Etiopathogenesis and

Prevalence of Amoebiasis
S.Magesh
Prevalence

 Prevalence of amoebiasis ranged from 3-23% in asymptomatic population

 0.64-11% in symptomatic patients and 1-17.5% in HIV-infected patients.
 Highest prevalence was seen in Tamil Nadu, Andaman Nicobar Island and
North East India.
 Etiology
 Causative agent – Entamoeba histolytica , an intestinal Protozoan
 Ingestion of viable cyst from fecally contaminated water,food /hands
 Most prevalent form of Transmission – Food-borne exposure
 Less common modes of Transmission – Oral and Anal sexual
practices
 Rarely – direct Rectal inoculation through colonic irrigation devices
Pathogenesis
Amoeboma
(localized
granuloma)
Produces lesions presents as
that are palpable mass in
In the maximally in rectum or a
colon ,Trophozoi caecum but filling defect in
tes emerge from extend to the colon on
cyst . anal canal radiography

The parasite flask shaped Amoebic ulcers

invades mucous ulcers may cause severe
membrane of surrounded by haemorrhage
large bowel healthy mucosa but rarely
proliferate the
bowel wall
 Cutaneous
Amoebiasis– Rare ,
causes Progressive
Amoebic genital , perianal or
trophozoites emerge multiply rapidly and peri-abdominal
from vegetative state destroy liver surgical wound
from bowel parenchyma ulceration .

Carried to liver in causes an abcess

Portal venule which has
characteristic
pinkish colour at
first , later changes
to Chocolate brown
(resembles Anchovy
sauce )
Pathogenesis - contd
 Trophozoites – 20-60 µm in diameter , contains vacuoles and a nucleus with
characteristic central nucleolus .
 Trophozoites attach to colonic mucus and epithelial cells by Gal/GalNAc
adherence lectin and release glycosidase and protease .

They damage
mucosa by

Contact- Contact-
dependent independent
cytotoxicity cytotoxicity

Inflammatory
Apoptotic cell mediators
death
(eg : PGE2)
 Ability to resist reactive Oxygen species and reactive Nitrogen species –
is a virulence factor (due to constant exposure to ROS ,RNS from host
during tissue invasion )
 Phagocytosis – is a virulence factor
 -- If inhibited , leads to defective Proliferation of E.histolytica
 Trophozoites use membrane associated carbohydrate-binding proteins to
phagocytose intestinal bacteria, especially gram-negative
Enterobacteriaceae, for their nutrients
 Amoebic liver abcess – age and gender dependent , Men 30-60 yrs are
affected 10-12 times more than women
 Syndromes associated - Intestinal Amoebiasis
- Amoebic Liver abscess
 Intestinal Amoebiasis
 The most common type of infection – asymptomatic cyst passage
 Symptomatic amoebic colitis develops 2-6 weeks after ingestion of
infected cysts
 Cecal involvement may mimic acute appendicitis
 Patients receiving glucocorticoids are at risk for severe amoebiasis
 Bangladeshi children with symptomatic E. histolytica infections were 2.9
times more likely to be malnourished and 4.7 times more likely to be short
for their age than were children without symptomatic infections.
Amoebic Liver Abscess

 Extraintestinal infection by E. histolytica most often involves the liver

 Young patients with an amebic liver abscess are more likely than older
patients to present in the acute phase with prominent symptoms of less
than 10 days duration.
 Older patients from endemic areas are more likely to have a subacute
course lasting 6 months, with weight loss and hepatomegaly.
 Thus, the clinical diagnosis of an amebic liver abscess may be difficult to
establish because the symptoms and signs are often nonspecific.
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