Amoebic liver abscess other diagnostic studies

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Yamuna Kondapally, M.B.B.S[2]

Overview

Other Diagnostic Tests

Needle aspiration

  • Needle aspiration is used to differentiate between amoebic and pyogenic liver abscess
  • The ultrasound and CT are used to guide percutaneous aspiration and drainage.
  • The aspirated fluid is odorless unless secondarily infected
  • The pathognomonic of the aspirate is the reddish-brown anchovy paste appearance, which indicates that the abscess has been present for weeks.
  • The trophozoites are present only in the wall of the abscess. Rest of abscess is composed of lysed leukocytes.
Laboratory Method Findings
Microscopy
  • Microscopic techniques include 1. Wet preparation 2. Concentration 3. Permanently stained smears[1]
  • Less reliable method than culture or antigen detection test[2][3]
  • Minimum three stool samples are examined for ova and parasites within 10days of sample collection as organisms are excreted intermittently[4]
  • Presence of RBCs in trophozoites is diagnostic of Entamoeba histolytica
  • The specificity of the test is low as the trophozoites containing RBCs are not present in all cases and E dispar may also contain RBCs in trophozoites[5][6]
Wet (Saline) preparation
  • Very insensitive method (<10%) Procedure
  • The sample is a fresh specimen that should be examined within 1 hr of collection
  • The test is positive when RBCs in trophozoites are detected
  • It is not used in patients without acute dysentery as trophozoites will not contain RBCs
Concentration Technique
  • It is helpful in detecting cysts in the stool sample in asymptomatic carriers
Permanently stained smears
  • This is an important method for identification and recovery of Entamoeba species
Culture Methods
  • The specimens for the culture of E histolytica include fecal specimens, rectal biopsy specimens or liver abscess aspirates.
  • There are two culture techniques. They are xenic and axenic systems.[7]
  • Culture of E histolytica is less sensitive than microscopy as a detection method.
  • Parasite cultures are expensive, labor intensive and difficult to maintain in the diagnostic laboratory.

Disadvantage

  • Culture is not recommended as the routine diagnostic test due to overgrowth of other organisms like bacteria and fungi in the culture media.
Isoenzyme analysis
  • Isoenzyme analysis is useful in the differentiation of Entamoeba species.[8][9][10]
  • There are three isoenzymes (zymodyme) for E histolytica and one for E dispar.
  • This techniques helps in differentiation of E histolytica and E dispar and is considered gold standard for diagnosing amoebic infection prior to development of newer DNA-based techniques.

Disadvantages

  • Difficult to perform test, time-consuming procedure, and not always successful.
  • The isoenzyme analysis is negative for many microscopy positive stool samples[5][11][12][6]
Antibody Detection Tests
  • Antibody detection tests are useful in the case of amoebic liver abscess as patients do not have detectable parasites in feces.
  • The sensitivity of the test is 100% in patients with amoebic liver abscess. The techniques include enzyme-linked immunosorbent assay (ELISA), indirect hemagglutination (IHA), latex agglutination, immunoelectrophoresis, counterimmunoelectrophoresis (CIE), the amebic gel diffusion test, immunodiffusion, complement fixation, and indirect immunofluorescence assay (IFA).

ELISA

  • Useful in the diagnosis of asymptomatic and symptomatic amoebiasis after fecal examination.
  • Useful in amoebic liver abscess and in the evaluation of intestinal and extraintestinal infections where organisms cannot be detected in feces but amebiasis is suspected.[13]
  • Easy to perform in the clinical laboratory.
  • The presence of IgM antibodies indicates current infection and IgG antibodies persists for years after E histolytica infection.[14]
  • Presence of antilectin antibodies are frequently used for the diagnosis of patients with amoebic liver abscess.[15]
  • The sensitivity is 95%. It is a useful test for the diagnostic clinical laboratory as this test does not have cross reaction with other non-Entamoeba histolytica species.[16][17][18][19][2]
Antigen Detection Tests
  • The antigen detection tests use monoclonal antibodies against the Gal/GalNAc-specific lectin of E. histolytica or against serine-rich antigen of E. histolytica.
  • This test is useful in differentiation of disease causing E histolytica as there are antigenic differences in the lectins of E histolytica and E dispar.
  • The test has good sensitivity and specificity for the detection of E histolytica antigen in stool specimens of patients with amoebic colitis and asymptomatic intestinal infection.[20][11][12]
Immunochromatographic Assays

DNA-Based Diagnostic Tests

Laboratory Methods Findings
Manual Methods
Automated Methods
Conventional PCR
Real-Time PCR
Microarray Development
Typing Methods

References

  1. Huston CD, Haque R, Petri WA (1999). "Molecular-based diagnosis of Entamoeba histolytica infection". Expert Rev Mol Med. 1999: 1–11. doi:doi:10.1017/S1462399499000599 Check |doi= value (help). PMID 14987356.
  2. 2.0 2.1 Tanyuksel M, Petri WA (2003). "Laboratory diagnosis of amebiasis". Clin Microbiol Rev. 16 (4): 713–29. PMC 207118. PMID 14557296.
  3. Krogstad DJ, Spencer HC, Healy GR, Gleason NN, Sexton DJ, Herron CA (1978). "Amebiasis: epidemiologic studies in the United States, 1971-1974". Ann Intern Med. 88 (1): 89–97. PMID 619763.
  4. Li E, Stanley SL (1996). "Protozoa. Amebiasis". Gastroenterol Clin North Am. 25 (3): 471–92. PMID 8863036.
  5. 5.0 5.1 González-Ruiz A, Haque R, Aguirre A, Castañón G, Hall A, Guhl F; et al. (1994). "Value of microscopy in the diagnosis of dysentery associated with invasive Entamoeba histolytica". J Clin Pathol. 47 (3): 236–9. PMC 501902. PMID 8163695.
  6. 6.0 6.1 Strachan WD, Chiodini PL, Spice WM, Moody AH, Ackers JP (1988). "Immunological differentiation of pathogenic and non-pathogenic isolates of Entamoeba histolytica". Lancet. 1 (8585): 561–3. PMID 2894495.
  7. Clark CG, Diamond LS (2002). "Methods for cultivation of luminal parasitic protists of clinical importance". Clin Microbiol Rev. 15 (3): 329–41. PMC 118080. PMID 12097242.
  8. Sargeaunt PG, Jackson TF, Wiffen S, Bhojnani R, Williams JE, Felmingham D; et al. (1987). "The reliability of Entamoeba histolytica zymodemes in clinical laboratory diagnosis". Arch Invest Med (Mex). 18 (2): 69–75. PMID 2889435.
  9. Blanc D, Sargeaunt PG (1991). "Entamoeba histolytica zymodemes: exhibition of gamma and delta bands only of glucose phosphate isomerase and phosphoglucomutase may be influenced by starch content in the medium". Exp Parasitol. 72 (1): 87–90. PMID 1825198.
  10. Jackson TF, Suparsad S (1997). "Zymodeme stability of Entamoeba histolytica and E. dispar". Arch Med Res. 28 Spec No: 304–5. PMID 9033111.
  11. 11.0 11.1 Haque R, Faruque AS, Hahn P, Lyerly DM, Petri WA (1997). "Entamoeba histolytica and Entamoeba dispar infection in children in Bangladesh". J Infect Dis. 175 (3): 734–6. PMID 9041357.
  12. 12.0 12.1 Haque R, Neville LM, Hahn P, Petri WA (1995). "Rapid diagnosis of Entamoeba infection by using Entamoeba and Entamoeba histolytica stool antigen detection kits". J Clin Microbiol. 33 (10): 2558–61. PMC 228528. PMID 8567882.
  13. Rosenblatt JE, Sloan LM, Bestrom JE (1995). "Evaluation of an enzyme-linked immunoassay for the detection in serum of antibodies to Entamoeba histolytica". Diagn Microbiol Infect Dis. 22 (3): 275–8. PMID 8565416.
  14. Abd-Alla MD, Jackson TG, Ravdin JI (1998). "Serum IgM antibody response to the galactose-inhibitable adherence lectin of Entameoba histolytica". Am J Trop Med Hyg. 59 (3): 431–4. PMID 9749639.
  15. Ravdin JI, Jackson TF, Petri WA, Murphy CF, Ungar BL, Gathiram V; et al. (1990). "Association of serum antibodies to adherence lectin with invasive amebiasis and asymptomatic infection with pathogenic Entamoeba histolytica". J Infect Dis. 162 (3): 768–72. PMID 2388003.
  16. Braga LL, Mendonca Y, Paiva CA, Sales A, Cavalcante AL, Mann BJ (1998). "Seropositivity for and intestinal colonization with Entamoeba histolytica and entamoeba dispar in individuals in northeastern Brazil". J Clin Microbiol. 36 (10): 3044–5. PMC 105108. PMID 9738064.
  17. Goncalves ML, da Silva VL, de Andrade CM, Reinhard K, da Rocha GC, Le Bailly M; et al. (2004). "Amoebiasis distribution in the past: first steps using an immunoassay technique". Trans R Soc Trop Med Hyg. 98 (2): 88–91. PMID 14964807.
  18. Grundy MS (1982). "Preliminary observations using a multi-layer ELISA method for the detection of Entamoeba histolytica trophozoite antigens in stool samples". Trans R Soc Trop Med Hyg. 76 (3): 396–400. PMID 6287685.
  19. Shamsuzzaman SM, Haque R, Hasin SK, Hashiguchi Y (2000). "Evaluation of indirect fluorescent antibody test and enzyme-linked immunosorbent assay for diagnosis of hepatic amebiasis in Bangladesh". J Parasitol. 86 (3): 611–5. doi:10.1645/0022-3395(2000)086[0611:EOIFAT]2.0.CO;2. PMID 10864262.
  20. Haque R, Ali IK, Akther S, Petri WA (1998). "Comparison of PCR, isoenzyme analysis, and antigen detection for diagnosis of Entamoeba histolytica infection". J Clin Microbiol. 36 (2): 449–52. PMC 104557. PMID 9466756.