Sarcomastigophora

 A phylum of PROTOZOA
 Subphyla: SARCODINA and
MASTIGOPHORA
 have flagella or pseudopodia
SARCODINA
A subphylum of protozoa (phylum SARCOMASTIGOPHORA )
 Rhizopoda is a superclass of protozoa (subphylum
SARCODINA )

 Vegetative cells form one or more pseudopodia

 CYSTS are commonly formed.
A sexual reproduction occurs by fission
 Include all the amoebae (USA: amebae)
i.e both free living & parasitic form
EPIDEMIOLOGY
 Worldwide distribution
 Major problem in developing countries
 Inadequate sanitation
 contaminated food and drinking water
 Third most common cause of death from parasitic
disease
i.e. After schistosomiasis & malaria
Infectious Agent- E. histolytica
E. histolytica has recently been reclassified into three
species
• E. histolytica -an invasive disease causing parasite
• E. dispar and E. moshkovskii- both noninvasive parasites
i.e. morphologically identical but genetically distinct
Other amebae - nonpathogenic commensals:
• Entamoeba hartmanni, Entamoeba coli, Entamoeba
polecki
• Entamoeba gingivalis , Iodamoeba butschlii,
 E. histolytica
 It is the most invasive of the Entamoeba group
 Pseudopod-forming nonflagellate protozoan parasite
 The only Entamoeba to cause amebic colitis and
liver abscess.
 It exists in two forms:
A. Trophozoites B. Cysts
A. Trophozoites
• 10 to 60 μm in diameter
• Contain a single nucleus
with a central karyosome
• Motile feeding amoebae
• Move with pseudopodia
• Multiply by simple binary
fission
B. Cyst
• 10 to 15 μm in diameter
• Contains 4 or fewer nuclei
• Resistant to chlorination
gastric acidity, desiccation
 Secreting chitinous cyst
wall
Mode of Transmission
 Ingestion of viable cysts
 Fecally contaminated water, food, or hands.

 Food-borne exposure is most prevalent

 Food handlers are shedding cysts

 Less common means of transmission

• oral and anal sexual practices
Life cycle in human
 Infection occur when cysts are ingested
 Excystation occurs in the intestine
 Cyst wall disintegrates & divides to form eight small trophozoites
 Trophozoites have the ability to colonize or invade the large bowel
 Invasion of the intestinal mucosal barrier by the trophozoite leads

to the formation of flask-shaped colonic ulcers.

 Migration to liver occur via portal vein.
 Encystment occurs in response to desiccation.
Life cycle of E. histolytica
Pathogenesis
 Pathogenesis of infection by E. histolytica is governed
(i) Adherence of trophozoite to the target cell

(ii) Lysis of target cell

(iii) phagocytosis of target cell
 Several molecules involved in pathogenesis of E.
histolytica
• Galactose N-acetyl galactosamine (Gal/Gal NAc)
lectin
• Cysteine proteinases
• Amoebic pore-forming proteins
CLINICAL FEATURES

Two forms of amoebiasis

1.Intestinal amoebiasis
2. Extra intestinal amoebiasis
1.Intestinal amoebiasis
 Roughly 90% of those infected have asymptomatic

infections
 10% invasive cases( intestinal or extra intestinal

amoebiasis)
Acute intestinal amebiasis presents
• Incubation period  2-6 weeks

• Grumbling abdominal pain

• Two or more unformed stools/day
• Periods of diarrhoea alternating with constipation
• Mucous and or blood mixed stool/ offensive odour
• Tenderness in lower abdominal region
• Tenesmus
2. Extra intestinal amoebiasis
 Amebic liver abscess
 Splenic abscess
 Brain abscess
 Empyema
 Pericarditis

 Amebic liver abscess is most common complication

from extra intestinal amoebiasis
Diagnosis
1.Diagnosis of intestinal amebiasis
A. Microscopic Method
Specimem:- stool or sigmoidoscopic aspirates
Sigmoidoscopy
• Flask shaped ulcer
• Do scrapping & examination
Method:-wet smear or concentration method
Result_ Trophozoites of E. histolytica trophozoites
i.e. Trophozoites with erythrophagocytosis

- Cyst of E. histolytica/ dispar

i.e. both E. histolytica/ dispar have similar cyst
morphology
i.e can be distinguished by isoenzyme studies & molecular
techniques
Trophozoites of E. histolytica trophozoites using direct wet smear

Cyst of E. histolytica/ dispar

 2. Diagnosis of extra intestinal amebiasis
Serologic tests are paramount importance.
Specimen:- Blood
Method:-
• Indirect hemagglutination test
• Enzyme immunoassays
• Latex agglutination rapid test
Treatment
 Intestinal amebiasis or hepatic abscesses
Oral Metronidazole 800mg tid x 5days or
Oral Tinidazole 2g daily x 3days and
Luminal amoebicide
• Oral Diloxanide furoate 500mg tid x 10days
• Paramomycin 500mg tid x 10days
Reading Assignment
Prevention and Control method of
Amebiasis