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Entamoeba histolytica

Amebiasis
(Amebic Dysentery)
Causal agent: Entamoeba histolytica is well recognized
as a pathogenic amoeba.
History: Loosh was first described in 1875
Geographic Distribution: Worldwide, with higher
incidence of amebiasis in developing countries.
In industrialized countries, risk groups include male
homosexuals, travelers and recent immigrants, and
institutionalized populations.

Morphology

Different form of E. histolytica;

1- trophozoite

2- precyst

3- cyst(1, 2, 4 nuclei)

Trophozoite chractere

Size: 12-60m in diameter;


Non-invasive form ( minuta) / E. dispare
Invasive form (magna) contain RBC, E. histolytica

Pseudopodia:
Motility:
Ectoplasm:
Endoplasm: may be contain ingested RBC
Nucleoplasm:

Non-invasive form

invasive form

Different form of E.histolytica cyst

Life cycle

Life cycle

Epidemiology

Prevalencia de infeccion amebiana vara con el nivel de


saneamiento y generalmente ms alta en zonas tropicales y
subtropicales que en los climas templados.
los quistes son la principal fuente de infeccion
La verdadera prevalencia estimada de E. histolytica es cercano
a 1 % en todo el mundo .
Entamoeba histolytica es la segunda causa de mortalidad por
enfermedad parasitaria en humanos. (la primera es la malaria).
Amebiasis es la causa de alrededor de 50,000-100,000
muertes cada ao.

Transmisin

1-contacto directo de persona a persona ( fecal-oral)


2- transmision sexual entre homosexuales (oral-anal )
3- alientos o agua contaminada con heces conteniendo
quistes de E. histolytica.
4-El
4- uso de heces humanas (suelo ) para fertilizante del
suelo
5- la contaminacin de los alimentos por las moscas , y
posiblemente cucarachas.

Pathogenesis

factores eficaces :
1- cepa virulienta:

- cepa clsica
- cepa no clsica ; Laredo , Huff, .
- sindrome patogenico

2- susceptibilidad; estado de nutricion, sistema immune.

3- ruptura de barrera inmunolgica ( invasin de tejidos )

Pathogenicity mechanisms

1- secrecion de encimas proteoliticas ( histolisina )


y sustancias citotoxicas.

2 muerte celular

3 citofagocitosis

Muerte deAmebic killing target cell:

1- receptore-mediated adherence of amebae to target cell ( adherence


lectin)
2- amebic cytolysis of target cell

3- amebic phagocytosis of killed target cell

Clinical symptoms
Asymptomatic infection

Symptomatic infection

Intestinal Amebiasis
Dysenteric

Non-Dysenteric colitis

Extraintestinal Amebiasis
Hepatic Pulmonary

Liver abscces

The extra foci

Acut nonsupprative

Intestinal Amebiasis symptoms: Diarrhea or dysentery, abdominal pain, cramping , anorexia,


weight loss, chronic fatigue

Pathology of Amebiasis

Flask-like Ulcer

Extra-ntestinalAmebiasis

Pyogenic- Liver Abscess

Liver abscess

This is an amebic abscess of liver. Abscesses may arise in liver when there is seeding of
infection from the bowel, because the infectious agents are carried to the liver from the
portal venous circulation.

Diagnosis

Paraclinical Diagnosis:
Sigmoidoscopic examination:

precence of a grossly normal mucosa between the ulcers serves to


differentiate amebic from bacillary dysentery,( the entire mucosa being
involvoed in bacillary dysentery).

Hepatomegally
C.B.C. : leukocytosis in Amebic dys. rises above 12000 per
microliter, but counts may reach 16000 to 20000 per microliter.

Laboratory Diagnosis

Entamoeba histolytica must be differentiated from other intestinal


protozoa including: E. coli, E. hartmanni, E. dispare,

Differentiation is possible, but not always easy, based on morphologic


characteristics of the cysts and trophozoites.

The nonpathogenic Entamoeba dispar, however, is morphologically


identical to E. histolytica, and differentiation must be based on

isoenzymatic or immunologic analysis.

Molecular methods are also useful in distinguishing between E.


histolytica and E. dispar and can also be used to identify E.
polecki.

Microscopy
Microscopic identification
This can be accomplished using:

Fresh stool: wet mounts and permanently stained preparations


(e.g., trichrome).

Concentrates from fresh stool: wet mounts, with or without


iodine stain, and permanently stained preparations (e.g.,
trichrome).

Trophozoites of Entamoeba histolytica /E.


dispar ( trichrome stain )

Microscopy

B
A

In the absence of erythrophagocytosis, the pathogenic E. histolytica is


morphologically indistinguishable from the nonpathogenic E. dispar!
Each trophozoite has a single nucleus, which has a centrally placed karyosome
and uniformly distributed peripheral chromatin.

Trophozoites of Entamoeba histolytica with ingested


erythrocytes (trichrome stain)

The ingested erythrocytes appear as dark inclusions.


Erythrophagocytosis is the only morphologic characteristic that can be
used to differentiate E. histolytica from the nonpathogenic E. dispar.

Cysts of Entamoeba histolytica


/E. dispar

GHI

Cysts of Entamoeba histolytica/E.


dispar, permanent preparations stained
with trichrome.

Immunodiagnosis
(Antibody Detection)

1- Antibody detection

2- Antigen detection may be useful as an adjunct to


microscopic diagnosis

The indirect hemagglutination (IHA)

The EIA test detects antibody specific for E. histolytica in


approximately 95% of patients with extraintestinal amebiasis,
70% of patients with active intestinal infection, and 10% of
asymptomatic persons who are passing cysts of E. histolytica.

Antigen Detection
Antigen detection may be useful as an adjunct to microscopic
diagnosis in detecting parasites and to distinguish between
pathogenic and nonpathogenic infections.
Recent studies indicate improved sensitivity and specificity of
fecal antigen assays with the use of monoclonal antibodies
which can distinguish between E. histolytica and E. dispar
infections.

Molecular diagnosis

In reference diagnosis laboratories, PCR is the


method of choice for discriminating between
the pathogenic species (E. histolytica) from the
(nonpathogenic species (E. dispar.

Treatment
Intestinal Amebiasis:
*Asymptomatic amebiasis(cyst passer): Diloxanide furoate

( furamide)
500 mg 3 times daily / 10 days

*Symptomatic amebiasis ( troph. & cyst): - Iodoquinol , 650 mg 3


times daily/ 20 days or Metronidazole (Flagyl) , 750 mg 3 times daily/ 10
days

*Amebic colitis: Chloroquine, 250 mg 2 times daily

* Acute amebic dysentery: Emetine hydrochloride, 1mg/kg daily IM or SC

Treatment

Extraintestinal Amebiasis:

*Amebic liver abscess, ameboma:


Metronidazole, as above plus dehydroemetine / 10 days or
Metronidazole or dehydroemetine as above plus Chloroquine ,
500 mg 2 times daily / 2 days,..