Amoebiasis

Amoebiasis is caused by E. histolytica. Common in developing countries: India, Bangladesh, Pakistan, Nepal. Risk factors: Crowded living conditions Poor sanitation Mental health Institutions and Travel to endemic areas.

Amoebiasis
Taxonomic position Phylum- Sarcomastigophora (motile with pseudopodia or flagella) Class – Rhizopoda Order- Amoebida Genus – Entamoeba,Endolimax,Iodamoeba, Dientamoeba

Species Entamoeba - E. histolitica, E.dispar, E. hatmani, E. Coli Endolimax - E. Nana Iodamoeba - I. butschlii Dientamoeba – D. fragilis.

Morphology
E. histolytica has two morphological stage: trophozoite cyst with an intermediate precyst.

Trophozoite
Size 10 to 60 µm in diameter Actively motile and invasive form cytoplasm consists of clear ectoplasm, finely granular endoplasm. food vacuoles often containing rbc's are common, may contain bacteria. nucleus has a distinctive central karyosome and a rim of chromatin lining the nuclear membrane primary habitat is the large intestine but have the ability to metastasize to other organs

Trophozoite

Trophozoite

Entamoeba histolytica trophozoites, two with ingested RBCs.

Cyst
During unfavorable condition, trophozoite condenses into a sphere – the precyst precyst secretes cyst wall to form the round cyst - 10 to 20 µ m in diameter nuclear division begins: Uninucleate cyst  Binucleate cyst  Quadrinucluate (mature) cyst chromatoidal bars are present but common in immature cysts.

﴾mature﴿

Important events of life cycle
Host: Man is the only host (definitive). Infective form: Mature quadrinucleated cyst. Route of infection: Fecal- oral route. Site of location: Large intestine. Pathogenic stage: Trophozoite. Diagnostic stage: Cyst and Trophozoite.

Life cycle
Ingestion of quadrinucleated cyst ↓ Exystation at small intestine, give rise to eight young trophozoites (Amebulae) ↓ Reside in the lumen of cecum and large intestine ↓ Adhere to the epithelial cells and invade ↓ Can spread to other organs through blood ↓ If condition becomes unfavorable re-encystation occurs and excreted with faeces.

Life cycle

Virulence factors
Galactose and N-acetyl-D-galactosamine – for binding with colonic mucosa Motility Pore forming proteins. Enzymes – Collagenases, elastase, hyaluronidas.

Pathogenesis
Infection with E. histolytica can cause: Asymptomatic infection. Intestinal amoebiasis. Extraintestinal disease: hepatic amoebiasis, pulmonary amoebiasis Other ectopic sites include: brain, skin, kidneys, spleen, male and female genitalia and pericardium.

Pathogenesis
Intestinal amoebiasis: Acute amoebic dysentery and chronic intestinal amoebiasis. Acute amoebic dysentery: Occurs over a period of one to several weeks. Symptoms: abdominal pain and tenderness, tenesmus and intermittent diarrhoea, vomiting and general malaise. E. histolytica can also cause amoebomas.

Acute amoebic dysentery
Character of ulcers: Location: May be generalized (Through out the large gut) or localized to ileo-caecal and sigmoidorectal junction. Size: Pin head to one inch or more. Shape: Round or oval. Margin: Flask-shaped. Base: Filled up by necrotic mass, yellowish or blackish slough.

Pathogenesis
Hepatic amebiasis – Trophozoites enter liver via portal vein and enter the sinusoids – form abscess stay small or continue to grow Center of abscess is fill with necrotic fluid and outer wall full of trophozoites. If abscess ruptures organisms are available to eat other organs.

Pathogenesis
Pulmonary amebiasis– Primary or secondary. Can enter to lungs via portal circulation or when liver abscess ruptures through diaphragm.

Laboratory diagnosis
Principle: Laboratory diagnosis of intestinal amoebiasis is based on demonstration of haematophagous trophozoite, cyst or antigen from stool. Laboratory diagnosis of hepatic amoebiasis is practically done by detection of trophozoite from pus or antigen detection from blood and saliva.

Laboratory diagnosis
Culture: Culture of stool samples followed by isoenzyme analysis can accurately distinguish E. histolytica from E. dispar and is considered to be the 'gold standard' for diagnosis. However, this method takes several weeks to carry out and requires special laboratory facilities, making it impractical for routine laboratory test.

Laboratory diagnosis
Immunological tests: Antigen detection. Antibody detection. Enzyme immunoassays (EIA) Nucleic acid based technique PCR-based methods.

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