Subkingdom: Protozoa

Phylum: Sarcomastigophora
a. Subphylum: Sarcodina
b. Subphylum: Mastigophora
Phylum: Ciliophora
Phylum: Apicomplexa
Phylum: Sarcomastigophora
Subphylum: Sarcodina
Superclass: Rhizopoda
Class: Lobosea
eneral characters o! Amoeba
All the members move by pseudopodium.
Having Trophozoite stage.
Multiplication by binary division.
Some of them parasitic, other free living.
Generic classification depends on structures of nuclear contents.
Commonly parasitizing the large intestine of man, ecept
Entamoeba gingivalis, !hich parasitized the oral cavity.
"
Members o! this !amily are:
O Entamoeba histolytica
O Entamoeba hartmani
O Entamoeba coli
O Entamoeba gingivalis
O Endolimax nana
O Iodamoeba buetschlii

Disease: Amebiasis
Geographical distribution
Cosmopolitan mainly in tropical " subtropical area.
Morphology, Biology & Life cycle:
#t has four stages$ #rophozoite$ precyst$ cyst$ metacyst
The stages recognized in the feces are trophozoites % cysts.
The other t!o found only inside the host body &precyst$ metacyst'

#rophozoite: #n its natural habitat, the large intestine " etra intestinal
foci the size about %&'()*+ m in diameter. #rophozoite up &()' m in
diameter ha*e been obser*ed in dysenteric stools.
Trophozoite has finely granular, endoplasm " a clear, grayish, green tinge
ectoplasm.
The endoplasm contain many structures include nucleus " !ood *acuoles
!ithin the food vacuoles !e may see R+C.
The nucleus spherical, surrounded by delicate nuclear membrane !hich
on its inner surface there is !ine$ regularly distributed chromatin
granules.
#n the center of the nucleus there is single dense karyosome. #mmediately
around the ,aryosome there is clear halo etending bet!een this " the
nuclear membrane are radially eending a chromatin fibrils.
,
#he pseudopodia ha*e , types
C Lobopodia for the locomotion
C -ilopodia for attachment to cells
#rophozoite stage convert to precyst stage !hich convert to cyst
stage !ith mononucleus, this divided into , nuclei, then these ' nuclei !ill
divide into . nuclei !hich no! called mature cyst.
The infection is usually started !ith the cyst stage by contaminated food or
!ater ingested by man. The cyst usually not affected by the -uice of
stomach.
/hen it goes to or through intestine it under go 0 processes 1hich are:
A2 3xcystation : Means the liberation of the metacyst from cyst !all,
then the cytoplasm divided forming metacystic trophozoites. So after
that . trophozoites are formed.
+2 4n*asion : The trophozoite invade the !all of large intestine,
particularly the caecum " colon " then colonization results from
multiplication by binary division.
C2 3ncystation : /ccur in the large intestine, !hen the Trophozoite
dehydrated in bo!el lumen, encystation started.
*
#rophozoite$ precyst considered as diagnostic stage.
*
Mature cyst as in!ecti*e stage.
0
E. histolytica
&#rophozoite'
&Cyst'

E. histolytica habitat is Caecum % !lexure colon.
5iable cysts of E. histolytica in eternal environment are soon ,illed by
drying, direct sun light, heat, hypertonicity " bacterial putrefaction.
.
Reproducing colony o! #rophozoite
in caecum % colon
Precyst
Cyst
/ith &"2.' nuclei
Metacyst
3*acuated in !eces
4n en*ironment
Cyst ingestion
Metacystic trophozoites
&4n colon'
Cyst passed in semiformed, form, solid, semisolid stool.
#rophozoite % precyst dies rapidly %so non(infective+ but cyst is
resistance %infective stage+.
Pathogenesis
#nfection !ith E. histolytica leads to formation of colonization.
The speed " depth of penetration depends on$
C 0athogenic capacity of the particular strain of E. histolytica
C General resistance of the host.
#he damage caused by E. histolytica is:
OChemical %1nzyme action+
OMechanical %engulfing of the parasite+
#rophozoite may lodge in the crypts of large intestine
2esion result from invasion leading to superficially minute cavity %are
result of lytic necrosis of the parasite on colon mucosa+.
More colonizing " more lytic action leading to narro! channel, !hich
lead to base of the mucosa.
6
-eeding
Colonized
Lytic acti*ity
4n*asion
The invasion etend laterally !hich leads to -lask shaped ulcer, and
the repair may ta,e place to lytic necrosis, lesion leads to etensive
functional damage to the mucosa.
#n many cases, the Amoeba erode a passage into muscularis mucosa then
sub mucosa.
#t can spread radially to surrounding tissues. &i! there is no secondary
bacterial in!ection$ there is no tissue reaction'.
3rom submucosa, the invasion etends to muscular coats " penetrate to
serosa %0erforation+. #t may perforate mesenteric venules or lymphatics "
carried into the liver " other etraintestinal sites %brain, lung+.
Any etraintestinal lesion is secondary to primary lesion in large intestine
ecept cutaneous lesion of the genitalia.
So the early uncomplicated amebic lesions are minute opening !ith slightly
raised yello!ish ring in mucosa leading into a deeper enlargement in the
submucosa !ith tunneled connection bet!een t!o or more lesions leading to
cuts off the blood supply sloughing of overlying layers.
As the lesion becomes chronic by bacterial infection tissue reaction
" cell infiltration, !ith neutrophilic leu,ocytes " fibroblasts tend to form a
!all a round the ulcer " over hanging edges become thic,ened.
Extraintestinal amebic lesion
At first consists of a small lesion !here are a more ameba enter the blood
vessels " lodged into the liver or other organ proceed to colonize producing
necrosis of surrounding host cells.
#n the liver, tendency for lesion to be multiple(later one or at most fe!
become enlarged to develop amebic liver abscess, this lesion
bacteriologicaly sterile, but the amount of tissue necrosis stimulates local "
systemic 2eu,ocytosis.
Symptomatology
The incubation period %the time or duration from time of eposure till first
symptoms appear+ is vary from fe! days to ) months or even a year.
#n E. histolytica it is difficult to determine the interval bet!een eposure
" first symptoms. The onset may be insidious !ith vague %not sharp+
abdominal discomfort or soft stools for variable period or it may be sudden
!ith dysentery or acute abdominal pain.
7
#n hepatic amebiasis, fre4uently there is no history of amebic infection in
colon.

8
3xtra intestinal 4ntestinal
9eep
%hepatic, pulmonary " cerebral+
Super!icial
%s,in+
9ysenteric type
%blood in diarrhea, sever
abdominal pain+
:on2dysenteric type
Abdominal pain$ tenderness
and ; or diarrhea 1ithout
blood
Completely a symptomatic
&carrier'
Amebiasis may be only one of t!o or more concurrent disease processes,
eample, Shigellosis, Salmonellosis, carcinoma, appendicitis, peptic
ulcers, cholecystitis.
At time or more amoebic granulomas %amebomas+ develop in the !all of
colon or rectum.
The patient !ith amebic dysentery have tenesmus, abdominal cramps. 5o
systemic intoication as seen in bacillary dysentery.
The abdominal pain " tenderness are mostly in the lo!er 4uadrants of the
abdomen, on the right side. Clinically sometime mista,en for appendicitis.
1traintestinal symptoms depend on the organ affected.
Hepatic abscess presents !ith fever, enlarged tender are mostly in the lo!er
4uadrants of the abdomen, on the right side, clinically sometimes mista,en
for appendicitis.
3xtraintestinal symptoms depend on the organ a!!ected.
<epatic abscess present !ith fever, enlarged tender liver, bulging "
fiation of the right leaf of the diaphragm " serious effusion of the right
pleura.
Skin amoebiasis occurs due to damaged s,in come in contact !ith
trophozoite stage.
* Most common skin in!ection seen in:
O Perineum$ secondary to amoebic dysentery.
O Penile lesion, ac4uired by anal intercourse.
O #he abdomen, at the mouth of fistulous tract from colon or from
hepatic abscess.
Diagnosis
#ntestinal amoebiasis cannot be diagnosed on clinical ground only, primary
depend on direct microscopic eamination of the stool to recover motile
trophozoite " charcot(leyden crystals.
4n extra intestinal amoebiasis, routine !or, of Histopathology using
&+est=s carmine' stain must be perform.
>
Treatment
6epend on clinical type. #n severe amebic dysentery the purpose of
treatment is not only to provide relief of discomfort but also improve
eradication of amebic infection.
4ntestinal amoebiasis$ the drug of choice is
* Metronidazole 78* mg, Tid for %8(&*+ days.
* 9iiodohydroxy?uin.
* Antibiotic &#etracycline'.
* 3metine hydrochloride, also effective.
:on dysenteric symptoms:
* 9iloxanide !uroat % 9iiodohydroxy?uin.
A symptomatic cases:
* Must be treated by Metronidazole.
3xtraintestinal:
* Metronidazole.
* 3metin hydrochloride.
* Chloro?uine.
@r all o! them
Epidemiology
High prevalence in !arm climates " people of all races, sees " ages are
sub-ected to infection.
Mode of transmission by:
C Contamination of !ater !ith viable cyst.
(
C 0erson(to(person contact.
C 3ood handler9s.
C 3ilth flies.
Control
C Treatment of patient.
C Screening of food handlers " treat the infected cases.
C #mprovement of hygiene " sanitation.
C Human ecreta must be disposed properly.
9i!!erences bet1een the amoebic % bacillary dysentery:2
Microscopic Amoebic dysentery +acillary dysentery
Pus cells Scanty " !ell preserved
:ery numerous, but it is
degenerated
R+C
S
Abundant, often in
rouleu
Scattered
Large macrophage 5ot a feature 5umerous
Charcot leyden
crystals
0resent Absent
E. histolytica 0resent Absent
")

* The most common amoebic parasite of man %commensal+.
* #t habits large intestine.
* #t has trophozoite " cyst stages, both of them are larger than those of E.
histolytica. The trophozoite size is %&8(8*+ , no ;<Cs seen in food
vacuoles. There is no sharp point bet!een ectoplasm " endoplasm in
trophozoite stage.
* #n cyst stage %its size &*()) m+, the mature cyst contains = nuclei, each
of them has same feature of trophozoite nuclei.
* The shape of chromatoidal bodies in of E. histolytica is cigarette,
rounded in shape, but it is needle shaped in the E. coli if presented.
* The E. coli is not parasitism but commensalisms.
* The presence of E. coli in stool of some bodies means the food of this
patient contaminated !ith feacal material, ho!> <y the Musca
domestica, filth fly, or others.
* The presence of E. coli in the host means his food been contaminated.

""
#rophozoite Cyst
E. coli
* #here are , things !or di!!erentiation bet1een E. histolytica %
E. coli :
#he di!!erence E. histolytica E. coli
Aaryosome Central 1ccentric
Chromatin line nuclear
membrane
3ine " regular
distributed
Course " irregular
distributed
* /nly trophozoite been reported in 1. gingivalis .
* The size of the trophozoite is %&8()*+ m.
* #t is nonpathogenic but opportunistic %in diseased gum or tonsils+.
* The ,aryosome is central or some!hat eccentric.
* Tt is found in diseased gum " tonsillitis as a phagocytic %opportunistic+.
* #t is transmitted through saliva droplets or intimate contact.
",
E. gingivalis
#rophozoite
* 2i,e the E. coli, its presence means the food of the person been
contaminated !ith stool %feacal matter+ of other person
* #t has trophozoite " cyst stages. The trophozoite has one nucleus, and the
cyst has . nuclei. The ,aryosome consisting from one or more granules,
commonly eccentric in position.
* The size of the trophozoite is %=(&*+ mm, the endoplasm finally granular
!ith numerous vacuoles.
* #n the cyst chromotoidal bodies, if present are short curved rods or
comma shaped.
"0
Endolimax nana
#rophozoite Cyst
Small race of E. histolytica, sometimes it is mista,en !ith E. nana,
fortunately both of them are non pathogenic.
* Cosmopolitan, commensal, living in lumen of large intestine.
* #t has , stages$
#rophozoit: %=(&*+m ?@?@ AB@, sluggish in motility !ith little evidence
of pseudopodial etensions.
Cyst: %8(&=+m.
/e can di!!erentiate bet1een 4. buetschlii % others by:
=The trophozoite " cyst have one nucleus " both of them have
glycogen vacuoles, so in stain !ith iodine to give bro!n mass.
=A large ,aryosome in nucleus found centrally or some!hat
eccentrically.
=/nly the trophozoite of this amoeba has one or t!o distinct glycogen
vacuoles.
=The cyst has only one nucleus, it has large glycogen vacuoles !hich
stained !ith iodine in deep bro!n color.
So these di!!erences are *ery important.
".
E. hartmani
#rophozoite
Cyst
#rophozoite Cyst
* #t is parasitic amoeba.
* 6iscovered in &C&'.
* #t9s life cycle is not clear.
* Since discovered, B. hominis has been the sub-ect of controversy, initially
described as algae, them as harmless intestinal yeast, and since around
&C=' as a protozoan parasite.
* Although a number of different forms of it are ,no!n, so only vacuolated
form is more common " easy to recognize, therefore only this form is
described.
The different form of B. hominis:-
O 5acuolated type$ 1hich is the most common type.
O ranulated type.
O Amoeboid type.
"6
The size range from %8()'+ m, but the average is %7(&*+ m !ith large
vacuole in the center forming about &*D at the periphery !ith . nuclei
situated at same level.
The life cycle has not been universally described, but it may participate in
a seual reproduction.
Main method of reproduction is by binary division " sporulation, and it
transmitted through contaminated food " !ater, and it is prevalent in
tropical " subtropical areas.
Pathogenesis
#s not !ell ,no!n " need to be determined.
Symptoms
Mainly diarrhea, nausea, vomiting, fever, as !ell as abdominal pain "
cramps.
Treatment
The best drug of choice is a combination of -lagyl " Septrin
"7
"8
+acillary dysentery Amoebic dysentery
:umber E &* per day
%F(=+ per day
Amount Small ;elatively copious
Appearance Consist of blood " mucus,
hardly any faecal matter
3eces !ith stratum of
blood " mucus seen
over the surface
Colour o! blood <right red
%fresh blood+
6ar, red
%latered blood+
Consistency :iscid, mucous
adherent to container
2i4uid or formed,
mucus not adherent to
container
@dour /dourless /ffensive
Chemical reaction Al,aline Acidic
Microscopic examination
Pus cells 5umerous Scanty
Red blood cells 6iscrete #n clumps, discoloured
3osinophils Absent or rare 0resent
Macrophages 0resent sho!ing ingested
erythrocytes
Absent
CL crystals Absent 0resent
E. histolytica Absent Trophozoites 0resent
+acteria Scanty, non motile 5umerous " motile
Cultural examination
ro1th on media !or
E. histolytica
5egative Trophozoites gro!n
ro1th on MacConkey
agar
0ositive for Shigella spp. 5egative
">
"(
A' Amoebic dysentery +' +acillary dysentery
Microscopic appearance o! exudate
,)
9istribution o! intestinal amoebic ulcers
4ntestinal amoebic ulcers