Protozoa

Amebae
Subkingdom Protozoa:
Phylum
Sarcomastigophora
Subphylum
Sarcodina
(Amebae)

Subphylum
Mastigophora
(Flagellates)

Phylum Ciliophora
(Ciliates)
 3 Genera of Amebae that
Inhabit the Intestinal Tract of
Humans
Entamoeba
Endolimax
Iodamoeba
Cysts are ingested and excyst in the small intestine.
Resulting trophozoites proliferate by binary fission
in the lumen of the colon. Both cysts and
trophozoites may be passed in feces, but only
mature cysts are infective. E. histolytica is the only
amebic species capable of invading tissues and
causing disease.
 Epidemiology
Intestinal amebae, flagellates and ciliates are
transmitted
through fecally-contaminated food, water or other
materials.

Contaminated water supplies are a particular

problem because
the usual levels of chlorination may not kill cysts.
Filtration is
required. Endemic and epidemic disease has been
traced to
water supplies that use surface water which either
is not filtered
or has been improperly filtered.
 Amebae
Characterized by possession of vesicular nucleus
with small karyosome
 Epidemiology of
Entamoeba histolytica
Population groups with a higher incidence of
amebiasis include
people from the developing world or recent
immigrants from
there to the developed nations.
Social changes seen in the late 1960s : open
expression of
homosexuality, increased sexual contacts,
increased frequency
of sexual activities and anonymity of sexual
partners
contributed to dramatic increases in sexually
transmitted
 Epidemiology of
Entamoeba histolytica
For every case of invasive disease
diagnosed, there are at least 10-20
asymptomatic individuals excreting
infective cysts, resistant to drying and
chlorination
Asymtomatic amebiasis may become
symptomatic or cause extra-intestinal
spread, public health issue
Diagnosis: (1) blood in stool; (2)serum
antibody titer; (3) stool E. histolytica
antigen titer
 Entamoeba histolytica
- Identical with the commensal E. dispar (differentiated
by isoenzyme analysis and monoclonal antibody
typing)

- Inhabits the large intestines, trophozoites are the

active forms

- Invades the mucosal crypts, feeds on RBCs and cause

ulcers, gives rise to amebic dysentery, liver abscess
 Trophozoite of Entamoeba
histolytica
- Size is 12 to 60 m

- Moves via pseudopodia, long and finger-like

movement progressive
and directional (other amoeba - aimless movement)

- The only characteristic that is pathognomonic for E.

histolytica is
phagocytosis of erythrocytes, which very rarely
occurs with other
species.

- In stained preparations, the peripheral nuclear

chromatin is evenly distributed along the nuclear
membrane as fine granules. The karyosome is small
 Cyst of Entamoeba histolytica
- Spherical and measure 10 to 20 m (usually 12 to 15 m) in
diameter

- The rounded precyst stage has a single nucleus but does not have
a refractile cyst wall.

- As it matures, the cyst develops four nuclei, each approximately

one-sixth the diameter of the cyst.

- Cyst nuclei appear similar to those of trophozoites, but their

smaller size makes them less useful as differentiating features.

- Cyst cytoplasm may contain glycogen vacuoles and

chromatoid bodies with blunted or rounded ends. The number
and size of nuclei and the appearance of chromatoid bodies are
important diagnostic criteria for identifying cysts.
 Entamoeba histolytica
Asymptomatically infected individuals: cyst-passing
carrier state
represent a risk to the community because they are a
source of
new infections definite risk for development of
invasive amebiasis
Most commonly; amebic dysentery characterized by
blood and
mucus in stools with abdominal cramping
Amebic colitis - symptoms less severe than dysentery
but may
include non-bloody diarrhea, constipation, abdominal
cramping,
and weight loss
 Entamoeba histolytica
Amebic liver abscess - most common form of
extraintestinal amebiasis ; occurring in
approximately 5% of patients with a history of
intestinal amebiasis.

Symptoms include fever and right upper quadrant

pain. These liver abscesses are usually diagnosed
by radiographic scans, ultrasound, and serologic
tests. Amebae are present in the stool in less than
half of patients at the time liver abscess is
manifest.
 Diagnosis of E. histolytica
Microscopic identification of cysts and trophozoites from
stool or aspirate samples using:
a) Fresh sample: wet mounts with/without iodine stain and
permanently stained preparations (ex. Trichome)
b) Concentrates then follow as above as in wet mount

Immunodiagnosis (ELISA, IFAT, Latex Agglutination)

Molecular analysis by PCR-based assays method of

choice for discriminating between the pathogenic species
(E. histolytica) and the non-pathogenic species (E. dispar)

Diagnostic stage: Cyst or trophozoite stage

Infective stage: quadrinucleated mature cyst
 Treatment of E. histolytica
Asymptomatic Drug of choice
Iodoquinol
OR Paromomycin
Alternative: Diloxanide furoate
Mild to Moderate Drug of choice
Intestinal Disease
Metronidazole
OR Tinidazole
Severe Intestinal and Drug of choice
Extraintestinal
Disease
Metronidazole
OR Tinidazole
 Entamoeba hartmanni

Has been called the small race of E. histolytica

Morphologic characteristics similar to those of E.
histolytica: except trophozoites have a maximum
diameter of 12 m; cysts have a maximum
diameter of 10 m, and cysts often have a single
nucleus.
Ingests bacteria, not RBCs
 Entamoeba coli
Non-pathogenic, difficult to differentiate from E.
histolytica.

Cytoplasm - more vacuolated, containing

numerous ingested bacteria, yeasts, and
other materials.

Mature cysts contain eight nuclei, although

occasional cysts contain 16 or more and larger
than pathogenic species

No RBCs ingested, sluggish movement,

pseudopodia short and
blunt (E histolytica - finger-like)
 Entamoeba gingivalis
Bears a close resemblance to E. histolytica
Trophozoites live in oral cavity of humans residing in
the gingival pockets near the base of the teeth
Cytoplasm may contain bacteria and occasional red
cells but most frequently filled with portions of
ingested leucocytes - the only species that ingest
these cells
No known cyst
Has been reported to multiply in bronchial mucosa
and to appear in the sputum, where it may be
mistaken for E. histolytica from a pulmonary abscess
Transmitted person to person by kissing or fomites
(such as eating utensils)
 Iodamoeba butschlii
Characteristic glycogen vacuole of the cyst stage,
usually single
nucleus, identification of unstained trophozoite is
difficult,
karyosome is large and centrally located
Disease of historical interest - Japanese POW had
disseminated
amebiasis, 6-year-old American had brain granuloma
 Endolimax nana
Most common of the smaller intestinal
amebae
Trophozoite contain food vacuoles with
ingested species
Cyst - ovoid, one to four nuclei, eccentric
karyosome
 Dientamoeba fragilis
Recently classified as flagellate on the basis of
ultra-
structural details and antigenic similarities

Lives in the mucosa of the large intestine,

never invades
tissue, no cyst stage, 80% in a binucleate form

May cause diarrhea and abdominal pain, show

a 10-20
times greater than expected association with
enterobiasis
(pinworm infection)
Morphology of Trophozoites
of Intestinal Amoebae
Morphology of Trophozoites
of Intestinal Amoebae
Morphology of Cysts of Intestinal
Amoebae
Morphology of Cysts of Intestinal
Amoebae