AMOEBIASIS

(Amebic Dysentery)

Departemen Mikrobiologi dan Parasitologi

Universitas Padjadjaran

Amoebiasis (Amebic Dysentery)

Causal agent: Entamoeba histolytica
History: was first described in 1875 by
Fedor Lch in St Petersburg
Geographic Distribution: Worldwide, with
higher incidence of amebiasis in developing
countries.

Morphology
Different form of E. histolytica;
1- trophozoite
2- precyst
3- cyst(1, 2, 4 nuclei)

Trophozoite characteristic
Size: 12-60m in diameter;
Non-invasive form (minuta) / E. dispar
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

Transmission

Keyword
is
:
Fecal Oral

 food and drink becoming contaminated

through exposure to human faeces
Recognized high-risk groups :
travellers, immigrants, migrant
workers, immunocompromised
individuals, individuals in mental
institutions, prisons and, possibly,
children in day-care centres.

Clinical symptoms
Asymptomatic infection

Symptomatic infection

Intestinal Amebiasis

Extraintestinal

Amebiasis
Dysenteric
Non-Dysenteric colitis
The extra foci

Hepatic

Liver abscces

Pulmonary

Acut

nonsupprative
Intestinal Amebiasis symptoms:

Diarrhea or dysentery, abdominal

pain, cramping , anorexia, weight loss, chronic fatigue

ExtrantestinalAmebiasis

Liver abscess

Diagnosis
1. Clinical diagnosis
2. Hematology Lab exam Leukocytosis (>12k
sometimes 20k)
3. Paradiagnostic modality:
1. Microscopy
2. If possible 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).

Microscopy
Microscopic identification
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 )

B
A

Microscopy

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.

Treatment
Intestinal Amebiasis:
*Asymptomatic amebiasis(cyst passer):
Diloxanide furoate
500 mg 3 times daily / 10 days

*Symptomatic amebiasis ( troph. & cyst): Iodoquinol , 650 mg 3 times daily/ 20 days or
Metronidazole, 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

http://abcnews.go.com/US/teen-athlete-dies-contracting-braineating-amoeba/story?id=33438944

free-living amoebae causing

human infections

Are normal inhabitants of soil and water where they feed on bacteria.

A few members have the ability to become facultative parasites when an

opportunity to enter a vertebrate exists.

They are able to infect humans

Naegleria fowleri
Acanthamoeba spp.

Naegleria fowleri
When a victim swims or
sinks into freshwater.
- all victims have had a
history of swimming in
freshwater lakes or ponds or
swimming pools a few days
before the onset of symptoms

Naegleria fowleri
_ Naegleria fowleri is a free living brain-eating
amoeba.
_ Typically found in warm fresh water (thermo tolerant
amoeba).
_ worldwide distribution.
_ It exists in trophozoite and cyst forms and in a
transient flagellate stage.
_ Naegleria fowleri is the causative agent of primary
amebic meningoencephalitis (PAM).
_ The period incubation is short, the symptoms are
acute, and death is almost certain and rapid.
_Naegleria fowleri invades the C.N.S. via penetration of
the olfactory mucosa and nasal tissues (nose).
_ Since Naegleria fowleri trophozoites and cysts are
susceptible to chlorine, swimming pools should be

Take home messages

Recognise the epidemiology (at least the
population at risk and how to prevent)
Know the Symptoms then diagnose
Know how to treat
If interested
Learn about the patomechanisms event in
the cell level
Realise the limitation in our setting and how
to improve in the future

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.

Pathogenicity mechanisms
1.secreting proteolytic enzymes
(histolysine ) and cytotoxic
substances.
2.contact-dependent cell killing
3.cytophagocytosis

Pathogenesis
Effective factors:
1- strain virulence:
- classic strain
- non-classic strain; Laredo , Huff, .
- pathogen zymodemes

2- susceptibility of the host; nutrition status,

immune-sys.

3- breakdown of immunologic barrier (tissue

invasion)