Diagnosis of intestinal amebiasis, colitis and rectocolitis. Differential diagnosis of dysentery.
|Iodine Wet mount||NO||YES|
|Modified acid fast for Isospora and Cyclospora||YES||NO|
Stool specimens submitted in preservative are subjected to microscopy employing iodine wet mount and Trichrome stain for detection of Entamoeba histolitica and other intestinal parasites.
Indications for Testing
Colitis, rectocolitis and dysentery.
Special Instructions and Forms
Entamoeba histolytica infection is a Provincial Notifiable Disease. More Provincial information can be obtained from LINK
The clinical spectrum of intestinal E. histolytica infection ranges from an asymptomatic carrier state and acute colitis to fulminant colitis with perforation, depending on the host’s nutritional status and susceptibility, including age and virulence of infecting strain.
Invasive intestinal amebiasis usually manifests as an acute rectocolitis. Most patients present with a nontoxic dysenteric syndrome, and constitutional symptoms are not as prominent as in Shigella dysentery. The onset of acute rectocolitis is gradual and 85% of patients have intense abdominal pain. Initially there are loose watery stools, but these rapidly become blood-stained and contain mucus. Tenesmus occurs in 50% of patients and is always associated with rectosigmoidal involvement. Watery diarrhea or loose stools without blood may be present for a few days, particularly if the distal colon is involved.
Entamoeba histolytica and Giardia lamblia infections are two of the most common protozoal infections seen worldwide. The infection is acquired by ingestion of cysts in fecally contaminated food or water, or sexually (particularly in men who have sex with men). Excystation and infection occur in the large intestine from where trophozoites attach to the intestinal wall and liberate extracellular enzymes which enable invasion of the mucosa and facilitates spread to other organs, especially the liver and lung where abscesses develop. Diagnosis of invasive amebiasis, in particular amebic liver abscess, is supported by E. histolytica-specific serology.
NO OVA CYSTS AND PARASITES DETECTED
E. histolytica (pathogenic), E. dispar (nonpathogenic) and E. moshkovskii (nonpathogenic) may be indistinguishable by microscopy. In addition, asymptomatic E. histolytica often occur, complicating interpretation of microscopic findings. On occasion, ingested red blood cells may be detectable in E. histolytica (only) aiding definitive identification of pathogenic E. histolytica.
Leber, A. L., and Novak-Weekley, S. 2007. Intestinal and Urogenital Amebae, Flagellates, and Ciliates, p. 2092-2112. In Murray, P. R., Baron, E. J., Jorgensen, J. H., Landry, M. L., and Pfaller, M. A. Manual of Clinical Microbiology, 9th ed., vol. 2. ASM Press, American Society for Microbiology, Washington, DC.
Petri, Jr., W. A., and Haque, R. 2010. Entamoeba Species, Including Amebiasis, p. 3411-3425. In Mandell, D., Bennett, J. E., and Dolin, R. Principles and practice of infectious diseases, 7th ed., vol. 2. Churchill Livingstone, Elsevier, Philadelphia, PA.
Martínez-Palomo, A. and Espinosa-Cantellano M. 1999. Amebiasis and other protozoan infections, 6.25.1 – 6.25.4. In Armstrong, D. and Cohen, J. Infectious Diseases, vol. 2. Mosby, Harcourt Publishers Ltd.