Encystation: the conversion of trophozoites to

Intestinal and cysts (trophozoite → cyst).

Commensal Encystation usually occurs if there is a change in
the environment that will make the protozoa
Amoeba unlikely to survive.

Must Know Information for Each Parasite

Pathogenic Amoeba – Entamoeba histolytica
1. Parasite Biology
TROPHOZOITE
2. Life Cycle
- Active vegetative stage, pathogenic stage.
3. Epidemiology - Found in the lumen and crypts of the colon
and other tissues.
4. Pathogenesis and Pathophysiology
- 10 – 60um, with pseudopodia.
5. Clinical Manifestations - Rapid, unidirectional movement – unique
E. histolytica.
6. Laboratory Diagnosis - RBC inclusion bodies – pathognomic sign.
7. Treatment
Because Entamoeba histolytica engulfs red
8. Prevention blood cells, this is what makes it pathogenic.
Among the amoebas, Entamoeba histolytica is
Biology of Amoebas
the most pathogenic and most clinically
The most important feature that separates amoebas important.
from the other groups of unicellular (eukaryotes)
Protozoa is the means by which they move. - Karyosome: small central mass of
Pseudopods: extension of cytoplasm to function for chromatin.
locomotion. - Peripheral chromatin: chromatin that
surrounds the karyosome
Other protozoa have different mechanisms of - Cytoplasm: finely granular cytoplasm.
movement, just like ciliates have, by the name
itself they have ciliation, for the flagellates they
have the flagellum.

2 Forms:
- Trophozoites (except Dientamoeba fragilis)
– the form that feeds, multiplies, and
possesses pseudopods; delicate and fragile.
- Cyst – the nonfeeding stage characterized
by a thick protective cell wall designed to
protect the parasite from the harsh outside
environment when deemed necessary;
contains a thick wall.
Trophozoites are the one that is metabolically
active while the cyst that is metabolically inert.

Excystation: the morphologic conversion from the

cyst form into the trophozoite form (cyst →
trophozoite), occurs in the ileocecal area of the
intestine.
CYST
- Infective stage quadrinucleate.
- Spherical to round
- 10-20 um
- With glycogen vacuoles and chromatoidal
bodies.
The cyst of Entamoeba histolytica is the infective
stage of the parasite. The trophozoite is not the
infective state, it is only the pathogenic state. So if
you take in trophozoites of Entamoeba histolytica you
won’t be infected because trophozoites do not have
that thick outer covering that will protect from harsh
environments, especially in the stomach. The
stomach has high acidity while the cyst has this thick
cell wall that will protect them from the harsh
environment.

Quadrinucleate – contains four nucleuses.

Entamoeba histolytica is notable to amoebic
colitis. The illustration below shows you how
Entamoeba histolytica affects our large intestine.
- Chromatid bars: squared or round-ended In the left picture, the lining of the colon is
structures; structures that contain erythematous, meaning it’s red because it has
condensed RNA material. inflammation, and on the right is the usual
- RBCs, bacteria, yeast, and other debris are histologic picture showing you the invasion of
not found in the cyst stage. (Found only in trophozoites through the intestinal wall.
the trophozoites stage)
NOTE:
- Differentiation between E. histolytica and
E. dispar (coli) is not possible by
microscopy.
- Therefore, the report is usually:
E. histolytica/ E. dispar trophozoites or
cyst.
E. coli and E. histolytica have the same
morphologic features, we can only differentiate
them through molecular methods.

Greenish fecal matter, usually it’s soft to watery.
Also, have greenish with blood streak and mucoid
in the stools, this is a usual clinical specimen
containing Entamoeba histolytica.
Why is there a blood streak? Because as you can
see in the histologic slide, there is ulceration.
Mode of Transmission
Feco-oral route: ingestion of contaminated food or
water with mature quadrinucleated cyst.
Sexual Contact: anogenital or orogenital tract.
(Especially, to those individuals who partake in high
sexual risk behavior such as men having sex with
men).
Vector: flies and cockroaches. (They can carry
fecal matter with cyst).
Development in Man (small intestine)
What happens during the infection, so an
infective form or quadrinucleated cyst is ingested,
it goes into the esophagus and then to the
stomach and then it goes into the small intestine.
In the small intestine, it is where the excystation
(cyst→ trophozoite) of the parasite occurs. Now
once the cyst is converted to trophozoite it then
travels to the large intestine which, it can, the
trophozoite can cause colitis or inflammation of
the colon. Now in the inflammation site or where
the trophozoite would elicit or with incite
inflammation to the site of infection, it has the
ability to invade through the intestinal wall
because of the cysteine proteinases. Now that
trophozoite when it encounters a harsh
environment, it undergoes encystation
(trophozoite → cyst) which occurs in the large
intestine and travels out through the fecal matter
as a cyst or trophozoite.
Entamoeba histolytica can manifest in various
ways most common is the:
Asymptomatic cyst passers: trophozoites don’t
cause any lesion, transform into cysts and excreted
in feces.
Meaning the patient has no symptoms at all but
the patient is the carrier, they still pass out cysts
that are potentially transmittable to one person
making them infectious.
Amoebic dysentery: proteolytic enzymes causes
destruction and necrosis of tissue and produces
flask shaped ulcers on the intestinal mucosa.
Very characteristic in Entamoeba histolytica is the
formation of the flask shape ulcer. Pretty sure that
you are familiar with the Erlenmeyer flask, which
is the usual shape or configuration of the ulcer
caused by the Entamoeba histolytica. You can
see in the illustration that the neck of the ulcer is
narrow, and you have a broad base. In contrast to
Balantidium coli ulceration in which you have a
broad neck and a broad base (beaker-like shaped
ulceration).
 E. histolytica ulceration

The most common intestinal amoebiasis it’s

usually in the cecum, now the cecum is the first
part of the large intestine.

Balantidium coli ulceration

Amoebic Liver Abscess: extensive erosions and
necrosis of small intestine → entrance into the
radicals of portal veins → multiply in liver.

Amoeba * Amoeboma
Dessication is drying up of the environment.
PATHOGENESIS OF INTESTINAL AMEBIASIS
We have several enzymes that breakdown the
connective tissues of our intestinal lining thus
they’re capable of invasion.
- Fulminant amoebic colitis
- Amoebic appendicitis – infection involves
the appendix causing inflammation and
obstruction of the appendiceal lumen
causing increased luminal pressure and
eventually necrosis of the wall of the
intestine resulting to inflammation.
- Intestinal perforation and amoebic
peritonitis – can occur if the ulcer progress
beyond the serosa. Now there are several
layers of the intestines, now the innermost
layer is the mucosa or the epithelial lining:
we have the mucosa layers and the serosa
layer. The serosa layer is the outermost
layer, if the ulcer reaches the serosa layer it
will result into perforation.
- Toxic megacolon and intussusception
- Amoeboma – it usually presents as a mass,
and this will make the gastroenterologist or
physician to think that the patient may have
colon cancer but in reality it’s just an
amoeboma.
- Chronic amoebiasis – when you say
strictures these are fibrotic structure or
strands that may potentially result into
 obstruction.

The liver is the most common site and why is this

possible? It’s because the drainage of our intestines
will eventually lead to the liver.

Amoebic dysentery, dysentery refers to the, it is an

inflammatory condition of the lower gastrointestinal
tract resulting into bloody stools, you have usually
bloody stools. So, this table shows you the
difference between amoebic dysentery, so
dysentery that is caused by an amoeba specifically
E. histolytica, and bacillary dysentery. Bacillary
means by a bacteria, so the most common of
bacillary dysentery is the shigella species of
bacteria. So, they cause a dysentery.

LABORATORY DIAGNOSIS OF INTESTINAL

When you say subphrenic it’s located under the AMOEBIASIS
diaphragm, phrenic means diaphragm.

Amoebic pericarditis the pericardium is the

hovering of the heart, so they, in terms of proximity
the pericardium is superior to the liver, so by virtue
of proximity and continuity it’s really possible that
the amoeba can travel to the pericardium traversing
the diaphragm.
Copro means stool.

If you perform a colonoscopy, you can use rectal

exudates and rectal ulcer tissues.