RESUMO
Abstract We present the case of a 56-year-old black female patient from a rural area in the Morón municipality, Ciego de Ávila province, Cuba. She was admitted with symptoms of dysentery with several days of evolution and a later episode of high fever, compromised general status, and abdominal pain located in the right hypochondrium. Analytical studies reported leukocytosis with a predominance of polymorphonuclear cells, Entamoeba histolytica was found in the stool study. Abdominal ultrasound reported a mixed image of 110 x 84 mm in the upper right lobe of the liver, as confirmed by computed tomography. This image was interpreted as a possible liver abscess. The patient received antimicrobial treatment for four weeks without a good response, thus requiring surgical intervention. She evolved favorably and was discharged after 21 days.
Resumen Se presenta el caso de una paciente de raza negra de 56 años procedente de área rural de Morón, provincia Ciego de Ávila (Cuba), quien ingresa por cuadro clínico de disentería de varios días de evolución acompañado de fiebre, compromiso de su estado general y dolor abdominal en el hipocondrio derecho. Los estudios analíticos de laboratorio mostraron leucocitosis con predominio de neutrófilos y presencia de trofozoitos de Entamoeba histolytica en la materia fecal. La ecografía de abdomen reporto una imagen mixta de 110 x 84 mm en el lóbulo derecho del hígado y la tomografía confirmó la lesión que se interpretó como un posible absceso hepático. Se inició tratamiento antimicrobiano por un periodo de 4 semanas sin adecuada respuesta por lo que requirió tratamiento quirúrgico. Su evolución fue favorable con egreso a los 21 días.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Entamoeba histolytica/patogenicidade , Fígado/diagnóstico por imagem , Abscesso Hepático Amebiano/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Ultrassonografia , Abscesso Hepático Amebiano/cirurgia , Abscesso Hepático Amebiano/parasitologia , Abscesso Hepático Amebiano/tratamento farmacológico , Antibacterianos/uso terapêuticoRESUMO
Entamoeba histolytica is a protozoan-pathogen-causing amoebic liver abscess (ALA). After amoeba establishment in the liver, it causes abundant infiltrate of neutrophils. Liver tissue damage by neutrophils results in part from anti-amoebic oxidative intermediates, including reactive oxygen species (ROS), reactive nitrogen species (RNS), and hypochlorous acid (HOCl), derived from the myeloperoxidase (MPO) enzyme. Ascorbic acid (ASC) is an antioxidant that acts as a scavenger for ROS and NOS-derived free radicals. No previous information regarding the effect of ASC concerning the participation of MPO in an experimental model of ALA in hamsters has been reported. Thus, the aim of the present work was to analyze the effect of ASC on acute ALA development and to measure the activity and gene expression of the MPO enzyme. Hamsters were treated with ASC (800 mg/kg) and then intrahepatically inoculated with E. histolytica trophozoites. Animals were sacrificed at 3, 6, and 12 h post-inoculation (p.i.), and liver samples were collected. The percentage of lesions, amoeba in situ count, MPO activity, and mpo gene expression were ascertained. Compared to ALA hamsters without ASC treatment as the control group (CT), the ALA group treated with ASC had a significant decrease in liver lesions (all p.i. hours) and viable amoeba count (12 h p.i.) and an increase in MPO activity (12 h p.i.) and mpo gene expression (6 h/12 h p.i.). These data suggest that ASC ameliorated liver damage caused by oxidizing products via modulation of mpo expression and activity.
Assuntos
Ácido Ascórbico , Abscesso Hepático Amebiano , Peroxidase , Animais , Ácido Ascórbico/farmacologia , Cricetinae , Entamoeba histolytica/patogenicidade , Abscesso Hepático Amebiano/tratamento farmacológico , Oxirredução , Estresse Oxidativo , Peroxidase/metabolismo , Espécies Reativas de OxigênioRESUMO
BACKGROUND: Amoebiasis is a parasitic disease caused by Entamoeba histolytica, which affects people living in low- and middle-income countries and has intestinal and extraintestinal manifestations. To date, knowledge on coronavirus disease 2019 (COVID-19) coinfection with enteric parasites is limited, and E. histolytica coinfection has not been previously described. Here we present the case of a patient with COVID-19 who, during hospitalisation, presented a clinical picture consistent with an amoebic liver abscess (ALA). CASE PRESENTATION: A 54-year-old man, admitted as a suspected case of COVID-19, presented to our hospital with dyspnoea, malaise, fever and hypoxaemia. A nasopharyngeal swab was positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by reverse-transcription polymerase chain reaction. After 7 days, he developed diarrhoea, choluria and dysentery. An abdominal ultrasound showed a lesion compatible with a liver abscess; stool examination revealed E. histolytica trophozoites, and additional serology for E. histolytica was positive. After 12 days of treatment with metronidazole, ceftazidime and nitazoxanide, the patient reported acute abdominal pain, and an ultrasound examination revealed free liquid in the abdominal cavity. An emergency exploratory laparotomy was performed, finding 3000 mL of a thick fluid described as "anchovy paste". Computed tomography scan revealed a second abscess. He ended up receiving 21 days of antibiotic treatment and was discharged with satisfactory improvement. CONCLUSION: Here we present, to the best of our knowledge, the first report of ALA and COVID-19 co-presenting. Based on their pathophysiological similarities, coinfection with SARS-CoV-2 and E. histolytica could change the patient's clinical course; however, larger studies are needed to fully understand the interaction between these pathogens.
Assuntos
COVID-19 , Entamoeba histolytica , Abscesso Hepático Amebiano , Humanos , Abscesso Hepático Amebiano/diagnóstico , Abscesso Hepático Amebiano/tratamento farmacológico , Masculino , Metronidazol/uso terapêutico , Pessoa de Meia-Idade , SARS-CoV-2Assuntos
Entamebíase , Abscesso Hepático Amebiano , Doença Relacionada a Viagens , Adulto , Colômbia , Entamoeba histolytica/genética , Entamebíase/diagnóstico por imagem , Entamebíase/tratamento farmacológico , Heparina/uso terapêutico , Humanos , Abscesso Hepático Amebiano/diagnóstico por imagem , Abscesso Hepático Amebiano/tratamento farmacológico , Masculino , Meropeném/uso terapêutico , Metronidazol/uso terapêutico , México , Peru , Combinação Piperacilina e Tazobactam/uso terapêutico , Reação em Cadeia da Polimerase , Resultado do Tratamento , Reino Unido , Adulto JovemRESUMO
Amoebic liver abscess (ALA) is the most common extraintestinal amoebiasis caused by Entamoeba histolytica (E. histolytica). However, despite current knowledge and scientific advances about this infection, there are no effective treatments to prevent it. Herein, the antiamoebic capacity of curcumin in a hamster model was evaluated. Curcumin (150 mg/kg, p.o., daily during 10 days before infection) considerably prevents liver damage induced at 12 and 48 h post-intrahepatic inoculation of trophozoites and decreases ALT, ALP, and γ-GTP activities, and macroscopic and microscopic observations were consistent with these results. On the other hand, after one week of intraportal inoculation, liver damage was prevented by curcumin (150 mg/kg, p.o., daily, 20 days before amoebic inoculation and during the week of infection); liver/body weight ratios and tissue and histological stains showed normal appearance; in addition, the increases in ALT, ALP, and γ-GTP activities were prevented; the depletion of glycogen content induced by the amoebic damage was partially but significantly prevented, while NF-κB activity was inhibited and the expression of IL-1ß was reduced; Nrf2 production showed a tendency to increase it, and HO-1 protein was overexpressed. These results suggest for the first time that curcumin can be a compound with antiamoebic effect in the liver, suggesting that its daily use could help greatly decrease the incidence of this type of infection.
Assuntos
Anti-Inflamatórios não Esteroides/farmacologia , Curcumina/farmacologia , Entamoeba histolytica , Abscesso Hepático Amebiano/metabolismo , Abscesso Hepático Amebiano/parasitologia , Substâncias Protetoras/farmacologia , Transdução de Sinais , Animais , Biópsia , Cricetinae , Heme Oxigenase-1/metabolismo , Humanos , Interleucina-1beta/metabolismo , Fígado/parasitologia , Fígado/patologia , Abscesso Hepático Amebiano/tratamento farmacológico , Abscesso Hepático Amebiano/patologia , Masculino , Fator 2 Relacionado a NF-E2/metabolismo , NF-kappa B/metabolismo , Índice de Gravidade de DoençaRESUMO
Amebiasis is the infection by Entamoeba histolytica, a protozoan capable of invading the colonic mucosa causing a diarrheic syndrome, although most of the time is mild, it can lead to a fulminating colitis. Sometimes it can spread to other organs; among extra-intestinal manifestations of this parasite, the most frequent is the amebic liver abscess. In the next pages, general aspects of this protozoan, its epidemiology, clinical findings, diagnosis and treatment are reviewed, emphasizing the possibilities of diagnosis and treatment available in Chile.
La amebiasis corresponde a la infección por Entamoeba histolytica, protozoo capaz de invadir la mucosa del colon provocando un cuadro diarréico que, si bien la mayoría de las veces es leve, puede llegar a una colitis fulminante. En algunas oportunidades puede diseminarse a otros órganos; dentro de las manifestaciones extra-intestinales de este parásito, la más frecuente es el absceso hepático amebiano. A continuación se revisan aspectos generales de este protozoo, su epidemiología, cuadro clínico, diagnóstico y tratamiento, destacando las posibilidades de diagnóstico y tratamiento disponibles en Chile.
Assuntos
Humanos , Disenteria Amebiana/diagnóstico , Disenteria Amebiana/tratamento farmacológico , Abscesso Hepático Amebiano/diagnóstico , Abscesso Hepático Amebiano/tratamento farmacológico , Diarreia/parasitologia , Disenteria Amebiana/parasitologia , Entamoeba histolytica/patogenicidade , Abscesso Hepático Amebiano/parasitologia , Metronidazol/uso terapêutico , Antiparasitários/uso terapêuticoRESUMO
Three water-soluble Ru(II) chiral heteroleptic coordination compounds [Ru(en)(pdto)]Cl2 (1), [Ru(gly)(pdto)]Cl (2), and [Ru(acac)(pdto)]Cl (3), where pdto = 2,2'-[1,2-ethanediylbis-(sulfanediyl-2,1-ethanediyl)]dipyridine, en = ethylendiamine, gly = glycinate, and acac = acetylacetonate, have been synthezised and fully characterized. The crystal structures of compounds 1-3 are described. The IC50 values for compounds 1-3 are within nanomolar range (14, 12, and 6 nM, respectively). The cytotoxicity for human peripheral blood lymphocytes is extremely low (>100 µM). Selectivity indexes for Ru(II) compounds are in the range 700-1300. Trophozoites exposed to Ru(II) compounds die through an apoptotic pathway triggered by ROS production. The orally administration to infected mice induces a total elimination of the parasite charge in mice faeces 1-2-fold faster than metronidazole. Besides, all compounds inhibit the trophozoite proliferation in amoebic liver abscess induced in hamster. All our results lead us to propose these compounds as promising candidates as antiparasitic agents.
Assuntos
Antiprotozoários/farmacologia , Entamoeba histolytica/efeitos dos fármacos , Compostos de Rutênio/farmacologia , Animais , Antiprotozoários/química , Antiprotozoários/uso terapêutico , Apoptose/efeitos dos fármacos , Células Cultivadas , Cricetinae , Cristalografia por Raios X , Humanos , Concentração Inibidora 50 , Abscesso Hepático Amebiano/tratamento farmacológico , Camundongos , Espécies Reativas de Oxigênio/metabolismo , Compostos de Rutênio/química , Compostos de Rutênio/uso terapêutico , EstereoisomerismoRESUMO
A 72-year-old man consulted in November 2012 for abdominal pain in the right upper quadrant. The patient had a history of suspected hepatic amebiasis treated in Senegal in 1985 and has not traveled to endemic areas since 1990. Abdominal CT scan revealed a liver abscess. At first, no parasitological tests were performed and the patient was treated with broad-spectrum antibiotics. Only after failure of this therapy, serology and PCR performed after liver abscess puncture established the diagnosis of hepatic amebiasis. The patient was treated with metronidazole and tiliquinol-tilbroquinol. Amebic liver abscess is the most frequent extra-intestinal manifestation. Hepatic amebiasis 22 years after the last visit to an endemic area is exceptional and raises questions on the mechanisms of latency and recurrence of these intestinal protozoan parasites.
Assuntos
Abscesso Hepático Amebiano/diagnóstico , Injúria Renal Aguda/induzido quimicamente , Idoso , Anticorpos Antiprotozoários/sangue , Antiprotozoários/uso terapêutico , Infecções Bacterianas/diagnóstico , Erros de Diagnóstico , Quimioterapia Combinada , Entamoeba histolytica/imunologia , França/epidemiologia , Humanos , Abscesso Hepático Amebiano/diagnóstico por imagem , Abscesso Hepático Amebiano/tratamento farmacológico , Abscesso Hepático Amebiano/epidemiologia , Masculino , Metronidazol/uso terapêutico , Oxiquinolina/administração & dosagem , Oxiquinolina/análogos & derivados , Oxiquinolina/uso terapêutico , Senegal , Fatores de Tempo , Tomografia Computadorizada por Raios X , Viagem , Combinação Trimetoprima e Sulfametoxazol/efeitos adversos , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Índias OcidentaisRESUMO
During amoebic liver abscess (ALA) formation in susceptible animals, immune response is regulated by prostaglandin E2 (PGE2) dependent mechanisms. The aim of this study was to analyze the effect of misoprostol (MPL), a PGE1 analogue, on ALA formation in BALB/c mice. Male mice from BALB/c strain were intrahepatically infected with 7.5 × 10(5) trophozoites of E. histolytica strain HM1:IMSS and treated with 10(-4) M of MPL daily until sacrifice at 2, 4, and 7 days postinfection (p.i.). ALA formation was evaluated at 2, 4, and 7 days postinfection; trophozoite morphology was analyzed using immunohistochemistry and image analysis. Results showed an increase in frequency of ALA formation in infected and MPL-treated mice only at 2 days p.i. (P = 0.03). A significant diminution in the size of trophozoites was detected in abscesses from mice independently of MPL treatment (from 5.8 ± 1.1 µm at 2 days p.i. to 2.7 ± 1.9 µm at 7 days p.i.) compared with trophozoites dimensions observed in susceptible hamsters (9.6 ± 2.7 µm) (P < 0.01). These results suggest that MPL treatment may modify the adequate control of inflammatory process to allow the persistence of trophozoites in the liver; however, natural resistance mechanisms cannot be discarded.