title: Evaluation of antigen detection and polymerase chain reaction for diagnosis of amoebic liver abscess in patients on anti-amoebic treatment.
abstract: BACKGROUND
  Diagnosis of amoebic liver abscess (ALA) in patients on anti-amoebic drugs is difficult. There is scanty data on this issue using Entamoeba histolytica (E. histolytica) lectin antigen and polymerase chain reaction (PCR). We studied utility of lectin antigen, PCR, and IgG antibody in diagnosis of liver abscess in patients on anti-amoebic treatment. Liver aspirate of 200 patients, of which 170 had anti-amoebic drug prior to drainage, was tested for E. histolytica lectin antigen by (ELISA), PCR, bacterial culture, and serum IgG antibody by (ELISA). Classification of abscesses was based on result of anti-amoebic IgG antibody and bacterial culture, E. histolytica PCR and bacterial culture, and E. histolytica lectin antigen and bacterial culture.
  
  
  RESULTS
  Using anti-amoebic IgG antibody and bacterial culture, 136/200 (68.0%) were classified as ALA, 12/200 (6.0%) as pyogenic liver abscess (PLA), 29/200 (14.5%) as mixed infection, and 23/200 (11.5%) remained unclassified. Using amoebic PCR and bacterial culture 151/200 (75.5%) were classified as ALA, 25/200 (12.5%) as PLA, 16/200 (8.0%) as mixed infection, and 8/200 (4.0%) remained unclassified. With E. histolytica lectin antigen and bacterial culture, 22/200 (11.0%) patients were classified as ALA, 39/200 (19.5%) as PLA, 2/200 (1.0%) as mixed infection, and 137/200 (68.5%) remained unclassified.
  
  
  CONCLUSIONS
  E. histolytica lectin antigen was not suitable for classification of ALA patients who had prior anti-amoebic treatment. However, PCR may be used as alternative test to anti-amoebic antibody in diagnosis of ALA.
authors.affiliation: Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India.
authors.forename: Virendra
authors.initials: V
authors.lastname: Jaiswal
authors.forename: Ujjala
authors.initials: U
authors.lastname: Ghoshal
authors.forename: Sanjay S
authors.initials: SS
authors.lastname: Baijal
authors.forename: Balraj
authors.initials: B
authors.lastname: Mittal
authors.forename: Tapan N
authors.initials: TN
authors.lastname: Dhole
authors.forename: Uday C
authors.initials: UC
authors.lastname: Ghoshal
mesh_terms: D000913:Antibodies, Protozoan / Q000032:analysis / Q000276:immunology*; D000953:Antigens, Protozoan / Q000276:immunology*; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D003470:Culture Media; D003937:Diagnosis, Differential; D004748:Entamoeba histolytica / Q000187:drug effects / Q000276:immunology* / Q000302:isolation & purification; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000032:analysis / Q000276:immunology; D037102:Lectins / Q000276:immunology; D008101:Liver Abscess, Amebic / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology; D046290:Liver Abscess, Pyogenic / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology; D008297:Male; D016133:Polymerase Chain Reaction / Q000379:methods
chemical_list: D000913:Antibodies, Protozoan; D000953:Antigens, Protozoan; D000981:Antiprotozoal Agents; D003470:Culture Media; D007074:Immunoglobulin G; D037102:Lectins