Amoebic Liver Abscess Research Articles

Entamoeba histolytica-induced NETs are highly cytotoxic on hepatic and colonic cells due to serine proteases and myeloperoxidase activities

During intestinal and liver invasion by the protozoan parasite Entamoeba histolytica, extensive tissue destruction linked to large neutrophil infiltrates is observed. It has been proposed that microbicidal components of neutrophils are responsible for the damage, however, the mechanism by which they are released and act in the extracellular space remains unknown. In previous studies, we have shown that E. histolytica trophozoites induce NET formation, leading to the release of neutrophil granule content into extruded DNA. In this work, we evaluate the possible participation of NETs in the development of amoeba-associated pathology and analyze the contribution of anti-microbial components of the associated granules. E. histolytica-induced NETs were isolated and their effect on the viability and integrity of HCT 116 colonic and Hep G2 liver cultures were evaluated. The results showed that simple incubation of cell monolayers with purified NETs for 24 h resulted in cell detachment and death in a dose-dependent manner. The effect was thermolabile and correlated with the amount of DNA and protein present in NETs. Pretreatment of NETs with specific inhibitors of some microbicidal components suggested that serine proteases, are mostly responsible for the damage caused by NETs on HCT 116 cells, while the MPO activity was the most related to Hep G2 cells damage. Our study also points to a very important role of DNA as a scaffold for the activity of these proteins. We show evidence of the development of NETs in amoebic liver abscesses in hamsters as a preamble to evaluate their participation in tissue damage. In conclusion, these studies demonstrate that amoebic-induced NETs have potent cytotoxic effects on target cells and, therefore, may be responsible for the intense damage associated with tissue invasion by this parasite.

Surgical treatment of extraintestinal amoebiasis with development of right lobe liver abscess: case study

The treatment of extraintestinal amoebiasis is a major surgical concern given the low prevalence in the Republic of Belarus and consequently difficult diagnosis. In this article, we present our own experience with the surgical treatment of a patient with an amoebic liver abscess. The patient underwent laparoscopy guided drainage of the abscess of the right lobe of the liver according to the technique developed in the clinic. A puncture-drainage system consisting of a Foley catheter and a guide stylet was used. The patient was discharged in satisfactory condition for outpatient treatment and observation by a surgeon, a general practitioner, and an infectious disease specialist. There were no repeated visits or admissions. The presented case emphasizes the importance of combined treatment of amoebic liver abscesses using percutaneous drainage and conservative therapy with amoebicidal drugs such as metronidazole.

Asymptomatic presentation of giant liver abscess: simultaneous Klebsiella pneumoniae and amoebic infection in an immunocompetent comorbid patient

Liver abscess is a rare clinical entity, giant abscess is also rare and asymptomatic presentation in immune competency is even rare. Simultaneous Klebsiella pneumoniae and amoebic liver abscess is rarely reported in immunocompetent patients, just few articles. Our case, a 69-year-old man was discovered to have hypoechoic liver mass during a scan of the abdomen for evaluation of dysuria. He was hospitalized through ER for advanced assessment. Systemic inquiries of the patient revealed generalized fatigue, constipation, but no fever, chills, abdominal pain or hypotension. Physical examination revealed normal liver span and no right upper quadrant tenderness. Tumor markers were not strikingly high and an enhanced abdominal computed tomography showed a large area of low attenuation with some liquefaction in the liver. Echo-guided aspiration revealed 220 ml of pus, which grew Klebsiella pneumoniae, and the same organism was isolated from the blood. Cytology examination of the pus showed scattered amoeba. The patient gradually improved over 3 weeks on treatment with meropenem and metronidazole, along with sustained drainage of the abscess cavity. No parasite ova or amoeba were found in the stool. He had no evidence of immunocompromise. Parasitic diseases may be a predisposing factor for bacterial infections, including pyogenic liver abscess. Giant size, possible coexistence of amoebae and bacteria in a liver abscess and asymptomatic presentation should not be discounted.

Rapid Detection of Amoebic Liver Abscess Using Recombinase Polymerase Amplification Assay in Resource-Limited Settings.

Amoebic liver abscess (ALA) is a significant public health concern in tropical countries. Traditional diagnostic methods, such as microscopy, have low sensitivity, and nested polymerase chain reaction (nPCR) has lengthy turnaround times. In this study, we aimed to evaluate the effectiveness of the recombinase polymerase amplification (RPA) assay for detecting Entamoeba histolytica in amoebic liver pus samples. The assay was tested on 150 clinical pus samples collected from suspected ALA patients in the emergency department of a tertiary care center located in Chandigarh, northern India. For comparison with RPA, nPCR was also performed on these samples. Of 150 samples, 79 (53%) tested positive for E. histolytica using the RPA assay, and similar (79; 53%) number of samples tested positive with nested PCR. In addition, sequences obtained through Sanger sequencing showed high similarity with other sequences in the National Center for Biotechnology Information database and were submitted to the database. Our findings highlight the potential of RPA as a valuable tool for the accurate diagnosis of ALA.

A Prospective Study on the Spectrum of Liver Abscess With Special Reference to Ruptured Abscess in a Tertiary Care Hospital.

Introduction Liver abscesses are one of the most concerning healthcare issues in Western countries, with a prevalence rate of three per 100,000. Although with the improvement in the socio-economic status and the health care system, its incidence has decreased in developed nations, pyogenic and amoebic liver abscesses are still high in resource-poor countries. Low socioeconomic conditions, improper hygiene, lack of awareness, and often a delay in diagnosis can lead to fatal complications and high mortality. Methods This prospective study was conducted in the Department of General Surgery, Calcutta National Medical College (CNMC) from 1st January 2019 to 31st August 2020 after obtaining approval from the Institute Ethical Committee (IRB no: EC-CNMC/2019/238/1). Patients over 10 years old with clinical and radiological features of liver abscesses were included in the study. Demographic, clinical, and treatment parameters were analyzed. Clinical and biochemical data were also compared statistically between ruptured and unruptured cases. Results Sixty patients with liver abscesses were included in the study. A pyogenic liver abscess (PLA) and amoebic liver abscess (ALA) were 28 and 32 cases, respectively. Most patients were between 21 and 40 years of age (53.3%, n=60), with male predominance (76.7%, n=60).The most common symptom was fever in both PLA (89.2%, n=28) and ALA (65.6%, n=32). Most abscesses were 5-10 cm in size (56.6%, n=60). Clinical parameters like pedal edema, ascites, respiratory distress, intercostal tenderness, and peritonitis were associated with ruptured abscesses. Biochemical parameters like low albumin raised total leucocyte count (TLC), increased prothrombin time, and large size of the abscess were predictors of ruptured abscess (p<0.001). Image-guided aspiration was performed in 14 patients (23.3%, n=60), and CT-guided percutaneous catheter drainage was done in 30 cases (50%, n=60). The most common organism isolated was E. coli. The ruptured abscess was diagnosed in six patients (10%, n=60). All ruptured abscesses required laparotomy and open surgical drainage. After three months of follow-up, a complete resolution of abscess cavities were seen in 38 patients (63.3%, n=60). Mortality in our study was 5 (8.3%, n=60). Conclusion Although modern diagnostic tools can efficiently diagnose liver abscesses, the identification of clinical features still has its place. Percutaneous catheter drainage is most commonly performed as a minimally invasive procedure without significant morbidity.Clinical suspicion of a ruptured liver abscess should be dealt without a delay. Improved hygiene and awareness can reduce its incidence, but early identification of clinical features, prompt diagnosis, and treatment can reduce mortality and morbidity.

Evaluation of Molecular Assays for Diagnosis of Amoebic Liver Abscess in India with Bayesian Latent Class Analysis.

Amoebic liver abscess (ALA) is the most common extra-intestinal complication of Entamoeba histolytica, accounting for 50,000 deaths annually, and is endemic in South Asia. Diagnosis based on microscopic examination is insensitive, and serological assays are not discerning of current infections in endemic settings with high exposure. For a rapid and confirmatory laboratory diagnosis of ALA, the performance of a polymerase chain reaction (PCR), quantitative real time PCR (qPCR), digital droplet PCR (ddPCR), and a loop-mediated isothermal amplification (LAMP) assay that detects E. histolytica DNA in liver abscess pus, and a lectin antigen detection ELISA were evaluated against clinical diagnosis (based on predefined criteria) as the gold standard. Owing to the lack of a laboratory gold standard, a Bayesian latent class analysis approach was also used to determine sensitivity and specificity of these assays. In the latent class analysis, qPCR and ddPCR showed the highest sensitivity (98% and 98.1%) and specificity (both 96.6%), and although clinical diagnosis had a comparable sensitivity to qPCR and ddPCR (95.2%), poorer specificity (64.3%) was seen. Kappa agreement analysis showed that qPCR and ddPCR had a perfect agreement of 1 followed by an agreement of 0.76 (95% CI: 0.64-0.88) with PCR. Considering the performance characteristics and relative ease of setting up qPCR as well as the wide availability of qPCR equipment needed, this would be the most optimal assay for rapid, confirmatory, molecular diagnosis of ALA in the tertiary care laboratory setting in India, whereas further optimization of LAMP or antibody-based detection is required for use at smaller or secondary hospitals.

Amoebic Liver Abscess Multifocal with Bilateral Parapneumonic Effusion: A Case Report

A liver abscess is defined as a pus-filled mass in the liver that can develop from injury to the liver or an intraabdominal infection disseminated from the portal circulation. The majority of these abscesses are categorized into pyogenic or amoebic, although a minority is caused by parasites and fungi. Most amoebic infections are caused by Entamoeba histolytica. Complications of amoebic liver is abscess Pleuropulmonary involvement, which is reported in 20–30% of patients. A male patient, 53 years old, was admitted to Hospital for Upper right abdominal pain, Fever, Cough, Pain in the lower right chest. Chest examination found weakened bronchovesicular breath sounds as high as RIC V, Pleural Friction Rub, wet crackles. Abdominal Examination found supel palpation, liver palpable 2 fingers below the arcus costae and 2 fingers below the process xiphoid, blunt edge, soft consistency, tenderness pain in the dextra hypochondrium. Laboratory report Anti Amoeba : Positive 40,3 unit. The patient was given intravenous metronidazole therapy 3x750 mg for 10 days. Complications of Amoebic Liver Abscess is Pleuropulmonary involvement. Pulmonary and pleural amebiasis is an uncommon disease, usually occurring on the right side of the lung compared to the left side. Pulmonary amoebiasis is a life-threatening, but treatable, condition.

Hepatic manifestation of a disease acquired during travel in Asia: amoebic liver abscess.

Hepatic manifestation of a disease acquired during travel in Asia: amoebic liver abscess.

Study of liver abscess in pediatrics patients in tertiary health care institute

liver abscess is mostly occurring due to the infection of bacteria, parasite like amoeba. The incidence of amoebic liver abscess varies all over the world and most of cases found in developing countries remain unreported. study of liver abscess in pediatric patients in tertiary health care institute. This was a prospective study, carried out in 64 at our tertiary care center, J K Lon Hospital, SMS Medical College, Jaipur from May 2022 to April 2023. We collect all data related to patients like demography, clinical features, laboratory finding, and imaging records and recorded on a pre-decided proforma. There were 64 patients (36 male, 56.25% and 28 females, 43.75%), The male to female ratio was 1.25:1. The mean age of presentation was 7.5 years. The common presenting symptom was anorexia in 55 (85.93%) cases. Most common symptom was abdominal pain in 60 (93.75%) cases, fever 58 (90.625%), and vomiting in 40 (62.5%%) cases. Diarrhoea was present in 5 patients. Anemia was most common clinical sign in present in 40 (62.5%) patients, weight loss 38 (59.37%). Respiratory distress was present in 4 (6.25%) due to pleural effusion and peritonitis cases. Jaundice was present in 5 (7.81%) . 5 case [7.81%] of patients had raised bilirubin and 28 patients [43.75%] had raised alkaline phosphatase levels. Raised SGOT and SGPT was 43.75 %. 34 patients of Amoebic liver abscess and 30 of Pyogenic liver abscess. 53.12% (34 cases) patients had amoebic liver abscess in the right lobe. less than 50 cc size of abscess was present in 24 patients (37.5%) cases. Most of the patients have cavity size 50-150cc. more than 200cc cavity found only in 10 cases. Average cavity size is 166cc. peritoneal ruptured liver abscess in 2 cases [3.12%%] had features of peritonitis, pleural effusion in 2 cases with complain of respiratory difficulties. Conservative medical management was done in 2 patients, USG guided needle aspiration 20 patients and 40 patients underwent pigtail catheter insertion. 12 fr pigtail catheter insertion was done in 30 patients and 10 patients underwent double pigtail catheter insertion. Exploration and drainage of liver abscess was done in 2 patients. In present study, mean hospital stay was 10.28 days. Hospital stays ranges from 5 to 17 days. Most of the patients stays 5 to 10 days [56.25%]. all amoebic liver abscesses were sterile. Most commonly found organism on pus culture was Staphylococcus in 25% cases followed by E. coli in 21.87% cases in pyogenic liver abscesses. from this study we found that ultrasonography is the standard modality for diagnostic and therapeutic management as well as for drainage and follow up. We also found that USG guided pigtail catheter drainage is a superior therapeutic approach than needle aspiration for large liver abscess, and abscess cavity resolves better in case of pigtail catheter drainage. We also concluded that ruptured liver abscess can also be managed with two pig tail catheter insertion.

Characterization of a model of liver regeneration: Role of hedgehog signaling in experimental hepatic amoebiasis

The development of amoebic liver abscess (ALA) leads to liver necrosis, accompanied by an exacerbated inflammatory response and the formation of multiple granulomas. Adequate management of the infection through the administration of treatment and the timely response of the organ to the damage allows the injury to heal with optimal regeneration without leaving scar tissue, which does not occur in other types of damage such as viral hepatitis that may conducts to fibrosis or cirrhosis. The Hedgehog signaling pathway (Hh) is crucial in the embryonic stage, while in adults it is usually reactivated in response to acute or chronic injuries, regeneration, and wound healing. In this work, we characterized Hh in experimental hepatic amoebiasis model, with the administration of treatment with metronidazole, as well as a pathway inhibitor (cyclopamine), through histological and immunohistochemical analyses including an ultrastructure analysis through transmission electron microscopy. The results showed an increase in the percentage of lesions obtained, a decrease in the presence of newly formed hepatocytes, a generalized inflammatory response, irregular distribution of type I collagen accompanied by the presence of fibroblast-type cells and a decrease in effector cells of this pathway. These results constitute the first evidence of the association of the activation of Hh with the liver regeneration process in experimental amebiasis.

Diagnosis of Clinically Suspected Amoebic Liver Abscess Using Conventional PCR and Antigen ELISA in Liver Aspirate and Serum

Diagnosis of Clinically Suspected Amoebic Liver Abscess Using Conventional PCR and Antigen ELISA in Liver Aspirate and Serum

Amoebic liver abscess in an adult Nigerian: A case report

Background: Amoebic liver abscess (ALA) is a parasitic infection caused by Entamoeba histolytica. ALA is a significant health concern, particularly in regions with poor sanitation and hygiene practices. Radiological imaging plays a crucial role in the diagnosis and management of ALA. Methods: We present a case report of a 40-year-old male patient with ALA. The patient presented to a radio diagnostic centre in Umuahia with right upper quadrant abdominal pain, fever,diarrhea and weight loss. Radiological evaluation was performed using abdominal ultrasound and contrast-enhanced CT scan. The imaging findings were correlated with clinical presentation and laboratory investigations. Results: The radiological findings revealed a focal hypoechoic lesion in the right hepatic lobe with ill-defined margins and internal echoes suggestive of liquefaction. The contrast-enhanced CT scan confirmed the presence of a well-defined, hypodense lesion with peripheral enhancement and central hypoattenuation. No evidence of biliary ductal dilatation or vascular invasion was observed. Based on the findings, a diagnosis of ALA was made, and the patient was initiated on intravenous metronidazole therapy. Follow-up imaging demonstrated a decrease in abscess size and resolution of internal echoes, indicating a positive response to treatment. Conclusion: Radiological imaging, including ultrasound and CT scan, plays a pivotal role in the diagnosis and management of ALA. The characteristic imaging findings, such as hypoechoic lesions with internal echoes and peripheral enhancement with central hypoattenuation, aid in differentiating ALA from other hepatic lesions. Early diagnosis and prompt initiation of appropriate therapy are crucial for favorable patient outcomes. Radiological follow-up allows monitoring of treatment response and guides further management decisions.

Enteropathogenic Escherichia coli modulates the virulence and pathogenicity of Entamoeba dispar

Amoebiasis is a disease caused by Entamoeba histolytica, affecting the large intestine of humans and occasionally leading to extra-intestinal lesions. Entamoeba dispar is another amoeba species considered commensal, although it has been identified in patients presenting with dysenteric and nondysenteric colitis, as well as amoebic liver abscess. Amoebic virulence factors are essential for the invasion and development of lesions. There is evidence showing that the association of enterobacteria with trophozoites contributes to increased gene expression of amoebic virulence factors. Enteropathogenic Escherichia coli is an important bacterium causing diarrhea, with high incidence rates in the world population, allowing it to interact with Entamoeba sp. in the same host. In this context, this study aims to evaluate the influence of enteropathogenic Escherichia coli on ACFN and ADO Entamoeba dispar strains by quantifying the gene expression of virulence factors, including galactose/N-acetyl-D-galactosamine-binding lectin, cysteine proteinase 2, and amoebapores A and C. Additionally, the study assesses the progression and morphological aspect of amoebic liver abscess and the profile of inflammatory cells. Our results demonstrated that the interaction between EPEC and ACFN Entamoeba dispar strains was able to increase the gene expression of virulence factors, as well as the lesion area and the activity of the inflammatory infiltrate. However, the association with the ADO strain did not influence the gene expression of virulence factors. Together, our findings indicate that the interaction between EPEC, ACFN, and ADO Entamoeba dispar strains resulted in differences in vitro and in vivo gene expression of Gal/GalNAc-binding lectin and CP2, in enzymatic activities of MPO, NAG, and EPO, and consequently, in the ability to cause lesions.

Amebic liver abscess: An update.

Amebic liver abscess (ALA) is still a common problem in the tropical world, where it affects over three-quarters of patients with liver abscess. It is caused by an anaerobic protozoan Entamoeba hystolytica, which primarily colonises the cecum. It is a non-suppurative infection of the liver consisting primarily of dead hepatocytes and cellular debris. People of the male gender, during their reproductive years, are most prone to ALA, and this appears to be due to a poorly mounted immune response linked to serum testosterone levels. ALA is more common in the right lobe of the liver, is strongly associated with alcohol consumption, and can heal without the need for drainage. While majority of ALA patients have an uncomplicated course, a number of complications have been described, including rupture into abdomino-thoracic structures, biliary fistula, vascular thrombosis, bilio-vascular compression, and secondary bacterial infection. Based on clinico-radiological findings, a classification system for ALA has emerged recently, which can assist clinicians in making treatment decisions. Recent research has revealed the role of venous thrombosis-related ischemia in the severity of ALA. Recent years have seen the development and refinement of newer molecular diagnostic techniques that can greatly aid in overcoming the diagnostic challenge in endemic area where serology-based tests have limited accuracy. Metronidazole has been the drug of choice for ALA patients for many years. However, concerns over the resistance and adverse effects necessitate the creation of new, safe, and potent antiamebic medications. Although the indication of the drainage of uncomplicated ALA has become more clear, high-quality randomised trials are still necessary for robust conclusions. Percutaneous drainage appears to be a viable option for patients with ruptured ALA and diffuse peritonitis, for whom surgery represents a significant risk of mortality. With regard to all of the aforementioned issues, this article intends to present an updated review of ALA.

Epidemiology and factors associated with amoebic liver abscess at a tertiary care hospital in Northern India

Liver abscess is a collection of purulent material in the liver most commonly seen in the tropical countries. It can sometimes lead to significant morbidity and mortality if not treated timely and adequately. Through this study we wish to put light upon the current status of clinical aspects, laboratory features, and outcomes of liver abscess. The study was conducted at a tertiary care hospital in Northern India in the period of August 2020 to July 2021. All patients diagnosed with liver abscess of size &amp;#62;5 cm or left lobe liver abscess of any size were included in the study. All relevant laboratory investigations were conducted. The outcomes were noted and data was entered in MS Excel sheet. Analysis was done using SPSS version 26. Sixty-three patients were included in the study. A male predominance was noted. Mean age at presentation was 37.8 years. Most patients were part of the lower socioeconomic class. Pain abdomen and fever were the most common presenting symptoms. Amoebic liver abscess was much more frequently seen than pyogenic liver abscess. Deranged coagulation profile was seen in 88.9% patients. 85.7% patients were amenable to treatment with minimal intervention. Mortality as an outcome was seen in 9.5% patients Significant correlation was found between various laboratory parameters and outcomes such as length of hospital stay and mortality. Early diagnosis and treatment is crucial in management of patients with liver abscess even today.

The Effect of Contrast-enhanced Ultrasound via Vessels and Surgical Drains Guidance Percutaneous Catheter Drainage in the Treatment of Pyogenic Liver Abscess.

Pyogenic liver abscess (PLA) is a purulent disease caused by microbial contamination of liver parenchyma and includes amoebic liver abscess, fungal liver abscess, and the most common bacterial liver abscess. Explore the efficacy of contrast-enhanced ultrasound (CEUS) via vessels and surgical drain guidance percutaneous catheter drainage (PCD) in the treatment of pyogenic liver abscesses (PLA). A total of 86 PLA patients who underwent PCD treatment in our hospital from May 2018 to February 2023 were retrospectively selected. Of them, 41 patients were treated under intravenous CEUS guidance (Control group), and 45 patients were treated under CEUS via vessels and surgical drain guidance (study group). Perioperative characteristics, treatment effectiveness, and incidence of complications were analyzed and compared between groups. The duration of surgery, drainage, white blood cell recovery, body temperature recovery, and hospitalization in the study group were longer than those in the control group (P<0.05). The total effective rate of the study group (95.56%) was higher than that of the control group (80.49%) (P<0.05). The incidence of complications in the study group (4.44%) was lower than that in the control group (19.51%) (P<0.05). Compared with intravenous CEUS alone, treatment under CEUS via vessels and surgical drains-guided PCD was associated with shorter surgical time, faster recovery, better treatment effect, lower risk of complications, and ensured treatment safety in PLA patients.

Amoebic Liver Abscess: Potential Application of New Diagnostic Techniques for an Old Pathogen.

Amoebic liver abscess is a severe and potentially life-threatening infection requiring prompt diagnosis and early targeted treatment. Diagnosis is challenging because conventional diagnostic methods such as light microscopy and serology are often unreliable. Molecular techniques have emerged as an additional diagnostic tool, suddenly becoming the new diagnostic reference standard. More recently, commercial multiplex PCR panels, including FilmArray, have been introduced, which permit the simultaneous detection of several enteric pathogens including Entamoeba histolytica in stool samples. We report a case of an amoebic liver abscess promptly diagnosed by FilmArray gastrointestinal panel performed on liver drainage fluid.

Revisiting the isolation and characterisation of Entamoeba histolytica lipopeptidophosphoglycan

The parasite Entamoeba histolytica is the cause of amoebic dysentery and liver abscess in humans. On the protozoan cell surface, a variety of glycosylated molecules are involved in the interaction with the environment, such as attachment to the colonic mucus. One of these molecules is the lipopeptidophosphoglycan (LPPG), a complex surface component with antigenic properties. Its structure is only partly known, it is a glycosylphosphatidylinositol (GPI)-linked glycoprotein with a large amount of O-glycosylation. To date, the sequence of a core protein has not been identified. In this study, we further investigated this complex surface molecule aided by the availability of the monoclonal antibody EH5, which had been raised in our laboratory. We studied the extraction of LPPG in various solvent mixtures and discovered that 2-butanol saturated water was simple and superior to other solvents used in the past. The isolated LPPG was subjected to treatment with several proteases and the Ser/Thr specific cleavage agent scandium (III) trifluoromethanesulfonate (scandium triflate). The products were probed with antibody EH5 and the blots showed that the LPPG preparation was largely resistant to standard proteases, but could be cleaved by the scandium compound. These observations could point to the existence of a Ser- or Thr-rich core protein structure.

Multi-locus sequence analysis reveals phylogenetically segregated Entamoeba histolytica population.

Amoebiasis, caused by the enteric parasite, Entamoeba histolytica, is one of the major food- and water-borne parasitic diseases in developing countries with improper sanitation and poor hygiene. Infection with E. histolytica has diverse disease outcomes, which are determined by the genetic diversity of the infecting strains. Comparative genetic analysis of infecting E. histolytica strains associated with differential disease outcomes from different geographical regions of the world is important to identify the specific genetic patterns of the pathogen that trigger certain disease outcomes of Amoebiasis. The strategy is able to elucidate the genealogical relation and population structure of infecting E. histolytica strains from different geographical regions. In the present study, we have performed a comparative genetic analysis of circulating E. histolytica strains identified from different parts of the world, including our study region, based on five tRNA-linked short tandem repeat (STR) loci (i.e., D-A, NK2, R-R, STGA-D and A-L) and evaluated their potential associations with differential disease outcomes of Amoebiasis. A number of regional-specific, emerging haplotypes of E. histolytica, significantly associated with specific disease outcomes have been identified. Haplotypes, which have a significant positive association with asymptomatic and amoebic liver abscess outcomes, showed a significant negative association with diarrheal outcome, or vice versa. Comparative multi-locus analysis revealed that E. histolytica isolates from our study region are phylogenetically segregated from the isolates of other geographical regions. This study provides a crucial overview of the population structure and emerging pattern of the enteric parasite, E. histolytica.

Practical approach to a patient with fever who travelled to the tropics.

By 2030, an estimated 2 billion international tourist trips are expected annually worldwide, with citizens of Poland as important contributors. Illness rates among returnees from developing regions range between 43% and 79%. Properly diagnosing fever in these travelers is vital due to potentially serious implications. After visiting tropical and subtropical zones, the main health complaints are diarrhea, fever, and skin lesions. A reliable diagnosis begins with taking a comprehensive travel history and identifying potential risks. In travelers returning from sub‑Saharan Africa, malaria caused by Plasmodium falciparum is the main cause of fever, affecting 50 in every 1000 cases. Among returnees from Southeast Asia, dengue is dominant, occurring in 50-60 per 1000 cases, and its prevalence rises significantly nowadays. Other significant diseases include chikungunya, Zika, typhoid fever, amebic liver abscess, and occasionally viral hemorrhagic fevers. SARS‑CoV‑2 and influenza viruses are crucial pathogens as well. An in‑depth assessment of the travel history, combined with knowledge on tropical diseases, are key to the diagnostic process, and algorithms may be helpful in selecting appropriate tests and treatment methods.