Review of Literature

REVIEW
OF
LITERATURE

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History
 Entamoeba histolytica was first described by fedorlosch (1875) from

Russia. The species name coined by fritz schaudinn in 1903. Amoebiasis is

a major health problem worldwide. The largest burden of the disease occurs

in tropics of china, central and South America, and Indian subcontinents

affecting 10% of the world’s population (D.R. Aroraet., al; 2014).

Habitat

Trophozoites of E. histolytica reside in mucosa and sub mucosa of large intestine

of man.

Morphology

The parasite exists in three morphological

 Trophozoite

 Precyst

 Cyst

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Trophozoite

It measures 10-60 µm the cytoplasm of the trophozoite can be divided into a clear

outer ectoplasm and an inner finely granular endoplasm in which red blood cells,

leucocytes and tissue debris are found within the food vacuoles.

Precyst

It is smaller in size, varying from 10-20µm in diameter. It is oval with a blunt

pseudopodium projecting from the periphery.

Cyst

It is spherical, 10-15µm in diameter. It is surrounded by a thick chitinous wall

which makes it highly resistant to the gastric acid, adverse environmental

conditions and the chlorine concentration found in potable water (D.R.

Aroraet.,al; 2014).

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Life cycle

Fig.1. Life cycle of Entamoeba histolytica

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Treatment

 Metronidazole or Tinidazole is the drug of choice for intestinal amoebiasis

and amoebic liver abscess.

 Other measures include fluid and electrolyte replacement and symptomatic

treatment.(Apurba S Sastryet., al; 2016).

Epidemiology

The largest burden of the disease occurs in tropics of china, central and south

America, and Indian subcontinents affecting 10% of the world’s population (500

million). It is the third most common parasitic cause of death in the world.

Globally, approximately 50 million cases and 110,000 deaths have been reported

annually by World Health Organization.

Prevalence of giardiasis in children ranges from 0.5-70%. Giardia has low zoonotic

potential although can infect many mammals such as mice beaver, cattle, dog and

cat.

A.duodenale is prevalent in southern Europe, North Africa, and northern Asia. N.

americanus is the predominant species in the Western world, found throughout

central and south Africa, central and South America. In Southeast Asia including
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India, both the species. Hookworm infection is almost eradicated form Europe and

USA. Hookworm infection is widely prevalent in India. More than 200 million

people are estimated to be infected in India. N. americanus is predominant in South

India and A. duodenale in North India. Heavily infected areas are Assam(tea

gardens ), West Bengal, Bihar, Odisha, Andhra Pradesh, Tamil Nadu, Kerala and

Maharashtra. (Apurba S Sastryet., al; 2016).

 Giardia Lamblia was first observed by AV Leeuwenhoek in 1681. While

examining his own diarrheal stool, and was described by

VilemDusanLambl in1859. And by Alfred Giardia in1895. Giardia

lamblia is worldwide in distribution, it is considered as one of the most

common parasite, causing both endemic and epidemic intestinal disease and

diarrhea (D.R. Aroraet.,al; 2014).

Habitat

It inhabits duodenum and the upper part of jejunum of man.

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Morphology

It exists in two Form

 Trophozoite

 Cyst

Trophozoite

It is pear-shaped with rounded anterior and pointed posterior end It measures 10-20

µm in length and5-15µm in width. The dorsal surface is convex while on the

ventral surface it has a shallow posteriorly notched concavity (sucking dies) that

embraces anterior half of the organism.it acts as an organelle of attachment.

Cyst

Paris of nuclei. Which may remain clustered at one end or lie in pairs at opposites

end the remains of the flagella and margins of the sucking dies may be seen inside

the cytoplasm of the cyst.

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Life cycle

Fig.2. Life cycle of Giardia Lamblia

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Treatment

Furazolidone is often used for treatment children tinidazole has proven more

effective than metronidazole as a single dose. Metronidazole is very effective but

has potential carcinogenicity in rate and produces mutagenic changes in

bacteria(D.R. Aroraet.,al; 2014).

 Cryptosporidium is an intestinal coccidian parasite affecting various

animals and men. Tyzzer (1907) was the first to describe it in gastric crypts

of laboratory mice. Subsequently it was found to affect many animals like

rats, guinea pigs, horses, etc. the first human cases was reported in 1976.

Cryptosporidium species infecting man is now classified as two separate

species, C. parvum (mammals, including humans) and C. hominis (primarily

humans). Other species infect wide range of mammals (C. felis, C.canis and

C. muris), fishes (C. nasorum) (Apurba S Sastryet., al; 2016).

Habitats

Cryptosporidiosis, a zoonotic diarrheal disease, significantly contributes to

the mortality of people with impaired immune systems worldwide.

Infections with an animal-adapted genotype (Genotype 2).

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Morphology

Oocyst

 It is round, small, 4-6 µm in size, surrounded by a cyst wall and bears

four sporozoites

 Each sporozoite is crescentic-shaped with pointed anterior end, blunt

posterior end a nucleus located posteriorly

 Two types of oocysts are demonstrated (1) thick walled (2) thin

walled

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Life cycle

Fig. no.3 Life cycle of cryptosporidium

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Treatment

 Mild cases are self-limited, requires fluid replacement like ORS, with

lactose-free glutamine supplemented diet.

 Sever cases: Nitazoxanide is given to adults (500 mg twice daily for 3 days).

It is not effective in HIV infected patient. Paromomycin can be given as an

alternate. Macrolide antibiotics including spiramycin, azithromycin and

clarithromycin and diclazuril have some activity against Cryptosporidium

species (Apurba S Sastry et., al; 2016).

 Blastocystis hominis (B. hominis) is an anaerobic, single-cell protozoan,

commonly present in human and animal stool samples. It can be found in

healthy people as well and it still has not been elucidated whether it is a

commensal organism or a pathogen. Blastocystosis is a disease caused by

the protozoan in humans (D.R. Aroraet.,al; 2014).

Habitat

Blastocystis species is single celled anaerobic protozoan parasite resides in the

intestine of many animals including humans.

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Morphology

It shows great morphological diversity. Four main morphological types have been

described-vacuolar, granular, amoeboid and cystic.

Vacuolar form

The vacuolar form is seen in faecal specimens and is predominant form in culture.

This form is usually spherical with a large size variation form 2µm to more then

200µm (average size between 4and5µm).

Granular form

This form can be regarded simply as a vacuolar form with granules in the central

vacuole

Amoeboid form

It is only rarely encountered. Extended pseudopodia are often seen in amoeboid

forms of B. hominies.

Cyst form

The classic form found in human stool is the cyst, which varies tremendously in

size form 6 to 40 µm.

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Life cycle

Fig.4 Life cycle of Blastocystis hominis

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Treatment

• Metronidazole is found to be effective used alone or in combination with

paromomycin or nitazoxanide.

 If failed with metronidazole treatment, then cotrimoxazoleand nitazoxanide

can be tried (D.R. Aroraet.,al; 2014).

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Prevention and control

 Avoidance of ingestion of food and water contaminated with human feces.

 Treatment of asymptomatic persons who pass E. histolytica cycts in the stool
may help to reduce opportunities for disease transmission.
 The amoebic infection can be prevented by avoiding faeca lcontamination of
food and water.
 There should be proper disposal of human faeces through proper drainage
system.
 Contamination may result from discharge of sewage into rivers.
 Purified water should be distributed through pipelines to avoid
contamination.
 Boiled water is safe
 The amount of chlorine normally used to purify water is insufficient to kill
cysts.
 Improved personal hygiene.
 Routine hand-washing.
 Control of insects which may come in contact with infected stool and then
contaminate food or water.

 Treatment of symptomatic and asymptomatic individuals (Apurba S

Sastryet., al; 2016).

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