Background
Diarrhea is frequent in communities without clean water which include low-income South African populations in Giyani and Pretoria. In these populations the amount of diarrhea caused by the Entamoeba histolytica parasite inclusive of all ages, sexes and HIV status is uncertain. Infection with E. histolytica can modulate the host microbiota and a key species indicative of this is the Prevotella copri pathobiont.
Results
A cross-sectional study on patients attending gastroenterology clinics was conducted to determine the frequency and burden of four Entamoeba species and P. copri. Entamoeba was present in 27% (E. histolytica 8.5% (41/484),E. dispar 8% (38/484), and E. bangladeshi 4.75% (23/484) E. moshkovskii 0%). This is the first description of E. bangladeshi outside Bangladesh. In E. histolytica positive samples the level of both parasite and P. copri were lower in non-diarrheal samples validating Bangladesh study results (p=0.0034). By contrast in E. histolytica negative samples positive for either the non-pathogenic E. dispar or E. bangladeshi neither P. copri nor Entamoeba levels were linked to gastrointestinal status.
Conclusions
Non-morphologic identification of this parasite is essential. In South Africa three morphologically identical Entamoeba were common but only E. histolytica was linked to both disease and changes in the microbiota.