Introduction
Amebiasis, an infection caused by the protozoan parasite Entamoeba histolytica, poses a significant global health concern, particularly in developing countries. Recognized as a causative agent for both intestinal and extra-intestinal invasive diseases, accurate amebiasis diagnosis is paramount for effective patient management and disease control. Globally, amebiasis is responsible for a substantial number of morbidities and mortalities, with estimations reaching up to 100,000 fatal cases annually. This underscores the urgent need for reliable and accessible diagnostic tools.
The diagnosis of amebiasis encompasses a range of methodologies, each with its own advantages and limitations. These include traditional methods like microscopy and culture, alongside advanced techniques such as antigen detection assays, molecular diagnostic tests, and serological assays. Each Amebiasis Diagnosis Test plays a crucial role in different clinical scenarios and resource settings. Microscopy, while economical and widely available, often lacks the sensitivity and specificity needed to differentiate E. histolytica from morphologically similar non-pathogenic species. Culture methods can enhance sensitivity but are often laborious and time-consuming, making them less practical for routine diagnostics.
To address these limitations, advancements in diagnostic technologies have led to the development of antigen detection and molecular-based assays. Antigen detection tests, such as enzyme-linked immunosorbent assays (ELISA) and rapid immunochromatographic assays, offer improved specificity and speed, facilitating more accurate and timely diagnoses. Molecular methods, including polymerase chain reaction (PCR), represent the gold standard for differentiating E. histolytica from non-pathogenic Entamoeba species due to their superior sensitivity and specificity. Serological assays, which detect antibodies against E. histolytica, are particularly valuable in diagnosing extra-intestinal amebiasis, such as amoebic liver abscess (ALA).
This review aims to provide an in-depth analysis of the current landscape of amebiasis diagnosis tests, examining their performance characteristics, clinical utility, and challenges. By synthesizing available data and highlighting the strengths and weaknesses of each diagnostic approach, this article seeks to guide clinicians and laboratory professionals in selecting the most appropriate amebiasis diagnosis test for various clinical presentations of this important parasitic infection. The focus will be on both intestinal and extra-intestinal amebiasis, emphasizing the practical considerations and advancements in diagnostic strategies up to March 2022.
Methods for Amebiasis Diagnosis Test Review
To comprehensively review the spectrum of amebiasis diagnosis tests, a systematic literature search was conducted across several prominent electronic databases and journals. This extensive search encompassed articles and textbooks published up to March 2022, ensuring the inclusion of the most recent advancements in the field. The search strategy targeted studies that evaluated various diagnostic methods for both intestinal and extra-intestinal amebiasis, including but not limited to stool examination, immunodiagnostic assays, molecular techniques, antigen detection, staining procedures, and culture methods.
The databases utilized in this search included international repositories such as ISI Web of Science, PubMed, EMBASE, Scopus, Science Direct, Research Gate, and Google Scholar. To ensure a broad coverage, national databases including Iran Medex, Iran Doc, Magiran, and Scientific Information Database (SID) were also consulted. The search terms employed a combination of keywords and phrases relevant to amebiasis diagnosis. These included “amoebiasis OR Entamoeba,” “amoebic liver abscess,” “diagnosis,” “immunodiagnosis,” “molecular,” “serology OR serodiagnosis,” “culture,” and “stool examination.” The search was deliberately broad to capture all relevant studies pertaining to amebiasis diagnosis tests.
To maintain focus and ensure relevance, the search was limited to articles published in English and Persian languages. Furthermore, the reference lists of the selected articles were meticulously reviewed to identify any additional studies that might have been missed in the initial database searches. Published abstracts from parasitology, microbiology, and infectious diseases congresses were also included to capture cutting-edge research and preliminary findings in the field of amebiasis diagnosis. This multi-faceted approach ensured a thorough and up-to-date review of the available amebiasis diagnosis tests and their applications in clinical and research settings.
Results: Intestinal Amebiasis Diagnosis Tests
Intestinal amebiasis presents in diverse forms, ranging from asymptomatic cyst carriage to severe dysentery. Therefore, the selection of an appropriate amebiasis diagnosis test is crucial and depends on the clinical presentation.
Diagnosis of Asymptomatic Cyst Passers
A significant proportion of individuals infected with E. histolytica, approximately 90%, are asymptomatic cyst passers. These individuals, while not exhibiting clinical symptoms, play a critical role in disease transmission. Accurate identification of cyst passers is thus essential for public health interventions aimed at controlling the spread of amebiasis. Microscopic stool examination is the cornerstone of amebiasis diagnosis for asymptomatic carriers.
Microscopy:
Direct microscopy of stool samples remains a widely used amebiasis diagnosis test due to its simplicity and cost-effectiveness. For cyst detection, fecal suspensions in saline (0.85% NaCl) or Lugol’s iodine solution are commonly employed. Saline wet mounts allow for the visualization of cysts as refractile bodies, while Lugol’s iodine staining enhances the internal structures, aiding in differentiation from other non-pathogenic cysts. However, iodine staining can obscure chromatoidal bodies, which are more readily visible in saline mounts.
Despite its accessibility, direct microscopy has limitations in sensitivity. Studies have reported varying sensitivity rates for direct wet mount examination in detecting E. histolytica / E. dispar. One study indicated a sensitivity of 61.54%, while another reported a lower sensitivity of 34.7% for detecting any intestinal parasites. These findings highlight that a single stool sample examination may miss infections due to intermittent cyst shedding. Therefore, examining multiple stool samples (at least three) is recommended to increase the likelihood of cyst detection.
Concentration Methods and Permanent Stains:
To enhance the sensitivity of microscopic amebiasis diagnosis tests, concentration methods are frequently employed. Sedimentation techniques, such as formalin-ether sedimentation, are particularly effective in concentrating cysts from fecal samples. These methods are especially valuable when cyst numbers are low or when assessing treatment efficacy. Sedimentation methods are also recommended for epidemiological surveys to accurately determine the prevalence of intestinal parasitic infections.
While zinc sulfate flotation is another concentration technique, it is less preferred for Entamoeba and Giardia cysts as it can distort cyst morphology. Formalin-ether/ethyl acetate sedimentation is favored for its ease of use, rapidity, and reduced technical errors. Studies have consistently demonstrated the superiority of sedimentation techniques over direct smears, with formalin-ether sedimentation showing approximately twice the sensitivity of direct saline or iodine preparations.
Furthermore, permanently stained smears are crucial for accurate cyst identification and differentiation. While E. histolytica cysts can be morphologically distinguished from other common non-pathogenic amoebae (E. coli, E. hartmanni, E. nana, I. butschlii), differentiation from E. dispar, E. moshkovskii, and E. bangladeshi is not possible by microscopy alone. The World Health Organization (WHO) recommends reporting cysts as E. histolytica / E. dispar in routine microscopy reports due to their morphological indistinguishability. Therefore, while microscopy remains a vital first-line amebiasis diagnosis test, its limitations in species differentiation necessitate the use of supplementary methods for definitive diagnosis, especially in research and epidemiological contexts. Laboratories must maintain vigilance for unusual findings and objects that mimic Entamoeba cysts to minimize diagnostic errors.
Diagnosis of Amoebic Dysentery
Amoebic dysentery represents the symptomatic, invasive form of intestinal amebiasis, characterized by trophozoite invasion of the intestinal mucosa. Diagnosing amoebic dysentery, particularly using traditional methods, presents unique challenges.
Microscopic Observation:
Microscopic examination for trophozoites is critical in diagnosing amoebic dysentery. However, morphological identification of Entamoeba trophozoites is complex and requires expertise. Inexperienced personnel may struggle to differentiate trophozoites from macrophages or degenerated polymorphonuclear cells from cysts. Factors such as sample processing time, storage conditions, sample freshness, parasite density, and the training of laboratory personnel significantly impact the accuracy of microscopic amebiasis diagnosis tests.
Unlike cyst diagnosis, concentration methods are contraindicated in amoebic dysentery diagnosis. Centrifugation, used in concentration techniques, destroys the fragile, motile trophozoites. Direct wet saline preparations of fresh stool specimens are essential for observing trophozoite motility. Lugol’s iodine staining renders trophozoites non-motile but can aid in visualizing internal structures after motility assessment. Multiple smears (three or more) should be examined to enhance detection probability.
Specimen handling is paramount. Fecal samples must be collected in clean containers, free from water or urine contamination, which can destroy trophozoites. Examination should ideally occur within a few hours of sample collection, especially for dysenteric stools. Motility is best observed when samples are kept warm (35-37°C) until examination. Delay in examination leads to trophozoite degeneration. If delays are unavoidable, samples should be stored at 4°C to minimize autolysis and bacterial overgrowth, but freezing is strictly prohibited as it destroys trophozoites.
For samples requiring referral, fixatives like polyvinyl alcohol (PVA), merthiolate-iodine-formalin, or sodium acetate–acetic acid–formalin (SAF) are necessary for trophozoite preservation. PVA and SAF are suitable for preparing permanently stained smears. The most reliable diagnostic indicator in direct microscopy is the presence of motile, hematophagous E. histolytica trophozoites (containing ingested red blood cells). However, hematophagous trophozoites are not consistently observed in all patients. While direct microscopy of saline wet mounts for dysentery diagnosis has limited sensitivity (around 60%), it remains a frequently used initial amebiasis diagnosis test in many laboratories. Crucially, it cannot differentiate E. histolytica from morphologically identical non-pathogenic species.
Staining Techniques:
Staining methods play a vital role in confirming the morphological identification of E. histolytica trophozoites, especially when hematophagous forms are not readily apparent. Permanent stains like iron hematoxylin, Wheatley’s trichrome, and iodine-trichrome are recommended for detailed nuclear morphology examination and definitive species identification. These stains are particularly useful when prior treatments (barium, mineral oil, bismuth, certain antibiotics) may interfere with trophozoite morphology. Modified iron hematoxylin and Wheatley’s trichrome are recommended for routine diagnostic use. Trichrome staining generally provides the most reliable results with both fresh and PVA-preserved specimens, making it a preferred amebiasis diagnosis test in many settings.
Culture Methods:
Culture techniques, while not routinely used in clinical diagnostic laboratories, represent a valuable amebiasis diagnosis test, particularly for dysenteric stool specimens. Culture enhances sensitivity for trophozoite detection but is labor-intensive, time-consuming, and expensive. Successful isolation of hematophagous trophozoites is more likely when specimens are processed and cultured promptly after collection. Following growth, accurate identification requires wet mount examination or permanent staining of culture sediment.
A significant challenge in culture is managing contamination from other intestinal organisms, such as Blastocystis. Maintaining Entamoeba cultures is technically demanding. Both mixed (xenic) and axenic culture systems are used. Xenic cultures employ diphasic or monophasic media with additional flora, while axenic cultures grow E. histolytica in the absence of other living cells. Common xenic media include diphasic Locke-egg (HSre + s), Robinson medium, and TYSGM-9 medium. Modified HSre + s medium has shown a sensitivity of 85% in E. histolytica cultivation. Reference laboratories report culture success rates between 50% and 70%.
Axenic culture, using media like TYI-S-33 and YI-S, is primarily used in research for isoenzyme analysis and species differentiation. Axenic culture can distinguish E. histolytica from E. dispar but is not practical for routine clinical diagnostics. Material obtained via colonoscopy/sigmoidoscopy from intestinal ulcers can be examined by direct wet mount, culture, or staining. Enemas and cathartics should be avoided prior to colonoscopy as they interfere with trophozoite identification.
Immunodiagnostic Methods:
Immunodiagnostic approaches provide valuable adjuncts to traditional amebiasis diagnosis tests. These methods include antibody detection assays and antigen detection assays in stool specimens.
Antibody Detection Assays:
Antibody detection tests are generally not recommended for routine amebiasis diagnosis of intestinal infections, particularly in asymptomatic individuals. However, in symptomatic patients, antibody detection, especially using ELISA, can be supportive, although antibody titers may be low and difficult to interpret. A high ELISA antibody titer in conjunction with microscopic detection of E. histolytica can strengthen the diagnosis, as ELISA exhibits high specificity and minimal cross-reactivity with other intestinal parasites. Antibody tests are less effective in asymptomatic carriers, with studies showing low positivity rates in cyst passers.
Despite limitations in asymptomatic cases, ELISA is frequently used to detect anti-amoeba antibodies in symptomatic patients and is the most common assay for diagnosing extra-intestinal amebiasis. ELISA is also widely used in seroepidemiological studies due to its high specificity and lack of cross-reactions with non-pathogenic amoebae. Detection of serum IgM antibodies to the E. histolytica Gal/GalNAc lectin by ELISA offers high sensitivity and specificity for amoebic colitis without cross-reactivity. Salivary IgA antibody detection by ELISA has shown variable sensitivity and specificity in intestinal amebiasis diagnosis across different studies.
Indirect hemagglutination assay (IHA) demonstrates good specificity and negative predictive value for invasive amebiasis, particularly in HIV-infected patients. IHA is technically simple but has lower sensitivity than ELISA, potentially leading to false negatives. Commercial and homemade dipstick assays for antibody detection offer rapid, user-friendly amebiasis diagnosis tests suitable for point-of-care settings. Dipstick assays have reported sensitivity and specificity ranging from 89-100% and 89-95%, respectively. Antibody detection tests should be used as supplementary tools to support or refute microscopic diagnosis of amoebic colitis.
Antigen Detection Assays:
Antigen detection assays represent a significant advancement in amebiasis diagnosis tests. These methods, primarily ELISA-based kits and rapid immunochromatographic assays, detect specific E. histolytica antigens in stool samples. They offer rapid and convenient diagnosis and some kits can differentiate E. histolytica from E. dispar. However, these kits can be expensive due to the use of monoclonal antibodies and are not routinely used in all clinical laboratories.
ELISA-based antigen capture assays in stool are highly effective. The E. histolytica Gal/GalNAc lectin is a key target antigen due to its high immunogenicity and specificity to E. histolytica. The TechLab E. histolytica kit, the first ELISA kit developed for this purpose, and its subsequent versions (TechLab E. histolytica II, CELISA PATH kit) are widely used for specific E. histolytica detection and differentiation from E. dispar. These kits exhibit high specificity (93-100%) and sensitivity (80-99% for TechLab I, 86-98% for TechLab II). However, some studies in non-endemic areas have reported lower sensitivity for TechLab II in detecting carriers.
Antigen detection kits are rapid and technically simple, making them suitable for clinical and epidemiological studies, particularly in resource-limited settings where molecular assays are not feasible. A limitation of TechLab and CELISA PATH kits is the requirement for fresh stool samples and limited applicability to fixed or frozen specimens. The ProSpecT kit can be used with both fresh and frozen samples but not formalin-fixed samples and does not differentiate E. histolytica from E. dispar.
Other antigen-based ELISA kits target different E. histolytica antigens, including serine-rich antigen, lectin-rich surface antigen, lipophosphoglycan, and a 170-kDa adherence lectin antigen found in saliva. Rapid diagnostic tests (RDTs) using immunochromatographic assays enable simultaneous detection of multiple protozoan parasite antigens in a single test. The Triage Parasite Panel (TPP) is an example, detecting Giardia lamblia, E. histolytica / E. dispar, and Cryptosporidium parvum antigens in fresh or frozen stool. TPP utilizes monoclonal antibodies against a 29-kDa surface antigen of E. histolytica / E. dispar. TPP offers high specificity and sensitivity compared to microscopy and can be completed in 15 minutes. However, it cannot differentiate between E. histolytica, E. dispar, and E. moshkovskii. ImmunoCard STAT® CGE is another EIA kit for simultaneous detection of C. parvum, G. lamblia, and E. histolytica / E. dispar. RIDA®QUICK Cryptosporidium/Giardia/Entamoeba Combi is a rapid immunochromatographic test using parasite-specific antibodies attached to latex particles. This kit and its Entamoeba-specific version (RIDA®QUICK Entamoeba) are rapid and can be used on fresh or frozen samples but may not always differentiate species. E. HISTOLYTICA QUIK CHEK™ is an EIA kit for qualitative E. histolytica detection without cross-reactivity with E. dispar.
Molecular Methods:
Molecular diagnostic methods, primarily PCR-based assays, represent the gold standard amebiasis diagnosis test for intestinal infections due to their superior sensitivity, specificity, and ability to differentiate E. histolytica from morphologically identical non-pathogenic species. However, high costs, specialized equipment, and technical expertise limit their routine use, particularly in resource-constrained settings. Molecular assays are typically confined to research laboratories and advanced clinical laboratories.
DNA extraction from stool samples can be challenging due to PCR inhibitors in fecal material. Kits like the QIAamp DNA stool kit are designed to mitigate this issue, enhancing PCR assay sensitivity. PCR-based methods are crucial for differential diagnosis between E. histolytica and E. dispar, E. moshkovskii. The most commonly targeted gene for Entamoeba species differentiation is the small subunit ribosomal RNA (rRNA) gene (18S rRNA), due to its high genetic variability between species and multi-copy nature. Other target genes include DNA repetitive sequences, hemolysin gene (HLY6), cysteine proteinase, serine-rich E. histolytica (SREHP) gene, actin gene, tandem repeats in extrachromosomal circular DNA, and 16S-like rRNA.
Various PCR-based techniques are used, including conventional PCR, PCR-RFLP, nested PCR, multiplex PCR, nested multiplex PCR, real-time PCR, and loop-mediated isothermal amplification assay (LAMP). Nested multiplex PCR has demonstrated high sensitivity (100%) and specificity (98.36%) in E. histolytica diagnosis compared to microscopy. Real-time PCR is gaining prominence due to its quantitative capabilities, reduced risk of contamination, and enhanced sensitivity. Real-time PCR assays often target the 18S rRNA gene or species-specific episomal DNA repeats for Entamoeba species identification and differentiation. Real-time PCR can detect very low parasite loads undetectable by conventional PCR.
Studies have shown the potential of real-time PCR on blood, urine, and saliva samples for amoebic colitis diagnosis, although sensitivity is lower compared to stool samples. Multiplex real-time PCR allows simultaneous detection and differentiation of E. histolytica, E. dispar, and E. moshkovskii. Tetraplex real-time PCR can further differentiate E. bangladeshi, achieving high sensitivity and specificity. Fully automated PCR systems, such as FilmArray™, Verigene® Enteric Pathogens Test, and Luminex xTAG® Gastrointestinal Pathogen Panel, offer rapid multiplex detection of gastrointestinal pathogens, including E. histolytica. FilmArray™ gastrointestinal panel can detect 22 common pathogens simultaneously. These automated systems exhibit high sensitivity and specificity for E. histolytica detection but their high cost limits routine implementation in developing countries.
Results: Extra-Intestinal Amebiasis Diagnosis Tests
Extra-intestinal amebiasis, most commonly presenting as amoebic liver abscess (ALA), poses distinct diagnostic challenges. Stool examination is generally unhelpful in ALA diagnosis as E. histolytica is rarely detected in stool samples of ALA patients. Diagnosis relies on a combination of imaging, serology, and molecular methods, alongside clinical findings.
Non-Specific Laboratory Findings:
Abnormalities in complete blood count are non-specific but leukocytosis with neutrophilia is common in ALA. Eosinophilia is typically absent, while erythrocyte sedimentation rate is usually elevated. Serum alkaline phosphatase is consistently elevated in approximately 80% of ALA cases. Serum albumin may be reduced, and transaminases elevated in acute cases or patients with multiple abscesses.
Invasive Procedures:
Aspiration of pus from hepatic abscesses is invasive and generally not recommended for routine amebiasis diagnosis. Aspiration is primarily therapeutic, used in patients unresponsive to medical treatment or with large abscesses. Microscopic examination and culture of pus aspirates have low sensitivity (11-25%) for E. histolytica detection. Trophozoites are often attached to abscess walls, and pus smears may contain polymorphs and hepatocytes misidentified as amoebae.
Serology:
Serological assays are the cornerstone amebiasis diagnosis test for extra-intestinal amebiasis, particularly ALA. Anti-amoebic antibodies are detectable in serum in approximately 95% of ALA patients. However, seropositivity can also be high in asymptomatic individuals in endemic areas, limiting the ability of serology alone to distinguish active from past infections in these regions. In developed countries, serology is more diagnostically useful for extra-intestinal infections.
ELISA is a rapid, easy, and reliable serological technique for extra-intestinal amebiasis diagnosis, with reported sensitivity and specificity of 80-100%. High ELISA antibody titers are more indicative of active invasive amebiasis due to the persistence of IgG antibodies post-infection. Detection of IgM antibodies, which are short-lived, can aid in diagnosing current infection, especially when combined with imaging and clinical findings. Salivary and serum IgA levels have also been explored in ALA diagnosis.
Indirect hemagglutination (IHA) is a simple serological test suitable for resource-limited settings. Commercial IHA tests have reported high sensitivity (99%) and specificity (99.8%) for ALA, although other studies report lower sensitivity. Commercial antibody assay kits, like IHA Cellognost-Amoebiasis and ELISA kits, are available, with ELISA generally showing higher sensitivity than IHA. Indirect immunofluorescence assay (IFA) offers rapid and reliable antibody detection, aiding in differentiating ALA from non-amoebic liver conditions. IgM antibody levels by IFA decline post-therapy, making it useful for monitoring treatment response. Sensitivity of IFA for ALA is reported around 93.6% with 96.7% specificity. Latex agglutination tests are rapid and suitable for field studies but may have non-specific reactions. Bentonite flocculation, cellulose acetate membrane precipitation, counter-immune electrophoresis, fluorescent immunoassay, immunoelectrophoresis, immunodiffusion, and tube precipitin are other serological procedures used in amebiasis serodiagnosis. Rapid dipstick tests for serum antibody detection offer convenience and similar performance to ELISA. Standardized serological tests using well-defined E. histolytica antigens like lipophosphoglycan, lectin-rich surface antigen, and pyruvate, phosphate dikinase (PPDK) are improving diagnostic accuracy and differentiation between past and current infections. A rapid dipstick test detecting anti-PPDK IgG4 antibodies for ALA has shown 87% sensitivity and 100% specificity.
Antigen Detection in Extra-intestinal Amebiasis:
While primarily designed for intestinal amebiasis, the TechLab E. histolytica II ELISA kit, targeting Gal/GalNAc lectin antigen, has been evaluated for ALA diagnosis using serum samples. Studies have shown variable sensitivity, with some reporting high sensitivity in pre-treatment samples but reduced sensitivity post-treatment, possibly due to rapid lectin clearance after therapy. Other studies have reported low sensitivity of TechLab II ELISA for ALA antigen detection in serum, suggesting it may not be reliable for ALA diagnosis. Comparative studies between antigen detection and PCR on liver aspirates from treated ALA patients indicate PCR is more sensitive, while antigen detection kits like TechLab E. histolytica II may be less suitable for ALA diagnosis, especially post-treatment.
Molecular Methods for Extra-intestinal Amebiasis:
Molecular methods offer high sensitivity and specificity for extra-intestinal amebiasis diagnosis but are limited by cost and technical demands. PCR-based assays have been evaluated for detecting E. histolytica DNA in serum, liver pus, saliva, and urine in ALA cases. PCR on liver pus aspirates allows rapid ALA diagnosis and differentiation from bacterial liver abscess. Conventional PCR sensitivity in ALA diagnosis ranges from 80% to 100%. Studies using specific primer pairs targeting extrachromosomal circular DNA and the 30-kDa antigen gene have achieved 100% sensitivity in PCR on pus samples. Quantitative PCR (qPCR) on serum samples has shown high sensitivity (89.5%) and specificity (100%) for ALA diagnosis, comparable to qPCR on pus aspirates, suggesting serum qPCR as a less invasive alternative. Nested multiplex PCR targeting 16S-like rRNA gene in urine samples has shown lower sensitivity compared to PCR on liver pus. Real-time PCR on blood, urine, and saliva samples from ALA patients has demonstrated varying levels of E. histolytica DNA detection, with urine and saliva showing promise as non-invasive diagnostic specimens. Loop-mediated isothermal amplification (LAMP) assay offers rapid, visually detectable E. histolytica DNA detection in ALA, showing higher sensitivity than conventional PCR in liver abscess samples. However, pus aspiration remains an invasive procedure with potential risks.
Conclusion
Amebiasis continues to be a significant global health challenge, particularly in developing nations. Accurate and timely amebiasis diagnosis, especially in extra-intestinal cases, is crucial for reducing morbidity and mortality. Effective diagnosis and treatment of cyst passers are also vital for preventing disease transmission.
Microscopic stool examination, combined with culture, remains a cornerstone amebiasis diagnosis test for both symptomatic and asymptomatic intestinal infections in resource-limited settings. However, microscopy alone cannot differentiate E. histolytica from morphologically identical non-pathogenic species, necessitating advanced methods, particularly molecular assays, for definitive species identification. These advanced methods, however, are not always feasible for routine diagnostics in developing countries.
For amoebic dysentery diagnosis, direct microscopy, staining, and culture are effective initial strategies. Molecular and immunological assays serve as valuable complementary amebiasis diagnosis tests to enhance accuracy and species differentiation. Fully automated PCR systems offer rapid, multiplex detection capabilities suitable for advanced laboratories in developed countries.
Serological tests are paramount for extra-intestinal amebiasis, especially ALA, and remain the most widely used amebiasis diagnosis test in combination with imaging and clinical findings. Serology serves as the current gold standard in ALA diagnosis. However, improvements in serodiagnosis are needed to better differentiate active from past infections. Molecular methods and rapid diagnostic tests show promise as complementary tools for ALA diagnosis, supplementing clinical assessments. In conclusion, advancements in diagnostic technologies have significantly improved amebiasis diagnosis, offering more sensitive and specific tools for better patient care and disease management.
Concluding Remarks and Future Perspectives
In summary, for intestinal amebiasis, direct microscopy, staining, and culture remain essential amebiasis diagnosis tests. Molecular and immunological assays provide valuable complementary approaches. For extra-intestinal infections, serological tests are crucial and remain the primary diagnostic modality, especially when combined with imaging and clinical evaluations. Future advancements should focus on refining serological assays to improve differentiation between active and past infections. Further development and wider accessibility of rapid, accurate, and cost-effective molecular and antigen-based amebiasis diagnosis tests are critical for enhancing global amebiasis control and patient outcomes.
Conflict of Interests
All authors declare that they have no conflict of interest.
References
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