Gastro-intestinal

tract

Entamoeba histolytica

Isna Indrawati
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Class Rhizopoda

8 species live in GI tract :

Entamoeba histolytica
Entamoeba dispar
Entamoeba coli
Entamoeba gingivalis
Entamoeba hartmani
Endolimax nana
Dientamoeba fragilis
Iodamoeba butschlii
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• HOST : human amebiasis

•DISTRIBUTION:
• cosmopolite, occurs worldwide
•>>> in tropic and sub tropic
• strong correlation with
personal hygiene
• high prevalence in countries
where poor socioeconomic and
sanitary conditions
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 Prevalence of amebiasis
• ± 50 million cases of invasive E.
histolytica disease occur each
year (up to 100,000 deaths)
• Only an estimated 10%–20% of
individuals infected with E.
histolytica become symptomatic.
• Prevalence of symptomatic
amebiasis vary geographically
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Prevalence (cont’d)

• Prevalence vary ranging from 1%

to 21% in developing countries
• Indonesia : 10 – 18 %
• Trophozoite forms were found in
58/889 (6.5%) children with bloody
diarrhea. (Budi Purnomo, Badriul
Hegar, 2011)

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Morphology &
Life cycle

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Pathogenesis

• the triad of Gal-lectin, cysteine

proteinases and amoebapores of
the parasite were thought to be
responsible for invasive process
• Typical intestinal amebic ulcers :
flask shape ulcer with slightly
elevated areas of the mucosa

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Pathogenesis

Predilection site
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Clinical symptoms

• Incubation period : 2–4 weeks

(but ranges from a few days to
years)
• Most infections (≥90%) remain
asymptomatic
• characterized classically by
abdominal pain and bloody
diarrhea.
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Clinical symptoms:
Intestinal Amebiasis
• Acute amebiasis ( 1 month):
– amebic dysentery, with
frequent, urgent, small
bloody stools, tenesmus
• Chronic amebiasis ( > 1 month):
– alternating diarrhea and
constipation every few days
– Fatigue, weight loss.
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 Complications
• Complications of intestinal
disease :
spread through percontinuitatum):
rectovaginal fistulas, perianal skin
ulceration, perforation, peritonitis,
shock, and death.
hematogenous : extra intestinal
amebiasis

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 Extra intestinal amebiasis

• 1-3 monts after first attack : 5 % of

intestinal amebiasis developed
extra instestinal amebiasis
• trophozoites enter the bloodstream
and disseminate to other body sites
• most common site: the liver
(amebic liver abscess= ALA).

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• Amebic liver abscess presents
with fever and right upper
quadrant abdominal pain,
hepatomegaly
• usually in the absence of
diarrhea.

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 Formation of ameboma

• Granulomatous reactions
are pseudotumoural lesions,
whose formation is associated
with : necrosis, inflammation and
oedema of the mucosa and
submucosa of the colon.
• These granulomatous masses
may obstruct the bowel (stricture)

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Diagnosis :
• Detection of amoebic
trophozoites containing ingested
red blood cells in the fresh faecal
specimen
• Biopsy : identification of
trophozoites within the tissues
• Detection of cysts ( light
microscopy): should be reported
as E. histolytica / E. dispar
two species are indistinguishable
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trophozoites:

Trichrome stain

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E.hist/E.dispar in iodine

Chromatoid body with

blunt rounded end

Trichrome stain
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Diagnostic support

• Colonoscopy
• Aspiration of liver abscess
• USG
• Rx. Serology : high titres of
specific antibody is strongly
correlated with the presence of
invasive amoebiasis

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Diagnosis (cont’d)

• E. histolytica and E.dispar can be

differentiated by :
– Isoenzyme patterns : particularly
hexokinase.
– Antigen detection: specific epitopes,
recognized by reaction with several
monoclonal antibodies.
– DNA blotting : sequence differences
in the rDNA

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Histopathology
Colon biopsy

Colonoscopy

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Ecoli E. histolytica

• Mature cyst • Mature cyst

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Even Semester 2014 30/04/2019
 E.coli cyst E. histolytica

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Even Semester 2014 30/04/2019
Epidemiology:
• Transmission occurs through
ingestion of cysts from food or
water contaminated by feces
• “Silent carrier” :
– have the ameba in their
intestines and excrete
amebic cysts, but have no
symptoms.
– important as a source of
infection
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Prevention :
• drink purified or boiled water
• Wash and peel all raw
vegetables and fruits before
eating
• Protecting food from fly
contamination
• Washing hands after defecation
and before preparing or eating
food using the toilet
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