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Increased risk for Entamoeba histolytica infection and invasive amebiasis in HIV seropositive men who have sex with men in Taiwan.

Hung CC, Ji DD, Sun HY, Lee YT, Hsu SY, Chang SY, Wu CH, Chan YH, Hsiao CF, Liu WC, Colebunders R - PLoS Negl Trop Dis (2008)

Bottom Line: The CD4 count at diagnosis of IA was significantly higher than that of the whole cohort (215 cells/microL vs. 96 cells/microL).In multiple logistic regression analysis, only MSM was significantly associated with acquisition of E. histolytica infection (adjusted odds ratio, 14.809; p = 0.01).Despite immunosuppression, amebic liver abscesses and colitis responded favorably to treatment.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.

ABSTRACT

Background: Incidence of Entamoeba histolytica infection and clinical manifestations and treatment response of invasive amebiasis (IA) in HIV-infected patients have rarely been investigated before.

Methodology/principal findings: At the National Taiwan University Hospital, medical records of HIV-infected patients who received a diagnosis of IA between 1994 and 2005 were reviewed. The incidence of amebiasis was investigated in serial blood and stool samples from 670 and 264 HIV-infected patients, respectively, using serological and specific amebic antigen assays. DNA extracted from stool samples containing E. histolytica were analyzed by PCR, sequenced, and compared. Sixty-four (5.8%) of 1,109 HIV-infected patients had 67 episodes of IA, and 89.1% of them were men having sex with men (MSM). The CD4 count at diagnosis of IA was significantly higher than that of the whole cohort (215 cells/microL vs. 96 cells/microL). Forty episodes (59.7%) were liver abscesses, 52 (77.6%) colitis, and 25 (37.3%) both liver abscesses and colitis. Fever resolved after 3.5 days of metronidazole therapy (range, 1-11 days). None of the patients died. The incidence of E. histolytica infection in MSM was higher than that in other risk groups assessed by serological assays (1.99 per 100 person-years [PY] vs. 0 per 100 PY; p<0.0001) and amebic antigen assays (3.16 per 100 PY vs. 0.68 per 100 PY; p = 0.12). In multiple logistic regression analysis, only MSM was significantly associated with acquisition of E. histolytica infection (adjusted odds ratio, 14.809; p = 0.01). Clustering of E. histolytica isolates by sequencing analyses from geographically-unrelated patients suggested person-to-person transmission.

Conclusions/significance: HIV-infected MSM were at significantly higher risk of amebiasis than patients from other risk groups. Despite immunosuppression, amebic liver abscesses and colitis responded favorably to treatment.

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Related in: MedlinePlus

Abdominal computed tomography showing multiple liver abscesses of a 28-year-old male homosexual who presented with right upper quadrant pain, vomiting, and watery diarrhea for 4 days.Diagnosis of amebic liver abscess was confirmed by positive PCR for Entamoeba histolytica of the liver abscess aspirate. The titer of indirect hemagglutination antibody for E. histolytica was 8192.
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pntd-0000175-g001: Abdominal computed tomography showing multiple liver abscesses of a 28-year-old male homosexual who presented with right upper quadrant pain, vomiting, and watery diarrhea for 4 days.Diagnosis of amebic liver abscess was confirmed by positive PCR for Entamoeba histolytica of the liver abscess aspirate. The titer of indirect hemagglutination antibody for E. histolytica was 8192.

Mentions: During the 11-year study period, 64 (5.8%) HIV-infected patients were diagnosed as having 67 cases of IA (Table 1). All of the 64 patients were males and 57 (89.1%) were MSM. MSM had a higher risk of invasive amebiasis compared with other risk groups: 57/781 vs. 7/328 (risk ratio, 3.42; 95% CI, 1.5777, 7.417). In 29 cases (43.8%), HIV infection was concurrently diagnosed with IA. The CD4 count at diagnosis of IA was significantly higher than that of the whole cohort (215 cells?L vs. 96 cells?L). Fever (72.6%), diarrhea (70.8%), right upper quadrant pain (32.3%), and dysentery (20.6%) were the most common symptoms of IA. Fifty-two (77.6%) of the 67 IA episodes were amebic colitis, 40 (59.7%) episodes were liver abscesses (including 4 multiple abscesses), and 25 (37.3%) were both amebic liver abscesses and colitis (Figures 1 and 2). By IHA assays, 51.6% of the patients with IA had titers≧512 (range, 0–16384). Eight (11.9%) developed serious complications necessitating surgical intervention, which included 3 intestinal perforations and peritonitis, 2 ruptures of the liver abscess, 2 subphrenic abscesses, 1 empyema, and 1 hepatogastric fistula. Metronidazole was administered for 13 days (range, 3–27 days) and the interval from initiation of metronidazole to defervescence was 3.5 days (range, 1–11 days). Thirty-five patients received concurrent antibiotic therapy, mainly ceftriaxone, and the fever resolved after 2 days of antibiotic therapy (range, 0–10 days). Of 21 patients receiving only metronidazole, the fever resolved after 3 days of therapy (range, 1–6 days). Liver aspiration and drainage was performed in 14 (20.9%) patients. Two required a laparotomy and chest tube drainage. Iodoquinol was administered to 42 (62.7%) patients following completion of metronidazole therapy to clear intestinal colonization and prevent relapse. Nobody died of IA after a median observation of 748 days (range, 9–4179 days).


Increased risk for Entamoeba histolytica infection and invasive amebiasis in HIV seropositive men who have sex with men in Taiwan.

Hung CC, Ji DD, Sun HY, Lee YT, Hsu SY, Chang SY, Wu CH, Chan YH, Hsiao CF, Liu WC, Colebunders R - PLoS Negl Trop Dis (2008)

Abdominal computed tomography showing multiple liver abscesses of a 28-year-old male homosexual who presented with right upper quadrant pain, vomiting, and watery diarrhea for 4 days.Diagnosis of amebic liver abscess was confirmed by positive PCR for Entamoeba histolytica of the liver abscess aspirate. The titer of indirect hemagglutination antibody for E. histolytica was 8192.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2254204&req=5

pntd-0000175-g001: Abdominal computed tomography showing multiple liver abscesses of a 28-year-old male homosexual who presented with right upper quadrant pain, vomiting, and watery diarrhea for 4 days.Diagnosis of amebic liver abscess was confirmed by positive PCR for Entamoeba histolytica of the liver abscess aspirate. The titer of indirect hemagglutination antibody for E. histolytica was 8192.
Mentions: During the 11-year study period, 64 (5.8%) HIV-infected patients were diagnosed as having 67 cases of IA (Table 1). All of the 64 patients were males and 57 (89.1%) were MSM. MSM had a higher risk of invasive amebiasis compared with other risk groups: 57/781 vs. 7/328 (risk ratio, 3.42; 95% CI, 1.5777, 7.417). In 29 cases (43.8%), HIV infection was concurrently diagnosed with IA. The CD4 count at diagnosis of IA was significantly higher than that of the whole cohort (215 cells?L vs. 96 cells?L). Fever (72.6%), diarrhea (70.8%), right upper quadrant pain (32.3%), and dysentery (20.6%) were the most common symptoms of IA. Fifty-two (77.6%) of the 67 IA episodes were amebic colitis, 40 (59.7%) episodes were liver abscesses (including 4 multiple abscesses), and 25 (37.3%) were both amebic liver abscesses and colitis (Figures 1 and 2). By IHA assays, 51.6% of the patients with IA had titers≧512 (range, 0–16384). Eight (11.9%) developed serious complications necessitating surgical intervention, which included 3 intestinal perforations and peritonitis, 2 ruptures of the liver abscess, 2 subphrenic abscesses, 1 empyema, and 1 hepatogastric fistula. Metronidazole was administered for 13 days (range, 3–27 days) and the interval from initiation of metronidazole to defervescence was 3.5 days (range, 1–11 days). Thirty-five patients received concurrent antibiotic therapy, mainly ceftriaxone, and the fever resolved after 2 days of antibiotic therapy (range, 0–10 days). Of 21 patients receiving only metronidazole, the fever resolved after 3 days of therapy (range, 1–6 days). Liver aspiration and drainage was performed in 14 (20.9%) patients. Two required a laparotomy and chest tube drainage. Iodoquinol was administered to 42 (62.7%) patients following completion of metronidazole therapy to clear intestinal colonization and prevent relapse. Nobody died of IA after a median observation of 748 days (range, 9–4179 days).

Bottom Line: The CD4 count at diagnosis of IA was significantly higher than that of the whole cohort (215 cells/microL vs. 96 cells/microL).In multiple logistic regression analysis, only MSM was significantly associated with acquisition of E. histolytica infection (adjusted odds ratio, 14.809; p = 0.01).Despite immunosuppression, amebic liver abscesses and colitis responded favorably to treatment.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.

ABSTRACT

Background: Incidence of Entamoeba histolytica infection and clinical manifestations and treatment response of invasive amebiasis (IA) in HIV-infected patients have rarely been investigated before.

Methodology/principal findings: At the National Taiwan University Hospital, medical records of HIV-infected patients who received a diagnosis of IA between 1994 and 2005 were reviewed. The incidence of amebiasis was investigated in serial blood and stool samples from 670 and 264 HIV-infected patients, respectively, using serological and specific amebic antigen assays. DNA extracted from stool samples containing E. histolytica were analyzed by PCR, sequenced, and compared. Sixty-four (5.8%) of 1,109 HIV-infected patients had 67 episodes of IA, and 89.1% of them were men having sex with men (MSM). The CD4 count at diagnosis of IA was significantly higher than that of the whole cohort (215 cells/microL vs. 96 cells/microL). Forty episodes (59.7%) were liver abscesses, 52 (77.6%) colitis, and 25 (37.3%) both liver abscesses and colitis. Fever resolved after 3.5 days of metronidazole therapy (range, 1-11 days). None of the patients died. The incidence of E. histolytica infection in MSM was higher than that in other risk groups assessed by serological assays (1.99 per 100 person-years [PY] vs. 0 per 100 PY; p<0.0001) and amebic antigen assays (3.16 per 100 PY vs. 0.68 per 100 PY; p = 0.12). In multiple logistic regression analysis, only MSM was significantly associated with acquisition of E. histolytica infection (adjusted odds ratio, 14.809; p = 0.01). Clustering of E. histolytica isolates by sequencing analyses from geographically-unrelated patients suggested person-to-person transmission.

Conclusions/significance: HIV-infected MSM were at significantly higher risk of amebiasis than patients from other risk groups. Despite immunosuppression, amebic liver abscesses and colitis responded favorably to treatment.

Show MeSH
Related in: MedlinePlus