Commensal Intestinal amoeba

• Entamoeba coli
• Entamoeba hartmani
• Entamoeba gingivalis
• Endolimax nana
• Iodamoeba butschlii
Life Cycle
• Significance of commensal amoeba
– 1. They may be mistaken for the pathogenic
Entamoeba histolytica
– 2. They are an indication of fecal
contamination of food or water.
Entamoeba coli
• Cosmopolitan in distribution and is harmless
inhabitat of the colon.

• Differentiated from E. histolytica by the following

features ( trophozoite)
– 1. A more vacuolated or granular endoplasm with bacteria
and debris but no red blood cells.
– 2. A narrower less differentiated ectoplasm
– 3. Broader and blunt pseudopodia
– 4. More sluggish unidirectional movements
– 5. Thicker, irregular peripheral chromatin with large
eccentric karyosome in the nucleus.
Entamoeba coli cyst

• Larger size ( 10-35 um)

• Greate number of nuclei
• More granular cytoplasm
• Splinter-like chromatoidal bodies.
Shape: ovoidal
BONUS QUESTION FOR 2 POINTS

Which of the following is not true about Entamoeba coli?

a. The parasite is found worldwide
b. It is considered to be a pathogen
c. The infection is transmitted through the ingestion of the
infected cyst through contaminated food or drink
d. The infection can be prevented by adequate disposal of
human feces and good personal hygiene practices.
Entamoeba gingivalis

• Trophozoite:
– Size: 10-20 um
– Moves quickly and has
numerous blunt
pseudopodia
– Food vacuoles are
numerous & contains
cellular debris & bacteria.
– Habitat: gum pockets &
teeth surfaces & in
tonsillar crypts.
– No cystic stage
BONUS QUESTION FOR 2 POINTS

What is the unique

characteristic of Entamoeba
gingivalis?
Endolimax nana

Trophozoite:
Size: 6- 15 um
Movement: sluggish
Dx. Feature : 1
nucleus with large
irregular karyosome
and thick nuclear
membrane

Shape: short and blunt

• Cystic Stage:
– Size: 5-14 um
– Shape: ovoidal
– Nuclei: 1-4 with large
eccentric karyosome
very thin membrane
BONUS QUESTION FOR 2 POINTS

What is the motility of

Endolimax nana?
Iodamoeba butschlii

• Trophozoite stage:
– Size: 9-14 um long. ( 6-
20 um)
– Dx. Feature: large
vesicular nucleus with a
large endosome
surrounded by a
chromatic granules
– No peripheral chromatin
granules on the nuclear
membrane
• Cystic stage:
– Size: 6-15 um
– Shape: ovoidal
– Dx. Feature: very large
glycogen body /
vacuole
• Uses: D’ Antoni's stain
( iodine)- mahogany
brown in color
• Called iodine cyst of
“Wenyoun”
– Uninucleated
BONUS QUESTION FOR 2 POINTS

Iodamoeba butschlii cysts

typically:
a. Cointain four nuclei
b. Have a small karyosome in a central
position
c. Lack chromatoid bars
d. Lack a glycogen mass
Entamoeba hartmani

– Trophozoite stage:
Similar to E. histolytica,
except that it is smaller and
no ingested red blood cells
Movement: more sluggish

• Cystic stage:
• Size: 5-10 um
• Nuclei: quadrinucleated with
coarse cytoplasm
• Immature cyst: with
chromatoidal barr with
tapered ends, thin & bar like
Trophozoite with 1 nucleus
BONUS QUESTION FOR 2 POINTS

What is the difference between

Entamoeba histolytica and
Entamoeba hartmanni?
Ciliates

• Balantidium coli
Capable of attacking
the intestinal
epithelium, resulting
in ulcer formation
which causes bloody
diarrhea .
Associated with pigs
Parasite Biology

• Trophozoite stage:
– Size: 30-300 um long by
30-100 um wide.
– Cytostome: which
acquire food
– Cytopyge: which it
excretes waste.
– Cilia : present
Has 2 dissimilar nuclei &
2 contractile vacuoles.
Macronucleus &
micronucleus
• Cystic Stage:
– Size: 40-60 um ,
spherical and ovoid
and is covered with
thick cell wall.
– Encystation does not
result in an increase
number of nuclei
– Human infection results in ingestion of
contaminated food / water.
» Cyst

• Small intestine

• Trophozoite
– Lumen, mucossa, cecal region.

Multiply Colonic wall and mucosa

Pathogenesis And Clinical Manifestations

• Attacks the intestinal

epithelium and creating a
characteristic ulcer with a
round base and wide neck.
• Ulceration is caused by the
lytic enzyme hyaluronidase
• Trophozoite also invades
the submucosa &
muscular coat, blood
vessels & lymphatics.
Signs & symptoms
• asymptomatic, but majority of patient
complains of diarrhea & dysentery
• Bloody and mucoid stools.
• Acute cases may have 6-15 episodes of
diarrhea per day.

• Chronic cases, diarrhea may alternate with

constipation, accompanied by abdominal
tenderness, anemia and cachexia
Diagnosis
• Microscopic demonstration of trophozoites
& cyst in feces
• DFS
• Concentration technique
• Rectal biopsy
Treatment

• Adults and older children:

– Tetracycline500 mg
– Metronidazole 750 mg
Epidemiology
• Uncommon in temperate climate
• Found in association with pigs
• Prevalence of Balantidial dysentery is
associated with poor environmental
sanitation
• Exposure to swine ( 25% cases in human
infection)
• In Philippines : sporadic (1%)
Prevention and Control
• Proper sanitaion
• Safe water suppy
• Protection of food from contamination
Intestinal Flagellates
• Giardia lamblia
– Otherwise known as:
• Giardia intestinalis, G. duodenalis, Lamblia
duodenalis, L. intestinalis
– First described in 1681 by Antoine van
Leewenhoek .
– Then by Lambl in 1859.
Parasite biology

• A flagellates that
lives in the
duodenum,
jejunum and
upper ileum of
humans.
• Simple life cycle:
Trophozoite stage:

• Size: 9-12 um long x 5-15 um wide

• Shape: pyriform, tear-drop, tennis
racket, pointed posteriorly
• Nuclei: 1 pair ,
• Flagella: 4 pairs
• Axoneme: 2 pairs
• Dorsal side: convex
• Ventral Side: concave with large
adhesive disc for attachment
• Motility: erratic tumbling motion
• Reproduction: binary fission
• Found in diarrheic stools.
• Cystic stage:
– Size: 8-12 um long by 7-
10 um wide.
– Nuclei: 2-4
– Characterized by: flagella
retracted into the
axonemes, the median
body, and deeply stained
curved fibrils surrounded
by tough hyaline cyst wall
secreted from condensed
cytoplasm
• Infective stage: cystic stage once ingested

stomach colon

duodenum(trophozoite) new cyst ( 2 nuclei)

multiply mature cyst(4 nuclei)

intestinal villi feces ( infective )

jejunum
Pathogenesis and Clinical manifestation

• Incubation period: 4 weeks( ave. 9 days)

• Asypmtomatic in approx. 50% of infected
individuals
• Spontaneous recovery in mild to moderate
cases in about 6 weeks.
• In mild giardiasis- moderate and
protracted diarrhea follwed by recovery.
• Acute giardiasis
Includes:
cramping and diarrheal stools, with excessive flatus with an
odor of hydrogen sulfide.
Abdominal bloating, nausea, anorexia

Severe disease:
Causes: malabsorption in the gut &
debilitation of the host.
inflammation of the mucosa & hyperplasia
of lymphoid follicles.
• Chronic infection
– Characterized by:
• Steatorrhea
• Weight loss
• Generalized weakness
• Chills
• Low grade fever
– In under developed countries this has
described as: “ the cause of the failure to
thrive syndrome”
Diagnosis
• DFS
– Trophozoites characterized by a a “floating-
leaf like motility”

– Cyst: spotty shedding requires 3 examination

– Duodenal aspiration or biopsy may be done.
– Entero-test demonstrate trophozoites.
– ELISA
Treatment
• Metronidazole
– 250 mg 3x/day (5-10 days)

– Pediatric dose: 15 mg/kg in divided doses.

• Tinidazole:
– Single dose 2 grms ( adult)
– 50 mg/kg( children)
Epidemiology
• Prevalence is associated with poor
environmental sanitation
• Distribution: worldwide
• In the Philippine: over all prevalence 6%
– 14 % under 9 yrs. Of age
– 16.9% among institutionalize
– Water-borne
Important Risk Factors
• Poor hygiene
• Poor sanitation
• Overcrowding
• Immunodeficiency
• Bacterial & fungal overgrowth in the small
intestine
• Homosexual practices.
• associated with “ gay bowel syndrome”
Prevention and Control
• Proper /sanitary disposal of human
excreta
• Avoid night soil fertilization
• Water boiling
END