Life Cycle, Pathogenicity and Prophylaxis of Entamoeba Histolytica

Life Cycle, Pathogenicity and Prophylaxis of Entamoeba histolytica
Discipline Courses-I
Semester-I
Paper: Divesity and Evolution of Choradata-I
Lesson: Life Cycle, Pathogenicity and Prophylaxis of Entamoeba
histolytica
Lesson Developer: Ranjana Saxena
College/Department: Zoology, Dyal Singh College, University of Delhi
Institute of Life Long Learning, University of Delhi 0

Table of Contents
 Introduction
 Discovery
 Taxonomic position
 Geographical distribution
 Host
 Reservoir
 Habit and habitat
 Morphology
 Trophozoite
 Pre cyst
 Cyst
 Life cycle
 Excystation
 Encystation
 Pathogenecity
 Noninvasive infection
 Invasive infection
 Metastatic lesion in other organs
 Epidemiology
 Mode of infection
 Infective stage
 Source of infection
 Transmission ways
 Prophylaxis
 Summary
 Exercises
 Glossary
 References

Introduction
Entamoeba is derived from Greek word Entos: within and Amoeba: change. Species of
Genera Entamoeba are found as parasites of invertebrates as well as vertebrates. There are
three species of Entamoeba which are commonly found in human:
 Entamoeba histolytica
 Entamoeba coli
 Entamoeba gingivalis
These three species are morphologically indistinguishable. The three species are
differentiated on the basis of nuclear structure. Out of the three, only Entamoeba
histolytica is the pathogenic form. It causes amoebiasis in human. The parasite causes
diarrhoea, dysentery and liver abscess in human. It lives in the mucosa and sub-
mucosa of the large intestine. The infection is worldwide in distribution. The parasite is the
third leading cause of death in the developing countries of the world. Entamoeba histolytica
is one of the most common parasitic infections worldwide, infecting about 50 million people
and resulting in 40, 000–100, 000 deaths a year. (S.J.van Hal et al., 2007)
Fig.1.Liver Abcess caused by Entamoeba histolytica.

Source: 164.67.82.58/parasite_course-old/amebiasis_files/new_page_1.htm
Entamoeba coli lives in the lumen of the intestine of human while Entamoeba gingivalis lives
in the mouth of human. Both these species of Entamoeba namely E. coli and E. gingivalis
are non-pathogenic.

Discovery
In 1903, Schaudinn differentiated the pathogenic form from the non-pathogenic form of
Entamoeba. It was Lambl who first discovered the parasite Entamoeba histolytica in
1859.
Value addition: Do you Know
Losch (1875) proved the pathogenic nature of Entamoeba histolytica. Losch while
studying the pathogenecity of Entamoeba observed colonic ulcers. He inoculated the
parasite through the rectum of a dog and found that the dog had developed
dysentery.
Source: Author
Taxonomic position
Kingdom: Protista
Phylum: Sarcomastigophora
Sub phylum: Sarcodina
Super class: Rhizopoda
Class: Lobosa
Genus: Entamoeba
Species: histolytica
NOTE: Vth ed. Barnes book has been consulted for classification
Geographical Distribution
Entamoeba is worldwide in distribution, more common in the tropics and the sub-tropics.
Amoebiasis is a major health problem in Africa, Latin America and South East Asia. More
than 10% of the world population is infected with amoebiasis.

Fig. 2. Geographical distribution of Amoebiasis infection

Areas shaded with dark green represent the distribution of the disease
Source: Author, ILLL in house
Host
Humans, apes and monkeys are common host of this parasite. However, it is also found in
pigs, dogs, cats and rats.
Reservoir
Human and monkeys. Asymptomatic human carriers act as reservoir for the spread of E.
histolytica
Habit and Habitat

Entamoeba histolytica exists in two forms
 Minuta or non-pathogenic form
 Virulent or pathogenic or tissue invading form
Minuta form is derived from the virulent form and is smaller in size. It lives in the lumen of
the large intestine whereas the virulent form lives in the mucosa and sub-mucosa of the
large intestine of human.

Fig.3. Large intestine of human infected with trophozoites of

Entamoeba histolytica
Source: http://cancer.tipstimes.com/colon-rectal-cancer/item/112-colon-cancer-
treatment#.Ufinh1P_5Yg
Morphology
Entamoeba histolytica exists in three forms:
 Trophozoite or feeding stage or free moving stage: This form lives in the
mucosa and sub-mucosa of large intestine (colon and cecum)
 Pre-cystic stage: it is the transient stage formed in the lumen of the large intestine
 Cystic stage: It is the non-feeding stage, resting stage found in the lumen of the
large intestine
Trophozoite
Average size of the trophozoite is about 25µm in diameter. However, its shape is not fixed.
It moves about with the help of pseudopodia and shows slow, gliding movement, thus it is
constantly changing its shape. The movement of the trophozoite is dependent on the
consistency of the surrounding medium, age and stage of the parasite and the temperature
of the host. The protoplasm is not completely differentiated into ecto- and endoplasm.
Ectoplasm is thin, clear and translucent while the endoplasm is central, more fluid like and
granular. All the organelles lie within this endoplasm.
A.
B.
Fig.4. Trophozoite of Entamoeba histolytica
A. Entamoeba histolytica Bailenger’s stain. Two trophozoites, with finely granular

cytoplasm
B. Source: http://www.atlas-protozoa.com/gallery.php
B. Diagrammatic sketch of trophozoite of Entamoeba histolytica

As is evident from the diagram, nucleus is the most distinguishing feature of Entamoeba.
Nucleus is lined externally by a thin nuclear membrane. The thin nuclear membrane is
lined internally by evenly distributed chromatin granules. A compact karyosome or
endosome is centrally located. A ring or halo appears to surround the endosome. Spoke

like lines (nuclear striations) radiate out from the endosome and extend upto the nuclear
membrane.
Fig. 5. Detailed structure of Nucleus of Entamoeba

The nucleolus in Entamoeba is known as karyosome or endosome because it persists

in them during cell division. The nuleolus in animals disappear during cell division
Source: Author

Contractile vacuoles are missing in Entamoeba!!!
Contractile vacuole is wanting in them. Can you think of a possible reason for this?
Entamoeba is an endoparasite that lives in the intestine of human. The osmotic

concentration of its body protoplasm equals that of the intestinal fluid of the host i.e.
it lives in an isotonic environment and hence does not need to osmoregulate.
Source: Author
The endoplasm also contains food vacuoles filled with RBC which may be in various
stages of digestion. RBCs are found in the food vacuole only in the pathogenic form. Food
also consists of bacteria and other organic substances found in the host’s intestine.

Feeding in Entamoeba!!!
Food is taken in by Entamoeba either by phagocytosis or by pinocytosis. Food
vacuole is formed by the invagination of the plasma membrane (plasmalemma). The
food particles are engulfed at the posterior end where the plasmalemma is more
sticky. The food particles stick to the plasmalemma at this point. The plasmalemma
then invaginates into the cytoplasm carrying the food particle along with it, pinches
off and forms the food vacuole. A new plasmalemma is formed at the point of
invagination.
The Digestion is intra-cellular within the food vacuole.
Source: Author
Precyst
A. B.
Fig. 6. Precyst of Entamoeba histolytica

A. Entamoeba histolytica Bailenger’s stain.
Source: http://www.atlas-protozoa.com/gallery.php
B. Diagrammatic sketch of precyst of Entamoeba histolytica

Precysts are formed at the onset of encystment when the trophozoites throw out any
undigested food it may contain and condenses into a sphere. Precyst are smaller in size
(10-20µm), round or oval with a blunt pseudopodia. It has a relatively large nucleus that
retains all the characteristics of a trophozoite. Endoplasm is free from RBC and other
ingested food particles.
Cyst
Cyst exists in following forms:
 Immature uninucleate cyst
 Binucleate cyst
 Mature quadrinucleate cyst
It is this mature quadrinucleate cyst which is the infective stage.
The trophozoite becomes completely round and is surrounded by a highly retractile double
walled membrane called the cyst wall. The cyst wall varies greatly in size from 6-9 µm

(small race) to 12-15 µm (large race). The cytoplasm is clear and hyaline
(transparent/glassy). Nucleus retains all the characteristics of the trophozoite.
Besides the nucleus, the endoplasm of the immature uninucleate cyst also contains one to
several large, smooth, oblong rods with rounded ends. These are called chromatoidal bars
or chromatoidal bodies (so called because they stain as chromatin with haematoxylin
stain). The chromatoidal bars contain DNA and phosphates and serve as storage for
ribosomes. Also seen in the cytoplasm of uninucleate cyst are round spaces which are
carbohydrate reserves and are called as glycogen mass.
The mature cyst has four nuclei. Although the nucleus retains all the characteristics of the
trophozoite, it is smaller in size due to successive mitotic division. Chromatoidal bars and
glycogen mass are lacking, having been absorbed by the cytoplasm.
When the cyst is formed it is uninucleate but the nuclei within the cyst divide to form a
quadrinucleate cyst. Occassionally, additional division may result in aberrant form with more
nuclei.
A.
B.
Fig. 7. Entamoeba histolytica mononucleate cyst.

A. Two immature mononucleate cysts. The left one is stained with MIF solution whereas the
right one is stained with Bailenger’s solution
B. Diagrammatic sketch of mononucleate cyst of Entamoeba histolytica

Source: ILLL in house
A.
B.
Fig. 8. Entamoeba histolytica binucleate cyst.

A. Left, an unstained immature binucleate cyst. Right, another one stained with Bailenger’s
solution. In binucleate cysts of this species, the nuclei are often paired.
B. Diagrammatic sketch of binucleate cyst of Entamoeba histolytica


A.
B.
Fig. 9. Entamoeba histolytica quadrinucleate cyst.
A. Left, Trichrome stain. Mature cyst with four nuclei. Right, Formalin-fixed specimen.
A mature cyst with four nuclei
B. Diagrammatic sketch of binucleate cyst of Entamoeba histolytica

Life Cycle
E. histolytica completes its life cycle only in one host (human), thus it is a monogenetic
parasite. Another host is required for the perpetuation of a species.
The infection begins with swallowing of the mature quadrinucleate cyst (infective stage)
of E. histolytica by host. It is the mature quadrinucleate cyst which is passed in the faeces
of human. The cysts are swallowed along with the contaminated food or water. The cyst
wall is resistant to the acidic juices of the stomach and passes unaltered into the intestine.
Excystation
Excystation starts in the small intestine with the increased activity of Entamoeba within the
cyst. In the intestine, the cyst wall is digested by the action of trypsin in an alkaline medium

at a temperature of 37°C. During this process, the cytoplasmic body retracts and loosens
from the cyst wall. Pseudopodia are formed at various points within the cyst. Vigorous
amoeboid movements occur within the cyst. Frequently the pseudopodia press against the
wall at certain spots as though the imprisoned organism were searching for exit. Eventually,
a tetranucleate amoeba (amoeba with four nuclei) emerges out. This is referred to as
metacyst.
The four nuclei of the metacyst immediately undergo division to form eight nuclei. Each
nuclei gets surrounded by a bit of its own cytoplasm and leads an independent existence.
Thus, eight amoebulae are formed. These are known as metacystic or metacyclic
trophozoites which are actively motile.
The young amoebulae being actively motile invade the tissues and finally lodge themselves
in the mucosa and submucosa of the large intestine-its normal habitat. They prefer this site
as the pH, gases and organic material in this part of the large intestine are more stable and
ideal for the existence of E. histolytica. Trophozoites are exclusively parasitic forms
growing at the expense of living tissues and multiplying by simple binary fission.
The metacystic trophozoites donot colonise in the small intestine but move down to the
large intestine (caecum and the ileo-caecal region) and lodge in the mucosa and the
submucosa of the colon and multiply by binary fission.
Some of the trophozoites however, may remain in the lumen of the large intestine and
multiply by binary fission (non-invasive trophozoites). These trophozoites feed on the hosts
nutrients from the surrounding medium.
Encystation
When the conditions become unfavourable in the lumen of the large intestine, the
trophozoites start to develop a cyst wall. A pre cyst is first formed which soon becomes a
uninucleate immature cyst and finally a quadrinucleate mature cyst (infective stage).
The transformation of trophozoite into a mature quadrinucleate cyst is called encystation.
A very important point to note is that encystation is not a reproductive process but a
means of protection of a species from extinction.
Encystation takes only a few hours and the mature quadrinucleate cyst can remain in the
lumen of the large intestine for only two days. Mature quadrinucleate cysts are passed out
along with the faeces of the host. About 45 million cyst may be voided out from one
infective person in a day. The cyst are resistant to the environmental conditions and can live
for a few weeks to a few months depending on the temperature (thermal death occurs at
50°C). Moisture is essential for the long existence of the cyst. They can live upto 10 days in
a moist stool. However, the cyst are very susceptible to dessication.
Encystation and excystation can take place in the same host, another host is required only
for the perpetuation of the species.
Encystation does not take place in the tissues of man, neither in the intestinal
mucosa nor in the liver, lungs etc. Thus, actually the metastatic invasion of the
trophozoite for all biological purposes is a dead end for the parasite.


Why trophozoite is not an infective stage of Entamoeba?
Trophozoites are also voided out along with the cysts in the faeces but they cannot
survive outside the body of the host for more than an hour and even if they are
ingested during this period they are killed in the body of the host by the acidic juices
of the stomach
Source: Author
Fig.10. Life cycle of Entamoeba histolytica


Pathogenicity
Entamoeba histolytica can cause:
 Amoebiasis: In case of uncomplicated intestinal infection, symptoms include diarrhoea,

cramps and flatulence (excessive gas in the alimentary canal).
 Acute amoebic dysentery: It occurs when the parasite invades the intestinal wall and
ulcers develop. Patients with amoebic dysentery suffer from diarrhoea that contains
blood and mucus and have severe abdominal pain. A large number of trophozoites are
also discharged with the slough in the faeces.
 Chronic amoebic dysentery or amoebic colitis: It is characterized by intermittent

diarrhoea over a long period of time. Often it is misdiagnosed as ulcerative colitis or
irritable bowel syndrome.
The infection can either be non-invasive or invasive
Non-invasive infection
The infection is localized and confined to the large intestine and is usually seen in people
with normal immune system
Invasive infection
As the name suggests the trophozoite can penetrate the intestinal wall and cause lesion.
This can be normally found in persons with a weak immune system.
The infection can either be in the intestinal wall or at the extraintestinal sites.
 Intestinal wall
Some of the trophozoites penetrate the epithelial cells of the mucosa and the submucosa in
the colon causing ulcers. E. histolytica secretes a proteolytic enzyme histolysin which not
only facilitates the penetration of the trophozoite into the mucosal layer but also digests the
hosts epithelial cells causing necrosis of the tissue resulting in ulcer. However, the ulcers
remain confined in the colon and the sigmoido-rectal areas.

Fig.11. Histopathology of Amebiasis

Rectal mucosa with surface erosion and Entamoeba histolytica trophozoites.
Source:
http://www.gastrointestinalatlas.com/English/Colon_and_Rectum/_Amebic_Colitis/_amebic
_colitis.html
 Extraintestinal sites
The trophozoites are motile and actively move about. Sometimes, they may find their way
from the colon into the radicals of portal vein and get carried to extraintestinal sites like the
liver, spleen, lung and maybe the brain also.
The trophozoites are carried from the ulcers in the colon and caecum to the right lobe of the
liver by the right branch of the portal vein. Here they multiply and cause liver abscess.
However, this happens in only 5-10% of the persons suffering from intestinal amoebiasis.
Metastatic lesion in other organs

Pulmonary amoebiasis is a complication of amoebic liver abscess. However, in rare
conditions the trophozoites may gain entry directly into the lungs from the gut via the portal
circulation (into the pulmonary capillaries) causing primary pulmonary amoebiasis.
Cerebral amoebiasis: A rare complication caused when the trophozoite gain entry in the
brain.
Splenic abscess: Trophozoites are able to gain access to the spleen, found in association
with the liver abscess.
Cutaneous abcess: Cutaneous amoebiasis is a form of amoebiasis that is caused

by Acanthamoeba or Entamoeba histolytica occurs primarily in the skin. When associated
with Acanthamoeba, it is also known as "cutaneous acanthamoebiasis".

Fig. 12. Entamoeba infection in human body


Value addition: Interesting fact

Cutaneous amoebiasis or Amebiasis cutis
“Lesions of the skin produced by Entamoeba histolytica have been reported by
various authors since 1892. Although cutaneous amebiasis is still recognized as a
rare condition, its presence should be considered when one encounters extensive
necrosis and ulceration of the skin and underlying tissues.
Fig. Entamoeba histolytica/dispar.
Amebiasis cutis can be divided into the following three types, depending on the
association with a primary visceral lesion.
1. Those cases following either surgery, or developing secondarily to a spontaneous

external rupture of an infected organ with subsequent involvement of the skin. The
primary site is usually a colic or appendiceal ulceration or liver abcess.
2. Cases involved with perianal skin and associated with amoebic colitis.
3. Cases involving no direct connection of viscera and primary skin infection.”
Source: Yo Seup Song,M.D.(1956).Cutaneous amebiasis: report of two cases

with one autopsy. Ann Intern Med. 1956;44(6):1211-1218.
http://img.medscape.com/fullsize/migrated/467/073/sm467073.fig1.jpg

Mode of infection
Infective stage
Mature Quadrinucleate or four nucleus cyst is the infective form.
Source and route of infection

Mode of infection: Faecal-oral route
Fig. 13. Faecal –oral route of Entamoeba histolytica

Transmission ways
 People who are asymptomatic cyst (quadrinucleate cyst) passers. (Persons with acute
amoebic dysentery are of no importance in transmission of E. histolytica as they
excrete only trophozoites which are not infective)
 Contaminated fruits and raw vegetables
 Contaminated water
 Unhygienic habits
 Mechanical vectors like houseflies and cockroaches. Houseflies may convey the
infection by carrying the cysts from faeces to unprotected foodstuff. The droppings of
cockroaches too have been found to contain mature cysts and thus they also serve as
a source of infection.

Epidemiology
Amoebiasis is caused by Entamoeba histolytica.
Carriers of Entamoeba histolytica are of two types:
1. Contact carriers: People who have never suffered from amoebic dysentery and
their health remain unaffected. They are healthy carriers of E. histolytica. They can shed
cysts for many years
2. Convalescent carriers: Persons who have recovered from acute amoebic

dysentery.
Susceptible age group: All age groups are susceptible to infection of E. histolytica
although it is more common in adults than in children.
About 50 million people are infected with Entamoeba histolytica worldwide but only a small
fraction of this number shows any clinical symptoms. Although the prevalence of E.
histolytica is higher in males, more serious and fatal complications affect women and children
Source: Author
Value Addition: Video
Heading Text: Endoscopic View of Amoebiasis Colitis.
Body Text: A 33 year-old male patient, who for work reasons had to live in Mexico for 5
months. 3 months earlier, he suffered an unspecified abdominal pain and diarrhoea. The
endoscopic findings showed amoebiasis colitis.
Source:
http://www.gastrointestinalatlas.com/English/Colon_and_Rectum/_Amebic_Colitis/_amebic_colitis.html

Value addition: Do you know

Diagnosis of Amoebiasis
Microscopic examination is a rather unreliable method for the correct identification of
Entamoeba spp. in fecal specimens. Even when carried out under optimal conditions
(i.e. with permanent staining), sensitivity is never above 60%. Due to their
morphological identity, Entamoeba histolytica, Entamoeba dispar, Entamoeba
moshkovskii cannot be microscopically distinguished. Therefore, other tests are
required to identify these species.
Diagnostic Presentation Sensitivity Specificity Commercial kits

test available
Microscopy Permanent stain kit
Faeces Colitis 30%–50% 10%–50%
Liver Liver abscess < 5% 100%

aspirate (rarely
seen)
Serology Colitis 40%–60% 90% Hemagglutination

(IHA), Latex
Liver abscess 95% 98% agglutination,
Indirect
immunofluorescence
(IFA) and ELISA.
Antigen Colitis 80%–99% 86%–98% ELISA kit

detection
Liver abscess 40%–100% 90%–
100%
Polymerase Colitis 80%–100% 85%– Commercially not

chain 100% available
Liver abscess 80%–100%
reaction
90%–
100%
Source: Sebastiaan J van Hal, Damien J Stark, Rashmi Fotedar, Debbie Marriott,
John T Ellis and Jock L Harkness. 2007. Amoebiasis: current status in Australia. Med
J Aust; 186 (8): 412-416.
www.atlas-protozoa.com/test_amoebae.php

Prophylaxis
 Cleanliness and personal hygiene
 Do not drink contaminated water
 Eat properly washed vegetables and fruits
 Sanitary disposal of faeces should be taken care off
 Care should be taken to keep the mechanical carriers like houseflies and cockroaches
under control
 Detection and treatment of asymptomatic carriers


Hyperparasitism
Hyperparasitism means a parasite living within the body of a parasite. A virus like
particle or a virus is sometimes found in the cytoplasm and nucleus of E. histolytica.
These viruses when liberated (because of the disintegrartion of Entamoeba) can
cause lysis and death of the host cell.
Miller and Swartzwelder observed a small array of virus-like particles about 40 nm in

diameter within the perinuclear cytoplasm in a single section of a trophozoite of the
NRS simian strain of Entamoeba histolytica cultivated in the presence of bacteria. (
Miller and Swartzwelder, 1960)
Infection of Entamoeba histolytica with chytridiaceous fungus Sphaerita was

observed in some specimens obtained from a farmer and stained with iron-
haematoxylin. The fungi were found in 78% of the cysts, mostly immature ones.
Within the amoebae this parasite occurred singly, in groups, or in the form of a
sporangium. It was located in the cytoplasm, the glycogen mass or the chromatoidal
bars (Cao and Feng, 1989).
Fig. Entamoeba histolytica/dispar. Trichrome stain. Trophozoite

parasitized by Sphaerita sp. (arrow).
Source: Miller, J. H., and J. C. Swartzwelder. 1960. Virus-like particles in an
Entamoeba histolytica trophozoite. J. Parasitol. 46:523-524.
Cao, C.Q. and Feng, Y.S. 1989. Report on a fungus parasitizing Entamoeba
histolytica. Zhongguo Ji Sheng Chong Xue Yu Ji Sheng Chong Bing Za Zhi.;
7(1):12-4.
Weblink for the image: http://www.atlas-
protozoa.com/gallery.php?SOT_CAP=A_HIST&link=Entamoebahistolytica.php


Treatment of Amoebiasis
Asymptomatic carriage (treat with luminal amoebicide ONLY)
• Oral paromomycin 500mg three times daily for 7 days
Invasive disease (treat with tissue amoebicide and luminal amoebicide)

• Oral metronidazole 750–800mg thrice a day for 6–10 days
OR
• Oral tinidazole 2 g once daily for 2–3 days (up to 10 days) and oral paromomycin
500mg thrice a day for 7 days
Liver abscess (treat with tissue amoebicide and luminal amoebicide)

• Oral or intravenous metronidazole 750–800mg thrice a day for 14 days
OR
• Oral tinidazole 2 g once daily for 5 days and oral paromomycin 500mg thrice a day
for 7 days
Patients with complications of invasive disease generally undergo surgery. Amoebic

liver abscess can be cured with medical therapy alone. The role of radiologically
guided percutaneous therapeutic aspiration in uncomplicated amoebic liver abscess
is controversial, but it has been shown to be of some clinical benefit in patients with
large abscesses. Aspiration should be considered in patients with an uncertain
diagnosis, lack of response to medical therapy (persistent fever > 4 days), and large
abscesses at risk of rupturing (especially left lobe abscesses, as these may rupture
into the pericardial space).
Source: Sebastiaan J van Hal, Damien J Stark, Rashmi Fotedar, Debbie Marriott,
John T Ellis and Jock L Harkness. 2007. Amoebiasis: current status in Australia. Med
J Aust; 186 (8): 412-416.

Summary
 Entamoeba histolytica is a parasite that lives in the mucosa and sub-mucosa of the
large intestine
 In majority of the persons it lives as harmless commensal
 Pathogenic Entamoeba may cause amoebiasis which may involve both intestinal and
extraintestinal lesions
 Infection by E. histolytica occurs through faecal-oral route
 Mature quadrinucleate cyst is the infective stage
 It can exist in three forms namely trophozoite, pre-cyst and cyst
 Excystation takes place in the slightly alkaline medium in the small intestine
 Encystation takes place in the lumen of the large intestine.
 Trophozoites cannot survive outside the body of the host
 Cyst is resistant to the environmental conditions as well as the acidic juices of the
stomach
 The salient features of lifecycle and epidemiology of Entamoeba histolytica are:
Causative agent /etiological Amoebiasis, acute amoebic dysentery, chronic

agent of amoebic dysentery, liver abscess, spleenic
abscess, pulmonary amoebiasis, cerebral
amoebiasis
Definitive host Human
Habitat Caecum and colon
Infective stage Quadrinucleate mature cyst
Port of entry Faecal-oral route
Method of transmission  Contaminated fruits and raw vegetables
 Contaminated water
 Unhygienic habits
 Mechanical vectors like houseflies and
cockroaches
Pathogenic stage Trophozoite
Distinctive feature of trophozoite Distinctive nucleus (chromatin granules, centrally
located karyosome, spikes radiating out from the
karyosome to the periphery), food vacuole
containing RBC

Distinctive features of immature

cyst: Parasite is enclosed in a cyst wall, single
Uninucleate cyst nucleus(nucleus retains all the characteristics of the
trophozoite), chromatoidal bars and glycogen mass
Two nuclei, all other characteristics are same as

Binucleate cyst uninucleate cyst
Parasite enclosed in a cyst wall with four nuclei,

Quadrinucleate cyst chromatoidal bars and glycogen mass absent
Diagnostic stage Cyst in the stool

Exercise
A. MCQ’S
1. Bundles of crystalline ribonucleic acid are:
i. Chromatoidal bodies
ii. Karyosome
iii. Peripheral chromatin
iv. Glycogen mass
2. The infective stage of E. histolytica is:
i. Pre- cyst
ii. Trophozoite
iii. Binucleate cyst
iv. Quadrinucleate cyst
3. Mature E. histolytica cyst is characterised by
i. Chromatoidal bars
ii. Glycogen mass
iii. Four nuclei
iv. One nuclei
B. Answer in short:
1. What is amoebiasis?
2. How can a person become infected with Entamoeba histolytica?
3. What precautions should a person take so as not to get infected by Entamoeba
histolytica?
4. If the trophozoite of Entamoeba histolytica enter the extraintestinal sites then it is
considered as the biological death of the parasite. Justify the statement.
5. Differentiate between:
a. Acute amoebic dysentery and chronic amoebic dysentery
b. Excystation and encystation
c. Minuta form and virulent form of Entamoeba histolytica
d. Convalescent carriers and contact carriers
6. What is the difference between monogenetic and digenetic parasite?
7. Why is Entamoeba histolytica considered as a monogenetic parasite?
8. What will happen to the trophozoite if it accidentally enters the body of human
through the oral route?
9. Who discovered the pathogenic nature of Entamoeba histolytica?
10. What is a metacyst?

C. Draw a neat labelled diagram of the following:

1. Trophozoite of Entamoeba histolytica
2. Mature binucleate and quadrinucleate cyst of Entamoeba histolytica
3. Nuclear structure of the trophozoite of Entamoeba histolytica
D. Long questions:
1. With the help of flow chart explain the life cycle of Entamoeba histolytica.
2. Write in details the pathogenetic effects of Entamoeba histolytica infection in
humans.
E. With respect to Entamoeba histolytica write the following

1. Infective stage
2. Habitat
3. Port of entry
4. Pathogenic stage
5. Diagnostic stage
6. Distinctive features of a binucleate cyst

Glossary
Chromatoidal bars: Dark, oblong rod like bodies with rounded ends found in the immature
cysts of Entamoeba that serves as storage for ribosomes
Cyst: Non-motile stage of the parasite with a distinct protective cyst wall.
Epidemiology: Science that deals with the incidence, distribution and control of disease in
a population
Encystation: Transformation of the trophozoite to a cyst.
Excystation: Emergence of the trophozoite from the cyst.
Karyosome: Dense irregular aggregation of chromatin in the nucleus, not undergoing

mitosis.
Metacyst: Metacyst means trophozoite emerging after the cyst stage of the parasite.
Trophozoite: Motile stage of amoeba capable of invading tissues and causing lesions.

References, Bibliography and further Reading:

1. Barnes, R.D. (1982). Invertebrate Zoology, Vth Edition. Holt Saunders
International Edition.
2. Dr. Subhash Chandra Parija. Textbook of medical parasitology, Protozoology
& Helminthology(Text and colour Atlas),IInd Edition. All India Publishers &
Distributers,Medical Books Publishers. Chennai, Delhi
3. Rattan Lal Ichhpujani and Rajesh Bhatia. Medical Parasitology, IIIrd Edition.
Jaypee Brothers Medical Publishers (P) Ltd., New Delhi.
4. E.R. Noble and G.A. Noble. Parasitology:the biology of animal parasites. Vth
Edition. Lea & Febiger, 1982
5. P. Chakraborty. Textbook of Medical Parasitology.II nd Edition. New Central
Book Agency (P) Ltd. Kolkata
Useful Web Links
A. http://www.pathobio.sdu.edu.cn/sdjsc/parasiteimages/entamoeba_lifecycle.html
B. http://164.67.82.58/parasite_course-old/default.aspx
C. http://www.atlas-
protozoa.com/gallery.php?SOT_CAP=A_HIST&link=Entamoebahistolytica.php
D. http://www.cdc.gov/parasites/amebiasis/biology.html
E. http://www.gastrointestinalatlas.com/English/english.html

Life Cycle, Pathogenicity and Prophylaxis of Entamoeba Histolytica

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Life Cycle, Pathogenicity and Prophylaxis of Entamoeba Histolytica

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Life Cycle, Pathogenicity and Prophylaxis of Entamoeba histolytica

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Fig.1.Liver Abcess caused by Entamoeba histolytica.

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Value addition: Do you Know

Sub phylum: Sarcodina

Super class: Rhizopoda

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Fig. 2. Geographical distribution of Amoebiasis infection

Habit and Habitat

 Minuta or non-pathogenic form

 Virulent or pathogenic or tissue invading form

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Fig.3. Large intestine of human infected with trophozoites of

Fig.4. Trophozoite of Entamoeba histolytica

A. Entamoeba histolytica Bailenger’s stain. Two trophozoites, with finely granular

B. Diagrammatic sketch of trophozoite of Entamoeba histolytica

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Fig. 5. Detailed structure of Nucleus of Entamoeba

Value addition: Do you Know

The nucleolus in Entamoeba is known as karyosome or endosome because it persists

Value addition: Do you Know

Entamoeba is an endoparasite that lives in the intestine of human. The osmotic

Value addition: Do you Know

The Digestion is intra-cellular within the food vacuole.

Fig. 6. Precyst of Entamoeba histolytica

B. Diagrammatic sketch of precyst of Entamoeba histolytica

 Immature uninucleate cyst

 Mature quadrinucleate cyst

It is this mature quadrinucleate cyst which is the infective stage.

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Fig. 7. Entamoeba histolytica mononucleate cyst.

B. Diagrammatic sketch of mononucleate cyst of Entamoeba histolytica

Source: ILLL in house

Fig. 8. Entamoeba histolytica binucleate cyst.

B. Diagrammatic sketch of binucleate cyst of Entamoeba histolytica

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Fig. 9. Entamoeba histolytica quadrinucleate cyst.

B. Diagrammatic sketch of binucleate cyst of Entamoeba histolytica

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Value addition: Do you Know

Fig.10. Life cycle of Entamoeba histolytica

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 Amoebiasis: In case of uncomplicated intestinal infection, symptoms include diarrhoea,

 Chronic amoebic dysentery or amoebic colitis: It is characterized by intermittent

The infection can either be non-invasive or invasive

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Fig.11. Histopathology of Amebiasis

Metastatic lesion in other organs

Cutaneous abcess: Cutaneous amoebiasis is a form of amoebiasis that is caused

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Fig. 12. Entamoeba infection in human body

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Value addition: Interesting fact

Fig. Entamoeba histolytica/dispar.

1. Those cases following either surgery, or developing secondarily to a spontaneous

3. Cases involving no direct connection of viscera and primary skin infection.”

Source: Yo Seup Song,M.D.(1956).Cutaneous amebiasis: report of two cases

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Source and route of infection