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Introduction: Recent-onset colitis poses a diagnostic challenge, necessitating a thorough evaluation to identify potential infectious and non-infectious etiologies. We considered inflammatory bowel disease (IBD) secondary to dipeptidyl peptidase 4 (DPP-4) inhibitor-induced colitis. Case Presentation: This case report details the presentation and management of a patient with persistent dysentery, refractory to conventional treatments, ultimately attributed to IBD possibly secondary to long-term DPP-4 inhibitor use. Following an episode of suspected amebiasis, the patient experienced prolonged bloody diarrhea with an endoscopic image compatible with ulcerative colitis. Extensive infectious diagnostics were negative. Ultimately, the cessation of sitagliptin therapy resulted in rapid symptom resolution and normalization of eosinophilia, as well as endoscopic improvement. However, after a few weeks, the patient was readmitted with diarrhea after continued cessation of sitagliptin. Conclusion: This case underscores the importance of considering IBD secondary to DPP-4 inhibitor use in the evaluation of patients with recent-onset IBD. Further research is needed to elucidate the pathophysiological mechanisms underlying the relationship between DPP-4 inhibitors and IBD. Introduction: Recent-onset colitis poses a diagnostic challenge, necessitating a thorough evaluation to identify potential infectious and non-infectious etiologies. We considered inflammatory bowel disease (IBD) secondary to dipeptidyl peptidase 4 (DPP-4) inhibitor-induced colitis. Case Presentation: This case report details the presentation and management of a patient with persistent dysentery, refractory to conventional treatments, ultimately attributed to IBD possibly secondary to long-term DPP-4 inhibitor use. Following an episode of suspected amebiasis, the patient experienced prolonged bloody diarrhea with an endoscopic image compatible with ulcerative colitis. Extensive infectious diagnostics were negative. Ultimately, the cessation of sitagliptin therapy resulted in rapid symptom resolution and normalization of eosinophilia, as well as endoscopic improvement. However, after a few weeks, the patient was readmitted with diarrhea after continued cessation of sitagliptin. Conclusion: This case underscores the importance of considering IBD secondary to DPP-4 inhibitor use in the evaluation of patients with recent-onset IBD. Further research is needed to elucidate the pathophysiological mechanisms underlying the relationship between DPP-4 inhibitors and IBD. Introduction: Recent-onset colitis poses a diagnostic challenge, necessitating a thorough evaluation to identify potential infectious and non-infectious etiologies. We considered inflammatory bowel disease (IBD) secondary to dipeptidyl peptidase 4 (DPP-4) inhibitor-induced colitis. Case Presentation: This case report details the presentation and management of a patient with persistent dysentery, refractory to conventional treatments, ultimately attributed to IBD possibly secondary to long-term DPP-4 inhibitor use. Following an episode of suspected amebiasis, the patient experienced prolonged bloody diarrhea with an endoscopic image compatible with ulcerative colitis. Extensive infectious diagnostics were negative. Ultimately, the cessation of sitagliptin therapy resulted in rapid symptom resolution and normalization of eosinophilia, as well as endoscopic improvement. However, after a few weeks, the patient was readmitted with diarrhea after continued cessation of sitagliptin. Conclusion: This case underscores the importance of considering IBD secondary to DPP-4 inhibitor use in the evaluation of patients with recent-onset IBD. Further research is needed to elucidate the pathophysiological mechanisms underlying the relationship between DPP-4 inhibitors and IBD. [ABSTRACT FROM AUTHOR]

Background: Amebiasis represents a significant global health concern. This is especially evident in developing countries, where infections are more common. The primary diagnostic method in laboratories involves the microscopy of stool samples. However, this approach can sometimes result in the misinterpretation of amebiasis as other gastroenteritis (GE) conditions. The goal of the work is to produce a machine learning (ML) model that uses laboratory findings and demographic information to automatically predict amebiasis. Method: Data extracted from Jordanian electronic medical records (EMR) between 2020 and 2022 comprised 763 amebic cases and 314 nonamebic cases. Patient demographics, clinical signs, microscopic diagnoses, and leukocyte counts were used to train eight decision tree algorithms and compare their accuracy of predictions. Feature ranking and correlation methods were implemented to enhance the accuracy of classifying amebiasis from other conditions. Results: The primary dependent variables distinguishing amebiasis include the percentage of neutrophils, mucus presence, and the counts of red blood cells (RBCs) and white blood cells (WBCs) in stool samples. Prediction accuracy and precision ranged from 92% to 94.6% when employing decision tree classifiers including decision tree (DT), random forest (RF), XGBoost, AdaBoost, and gradient boosting (GB). However, the optimized RF model demonstrated an area under the curve (AUC) of 98% for detecting amebiasis from laboratory data, utilizing only 300 estimators with a max depth of 20. This study highlights that amebiasis is a significant health concern in Jordan, responsible for 17.22% of all gastroenteritis episodes in this study. Male sex and age were associated with higher incidence of amebiasis (P = 0.014), with over 25% of cases occurring in infants and toddlers. Conclusions: The application of ML to EMR can accurately predict amebiasis. This finding significantly contributes to the emerging use of ML as a decision support system in parasitic disease diagnosis. [ABSTRACT FROM AUTHOR]

Although diloxanide is a drug of choice for treating asymptomatic amoebiasis, its mechanism of action (MOA) remains unclear. This review aims to shed light on the current understanding of the effectiveness and MOA of diloxanide in treating amoebiasis. It involves analysis of articles, retrieved from PubMed, Google Scholar and EBSCOhost, on diloxanide and the treatment of Entamoeba histolytica infection. Diloxanide is used in an ester form, which allows its high luminal concentration and greater efficacy than metronidazole in the management of asymptomatic amoebiasis. The current understanding of the action of diloxanide is based on its structural similarity to chloramphenicol at dichloroacetamide group. It acts against protein synthesis in E. histolytica trophozoites, blocking their conversion to more virulent and invasive cyst forms. Furthermore, it has a parasite clearance rate of 81–96% and treats amoebic abscesses when combined with metronidazole and chloroquine. Nevertheless, it is associated with adverse events such as flatulence, anorexia, headache and urticaria. Diloxanide is efficacious against amoebiasis but there is a need to explore its structure–activity relationship.The study suggests future directions, including novel drug formulations, diagnostic improvements, and combination regimens to enhance treatment outcomes and mitigate relapse associated with the use of diloxanide. [ABSTRACT FROM AUTHOR]

Entamoeba histolytica is considered the primary species causing the parasitic gastrointestinal infection amebiasis. A cluster of amebiasis infections was identified in 2018 among men who have sex with men in New York City and was likely caused by Entamoeba dispar , traditionally considered to be nonpathogenic. [ABSTRACT FROM AUTHOR]

Amoebic dysentery is designated a Category 5 disease under the Infectious Disease Control Law in Japan, with approximately 1,000 cases reported annually. About 10% of these are cases of invasive amoebic dysentery, 90% of which have an asymptomatic course and are often discovered incidentally, and there is concern that the number of undiagnosed cases is increasing since the reagent for that blood antibody test was discontinued in 2017. Invasive amoebic dysentery often causes ulcerative lesions that affect the cecum and rectum predominantly, but eradication of amoebic dysentery is possible with proper diagnosis and treatment. However, there have been cases in which delayed diagnosis and treatment have resulted in fulminant forms of colorectal ulceration, including perforated peritonitis and amoebic liver abscesses. In this report, the importance of the diagnosis and treatment of this disease is reiterated, and a case that was difficult to diagnose is presented. [ABSTRACT FROM AUTHOR]

Amebiasis remains a public health challenge in Mexico, especially in areas with poor sanitation. Despite declining prevalence (2014–2023), hotspots persist because of socioeconomic factors such as poverty. Addressing regional disparities through targeted interventions, improved infrastructure, and education is crucial to further reduce the disease burden and prevent future outbreaks.

Background Granulomatous amebic encephalitis (GAE) is caused by Acanthamoeba species or Balamuthia mandrillaris, which are microscopic, free-living amoebas found worldwide. People with compromised immune systems are at an increased risk of fatal cerebral infection caused by Acanthamoeba species, whereas B. mandrillaris can affect both immunocompromised and immunocompetent patients. Infections can involve the central nervous system causing GAE. Case Report A 71-year-old Caucasian woman, previously diagnosed with chronic lymphocytic leukemia and undergoing chemotherapy, arrived at the emergency department exhibiting seizure-like symptoms. Brain imaging revealed bilateral cerebral masses with central necrosis and hemorrhage, among other findings. The patient underwent a biopsy and was diagnosed with GAE. Conclusion Unfortunately, even with the correct diagnosis, GAE leads to rapid deterioration and a higher risk of mortality. This case demonstrates the rapid and severe nature of GAE and emphasizes the need for ongoing studies and better treatment options to improve GAE outcomes.

The intestinal parasites Giardia lamblia and Entamoeba histolytica are major causes of morbidity and mortality associated with diarrheal diseases. Metronidazole is the most common drug used to treat giardiasis and amebiasis. Despite its efficacy, treatment failures in giardiasis occur in up to 5%-40% of cases. Potential resistance of E. histolytica to metronidazole is an increasing concern. Therefore, it is critical to search for more effective drugs to treat giardiasis and amebiasis. We identified antigiardial and antiamebic activities of the rediscovered nitroimidazole compound, fexinidazole, and its sulfone and sulfoxide metabolites. Fexinidazole is equally active against E. histolytica and G. lamblia trophozoites, and both metabolites were 3- to 18-fold more active than the parent drug. Fexinidazole and its metabolites were also active against a metronidazole-resistant strain of G. lamblia. G. lamblia and E. histolytica cell extracts exhibited decreased residual nitroreductase activity when metabolites were used as substrates, indicating nitroreductase may be central to the mechanism of action of fexinidazole. In a cell invasion model, fexinidazole and its metabolites significantly reduced the invasiveness of E. histolytica trophozoites through basement membrane matrix. A q.d. oral dose of fexinidazole and its metabolites at 10 mg/kg for 3 days reduced G. lamblia infection significantly in mice compared to control. The newly discovered antigiardial and antiamebic activities of fexinidazole, combined with its FDA-approval and inclusion in the WHO Model List of Essential Medicines for the treatment of human African trypanosomiasis, offer decreased risk and a shortened development timeline toward clinical use of fexinidazole for treatment of giardiasis or amebiasis.

Entamoeba histolytica, a protozoan parasite, is the causative agent of amoebiasis, which is a significant global health concern. The virulence mechanisms underlying its pathogenicity are multifaceted and complex. However, endocytic processes and motility are well accepted virulence determinants. As previously reported, an AGCK family kinase, EhAGCK1 to be involved in trogocytosis exclusively while another one from same family named EhAGCK2 participates in all actin dependent endocytic processes. As the kinase dead mutants of EhAGCK1 showed significant defect in destruction of live host cells and also the localisation pattern of same is distinguishable from EhAGCK2. From observations so far, it appears that former initiates a distinguishable signaling cascade. In this work, we have demonstrated distinct biochemical properties of kinases involved in related yet distinguishable endocytic processes for the first time. Our biochemical characterization highlights distinct ion dependency of EhAGCK1 along with substrate specificity. We also show upstream activator of these kinases, 3-phosphoinositide dependent kinase 1 (PDK1) activity and its role in activating the kinase activity. The kinases exhibit property of autophosphorylation, and which may regulate the kinase activity subsequently. Summarily, these studies show that EhAGCK1 and EhAGCK2 show distinct biochemical properties which further confirm their unique role in related endocytic processes of trogocytosis and phagocytosis. Author summary: The protozoan parasite E. histolytica causes amebiasis in humans. The trophozoites depend on variety of endocytic processes to survive and cause pathogenesis in the gut of host system. Phagocytosis and trogocytosis are two related endocytic processes known to contribute to the pathogenesis by the parasite in vivo. The two processes are phenotypically different, trogocytosis being fast paced resembling nibbling and specific to live host cells. In terms of molecular mechanism of these processes, an AGC family kinase, EhAGCK1 is known to be involved in trogocytosis specifically while another one EhAGCK2 is involved in all types of endocytic processes including fluid uptake. Our biochemical characterization of these two kinases reveal that they have distinct substrate specificity and ion requirement. The overall biochemical assessment indicates the two kinases belonging to same family are involved in the phagocytic and trogocytic pathway distinctly. Hence, although the phagocytosis and trogocytosis at molecular level appear to be related but they also involve steps unique to each pathway. [ABSTRACT FROM AUTHOR]

Entamoeba histolytica causes amebiasis, a significant global health issue, with millions affected annually, especially in developing countries. EhDUF2419, an important protein involved in E. histolytica's queuine salvage pathway and its interaction network, remains unclear. To explore this, we transfected E. histolytica trophozoites with a plasmid encoding Myc-tagged EhDUF2419 and achieved successful overexpression. Through immunoprecipitation with the Myc antibody followed by mass spectrometry, we identified 335 proteins interacting with Myc-tagged EhDUF2419, including over 100 ribosomal proteins, along with translation initiation and elongation factors, and aminoacyl-tRNA synthetases. Ribosome purification revealed the presence of EhDUF2419 in ribosomal protein-enriched fractions. Treatment with queuosine (Q) significantly reduced the EhDUF2419 protein levels and decreased the Q-modified tRNA in Myc-tagged EhDUF2419 overexpressing trophozoites. This effect, which was Q-dependent, was not observed in strains carrying an empty vector control or overexpressing a truncated form of EhDUF2419 lacking catalytic activity. The reduction in the EhDUF2419 protein levels was regulated by proteasome-mediated degradation, as evidenced by the reduced degradation in the presence of MG132, a proteasome inhibitor. Our study uncovers the novel interaction of EhDUF2419 with ribosomal proteins and its regulation by the proteasome machinery, providing new insights into its role in E. histolytica and potential therapeutic strategies. [ABSTRACT FROM AUTHOR]

Macropinocytosis is an evolutionarily conserved endocytic process that plays a vital role in internalizing extracellular fluids and particles in cells. This non-selective endocytic pathway is crucial for various physiological functions such as nutrient uptake, sensing, signaling, antigen presentation, and cell migration. While macropinocytosis has been extensively studied in macrophages and cancer cells, the molecular mechanisms of macropinocytosis in pathogens are less understood. It has been known that Entamoeba histolytica, the causative agent of amebiasis, exploits macropinocytosis for survival and pathogenesis. Since macropinocytosis is initiated by actin polymerization, leading to the formation of membrane ruffles and the subsequent trapping of solutes in macropinosomes, actin cytoskeleton regulation is crucial. Thus, this study focuses on unraveling the role of well-conserved actin cytoskeleton regulators, Rho small GTPase family proteins, in macropinocytosis in E. histolytica. Through gene silencing of highly transcribed Ehrho/Ehrac genes and following flow cytometry analysis, we identified that silencing EhracM enhances dextran macropinocytosis and affects cellular migration persistence. Live imaging and interactome analysis unveiled the cytosolic and vesicular localization of EhRacM, along with its interaction with signaling and membrane traffic-related proteins, shedding light on EhRacM's multiple roles. Our findings provide insights into the specific regulatory mechanisms of macropinocytosis among endocytic pathways in E. histolytica, highlighting the significance of EhRacM in both macropinocytosis and cellular migration. Author summary: Entamoeba histolytica is an intestinal protozoan parasite that causes amoebic dysentery and liver abscesses in humans. This organism exploits macropinocytosis, a cellular process that engulfs extracellular fluids and particles, for its survival and pathogenicity. Although macropinocytosis is well-characterized in immune cells and cancer cells as it is essential for nutrient uptake, its mechanisms in pathogens, such as E. histolytica, remain less explored. Our research focused on the molecular mechanisms underpinning macropinocytosis in this parasite, specifically examining the role of Rho small GTPase family proteins. These proteins are critical regulators of the actin cytoskeleton in eukaryotic cells. Our study reveals that one specific Rho small GTPase, EhRacM, is in the maturation of macropinosomes as well as in directing linear cell migration. The physiological significance of EhRacM in regulating both macropinocytosis and migration opens new avenues for understanding the role of Rho small GTPases in these signaling pathways, which could eventually lead to the development of new control measures against diseases caused by this parasite. [ABSTRACT FROM AUTHOR]

Here we describe a case of fatal amebic gastritis associated with Naegleria australiensis infection in an 11-mo-old Linnaeus's two-toed sloth (Choloepus didactylus). The sloth had a history of weight loss and intermittent diarrhea for 18 d, and subsequently died despite empirical treatment. Postmortem findings included emaciation, gastric dilation with fluid content, and fibrinonecrotic gastritis with intralesional amebic trophozoites and cysts in the glandular region of the fundus. Transmission electron microscopy ruled out Amoebozoa of the family Entamoebidae based on the presence of mitochondria in the amoeboid organisms. PCR for pan–free-living amebae followed by next-generation sequencing of the PCR product revealed 99% identity with Naegleria australiensis. Gastric amebiasis has been reported sporadically in macropods and in leaf-eating monkeys with a sacculated stomach. To our knowledge, gastric amebiasis has not been reported previously in a sloth, which also has a sacculated and multi-chambered stomach. [ABSTRACT FROM AUTHOR]

This survey was aimed to find out the ethno-medicinal plants of Salboni Block in the Paschim Medinipur District, West Bengal, India. These ethno-medicinal plants are used by the tribal communities like Santal, Lodha, Bhumij and Munda etc. to treat various disorders and diseases. In this study, forty-two medicinal plants belonging to twenty-five families used as ethno-medicine have been identified. The information about the traditional knowledge of uses of medicinal plants was collected by interaction with the tribal oldaged people, local herbal drug sellers etc. in this rural area. These ethno-medicinally important plants can be used as common cough and cold, asthma, antiseptic, stimulant, stomachic, dyspepsia, antifungal, antibacterial, carminative, abdominal pain, amoebic dysentery etc. by ethnic peoples. The sustainable utilization of medicinal plants in this area may open up a new avenue for getting new ethnomedicine for the society in future. [ABSTRACT FROM AUTHOR]

Intestinal amebiasis is an endemic disease in developing countries caused by the protozoan Entamoeba histolytica. It is typically asymptomatic, but in rare cases, it can present with severe manifestations. This is the case of a 30-year-old female patient who, two days after undergoing open appendectomy, developed rectal bleeding and abdominal pain accompanied by signs of hemodynamic instability. Colonoscopy revealed multiple necrotic ulcers in the mucosa with abundant clots. The patient experienced clinical deterioration, persistent bleeding, and signs of peritoneal irritation, necessitating exploratory laparotomy. Intraoperative findings included hypoperfused colon and cecal perforation, requiring total colectomy. Histopathological analysis confirmed acute severe ulcerative colitis caused by E. histolytica. [ABSTRACT FROM AUTHOR]

Free-living amoebae (FLA) are prevalent in diverse environments, representing various genera and species with different pathogenicity. FLA-induced infections, such as the highly fatal amoebic encephalitis, with a mortality rate of 99%, primarily affect immunocompromised individuals while others such as Acanthamoeba keratitis (AK) and cutaneous amebiasis may affect immunocompetent individuals. Despite the prevalence of FLA, there is a lack of standardized guidelines for their detection near human habitats. To date, no studies on the isolation and identification of FLA in environmental soil samples in Warsaw have been published. The aim of this study was to determine the presence of amoebae in soil samples collected from Warsaw parks and squares frequented by humans. The isolated protozoa were genotyped. Additionally, their pathogenic potential was determined through thermophilicity tests. A total of 23 soil samples were seeded on non-nutrient agar plates (NNA) at 26 °C and monitored daily for FLA presence. From the total of 23 samples, 18 were positive for FLA growth in NNA and PCR (78.2%). Acanthamoeba spp. was the most frequently isolated genus, with a total of 13 positive samples (13/18; 72.2%), and the T4 genotype being the most common. Moreover, Platyamoeba placida (3/18; 16.7%), Stenamoeba berchidia (1/18; 5.6%) and Allovahlkampfia sp. (1/18; 5.6%), also potentially pathogenic amoebae, were isolated. To our knowledge, this is the first report of FLA presence and characterization in the Warsaw area. [ABSTRACT FROM AUTHOR]

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Amebic liver abscesses should be considered in adult males with a liver abscess and a history of travel to endemic areas. Effective treatment includes metronidazole, followed by paromomycin.

Entamoeba histolytica has been detected in stool samples of patients attending the Children’s General Hospital in Kirkuk City. Zinc oxide nanoparticles (ZnO NPs) are biosynthesized by Pseudomonas aeruginosa, which produces the pigment pyocyanin that acts as an agent of reducing in the production of ZnO NPs. The purpose of this work was to ascertain how ZnO NPs might be used therapeutically to treat E. histolytica-infected mice's kidney tissues. Scanning electron microscopy used to characterize biosynthesized ZnO NPs , atomic force microscopy, Fourier transform infrared spectroscopy, UV-visible spectroscopy and X-ray diffraction. ZnO NPs were used to treat mice that had been experimentally infected with E. histolytica. Mouse kidneys were collected and divided into six groups for evaluation. Two groups served as negative and positive controls, respectively. Three other groups (four mice each) were treated with 30, 45, or 60 µg/mL ZnO NPs once daily for ten days. The final group was the uninfected group and treated with 30 µg/mL ZnO NPs. Mice treated with 30, 45, and 60 µg/mL ZnO NPs had kidney histological sections that resembled the negative control, demonstrating that the nanoparticles were effective against the parasite. The uninfected group treated with ZnO NPs showed no negative effects on the kidney tissue.

Entamoeba histolytica, the causative agent of amebiasis, is one of the top three parasitic causes of mortality worldwide. However, no vaccine exists against amebiasis. Using a lead candidate vaccine containing the LecA fragment of Gal-lectin and GLA-3M-052 liposome adjuvant, we immunized rhesus macaques via intranasal or intramuscular routes. The vaccine elicited high-avidity functional humoral responses as seen by the inhibition of amebic attachment to mammalian target cells by plasma and stool antibodies. Importantly, antigen-specific IFN-γ-secreting peripheral blood mononuclear cells (PBMCs) and IgG/IgA memory B cells (BMEM) were detected in immunized animals. Furthermore, antigen-specific antibody and cellular responses were maintained for at least 8 months after the final immunization as observed by robust LecA-specific BMEM as well as IFN-γ+ PBMC responses. Overall, both intranasal and intramuscular immunizations elicited a durable and functional response in systemic and mucosal compartments, which supports advancing the LecA+GLA-3M-052 liposome vaccine candidate to clinical testing.

Key points: Dupilumab targets Th2‐associated inflammatory mediators to reduce disease burden in CRSwNP.While rare, potential sequelae include viral, helminth, and potentially amebic infections. [ABSTRACT FROM AUTHOR]

Background: Entamoeba histolytica, a protozoan parasite, is responsible for intestinal amebiasis and can cause severe complications. It is prevalent in tropical and subtropical regions and is a significant health concern in developing countries. Traditional diagnostic methods often delay the diagnosis, leading to prolonged patient suffering and increased risk of complications. Methods: We report the case of a 59-year-old HIV-positive man on Odefsey, who presented with a week-long history of abdominal pain and diarrhea. Initial stool analysis suggested bacterial colitis, and empirical treatment with levofloxacin was initiated. However, the patient's condition worsened, resulting in hospitalization. Laboratory findings included elevated white blood cell count and high-sensitivity C-reactive protein, with low plasma sodium and potassium levels. Stool bacterial cultures were negative for common pathogens. Results: Rapid diagnosis was achieved using the FilmArray GI Panel, which detected E. histolytica within an hour. Subsequent stool microscopy suggested the presence of E. histolytica/E. dispar cysts. Prompt anti-amoebic therapy with metronidazole and paromomycin resulted in significant clinical improvement. The case was reported to the Centers for Disease Control (CDC) as a Category II notifiable disease. Conclusions: This case underscores the critical role of the FilmArray GI Panel in the rapid detection of E. histolytica, facilitating timely and effective treatment. Early diagnosis using advanced molecular diagnostics significantly improves patient outcomes and should be incorporated into routine clinical practice for managing gastrointestinal infections. [ABSTRACT FROM AUTHOR]

Free-living amoebae are rare causes of morbidity and mortality in humans and animals around the globe. Because the route of exposure and clinical progression of disease caused by different species of amoebae may vary in people and animals, determining the species of amoeba present is important. We describe here a fatal infection by the free-living amoeba Balamuthia mandrillaris in a Siberian tiger (Panthera tigris altaica). The 17-y-old patient had a rapid clinical decline after a peracute onset of severe lethargy, dull mentation, and anorexia. Autopsy did not identify a cause of death. Histology revealed inflammation associated with amoebic trophozoites in the brain, lungs, and iris of one eye. These amoebae were confirmed to be B. mandrillaris based on a PCR assay and sequencing. Although there are subtle morphologic differences between cyst stages of Acanthamoeba spp., B. mandrillaris, and Naegleria fowleri when present and identified on routine staining, other modalities, including PCR, immunofluorescence, electron microscopy, and immunohistochemistry, are typically utilized to confirm the pathogen involved in these cases. We review the reports of balamuthosis in animals.

Entamoeba histolytica is a protozoan parasite belonging to the phylum Amoebozoa that causes amebiasis, a global public health problem. E. histolytica alternates its form between a proliferative trophozoite and a dormant cyst. Trophozoite proliferation is closely associated with amebiasis symptoms and pathogenesis whereas cysts transmit the disease. Drugs are available for clinical use; however, they have issues of adverse effects and dual targeting of disease symptoms and transmission remains to be improved. Development of new drugs is therefore urgently needed. An untargeted lipidomics analysis recently revealed structural uniqueness of the Entamoeba lipidome at different stages of the parasite's life cycle involving very long (26–30 carbons) and/or medium (8–12 carbons) acyl chains linked to glycerophospholipids and sphingolipids. Here, we investigated the physiology of this unique acyl chain diversity in Entamoeba, a non-photosynthetic protist. We characterized E. histolytica fatty acid elongases (EhFAEs), which are typically components of the fatty acid elongation cycle of photosynthetic protists and plants. An approach combining genetics and lipidomics revealed that EhFAEs are involved in the production of medium and very long acyl chains in E. histolytica. This approach also showed that the K3 group herbicides, flufenacet, cafenstrole, and fenoxasulfone, inhibited the production of very long acyl chains, thereby impairing Entamoeba trophozoite proliferation and cyst formation. Importantly, none of these three compounds showed toxicity to a human cell line; therefore, EhFAEs are reasonable targets for developing new anti-amebiasis drugs and these compounds are promising leads for such drugs. Interestingly, in the Amoebazoan lineage, gain and loss of the genes encoding two different types of fatty acid elongase have occurred during evolution, which may be relevant to parasite adaptation. Acyl chain diversity in lipids is therefore a unique and indispensable feature for parasitic adaptation of Entamoeba. Author summary: Entamoeba, a protozoan parasite, thrives in its niche by alternating its form between a proliferative trophozoite and a dormant cyst. Entamoeba parasites were recently shown to generate lipid acyl chain diversity throughout their life cycle. Here, we provide insight into the mechanism generating this acyl chain diversity and its importance in maintaining the parasite's life cycle. We also show that the E. histolytica isozymes responsible for generating this diversity are reasonable targets for developing new anti-amebiasis drugs, and that the herbicides, flufenacet, cafenstrole, and fenoxasulfone, are promising leads for such drugs. Interestingly, gain and loss of the two genes encoding the isozymes controlling acyl chain diversity is plausibly related to E. histolytica host adaptation. [ABSTRACT FROM AUTHOR]

Objective: In this study; it is aimed to evaluate E. histolytica-specific ELISA adhesin antigen test results in stool samples sent to the medical microbiology laboratory with suspicion of amebiasis. Material and Methods: ELISA (Cellabs, Entamoeba Celisa Path, Brookvale, NSW Australia) adhesin antigen test results, examined on stool samples sent to the medical microbiology laboratory with suspicion of amebiasis in a two-year period between January 2022 and December 2023 were evaluated retrospectively. The data including the test results, gender, age, date and clinical information of the cases of the examined sample were obtained from our hospital’s laboratory data software system. Fisher’s exact chi-square test was used in statistical analyses. Results: Of the 1120 samples in the study, 578 (51.6%) belong to male patients and 542 (48.4%) belong to female patients. The ages of the patients ranged from 0 to 94 years, and the average age was 33.92 (standard deviation: ±24.33). There were 335 (30%) samples from pediatric patients, and the mean age was determined as 4.48 ±4.78. One hundred and sixty-one (14.3%) samples were found positive with the ELISA adhesin antigen test specific to E. histolytica. Of patients with positive test results, 77 (47.8%) were male and 84 (52.2%) were female. Among the positive samples, there were 55 (34.1%) samples from pediatric patients. While there was no statistically significant difference between the positivity status and age and gender of the patients (p>0.05), the seasonal difference was considered significant (p<0.05). Conclusion: In our study, E. histolytica specific ELISA adhesin antigen test positivity was determined as 14.3%, and this rate was found close to the country’s literature data. It has been determined that amoebiasis is more common in tropical and subtropical climates. With the use of ELISA adhesin antigen test specific to E. histolytica, which is cheap, fast and does not require experienced personnel, the rate of misdiagnosis can be reduced and unnecessary treatment applications can be reduced. [ABSTRACT FROM AUTHOR]

The protozoan parasite Entamoeba histolytica is the causative agent of amebiasis, with clinical outcomes ranging from asymptomatic infections to severe invasive diseases. The innate immune system, particularly macrophages, is of paramount importance in resisting the invasion of host tissues and organs by the trophozoites of E. histolytica. Parasite-derived pathogenic factors, such as lectins, play a pivotal role in the promotion of macrophage polarization phenotypes that have undergone alteration. Nevertheless, the precise mechanisms by which E. histolytica modulates immune polarization remain largely unknown. The current study focused on the immunomodulatory effects of the Igl-C fragment of E. histolytica Gal/GalNAc lectin on macrophage polarization. These results demonstrated that Igl-C could induce the secretion of IL-1b, IL-6, and other cytokines, activating a mixed M1/M2 polarization state. M1 polarization of macrophages occurs in the early stages and gradually transitions to M2 polarization in the later stages, which may contribute to the persistence of the infection. Igl-C induces the macrophage M1 phenotype and causes the release of immune effector molecules, including iNOS and cytokines, by activating the NF-kB p65 and JAK-STAT1 transcription factor signaling pathways. Furthermore, Igl-C supports the macrophage M2 phenotype via JAK-STAT3 and IL-4-STAT6 pathways, which activate arginase expression in later stages, contributing to the tissue regeneration and persistence of the parasite. The involvement of distinct signaling pathways in mediating this response highlights the complex interplay between the parasite and the host immune system. These findings enhance our understanding of the Igl-Cmediated pathogenic mechanisms during E. histolytica infection. [ABSTRACT FROM AUTHOR]

The need for new drugs to treat human infections is a global health concern. Diseases like tuberculosis, trypanosomiasis, amoebiasis, and AIDS remain significant problems, especially in developing countries like Mexico. Despite existing treatments, issues such as resistance and adverse effects drive the search for new alternatives. Herein, we introduce the NUATEI research consortium, made up of experts from the Institute of Biomedical Research at UNAM, who identify and obtain natural and synthetic compounds and test their effects against human pathogens using in vitro and in vivo models. The consortium has evaluated hundreds of natural extracts and compounds against the pathogens causing tuberculosis, trypanosomiasis, amoebiasis, and AIDS, rendering promising results, including a patent with potential for preclinical studies. This paper presents the rationale behind the formation of this consortium, as well as its objectives and strategies, emphasizing the importance of natural and synthetic products as sources of antimicrobial compounds and the relevance of the diseases studied. Finally, we briefly describe the methods of the evaluation of the compounds in each biological model and the main achievements. The potential of the consortium to screen numerous compounds and identify new therapeutic agents is highlighted, demonstrating its significant contribution to addressing these infectious diseases. [ABSTRACT FROM AUTHOR]

Background: Enterocolitis and gastroenteritis remain major health problems, particularly in children living in developing countries. Intestinal protozoa, such as Entamoeba histolytica, Blastocystis, and Cyclospora, are frequently associated with these conditions. Amebic colitis can cause serious complications, including fulminant necrotizing colitis, toxic megacolon, extraintestinal amebiasis, and stunting in children. The diagnosis of amoebiasis is challenging, relying on microscopic examination, which cannot distinguish E. histolytica from the nonpathogenic E. dispar and E. moshkovskii. Therefore, this study aimed to identify intestinal parasites, particularly Entamoeba, their prevalence, and the clinical characteristics of patients admitted for enterocolitis and gastroenteritis at a tertiary-referral hospital. Material and Methods: A cross-sectional, retrospective study was conducted at a national, tertiary-referral government hospital, in Jakarta. Of the 111 retrieved medical records from hospitalized patients with enterocolitis and gastroenteritis, for which parasitology feces were examined, 54 fecal samples (48.6%) were still available in the parasitology laboratory storage. All fecal samples underwent the following tests: 1) direct stool examination, after staining with 1% Lugol’s solution, and using the water–ether concentration method; 2) modified acid-fast staining for coccidian parasites; 3) Jones’ culture medium to detect Blastocystis; 4) copro-antigen assay to detect Cryptosporidium and Giardia; and 5) a polymerase chain reaction (PCR) assay to identify Entamoeba. Clinical and demographic data were obtained from the medical records. Results: Largely, patients (44.1%) were from the cohort of young children ≤5 years old, followed by adults aged 19–60 years old (24.3%). Both cohorts exhibited polyparasitism. Intestinal parasites were detected in 17 out of the 54 samples (31.4%). These included 6 (11.1%), 2 (3.7%),5 (9.2%), 3 (5.5%), 2 (3.7%), and 1 (1.8%) samples that were positive for Blastocystis, E dispar, E. histolytica, E. moshkovskii, Cryptosporidium, and Dientamoeba fragilis, respectively. PCR analysis revealed that 10 samples were positive for Entamoeba infection, eight of which originated from pediatric patients. Conclusion: At a national tertiary-referral hospital in Indonesia, Entamoeba infection was the most prevalent parasite among pediatric patients with enterocolitis. E. histolytica and E. moshkovskii were the two main species identified by PCR. Therefore, PCR assays and fecal occult–blood tests are recommended in cases of enterocolitis and gastroenteritis. [ABSTRACT FROM AUTHOR]

Digestive health is an overlooked but vital component of the success of Western honey bee (Apis mellifera) colonies. Viral, bacterial, fungal, and protozoal infections can inhibit nutrient uptake and waste elimination by the honey bee digestive tract. Active management requires monitoring honey bee health on an individual and colony basis, providing adequate nutrition, and controlling for other pests and diseases. One organism that has gained recent attention is Malpighamoeba mellificae. This publication describes how to detect M. mellificae in A. mellifera colonies.

Entamoeba histolytica is a disease-causing parasitic amoeba which affects an estimated 50 million people worldwide, particularly in socioeconomically vulnerable populations experiencing water sanitation issues. Infection with E. histolytica is referred to as amoebiasis, and can cause symptoms such as colitis, dysentery, and even death in extreme cases. Drugs exist that are capable of killing this parasite, but they are hampered by downsides such as significant adverse effects at therapeutic concentrations, issues with patient compliance, the need for additional drugs to kill the transmissible cyst stage, and potential development of resistance. Past screens of small and medium sized chemical libraries have yielded anti-amoebic candidates, thus rendering high-throughput screening a promising direction for new drug discovery in this area. In this study, we screened a curated 81,664 compound library from Janssen pharmaceuticals against E. histolytica trophozoites in vitro, and from it identified a highly potent new inhibitor compound. The best compound in this series, JNJ001, showed excellent inhibition activity against E. histolytica trophozoites with EC50 values at 0.29 μM, which is better than the current approved treatment, metronidazole. Further experimentation confirmed the activity of this compound, as well as that of several structurally related compounds, originating from both the Janssen Jump-stARter library, and from chemical vendors, thus highlighting a new structure-activity relationship (SAR). In addition, we confirmed that the compound inhibited E. histolytica survival as rapidly as the current standard of care and inhibited transmissible cysts of the related model organism Entamoeba invadens. Together these results constitute the discovery of a novel class of chemicals with favorable in vitro pharmacological properties. The discovery may lead to an improved therapy against this parasite and in all of its life stages.

A patient in California, USA, with rare and usually fatal Balamuthia mandrillaris granulomatous amebic encephalitis survived after receiving treatment with a regimen that included the repurposed drug nitroxoline. Nitroxoline, which is a quinolone typically used to treat urinary tract infections, was identified in a screen for drugs with amebicidal activity against Balamuthia.

Fulminant amoebic colitis is a rare complication of amoebiasis that carries a high mortality rate. Its diagnosis is challenging and requires a high index of suspicion, and its early recognition is a priority to provide timely medical and surgical treatment. We present the case of a male patient who came to the emergency department with unspecific clinical presentation of abdominal pain, systemic inflammatory response and imaging study showing intestinal perforation of the right colon. Fecal peritonitis and perforation at the level of the hepatic flexure were observed, so a right hemicolectomy with terminal ileostomy was performed. Despite adequate medical and surgical treatment, the patient presented progressive deterioration and died. Colon perforation due to Entamoeba histolytica was the final diagnosis. [ABSTRACT FROM AUTHOR]

Currently, one of most severe environmental problems is the high levels of pollution of many of drinking water bodies in India. The present research is focuses on the relationship between total coliform bacteria levels and the increase of human digestive tract diseases in the highly polluted water in the various drinking water source of Bhopal. Aim of the studied to find out what is the connection between gastrointestinal diseases and water bodies of Bhopal by conducting an online survey with questions related to the topic. This survey was particularly based for the residents in Bhopal where a total of 333 respondents were surveyed. Most of the respondents were aged 18-25 years old. Out of all the respondents, majority were the females. Around 68.5 % respondents were the local residents of Bhopal who have been there in Bhopal for around 1-5 years. A majority of people were from the western part of the Bhopal and were also aware about the gastrointestinal diseases. The results presented here are the first of their kind of this water bodies and will serve as basis for future research exploring other similarly contaminated riparian communities. As the causes of pollution are directly related to the economic development and population growth of the region, further research should be conducted for prevention of diseases, educational programs, water remediation and conservation programs that will have a positive impact on the quality of life of the population presently at risk. [ABSTRACT FROM AUTHOR]

Introduction: Intestinal infections are a significant health issue; antibiotics are essential in treating acute intestinal infections. However, evidence in the literature shows that the excessive use of antibiotics has created many threats to human health. This work aimed to study the impact of apple pectin in combination with antibiotics on treating patients with amebiasis and dysentery. Methodology: Patients suffering from acute intestinal diseases (amebiasis and dysentery) were treated with traditional antibiotic therapy and a new formula containing antibiotics with low and high methoxylated apple pectin in a randomized block design. Four clinical trials were performed at the Infection Disease Hospital from 1998 until 2013. Results: The study demonstrated that the antibiotic-pectin formulae (APF) significantly reduced the severity of acute intestinal infection diseases and allowed patients to recover faster than conventional treatment. APF reduced the patient's stay in the hospital by 3.0 ± 1.0 days. The clinical trial findings demonstrated that applying APF in intestinal infection diseases helped maintain a constant concentration of the antibiotic in the blood and accelerated the clinical recovery of the patients. Conclusions: It was concluded that using pectin with antibiotics could improve clinical outcomes in patients with acute infectious diseases. Research on elucidating the mechanisms of pectin digestion in the colon, polyphenol content, and its role in dysbiosis recovery, etc., is also considered. [ABSTRACT FROM AUTHOR]

Amoebic liver abscess is caused by Entamoeba histolytica infection, which manifests as invasive extraintestinal amoebiasis and is often found in tropical countries including Indonesia. Amoebic liver abscess contributes to 50,000 deaths globally. Establishing the diagnosis requires liver imaging and serological tests. The detection of Entamoeba histolytica parasite is crucial in determining the etiology of amoebic liver abscess. The aim of this study is to report a case of a 20-year-old male with symptoms of right upper abdominal pain, fever, nausea, and anorexia, and to evaluate the effectiveness of laparoscopic abscess drainage as a treatment method. The method used is clinical data analysis and therapy outcome evaluation. The results show that the patient experienced clinical improvement after treatment with metronidazole and laparoscopic abscess drainage, with no additional physical complications. Entamoeba histolytica is an amoeba transmitted through the fecaloral route and enters the bloodstream, subsequently forming abscesses in the liver. The patient presented with a large liver abscess and required operative drainage. Amoebic liver abscess generally responds well to medical treatment. However, in certain cases such as large abscess sizes, percutaneous drainage is needed to prevent abscess rupture. The patient was managed with laparoscopic drainage, which resulted in fewer physical injuries. Proper management can prevent complications from liver abscess rupture. [ABSTRACT FROM AUTHOR]

ABSTRACT Diarrheal diseases with infectious etiology remain a major cause of death globally, particularly in low-income countries. Entamoeba histolytica is a pathogenic protozoan parasite that is the causative agent of amebiasis. Amebiasis has a wide presentation in clinical severity with many factors, including the bacterial microbiota, contributing to this variation. The innate immune response also plays a critical role in regulating the severity of E. histolytica infection, with neutrophils reported to have a protective role. Despite this, the precise mechanism of how neutrophils mediate amebic killing is poorly understood. Thus, modern platforms that allow for inquiry of granulocyte–ameba interactions will increase our understanding of this disease. Herein, we describe an assay for neutrophil killing of E. histolytica by utilizing high-dimensional spectral flow cytometry. Neutrophils were isolated from wild-type 5-week-old C57BL/6 mice and co-cultured with E. histolytica at various multiplicity of infections (MOIs). After co-culture, neutrophils and E. histolytica were stained for spectral flow cytometry. Cell populations were identified using surface markers and fluorescence minus one (FMO) controls. We have previously shown that animals colonized with a component of the human microbiota, Clostridium scindens, were protected from E. histolytica. This protection was associated with elevated neutrophil count. Here, we explored amebic killing capacity and observed that neutrophils from animals with C. scindens possessed heightened amebic killing compared with controls. Thus, this study establishes a novel platform that can provide an in-depth analysis of granulocyte–parasite interactions in various contexts, including during alteration of the intestinal microbiota.IMPORTANCEThe tools for studying host immune cell–E. histolytica interactions are limited. Factors, such as parasite heterogeneity, infectivity, and difficulties with culture systems and animal models, make interrogation of these interactions challenging. Thus, Entamoeba researchers can benefit from next-generation models that allow for the analysis of both host and parasite cells. Here, we demonstrate the use of a novel platform that allows for the determination of parasite–host cell interactions and customizable high-dimensional phenotyping of both populations. Indeed, spectral flow cytometry can approach >40 markers on a single panel and can be paired with custom-developed parasite antibodies that can be conjugated to fluorochromes via commercially available kits. This platform affords researchers the capability to test highly precise hypotheses regarding host–parasite interactions.

Entamoeba histolytica is the cause of amoebiasis. The trophozoite (amoeba) form of this parasite is capable of invading the intestine and can disseminate through the bloodstream to other organs. The mechanisms that allow amoebae to evade complement deposition during dissemination have not been well characterized. We previously discovered a novel complement-evasion mechanism employed by E. histolytica. E. histolytica ingests small bites of living human cells in a process termed trogocytosis. We demonstrated that amoebae were protected from lysis by human serum following trogocytosis of human cells and that amoebae acquired and displayed human membrane proteins from the cells they ingested. Here, we aimed to define how amoebae are protected from complement lysis after performing trogocytosis. We found that amoebae were protected from complement lysis after ingestion of both human Jurkat T cells and red blood cells and that the level of protection correlated with the amount of material ingested. Trogocytosis of human cells led to a reduction in deposition of C3b on the surface of amoebae. We asked whether display of human complement regulators is involved in amoebic protection, and found that CD59 was displayed by amoebae after trogocytosis. Deletion of a single complement-regulatory protein, CD59 or CD46, from Jurkat cells was not sufficient to alter amoebic protection from lysis, suggesting that multiple, redundant complement regulators mediate amoebic protection. However, exogeneous expression of CD46 or CD55 in amoebae was sufficient to confer protection from lysis. These studies shed light on a novel strategy for immune evasion by a pathogen. IMPORTANCE Entamoeba histolytica is the cause of amoebiasis, a diarrheal disease of global importance. While infection is often asymptomatic, the trophozoite (amoeba) form of this parasite is capable of invading and ulcerating the intestine and can disseminate through the bloodstream to other organs. Understanding how E. histolytica evades the complement system during dissemination is of great interest. Here, we demonstrate for the first time that amoebae that have performed trogocytosis (nibbling of human cells) resist deposition of the complement protein C3b. Amoebae that have performed trogocytosis display the complement-regulatory protein CD59. Overall, our studies suggest that acquisition and display of multiple, redundant complement regulators is involved in amoebic protection from complement lysis. These findings shed light on a novel strategy for immune evasion by a pathogen. Since other parasites use trogocytosis for cell killing, our findings may apply to the pathogenesis of other infections.

A fluorescence immunochromatography (FIC) kit was developed recently using fluorescent silica nanoparticles coated with a recombinant C-terminal fragment of the surface lectin intermediate subunit (C-Igl) of Entamoeba histolytica to establish rapid serodiagnosis of amebiasis. We further evaluated the system using serum samples from 52 Thai patients with amebiasis. Of the patients, 50 (96%) tested positive using FIC. The samples were also tested using enzyme-linked immunosorbent assay (ELISA) with C-Igl as the antigen. Two samples were negative on ELISA but positive on FIC. The correlation coefficient between the fluorescence intensity using FIC and the optical density value using ELISA was 0.5390, indicating a moderate correlation between the two tests. Serum samples from 20 patients with malaria and 22 patients with Clostridioides difficile infection were also tested using FIC. The false-positive rates were 4/20 (20%) and 1/22 (4%) in patients with malaria and C. difficile infection, respectively. Combining the data from the present study with our previous study, the sensitivity and specificity of FIC were determined to be 98.5% and 95.2%, respectively. The results of the 50 samples were studied using a fluorescence scope and a fluorescence intensity reader, and the findings were compared. Disagreements were found in only two samples showing near-borderline fluorescence intensity, indicating that the use of scope was adequate for judging the results. These results demonstrate that FIC is a simple and rapid test for the serodiagnosis of amebiasis. [ABSTRACT FROM AUTHOR]

Amoebiasis is still of serious concern for public health in developing countries. The main issue in diagnosing amoebiasis infection through stool samples is the inability to differentiate the morphologically indistinguishable Entamoeba histolytica from the nonpathogenic Amoeba. This study aimed at detecting Entamoeba species (E. histolytica / dispar) among the microscopically diagnosed amoebiasis infections in the Nablus district using nonconventional immunoassay methods. The study utilized 101 Amoeba-positive stool samples based on the microscope examination. The stool specimens were collected from patients who sought medical investigation and diagnosis regardless of age or gender. The consented patients answered questionnaires. The immunoassay method detected E. histolytica / E. dispar in 36.2% of stool specimens out of the tested samples. There was a variation in the prevalence of amoebiasis among the different age groups. Noteworthy, infants positive, 9.9 % and 20.6 % microscopically and using the immunoassay, respectively. In conclusion, this study stressed the urgent need to revise the conventional technique used to diagnose amoebiasis for its serious impact on health. The immunoassay kits could be a good and fast screening technique. [ABSTRACT FROM AUTHOR]

In order to accurately diagnose Entamoeba spp., this study's major goal was to develop a proof-of-concept method for simultaneously detecting pathogenic and nonpathogenic amoebae using DNA. During amoebiasis, two diagnostic techniques (microscopic inspection and PCR techniques with particular primers) were evaluated. About 100 feces samples from Fallujah individuals who had clinical symptoms were taken. The outcome reveals that only 20 samples have Entamoeba spp. infections. According to this study, the two species had distinct infection percentages. Entamoeba histolytica was the most prevalent infection, at 85%, followed by Entamoeba dispar, which was 15% of all the Entamoeba-positive samples. In addition to studying the morphology and genes of the positive samples, the residential environment, age, and gender were also taken into consideration. It showed the infective patients in the rural area had a higher rate of infection, which was 18%, while the infection in the urban area was less, which was represented by 2%. As for the effect of the age factor, the highest percentage was from children who did not exceed ten years old, which was 10%. The lowest percentage was 2% for people over the age of sixteen (16). According to the gender factor, a different percentage appeared in males than females. The result showed a high infection rate for males, which was estimated at about 16%, but for females it was much less, at only 4%. [ABSTRACT FROM AUTHOR]

Background: Parasitic infections in children are one of the most important health and health problems worldwide, especially in developing countries. Diarrheal diseases such as those caused by Entamoeba histolytica are among the causes of death in children, so the purpose of this systematic review and meta-analysis is to determine the prevalence of Entamoeba histolytica in Iranian children. Materials and Methods: This study is a systematic review and meta-analysis by examining the Scientific Information Database (SID), Medline (PubMed), Scopus and Google Scholar until March 2023. Results: In a review of 12 studies with a sample size of 10,982 Iranian children, the prevalence of Entamoeba Histolytica in Iranian children was reported to be 1% (95% CI 0.6-1.7%). The meta-regression results showed that in examining the factors influencing the heterogeneity of studies and examining the effect of sample size on this heterogeneity, it was reported that with increasing sample size, the prevalence of Entamoeba histolytica in Iranian children decreased (P<0.05) and also with the increase in the year of conducting studies, the prevalence decreases in Iranian children (P=0.289). Conclusion: The results of the present study show that the prevalence of Entamoeba histolytica in Iranian children is not at a very high level, but to continue preventive measures and reach lower levels, it still requires the attention of health policymakers in this area to carry out extensive information and screening to prevent the effects of this parasitic disease on children. [ABSTRACT FROM AUTHOR]

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Copyright of Salud, Ciencia y Tecnología is the property of Fundacion Salud, Ciencia y Tecnologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)