Entamoeba histolytica

Mrs. Dalia Kamal Eldien

Msc in Microbiology

Lecture NO (3)

Objective
Revision for amoeba
Main species for medically important
Introduction to E .histolytica
Modes of Transmission
Morphology of cyst, trophozoite & precyst
Life cycle
Pathology of amoebic dysentery
Laboratory diagnosis
Treatment& control of infection

Introduction
Amoeba
Amoebae consist of a shapeless mass of moving
cytoplasm which is divided into granular endoplasm and
clear ectoplasm.
They move by pushing out the ectoplasm to form
pseudopodia (false feet) into which the endoplasm then
following it.
Amoeba reproduce asexually by simply dividing into two
cells (binary fission).

Main species
According to the pathogenicity, they classified in to two
groups, pathogenic and non pathogenic

Entameboa histolytica

A world-wide distribution, with a higher prevalence in

tropical and subtropical countries, 10 % of the world
population carries the parasite.
Entameboa histolytica lives in the intestine as a
trophozoite, i.e. vegetative stage of protozoa showing
motility and the ability to grow, feed, and reproduce.
It produces resistant cysts by which it is transmitted to
other people (infective stage).

Disease
Entameboa histolytica cause Amoebiasis or amoebic
dysentery, occurs when E. histolytica trophozoites invade
the wall of the large intestine and multiply in the
submucosa, forming large flask-shaped ulcers.
The amoebae ingest red cells from damaged capillaries.
Compared with bacillary dysentery, the onset of amoebic
dysentery is less acute, lasts longer, and there is usually
no significant fever.

Modes of Transmission

By ingestion of contaminated food or water with

amoebae cyst (infective stage).
Oral fecal contamination (children).
House flies and cockroaches

Incubation period:
1 - 14 days with often sudden onset.

Morphology
1- Trophozoite:
It is 10-20m, present in large intestine.
o Ectoplasm: well defined hyaline layer.
o Endoplasm: granular cytoplasm
o Nucleus: 3.7m, spherical, central, small karyosome and fine
peripheral chromatin dots.
Trophozoite acts as active motile feeding reproducing stage.

E. histolytica trophozoite with ingested

red blood cell

2-Precyst: Trophozoite withdraws its pseudopodia and

becomes rounded and devoid of food inclusions.

3- Cyst: 10-18 m, nucleus divides twice by mitotic division to

form 4 nucleated cyst (infective stage).

Life cycle
Cysts ingested in food, water or from hands contaminated
with faeces.
Cysts excyst in the small intestine, forming trophozoite,
which pass and multiply in large intestine.
Trophozoites encyst.
Infective cysts passed in faeces.
Faeces containing infective cysts contaminate the
environment.

Life cycle

Pathology
1- Intestinal amoebiasis:o Invasion of the intestinal wall leads to formation of
several flask-shaped ulcers in the colon as primary
lesions.

2- Extra-intestinal amoebiasis:
o The lesions are secondary to the primary large
intestinal lesions and may result in hepatic,
pulmonary or cerebral, renal....ect amoebic abscess.

Clinical manifestations
Infections of E. histolytica vary in intensity from
asymptomatic to severe or fatal invasions.
Asymptomatic infections are responsible for the spread
of the parasite with numerous cysts being passed in
normal stools. Diarrheic stools primarily contain
trophozoites which cannot persist in the environment.

 Invasive forms of the disease lead to amoebic dysentery

in which the trophozoites invade the intestinal wall,
leading to the formation of amoebic ulcers. This results
in severe diarrhea with blood and mucus present. In such
cases it is important to identify E. histolytica in the stools
to differentiate among other causes of dysentery.

Laboratory diagnosis
1) Diagnosis of intestinal amoebiasis:
a) Stool examination: cyst is found in formed stool,
trophozoite in diarrheic stool. Both forms may be
found in soft stools. Examination must be carried out
immediately because most trophozoites die in less
than 30 minutes.
b) Culture: Culture on specific media may be used to
increases the number of predicted positive cases.
Lock- egg slant medium (L.E.S), this medium is
used for culturing the E. histolytica in clinical
specimens.

E.histoltica cyst in normal

saline preparation

E.histoltica cyst in iodine preparation

E.histoltica trophozoite

Cyst vs trophozoite

Cyst & trophozoite in same slide

c) Sigmoidoscopy and biopsy: In mild cases there

are usually no findings. However, characteristic
amoebic lesions may be found in severe cases.
d) Serology: Many tests are available, but their
use for diagnosis of intestinal amoebiasis is
limited because antibody develops only after a
significant degree of tissue invasion.
Asymptomatic cysts carriers have negative
serologic tests, unless tests are positive from
previous invasive amoebiasis.

2) Diagnosis of extra-intestinal amoebiasis:

a) Serology: More than 90% of patients have
positive serologic titers.
b) Radiology: May be suggestive specially in
hepatic amoebic abscess.
c) Detecting the parasite: Aspiration of the lesion in
selected cases may be of help.

Treatment
The drug of choice for intestinal amoebiasis, is
Metronidazole (Flagyl) 5 - 10 days
The Side effects; headache, nausea, diarrhea, altered
sense of smell

Infection Control
1) Treatment of infected cases.
2) Flies control.
3) Food handlers examination.
4) Health education.