VALUE OF MICROSCOPY IN THE DIAGNOSIS OF DYSENTERY ASSOCIATED WITH INVASIVE ENTAMOEBA-HISTOLYTICA
VALUE OF MICROSCOPY IN THE DIAGNOSIS OF DYSENTERY ASSOCIATED WITH INVASIVE ENTAMOEBA-HISTOLYTICA
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DOI：
10.1136/jcp.47.3.236
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发表时间：
1994-03-01
影响因子：
3.4
通讯作者：
WARHURST, DC
中科院分区：
文献类型：
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作者：
GONZALEZRUIZ, A;HAQUE, R;WARHURST, DC
目的：评价粪便标本中检测吞噬红细胞的阿米巴滋养体在诊断侵袭性溶组织内阿米巴相关性痢疾中的可靠性。方法对来自墨西哥、哥伦比亚和孟加拉国的患者的单一粪便标本进行阿米巴培养。对粪便进行了光学显微镜检查。在一例出血性腹泻中观察到吞噬红细胞的E溶组织滋养体，即可诊断为阿米巴痢疾。用同工酶电泳法对E组分离株进行鉴定，并将结果与粪便中的镜检结果相关联。使用X(2)检验进行统计分析。结果：在痢疾粪便标本中观察到吞噬红细胞的阿米巴，溶组织肠杆菌的表型总是侵袭性的(p<；0.0001)。在痢疾中观察到吞噬红细胞的阿米巴对侵袭性溶组织性肠杆菌感染有100%的特异性和预测性。当只考虑阿米巴培养阳性病例时，它的敏感性为96%。在本研究中，酵母菌XIV的E溶血性肠杆菌与阿米巴痢疾的相关性比酵母菌II更常见。侵袭性和非侵袭性溶血性肠杆菌在非痢疾性腹泻中的携带率没有显著差异。无症状受试者携带非侵袭性溶组织肠杆菌的频率高于侵袭性溶组织肠杆菌。非阿米巴性痢疾患者感染溶组织埃希菌时，携带非侵袭性菌株(12%)。结论：单个粪便标本镜检诊断阿米巴痢疾的敏感性和特异性很高；培养发现肠道携带侵袭性溶组织埃希菌不一定是活动性疾病的指征，因为腹泻患者和无症状的受试者脱落侵袭性和非侵袭性溶组织埃希菌。可能存在两个致病潜力不同的入侵溶组性肠杆菌亚群，通过酵母菌分析可以将其区分开来。
Aims-To assess the reliability of the detection of erythrophagocytic amoebic trophozoites in stool samples in the diagnosis of dysentery associated with invasive Entamoeba histolytica.Methods-Amoebic culture was carried out on single stool samples collected from patients from Mexico, Colombia, and Bangladesh. The stools had been examined by light microscopy. Amoebic dysentery was diagnosed when erythrophagocytic E histolytica trophozoites were observed in a case of bloody diarrhoea. E histolytica isolates were characterised by isoenzyme electrophoresis and results correlated with microscopical findings in stools. Statistical analysis was performed using the chi(2) test.Results-Where erythrophagocytic amoebae had been observed in dysenteric stool specimens the E histolytica phenotype was invariably invasive (p < 0.0001). Observation of erythrophagocytic amoebae in dysentery is 100% specific and predictive of infection with invasive E histolytica. When amoebic culture-positive cases only are considered it is 96% sensitive. In this study E histolytica of zymodeme XIV was more commonly associated with amoebic dysentery than zymodeme II. There was no significant difference between the carriage rate of invasive and non-invasive E histolytica in non-dysenteric diarrhoea. Asymptomatic subjects carried non-invasive E histolytica more frequently than invasive E histolytica. Patients with non-amoebic dysentery, when shown to be infected with E histolytica, carried non-invasive strains (12%).Conclusions-Sensitivity and specificity of microscopical examination of a single stool specimen for diagnosing amoebic dysentery is very high; intestinal carriage of invasive E histolytica detected by culture is not necessarily an indication of active disease as patients with diarrhoea and asymptomatic subjects shed invasive and non-invasive E histolytica. There are possibly two subpopulations of invasive E histolytica with different pathogenic potential which can be differentiated by zymodeme analysis.