Global systematic review of patients with cerebral amebiasis: Successful and rapid clinical and paraclinical diagnostic methods.

Cerebral amebiasis is the most dangerous extraintestinal manifestation of Entamoeba histolytica and poses a critical concern in developing countries. This study aims to systematically review the clinical features, paraclinical findings, and treatment approaches of patients with cerebral amebiasis. The articles were retrieved from Web of Science, PubMed, Scopus, ScienceDirect, and Google Scholar. Literature searches were conducted through October 25, 2024. Clinically, common symptoms include fever, headaches, hemiparesis, left-sided hemiplegia, and seizures. Regarding diagnosis, although the indirect hemagglutination assay (IHA) is the most sensitive serological test, its results may remain positive for several months after infection. In recent years, polymerase chain reaction (PCR) and histopathology have emerged as two reliable techniques for diagnosing cerebral amebiasis. Radiological imaging revealed that multiple abscesses usually appeared as hypodense lesions in several lobes, often accompanied by surrounding edema. The right hemisphere was primarily affected, and the parietal lobe was the predominant region involved. For treatment, metronidazole is the first-line treatment for cerebral abscesses, and craniotomy may be considered in conjunction with antimicrobial therapy. Despite treatment availability, cerebral amebiasis has often been diagnosed late due to its low prevalence and similarity to other diseases, which has been associated with a high mortality rate. Thus, when computed tomography (CT) or magnetic resonance imaging (MRI) reveals cerebral abscesses, cerebral amebiasis should be considered in the differential diagnosis. This consideration is especially important in patients with a history of intestinal amebiasis and involvement of other extraintestinal organs. Hygiene improvement, access to purified water, and enhanced food safety in developing countries could prevent the transmission of Entamoeba histolytica.