AMEBIASIS

caused by Entamoeba hystolytica

90 % cases are asymptomatic
First described by Lsch (1875) from a
patient in Leningrad and discovered a
trophozoit form
Quinche & Roos (1893) discovered a cyst
form
Walker & Sellards proved that E,
hystolytica caused amebic colitis
Infection

ETIOLOGY
Entamoeba hystolytica (pathogen ) &
Entamoeba dispar (apathogen)
E. hystolytica :
Trophozoit : hystolytica & minuta
20-40 um (12-50 um), round nucleus,
endoplasma (food vacuoles
RBC, phagocytized elements), clear
ectoplasma
Cyst : 10-20 um, oval or round, 1 4 nuclei

Entamoeba hystolytica
LIFE CYCLE ..(1)
Infective cyst is ingested the wall is
digested in small intestines released of 4
quadrinucleat ameba.
Passed into large intestine to grow and
divide by binary fision to form trophozoites
Trophozoites live in the lumen and mucosal
crypt of the large bowel (caecum,
descending colon, recto-sigmoid)

Entamoeba hystolytica

LIFE CYCLE

..(2)

Invasion of mucosa and passage via

bloodstream may occur colitis, liver
abscess
In the absent of diarrhea, trophozoites
round up and encyst in the lumen of
large intestines (never in the tissue)
passed in the faeces
Within few hours cysts are infected

EPIDEMIOLOGY
Worldwide , tropical region
Infect 10 % of world population
Third cause of death among parasitic
diseases (schistosomiasis, malaria)
Relevent factors in transmission : fecal
disposal, water-borne infections, food
handlers, personal hygiene, arthropodes as
mechanical vectors.
Humans are the principal reservoir

PATHOGENESIS
Trophozoites in the intestinal lumen
Depletion of intestinal mucus, diffuse
inflammation, disruption of the epithelial
barrier
Attach to the interglandular epithel
Microulceration of the mucosa (cecum
sigmoid colon, rectum)
Submucosal extension of ulceration
flask shaped ulcer

CLINICAL MANIFESTATION .. (1)

Asymptomatic cyst passage
intestinal amebiasis fulminant
disease
Asymptomatic cyst passage
most common type
persistent state
symptomatic form

CLINICAL MANIFESTATION (2)

Symptomatic amebic colitis
develops 2-6 weeks after ingestion
of infected cyst
lower abdominal pain, mild diarrhea
malaise, weight loss full blown
dysentriae
stool : little fecal material, blood, mucus

CLINICAL MANIFESTATION .(3)

Toxic megacolon
fulminant intestinal infection
high fever, profused diarrhea, severe
abdominal pain, severe bowel
dilatation with intramural air
children, geriatric, steroid
Chronic amebic colitis
uncommon, mimic IBS

CLINICAL MANIFESTATION .(4)

Ameboma (amebic granuloma)
excessive production of granulation
tissue
cecum, rectosigmoid
present as an irregular tumor
pain, palpable mass, obstructive
symptoms, haemorrhage

CLINICAL MANIFESTATION .(5)

Amebic liver abscess
preceded by intestinal colonization
trophozoites invade vein through
portal
systems
liver parenchyma is replaced by
necrotic
materials anchovy paste) surrounded by a
thin rim of
congested liver tissue
ameba may be found near the capsule of
the abscess

CLINICAL MANIFESTATION ..(6)

Amebic liver abscess
febrile, right upper quadrant abdominal
pain radiate to the shoulder, hepatomegaly, weight loss
elevated right dome of diaphragm on
chest X ray
complication : rupture amebic empyema,
peritonitis, pericarditis, cardiac
tamponade

CLINICAL MANIFESTATION ..(7)

Other form of extraintestinal
amebiasis
- Cutaneus and genital amebiasis
- Pleuropulmonary amebiasis
- Brain abscess

DIAGNOSIS (1)
Anamnesis
Physical diagnosis
Laboratory
- Stool : E. hystolytica) (trophozoite)
- Culture
- Serology : counterimmunodiffusion,
agar gel diffusion, ELISA (6-12 mo
neg), IHA (up to 10 yrs)

DIAGNOSIS .(2)
Amebic liver abscess:
Chest X-ray, liver scan, ultrasonography, MRI
Radiographic barium harmful in
acute amebic colitis.
Endoscopy + biopsy in ameboma

DIFFERENTIAL DIAGNOSIS
Bacterial diarrhoea caused by
Campylobacter, enteroinvasive Escherichia coli, Shigella sp, Salmonella sp,
Vibrio sp.
Pyogenic liver abscess : older patient,
underlying bowel disease, surgery

TREATMENT ..(1)
Luminal amebicides
- Poorly absorbed
- High concentration in the bowel
- Limited to cyst & trophozoites close
to mucosa
- Iodoquinol, Diloxanide furoate,
Paromomycin

TREATMENT ..(2)
Tissue amebicides
- High concentration in blood and
tissue
- Metronidazole, Tinidazole, Ornidazole
Aspiration of liver abscess
- Diagnostic
- Failure to respond clinically in 3-5 days.
- To threat of imminent rupture
- To prevent left lobe liver abscess rupture

PREVENTION
Adequate sanitation
Eradication of cyst carriage
Disinfection by iodination (tetraglycine hydroperiodide)
No effective chemoprophylaxis