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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

Study populations to determine the incidence of amebiasis among HIV-infected patients between 1994 and 2005.
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pntd-0000175-g003: Study populations to determine the incidence of amebiasis among HIV-infected patients between 1994 and 2005.

Mentions: Of 991 patients (89.4%) with available IHA assay results at baseline, 66 patients (6.7%) had IHA titers of 128 or greater. Between January 2001 and December 2005, 670 patients, including 433 (63.6%) MSM, who had more than one blood sample available for follow-up IHA assay, were enrolled in the sero-incidence study (Figure 3). There were no significant differences in demographics and clinical characteristics between the 670 patients who had follow-up IHA assays and the 321 who did not (data not shown). There were no significant differences in median CD4 count and plasma HIV RNA load (PVL) between MSM and patients from other risk groups when the first IHA assays were performed. At baseline, a significantly higher proportion of MSM (7.2%) had IHA titers of 128 or greater than patients from other risk groups (pā€Š=ā€Š0.006) (Table 2).


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)

Study populations to determine the incidence of amebiasis among HIV-infected patients between 1994 and 2005.
© Copyright Policy
Related In: Results  -  Collection

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

pntd-0000175-g003: Study populations to determine the incidence of amebiasis among HIV-infected patients between 1994 and 2005.
Mentions: Of 991 patients (89.4%) with available IHA assay results at baseline, 66 patients (6.7%) had IHA titers of 128 or greater. Between January 2001 and December 2005, 670 patients, including 433 (63.6%) MSM, who had more than one blood sample available for follow-up IHA assay, were enrolled in the sero-incidence study (Figure 3). There were no significant differences in demographics and clinical characteristics between the 670 patients who had follow-up IHA assays and the 321 who did not (data not shown). There were no significant differences in median CD4 count and plasma HIV RNA load (PVL) between MSM and patients from other risk groups when the first IHA assays were performed. At baseline, a significantly higher proportion of MSM (7.2%) had IHA titers of 128 or greater than patients from other risk groups (pā€Š=ā€Š0.006) (Table 2).

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