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Dr.

Muhammad Sajid
Email: muhammaddrsajid@yahoo.com
Objectives
 By the end of this lecture Students of 2nd Year BDS
will be able to know;
 Define Entameoba Histolytica
 Discuss Morphology of EH
 Explain Life cycle of EH
 Describe Pathogenicity of EH
 Discuss Transmission and Treatment of
EH
Entamoeba Histolytica

• One of the most important and pathogenic parasites of


humans.

▫ This parasite is primarily a human parasite and is


transmitted from human to human.

• Causative agent of the disease amebiasis (old name is


Amebic Dysentery).
Morphology
Trophozoite:

 Active, feeding stage


 Growing stage
 Amoeboid with blunt
pseudopodia
 Non-foamy cytoplasm
 Uninucleated; nucleus
with fine peripheral
chromatin granules,
small central endosome
Trophozoite: 20-30 µm
Cyst:

 Dormant/resistant
stage
 Spherical
 1-4 nuclei, (4 in
mature cysts)
 Bluntly rounded
chromatoidal bars
Cyst:10-20 μm
Entamoeba histolytica Cysts
Entamoeba histolytica Cysts

Uninucleate cyst Binucleate cyst


Entamoeba histolytica Cysts

Quadrinucleate or mature cysts


Life
cycle

Life cycle
Entamoeba histolytica Life
Cycle
• CYST: ingested with fecal
contaminated food or water.

• Excystation occurs in the small


intestine in an alkaline
environment.

• Metacystic amebas emerge,


divide and move down into the
large intestine.
Entamoeba histolytica Life
Cycle
 Trophozoites colonize the
large intestine and invade
the mucosa.

 They live within the crypts


and mucosa of the large
intestinal lining.

 Trophozoites may live and


multiply indefinitely within
the crypts of the LI mucosa
feeding on starches and
mucous secretions.
Entamoeba histolytica Life
Cycle
• Cysts form in response to
unfavorable (deteriorating)
environmental conditions,
as they move down the LI.

• They are released in


formed feces.
Direct contact
of person to
person

Contamination
of foodstuffs Use of human
by flies, and Transmis feces (night
possibly sion soil) for soil
cockroaches fertilizer

Food or drink
contaminated
with feces
containing
the E.his. cyst
Pathogenicity mechanisms
 E. histolytica has surface enzymes that can digest
epithelial cells and therefore hydrolyze host
tissues and cause pathology.

 Usually the hosts’ repair of the epithelial cells can


keep pace with the damage.

 However, when the host is stressed, has too much


HCl, or a high bacterial flora, the digestion will be
ahead of repair.
Clinical symptoms
Asymptomatic infection Symptomatic infection

Intestinal Amebiasis Extraintestinal Amebiasis

Dysenteric Non-Dysenteric colitis Hepatic Pulmonary The extra foci

Liver abscess Acute non supprative


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
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.
Difference b/w Amoebic and
Bacillary Dysentery
Amoebic Bacillary

Macroscopic

Number 6-8 motions per day Over 10 motions per day

Amount Relatively copius Small

Odour Offensive Odourless

Colour Dark red Bright red

Nature Blood and mucous mixed Blood and mucus; no faeces


with feces

Reaction Acid Alkaline

consistency Fluid mucus not adherent to Viscid mucus adherent to


the container the bottom of the container
Difference b/w Amoebic and
Bacillary Dysentery
Amoebic Bacillary

Microscopic
RBC In clumps, redish yellow in Discrete, bright red in col
colour

Pus cells scanty Numerous


Macrophages Very few Large and numerous

Eosinophills Present Scare


Pyknotic bodies Very common Nil
Ghost cells Nil Numerous
Parasite Trophozoites of E. histolytica Nil

Bacteria Many motile bacteria Nil


Diagnosis
 Sigmoidoscopic examination:
Differentiate amebic from bacillary dysentery
the entire mucosa being involved 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. dispare,……

 The nonpathogenic Entamoeba dispar, however, is morphologically


identical to E. histolytica, and differentiation
must be based on isoenzymatic or
immunologic analysis.
Microscopy

 Microscopic identification
This can be accomplished using:

 Fresh stool: wet mounts and


permanently stained preparations
(e.g., trichrome).
Treatment
• Asymptomatic intestinal infection
 Iodoquinol
 Diloxanide furoate.

• Symptomatic intestinal disease and for


hepatic abscess
 Metronidazole
 Tinidazole.
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