Abstract
BackgroundEntamoeba infections have major impact on millions of the people worldwide. Entamoeba histolytica has long been accepted as the only pathogenic species. However, recent reports of other Entamoeba spp. in symptomatic cases have raised questions on their pathogenicity.Methodology/Principal findingsTotal 474 stool samples and 125 liver aspirates from patients with intestinal and extra intestinal manifestations and from community were included. Sewage samples from the hospital and the city were also included. Microscopic examination and molecular detection were performed to detect presence of E. histolytica/ dispar/ moshkovskii/ bangladeshi. The associated demographic and socioeconomic factors were statistically analyzed with the presence of Entamoeba. Microscopy detected Entamoeba spp. in 5.4% stool and 6.4% liver aspirate samples. Through nested multiplex PCR, prevalence of Entamoeba spp. in intestinal and extra-intestinal cases was 6.6% (20/301) and 86.4% (108/125) respectively and in asymptomatic population was 10.5% (13/123). Sewage samples did not show presence of any Entamoeba spp. Uneducated subjects, low economic conditions, untreated drinking water, consumption of raw vegetables and habit of not washing hands before meals were significantly associated with presence of Entamoeba spp.ConclusionsE. histolytica still remains the only Entamoeba spp. in invasive extra intestinal infections. E. dispar was detected in both asymptomatic and symptomatic intestinal infections. Routine identification of Entamoeba spp. should incorporate PCR based detection methods.
Highlights
Infections due to Entamoeba spp. are ubiquitous
[1] There has been constant debate on the commensal and pathogen status of several Entamoeba spp., owing to sporadic reports of infections due to Entamoeba dispar (E. dispar) and Entamoeba moshkovskii (E. moshkovskii), which were once considered as commensals. [2,3] There are different species of Entamoeba found in humans of which Entamoeba histolytica (E. histolytica) is the one considered as pathogenic since the beginning
[4] It has been established that E. histolytica has the potential to cause both invasive and non-invasive infections while E. dispar and E. moshkovskii are associated with non-invasive infections only
Summary
Infections due to Entamoeba spp. are ubiquitous. Alarmingly high prevalence is seen in tropical countries with lower socioeconomic communities and poor sanitation. [1] There has been constant debate on the commensal and pathogen status of several Entamoeba spp., owing to sporadic reports of infections due to Entamoeba dispar (E. dispar) and Entamoeba moshkovskii (E. moshkovskii), which were once considered as commensals. [2,3] There are different species of Entamoeba found in humans of which Entamoeba histolytica (E. histolytica) is the one considered as pathogenic since the beginning. [4] It has been established that E. histolytica has the potential to cause both invasive and non-invasive infections while E. dispar and E. moshkovskii are associated with non-invasive infections only. [5] Recently, Entamoeba bangladeshi (E. bangladeshi) causing diarrhea in children has been reported. [6] The epidemiological data from most of the resource limited endemic countries are based on microscopy with very low sensitivity. [2] It is widely acknowledged that Entamoeba infections are of public health importance but the geographical distribution and regional burden are yet to be determined. Species like E. dispar, E. moshkovskii and E. bangladeshi have been a recent addition and not much data exist on their prevalence. In this context, one of our recent study has shown high prevalence of E. histolytica in the cases of liver abscesses. Recent reports of other Entamoeba spp. in symptomatic cases have raised questions on their pathogenicity
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