ENTAMOEBA

HISTOLYTICA
Trophozoites of E.
histolytica with ingested
erythrocytes stained with
trichrome. The ingested
erythrocytes appear as dark
inclusions. The parasite
above show nuclei that have
the typical small, centrally
located karyosome, and thin,
uniform peripheral
chromatin.

GEOGRAPHICAL DISTRIBUTION
Worldwide
Higher rates are found in tropical countries
High risk groups include male homosexuals,
travelers, and institutionalized population.

EPIDEMIOLOGY

E. histolytica is a worldwide distributed pathogen and is the second leading cause of parasitic
death .
It infects an estimated 500 million people per year, causes liver abscess and colitis in 50
million, and results in death of an estimated 40,000-100,000 individuals annually .
Infections due to E. histolytica are more common in tropical and subtropical areas such as
Mexico, South and West Africa, western South America and South Asia.
Infection rates are also high in temperate areas with poor sanitation. Most cases of amebiases
in the Unites States occur in immigrants from endemic areas, in HIV infected patients and
people living in states that border Mexico .
Individuals travelling to endemic areas are also at risk of developing amebiases due to E.
histolytica .
Amebic liver abscess is rare (occurring in less than 5% of cases), but is the most common
extraintestinal manifestation of E. histolytica infection .
It is endemic in Mexico, the Indian subcontinent, Indonesia, sub-Saharan and tropical regions
of Africa, and parts of Central and South America .

 HOST RANGE: Humans and non-human primates.

INFECTIOUS DOSE: Average infectious dose is >1000 organisms. Ingestion of one
cyst, however, has also been reported to cause disease .
MODE OF TRANSMISSION: Transmission can occur through fecal-oral route
(ingestion of food and water, contaminated with feces containing E. histolytica cysts).
Sexual transmission can also occur.
INCUBATION PERIOD: Intestinal diseases due to E. histolytica may occur within a
few days or may take months . Amebic liver abscess associated with E. histolytica
usually appears 8 to 20 weeks after the patient has left an endemic area.
COMMUNICABILITY: Amebiases can spread within families. Person-person
transmission occurs through fecal-oral-route under conditions of poor hygiene (45
million cysts are passed in the stool daily) . Sexual transmission occurs mainly in
homosexual males.

MORPHOLOGY
Trophozoite
18-40m in diameter
Hyaline/clear ectoplasm, granulated endoplasm
Erythrocyte, leucocyte & tissue debris @ food vacuole in endoplasm
Appears elongated in diarrhoeic faeces
Single nucleated, spherical shaped, 4-6m
a small dot-like st. (karyosome) is centrally positioned & surrounded by a clear halo
Delicate nuclear membrane is lined by chromatin granules layer
Linin network (achromatic fibrils) transverse the space bet. karyosome & nuclear
membrane in spoke-like radial arrangement
Motile due to pseudopodia @ amoeboid movement

Pre-cystic stage (non-motile, immature cyst)

Smaller than trophozoite (10-20m in diameter)

Round/ oval shaped with blunt pseudopodium
Similar nucleuscharacteristic as that of trophozoite
Single/ binucleated

Cyst (non-motile, mature cyst)

Round shaped, 10-15m in diameter

Cyst ofE. histolytica/
disparstained with
Surrounded by highly retractile membrane called cyst wall
trichrome. Two nuclei are
visible in the focal plane
Thus is resistant to gastric juice & extreme env. conditions
(black arrows), and the cyst
contains a chromatoid body
Similar nucleus characteristics as the one in trophozoite
with typically blunted ends
(red arrow).
Quadrinucleated, formed via binary fission
Has 2 other inclusions: glycogen vacuole & chromatid bodies/bars
Their size as cyst ages
Iodine stain: brown/ dark yellow glycogen vacuole
Iron-hematoxylin stain: dark blue chromatid bars (rod shaped with 2 rounded ends)

Glycogen vacuole

CLINICAL MANIFESTATION
Most patients harbouring Entamoeba are 90% asymptomatic
(symptomless), but individuals with E. histolytica can develop disease
There are 2 types:-

INTESTINAL AMOEBIASIS
Amoebic dysentery
Amoebic dysentery is a more
dangerous form of the disease
with frequent watery and bloody
stools and severe stomach
cramping
Amoebic colitis
Mild to moderate colitis- patients
has mucus diarrhoea, but no blood
in stool
Severe colitis- patients pass
offensive and bulky stools
containing blood and mucus, have
fever and lower abdominal
cramping

EXTRAINTESTINAL
AMOEBIASIS
Amoebic liver abcess (liquid
necrotic liver)
Some people with intestinal
amoebiasis develop hepatic
amoebiasis in which abscess is
formed. From the liver,
trophozoites may enter into
systemic circulation involving
other organs such as lungs, brain,
spleen, skin. Symptoms of amoebic
liver disease include fever and
tenderness in the upper-right part
body.

LIFE CYCLE
The cysts

can
survive days to
weeks in the external
environment and are
responsible for
transmission

Trophozoites
passed in the stool
are rapidly destroyed
once outside the
body

PATHOGENESIS
E. histolytica possess a potent repertoire of adhesins, proeinases and pore forming
proteins and molecules that enable them to lyse cells and tissue.
These molecules induce cellular necrosis and apoptosis.
Resist both innate and adaptive immunity.
E. histolytica trophozoites adhere to the colonic mucosal epithelial cells leads to
disruption

DIAGNOSIS
1)
-)
-)
-)
-)
2)
-)
-)
3)
-)
-)
-)

Stool Experiment:
Naked eye or microscopic examination
Normal saline (Charcot-Leyden crystals, active tropozoites)
Iodine (cysts, dead tropozoites )
Fresh, uncontaminated and sufficient
Serological Test:
Antibody Detection ( specific for E.hystolytica )
Antigen Detection ( differentiate pathogenic and non-pathogenic )
Clinical Test:
Liver function: if the ameba has damaged liver.
Ultrasound or CT scan: If damage to internal organs is a concern, to check for lesions on liver.
Needle Aspiration: to see if the liver has any abscesses. An abscess in the liver is a serious
consequence of amebiasis.
-) Colonoscopy: to check for the presence of the parasite in intestinal or colon tissue.

PREVENTION
Food and water precautions
- Filtering or purifying drinking water (iodine or boiling) in endemic areas
- washing of fruits and vegetables
Hand hygiene
Proper disposal of human faeces
Avoid fecal exposure during sexual activity
- Ingestion of fecally contaminated food or water is the primary mode of
transmission

CONTROL AND TREATMENT

For asymptomatic infections:
- paromomycin or iodoquinol
For symptomatic intestinal disease or extraintestinal infections :
- metronidazole or tinidazole
- treatment with paromomycin or iodoquinol.