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|Year : 1978 | Volume
| Issue : 2 | Page : 103-105
Indirect haemagglutination test in intestinal and extra-intestinal amoebiasis
Ajita P Mehta, Leena P Deodhar, PS Gujarathi
Department of Pathology and Microbiology, Seth G.S. Medical College and K.E.M. Hospital, Parel, Bombay-400 012., India
Ajita P Mehta
Department of Pathology and Microbiology, Seth G.S. Medical College and K.E.M. Hospital, Parel, Bombay-400 012.
Source of Support: None, Conflict of Interest: None
Indirect haemagglutination test has been evaluated in cases of amoebiasis. It gave positive percentages of 90, 91.8 and 68.1 in amoebic liver abscess, chronic amoebic dysentery and amoebic hepatitis respectively. The test was negative in acute amoebic dysentery group. Positivity of 4.3% was obtained in apperently healthy subjects. Details regarding above findings, are presented.
|How to cite this article:|
Mehta AP, Deodhar LP, Gujarathi P S. Indirect haemagglutination test in intestinal and extra-intestinal amoebiasis. J Postgrad Med 1978;24:103-5
| :: Introduction|| |
Amoebiasis is a world wide problem. Its incidence in India has been reported to vary from 3.87 to 58% as quoted by Guirges,  and about 10-20% of people are supposed to be healthy carriers in an endemic area.
Diagnostic utility of several serologic tests in bacterial infections is well established. Its application in parasitological infections has become the subject of recent interest and importance, especially to the investigators in tropical countries where the parasitic diseases are common. The various immunological tests like Bentonite flocculation test, counter-immunoelectrophoresis, Indirect haemagglutination (IHA) test, complement fixation test etc. have been evaluated by several workers. ,, The IHA test has been recommended by several investigators as it seems to provide a sensitive and reproducible means of detecting antibodies against Entamoeba histolytica. 
| :: Material and Methods|| |
Antigen--prepared from axenically grown E. histolytica strain HK-9 in Diamond's medium was obtained from ICN/ para-Tek Medical Diagnostic products, Portland, U.S.A. This antigen contained approximately ten million amoebae and 1.8-2 mg. of nitrogen per ml. of the original solution and 0.1 ml. of this solution was lyophilized in each vial. Preparation of various reagent solutions and dilluents, tanning of the red blood cells, sensitization of tanned cells were carried out as per instructions given along with the antigen, from ICN Medical Diagnostic products. The indirect haemagglutination test was performed according to microtitre procedure of Kessel et al  and the serum was considered positive if IHA titre was 1:128 or greater.  Sera which showed positive reaction of 1:512 were retested with higher dilution.
Human Sera -serum samples from 190 individuals were tested and were grouped as (a) Amoebic liver abscess (30 cases) ; (b) Amoebic hepatitis (44 cases) ; (c) Chronic amoebic dysentery (37 cases); (d) Acute amoebic dysentery (33 cases) and (e) Apparently healthy subjects (46 cases).
Examination of stool samples was carried out in all the cases.
| :: Results|| |
The results of the IHA test in subjects suffering from intestinal and extraintestinal forms of amoebiasis, and in control subjects are shown in [Table 1].
The IHA test detected 90.0% and 91.8% cases of amoebic liver abscess and chronic amoebic dysentery respectively. In 4.3 per cent of cases, in the control group the test was positive.
Examination of stool sample showed the presence of trophozoites or cysts in all the samples of acute dysentery group while in chronic variety, 80% showed the parasite in stool sample. Amongst the amoebic liver abscess cases, only in 13%, trophozoites of E. histolytica were demonstrated in the aspirated pus.
| :: Discussion|| |
The indirect haemagglutionation test in the present series detected 90 per cent cases of amoebic liver abscess. The positivity rate compares favourably with the findings of other investigators who reported it to be positive in 75-100 per cent cases. ,, The results in chronic amoebic dysentery were encouraging while in acute amoebic dysentery group the test was negative in all the cases. It is possible that cases of acute amoebic dysentery were detected early, there was no tissue invasion in these cases and hence no production of detectable antibodies.
As quoted by Maddison,  "The duration of infection necessary for the development of detectable antibodies is not known, but the occurrence of relapse or re-infection in patients known to have antibodies suggests that these are not protective." Several factors may influence the antibody response such as the ability of the host to recognise the parasite as an antigen and to respond to this antigenic stimulus; the stage of the disease; the degree of invasion of the host and the number of amoebae entering the blood stream . 
`Amoebic hepatitis' is more of a clinical entity and there is no definite test to prove the diagnosis except for a post mortem. In the present series, the test was positive in 68.1 per cent of cases while the results of other workers vary from 54 to 85 per cent. 
Apperently healthy (control) group consisted of staff members working in the department of Microbiology and some voluntary blood donors and thus belonged to a comparatively high socio-economic status. The IHA test was positive in 4.3 per cent of cases. Hence the results of the present study indicate that the IHA test is a good tool for diagnosis of invasive amoebiasis.
| :: References|| |
|1.||Guirges. S. Y.: 'A survey of intestinal parasites in Maharashtra State with special reference to amoebiasis and its hemagglutination test.' Thesis for The Degree of "Master of Science" in Microbiology submitted to Bombay University. Part II Amoebiasis and hemagglutination testChapter III pages 223, 253, 1974. |
|2.||Kessel, J. F., Lewis, W. P., Pasquel, C.M. and Turner, J, A.: Indirect hemagglutination and complement fixation tests in amoebiasis. Amer. J. Trop. Med. and Hyg., 14: 540-550, 1965. |
|3.||Krupp, I. M,: Antibody response in intestinal and extra-intestinal amoebiasis. Amer. J. Trop. Med. and Hyg., 19: 57-62, 1970. |
|4.||Maddison, S. E., Powell, S. J. and ElsdonDew, R.: Application of serology to the epidemiology of amoebiasis. Amer. J. Trop. Med. and Hyg.. 14: 554-557, 1965. |
|5.||Mahajan, R . C., Ganguli, N. K., Chhabra, M. B., Chitkara, N. L. and Chhuttani, P. N.: Evaluation of Serameha, counterimmuno electrophoresis and bentonite flocculation test in rapid diagnosis of invasive amoebiasis. Ind. J. Path. and Microbiol., 19: 123-12G, 1976. |
|6.||Prakash, 0., Sama, S. K., Vinayak, V. K. and Bhalla, I.: Evaluation of a new antigen for hemagglutination tests in amoebiasis. Amer. J. Trop. Med. and Hyg., 19: 418-421, 1970. |
|7.||Vinayak, V, K., Om Prakash, Talwar, G. P., Tandon, B. N. and Mohapatra, L. N.: Significance of the Indirect Haemagglutination test for the Diagnosis of Amoebiasis. Ind. J. Med. Res., 62: 11711175. 1974. |