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Amebic liver abscess in northern region of Bangladesh: sociodemographic determinants and clinical outcomes.

ABSTRACT: BACKGROUND: Amebic liver abscess (ALA) is endemic in Bangladesh since historical age but its epidemiology and sociodemographic determinants are not well described in the literatures. This paper focuses on the endemicity, sociodemographic determinants and clinical outcomes of ALA patients from certain northern districts in Bangladesh. Ninety hospitalized ALA patients enrolled from 6 northern districts of Bangladesh during July 2008 to June 2010 were analyzed. FINDINGS: Clinical presentations of ALA was initially substantiated by ultrasound imaging and later confirmed by detection of small subunit rRNA gene of E. histolytica using a Real Time PCR. Structured questionnaire and data sheet were used to record sociodemographic characteristics, clinical presentations and outcomes. Patients were followed for immediate and late treatment outcomes up to 2 years since diagnosis. Northern districts those situated on the Ganges basin were noted as endemic areas. Male significantly outnumbered the female with a male to female ratio of 21:1 and majority of patients (58%) were in their 3rd and 4th decades. A significant (21%) number of patients were aborigines despite their ethnic minority as population under investigation and overall 68% belonged to low socioeconomic group. Habit of indigenous alcohol consumption was very high (78%) among ALA patients with overwhelming majority was illiterate (74.44%) and from rural population (70%). Fever with right hypochondriac pain of variable duration was the principal presenting complains. Gross fluid derangements including pleural effusion, edema and ascities were observed in 39% cases and 6% had rupture of abscess. All patients were treated with standard antimicrobial regimen and discharged with initial recovery. Recurrent attack was observed in 6% cases and 3 (3.33%) patients died during 2 years follow-up period. Complicated (37.78%) ALA patients showed significant Odds ratio (P < 0.05) for major sociodemographic determinants in comparison to non-complicated patients. CONCLUSIONS: Amebic liver abscess is endemic in certain northern districts of Bangladesh especially on the Ganges basin with relatively high prevalence among aborigines. Rural habitat, ethnicity (Aborigine) and habit of indigenous alcohol consumption were found to be strong determinants, especially for complicated ALA, which were associated with different grades of morbidity and a few mortalities.

SUBMITTER: Alam F

PROVIDER: S-EPMC4169810 | biostudies-literature | 2014

REPOSITORIES: biostudies-literature

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Amebic liver abscess in northern region of Bangladesh: sociodemographic determinants and clinical outcomes.

Alam Faisal F Salam Md Abdus MA Hassan Pervez P Mahmood Iftekhar I Kabir Mamun M Haque Rashidul R

BMC research notes 20140910

<h4>Background</h4>Amebic liver abscess (ALA) is endemic in Bangladesh since historical age but its epidemiology and sociodemographic determinants are not well described in the literatures. This paper focuses on the endemicity, sociodemographic determinants and clinical outcomes of ALA patients from certain northern districts in Bangladesh. Ninety hospitalized ALA patients enrolled from 6 northern districts of Bangladesh during July 2008 to June 2010 were analyzed.<h4>Findings</h4>Clinical prese ...[more]

PMID: 25204395

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Project description:Amebiasis is an endemic disease and a public health problem throughout Mexico, although the incidence rates of amebic liver abscess (ALA) vary among the geographic regions of the country. Notably, incidence rates are high in the northwestern states (especially Sonora with a rate of 12.57/100,000 inhabitants) compared with the central region (Mexico City with a rate of 0.69/100,000 inhabitants). These data may be related to host genetic factors that are partially responsible for resistance or susceptibility. Therefore, we studied the association of the HLA-DRB1 and HLA-DQB1 alleles with resistance or susceptibility to ALA in two Mexican populations, one each from Mexico City and Sonora. Ninety ALA patients were clinically diagnosed by serology and sonography. Genomic DNA was extracted from peripheral blood mononuclear cells. To establish the genetic identity of both populations, 15 short tandem repeats (STRs) were analyzed with multiplexed PCR, and the allelic frequencies of HLA were studied by PCR-SSO using LUMINEX technology. The allele frequencies obtained were compared to an ethnically matched healthy control group (146 individuals). We observed that both affected populations differed genetically from the control group. We also found interesting trends in the population from Mexico City. HLA-DQB1*02 allele frequencies were higher in ALA patients compared to the control group (0.127 vs 0.047; p= 0.01; pc= NS; OR= 2.9, 95% CI= 1.09-8.3). The less frequent alleles in ALA patients were HLA-DRB1*08 (0.118 vs 0.238 in controls; p= 0.01; pc= NS; OR= 0.42, 95% CI= 0.19-0.87) and HLA-DQB1*04 (0.109 vs 0.214; p= 0.02; pc= NS; OR= 0.40, 95% CI= 0.20-0.94). The haplotype HLA-DRB1*08/-DQB1*04 also demonstrated a protective trend against the development of this disease (0.081 vs. 0.178; p=0.02; pc=NS; OR= 0.40, 95% CI= 0.16-0.93). These trends suggest that the prevalent alleles in the population of Mexico City may be associated with protection against the development of ALA.

Project description:BackgroundEntamoeba histolytica is an intestinal protozoan parasite that causes amoebiasis, including amebic dysentery and liver abscesses. E. histolytica invades host tissues by adhering onto cells and phagocytosing them depending on the adaptation and expression of pathogenic factors, including Gal/GalNAc lectin. We have previously reported that E. histolytica possesses multiple CXXC sequence motifs, with the intermediate subunit of Gal/GalNAc lectin (i.e., Igl) as a key factor affecting the amoeba's pathogenicity. The present work showed the effect of immunization with recombinant Igl on amebic liver abscess formation and the corresponding immunological properties.Methodology/principal findingsA prokaryotic expression system was used to prepare the full-length Igl and the N-terminal, middle, and C-terminal fragments (C-Igl) of Igl. Vaccine efficacy was assessed by challenging hamsters with an intrahepatic injection of E. histolytica trophozoites. Hamsters intramuscularly immunized with full-length Igl and C-Igl were found to be 92% and 96% immune to liver abscess formation, respectively. Immune-response evaluation revealed that C-Igl can generate significant humoral immune responses, with high levels of antibodies in sera from immunized hamsters inhibiting 80% of trophozoites adherence to mammalian cells and inducing 80% more complement-mediated lysis of trophozoites compared with the control. C-Igl was further assessed for its cellular response by cytokine-gene qPCR analysis. The productions of IL-4 (8.4-fold) and IL-10 (2-fold) in the spleen cells of immunized hamsters were enhanced after in vitro stimulation. IL-4 expression was also supported by increased programmed cell death 1 ligand 1 gene.Conclusions/significanceImmunobiochemical characterization strongly suggests the potential of recombinant Igl, especially the C-terminal fragment, as a vaccine candidate against amoebiasis. Moreover, protection through Th2-cell participation enabled effective humoral immunity against amebic liver abscesses.

Dataset Information

Amebic liver abscess in northern region of Bangladesh: sociodemographic determinants and clinical outcomes.

Publications

Amebic liver abscess in northern region of Bangladesh: sociodemographic determinants and clinical outcomes.

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