Need for species-specific detection for the diagnosis of amoebiasis in a non-endemic setting

The diagnosis of amoebiasis caused by Entamoeba histolytica is traditionally based on microscopy. However, the specificity of this method may be questioned, especially in areas where infections by E. histolytica are rare. In the present study, a species-specific real-time PCR was used for the identification of the morphologically similar species E. histolytica and Entamoeba dispar. Out of 15 microscopy-positive stool samples, all were negative for E. histolytica and positive for E. dispar. In 2 cases, a suspicion of amoebic liver abscesses was confirmed by detection of E. histolytica DNA in stored sample material. Microscopy alone is clearly insufficient for the detection of E. histolytica in a setting where this parasite is rare. Microscopy-positive stool samples should be further tested by species-specific tests to distinguish E. histolytica from the non-pathogenic parasite E. dispar. On specific suspicion of amoebiasis, such as the suspicion of amoebic liver abscesses, species-specific tests can be applied even after storage.