Entamoeba Histolytica (Medical Microbiology-Jawetz)

Entamoeba histolytica
(Medical Microbiology- Jawetz)

Morphology of Trophozoite(vegetative form):
• 10-60 X 15-30 m average (20-25 m)
• Cytoplasm is clearly differentiated into:
• Ectoplasm: is clear with well developed
pseudopodia.
• Endoplasm: dense & fine granular
enclosing:
• Nucleus: spherical containing central
karyosome & peripheral evenly
distributed small chromatin dots.
• Food vacuoles: contain leucocytes-
bacteria-may be RBCs.
Precyst stage:-
10-60 X 15-30 m average (15-20 m)
-Round or oval with a blunt pseudopodia.
-Absent cyst wall
-Single nucleus present.
Cyst stage:-
10-20 m average (15 m)
-Four nuclei are present in mature
quadrinucleated cyst
-Glycogen mass & chromatoid bodies are
present in immature cysts –disappear in
mature ones.
Morphology of cyst:
Life Cycle of Entamoeba inside human colon
Precyst Uninucleate cyst Binucleate cyst Pass out in stool

In the
lumen
Lumen(non invasive) form Quadrinucleate cyst
Attached Enter with food
to mucosa Binary fission trophozoite
Mucosa of large intestine

Life cycle of
E. histolytica
• Cause amoebiosis
• It occurs usually in the large intestine and causes internal inflammation
• The life cycle of Entamoeba histolytica does not require any intermediate host.
• Mature cysts (spherical, 12–15 µm in diameter) are passed in the feces of an
infected human.
• Another human can get infected by ingesting them in fecally contaminated water,
food or hands.
• If the cysts survive the acidic stomach, they transform back into trophozoites in the
small intestine.
• Trophozoites migrate to the large intestine where they live and multiply by binary
fission.
• Both cysts and trophozoites are sometimes present in the feces.
• Cysts are usually found in firm stool, whereas trophozoites are found in loose stool.
• Only cysts can survive longer periods (up to many weeks outside the host) and
infect other humans.
• If trophozoites are ingested, they are killed by the gastric acid of the stomach.
• Occasionally trophozoites might be transmitted during sexual intercourse.
Pathogenesis
Depends on:
 Parasite virulence.
 Host resistance. Trophozoite
 Condition of the intestinal tract.
Non-pathogenic: in the lumen.
OR Pathogenic: trophozoites invade intestinal mucosa. Tissue (invasive form)
Trophozoites produce histolytic enzyme that produce

necrosis of mucosa leading to the formation
of flask- shaped ulcer.
Trophozoites exist in the base of

the ulcer
Pathogenesis & Complications
This is followed by:
Brain
• Proliferation of connective tissue.
abscess
• Intensive ulcerations.
Lung
• Extra-intestinal invasion to brain, abscess
liver, lung or skin.
Skin
abscess
Liver
abscess
(common)
Blood vessel
Clinical Picture
Asymptomatic: parasite in lumen and cysts pass in stool.
(healthy cyst passer – most common – more than 75%)
Symptomatic: (gradual onset), fever (low grade), diarrhea, dysentery,
abdominal pain, localized abdominal tenderness, & strain, painful
spasm of anal sphincter (indicates rectal ulceration).
Acute intestinal amoebiasis (colitis)
Recurrent attacks of dysentery with intervening periods of
constipation, abdominal distension & weight loss.
Chronic intestinal amoebiasis.
Rare progressive disease of high mortality (high fever- severe bloody
diarrhea – diffuse tenderness)
Extra-intestinal amoebiasis
Amoebic hepatitis or amoebic abscess, lung abscess, brain abscess or
skin abscess.
Complications
• Amoeboma.
(localized granulomatous mass misdiagnosed
with carcinoma)
• Hemorrhage.
• Perforation of ulcer.
(secondary peritonitis --- rare but fatal)
• Stricture of colon.
(secondary to fibrosis)
• Appendicitis.
Minor infections (luminal amoebiasis) can cause
symptoms that include:
• gas (flatulence)
• intermittent constipation
• loose stools
• stomach ache
• stomach cramping.
Extra intestinal amoebiasis
• severe infections inflame the mucosa of the large
intestine causing amoebic dysentery.
• The parasites can also penetrate the intestinal
wall and travel to organs such as the liver via
bloodstream causing extraintestinal amoebiasis.
Symptoms
• appendicitis (inflammation of the appendix)
• bloody diarrhea
• fatigue
• fever
• gas (flatulence)
• genital and skin lesions
• intermittent constipation
• liver abscesses (can lead to death, if not treated)
• malnutrition
• painful defecation (passage of the stool)
• peritonitis (inflammation of the peritoneum which is the thin membrane that lines the
abdominal wall)
• pleuropulmonary abscesses
• stomach ache
• stomach cramping
• toxic megacolon (dilated colon)
• weight loss.
Diagnosis (Intestinal amoebiasis)
• Clinically: Dysentery: painful frequent evacuation of small
quantities of stool containing mucus tinged with blood.
• Laboratory:
1- Direct stool examination: Trophozoites are found in
diarrhoeic stool. Cysts are found in formed stool.
- Wet preparation.
- Iodine stained.
- Permanent stain with iron haematoxylin
2- Concentration techniques for cysts.
Lab diagnosis
• Presence of cysts and (rarely trophozoites)
from a stool sample
• blood test
• biopsy samples
Lab diagnosis(read from Jawetz)
A. Specimen
B. Microscopic examination
C. Culture
D. Serology
E. Radiation methods
prevention
• Wash your hands often.
• Avoid eating raw food.
• Avoid eating raw vegetables or fruit that you
did not wash and peel yourself.
• Avoid consuming milk or other dairy products
that have not been pasteurized.
• Drink only bottled or boiled water or
carbonated (bubbly) drinks in cans or bottles.
Treatment
• metronidazole or tinidazole immediately
followed with paromomycin, diloxanide
furoate or iodoquinol.
• Asymptomatic intestinal amoebiasis is treated
with paromomycin, diloxanide furoate or
iodoquinol.

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Entamoeba histolytica

(Medical Microbiology- Jawetz)

Precyst Uninucleate cyst Binucleate cyst Pass out in stool

Mucosa of large intestine

Trophozoites produce histolytic enzyme that produce

Trophozoites exist in the base of

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