España: ¿una enfermedad emergente? Descripción de 2 nuevos casos clínicos y de una técnica diagnóstica basada en la reacción en cadena de la polimerasa. Enferm Infecc Microbiol Clin 2009;27:326–30.10.1016/j.eimc.2008.06.007Search in Google Scholar PubMed
4. Snow M, Chen M, Guo J, Atkinson J, Stanley SL Jr. Short report: differences in complement-mediated killing of Entamoeba histolytica between men and women – an explanation for the increased susceptibility of men to invasive amebiasis? Am J Trop Med Hyg 2008;78:922–3.10.4269/ajtmh.2008.78.922Search in Google Scholar
5. Lotter H, Helk E, Bernin H, Jacobs T, Prehn C, Adamski J, et al. Testosterone increases susceptibility to amebic liver abscess in mice and mediates inhibition of IFN secretion in natural killer T cells. PLoS One 2013;8:e55694.10.1371/journal.pone.0055694Search in Google Scholar PubMed PubMed Central
6. Lachish T, Wieder-Finesod A, Schwartz E. Amebic liver abscess in Israeli travelers: a retrospective study. Am J Trop Med Hyg 2016;94:1015.10.4269/ajtmh.15-0576Search in Google Scholar PubMed PubMed Central
7. Haque R, Huston CD, Hughes M, Houpt E, Petri WA Jr. Amebiasis. N Engl J Med 2003;348:1565–73.10.1056/NEJMra022710Search in Google Scholar PubMed
8. Katzenstein D, Rickerson V, Braude A. New concepts of amebic liver abscess derived from hepatic imaging, sero diagnosis, and hepatic enzymes in 67 consecutive cases in San Diego. Medicine (Baltimore) 1982;61:237.10.1097/00005792-198207000-00003Search in Google Scholar PubMed
9. Joyce MP, Ravdin JI. Antigens of Entamoeba histolytica recognized by immune sera from liver abscess patients. Am J Trop Med Hyg 1988;38:74.10.4269/ajtmh.1988.38.74Search in Google Scholar PubMed
10. Cuarón A, Gordon F. Liver scanning analysis of 2,500 cases of amebic hepatic abscesses in Hospital General, Centro Médico Nacional, Mexico City, Mexico. J Nucl Med 1970;11:435–9.Search in Google Scholar
11. Tanyuksel M, Petri WA Jr. Laboratory diagnosis of amebiasis. Clin Microbiol Rev 2003;16:713–29.10.1128/CMR.16.4.713-729.2003Search in Google Scholar PubMed PubMed Central
12. Salata RA, Ravdin JI. The interaction of human neutrophils and Entamoeba histolytica increases cytopathogenicity for liver cell monolayers. J Infect Dis 1986;154:19.10.1093/infdis/154.1.19Search in Google Scholar PubMed
13. Salles JM, Salles MJ, Moraes LA, Silva MC. Invasive amebiasis: an update on diagnosis and management. Expert Rev Anti Infect Ther 2007;5:893.10.1586/14787210.5.5.893Search in Google Scholar PubMed
14. Khan U, Mirdha BR, Samantaray JC, Sharma MP. Detection of Entamoeba histolytica using polymerase chain reaction in pus samples from amebic liver abscess. Indian J Gastroenterol 2006;25:55.Search in Google Scholar
15. Jaiswal V, Ghoshal U, Baijal SS, Mittal B, Dhole TN, Ghoshal UC. Evaluation of antigen detection and polymerase chain reaction for diagnosis of amoebic liver abscess in patients on anti-amoebic treatment. BMC Res Notes 2012;5:416.10.1186/1756-0500-5-416Search in Google Scholar PubMed PubMed Central
16. Roy S, Kabir M, Mondal D, Ali IK, Petri WA Jr, Haque R. Real-time-PCR assay for diagnosis of Entamoeba histolytica infection. J Clin Microbiol 2005;43:2168.10.1128/JCM.43.5.2168-2172.2005Search in Google Scholar PubMed PubMed Central
17. Othman N, Mohamed Z, Verweij JJ, Huat LB, Olivos-García A, Yeng C, et al. Application of real-time polymerase chain reaction in detection of Entamoeba histolytica in pus aspirates of liver abscess patients. Foodborne Pathog Dis 2010;7:637.10.1089/fpd.2009.0427Search in Google Scholar PubMed
18. Castillo RA, Hernández AF, Hernández JL, Méndez A, Soria M, Zavaleta NO. Diagnóstico, tratamiento del absceso hepático amebiano no complicado. Guía de Práctica clínica. México: Secretaría deSalud; 2014. 18. http://www.cenetec.salud.gob.mx/interior/catalogoMaestroGPC.html.Search in Google Scholar
19. Bammigatti C, Ramasubramanian N, Kadhiravan T, Das AK. Percutaneous needle aspiration in uncomplicated amebic liver abscess: a randomized trial. Trop Doct 2013;43:19–22.10.1177/0049475513481767Search in Google Scholar PubMed
20. Vallois D, Epelboin L, Touafek F, Magne D, Thellier M, Bricaire F, et al. Amebic liver abscess diagnosed by polymerase chain reaction in 14 returning travelers. Am J Trop Med Hyg 2012;87:1041–5.10.4269/ajtmh.2012.12-0366Search in Google Scholar PubMed PubMed Central
21. Caballero-Salcedo A, Viveros-Rogel M, Salvatierra B, Tapia-Conyer R, Sepulveda-Amor J, Gutierrez G, et al. Seroepidemiology of amebiasis in Mexico. Am J Trop Med Hyg 1994;50:412–9.10.4269/ajtmh.1994.50.412Search in Google Scholar PubMed
22. Parija SC, Khairnar K. Detection of excretory Entamoeba histolytica DNA in the urine, and detection of E. histolytica DNA and lectin antigen in the liver abscess pus for the diagnosis of amoebic liver abscess. BMC Microbiol 2007;7:41.10.1186/1471-2180-7-41Search in Google Scholar PubMed PubMed Central
23. Laude A, Valot S, Desoubeaux G, Argy N, Nourrisson C, Pomaresc C, et al. Is real-time PCR-based diagnosis similar in performance to routine parasitological examination for the identification of Giardia intestinalis, Cryptosporidium parvum/Cryptosporidium hominis and Entamoeba histolytica from stool samples? Evaluation of a new commercial multiplex PCR assay and literature review. Clin Microbiol Infect 2016;22:190.e1–8.10.1016/j.cmi.2015.10.019Search in Google Scholar PubMed
24. Won EJ, Kim SH, Kee SJ, Shin JH, Suh SP, Chai JY, et al. Multiplex real-time PCR assay targeting eight parasites customized to the Korean population: potential use for detection in diarrheal stool samples from gastroenteritis patients. PLoS One 2016;11:e0166957.10.1371/journal.pone.0166957Search in Google Scholar PubMed PubMed Central
25. Verweij JJ, Schinkel J, Laeijendecker D, van Rooyen MA, van Lieshout L, Polderman AM. Real-time PCR for the detection of Giardia lamblia. Mol Cell Probes 2003;17:223–5.10.1016/S0890-8508(03)00057-4Search in Google Scholar
26. Morgan UM, Pallant L, Dwyer BW, Forbes DA, Rich G, Thompson RC. Comparison of PCR and microscopy for detection of Cryptosporidium parvum in human fecal specimens: clinical trial. J Clin Microbiol 1998;36:995–8.10.1128/JCM.36.4.995-998.1998Search in Google Scholar PubMed PubMed Central
27. Buss SN, Leber A, Chapin K, Fey PD, Bankowski MJ, Jones MK, et al. Multicenter evaluation of the BioFire FilmArray gastrointestinal panel for etiologic diagnosis of infectious gastroenteritis. J Clin Microbiol 2015;53:915–25.10.1128/JCM.02674-14Search in Google Scholar PubMed PubMed Central
28. Madison-Antenucci S, Relich RF, Doyle L, Espina N, Fuller D, Karchmer T, et al. Multicenter evaluation of BD Max enteric parasite real-time PCR assay for detection of Giardia duodenalis, Cryptosporidium hominis, Cryptosporidium parvum, and Entamoeba histolytica. J Clin Microbiol 2016;54:2681–8.10.1128/JCM.00765-16Search in Google Scholar PubMed PubMed Central
© 2020 Walter de Gruyter GmbH, Berlin/Boston
Articles in the same Issue
- Frontmatter
- Editorial
- Learning and teaching aren’t the same – the need for diagnosis curricula in graduate medical education
- Mini Review
- Controversies in diagnosis: contemporary debates in the diagnostic safety literature
- Opinion Paper
- Balancing confidence and humility in the diagnostic process
- Point/Counterpoints
- Roots of the total testing process
- Total testing process: roots and state-of-the-art
- Original Articles
- Embedding a longitudinal diagnostic reasoning curriculum in a residency program using a bolus/booster approach
- Structured case reviews for organizational learning about diagnostic vulnerabilities: initial experiences from two medical centers
- Breakdowns in the initial patient-provider encounter are a frequent source of diagnostic error among ischemic stroke cases included in a large medical malpractice claims database
- Perspectives from the other side of the screen: how clinicians and radiologists communicate about diagnostic errors
- Routine coagulation testing in Vacutainer® Citrate Plus tubes filled at minimum or optimal volume
- Diagnostic accuracy of fine needle aspiration cytology of thyroid nodules
- Letter to the Editor
- The day God created man
- Case Reports
- Entamoeba histolytica liver abscess case: could stool PCR avoid it?
- A rare cause of subclinical hypothyroidism: macro-thyroid-stimulating hormone
Articles in the same Issue
- Frontmatter
- Editorial
- Learning and teaching aren’t the same – the need for diagnosis curricula in graduate medical education
- Mini Review
- Controversies in diagnosis: contemporary debates in the diagnostic safety literature
- Opinion Paper
- Balancing confidence and humility in the diagnostic process
- Point/Counterpoints
- Roots of the total testing process
- Total testing process: roots and state-of-the-art
- Original Articles
- Embedding a longitudinal diagnostic reasoning curriculum in a residency program using a bolus/booster approach
- Structured case reviews for organizational learning about diagnostic vulnerabilities: initial experiences from two medical centers
- Breakdowns in the initial patient-provider encounter are a frequent source of diagnostic error among ischemic stroke cases included in a large medical malpractice claims database
- Perspectives from the other side of the screen: how clinicians and radiologists communicate about diagnostic errors
- Routine coagulation testing in Vacutainer® Citrate Plus tubes filled at minimum or optimal volume
- Diagnostic accuracy of fine needle aspiration cytology of thyroid nodules
- Letter to the Editor
- The day God created man
- Case Reports
- Entamoeba histolytica liver abscess case: could stool PCR avoid it?
- A rare cause of subclinical hypothyroidism: macro-thyroid-stimulating hormone
