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      Evaluación del diagnóstico de amibiasis en laboratorios notificantes del estado Carabobo Translated title: Assessing amoebiasis diagnosis in notifying laboratories of Carabobo State


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          El diagnóstico de la amibiasis ha estado basado por décadas en el análisis microscópico. Sin embargo, conociendo la existencia de amibas no patógenas morfológicamente similares a Entamoeba histolytica, este procedimiento tiene sus criterios de análisis establecidos por la OMS que permiten obtener un diagnóstico más preciso. El desconocimiento de estos criterios ha llevado a una sobreestimación de esta parasitosis. En el marco de una investigación descriptiva, no experimental y transversal, se aplicó una encuesta, previa validación y consentimiento informado al analista presente en el momento de la entrevista, representando la muestra que estuvo conformada por 20 laboratorios distribuidos en 10 municipios del Estado Carabobo. Se pudo constatar, que 65% de los laboratorios cuenta con infraestructura adecuada. El 15% posee equipamiento para el diagnóstico serológico. Ninguno de los laboratorios posee microscopios con un micrómetro. El 65% del personal debe rotar por más de dos áreas de trabajo y 85% procesa las muestras de heces después de dos horas de recibida. El 45% de los encuestados aplica criterios de rechazo de las muestras pero sólo 40% da instrucciones acerca de su recolección. El 100% de los encuestados omite el uso de métodos de concentración, coloraciones especiales y uso del objetivo de inmersión. Sólo 10% afirma reportar el Complejo Entamoeba histolytica/dispar y 20% haber reportado a E. hartmanni. El 75% del personal desconoce las pautas de la OMS. Se concluye que en los laboratorios evaluados, el cumplimiento de la normativa para una adecuado y preciso diagnóstico de E. histolytica es deficiente.

          Translated abstract

          For decades the diagnosis of amoebiasis has been based on microscopic analysis. However, due to the existence of nonpathogenic amoebae morphologically similar to E. histolytica, for a more accurate diagnosis WHO provides some criteria for this procedure. Ignorance about analysis criteria has led to an overestimation of this parasitic infection. Through a descriptive, nonexperimental and cross-sectional survey and prior validation and informed consent, analysts participating in an interview represented the sample which consisted of 20 laboratories distributed in 10 municipalities of Carabobo State. Absolute and relative frequencies obtained by statistical data processing software (SPSS 11.0) showed that 65% of laboratories have appropriate infrastructure and reference material. 15% have equipment for serological diagnosis. None of the laboratories has a microscope with a micrometer. 65% of the staff has to rotate through two work areas, and 85% processes stool samples after two hours of reception. 45% of analysts apply sample rejection criteria and only 40% provide instructions about proper collection. 100% omitted the use of concentration methods, special stains and using immersion objective. Only 10% reported E. histolytica/dispar complex and 20% mentioned reporting E. hartmanni. 75% of analysts are unaware of WHO guidelines. We conclude that in the assessed laboratories, compliance with regulations for a proper and accurate diagnosis of E. histolytica is poor.

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          Most cited references43

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          Laboratory diagnostic techniques for Entamoeba species.

          The genus Entamoeba contains many species, six of which (Entamoeba histolytica, Entamoeba dispar, Entamoeba moshkovskii, Entamoeba polecki, Entamoeba coli, and Entamoeba hartmanni) reside in the human intestinal lumen. Entamoeba histolytica is the causative agent of amebiasis and is considered a leading parasitic cause of death worldwide in humans. Although recent studies highlight the recovery of E. dispar and E. moshkovskii from patients with gastrointestinal symptoms, there is still no convincing evidence of a causal link between the presence of these two species and the symptoms of the host. New approaches to the identification of E. histolytica are based on detection of E. histolytica-specific antigen and DNA in stool and other clinical samples. Several molecular diagnostic tests, including conventional and real-time PCR, have been developed for the detection and differentiation of E. histolytica, E. dispar, and E. moshkovskii in clinical samples. The purpose of this review is to discuss different methods that exist for the identification of E. histolytica, E. dispar, and E. moshkovskii which are available to the clinical diagnostic laboratory. To address the need for a specific diagnostic test for amebiasis, a substantial amount of work has been carried out over the last decade in different parts of the world. The molecular diagnostic tests are increasingly being used for both clinical and research purposes. In order to minimize undue treatment of individuals infected with other species of Entamoeba such as E. dispar and E. moshkovskii, efforts have been made for specific diagnosis of E. histolytica infection and not to treat based simply on the microscopic examination of Entamoeba species in the stool. The incorporation of many new technologies into the diagnostic laboratory will lead to a better understanding of the public health problem and measures to control the disease.
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            A Redescription of Entamoeba Histolytica Schaudinn, 1903 (Emended Walker, 1911) Separating It From Entamoeba Dispar Brumpt, 1925

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              Value of microscopy in the diagnosis of dysentery associated with invasive Entamoeba histolytica.

              To assess the reliability of the detection of erythrophagocytic amoebic trophozoites in stool samples in the diagnosis of dysentery associated with invasive Entamoeba histolytica. Amoebic culture was carried out on single stool samples collected from patients from Mexico, Colombia, and Bangladesh. The stools had been examined by light microscopy. Amoebic dysentery was diagnosed when erythrophagocytic E histolytica trophozoites were observed in a case of bloody diarrhoea. E histolytica isolates were characterised by isoenzyme electrophoresis and results correlated with microscopical findings in stools. Statistical analysis was performed using the chi 2 test. Where erythrophagocytic amoebae had been observed in dysenteric stool specimens the E histolytica phenotype was invariably invasive (p < 0.0001). Observation of erythrophagocytic amoebae in dysentery is 100% specific and predictive of infection with invasive E histolytica. When amoebic culture-positive cases only are considered it is 96% sensitive. In this study E histolytica of zymodeme XIV was more commonly associated with amoebic dysentery than zymodeme II. There was no significant difference between the carriage rate of invasive and non-invasive E histolytica in non-dysenteric diarrhoea. Asymptomatic subjects carried non-invasive E histolytica more frequently than invasive E histolytica. Patients with non-amoebic dysentery, when shown to be infected with E histolytica, carried non-invasive strains (12%). Sensitivity and specificity of microscopical examination of a single stool specimen for diagnosing amoebic dysentery is very high; intestinal carriage of invasive E histolytica detected by culture is not necessarily an indication of active disease as patients with diarrhoea and asymptomatic subjects shed invasive and non-invasive E histolytica. There are possibly two subpopulations of invasive E histolytica with different pathogenic potential which can be differentiated by zymodeme analysis.

                Author and article information

                Universidad de Carabobo (Valencia, Carabobo, Venezuela )
                April 2015
                : 19
                : 1
                : 20-26
                [02] Valencia Carabobo orgnameUniversidad de Carabobo orgdiv1Facultad de Ciencias de la Salud orgdiv2Escuela de Bioanálisis
                [01] Valencia Carabobo orgnameUniversidad de Carabobo orgdiv1Escuela de Ciencias Biomédicas y Tecnológicas orgdiv2Departamento de Parasitología
                S1316-71382015000100005 S1316-7138(15)01900105


                : 26 November 2014
                : 04 March 2015
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 30, Pages: 7

                SciELO Venezuela

                Self URI: Texto completo solamente en formato PDF (ES)

                Entamoeba histolytica,Entamoeba dispar,Entamoeba hartmanni,trophozoites,chromatoid bodies,trofozoítos,cuerpos cromatoides


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