Identification of Entamoeba histolytica in Patients with Suspected Amebiasis in Jordan Using PCR-based Assays

Background and Objective: Identification of Entamoeba histolytica (E. histolytica) by microscopy alone can be problematic because E. dispar and E. moshkovskii are morphologically similar to E. histolytica. Therefore, this study aimed to assess the performance of microscopy in the detection of E. histolytica in stool specimens with the help of PCR-based assays and enzyme-linked immunosorbent assay (ELISA). Materials and Methods: Between September, 2017 and September, 2018, 200 stool specimens were obtained from Jordanian patients with suspected amebiasis. All specimens were subjected to microscopic analysis. DNA was extracted from the microscopy-positive stool samples. A conventional PCR and a duplex real-time PCR were performed to detect E. histolytica and E. dispar. Results: By microscopy, 35% (70/200) of specimens were tested positive for Entamoeba complex. All 70 microscopic-positive Entamoeba complex samples were negative for the presence of E. histolytica by the NOVITEC? E. histolytica ELISA assay. All 70 samples positive by microscopy were negative for the presence of E. histolytica and E. dispar by PCR-based assays. Conclusion: We suspect some of these microscopy-positive stool specimens might contain a potentially novel species of Entamoeba that could not be detected by ELISA or PCR-based assays specific for E. histolytica and E. dispar. Diagnosis of amebiasis remains challenging here in Jordan and hence highlighting the need for improved diagnostic method