LETTERS TO THE EDITOR
I am an ardent reader of your esteemed journal and enjoy reading your short write-ups under “Cost effectiveness/Yield/Medical Economics” as they are brief and straight on the point.
In the last issue 1-2000 (Volume-42) under caption “It is time that pathologists stop reporting cyst of Entamoeba histolytica in the stool”. You have suggested that one should not report this cyst anymore and only report if they find vegetative form of Entamoeba histolytica in the stool sample.
With respect to the above I would like to submit, that using conventional light microscopy it is not possible to classify the vegetative form of any amoeba (as there is variation in species, size, feeding habits and pathogenicity). It is only in their cystic forms that one can classify amoeba into its subtypes.
Unfortunately, Inspite of knowing that Stool Microscopy is the trickiest of all, quite often the stool specimens are passed off to junior staff for examination and the outcome is the consequence of the unexperienced eye! (My personal experience of last 23 yrs is that cysts of E. histolytica are found in less than 10% of all faecal specimen only). An ideal but costly option would be Enzyme Immunoassay using Monoclonal Antibody to Entamoeba histolytica.
Presently, for the laboretarian, the prudent option would be (1) To report ‘Amoeba Present if seen in its vegetative form and (2) Add a short footnote in the report itself explaining the various circumstances that help segregating the amoeba into pathological, commensal, dormant v/s virulent stage. And leave the discretion in the hands of the clinician who can evaluate the case in its totality.
Trust this would abate development of “Amoebiasis neurosis”.BL Ganjawalla
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