INTESTINAL PROTOZOA

Parasitology Dept.

Entamoeba histolytica

Phylum : Sarcomastigophora Class : Lobosea Order : Amoebida Family : Endamoebidae Genus : Entamoeba Species : histolytica

Entamoeba histolytica

E. histolityca frequently lives as a commensal in the lumen of the large intestine without causing disease. May invade the colon wall, produce ulceration & migrate via the blood stream to the liver, where it produces hepatic abcesses. Very rarely infect the : lungs, brain, etc

DISTRIBUTION

E. histolityca is an enteric protozoan parasite that infects 500 million people per year Cosmopolitan, temperate and tropical climates. More prevalent in tropical areas associated with poor economic status, poor nutrition, poor hygiene and sanitation

MORPHOLOGY

Several successive stages occur in the lifecycle of E. histolityca : trophozoite, precyst metacyst, metacystic trophozoites & cyst. Trophozoite : - size : 10-60 m - single nucleus, peripheral chromatine, central karyosome - endoplasm contain food vacuoles, rbc, & other phagocytosed elements

MORPHOLOGY

Trophozoite

Figure 1. Trophozoite E. histolytica4

MORPHOLOGY

Pre cyst - shape : ovoid, ussually spheroid - size : 10-20 m - RBC : (-)

MORPHOLOGY

Cyst - size : 10-20 m - mature cyst has 4

nuclei, round shape - chromatoidal body (+)

Figure 2. Cyst E. histolytica5

LIFE CYCLE

Figure 3. Lifecycle E. histolytica6

TRANSMISSION

Ingestion of the mature cyst Food handler Flies, cockroaches Sexual transmission Reservoir host

EPIDEMIOLOGY

All ages are susceptible to infection but the rate is lower in infants and young children Cysts are sensitive to dessication and to temperatures above 40C or below 5C, resistent to chlorine.

athogenesis of Amebiasis
NON-INVASIVE ameba colony on intestinal mucosa asymptomatic cyst passer non-dysenteric diarrhea, abdominal cramps, other GI symptoms INVASIVE necrosis of mucosa ulcers, dysentery ulcer enlargement dysentery, peritonitis metastasis extraintestinal amebiasis cessation of cyst production

 ulcers with raised borders little inflammation between lesions

 flasked-shaped ulcer trophozoites at boundary of necrotic and healthy tissue trophozoites ingesting host cells dysentery (blood and mucus in feces)

Ulcer Enlargement and Disease Progression

ameba expand laterally and downward into lamina propria localized sloughing (ulcers coalesce) perforation of intestinal wall peritonitis 2o bacterial infections local abscesses ameboma (=amebic granuloma)
ameboma = inflammatory thickening of intestinal wall around the abscess (can be confused with tumor)

Extraintestinal Amebiasis
metastasis via blood stream primarily liver (portal vein) other sites less frequent ameba-free stools common high antibody titers

Amebic Liver Abscess

chocolate-colored pus necrotic material usually bacteria free lesions expand and coalesce further metastasis, direct extension or fistula

Pulmonary Amebiasis
rarely primary rupture of liver abscess through diaphragm 2o bacterial infections common fever, cough, dyspnea, pain, vomica

Cutaneous Amebiasis
intestinal or hepatic fistula mucosa bathed in fluids containing trophozoites perianal ulcers urogenital (eg, labia, vagina, penis)

Facultative Pathogenicity
85-90% of infected individuals are asymptomatic ~10% of the symptomatic will develop severe invasive disease

Treatment
Entamoeba
asymptomatic iodoquinol or paromomycin symptomatic metronidazole or tinidazole followed by lumenal agents drain liver abscess only with high probability of rupture!

References
1.

Sutanto I, Adjung, SA. Entamoeba histolytica. Dalam : Sutanto I, Ismid IS, Sjarifuddin PK, Sungkar S (eds.). Buku Ajar Parasitologi Kedokteran. Edisi ke-4. Jakarta:FK-UI;2008.p.107-18 Sandjaja B. Sarcodina. Parasitologi Kedokteran Buku I Protozoologi Kedokteran. Ed.1. Jakarta:Prestasi Pustaka. 2007. p. 87-106 Schmidt GD, Robert LS. Foundations of parasitology. 7th ed. New York:Mc Graw Hill;2005.p.107-13 Entamoeba histolytica. Available from http://www.dhs.state.tx.us/lab/par_parasites.shtm&usg (accessed on 21st of July, 2010) Entamoeba histolytica cyst Available from http://www.asm.org (accessed on 26th of August 2010) Entamoeba histolytica Available from http://www.arthusclipart.org (accessed on 21st of July, 2010)

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