Entamoeba histolytica liver abscess case: could stool PCR avoid it?

Area of Science:

• Medical Microbiology
• Infectious Diseases
• Gastroenterology

Background:

• Liver abscess is a common extraintestinal manifestation of Entamoeba histolytica.
• Clinical symptoms may be delayed, appearing years after exposure in endemic areas.
• Diagnosis typically relies on microbiological confirmation.

Observation:

• A 55-year-old woman with Crohn's disease on immunosuppressants presented with liver abscesses.
• Initial diagnostic attempts, including Gram staining and microscopy of abscess pus, were negative.
• Bacteriological culture of pus was also negative.

Findings:

• Multiplex polymerase chain reaction (PCR) on liver pus confirmed Entamoeba histolytica.
• PCR testing was positive for E. histolytica in blood, pleural fluid, and stool samples.
• Previous stool sample microscopy (2 months prior) was negative for parasites.

Implications:

• Microscopy techniques for Entamoeba histolytica detection lack sensitivity.
• Routine use of molecular methods, such as PCR, for stool parasite detection is recommended.
• This is particularly crucial for immunocompromised patients to ensure timely diagnosis and treatment.