3 MAJOR GROUPS OF CLINICALLY SIGNIFICANT PARASITES

➤PROTOZOA - single-celled parasites

➤METAZOA - multicellular worms/ helminths
➤ANIMALIA - arthropods (insects and their
allies)
PROTOZOA
KINGDOM PROTISTA
PROTOZOA
PROTOZOA
PROTOZOA
HELMINTHS
ARTHROPODS
 AMEBAS

PARASITOLOGY LECTURE
SERIES
LUZ GREGORIA LAZO-VELASCO,
MD
NOVELYN AVILA-RAFANAN, MD
PROTOZOA
➤Unicellular

➤Lowest form of animal life

➤All live in the large intestines, except Entamoeba
gingivalis, which is found in the mouth
➤Only one species is an important pathogenic parasite
of humans, Entamoeba histolytica
➤ Naegleria, Acanthamoeba spp. (free-living,
accidental parasites of human beings)
AMEBAS
➤Equipped with the ability to extend their cytoplasm
(pseudopods)
➤Morphologic forms in the life cycle:
1. trophozoite – feeds, multiplies, possesses
pseudopods
delicate, fragile, motile, easily destroyed by gastric
juices
2. cyst – nonfeeding; with thick protective shell
AMEBAS
➤EXCYSTATION – morphologic conversion from cyst form
into trophozoite form (ileocecal area of the intestine)
➤ENCYSTATION – conversion of trophozoites to cysts;
occurs in the intestine when the environment becomes
unacceptable for continued trophozoite multiplication
➤ Ameba overpopulation, pH change, food supply (too much or too
little), available oxygen (too much or too little)
AMEBAS
➤LABORATORY DIAGNOSIS
Stool examination
trophozoite – soft, liquid, stools with loose consistency
cyst – formed stool
appearance of key nuclear characteristics (number of nuclei,
positioning of nuclear structures, h inclusions, motility)
saline wet preparation
iodine wet preparation
permanent stains
AMEBAE
➤ Based on nuclear characteristics, they are divided into:
➤ Genus Entamoeba
➤ Vesicular nucleus with a comparatively small karyosome
at or near its center and with varying numbers of
peripheral chromatin granules attached to the nuclear
membrane
AMEBAE
➤ Genus Entamoeba
➤ Entamoeba histolytica
➤ Entamoeba dispar
➤ Entamoeba moshkovskii
➤ Entamoeba hartmanni
➤ Entamoeba coli
➤ Entamoeba nana
➤ Iodamoeba butschlii
AMEBAS
➤Genus Endolimax
➤Relativelylarge karyosome of irregular shape and
several achromatic threads connecting it with a
delicate nuclear membrane
➤Endolimax nana
Endolimax

Large karyosome
AMEBAS
➤Genus Iodamoeba
➤Large karyosome (endosome) rich in chromatin,
typically surrounded by a single layer of
periendosomal granules and attached to the
karyosome and the nuclear membrane by radiating
achromatic fibrils
➤Iodamoeba bütschlii
Iodamoeba
AMEBAS
➤ BASED ON NUCLEAR CHARACTERISTICS, THEY ARE DIVIDED
INTO:
➤ DIENTAMOEBA
➤ KARYOSOME CONSISTS OF SEVERAL CHROMATIN
GRANULES EMBEDDED IN AN ACHROMATIC MATRIX
WHICH IS CONNECTED WITH A DELICATE NUCLEAR
MEMBRANE BY VERY FINE ACHROMATIC FIBRILS
➤ DIENTAMOEBA FRAGILIS
AMEBAE
➤ Based on nuclear characteristics, they are divided into:
➤ Genus Entamoeba
➤ Vesicular nucleus with a comparatively small karyosome
at or near its center and with varying numbers of
peripheral chromatin granules attached to the nuclear
membrane
 ENTAMOEBA HISTOLYTICA

➤PARASITE BIOLOGY:
➤Most invasive
➤Pseudopod-forming non-flagellated

➤Only member of the Entamoeba family to cause

colitis and liver abscess
➤Principally
inhabits the LARGE INTESTINE (lumen,
mucosal crypts)
ENTAMOEBA HISTOLYTICA

ps
eu
do
po
di
u
EXCYSTATION
 ENTAMOEBA HISTOLYTICA

➤ METHODS OF TRANSMISSION
1. Food or water contaminated with feces containing cysts of
Entamoeba histolytica
2. Venereal transmission through fecal-oral contact
3. Direct colonic inoculation through contaminated enema
equipment

➤ HUMAN BEINGS - principal host and source of infection

(cyst-passing chronic or asymptomatic carrier)
ENTAMOEBA HISTOLYTICA

➤ GEOGRAPHICAL DISTRIBUTION:
➤ Cosmopolitan

➤ More prevalent in the tropics and subtropics than in cooler

climates
➤ Endemic in the Philippines
ENTAMOEBA HISTOLYTICA

Binucleated
Trophozoite
 Entamoeba histolytica
➤ STAGES OF DEVELOPMENT:
➤ Trophozoite- found in the lumen & glandular crypts of colon & in
the tissues (invasive)
➤ Active vegetative state; MOTILE
➤ involved in the actual infection of the host by invading the host
epithelial cells
➤ 12-60 mm in diameter, ave 20mm
➤ Clear, refractile, hyaline ectoplasm (comprises 1/3 of the ameba)
➤ pseudopodia for locomotion- progressive and directional
movement
ENTAMOEBA
HISTOLYTICA
➤STAGES OF DEVELOPMENT:
➤ TROPHOZOITE

➤ A finely granular endoplasm usually contains no bacteria or

foreign particles; sometimes includes rbcs in various stages of
disintegration
➤ single eccentric nucleus may be faintly discerned as a faintly
granular ring in the unstained ameba
➤ Unstained organism: motile or rounded; nucleus is not visible
➤ Iodine stained: nucleus visible
 ENTAMOEBA
HISTOLYTICA

Motile trophozoite in stool specimen,

wet mount
 ENTAMOEBA
HISTOLYTICA

Trophozoite in stool specimen, Trichrome stained

Cytoplasm may contain purple-colored, ingested red
cells
A single nuclei contains reddish, concentric karyosome,
and
peripheral chromatin evenly distributed
 
ENTAMOEBA HISTOLYTICA

➤ STAGES OF DEVELOPMENT:
➤ TROPHOZOITE

➤ Habitat: wall and lumen of the colon (esp. cecal and

sigmoidorectal regions)
➤ Reproduction- binary fission
➤ Encystation only occurs in the intestinal lumen; does not
occur in host tissue nor if the trophozoites are passed in
diarrheic stools
 ENTAMOEBA
HISTOLYTICA
➤ STAGES OF DEVELOPMENT:
➤ CYST

➤ spherical

➤ 10 – 20 m in diameter
➤ characterized by a highly refractile hyaline cyst wall ,
1-4
nuclei, rod-shaped (or cigar-shaped) chromatoidal bars
ENTAMOEBA HISTOLYTICA

➤ STAGES OF DEVELOPMENT:
➤ CYST

➤ Immature cyst has a single nucleus, about 1/3 of its

diameter
➤ Mature infective cyst contains four smaller nuclei
➤ Maturation entails 2 nuclear divisions to produce 4 nuclei
➤ Quadrinucleate cyst- infective stage
ENTAMOEBA HISTOLYTICA

Uninucleated cyst
(stool specimen, wet mount,
iodine stained)

The nucleus contains

refractile concentric
karyosome
ENTAMOEBA HISTOLYTICA

Immature, uninucleated cyst, Trichrome stained

ENTAMOEBA HISTOLYTICA

Immature, binucleated cyst, Trichrome stained

Spherical or ovoidal in shape, 12-20 micrometer in diameter
Cytoplasm  contains reddish-purple colored, cigar-shaped chromatoid
bars
Each nucleus contains reddish, concentric karyosome, and peripheral
chromatin evenly distributed
ENTAMOEBA HISTOLYTICA

Mature, quadrinucleated cyst

(Iron-hematoxylin stained)
ENTAMOEBA HISTOLYTICA
ENTAMOEBA HISTOLYTICA

➤ PHYSIOLOGY

➤ Traditionally considered an anaerobe (grows best under

reduced oxygen tension), but readily consumes oxygen when
provided
➤ Has no mitochondria, cytochromes or functional tricarboxylic
acid cycle
➤ Only D-glucose & D-galactose are oxidized
➤ Various alcohols can serve as substrates
➤ L-serine only AA that elicits oxygen consumption
ENTAMOEBA
HISTOLYTICA
 ENTAMOEBA HISTOLYTICA

➤ PATHOGENESIS & CLINICAL MANIFESTATIONS

Proposed mechanisms for virulence
1.Production of enzymes or other cytotoxic substances
2.Contact-dependent cell killing
3.Cytophagocytosis
ENTAMOEBA
HISTOLYTICA
➤ PATHOGENESIS& CLINICAL
MANIFESTATIONS

➤Asymptomatic - ( CYST BEING PASSED OUT IN THE

STOOLS –CYST CARRIER) - 90% OF ALL INFECTIONS
➤Amebic Colitis
➤ Ameboma
➤ Amebic Liver Abscess
ENTAMOEBA HISTOLYTICA

➤AMEBIC COLITIS
➤ dysentery without fever
➤ Flask- shaped colon ulcer

most common sites of amebic ulcer:

1. cecum
2. ascending colon
3. sigmoid
Amoebic colitis: ulceration of the large
intestine
ENTAMOEBA HISTOLYTICA

Pathogenesis and Clinical Manifestations

➤ ACUTE INTESTINAL AMEBIASIS

➤ INCUBATION PERIOD: 1-14 WEEKS
➤ SEVERE DYSENTERY WITH NUMEROUS SMALL STOOLS
CONTAINING BLOOD, MUCUS, SHREDS OF NECROTIC MUCOSA,
ACCOMPANIED BY ACUTE ABDOMINAL PAIN AND TENDERNESS
➤ FEVER
➤ DEHYDRATION, TOXEMIA, PROSTRATION MAY BE MARKED
ENTAMOEBA HISTOLYTICA

Pathogenesis and Clinical Manifestations

➤ ACUTE INTESTINAL AMEBIASIS

➤ LEUKOCYTOSIS
➤ TROPHOZOITES FOUND IN STOOLS
➤ CHRONIC AMEBIASIS
➤ RECURRENT ATTACKS OF DYSENTERY WITH INTERVENING
PERIODS OF MILD OR MODERATE GASTROINTESTINAL
DISTURBANCES OR CONSTIPATION
➤ LOCALIZED ABDOMINAL TENDERNESS
➤ LIVER MAY BE ENLARGED
ENTAMOEBA HISTOLYTICA

➤ PATHOGENESIS & CLINICAL MANIFESTATIONS

➤Amebic Hepatitis
colon  portal vein  liver  periportal inflammation
once in the liver, the trophozoites lyse both
inflammatory and liver cells  abscess
 ENTAMOEBA
HISTOLYTICA
➤ PATHOGENESIS & CLINICAL MANIFESTATIONS
Signs and Symptoms
➤Ameboma – mass-like granulomatous lesion with abdominal
pain and history of dysentery; 1% of intestinal infections
➤Amebic Liver Abscess (ALA)
most common extraintestinal form of amebiasis
fever, RUQ pain
localized pain or referred to the right shoulder
tender liver, hepatomegaly
ENTAMOEBA HISTOLYTICA
➤ PATHOGENESIS & CLINICAL MANIFESTATIONS
➤Amebic Liver Abscess
Single or multiple
85% confined to the right lobe of the liver, with
predilection to the posterosuperior aspect of the right lobe
Leukocytosis with increased PMNs; ESR may be
elevated
Males chiefly affected
Amoebic liver abscess
ENTAMOEBA HISTOLYTICA

➤ PATHOGENESIS & CLINICAL MANIFESTATIONS

➤Amebic Liver Abscess
Onset of amebic colitis may be sudden after an
incubation period of 8-10 days or after a long period of
asymptomatic cyst carrier state
ENTAMOEBA HISTOLYTICA
➤PATHOGENESIS & CLINICAL MANIFESTATIONS

➤Complications of amebic colitis:

1. Perforation –most serious

2. Secondary bacterial peritonitis
➤Complications of ALA:

1. Rupture into the pericardium (mortality rate 70%)

2. Rupture into the pleura (mortality rate 15-30%)
3. Superinfection
4. Intraperitoneal rupture- 2nd most common
complication
ENTAMOEBA HISTOLYTICA

➤ PATHOGENESIS & CLINICAL MANIFESTATIONS

➤Secondary Amebic Meningoencephalitis
Occurs in 1-2%
Considered in amebiasis with abnormal mental status
➤Genital involvement
2o to fistulae from ALA and colitis or primary infection
through sexual transmission
ENTAMOEBA HISTOLYTICA

➤SIGNS AND SYMPTOMS

➤PULMONARY AMEBIASIS
➤Resultsfrom direct extension of a hepatic abscess, or
from an emboli (less frequent)
➤Appears as pneumonic consolidation in the lower
right lung
➤Chest pain, cough
➤Chills, fever, leukocytosis
ENTAMOEBA HISTOLYTICA

➤SIGNS AND SYMPTOMS

➤BRAIN ABSCESS
S/s of brain abscess or tumor
➤SPLENIC ABSCESS
➤POST-AMEBIC COLITIS
Nonspecific colitis following a bout of severe acute
amebic colitis
Colon is free of parasites and the clinical findings
resemble those of chronic ulcerative colitis
ENTAMOEBA HISTOLYTICA

➤PATHOLOGY

➤ Ability to lyse tissues

➤ Invasive process initiated when the trophozoite stage is able to
penetrate through the mucus layer covering the colonic epithelium
➤ Invasion is facilitated by the expression of virulence factors:
1. Gal/gal Nac lectin – mediates adherence to host cells
2. Amebapores – form pores in host cell membranes, for
penetration
3. Cysteine proteinases – cytopathic for host tissues
ENTAMOEBA HISTOLYTICA

➤PATHOLOGY

➤ Cause thinning of
the mucin layer, shortening of villi and
breakdown of extracellular matrix through the action of cysteine
proteinases
➤ Trophozoites attach to mucosal cells facilitated by lectin  LYSE
cells through amebaphores  release of IL 8 (attracts and
activates neutrophils)  erode lamina propia, extend laterally
(flask-shaped ulcer)
➤ Most common sites of amebic ulcer: cecum, ascending colon,
sigmoid
➤ FLASK-SHAPED ULCER
FLASK-SHAPED ULCER
ENTAMOEBA HISTOLYTICA

➤PATHOLOGY

➤Histologic changes: histolysis, thrombosis of the capillaries,

petecchial hemorrhages, round-cell infiltration, necrosis
➤Hyperemia, edema
➤ Amebas maybe found in the floor of the ulcer, particularly
at the base of the intestinal glands, or scattered throughout
the tissues
Amoebae lodge in large
intestine and cause ulceration
and diarrhea.

Secondary sites are the liver,

lung and brain.
ENTAMOEBA HISTOLYTICA

➤ Complications of intestinal amebiasis:

1. Granulomas – firm, painful, movable, nodular,
inflammatory thickenings of the intestinal
wall around an ulcer (cecum or sigmoid)
2. Pseudopolyposis
ENTAMOEBA HISTOLYTICA

➤ SYSTEMIC AMEBIASIS
➤ Liver is invaded
➤ Dissemination from primary intestinal focus is chiefly by
the bloodstream, but at times, by direct extension
➤ Diffuse amebic hepatitis – large, tender liver; amebic
invasion and nonspecific reaction of the liver to the
bacteria, debris, and toxic material resulting from
intestinal ulceration
Pathogenesis of E histolytica infection
 CLASSIFICATION OF AMEBIASIS

WHO Clinical Classification of

Amebiasis Infection (Modified)
Asymptomatic Infection
Symptomatic Infection
Intestinal Amebiasis
Pathophysiologic Mechanisms
Colonization without tissue invasion
Invasive Infection

A. Amebic dysentery Fulminant ulcerative intestinal disease

B. Nondysentery
Ulcerative intestinal disease
Gastroenteritis
C. Ameboma Proliferative intestinal disease
D. Complicated Intestinal
Perforation, hemorrhage, fistula
Amebiasis
E. Post-amebic Colitis Mechanism unknown
 CLASSIFICATION OF AMEBIASIS

WHO Clinical Classification of

Pathophysiologic Mechanisms
Amebiasis Infection (Modified)

Extraintestinal Amebiasis
Intestinal infection with no demonstrable
A. Nonspecific hepatomegaly
invasion

B. Acute Nonspecific Infection Amebas in liver but without abscess

C. Amebic Abscess Focal structural lesion

D. Amebic Abscess, Direct extension to pleura, peritoneum, or

Complicated pericardium

E. Amebiasis Cutis Direct extension to skin

Metastatic infection to lung, spleen, and
F. Visceral Amebiasis
brain
DIAGNOSIS
➤ THE FINAL DIAGNOSIS OF AMEBIASIS RESTS UPON THE IDENTIFICATION OF
THE PARASITES IN THE FECES OR TISSUES AND UPON SEROLOGIC STUDIES
➤ THE CLINICAL DIAGNOSIS OF INTESTINAL AMEBIASIS REQUIRES
DIFFERENTIATION FROM OTHER DYSENTERIES AND INTESTINAL DISEASES, AND
THAT OF HEPATIC ABSCESS FROM VIRAL HEPATITIS, ABSCESS AND BACTERIAL
HYDATID CYST, GB INFECTION, MALIGNANCY, AND PULMONARY DISEASE
➤ HISTORY OF TRAVEL TO OR RESIDENCE IN AN ENDEMIC AREA, TYPICAL
GASTROINTESTINAL AND GENERAL S/S ON PE, SIGMOIDOSCOPY,
ROENTGENOLOGY.
DIAGNOSIS
BACILLARY DYSENTERY AMEBIC DYSENTERY

May be epidemic Seldom epidemic

Acute onset Gradual onset

Prodromal fever & malaise common No prodromal features

Vomiting common No vomiting

Patient prostrate Patient usually ambulant

Watery, bloody diarrhea Bloody diarrhea

Odorless stool Fishy odor stool

DIAGNOSIS
BACILLARY DYSENTERY
Stool microscopy:
Numerous bacilli, pus cells,
macrophages, red cells, NO Charcot-
Leyden crystals
Abdominal cramps common and
severe
Tenesmus common
Natural history: spontaneous
recovery in a few days, weeks or
more; no relapse
AMEBIC DYSENTERY
Few bacilli, red cells, trophozoites
w/ ingested RBCs, Charcot-
Leyden crystals
Mild Abdominal cramps
Tenesmus uncommon
Lasts for weeks, dysentery returns
after remission, infection persists for
years
DIAGNOSIS
PYOGENIC ABSCESS AMEBIC ABSCESS
High fever Adult males
Hyperbilirubinemia Insidious onset
Multiple hepatic filling defects Chronic diarrhea
Foul-smelling aspirate Significant pleuritic chest pain
Solitary right lobe
DIAGNOSIS
➤STANDARD METHOD: MICROSCOPIC DETECTION OF THE
TROPHOZOITES AND CYSTS IN STOOL SPECIMENS
➤Detectionof trophozoites- FRESH STOOL specimens should
be examined within 30 mins from defecation
➤DFS- SALINE, METHYLENE BLUE, IODINE
DIAGNOSIS

➤ CONCENTRATION METHODS:
MORE SENSITIVE THAN DFS FOR DETECTION OF CYSTS
1. FORMALIN ETHER/ ETHYL ACETATE CONCENTRATION
TEST (FECT)
2. MERTHIOLATE IODINE FORMALIN CONCENTRATION TEST
(MIFC)
DIAGNOSIS
➤STOOL CULTURE (ROBINSON’S AND INOKI MEDIUM):
MORE SENSITIVE THAN STOOL MICROSCOPY, BUT NOT
ROUTINELY AVAILABLE
➤PCR, ELISA, ISOENZYME ANALYSIS
➤DETECTION OF ANTIBODIES IN THE SERUM- KEY IN THE
DIAGNOSIS OF ALA
DIAGNOSIS
➤ SEROLOGIC TESTS FOR AMEBIC DISEASE:
1. INDIRECT HEMAGGLUTINATION (IHAT)
2. COUNTER IMMUNOELECTROPHORESIS (CIE)
3. AGAR GEL DIFFUSION (AGD)
4. INDIRECT FLUORESCENT ANTIBODY TEST (IFAT)
5. ELISA
OTHER DIAGNOSTIC PROCEDURES

➤ Ultrasound, CT scans, MRI are effective in detecting liver

abscess
➤ ULTRASOUND: round or oval hypoechoic area with wall echoes
➤ Laboratory diagnosis for intestinal amebiasis:
➤ Microscopic identification of the parasite in the feces or
tissues
➤ Sigmoidoscopy – visualize mucosal lesions; collect aspirates
or biopsy materials for examination of trophozoites
TREATMENT
➤ Objectives:

1. To cure invasive disease at both intestinal and extra-

intestinal sites
2. To eliminate the passage of cysts from the intestinal
lumen
➤ METRONIDAZOLE – DOC for the tx of invasive amebiasis
➤ SECNIDAZOLE, TINIDAZOLE
➤ DILOXANIDE FUROATE – DOC for asymptomatic cyst
passers
TREATMENT
➤ ASYMPTOMATIC CARRIER STATE
- Diloxanide furoate (DOC)
- Iodoquinol
- Paromomycin

AMEBIC COLITIS
- Metronidazole
- Tinidazole
- Diloxanide furoate

AMEBIC LIVER DISEASE

- Metronidazole
- Tinidazole
- Percutaneous drainage for nonresponders
TREATMENT
➤ PERCUTANEOUS DRAINAGE OF LIVER ABSCESS-
- non-response to Metronidazole
- prompt symptomatic relief of severe pain
- left lobe abscess (may rupture into the pericardium)
- large abscesses in danger of rupture
- multiple abscesses with a probable associated pyogenic etiology
➤ Bed rest, bland, high-protein and high-vitamin diet
➤ Adequate fluids
PREVENTION & CONTROL

➤ Effective environmental sanitation – proper use of latrines & avoidance of

night soil as fertilizer
➤ Sanitary methods of waste disposal
➤ Filtered water supply; water must be boiled; chlorination not wholly effective
➤ Iodine tablets may be used to kill cysts
➤ Control of insects by insecticides
➤ Food screened and protected from dust contamination
COMMEN
SAL
AMEBAE
COMMENSAL AMEBAE
➤ The presence of commensal amebae in the stools of an
individual is significant for two reasons:
✓ They may be mistaken for the pathogenic E.
histolytica
✓ They are an indication of fecal contamination of food
or water
➤ Accurate diagnosis of the commensal amebae is,
therefore, crucial.
COMMENSAL AMEBAE

❖ Parasite biology
➤ Commensal amebae must be differentiated from the
pathogenic Entamoeba histolytica
➤ genus Entamoeba has a spherical nucleus with a
distinct nuclear membrane lined with chromatin
granules and a small karyosome near the center of
the nucleus;
➤ Trophozoites usually have only one nucleus
COMMENSAL AMEBAE

❖ Parasite biology
➤ genus Endolimax has a vesicular nucleus with a
relatively large and irregularly-shaped karyosome
anchored to the nucleus by achromatic fibrils
➤ genus Iodamoeba is characterized by large chromatin-
rich karyosome and surrounded by a layer of achromatic
globules, anchored to the nuclear membrane by
achromatic fibrils
Entamoeba
Endolimax

Iodamoeba
COMMENSAL AMEBAE

❖ Parasite biology
➤ All species have the following stages:
➢ Trophozoite

➢ Precyst
➢ Cyst
➢ Metacystic trophozoite
With the exception of Entamoeba gingivalis which has NO
cyst stage and does not inhabit the intestines
➤ Humans are infected by commensal intestinal amebae through
ingestion of viable cysts in food or water
COMMENSAL AMEBAE

➤ Entamoeba dispar
➢ Morphologically similar to E. histolytica, DNA and rRNA are
different
➤ Entamoeba moshkovskii
➢ Morphologically indistinguishable from E. histolytica and E.
dispar; differs biochemically and genetically
➢ non-pathogenic in humans; limited pathogenicity in
experimental trials in animals
➢ physiologically unique- osmo-tolerant, able to grow at room
temperature (25-30oC optimum), able to survive at
temperatures ranging from 0-41oC
COMMENSAL AMEBAE
➤ Entamoeba hartmanni
➢ Appearance relatively similar to E. histolytica, apart from
its smaller size
➢ Trophozoites: 3-12 mm diameter (E. histolytica: 12-60 mm
diameter)
➢ Mature cysts: 4-10 mm diameter, quadrinucleated, with rod-
shaped chromatoid material with rounded or square ends)
➢ DOES NOT INGEST RBCs
COMMENSAL AMEBAE
➤ Entamoeba coli
➢ Cosmopolitan in distribution; more common than other human
amebae
➢ Trophozoites: 15-50mm diameter
➢ differentiated from E. histolytica by the following features:

1. More vacuolated or more granular endoplasm with ingested

bacteria and debris but no RBCs
2. Narrower, less differentiated ectoplasm
3. Broader and blunter pseudopodia (used more for feeding than
locomotion)
4. More sluggish undirected movements
5. Thicker), irregular peripheral chromatin with a large eccentric
karyosome in the nucleus
COMMENSAL AMEBAE

➤ Entamoeba coli
➢ Cyst differentiated from E. histolytica by the following
features:
1. Larger size (10-35mm diameter)
2. More nuclei (8 vs 4 in E. histolytica)
3. More granular cytoplasm
4. Splinter-like chromatoidal bodies
➢ Iodine staining reveals dark-staining perinuclear
masses (glycogen)
ENTAMOEBA COLI
ENTAMOEBA COLI
ENTAMOEBA COLI
ENTAMOEBA COLI

Pseudopodia with
hardly defined ectoplasm

Trophozoite in stool specimen, Trichrome-stained

A single nucleus contains reddish, eccentric karyosome
Peripheral nuclear chromatin unevenly distributed, giving
uneven thickness to nuclear membrane
ENTAMOEBA
COLI

Motile trophozoite in stool

specimen, wet mount

Pseudopodia with hardly-

defined ectoplasm
Move sluggishly
Nucleus is hardly visible
COMMENSAL AMEBAE
➤ Entamoeba polecki
➢ Parasite found in the intestines of pigs and monkeys;
rarely infects humans
➢ Trophozoite motility sluggish
➢ Small karyosome centrally located in the nucleus
➢ Differentiation from E. histolytica:

cyst is UNINUCLEATED
chromatoidal bars frequently angular or pointed
COMMENSAL AMEBAE

Entamoeba polecki
➤ Entamoeba chattoni
➢ found in apes and monkeys
➢ Morphologically identical to E. polecki
➤ Entamoeba gingivalis
➢ Found in the mouth
➢ Trophozoite: 10-20mm
➢ Moves quickly with numerous blunt pseudopodia
➢ Numerous food vacuoles that contain cellular debris
(mostly leukocytes) and bacteria
➢ Lives on the surface of gum and teeth, in gum pockets,
sometimes in tonsillar crypts
➢ Abundant in oral disease
ENTAMOEBA GINGIVALIS

NO CYST STAGE

Trophozoite, Trichrome-stained
Ingested leukocytes in cytoplasm is its distinct character
COMMENSAL AMEBAE
➤ Endolimax nana
➢ Occurs with the same frequency as E. coli
➢ Trophozoites small; 5-12mm diameter; exhibit sluggish
movement, with blunt hyaline pseudopodia
➢ Nucleus exhibits a large irregular karyosome
➢ Food vacuoles found in the cytoplasm may contain bacteria
➢ Cysts same size as trophozoites, quadrinucleated when
mature
➤ Chromatoid bodies are not found and glycogen is diffuse
ENDOLIMAX NANA

Trophozoite in stool specimen, Iron-Hematoxylin stained

Smallest amoeba of man
Note a large, irregular karyosome
ENDOLIMAX NANA
DIENTAMOEBA FRAGILIS
➤ AMEBOFLAGELLATE OF THE INTESTINAL TRACT
➤ FOUND ONLY AS A TROPHOZOITE
➤ HAS 2 NUCLEI
➤ RESEMBLES TRICHOMONADS ANTIGENICALLY AND
ULTRASTRUCTURALLY
➤ CAN BE RECOGNIZED ONLY IN FRESH LIQUID OR SOFT STOOLS
➤ IDENTIFICATION BASED ON ITS SMALL SIZE, 2 NUCLEI, CIRCULAR
APPEARANCE AT REST, RAPID ACTION OF THE MULTIPLE LEAF-
SHAPED PSEUDOPODIA (GIVES A STELLATE APPEARANCE),
EXPLOSIVE DISINTEGRATION IN WATER
DIENTAMOEBA FRAGILIS

➤ MAY INGEST RED BLOOD CELLS

➤ TX: IODOQUINOL 650MG TID FOR 10 DAYS
TETRACYCLINE 250MG QID FOR 7 DAYS
COMMENSAL AMEBAE
➤ Iodamoeba bütschlii

➢ Trophozoites: 9-14μm diameter (range 4-20μm)

➢ Large vesicular nucleus with a large central karyosome,
surrounded by achromatic granules
➢ NO peripheral chromatin granules on nuclear
membrane
➢ Cyst: 9-10μm diameter (range 6-16μm), Uninucleated,
has large glycogen body that stains dark brown deeply
with iodine
IODAMOEBA BÜTSCHLII

Trophozoite in stool
specimen,
Trichrome-stained

Single nucleus with a large

Irregular karyosome makes a
"basket" nucleus

Inconspicuous peripheral
nuclear
chromatin
 
IODAMOEBA BÜTSCHLII

Cyst, mature, uninucleated, in stool

specimen, Trichrome-stained
Note a large and sharply demarcated
unstained glycogen vacuole in cytoplasm
Single nucleus with large irregular
karyosome
DIAGNOSIS

➤ STOOL EXAMINATION
✓ FORMALIN ETHER/ETHYL ACETATE CONCENTRATION
TECHNIQUE (FECT) AND IODINE STAIN – DIFFERENTIATE THE
SPECIES
✓ E. GINGIVALIS – SWAB BETWEEN THE GUMS AND TEETH
(FOR TROPHOZOITES)
✓ CYSTS RECOVERED FROM FORMED STOOLS, TROPHOZOITES
FROM WATERY OR SEMI-FORMED STOOLS
TREATMENT

NO TREATMENT NECESSARY
EPIDEMIOLOGY

PREVALENCE

Entamoeba coli 21%

Endolimax nana 9%

Iodamoeba butschlii 1%
PREVENTION

➤ PROPER DISPOSAL OF HUMAN WASTE

➤ GOOD PERSONAL HYGIENE