Aspect/ Entamoeba histolytica

Organism/
species
Causes disease .Amoebic desentery .Amebiasis
.Extraintestinal tissue invasion .Amebic hepatitis
Species
involved
Geo distribution .Cosmopolitan

Host Human
Habitat .Wall and lumen of colon
.Cecal and sigmoidorectal Regions
Human Contaminated food with cyst
Infection by / Portal of entry: Mouth
Mode of
infection
Morphology Trophozoite  Precyst (trans) 
Cyst --
Trophozoite .Wide, ectoplasm
.Thin fingerlike ectoplasmic pseupodia for movement and nutrition
.Endoplasm
..has RBCs in invasive stage
..single eccentric nucleus w central karyosome & fine peripheral chromatin granules
Precystic stage .Intermediate stage, no food inclusion
.Smaller than trophozoite, larger than cyst
Cyst .Rounded or oval, 10 – 20 µ in diameter
.Young cyst contains vacuoles w glycogen & Chromatoid bodies (RNA, DNA, represent stored food)
.Growing, dividing
.Immature cyst: single big nucleus
.Mature cyst: 4 nuclei
Reproduction / Excystation  simple binary fission  Encystation
Life cycle
Excystation .begins in cyst forms
.nucleus divides first
Encystation .in lumen of gut (lumen form only)
.essential for transmission
.only mature cyst is infective
Strains E.hartmanni
-small strain
-morphologically identical to E.histolytica
-Non-pathogenic
-Commensal in lumen of intestine
E. histolytica
-Has a commensal phase
Most of healthy carriers harbours minuta variety which changes into pathogenic form due to:
--lowered resistance
--bacterial & viral infections
--change of diet, etc..
Epidemiology .directly correlated w sanitary conditions (poor in tropical & subtropical areas)
.prevalent in ppl living under crowded conditions
.inadequate toilet & sanitary facilities (mental hospitals & migrant labour camps)
.generally poor socioeconomic circumstances
.male homosexuals (oral & anal intercourse)
Amoebic liver abscess, high in Mexico, India, Indonesia, some African countries
.Source of infection is cyst passing chronic patients or asymptomatic carriers
.transmission:
-water & vegetable contaminated w infective feces
-food contaminated by flies
-hands of infected food handlers
Pathology The lesion
-primarily intestinal
-secondarily extra-intestinal
Sites of 1º lesions
-wall of lumen of colon esp in cecal and sigmoidorectal regions (where colonic flow is slow)
Less frequently: ilio-cecal valve, ascending colon, rectim, sigmoid & hepatic flexures of transverse colon or appendix
.As infect progresses, additional sites of invasn develop
.Extraintestinal invasn (eg liver, etc) may occur in Px w clinical dysentery or in those w mild or latent infect

Pathologenic -resistance of host

xtvt depends -innate immunity
upon -state of nutritn
-freedom from infectious & debilitation d/s
 -pathogenic & non-pathogenic strains + No of cysts
-condition in intestinal tract
mucosal injury
stasis
bacterial flora
carbohydrate diet

Complicatn Of intestinal amoebiasis (local)

.Appendicitis
.Intestinal perforation
.Amoeboma
.2º infect
Extra-intestinal
.Hepatic ameobiasis
-tissue forms reach the liver
-as emboli in portal circulatn
-direct extensn from amoebic ulcer in hepatic flexure of transverse colon
-Abscess may be single or multiple
-Abscess may become chronic
-Commonest site is dome of Rt lobe
.Pulmonary amoebiasis
.Amoebic brain abscess
Clinical Acute amoebic dysentery
manifestatn .onset is usually gradual w gripping abdominal pain, w or w/t tetesmus, may be preceded by an afibril diarrhea
.no of motion averages 4-8/day
.toxemic manifestatn – fever, anorexia, tachycardia
.dehydratn
.on palpation, abdominal tenderness
.differential dx = bacillary dysentery
Diagnosis A: Intestinal Amoebasiasis
1. Clinical picture
2. Stool examintn
-trophozoite in loose bloody stool
-cyst of 1 or 4 nuclei in normal stool
3. Sigmoidscopy
4. Barium enema
5. Stool culture
6. Serological dx

Treatment .Metronidazole (Flagyl)

.Emetine hydrochloride (alternative to [1])
Prevention .Tx of cases & carriers, examinant of contact
.sanitary sewage disposal & safe guarded water supply
.water may be boiled & ice should be made from boiling (if potable water is not available)
--trophozoites survive 5 hours at 37ºC
--killed by gastric acid juice
--cyst survive for 2 days at 37ºC
.Effect of chemicals
-Chlorice in concentratn used for water purification is not effective
 Genus and Species Entamoeba histolytica
Amoebiasis; Amoebic dysentery; Extraintestinal Amoebiasis, usually
Etiologic Agent of: Amoebic Liver Abscess = “anchovy sauce”); Amoeba Cutis; Amoebic
Lung Abscess (“liver-colored sputum”)
Infective stage Quadrinucleated cyst (having 4 nuclei)
Definitive Host Human
Portal of Entry Mouth
Mode of Transmission Ingestion of mature cyst through contaminated food or water
Habitat Colon and Cecum
Pathogenic Stage Trophozoite
Locomotive apparatus Pseudopodia (“False Foot”)
Motility Active, Progressive and Directional
'Ring and dot' appearance: peripheral chromatin and central
Nucleus
karyosome
Mode of Reproduction Binary Fission
Pathogenesis Lytic necrosis (it looks like “flask-shaped” holes in Gastrointestinal
 tract sections (GIT)
Type of Encystment Protective and Reproductive
Most common is Direct Fecal Smear (DFS) and staining (but does not
allow identification to species level); Enzyme immunoassay (EIA);
Indirect Hemagglutination (IHA); Antigen detection – monoclonal
Lab Diagnosis
antibody; PCR for species identification. Sometimes only the use of a
fixative (formalin) is effective in detecting cysts. Culture: From faecal
samples - Robinson's medium, Jones' medium
Metronidazole for the invasive trophozoites PLUS a lumenal
amoebicide for those still in the intestine. Paromomycin (Humatin) is
the luminal drug of choice, since Diloxanide furoate (Furamide) is not
commercially available in the USA or Canada (only being available
from the Centers for Disease Control and Prevention). A direct
comparison of efficacy showed that Paromomycin had a higher cure
rate.[8] Paromomycin (Humatin) should be used with caution in
Treatment
patients with colitis as it is both nephrotoxic and ototoxic. Absorption
through the damaged wall of the intestinal tract can result in
permanent hearing loss and kidney damage. Recommended dosage:
Metronidazole 750 mg tid orally, for 5 to 10 days FOLLOWED BY
Paromomycin 30 mg/kg/day orally in 3 equal doses for 5 to 10 days or
Diloxanide furoate 500 mg tid orally for 10 days, to eradicate lumenal
amoebae and prevent relapse.[9]

Trophozoite Stage
Pathognomonic/Diagnostic
Ingested RBC; distinctive nucleus
Feature

Chromatoidal Body
Number of Nuclei
Pathognomonic/Diagnostic
Feature
Cyst Stage
'Cigar' shaped bodies (made up of crystalline ribosomes)
1 in early stages, 4 when mature
'Ring and dot' nucleus and chromatoid bodies