Entamoeba

histolytica

BS 8TH MICROBIOLOGY
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Entamoeba histolytica
CONTENTS

o Introduction
o Epidemiology
o Morphology
o Taxonomy
o Life cycle
o Pathogenesis
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Entamoeba histolytica
CONTENTS

o Transmission
o Sign and symptoms
o Diagnosis
o Treatment
o Prevention
o References
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Entamoeba histolytica
INTRODUCTION

• Entamoeba histolytica is an anaerobic parasite

• Predominantly infecting humans and other animals
causing amoebiasis
• Amoebiasis is a major cause of morbidity and mortality
worldwide
• An important cause of diarrhea in developing countries
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Entamoeba histolytica
EPIDEMIOLOGY

• Entamoeba histolytica affects approximately 500 million

people worldwide
• Symptomatic diseases in 50 million
• Mortality in 100,000 persons
• About 80-90% of infections are asymptomatic
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Entamoeba histolytica
MORPHOLOGY

Have three morphological forms

i. Trophozoite
ii. Precyst
iii. Cyst
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Entamoeba histolytica
MORPHOLOGY

Trophozoite
• Trophozoite are actively motile with the help of
pseudopodia.
• Trophozoite are anaerobic parasite, present in large
intestine
• It is the growing and feeding stage of parasite
• Shape is not fixed because of constantly changing
position
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Entamoeba histolytica
MORPHOLOGY

Trophozoite
– Size
ranging from 18-40 µm
average 20-30 µm
– Nucleus
spherical shape
size ranging from 4-6µm
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Entamoeba histolytica
MORPHOLOGY

Pre cyst
• Intermediate stage between trophozoite and cyst
• It is smaller in size
– 10-20µ
• Round or slightly ovoid in shape
• No RBC or food materials are found on its
endoplasm
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Entamoeba histolytica
MORPHOLOGY

Cyst
• It is the infective form of parasite
• Surrounded by cyst wall
• The cyst wall is resistant to digestion by gastric
juice in human stomach
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Entamoeba histolytica
MORPHOLOGY

Cyst
• Nucleus
A mature cyst is quadri-nucleated
• Mature cyst passed out in stool from infected patient
and remained in soil for few days without further
development
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Entamoeba histolytica
TAXONOMY

– Domain Eukaryota
– Phylum Amoebozoa
– Family Entamoebidae
– Genus Entamoeba
– Species E. histolytica
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Entamoeba histolytica
LIFE CYCLE

• Life cycle of histolytica consists of infective cyst and

invasive trophozoite stage
• Life cycle completes in single host i.e. human
• Human get infected with E. histolytica cyst from
contaminated food and water
• Infection can also acquired directly by ano-genital or oro-
genital sexual contact
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Entamoeba histolytica
LIFE CYCLE

• The mature Cyst is resistant to low pH of stomach, so

remain unaffected by the gastric juices
• The cyst wall is then lysed by intestinal trypsin and when
the cyst reaches the caecum or lower part of ilium
excystation occurs
• The neutral or alkaline environment as well as bile
components favor excystation
• Excystation of a cyst gives 8 trophozoites
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Entamoeba histolytica
LIFE CYCLE

• Trophozoites are actively and carried to large intestine by

peristalsis of small intestine
• Trophozoites then gain maturity and divide by binary
fission.
• The trophozoites adhere to mucus lining of intestine by
lectin and secretes proteolytic enzymes which causes
tissue destruction and necrosis
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Entamoeba histolytica
LIFE CYCLE

• Parasite, when gain access to blood, migrates and causes

extra-intestinal diseases
• When the load of trophozoites increases, some of the
trophozoites stop multiplying and revert to cyst form by
the process of encystation
• These cysts are released in completing the life cycle
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Entamoeba histolytica
LIFE CYCLE
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Entamoeba histolytica
VIRULENCE FACTORS

• Cyst wall
cyst wall is resistant to low pH and gastric juice of
stomach
• Lectin
Surface of trophozoite contains lectin that is specific to
lingards (N-acetyl-galactosamine and galactose sugar)
present in surface of intestinal epithelium
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Entamoeba histolytica
VIRULENCE FACTORS

• Hydrolytic enzymes
Phosphatase
Proteinease
Glycosidase
RNase
causes tissue destruction and necrosis
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Entamoeba histolytica
VIRULENCE FACTORS
•  Ionophore like protein

causes leakage of ions such as Na+, K+, Ca++ from

target cells
• Toxin 
• Haemolysin
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Entamoeba histolytica
PATHOGENESIS

• The parasites express large number of virulence factors

• Excystation of cyst in intestine releases 4 trophozoites
which then colonizes the large intestine
• The binding of trophozoites with the colonic epithelium is
a dynamic process in the pathogenesis
• After adherence trophozoite lyse the target cell by its
ionophore like protein that causes leakage of ions from
cytoplasm
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Entamoeba histolytica
PATHOGENESIS

• The proteolytic enzymes secreted by the amoeba causes

tissue destruction giving flask shaped amoebic ulcer, is a
typical feature of intestinal amoebiasis
• Trophozoites penetrates the columnar epithelium of mucosa
causing lysis and moves deep inside till they reached sub-
mucosa layer and multiply rapidly
• Ultimately amoeba destroy considerable area of the sub-
mucosa leading an abscess formation which breaks down to
form ulcer
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Entamoeba histolytica
PATHOGENESIS

• The ulcer is flask shaped with narrow neck and broad base
• The ulcer may be localized throughout the large intestine
• From intestine, the parasites may be carried to other vital
organs such as liver, heart, brain etc. through blood
circulation
• Pulmonary and hepatic amoebic abscesses are frequent
and rarely cerebral, cutaneous and splenic amoebic
abscesses
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Entamoeba histolytica
TRANSMISSION

• Fecal-oral route
• Ingestion of cyst contaminated foods and water
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Entamoeba histolytica
INCUBATION PERIOD

• The incubation period for amoebiasis is variable

• Symptoms begin to appear in about one to four weeks
after ingestion of the cysts
• However, the range may be from a few days to years
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Entamoeba histolytica
SYMPTOMS

• Early symptoms
Loose stools
Mild abdominal cramping
• If the disease progresses
frequent, watery, or bloody stools with severe
abdominal cramping
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Entamoeba histolytica
SYMPTOMS

• Stomach pain
• Flatulence
• Appetite loss
• Weight loss
• Fatigue
• Anemia
• Occasionally cause skin lesions (cutaneous amoebiasis)
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Clinical Signs

• Infection ranges from asymptomatic to invasive intestinal

amoebiasis and extra-intestinal amoebiasis
• Asymptomatic infection
90% of E. Histolytica infection is mild or
asymptomatic
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Entamoeba histolytica
Clinical Signs
• Intestinal amoebiasis
- Mild diarrhea
- Acute amoebic dysentery
More common
Characterized by
Abdominal pain
Fever
Stool contains RBCS
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Entamoeba histolytica
Clinical Signs

• Extra intestinal amoebiasis

Hepatic infection
Pulmonary infection
Cerebral infection
Genitourinary infection
Spleenic infection
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Diagnostic Tests

• Stool macroscopy
• Microscopy
• Stool Ag detection
Elisa
•  Stool culture
• PCR
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Entamoeba histolytica
Diagnostic Tests
• Serology
Indirect haemagglutination assay IHA
Indirect fluorescent antibody IFA
• Radiological finding
X-rays
MRI
CT scan
Ultrasonography
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Entamoeba histolytica
Diagnostic Tests

•  Blood test 
Blood count
Liver function test
Kidney function test
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Entamoeba histolytica
Treatment

• Diloxanide fluorate
• Diidohydroxyquin
• Paramycin
• Metronidazole
• Imidazole
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Entamoeba histolytica
Treatment

• 4-aminoquinoline
For extra intestinal infection
• Oral rehydration
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Entamoeba histolytica
PREVENTION

• Avoiding contaminated food and water

• Good sanitation techniques
• Avoidance of contaminated food handlers
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Entamoeba histolytica
REFERENCES

– Https://www.Waterpathogens.Org/book/entamoeba-histol
ytica
– Https://www.Medicinenet.Com/amebiasis_entamoeba_his
tolytica_infection/article.Htm
– Https://www.Onlinebiologynotes.Com/entamoeba-histoly
tica-morphology-life-cycle-pathogenesis-clinical-manifes
tation-lab-diagnosis-treatment
/