About this class About this class

�� Move Move by pseudopodiaby pseudopodia

�� StableStable form : cystform : cyst

�� Pleomorph form:Pleomorph form: trophozoittrophozoit

�� Replication:Replication: binary fissionbinary fission

�� Important Important order order AmoebidaAmoebida

Pathogen genus of amoeba Pathogen genus of amoeba

• Genus Entamoeba: E. histolytica, E. coli

and E. gingivalis

• Genus Endolimax: Endolimax nana

• Genus iodamoeba: iod. Butschlii

• Genus dientamoeba: D. fragilis

Genus specification Genus specification

• Genus Entamoeba: Nucleus intra granules

and Karyosome

• Genus Endolimax: Karyosome large mass

• Genus Iodamoeba: ≈ ≈ ≈ cover with globule

• Genus Dientamoeba: Karyosome, chromatin

granule and doubles nucleus

Amoeba classification Amoeba classification

♣ 1- pathogenic:

►intestinal amoeba: E- histolytica.

♣ 2- non pathogenic:

►Mouth amoeba: E- gingivalis

►intestinal amoeba: E- coli, endolimax

nana, iodamoeba butschlii and dientamoeba

fragilis

Entamoeba histolytica Entamoeba histolytica

۩۩ Morphologic forms:Morphologic forms:

►►11-- active trophozoit form:active trophozoit form:

�� Cytoplasm:(Cytoplasm:(22//33endoplasm and endoplasm and 11//33 ectoplasm)ectoplasm)

�� Nucleus: circle with karyosomeNucleus: circle with karyosome

�� Replication stage 2Replication stage 2--4 nucleus 4 nucleus

Trophozoite formTrophozoite form

►►Precystic form:Precystic form:

■■ intermediate stageintermediate stage

■■ Sluggish motility Sluggish motility

■■ untrue morphologic stageuntrue morphologic stage of parasitesof parasites

■■ shape:shape: oval or circleoval or circle

Procystic formProcystic form

►►Cystic formCystic form::

♦♦ Stable and non motileStable and non motile

♦♦ SmallSmall and and largelarge race cystsrace cysts

♦♦ primary cyst with primary cyst with one nucleusone nucleus

♦♦ in replication stage in replication stage 22--4 nucleus4 nucleus

♦♦ karyosome, chromatoide body and karyosome, chromatoide body and

glycogen in nucleus glycogen in nucleus

Cyst formCyst form

Replication stage of cystReplication stage of cyst

PrimaryPrimary

Culture Culture

�� Growth in Growth in thioglycolatethioglycolate and and blood agarblood agarmedium.medium.

�� And some medium with And some medium with StarchStarch and and eggseggs

Stability Stability

�� Trophozoit form: Trophozoit form: unstableunstable

�� Cystic form: stable in Cystic form: stable in 2020êê for for 3 days3 days and and in in 4545êê for for 30 min30 min

�� Cystic form also stable against low Cystic form also stable against low concentration of concentration of CLCL and and HCLHCL

�� But unstable against But unstable against ≤≤8080êê

Life cycle Life cycle

Transmission Transmission

�� transmitted by cystic formtransmitted by cystic form

�� Direct transmission:Direct transmission:

☻☻with contaminated handswith contaminated hands

■■ indirect transmission:indirect transmission:

☻☻Contaminated food , water and arthropods Contaminated food , water and arthropods

Pathogenesis Pathogenesis

�� Cases Cases acute dysenteryacute dysentery

�� Chronic stage:Chronic stage: occur intestinal ulcer, occur intestinal ulcer, inflammation and necrosis with inflammation and necrosis with proteolytic proteolytic enzymeenzyme

�� Heavy infection:Heavy infection: occur intestine occur intestine sclerosesscleroses , , hypertrophy and hypertrophy and perforationperforation

�� Metastases:Metastases: to liver, brainto liver, brain……………………

Intestinal ameobiasisIntestinal ameobiasis

�� Incubation periodIncubation period is 8 days or several is 8 days or several monthmonth

�� Acute stage:Acute stage: diarrheadiarrhea with with epitheliumepithelium but but without blood, and abdominal pine , loss without blood, and abdominal pine , loss of weight ,of weight , flatulenceflatulence and and constipationconstipation

�� Sever infectionSever infection : : 1010--20/day20/day , , diarrheadiarrhea with with epiepi and and bloodblood , abdominal pine (colon) , abdominal pine (colon) dehydration and fever.dehydration and fever.

�� Metamoebic colitisMetamoebic colitis

Extra intestinal amoebiasisExtra intestinal amoebiasis

�� Spread of amoeba from bloodSpread of amoeba from blood to liver , spleen to liver , spleen

,brain and pulmonary ,brain and pulmonary

�� Direct extra intestinal amoebiasisDirect extra intestinal amoebiasis (without (without

intestinal infection).intestinal infection).

Hepatic AmoebiasisHepatic Amoebiasis

►►Cases liver abscessCases liver abscess..

►►SingleSingle abscess, different abscess, different sizesize , at the , at the rightrightloblob of the liver.of the liver.

►►Symptoms:Symptoms: liver pine , fever , right liver pine , fever , right hypochondrium pain hypochondrium pain

►►transmittransmit to to pleurapleura, , peritoneperitone and pericardial and pericardial …………………………dead . dead .

Pulmonary AmoebiasisPulmonary Amoebiasis

11-- Direct primary infectionDirect primary infection (blood circulation)(blood circulation)

22-- secondary infection:secondary infection: after liver amoebiasis at after liver amoebiasis at

the the right pulmonaryright pulmonary ..

►►cases cases single single or or several several abscess.abscess.

Cerebral AmoebiasisCerebral Amoebiasis

�� Occur from complication of liver and Occur from complication of liver and

pulmonary amoebiasis.pulmonary amoebiasis.

�� Cases single or several abscessCases single or several abscess

SpleenSpleen and and CutaneousCutaneous Amoebiasis Amoebiasis

�� Spleen abscess always seem with liver Spleen abscess always seem with liver

amoebiasisamoebiasis

�� Cutaneous amoebiasis seem in perianal site Cutaneous amoebiasis seem in perianal site

Diagnosis Diagnosis

�� Detection of Detection of trophozoittrophozoit and and cysticcystic form of form of

parasites in fresh stoolparasites in fresh stool

�� After 30min trophozoit form will destroy After 30min trophozoit form will destroy

�� Extra intestinal amoebiasis: detection of Extra intestinal amoebiasis: detection of

parasite by lugolparasite by lugol stain of infected tissue stain of infected tissue

�� Cutaneous testCutaneous test

Direct Direct

Treatment Treatment

�� MetronidazoleMetronidazole 750mg + diloxanide furoate 500mg 750mg + diloxanide furoate 500mg

X 3 . 10 days.X 3 . 10 days.

�� MetronidazoleMetronidazole + Iodoquinol 650mg X 3 . 21 days+ Iodoquinol 650mg X 3 . 21 days

�� MetronidazoleMetronidazole + tetracycline 250mg X 4 . 10 days+ tetracycline 250mg X 4 . 10 days

�� Chloroquine 500mg X 1 . 7days (liver amoebiasis)Chloroquine 500mg X 1 . 7days (liver amoebiasis)

�� Paromycine 250mg/kg X 3 . 7days Paromycine 250mg/kg X 3 . 7days