12
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Approach to amoebic colitis: Epidemiological, clinical and diagnostic considerations in a non-endemic context (Barcelona, 2007-2017)

      research-article

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Background

          Amoebic colitis is the most frequent clinical manifestation of invasive intestinal infection due to Entamoeba histolytica and a common cause of diarrhoea worldwide. Since higher transmission rates are usually related to poor health and exposure to unhygienic conditions, cases reported in Europe usually involve immigrants and international travellers. The goal of this study was to characterise both the clinical and the epidemiological features of a European population diagnosed with amoebic colitis and then to evaluate the diagnostic tools and therapeutic options applied.

          Methods and results

          This was a retrospective observational study in which data from all patients diagnosed with amoebic colitis attending at the International Health Units of two tertiary referral hospitals, Germans Trias i Pujol University Hospital (Badalona, North Barcelona Metropolitan Area) and Vall d’Hebron University Hospital (Barcelona city) between 2007 and 2017 were analysed. During the study period 50 patients were diagnosed with amoebic colitis. Thirty-six (72%) were men, and immigrants accounted for 46% of all cases. Antecedents of any international travel were reported for 28 (56%), the most frequent destinations having been the Indian subcontinent, South and Central America and sub-Saharan Africa. Preexisting pathological conditions or any kind of immunosuppression were identified in 29 (58%) patients; of these, 13 (26%) had HIV infection—all of them men who have sex with men—and 5 (10%) had inflammatory bowel disease. Diarrhoea, abdominal pain and dysentery were the most frequently recorded symptoms of invasive amoebae. Diagnosis was made through microbiological study in 45 (90%) and/or histological identification of amoebae in colon biopsies in 10 (20%). After treatment with metronidazole (82%) or tinidazole (8%), all patients had good outcomes. Post-acute intraluminal treatment was indicated in 28 (56%).

          Conclusions

          Amoebic colitis should be suspected in patients with diarrhoea and compatible epidemiological risk factors (immigration, travelling abroad or men who have sex with men), especially if some degree of immunosuppression concurs. These risk factors must be taken into account in any diagnostic approach to inflammatory bowel disease (IBD), and active searches for stool parasites should be performed in such cases to rule out misdiagnosis or simultaneous amoebic infection. Treatment should include intraluminal anti-amoebic treatment in order to avoid relapse and prevent further spread of the disease.

          Related collections

          Most cited references24

          • Record: found
          • Abstract: found
          • Article: not found

          Amoebiasis.

          Amoebiasis is the second leading cause of death from parasitic disease worldwide. The causative protozoan parasite, Entamoeba histolytica, is a potent pathogen. Secreting proteinases that dissolve host tissues, killing host cells on contact, and engulfing red blood cells, E histolytica trophozoites invade the intestinal mucosa, causing amoebic colitis. In some cases amoebas breach the mucosal barrier and travel through the portal circulation to the liver, where they cause abscesses consisting of a few E histolytica trophozoites surrounding dead and dying hepatocytes and liquefied cellular debris. Amoebic liver abscesses grow inexorably and, at one time, were almost always fatal, but now even large abscesses can be cured by one dose of antibiotic. Evidence that what we thought was a single species based on morphology is, in fact, two genetically distinct species--now termed Entamoeba histolytica (the pathogen) and Entamoeba dispar (a commensal)--has turned conventional wisdom about the epidemiology and diagnosis of amoebiasis upside down. New models of disease have linked E histolytica induction of intestinal inflammation and hepatocyte programmed cell death to the pathogenesis of amoebic colitis and amoebic liver abscess.
            Bookmark
            • Record: found
            • Abstract: not found
            • Article: not found

            Amebiasis.

              Bookmark
              • Record: found
              • Abstract: not found
              • Article: not found

              Strongyloides stercoralis in the Immunocompromised Population

                Bookmark

                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: MethodologyRole: Writing – original draft
                Role: Writing – review & editing
                Role: Data curationRole: Investigation
                Role: Data curation
                Role: Investigation
                Role: Investigation
                Role: Data curationRole: Investigation
                Role: Formal analysisRole: Investigation
                Role: Investigation
                Role: Supervision
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                21 February 2019
                2019
                : 14
                : 2
                : e0212791
                Affiliations
                [1 ] Infectious Disease Department, North Metropolitan International Health Unit PROSICS, Germans Trias i Pujol University Hospital, Universitat Autònoma de Barcelona, Badalona, Spain
                [2 ] North Metropolitan International Health Unit PROSICS, Institut Català de la Salut, Santa Coloma de Gramenet, Barcelona, Spain
                [3 ] Infectious Disease Department, Vall d’Hebron University Hospital, PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
                [4 ] Microbiology Depatment, Clinical Laboratory North Metropolitan Area, Germans Trias i Pujol University Hospital, Departament of Genetics and Microbiology, Autonomous University of Barcelona, Badalona, Spain
                [5 ] Microbiology Department, Vall d’Hebron University Hospital. PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
                [6 ] Inflammatory Bowel Disease Unit, Gastroenterology Department,Germans Trias i Pujol University Hospital and Centro de Investigaciones Biomédicas en Red de Enfermedades Hepáticas y Digestivas, Badalona, Spain
                [7 ] Infectious Diseases Department, Germans Trias i Pujol University Hospital, Universitat Autònoma de Barcelona, Badalona, Spain
                [8 ] Department of Pathological Anatomy, Germans Trias i Pujol University Hospital, Badalona, Spain
                [9 ] Infectious Disease Department, AIDS Research Institute-IrsiCaixa, Germans Trias i Pujol University Hospital, Universitat Autònoma de Barcelona, Badalona, Spain
                University of Witwatersrand/NHLS, SOUTH AFRICA
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0002-7982-0890
                http://orcid.org/0000-0002-3324-0225
                Article
                PONE-D-18-28744
                10.1371/journal.pone.0212791
                6383915
                30789955
                c7521dea-ca80-41d3-83b4-ea11249e8687
                © 2019 Roure et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 3 October 2018
                : 8 February 2019
                Page count
                Figures: 1, Tables: 3, Pages: 10
                Funding
                The authors received no specific funding for this work.
                Categories
                Research Article
                Medicine and Health Sciences
                Gastroenterology and Hepatology
                Inflammatory Bowel Disease
                Colitis
                Medicine and Health Sciences
                Diagnostic Medicine
                Biology and Life Sciences
                Organisms
                Eukaryota
                Protozoans
                Parasitic Protozoans
                Entamoeba Histolytica
                Medicine and Health Sciences
                Gastroenterology and Hepatology
                Inflammatory Bowel Disease
                Medicine and Health Sciences
                Tropical Diseases
                Neglected Tropical Diseases
                Amebiasis
                Medicine and Health Sciences
                Parasitic Diseases
                Parasitic Intestinal Diseases
                Amebiasis
                Medicine and Health Sciences
                Parasitic Diseases
                Protozoan Infections
                Amebiasis
                Biology and Life Sciences
                Anatomy
                Digestive System
                Gastrointestinal Tract
                Colon
                Medicine and Health Sciences
                Anatomy
                Digestive System
                Gastrointestinal Tract
                Colon
                Biology and Life Sciences
                Parasitology
                Parasite Groups
                Apicomplexa
                Trophozoites
                Medicine and Health Sciences
                Gastroenterology and Hepatology
                Diarrhea
                Medicine and Health Sciences
                Diagnostic Medicine
                Signs and Symptoms
                Diarrhea
                Medicine and Health Sciences
                Pathology and Laboratory Medicine
                Signs and Symptoms
                Diarrhea
                Custom metadata
                All relevant data are within the manuscript.

                Uncategorized
                Uncategorized

                Comments

                Comment on this article