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Nondysenteric intestinal amebiasis colonic morphology and search forEntamoeba histolytica adherence and invasion

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Abstract

There is controversy regarding the presence of colonic mucosal abnormalities or mucosal invasion by Entamoeba histolyticain patients with “nondysenteric intestinal amebiasis.” To determine the role of E. histolyticain causing symptoms and mucosal changes and to detect if mucosal invasion by E. histolyticais present in nondynsenteric intestinal amebiasis, we evaluated 24 E.histolytica-infected patients (stool microscopy positive for E. histolytica)and 12 noninfected controls who presented with chronic gastrointestinal symptoms, but without dysentery, to a clinic in Calcutta. The colonic mucosa was evaluated at colonoscopy, and mucosal biopsies obtained from the cecum, sigmoid colon, and rectum were evaluated by light microscopy, indirect immunofluorescence microscopy, and scanning electron microscopy. At colonoscopy mucosal ulcerations were absent in all the controls and all except one of the E. histolytica-infected patients. E. histolyticatrophozoites or cysts were not seen in the lamina propria or on the luminal surface in any infected patient by light and immunofluorescence microscopy. On scanning electron microscopy, structures that resembled rounded E. histolyticatrophozoites were seen on the luminal surface in two of 19 cecal specimens from the infected patients. Moderate or severe mucosal inflammation was frequent on light microscopy in both the E. histolytica-infected patients and the noninfected controls with the cecum involved in two thirds of both groups. Antibodies to E. histolyticawere detected in serum of 25% of study patients and 58% of controls. Mucosal inflammation did not correlate with stool positivity for E. histolyticaor seropositivity for ameba antibody. We conclude that in patients with “nondysenteric intestinal amebiasis,” E. histolyticaadherence to colonic mucosa is infrequent and that mucosal invasion by the organism is unlikely. Colonic mucosal inflammation is highly prevalent in patients with chronic lower abdominal symptoms in this tropical region, but the inflammation and symptoms are unrelated to E. histolyticainfection.

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Author notes

  1. Shiv Pillai MD

    Present address: Cancer Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts

  2. Honorine Ward MD

    Present address: Division of Geographic Medicine and Infectious Diseases, Tufts University School of Medicine, Boston, Massachusetts

Authors and Affiliations

  1. The Departments of Medicine and Pathology, Veterans Administration Medical Center, USA

    Easwaran P. Variyam MD, Prema Gogate MD, Mehdat Hassan MD, William J. Costerton PhD, Shiv Pillai MD, Honorine Ward MD & Kamal Jalan MRCP

  2. Case Western Reserve University School of Medicine, Cleveland, Ohio

    Easwaran P. Variyam MD, Prema Gogate MD, Mehdat Hassan MD, William J. Costerton PhD, Shiv Pillai MD, Honorine Ward MD & Kamal Jalan MRCP

  3. Department of Biology, University of Calgary, Alberta, Canada

    Easwaran P. Variyam MD, Prema Gogate MD, Mehdat Hassan MD, William J. Costerton PhD, Shiv Pillai MD, Honorine Ward MD & Kamal Jalan MRCP

  4. Kothari Center of Gastroenterology, Calcutta, India

    Easwaran P. Variyam MD, Prema Gogate MD, Mehdat Hassan MD, William J. Costerton PhD, Shiv Pillai MD, Honorine Ward MD & Kamal Jalan MRCP

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  1. Easwaran P. Variyam MD
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  2. Prema Gogate MD
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  3. Mehdat Hassan MD
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  5. Shiv Pillai MD
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This research was supported in part by the Veterans Administration.

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Variyam, E.P., Gogate, P., Hassan, M. et al. Nondysenteric intestinal amebiasis colonic morphology and search forEntamoeba histolytica adherence and invasion. Digest Dis Sci 34, 732–740 (1989). https://doi.org/10.1007/BF01540345

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  • DOI: https://doi.org/10.1007/BF01540345

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