Entamoeba histolytica: efficacy of microscopic, cultural, and serological techniques for laboratory diagnosis

Of 110 subjects with clinical evidence of amebiasis, 15 (14%) were shown to be infected with Entamoeba histolytica. Microscopic examination of stool specimens rendered a diagnosis in all eight cases of localized intestinal infection, but in only one of seven patients with invasive amebiasis. Culture was concomitantly diagnostic in six patients intestinal amebiasis and in one patient with extraintestinal infection. Assay for antibody to E. histolytica by counterimmunoelectrophoresis and indirect hemagglutination were each 100% effective in all cases of invasive amebiasis and in diagnosing two of eight patients with intestinal infection. Stool specimens of 15 patients revealing intestinal parasites other than E. histolytica failed to demonstrate cultural or serological evidence of amebiasis. Low levels of antibody were observed in the indirect hemagglutination assay in four patients with disease other than amebiasis and in three control sera positive for rheumatoid factor. By counterimmunoelectrophoresis, reactive sera were only encountered among those derived from patients with amebiasis. Six of seven patients with hepatic amebiasis may have gone undiagnosed if not for serology.