Entamoeba histolytica

Notes that were left out

 Pathogenesis
– NOTE:
– 1) Only the harmless trophozoites produce cysts
– 2) Patients suffering from amoebic dysentery do not pass
out cysts in the watery or diarrhoeic stool, instead they
pass out adult trophozoites.
 Pathogenesis and pathology
1) Symptomless carriers
• Trophozoites feed on bacteria in intestinal lumen
• They multiply by binary fission and they are passed out
with formed stool in the form of cysts
2) Show symptoms/clinical signs
– Trophozoites have the potential to invade
tissues
– Secrete proteolytic enzymes which hydrolyze tissues of the mucosa &
submucosa –formation of a xtic flask shaped lesions/ulcers
– Ulcers usually develop in the colon, caecum & appendix
– In the process, many blood vessels in the mucosa are broken which
accounts for the bloody stools-a xtic feature of dysentry
– Trophozoites become haematophagous feeding on red blood cells
– Some trophozoites get into the portal circulation & are carried into the
liver, lungs and brain where they cause hepatic amoebic absecces
 Cont’d
• In lungs, it causes haemorrhage, ingestion leading
to pneumorhitis or clog blood tissue in the brain
leading to limitted/no oxygen supply to the brain
• This leads to convulsions and finally death
• The disease which results is called amoebic
dysentry or amoebiasis
• Symptoms
– Pain in the abdomen
– Vomiting
– Diarrhoea with blood stools-blood loss & dehydration
– In acute cases, death may result from fluid & blood
loss, cardiac arrest
 Transmission
• 1) Contaminated water: Most people in the world get water
by ground/surface water.

2) Contaminated food:• Defecation in vegetable gardens, fields. •

Night soil (human excrement used as fertilizer).
• The practice of humans using their bare hands to clean toilet pits

3) Mechanical contamination:
• Medical Equipment
• Flies, roaches, etc.
• Hand to mouth (finger nails, contaminated objects, toys, etc.)
• Hand to eye (ectopic)
• Hand to open sore (ectopic)
• Anal sex (ectopic)
 Diagnosis
• Specimen: stool, pus or liver abscesses, sputum and biopsy samples
• Direct (Microscopic) - Most reliable:
• Demonstration of trophozoites in diarrhoeic stools
– look for cysts (4 nuclei) in fecal smear (formed stool)
– Biopsy of lesion or abscess
 Epidemiology
1. E.histolytica has a worldwide distribution
2. Excystment takes place in the intestines
3. Cysts are resistant & can withstand extreme
conditions
4. Cysts can survive in intestines of house flies
which spread the disease mechanically
5. Food vendors with poor personal hygiene
6. Use of untreated sewage as fertilizer
 Treatment of amoebiasis
◼ Drug of choice: Metronidazole 2x3 for 5 days
◼ Tinidazole 4x1 for 3 days
◼ Secnidazole-clears it completely
• Control and prevention (prophylaxis)
◼ Control epidemiological factors
◼ Boil drinking water
◼ Cover food always to prevent house flies
◼ Destroy house flies
◼ Observe proper personal hygiene
◼ Provide good sanitation facilities
◼ Refrigerate food below-5
◼ Avoid eating raw vegetables grown by sewerage irrigation