Entamoeba Histoytica

Entamoeba histolytica
Dr. Umar Farooq
Entamoeba histolytica Classification :Phylum :- Sarcomastigopdora Subphylum :- Sarcodina Superclass:-Rhizopoda Class:- Lobosea Orders:- Euamoebida Genus:- Entamoeba Species:-histolytica
Entamoeba histolytica was first described by Losch in 1875 after being isolated in Russia from a patient with dysentric stool Geographical distribution:-
World wide
Worldwide amoebiasis causes 40,000-100,000 deaths

every year
Habitat
Large intestine of man : Trophozite Forms : Mucous and submucous layer
Morphology
The parasite exists in three morphological forms: Tropozoite Precyst Cyst
Trophozite
10-60m
Endoplasm granular Food vacuoles: RBCs, leucocytes and tissue debris Motile Blunt single Pseudopodia Single Large nucleus Only Trophozite present in the tissues
Precyst:-
Smaller in size
10-20m in diameter Oval with a blunt pseudopodium Food vacuoles disappear Characteristics nucleus
Cyst
Spherical, 1-15 m in diameter Surrounded by a thick chitinous wall Uni nucleated Bi nucleated tetra nucleated Cyst are present only in the lumen of the colon and in
formed faeces
Tropozoite
Precyst
Cyst
Life cycle:
In life cycle in only one host: man
Pathogenicity Mode of Transmission: Feco-Oral Route: By Ingestion

of contaminated food and Drinking water
Intestinal amoebiasis : Intestinal amoebiasis indicate that organism are confined to gastrointestinal tract. Incubation period :1-4 weeks The amoebae invade the colonic mucosa , producing characteristic ulcerative flask shaped lesions and a profuse bloody diarrhea ( amoebic dysentery).
FLASK SAHPED ULCER
PERFORATED INTESTINE
Extra intestinal amoebiasis:About 5% individuals 1. Hepatic amoebasis: Acute Liver Abscess: Develop after 1-3 Months Transmit through portal veins from intestine to Liver Pus of liver abscess: Anchovy Sauce
appearance: Contain few Pus cells
Patient with amoebiasis liver abscess, with perforation of abscess through abdominal skin.
2. Pulmonary Amoebiasis: Transmitted from Liver and develop pulmonary Lesions
3. Cerebral Amoebiasis: Transmitted from Liver to heart then Brain and develop cerebral lesion
Mild symptoms include:

Loose stools/diarrhoea, including slimy diarrhoea with pus (which is often foul smelling) and painful passage of stools (tenesmus) Stomach pain Stomach cramps (colic) Nausea
Severe symptoms include:

Amoebic dysentery (associated with severe abdominal pain, bloody stools, and fever) Profuse diarrhoea (patients may pass about 10-12 stools during an acute episode, and still constantly feel an urgency to pass stools) Liver abscess Severe ulceration Severe gastric distention of the bowel Peritonitis (inflammation of the intestinal wall and its lining) or colitis (inflammation of the colon, specifically) Megacolon (very rare, in 0.5% of the cases) Ameboma (which results from formation of annular colonic granulation tissue and may mimic carcinoma of the colon)
Laboratory diagnosis
Intestinal amoebiasis
Stool examination :-In acute amoebiasis, stool or colonic scraping from ulcerated areas are examined by macroscopic and microscopic
examination . Blood examination :- It shown moderate leucocytosis.
Serological tests: These are negatives in early cases however, in
later stages of invasive intestinal amoebasis

antibodies appear and serological testes become positive These test inculde indirect fluorescent
haemagglutination(IHA), indirect
antibody (IFA) test and enzymes linked immunosorbent assay (ELISA)
Hepatic amoebiasis Diagnostic aspiration :- Trophozoites of E. histolytica may be demonstrated by microscopy of the pus aspirated by puncture of amoebic liver abscess in less than 15% cases Liver biopsy :-Trophozite of E.histolytica can be demonstrated in the specimens of liver biopsy from the cases of amoebic hepatitis or the wall of the liver abscess
Blood examination:It shows leucocytosis with total leukocyte count of 15,000- 30,000l of which 70-75% are polymorphonuclear leucocytes. Stool examination:In less than 15% cases of amoebic hepatitis , cysts of E.histolytica can be demonstrated in the stool . This indicates persistence of intestinal infection.
Serological tests :- serological tests like IHA, IFA,

coagglution test and ELISA are of immense value in detected in the patient serum by ELISA and a simple and economical slide agglutination test, the
coagglutination test. Molecular methods :- DNA probes and PCR are the recent molecular methods of promise for the dectection of E.histolytica in stool and liver aspirates.
TREATMENT
Treatment of amoebiasis is based on the use of amoebicides drugs Amoebicides with luminal action Di-iodohydroxyquin Diloxanide furoate Paromomycin Amoebicides effective in the liver, intestinal wall and other tissues Emetine Dehydroemetine
Amoebicides effective only in the liver chloroquine Amoebicides effective in both tissues and the intestinal lumen Metronidazole Nitroimidazole
Prevention
The amoebic infection
can be prevented by
avoiding faecal contamination of food and water
There should be proper disposal of human faces

through proper drainage system
Contamination may result from discharge of

sewage into rivers. Purified water should be
distributed
through
pipelines
to
avoid
contamination . Boiled water is safe.
The amount of chlorine normally used to purify water is insufficient to kill cysts , higher levels of chlorine are effective but the water thus treated must be dechlorinated before use. Vegetables that are usually eaten raw should be cleaned with
uncontaminated runing water and treated with 5% acetic acid

before consuming

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Entamoeba histolytica

Dr. Umar Farooq

Worldwide amoebiasis causes 40,000-100,000 deaths

In life cycle in only one host: man

Pathogenicity Mode of Transmission: Feco-Oral Route: By Ingestion

FLASK SAHPED ULCER

2. Pulmonary Amoebiasis: Transmitted from Liver and develop pulmonary Lesions

Mild symptoms include:

Severe symptoms include:

examination . Blood examination :- It shown moderate leucocytosis.

Serological tests: These are negatives in early cases however, in

later stages of invasive intestinal amoebasis

antibody (IFA) test and enzymes linked immunosorbent assay (ELISA)

Serological tests :- serological tests like IHA, IFA,

The amoebic infection

avoiding faecal contamination of food and water

There should be proper disposal of human faces

Contamination may result from discharge of

contamination . Boiled water is safe.

uncontaminated runing water and treated with 5% acetic acid

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