Distinguishing between pathogenic and non-pathogenic species of intestinal amoeba

Entamoeba histolytica/dispar/moshkovskii

A trophozoite, line drawing

B trichrome stain

C trichrome stain

D trichrome stain

Entamoeba histolytica/dispar/moshkovskii trophozoites measure usually 15 to 20 m (range 10 to 60 m),

tending to be more elongated in diarrheal stool.
In the absence of erythrophagocytosis, the pathogenic E. histolytica is
morphologically indistinguishable from the nonpathogenic E. dispar!
Each trophozoite has a single nucleus, which has a centrally placed karyosome and uniformly distributed
peripheral chromatin. This typical appearance of the nucleus is not always observed: some trophozoites can
have nuclei with an eccentric karyosome and unevenly distributed peripheral chromatin. The cytoplasm has a
granular or "ground-glass" appearance.
Entamoeba histolytica
Trophozoites of Entamoeba histolytica with
ingested erythrocytes (trichrome stain). The
ingested erythrocytes appear as dark
inclusions. Erythrophagocytosis is the only
characteristic that can be used to differentiate
morphologically E. histolytica from the
nonpathogenic E. dispar.
In these specimens, the parasite nuclei have
the typical small, centrally located karyosome,
and thin, uniform peripheral chromatin
Entamoeba histolytica/dispar/moshkovskii

A cyst, drawing

B stained with iodine

C stained with iodine

D trichrome stain

Entamoeba histolytica cysts usually measure 12 to 15 m. The cysts are usually spherical and often have a
halo (B, C). Mature cysts have 4 nuclei. The cyst in B appears uninucleate while in C and D 2 to 3 nuclei are
visible in the focal plane. The nuclei have characteristically centrally located karyosomes, and fine, uniformly
distributed peripheral chromatin. The cysts in C and D contain chromatoid bodies with the one in D being
particularly well demonstrated, with typically blunted ends.
Entamoeba moshkovskii, considered to be primarily a free-living amoeba, is indistinguishable in its cyst and
trophozoite forms from E. histolytica. Previous reports on the identification of E. moshkovskii in fecal samples
have not shown any association with clinical illness, recent studies have reported E. moshkovskii as a sole
potential enteropathogen in patients presenting with gastrointestinal symptoms and/or dysentery, highlighting
the need for further study to investigate the pathogenic potential of this organism.
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Entamoeba hartmanni

A trophozoite, drawing

C trichrome stain

B trichrome stain

Entamoeba hartmanni trophozoites. Trophozoites of E. hartmanni measure usually 8 to 10 m

(range 5 to 12 m ) and are smaller than those of E. histolytica (10 to 60 m).
Entamoeba hartmanni is often called a "small histolytica" because these two species share many
morphological characteristics, except their size. The trophozoites of E. hartmanni (A, B, and C) each have
one nucleus with fine peripheral chromatin and a small, often centrally located karyosome.
The cytoplasm is finely granular. Note that in B, the trophozoite has ingested a yeast, not an
erythrocyte. Ingestion of erythrocytes is pathognomonic of E. histolytica.
Cysts of E. hartmanni when mature have 4
nuclei and elongated chromatoid bodies with
rounded ends.
Cysts of E. hartmanni measure usually 6 to 8 m
(range 5 to 10 m) and are smaller than those of
E. histolytica (10 to 20 m).

A cyst, drawing

B trichrome stain

Entamoeba coli

A trophozoite, drawing

C trichrome stain

B trichrome stain

The trophozoites each have one nucleus with characteristically a large, eccentric karyosome and coarse,
irregular peripheral chromatin. The cytoplasm is coarse and vacuolated ("dirty" cytoplasm) as illustrated in
C. Occasionally the cytoplasm contains ingested bacteria (B), yeasts or other materials. The trophozoites of
E. coli measure usually 20 to 25 m, but they can be elongated (C) and reach up to 50 m.

A cyst, drawing

B stained with iodine

C trichrome stain

D trichrome stain

Mature cysts typically have 8 nuclei (A,B), and measure usually 15 to 25 m (10 to 35 m). The cyst in B
shows 5 nuclei visible in this focal plane.
The cyst in D is an immature, binucleate form, frequently seen with E. coli, where a large glycogen vacuole
pushes the nuclei to opposite sides. Chromatoid bodies are seen less frequently than in E. histolytica. When
present they are usually splinter like with pointed ends (C) and thus different from the chromatoid bodies of E.
histolytica, which have rounded ends.
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Entamoeba polecki

A trophozoite, drawing

B trichrome stain

C trichrome stain

The trophozoites measure usually 15 to 20 m (range 10 to 25 m). The trophozoites each have one
nucleus that usually has small, discrete karyosomal chromatin and evenly distributed peripheral chromatin.
Their cytoplasm is coarsely granular, vacuolated and can contain bacteria and yeasts (C).

A cyst, drawing

B trichrome stain

C trichrome stain

The cysts have one nucleus (rarely two, C) with a small, usually eccentric karyosome (which
can also be rather pleomorphic). Their cytoplasm contains small inclusions and an "inclusion
mass", which stains only weakly in iodine. The cysts measure usually 11 to 15 m (range 9 to
18 m) and their shape varies from spherical to oval.
Endolimax nana

A trophozoite, drawing

B trichrome stain

The trophozoites measure usually 8 to 10 m (range 6 to 12 m). The trophozoites each have one nucleus
with a characteristically large, irregularly shaped, blot-like karyosome. Their nucleus has no peripheral
chromatin. Their cytoplasm is granular and vacuolated.

A cyst, drawing

B stained with iodine

C trichrome stain

The cysts when mature have 4 nuclei with large, blot-like karyosomes (The cysts of E. nana do not have
chromatoid bodies. The cysts measure 6 to 8 m (range 5 to 10 m).
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Iodamoeba buetschlii

A trophozoite, drawing

B trichrome stain

C iron hematoxylin stain

The trophozoites measure usually 12 to 15 m (range 8 to 20 m). The trophozoites each have one nucleus
with a large, usually central karyosome surrounded by refractile, achromatic granules. Their cytoplasm is
coarsely granular, vacuolated and can contain bacteria, yeasts or other materials.

A cyst, drawing

B trichrome stain

The cyst have only one nucleus with a large, usually eccentric karyosome. They do not have
chromatoid bodies but have a compact, well defined glycogen mass. The cysts measure usually
10 to 12 m (range 5 to 20 m) and their shape varies from ovoidal to rounded.
Blastocystis hominis

A trichrome stain

B trichrome stain

C trichrome stain

D trichrome stain

Blastocystis hominis appear as spherical to oval cyst-like structures.

They can vary widely in size (5 to 30 m; usual range 8 to 10 m), and typically consist of a central body, or
"vacuole" surrounded by a thin rim of cytoplasm containing up to 6 nuclei.

E stained with iodine

F stained with iodine