Amoebiasis

Amoebiasis is caused by E. histolytica.

Common in developing countries: India,
Bangladesh, Pakistan, Nepal.
Risk factors:
Crowded living conditions
Poor sanitation
Mental health Institutions and
Travel to endemic areas.
 Amoebiasis
Taxonomic position
Phylum- Sarcomastigophora (motile with
pseudopodia or flagella)
Class – Rhizopoda
Order- Amoebida
Genus – Entamoeba,Endolimax,Iodamoeba,
Dientamoeba
Species
Entamoeba - E. histolitica, E.dispar,
E. hatmani, E. Coli
Endolimax - E. Nana
Iodamoeba - I. butschlii
Dientamoeba – D. fragilis.
 Morphology

E. histolytica has two morphological stage:

trophozoite
cyst with an intermediate precyst.
 Trophozoite
Size 10 to 60 µm in diameter
Actively motile and invasive form
cytoplasm consists of clear ectoplasm, finely
granular endoplasm.
food vacuoles often containing rbc's are common,
may contain bacteria.
nucleus has a distinctive central karyosome and a
rim of chromatin lining the nuclear membrane
primary habitat is the large intestine but have the
ability to metastasize to other organs
Trophozoite
 Trophozoite

Entamoeba histolytica trophozoites, two with

ingested RBCs.
 Cyst
During unfavorable condition, trophozoite
condenses into a sphere – the precyst
precyst secretes cyst wall to form the round
cyst - 10 to 20 µ m in diameter
nuclear division begins: Uninucleate cyst 
Binucleate cyst  Quadrinucluate (mature)
cyst
chromatoidal bars are present but common
in immature cysts.
﴾mature﴿
 Important events of life cycle

Host: Man is the only host (definitive).

Infective form: Mature quadrinucleated cyst.
Route of infection: Fecal- oral route.
Site of location: Large intestine.
Pathogenic stage: Trophozoite.
Diagnostic stage: Cyst and Trophozoite.
 Life cycle
Ingestion of quadrinucleated cyst
↓
Exystation at small intestine, give rise to eight young
trophozoites (Amebulae)
↓
Reside in the lumen of cecum and large intestine
↓
Adhere to the epithelial cells and invade
↓
Can spread to other organs through blood
↓
If condition becomes unfavorable re-encystation
occurs and excreted with faeces.
Life cycle
 Virulence factors

Galactose and N-acetyl-D-galactosamine –

for binding with colonic mucosa
Motility
Pore forming proteins.
Enzymes – Collagenases, elastase,
hyaluronidas.
 Pathogenesis
Infection with E. histolytica can cause:
Asymptomatic infection.
Intestinal amoebiasis.
Extraintestinal disease: hepatic
amoebiasis, pulmonary amoebiasis
Other ectopic sites include: brain, skin,
kidneys, spleen, male and female genitalia
and pericardium.
 Pathogenesis
Intestinal amoebiasis: Acute amoebic
dysentery and chronic intestinal amoebiasis.
Acute amoebic dysentery: Occurs over a
period of one to several weeks.
Symptoms: abdominal pain and tenderness,
tenesmus and intermittent diarrhoea,
vomiting and general malaise.
E. histolytica can also cause amoebomas.
 Acute amoebic dysentery
Character of ulcers:
Location: May be generalized (Through out the
large gut) or localized to ileo-caecal and sigmoido-
rectal junction.
Size: Pin head to one inch or more.
Shape: Round or oval.
Margin: Flask-shaped.
Base: Filled up by necrotic mass, yellowish or
blackish slough.
 Pathogenesis
Hepatic amebiasis –
Trophozoites enter liver via portal vein and
enter the sinusoids – form abscess stay
small or continue to grow
Center of abscess is fill with necrotic fluid
and outer wall full of trophozoites.
If abscess ruptures organisms are available
to eat other organs.
 Pathogenesis
Pulmonary amebiasis–
Primary or secondary.
Can enter to lungs via portal circulation or
when liver abscess ruptures through
diaphragm.
 Laboratory diagnosis

Principle:
Laboratory diagnosis of intestinal amoebiasis is
based on demonstration of haematophagous
trophozoite, cyst or antigen from stool.
Laboratory diagnosis of hepatic amoebiasis is
practically done by detection of trophozoite from
pus or antigen detection from blood and saliva.
 Laboratory diagnosis
Culture: Culture of stool samples followed by
isoenzyme analysis can accurately distinguish E.
histolytica from E. dispar and is considered to be
the 'gold standard' for diagnosis.
However, this method takes several weeks to carry
out and requires special laboratory facilities,
making it impractical for routine laboratory test.
 Laboratory diagnosis
Immunological tests:
Antigen detection.
Antibody detection.
Enzyme immunoassays (EIA)
Nucleic acid based technique PCR-based
methods.