AMOEBAE

DR S.LIOMA
MBChB, BScCMED, BScHB, ADGEMED,DCM
 AMOEBAE
• INTESTINAL AMOEBAE
• IMPHIZOITIC AMOEBAE
Phylum : Sarcomastigophora
Subphylum : Sarcodina
Class : Rhizopoda
Order : Amoebida
Family : Endamoebidae
Genera : Entamoeba
Entamoeba hystolytica

Distribution
 World-wide and highest in Tropics and Subtropics
 Predisposing factor
Poor sanitation
Dietary deficiencies
Morphology
 Primarily inhabits large intestines
 2 Developmental stages:-
 Trophozoites – actively motile and is the feeding stage
 Cysts – Quadrinucleate; Quescent; Resistant; Infective stage
 Trophozoites
 vary in size, 12 – 60 μm diameter
 movement by means of pseudopodia
 surface posses phagocytic stomata
 Cysts
 vary from 10 – 20 μm diameter
 With a distinct cyst wall
 Usually spherical (ovoid; irregular)
TRANSMISSION

Fecal oral route

5Fs: fingers,
flies,
feces,
food/water,
fomites
Entamoeba hystolytica - Trophozoite
Entamoeba hystolytica - Trophozoites
Entamoeba hystolytica - Cyst
Life cycle

 Infection is by ingestion of an infective cyst

 The ingested cyst passes through the stomach unaltered
 Excystation occurs in terminal ileum. Emergence of
Trophozoites
 Trophozoites invade large intestinal tissues, lodging in the
submucosa
Life cycle
 When lodged, Trophozoites grow and multiply by Binary
Fission
 Some Trophozoites move to other tissues (extra intestinal
Amebiasis) – Liver; Lungs; Brain
 Some Trophozoites move to the intestinal lumen and
transform into pre-cyst forms
 Pre-cyst forms secret a cyst wall – uninucleate cysts
 Uninucleate cysts mature into Quadrinucleate Cyst
 Both mature and Immature Cysts are shed in feaces
 Immature cysts mature in the external environment
 Mature Cysts are the infective stage
Clinical Features
Broadly divided into 2:-
 Symptomatic – Intestinal & Extra intestinal
 Asymptomatic (Carrier state)

Intestinal Amebiasis
 The most common form of Amebiasis
 Dysenteric – blood and mucus in stool
 Pathologically - Erosion of submucosa vessels; ulceration; necrosis; perforations
 Non-dysenteric Colitis – diarrhoea; abdominal pain/cramping; anorexia; weight
loss; chronic fatigue
Extra Intestinal Amebiasis
 Through the portal vein Trophozoites move to Liver; Lungs; Brain
 Hepatic involvement
 Liver enlargement; Fever; Weight loss; Abscesses
 Pulmonary involvement
 Lower lobe pneumonitis
Host-Parasite Relationship

 Both Humoral and Cellullar Immune responses are

involved
 There is activation of Complement Immune response
Laboratory Diagnosis

 Direct wet film - most useful for detecting the trophic

forms :-
 Examination of fresh dysenteric faecal specimen – motile amoeba
containing RBCs
 Examination of formed faecal specimen - Cysts (uni- &
Quadrinucleate)
 Scanning Procedures – liver and lung abscesses
 Serological tests :-
 Indirect Haemagglutination (IH)
 ELISA
 Enzyme Immunoassays
Treatment and Prevention
Treatment
 Metronidazole
 Iodoquinol
 Diloxanide fuorate

Prevention
 Breaking the transmission cycle
 Avoiding food/water contamination – improving hygiene
 Superchlorination of drinking water
 Routine screening and treatment of food handlers
OTHER CONTROL MEASURES
1. Sanitary disposal, nightsoil composting
(human faeces as fertilizer)
2. Hand washing/ personal hygiene
3. Health education – to prevent oral-fecal
transmission
4. Strict control of food handlers, protecting,
food hygiene – routine medical checkups
5. Treatment of drinking water – boiling (not
killed by quantity of chlorine ordinarily used
in water purification)
6. Group treatment
7. Travelers: use I2 tablets kill cysts
Other Intestinal Amoebas – mostly are commensals

1. Entamoeba hartman
 Trophozoites are less motile
 Trophozoites don’t ingest RBCs
 Trophozoite size, 8–10 μm; Cyst, 6-8 μm
 Mature Cysts, Quadrinucleate; Immature, 1 or 2 Nucleus/Nuclei

2. Entamoeba coli
 Life cycle stages are Trophozoite, Pre-Cyst; Cyst; Metacyst; and
Metacyctic Trophozoite
 Trophozoite motility is sluggish
 Transmission is by viable Cystic stage
 Mature Cyst has more than 4 Nuclei
 Trophozoite size, 20 – 25 μm; Cyst, 15 -25 μm
Other Intestinal Amoebas – mostly are commensals
3. Entamoeba polecki
 Trophozoite size, 15–20 μm
 Mature Cysts, 1 Nucleus

4. Entamoeba gingivitis
 Only Trophozoite stage present
 Survives best on unhealthy gums

5. Endolimax nana
 Trophozoite size, 8 – 10 μm; Cyst, 6 -8 μm
 Mature Cysts, Quadrinucleate

6. Iodamoeba buetschlii
 Trophozoite size, 8 – 14 μm; Cyst, 9 - 10 μm
 Mature Cysts, 1 Nucleus
AMPHIZOITIC AMOEBA – Pathogenic; Facultative;
Free living Amoeba
 Free living in Soil, Dust, and Water habitats
 Can be found everywhere:-
 diverse forms of natural waters (lakes, rivers)
 springs (including hot springs)
 swimming pools (even in pools treated 'adequately')
 industrial - cooling water, heating ventilation and air conditioning
units
 Soils; dust and oceanic sediment, including soil and water from the
Antarctic
 Have been isolated:-
 from domestic tap water
 from bottled mineral waters
 contact lens cleaning and storing liquids
 from the human cornea, skin, lung and central nervous system
Amphizoitic Amoeba – Pathogenic; Facultative; Free
living Amoeba
 A single specie in the genus can comprise a mixture of pathogenic
and non-pathogenic strains
 Problems of identification and determination of pathogenicity are
compounded by attenuation of virulence during laboratory culture
 Pathogenicity is probably opportunist and it is possible that all strains
have a pathogenic potential
 Morphologically:-
 Naegleria fowleri – Trophozoites occur in 2 forms (single

pseudopodia; flagella)
 Acanthameba species – Trophozoites have an irregullar
appearance, and a spine like pseudopodia; Dry cysts can survive
for several years
 Balamuthia species – Trophozoites extend broadly
Amphizoitic Amoeba - Pathogenic; Free living
Amoeba

Isolation, identification and increasing importance of ‘free-

living’ amoebae causing human disease

 Important Genera : Naegleria

Acanthamoeba
 Pathogenic role is far more important than was thought
previously: -
 Naegleria is the aetiological agent of Fulminant Primary Amoebic
Meningoencephalitis (PAM)

 Acanthamoeba & Balamunthia can produce Chronic and Acute

Granulomatous Amoebic Encephalitis (GAE)
 END

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