Parasitic Amoebas | Dr. C. J.

Castro Macrofaj

I. TAXONOMIC CLASSIFICATION

 Kingdom: Protista
 Subkingdom: Protozoa (single celled organism)
 Phylum: Sarcodina (pseudopods)
o Other phyla: Ciliophora (cilia – Balantidium coli), Mastigophora (flagella – Giardia, Trichomonas) &
Sporozoa (non-motile)
o Classified by their organ of locomation
 Class: Lobosea
 Order: Amoebida
 Family: Endamoebidae (amebas)
o Closely related: Blastocystidae (Blastocystis hominis)

II. AMOEBAS

 Belong to a group of protozoans that are motile through cytoplasmic extensions known as pseudopods
 Two major groups:
o Free living (Nigleria, acanthamoeba) – can survive at environment
o Parasitic (Pathogenic & Non-pathogenic)

III. PARASITIC AMOEBAS – Large intestine is the major habitat except E. gingivalis

 Entamoeba histolytica – most important; only one pathogenic (others are commensals)
 Entamoeba coli
 Entamoeba dispar
 Entamoeba hartmanii
 Entamoeba gingivalis
 Endolimax nana
 Iodamoeba butschii/butschlii

IV. Entamoeba histolytica

 Pathogenic
 Habitat: Large Intestine
 Human beings are the prinicipal host and source of infection
 Can cause:
o Amebiasis
o Amebic dysentery (bloody diarrhea)
 Bacillary – Etiologic Agent: Bacilli (Shigella)
o Amebic hepatitis
 Appears as cyst or trophozoite
o Cyst mas matibay kasi may cyst wall pa, found in formed stool, infective stage
 Watery stool - trophozoites
 Epidemiology
o Incidence of infection varies from 0.2% to 50%
o Infection is most prevalent among people living under crowded conditions
o Prevalence in homosexual is as high as 25-35% because of their sexual practices

V. MORPHOLOGY

 Trophozoite
o Active vegetative form, “kumakain”
o 15-30 um
o Ectoplasm sharply separated from the endoplasm

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Parasitic Amoebas | Dr. C. J. Castro Macrofaj

o Endoplasm: includes RBC

o It has a single eccentric nucleus that contains a centrally located karyosome (nucleolus) – important
feature to differentiate from others
o Finger-like pseudopodia are extended rapidly (explosive)
 Direction of movement: where the pseudopod is

 Cyst
o Round to oval
o 10-20 um
o Can survive for 2 days at 37C or 60 days at 0C
o Has a smooth refractile wall
o Cystoplasm contains glycogen and chromatoid bodies (sausage-
shaped with blunt ends) -> for nutrition since di pa makakain
o Types
 Immature cyst – mono/binucleated
 Mature cyst – tetranucleated, infective form

VI. REPRODUCTION

 Binary fission (trophozoite)

o 1 becomes 2, 2 becomes 4…etc
 Cyst formation

Cyst – resistant to gastric acid

but when reaches SI, undergo
excystation becomes
metacystic trophozoite

8 small trophozoites aka

amebulae (still in SI)

At colon, will undergo binary

fission to become trophozoites
or
cysts when there’s
dehydration in the colon
(encystation)

*liquid stool – trophozoite

*formed stool - cyst

VII. PATHOLOGY

 Intestinal – Primary
o Colonization of the large intestine - flask shaped ulcers with a wide base and narrow opening and with
irregular slightly elevated, overhanging edges
 Kapag naharangan ng smooth muscle ng muscularis mucosa yung pag-invade, magdedetour kaya
pagilid instead of palalim
o Complications: appendicitis, intestinal perforation, hemorrhage, stricture, granuloma (in chronic cases)
 Extraintestinal – Secondary {liver - most common}
o Hepatic amebiasis
 Dissemination from the intestine chiefly by the blood stream thru portal vein

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Parasitic Amoebas | Dr. C. J. Castro Macrofaj

 The wall of the abscess thickens and the center liquefies becoming a red brown mass of
autolysed hepatic cells, RBCs, bile (produced in the live; stored in the gallbladder), etc.
 Appears as anchovy-paste
 80% are confined to the right lobe.
o Pulmonary amebiasis
o Cerebral amebiasis

VIII. DIAGNOSTIC TEST

 Microscopic identification of the cysts/trophozoites in feces or tissues

 Amebic stools
o Acidic, few neutrophils, with degenerated RBCs, (+) Charcot Leyden crystals (derived from eosinophils)
 If bacillary – alakalinic, many neutrophils (since bacterial), intact RBCs, (-) Charcot Leyden crystals

IX. TREATMENT
 Metronidazole 750mg TID for 5-10 days or
 Iodoquinol 650mg TID for 20 days

X. NON PATHOGENIC AMEBAS – do not cause disease

 Entamoeba Coli
o Prevalence 10-30%; mistaken for E.
histolytica
o Same life cycle
o Trophozoite
 More granular endoplasm
containing ingested bacteria
instead of RBC
 Narrower ectoplasm
 Broader or blunter
pseudopodia instead of finger
like and sluggish instead of
explosive
 Eccentric karyosome in the
nucleus
 More sluggish movements
o Cyst
 Larger, with more granular
cytoplasm
 Slender, splinter-like
chromatoid bodies
 8 nuclei with eccentric
karyosome
o Tx : NONE

 Entamoeba dispar
o 1993 – proposed name for non pathogenic E. histolytica
o Identical to e histolytica but does not invade the tissues; incidental findings only

 Entamoeba hartmanii
o Originally thought to be a "small race" of E. histolytica, now considered as a separate species (12-15u)

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Parasitic Amoebas | Dr. C. J. Castro Macrofaj

 Entamoeba gingivalis
Iodamoeba butschlii
o Non pathogenic inhabitant of the mouth
o Most striking feature: Large number of food vacuoles

 Endolimax nana
o Also with tetranucleated cyst
o Karyosome centrally located and larger
o Prevalence of 10-20%
o Small (5-14u), sluggish
o Nana = maliit

 Iodamoeba butschlii
o With characteristic nucleus and with large glycogen body in the uninucleated cyst
o With refractile bodies near the nucleolus

XI. Blastocystis hominis

 Different family from amoeba
 Formerly classified as yeast -->now classified as protozoan
 Appear in the feces as spherical cyst-like stage containing a large central vacuole
with a narrow rim of cytoplasm containing nuclei
 Commonly found in the stool
 Large number are found in the feces of patients with severe diarrhea
 No pathology (but this claim is still in question)
 Tx: Metronidazole if it caused diarrhea

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