MEDICAL

BIOLOGY
Lesson 2
 Phylum Amoebozoa
Infective agent Disease name
Entamoeba coli - amoeba non-pathogenic, non-parasitic
Entamoeba histolytica amoeba Amoebic dysentery, amoebiasis
Acantoamoeba castellani Granulomatous amoebic encephalitis
Naegleria fowleri – Naegleria, Primary amoebic
or brain-eating amoeba meningoencephalitis (PAM)

Phylum Metamonada
Giardia lamblia = duodenalis = Giardiasis (old name lambliasis)
intestinalis = Lamblia
intestinalis) - giardia, or
lamblia
Ttichomonas tenax Oral trichomonisis
Trichomonas vaginalis Urogenital trichomoniasis
• The amoebic organisms exist in two
states. The vegetative state is called
trophozoite. This is the metabolic stage
of the protozoan which is very sensitive
to the environment changes.

• As unfavorable conditions set in, the

organisms go through a process called
encystation. The cyst is the resistant
state of amoebic organisms.
• Excystation takes place with the return of
favorable conditions.

• Some species in this class also use the

encystation process for the purpose of
reproduction.
 Entamoeba histolytica
COMMON NAME: Amoeba
Group characteristics: pseudopodia
for locomotion.
GEOGRAPHICAL DISTRIBUTION:
Cosmopolitan, prevalent in the
tropics and subtropics.
PATHOGENESIS: amoebic dysentry,
amoebiasis
HABITAT: Primary Site: colon and
cecum (intestine)
Secondary Site: liver, lungs, brain
RESERVOIR HOST: Other mamalls.
INFECTED FORM: Mature
quadrinucleated cyst.
DIAGNOSTIC FORM Cysts,
trophozoites
MODE OF INFECTION: Ingestion.
SPECIMEN SOURCE: Feces,
contaminated water
 TROPHOZOITE
SIZE: 11 to 60 mcm. CYST
SHAPE : Irregular. SIZE: 11 to 20 mcm. SHAPE : Spherical.
NUCLEUS: Vesicular, dispersed. NUCLEUS:
NUMBER: One NUMBER: One to four; the mature cyst has four

E. histolytica trophozoites have an amorphous shape and are generally 15-30 µm in

diameter. The trophozoites move by extending a finger-like pseudopodium (psd) and
pulling the rest of the body forward (called ameboid movement). The pseudopodia,
and sometimes the outer edge of the trophozoite, have a clear refractile appearance
and is referred to as the ectoplasm (ecto). The rest of the cytoplasm has a granular
appearance and is called the endoplasm (endo).
 Entamoeba dispar (formerly known as
non-pathogenic E. histolytica)

E. dispar is the most frequently found Entamoeba both in humans and

primates. Entamoeba histolytica and Entamoeba dispar are morphologically
identical species. E. dispar does not cause disease in humans.
 Entamoeba coli
eight nuclei

Entamoeba histolytica -

four nuclei
 cysts larger, with eight nuclei when mature; small, oval cysts with
chromatoid bars are rarely present but, four nuclei but no
when they are, they are thin chromatoid
bars

uninucleate cyst, often containing a large

glycogen vacuole which stains dark brown
with iodine but appears clear in fresh
specimens

Schematic depictions of the morphology of the E. histolytica

trophozoite and cyst, as compared to other amoebae found in the human
intestine. Reproduced from Nappi AJ, Vass E, eds. Parasites of Medical
Importance. Austin: Landes Bioscience, 2002:20.
Entamoeba histolytica
life cycle

Mammals such as dogs and

cats can also become infected
but do not contribute
significantly to transmission
 Stages of amoebic dysentery
3 Severe disease
1 Asymptomatic carriage • High fever
2 Mild disease • Dehydration
• Loose stool (± blood) • Severe bloody
• Low-grade fever, diarrhoea
malaise, anorexia • Abdominal pain;

After Matthews 2012 Tropical medicine notebook

Entamoeba histolytica location in human body
in the case of amoebiasis
 Amoebic abscesses may be
found in all age groups, but are 10
times more frequent in adults than
in children and are more frequent in
males than in females. They are
more common in the poorest
sectors or urban populations.
Approximately 20% of patients
have a past history of dysentery.
About 10% of patients have
CT scan images of a patient with a diarrhoea or dysentery at the time
right lobe amoebic liver abscess of diagnosis of amoebic liver
Daniel J. Eichinger. 2009. Ch. 28. Amebiasis. Medical Parasitology Ed. abscess.
Satoskar et al. L A N D E S B I O S C I E N C E.

FROM Matthews 2012 Tropical medicine

notebook
 Diagnosis and differential diagnosis
Detection of the parasite
• Amoebiasis, although often suspected clinically, requires
confirmation in the laboratory by finding cysts and trophozoites in
the stools or trophozoites in the various tissues. The detection of
the organism depends on appropriate specimen collection,
processing and examination by trained personnel.

DIAGNOSIS
• Stool microscopy (≥ 3 samples)
--‘Hot’ (fresh) stool needed to identify trophozoites
--Only useful in non-endemic areas
• Endoscopy
--For colitis ± ulceration
--Contraindicated in severe disease

After Matthews 2012 Tropical medicine notebook

Distribution map of amoebic dysentery

The disease is found worldwide, with possibly 500 million infected and an
incidence of 48 million new cases each year. It is found in deprived
communities, being associated with poverty and inadequate sanitation. It is a
major health problem in parts of Africa, Asia and Latin America, where highly
virulent strains may exist. Around 70 000 deaths probably occur each year.
(Cook_Zumla (eds.) 2008 Manson's Tropical Diseases 22nd Edition)
 Naegleria fowleri
COMMON NAME: brain-eathing
amoeba
• GEOGRAPHICAL DISTRIBUTION:
Australia, Europe, and America.
• PATHOGENESIS: Primary amebic
meningoencephalitis (PAM).
• HABITAT: Usually free living;
• the meninges in humans.
• RESERVOIR HOST: None known.
• INFECTED FORM: Biflagellated
trophozoite.
• MODE OF INFECTION: Active
penetration through the nostrils.
• LABORATORY IDENTIFICATION:
the diagnosis can be made by
microscopic examination of
cerebrospinal fluid (CSF). A wet
mount may detect motile
trophozoites
Naegleria is an ameba commonly found in warm
freshwater and soil. Only one species of
Naegleria infects people, Naegleria fowleri. It
causes a very rare but severe brain infection.
Case fatal ratio is greater than 97%. Usually,
victims die not later than 14th day after infection.

Flagellate stage of Naegleria fowleri

Naegleria fowleri trophozoites, cultured from

cerebrospinal fluid. These cells have characteristically
large nuclei with a large, dark staining karyosome. The
amebae are very active and extend and retract
pseudopods.
From a patient who died from primary amebic
meningoencephalitis in Virginia.
Naegleria fowleri life cycle
• How does infection
with Naegleria
occur?

• Naegleria infects
people by entering
the body through the
nose. Generally, this
occurs when people
use warm freshwater
for activities like
swimming or diving.
The ameba travels
up the nostrils to the
brain and spinal cord
where it destroys the
brain tissue.
Infections do not
occur as a result of
drinking
contaminated water.
Flagellate stage of Naegleria fowleri.
(Environmental isolate)

The fatality rate is over 97%.

Only 4 people out of 143 known
infected individuals in the
United States from 1962 to 2017
have survived.

Naegleria fowleri in human brain section.

(Stained by specific fluorescent antibody
test.)

(David C. Warhurst Ch. 80. Cook_Zumla (eds.)

2008 Manson's Tropical Diseases 22nd Edition)
Acanthamoeba castellanii
• Cyst (A), amoeboid stage (B)
and symptoms of infection with
Acanthamoeba castellanii.
• GAE, Granulomatous amoebic
encephalitis; H, cyst wall; K,
Keratitis in eye; N, Nucleus; P,
pseudopodia.
 Acanthamoeba castellanii has been isolated from water
(including natural and treated water in pools or hot tubs), soil,
air (in association with cooling towers, heating, ventilation and
air conditioner [HVAC] systems), sewage systems, and drinking
water systems (shower heads, taps). Most people will be
exposed to Acanthamoeba during their lifetime and will not get
sick. However, Acanthamoeba is capable of causing several
infections in humans.-

Acanthamoeba keratitis – A local infection of the eye that

Early
typically occurs in healthy persons and can result in
inflammation
permanent visual impairment or blindness.
caused by
Granulomatous Amebic Encephalitis (GAE) – A serious
Acanthamoeba
infection of the brain and spinal cord that typically occurs
keratitis
in persons with a compromised immune system.
Disseminated infection – A widespread infection that can
affect the skin, sinuses, lungs, and other organs
independently or in combination. It is also more common
in persons with a compromised immune system.

• The major part of the increase in
developed countries is probably
related to contact lens use and is
related to direct inoculation of
amoebic trophozoites or cysts into
the cornea during insertion of the
contaminated lens.
Acanthamoeba
keratitis or
keratouveitis presents
a serious diagnostic
and treatment problem
to ophthalmologists.
Since the first reports
from the UK and the
USA in the early
1970s, many further
cases have been seen
in Europe, the USA
and other countries.
Oxford Textbook of Medicine 4th edition (March 2003): by
David A. Warrell (Editor), Timothy M. Cox (Editor), John D. Firth
(Editor), Edward J., J R., M.D. Benz
(Editor) By Oxford Press
David C. Warhurst Ch/ 80. 2008 Manson's Tropical Diseases
22nd Edition
Acanthamoeba keratitis in young and Acanthamoeba keratitis, Insert: higher
healthy female patient, 6 weeks evolution magnification
time, edema, and central ulcer. showing epithelial irregularity in early
acanthamoeba keratitis

Ana Lilia Pérez-Balbuena et al., 2012. Therapeutic Elisabeth Karsten et al., 2012. Diversity of Microbial
Keratoplasty for Microbial Keratitis Species Implicated in Keratitis: A Review
 Giardia lamblia
(Lamblia intestinalis)
COMMON NAME: Giardia or lamblia
GEOGRAPHICAL DISTRIBUTION:
Cosmopolitan, prevalent in the
tropics
and subtropics.
HABITAT: digestive system
RESERVOIR HOST: None
INFECTED FORM: cysts
DIAGNOSTIC FORM: cysts and
trophozites
MODE OF INFECTION: Ingestion.
SPECIMEN SOURCE: Feces,
contaminated water and food
Giardia lamblia life forms and
location in human body
Gardia lamblia life cycle
•Giardia is common enough in man
all over the world, though it is
probably commoner in the warmer
countries. Some 5 to 16 % of people
examined have been found infected
with it and it is especially common in
children.
•Its life history is simple and direct.
In the human food canal it multiplies in
numbers, sometimes with great
rapidity by dividing longitudinally. Its
method of leaving one host to find
another is to enclose itself in a
protective cyst-wall and to pass out of
the host in its excreta. These oval
cysts, which are 10 to 14 micra long,
get into the food or drink of other
human beings, and thus infect them.
•Many quite healthy people carry it in
their food canals and do not suffer in
any way (asymptomatic carrier), but if
any other condition upsets the
processes of digestion, or sets up in
the duodenum conditions favorable to
the giardia multiplication
 Transmission
• Cysts can survive for long periods outside the
host in suitable environments (e.g. surface
water).
• Giardia cysts are NOT killed by chlorination.
• Infection follows ingestion of cysts in faecally
contaminated water (from humans or animal
hosts) or through direct person to person
contact.
• Partial immunity may be acquired through
repeated infections.

Oxford Handbook of Tropical Medicine. Fourth edition. 2014.

Ed. by
Robert Davidson, Andrew Brent, Anna Seale.
FROM Matthews 2012 Tropical medicine notebook
• Giardia lamblia is a small flagellate, which differs in structure from
most other Protozoa, because it is bilaterally symmetrical and it has two
sets of organs in its body.
•Its body is shaped like a pear flattened on its ventral side, on which
there is a small depression, used by the parasite as a kind of sucker
with which it adheres to the cells of duodenum. Inside the body there
are two nuclei and eight flagellag. With these flagella Giardia swims
along more or less in a straight line, its body swaying from side to side
as it goes. It feeds by absorbing through its body surface nutritive
materials in the contents of the host’s food canal.

Clinical Features:
•The spectrum varies from asymptomatic carriage to severe diarrhea
and malabsorption. Acute giardiasis develops after an incubation period
of 5 to 6 days and usually lasts 1 to 3 weeks. Symptoms include
diarrhea, loose or watery stool, stomach cramps abdominal
pain, bloating.
•Laboratory Diagnosis:
•Giardiasis is diagnosed by the identification of cysts or trophozoites in
the feces, using direct mounts as well as concentration procedures.
Repeated samplings may be necessary. In addition, samples of
duodenal fluid (e.g., Enterotest) or duodenal biopsy may demonstrate
trophozoites.
 Trichomonas vaginalis
COMMON NAME: none
GEOGRAPHICAL DISTRIBUTION:
worldwide.
• PATHOGENESIS: trichomoniasis.
• HABITAT: genital tract
• INTERMEDIATE HOST: None.
• RESERVOIR HOST: None.
• INFECTED FORM: trophozite
• no cysts
• MODE OF INFECTION: sexual direct
transmission

Trixomonas tenax
HABITAT: oral cavity of humans

https://en.wikipedia.org/wiki/Trichomonas_tenax
 Trichomoniasis
•Causal agent (infectious
agent):Trichomonas vaginalis, a most
common pathogenic protozoan of
humans in industrialized countries.

•Life Cycle: Trichomonas vaginalis

resides in the female lower genital tract
and the male urethra and prostate,
where it replicates by binary fission.
The parasite does not appear to have a
cyst form, and does not survive well in
the external environment.
Trichomonas vaginalis is transmitted
among humans.

can ingest and store •Geographic Distribution: Worldwide.

gonococci, which hamper
Higher prevalence among persons with
the successful treatment
of gonorrhea
multiple sexual partners or other
venereal diseases.
 •Clinical Features: Trichomonas vaginalis
Trichomoniasis infection in women is frequently symptomatic.
Vaginitis with a purulent discharge is the
prominent symptom, and can be accompanied by
vulvar and cervical lesions, abdominal pain,
dysuria and dyspareunia. The incubation period
is 5 to 28 days. In men, the infection is frequently
asymptomatic; occasionally, urethritis,
epididymitis, and prostatitis can occur.

•Laboratory Diagnosis: Microscopic examination

of wet mounts may establish the diagnosis by
detecting actively motile organisms. This is the
most practical and rapid method of diagnosis
(allowing immediate treatment), but it is relatively
insensitive. Direct immunofluorescent antibody
staining is more sensitive than wet mounts, but
technically more complex. Culture of the parasite
is the most sensitive method, but results are not
available for 3 to 7 days. In women, examination
should be performed on vaginal and urethral
secretions. In men, anterior urethral or prostatic
secretions should be examined.