Entamoeba histolytica / E.

dispar
• Trophozoite:
– 8-65 mm (ave.12-25)
– Finely granular
cytoplasm
– Evenly distributed
peripheral chromatin
– Small, central karyosome
– Progressive motility
– Ingested RBC = E.
histolytica
Entamoeba histolytica / E. dispar

• Cyst:
– 8-22 mm (ave. 12-18)
– Hyaline cell wall
– Up to 4 nuclei
– Small, central karyosome
– Elongated chromatoid
bodies (bars) with
rounded blunt ends
Entamoeba hartmanni
• Old name = “Small race
histolytica” (but, non-
pathogen)
• Troph:
– 5 - 15 mm
– Finely granular cytoplasm
– Evenly distributed peripheral
chromatin
– Small, central karyosome
– Non-progressive motility,
Entamoeba hartmanni

• Cysts:
– 5 – 12 mm
– 1-4 small nuclei
– Elongated chromatoid
body with blunt
smooth ends
– Central, compact
karyosome with even
peripheral chromatin
 Entamoeba coli
• Troph:
– 15 – 50 mm (18-27)
– Coarsely granular cytoplasm
– Unevenly distributed
peripheral chromatin
– Large, discrete, eccentric
karyosome
– Inclusions: bacteria, yeast,
debris
– Sluggish, non-progressive
motility
Do NOT go by drawing in textbook – it’s incorrect
Entamoeba coli
• Cyst:
– 10 - 35 mm (12-25)
– Mature cysts have 8
nuclei (up to 16!)
– Splinter shaped
chromatoid bars with
sharp pointed ends
– Large, eccentric
karyosomes
 Entamoeba polecki
Trophozoite
• 8-25 µm (12-20)
• Small central
karyosome, fine and
evenly distributed
chromatin
• Granular cytoplasm
• Blunt psuedopodia with
progressive movement

CDC DPDX
Entamoeba polecki
Cyst
• 8- 25 µm (12-20)
• Large nucleus with
pleomorphic karyosome
• Pointed ended
chromatin bars
Endolimax nana
• Troph:
– 6 – 12 mm
– Granular cytoplasm
– No peripheral chromatin
– Large blot-like
karyosome (bird’s eye)
– Inclusions: bacteria
– Sluggish, non-
progressive motility
Endolimax nana
• Cyst:
– 5 – 10 mm
– Up to 4 nuclei
– No peripheral chromatin
– Large karyosome
(central)
– No visible chromatoid
bodies
Iodamoeba butschlii
• Troph:
– 8 – 20 mm
– Granular, vacuolated
cytoplasm
– No peripheral chromatin
– Large karyosome
– Cytoplasimic inclusions:
bacteria and yeast
– Sluggish, non-
progressive motility
Iodamoeba butschlii

• Cyst:
– 5 – 20 mm
– Mature cyst has only 1
nucleus
– No peripheral chromatin
– Large karyosome, with
granules on one side
– No visible chromatoid bodies
– Prominent glycogen vacuole
 Naegleria fowleri

Trichrome stain of N.
fowleri in brain tissue
sections

CDC DPDX
 Naegleria fowleri

cultured from CSF Cyst in culture

Ameboflagellate trophozoite Trophozoite in culture

 Acanthamoeba sp.

Corneal biopsy showing

Acanthamoeba sp.
 Morphological Characteristics of
Flagellates

Nuclei Undulating membrane

Sucking Axostyle
disc
Median
bodies
Flagella
Giardia intestinalis
• Troph:
– 8-20 mm by 5-16 mm
– Pear or tear-drop
shaped
– 2 nuclei lying on top of
sucking disc
– Linear axonemes
(creating axostyle)
– 2 curved median bodies
– 8 flagella (2 anterior, 4
ventral, 2 posterior)
– Falling-leaf motility
Giardia intestinalis

• Cyst:
– 8-17 mm by 6-10 mm
– Round to oval shaped
– 4 nuclei in mature cyst
– Axonemes and median
bodies are present
Chilomastix mesnili
• Troph:
– 5-24 mm by 5-8 mm
– Teardrop shaped
– Prominent cytostome
– 1 nucleus
– 4 anterior flagella
– Stiff, rotary motility
Chilomastix mesnili

• Cyst:
– 5-10 mm by 4-6 mm
– Lemon-shaped with an
anterior hyaline knob
(nipple)
– 1 nucleus
Dientamoeba fragilis
• Troph:
– 5-16 mm
– Amoeba-like shape
– 1 or 2 (more commonly)
nuclei with large,
prominent karyosomes
– No visible flagella(!)
– Debris in cytoplasm
– Active motility
– Pseudopods present
• (NO Cyst form known)
 Trichomonas vaginalis
(Wet prep) • Troph:
– 8-23 mm by 5-12 mm
– Pear-shaped
– 1 nucleus
– 4-6 flagella
– Prominent axostyle
– Undulating membranes
that extends ½-way down
length of troph
– Rapid, jerky movement
• (NO cyst form)
(Giemsa stain of
cultured organism)
Balantidium coli
• Troph:
– 30-100 mm by 30-80 mm
– Very large ovoid shape
– Kidney bean-shaped
macronucleus with
adjacent micronucleus
– Numerous cilia covering
membrane
– Cytostome and cytopyge
Balantidium coli
• Cyst:
– 45-65 mm
– Oval or round shape
– Large kidney bean-
shaped macronucleus
– Double-layered cyst
wall (with or without
visible cilia in
between)
Morphologic forms of
hemoflagellates:
• Not all forms are seen in
clinical specimens:
– Amastigotes (within
macrophages) are the
only form seen in human
Leishmaniasis
– Amastigotes or
trypomastigotes may be
seen in Trypanosomiasis
 Diagnosis of Leishmaniasis
• Identification of organism in Giemsa stained slides of
active ulcer biopsy, bone marrow or lymph node
biopsy
• Diagnostic form is intracellular amastigote within
macrophages (species are morphologically
indistinguishable)
 Diagnosis of Leishmaniasis

• Need to be careful to differentiate

Leishmaniasis from Histoplasma
Bone marrow capsulatum (fungus which is also
found inside macrophages)
• H. capsulatum does NOT have a
kinetoplast
• PCR (CDC)
• Serological assays for non-HIV
VL
Leishmania sp.
 Trypomastigotes
Amastigotes
ONLY with T.
cruzi

T. cruzi or T. rangeli
T. brucei spp.
 Trypanosomes in peripheral blood

T. brucei spp.

T. cruzi