Molecular epidemiology of amoebiasis in Malaysia

Highlighting the different risk factors of Entamoeba histolytica and Entamoeba dispar infections among Orang Asli communities

Tengku Shahrul Anuar, Hesham M. Al-Mekhlafi, Mohamed Kamel Abdul Ghani, Edariah Abu Bakar, Siti Nor Azreen, Fatmah Md Salleh, Nuraffini Ghazali, Mekadina Bernadus, Norhayati Moktar

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Currently, species-specific information on Entamoeba infections is unavailable in Malaysia and is restricted worldwide due to the re-description of pathogenic Entamoeba histolytica and non-pathogenic Entamoeba dispar and Entamoeba moshkovskii. Therefore, this cross-sectional study was conducted to provide the first known documented data on the true prevalence of these three species in western Malaysia using a molecular method. Another aim of this study was to determine the association of potential risk factors associated with each Entamoeba sp. A total of 500 stool samples from three Orang Asli tribes were randomly collected. The overall prevalence of E. histolytica, E. dispar and E. moshkovskii determined by microscopy was 18.6% (93/500). Molecular analysis revealed that while most Entamoeba-positive individuals were infected with E. dispar (13.4%), followed by E. histolytica (3.2%) and E. moshkovskii (1.0%), the present findings show low prevalence rates of mixed infections with E. histolytica and E. dispar (2%), E. dispar and E. moshkovskii (1.2%) and association infections of E. histolytica, E. dispar and E. moshkovskii (0.4%). Logistical regression analysis indicates that the dynamics of the transmission of the three Entamoeba spp. was different. Of six statistically significant variables observed in the univariate analysis, three were retained as significant risk factors for E. histolytica infection in the logistical regression model. These factors were (i) not washing hands after playing with soil or gardening (Odds ratio (OR) = 4.7; 95% confidence level (CI) = 1.38, 16.14; P=0.013), (ii) indiscriminate defecation in the river or bush (OR = 5.7; 95% CI = 1.46, 21.95; P=0.012) and (iii) close contact with domestic animals (OR = 5.4; 95% CI = 1.36, 2.51; P=0.017). However, subjects with family members who were infected with E. histolytica/E. dispar/E. moshkovskii (OR = 3.8; 95 CI = 2.11, 6.86; P<0.001) and those who consumed raw vegetables (OR = 1.8; 95% CI = 1.01, 3.23; P=0.047) were more likely to be infected with E. dispar. On the other hand, no associated factor was identified with E. moshkovskii infection. Nevertheless, diarrhoea (P=0.002) and other gastroenteritis symptoms (P<0.001) were only associated with E. histolytica infection. The present study provides new insight into the distribution and risk factors of E. histolytica, E. dispar and E. moshkovskii infections among Orang Asli communities in Malaysia. Identifying the different risk factors of E. histolytica and E. dispar infections will help in the planning specific strategies in the control and prevention of each infection in the communities. Moreover, it emphasises the need for molecular methods to determine the species-specific prevalence of Entamoeba spp.

Original languageEnglish
Pages (from-to)1165-1175
Number of pages11
JournalInternational Journal for Parasitology
Volume42
Issue number13-14
DOIs
Publication statusPublished - Dec 2012

Fingerprint

Entamoeba
Amebiasis
Entamoeba histolytica
Molecular Epidemiology
Malaysia
Infection
Odds Ratio
Gardening
Hand Disinfection
Defecation
Domestic Animals
Gastroenteritis
Coinfection
Rivers
Vegetables
Microscopy
Diarrhea
Soil
Cross-Sectional Studies
Regression Analysis

Keywords

  • Amoebiasis
  • Entamoeba dispar
  • Entamoeba histolytica
  • Malaysia
  • Orang Asli
  • Risk factors

ASJC Scopus subject areas

  • Parasitology
  • Infectious Diseases

Cite this

Molecular epidemiology of amoebiasis in Malaysia : Highlighting the different risk factors of Entamoeba histolytica and Entamoeba dispar infections among Orang Asli communities. / Anuar, Tengku Shahrul; Al-Mekhlafi, Hesham M.; Abdul Ghani, Mohamed Kamel; Abu Bakar, Edariah; Azreen, Siti Nor; Salleh, Fatmah Md; Ghazali, Nuraffini; Bernadus, Mekadina; Moktar, Norhayati.

In: International Journal for Parasitology, Vol. 42, No. 13-14, 12.2012, p. 1165-1175.

Research output: Contribution to journalArticle

Anuar, Tengku Shahrul ; Al-Mekhlafi, Hesham M. ; Abdul Ghani, Mohamed Kamel ; Abu Bakar, Edariah ; Azreen, Siti Nor ; Salleh, Fatmah Md ; Ghazali, Nuraffini ; Bernadus, Mekadina ; Moktar, Norhayati. / Molecular epidemiology of amoebiasis in Malaysia : Highlighting the different risk factors of Entamoeba histolytica and Entamoeba dispar infections among Orang Asli communities. In: International Journal for Parasitology. 2012 ; Vol. 42, No. 13-14. pp. 1165-1175.
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abstract = "Currently, species-specific information on Entamoeba infections is unavailable in Malaysia and is restricted worldwide due to the re-description of pathogenic Entamoeba histolytica and non-pathogenic Entamoeba dispar and Entamoeba moshkovskii. Therefore, this cross-sectional study was conducted to provide the first known documented data on the true prevalence of these three species in western Malaysia using a molecular method. Another aim of this study was to determine the association of potential risk factors associated with each Entamoeba sp. A total of 500 stool samples from three Orang Asli tribes were randomly collected. The overall prevalence of E. histolytica, E. dispar and E. moshkovskii determined by microscopy was 18.6{\%} (93/500). Molecular analysis revealed that while most Entamoeba-positive individuals were infected with E. dispar (13.4{\%}), followed by E. histolytica (3.2{\%}) and E. moshkovskii (1.0{\%}), the present findings show low prevalence rates of mixed infections with E. histolytica and E. dispar (2{\%}), E. dispar and E. moshkovskii (1.2{\%}) and association infections of E. histolytica, E. dispar and E. moshkovskii (0.4{\%}). Logistical regression analysis indicates that the dynamics of the transmission of the three Entamoeba spp. was different. Of six statistically significant variables observed in the univariate analysis, three were retained as significant risk factors for E. histolytica infection in the logistical regression model. These factors were (i) not washing hands after playing with soil or gardening (Odds ratio (OR) = 4.7; 95{\%} confidence level (CI) = 1.38, 16.14; P=0.013), (ii) indiscriminate defecation in the river or bush (OR = 5.7; 95{\%} CI = 1.46, 21.95; P=0.012) and (iii) close contact with domestic animals (OR = 5.4; 95{\%} CI = 1.36, 2.51; P=0.017). However, subjects with family members who were infected with E. histolytica/E. dispar/E. moshkovskii (OR = 3.8; 95 CI = 2.11, 6.86; P<0.001) and those who consumed raw vegetables (OR = 1.8; 95{\%} CI = 1.01, 3.23; P=0.047) were more likely to be infected with E. dispar. On the other hand, no associated factor was identified with E. moshkovskii infection. Nevertheless, diarrhoea (P=0.002) and other gastroenteritis symptoms (P<0.001) were only associated with E. histolytica infection. The present study provides new insight into the distribution and risk factors of E. histolytica, E. dispar and E. moshkovskii infections among Orang Asli communities in Malaysia. Identifying the different risk factors of E. histolytica and E. dispar infections will help in the planning specific strategies in the control and prevention of each infection in the communities. Moreover, it emphasises the need for molecular methods to determine the species-specific prevalence of Entamoeba spp.",
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AU - Abdul Ghani, Mohamed Kamel

AU - Abu Bakar, Edariah

AU - Azreen, Siti Nor

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N2 - Currently, species-specific information on Entamoeba infections is unavailable in Malaysia and is restricted worldwide due to the re-description of pathogenic Entamoeba histolytica and non-pathogenic Entamoeba dispar and Entamoeba moshkovskii. Therefore, this cross-sectional study was conducted to provide the first known documented data on the true prevalence of these three species in western Malaysia using a molecular method. Another aim of this study was to determine the association of potential risk factors associated with each Entamoeba sp. A total of 500 stool samples from three Orang Asli tribes were randomly collected. The overall prevalence of E. histolytica, E. dispar and E. moshkovskii determined by microscopy was 18.6% (93/500). Molecular analysis revealed that while most Entamoeba-positive individuals were infected with E. dispar (13.4%), followed by E. histolytica (3.2%) and E. moshkovskii (1.0%), the present findings show low prevalence rates of mixed infections with E. histolytica and E. dispar (2%), E. dispar and E. moshkovskii (1.2%) and association infections of E. histolytica, E. dispar and E. moshkovskii (0.4%). Logistical regression analysis indicates that the dynamics of the transmission of the three Entamoeba spp. was different. Of six statistically significant variables observed in the univariate analysis, three were retained as significant risk factors for E. histolytica infection in the logistical regression model. These factors were (i) not washing hands after playing with soil or gardening (Odds ratio (OR) = 4.7; 95% confidence level (CI) = 1.38, 16.14; P=0.013), (ii) indiscriminate defecation in the river or bush (OR = 5.7; 95% CI = 1.46, 21.95; P=0.012) and (iii) close contact with domestic animals (OR = 5.4; 95% CI = 1.36, 2.51; P=0.017). However, subjects with family members who were infected with E. histolytica/E. dispar/E. moshkovskii (OR = 3.8; 95 CI = 2.11, 6.86; P<0.001) and those who consumed raw vegetables (OR = 1.8; 95% CI = 1.01, 3.23; P=0.047) were more likely to be infected with E. dispar. On the other hand, no associated factor was identified with E. moshkovskii infection. Nevertheless, diarrhoea (P=0.002) and other gastroenteritis symptoms (P<0.001) were only associated with E. histolytica infection. The present study provides new insight into the distribution and risk factors of E. histolytica, E. dispar and E. moshkovskii infections among Orang Asli communities in Malaysia. Identifying the different risk factors of E. histolytica and E. dispar infections will help in the planning specific strategies in the control and prevention of each infection in the communities. Moreover, it emphasises the need for molecular methods to determine the species-specific prevalence of Entamoeba spp.

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