Comparative Evaluation of Diagnostic Methods for Entamoeba species Detection in Zakho, Kurdistan Region of Iraq

Objective: In this study, we compared the effectiveness of three detection methods: direct wet mount microscopy, zinc sulfate floatation, and enzyme-linked immunosorbent assay (ELISA) to detect Entamoeba. histolytica among inhabitants of Zakho city, Kurdistan Region of Iraq. Methods:The collection of faeces was carried out between September 2024 and May 2025 (615 samples, 515 symptomatic patients, and 100 asymptomatic patients). Direct wet mount microscopy, zinc sulfate flotation, and ELISA target E. histolytica-specific antigen were used to examine each specimen. Results:Wet mount revealed 105 positive results (17.07%), whereas zinc sulfate flotation was able to detect significant number of positive cases 149 of them (24.22%, p < 0.001). Only 35 cases (5.69%) were positive using E. histolytica-specific antigen detected by ELISA, which is more specific and can rule out deliberately nonpathogenic species that otherwise resemble pathogens morphologically, such as Entamoeba dispar and E. moshkovskii. The prevalence of infection was the highest in children between the ages of 1 to 10 years with the absence of any significant differentiation between the genders. Socioeconomic factors, in general, and low level of education and low income were found to be significantly associated with the infection rates. Conclusion: Wet mount microscopy is not very sensitive, and zinc sulfate flotation lacks specificity, although it improves sensitivity. ELISA gives valid validation of pathogenic E. histolytica. A combination of flotation and ELISA should be adopted to enhance better accuracy of diagnosis, prevent overtreatment and provide better and reliable epidemiological data in endemic settings.