AMOEBIASIS

Locomotion

• Pseudopodia: Apparatus for locomotion

• Serial projections from the ectoplasm effect the
movement for food for trophozoite.
• Food ingestion through vacuole formation-
I.e. engulfing of particles, bacteria or
erythrocytes by pseudopodia.
 Encysting and Excysting
• Excysting-- From Cyst to Trophhozoite
In the alkaline state around Ileum/Coecum Galactose-
lectine rxn (Gal-Lectin)

• Encysting--- Fro m Trophozoite to Cyst

• In the rectum of trophozoite are dehydration takes place.
It releases its food out shrinks and
• Trophozoite forms a tough sphericalsheathing around its
body (Precyst)
• Cyst can be evacuated in to the environment in faeces

• .
Introduction Disease biology Epidemiology Clinical Summary
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Life cycle and transmission 1

• Entammoeba histolytica has a biphasic life cycle, existing in two
forms; as an infectious cyst and an amoeboid trophozoite

Mouth - Cyst ingested

Passed in stool Excyst to trophozoite

Amoebic disease

Cyst Trophozoite

Invades gut mucosa – cyst formation

Life cycle of E. histolytica
 Pathogenesis 1
•Amoebic trophozoites invade the colon causing colitis. They
may also invade the portal circulation and travel to the liver,
causing liver abscess.
Gastrointestinal Pathology
• The spectrum of colitis in amoebiasis ranges from mucosal
thickening, to multiple cyst formation, to diffuse Inflammation /
oedema, to necrosis and perforation of colonic wall.
• Binding of E. histolytica to epithelial cells via gal-lectin--. A
change in the epithelial permeability is induced, probably via
the inter-cellular tight junctions.
Cell lysis and apoptosis of mucosa are mediated by
amoebapores, peptides capable of forming pores in lipid bi-
layers.
•Trophozoites invade through to the submucosa causing
flask shaped cysts .
 Pathogenesis 2
• Cysteine proteases released by trophozoites
digest extracellular matrix in liver and colon, and
induce interleukin-1 mediated inflammation.
Proteases also cleave IgA and IgG antibodies.
• Neutrophils and macrophages are drawn to
invasion sites. E. histolytica can lyse neutrophils
leading to further tissue damage, and
contributing towards the induction of diarrhoea.
• Inflammation is a significant cause of tissue
damage, however, innate immunity may be the
main combatant against the disease
 Pathogenesis 2
Hepatic Pathology
• Trophozoites invading the colonic mucosa may enter the hepatic
circulation and reach the liver
•Well circumscribed abscesses are
formed in the liver containing
liquefied cells surrounded by
inflammatory cells and trophozoites
•Adjacent parenchyma is usually
unaffected

Amoebic liver abscess

Histological cross section of classical flask Amoebic colitis with multiple ulcer formation
shaped amoebic ulcer in colonic mucosa.
 Presentation 1
Some individuals carry E. histolytica asymptomatically. 4
-10% will go on to develop the disease within a year.

Gastroenterological
• Gradual onset (weeks) of bloody diarrhoea, occasionally
with small volumes of mucoid stool. If blood is not visible,
stool is usually ‘haem’ positive due to the breach of the
mucosa.
• Abdominal pain and tenderness.
•
•Leucocytes and pus may be present in stool. Fever present
in <40% of patients.
• Weight loss and anorexia can be present.

•In more severe cases fulminant amoebic colitis develops.

Liver involvement is more common in these cases, along with
paralytic ileus, toxic megacolon and mucosal sloughing.
 Presentation 2
• Gastroenterological: Over 75% of patients with fulminant
colitis develop intestinal perforation.
• Local inflammatory masses, amoebomas, may cause
obstructive symptoms
• Hepatic
• More common in men
• Liver abscess pan present in conjunction with bowel
symptoms (10% of cases), or in isolation.
• Sudden onset of upper abdominal pain with fever. Pain may
radiate to right shoulder or be exacerbated by repiratory
movements.
• Hepatic tenderness may be present. Jaundice is unusual.
• Complicated liver abscess may develop if abscess ruptures
into the peritoneal, pericardial or pleural cavity. Morbidity
and mortality is high.
• Rarely, trophozoites may also invade the respiratory tract,
brain and GU tract
Introduction Disease biology Epidemiology Clinical Summary
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Treatment and Management

Presentation • Amoebiasis, in particular with liver involvement, can be fatal if not

treated. Chemotherapy can effectively cure ameobiasis.
Diagnosis
• Nitroimidazole (e.g.metronidazole) is used to treat the invasive
Treatment and pathogens – 800mg t.d.s for 10 days.
Management
• This is followed by a luminal agent (e.g.diloxanide furoate) to
Vaccine eliminate colonisation – 500mg t.d.s for 10 days. This is also suitable
Development 1 for asymptomatic individuals.

Vaccine •Complicated liver abscesses should be drained surgically.

Development 2
Prevention
Vaccine
Development 3 •Boiling water for at least ten minutes kills amoebic cysts
effectively. Chlorine and iodine tablets are not thought to be 100%
Self Assessment effective.
 Treatment - 2
Antiamoebic drugs can be classified into:
1. Lumen amoebicide: not well adsorbed from the gut, act
on trophozoites in the intestinal lumen
– diloxanide furoate the drug of choice
– antibiotics such as paramomycin
2. Tissue amoebicide:
– These are readily absorbed from the small intestine
– act primarily in the bowel wall, liver and
other extraintestinal tissues
– do not reach high enough concentrations in the large
intestinal lumen to eliminate the amoebae
• 5-nitroimidazole derivates, such as metronidazole,
• tinidazole and secnidazole
 Treatment 3
• The WHO recommends that unless reliable
observation of amoebic trophozoites is made,
treatment for bloody diarrhoea in small children
should initially be for shigellosis, and antiamoebic
therapy should only be given when there is no
response to the antibacterial

• This recommendation is based on a very large study

carried out in China, India, Mexico, Myanmar, Pakistan)
showing that of 3,640 children under 3 years of age with
acute diarrhoea, only 1.5% of those presenting blooding
diarrhoea were classified as invasive amoebiasis
Diagnosis/significance of
commensal
E. Histolytica and the commensals
 Entamoeba histolytica

Trophozoit of E. histolytuca with Entamoeba coli Trophozoite

phagocytized erythrocytes

Dantamoeba trophozoit
Cysts of E. histolytica/ E. coli
10 – 20 µm 10 – 35 µm

E. histolytica cyst Mature

10 – 20 µm Entamoeba coli cyst
10 – 35 µm
 Entamoeba histolytica

E. histolytica cyst Mature

10 – 20 µm Endolimax nana cysts

4 -14 µm
 Entamoeba histolytica

E. histolytica cyst Mature

10 – 20 µm Iodamoeba buetschlii cysts
6-20 µm
 Vaccine Development 1
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Amoebiasis incidence could be vastly reduced with simple sanitation and
hygiene measures. However, given the current political and economic
climate, this seems unlikely in the near future. Furthermore, with developing
drug resistance in E. histolytica, vaccine development could be effective.

Why vaccinate?
• Could prevent development of amoebic disease and associated sequelae.
• Humans only host for E. histolytica, therefore eradication vaccine would
eliminate E. histolytica from the carrier pool.

Which target?
•A number of potential targets have been identified including cysteine
proteases, LPGs and peroxiredoxins. The two most promising antigens
identified are Serine-Rich E. histolytica Protein (SREHP) and Galactose/N-
acetylgalactosamine lectin (Gal-lectin). Here the potential Gal-lectin vaccine
will be described
Introduction Disease biology Epidemiology Clinical Summary
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Vaccine Development 2
Gal – lectin and the immune response
•Gal-lectin is a 260kDa complex protein which consists of disulphide linked light (35 kDa) and heavy
subunits (170kDa). The heavy chain is cysteine rich and is thought to be a target for immune responses,
inducing a Th1 cytokine cell mediated immune response
•Macrophages induced by cytokines interferon(INF)-γ have amoebocytic activity, as do T-cells exposed to
INF-γ exposed or TNF.
•Trophozoite killing by macrophages is done via nitric oxide (NO). Gal-lectin can directly activate
macrophages to release NO and induce mRNA transcription of Th1 cytokines, thereby enhancing the cell
mediated immune response.
•Monoclonal antibodies (MAbs), antiserum and IgA secreted from the gut mucosa against the Gal-Lectin
antigen, have the ability to inhibit E. histolytica adherence to colonic mucosa in vitro.

IgA, MAb, antiserum Macrophage

Key
NO Activate
Attack
Inhibit
Trophozoite Cytokines
e.g INF-γ Mucosa
epithelial cell
Gal-lectin

Th1 cell
LAB LESSONS
 Laboratory lessons: Stool
microscopy
• Stool microscopy, due to its low cost and
capacity for detecting different parasitic
protozoa and
• helminths in the same assay, will continue
to play an essential role in supporting the
physicians in the diagnosis of intestinal
parasitism
 Laboratory lessons of protozoan
infections
• Trophozoites and cysts of the intestinal amoebae,
flagellates and ciliates can be found and identified
best in permanently stained faecal smears.
• Trophozoite stages are most often found in
watery or diarrhoeic faecal specimens and usually
cysts are not seen in such specimens.
• Cysts are the stage typically found in formed
faecal specimens. A mixture of trophozoites and
cysts may occur in softer and semi-formed
faeces.
 Materials and reagents

• 1. Adhesive tape
• 2. Applicator sticks, wooden
• 3. Bottles, 1000 ml
• 4. Labels
• 5. Pen or marker for labeling
• 6. Vials, 20 ml, with tight-fitting screw-caps
• 7. 10% formalin (formaldehyde)
 procedure to perform the direct
smear
• With a wax pencil or other marker, write
the patient’s name or identification number
and the date at the left-hand side of the
slide. Place a drop of saline in the centre
of the left half of the slide and place a drop
of iodine in the centre of the right half of
the slide. (Note: iodine wet mount
preparations are most useful for protozoan
organisms, less so for helminths.)
• With an applicator stick or match, pick up
a small portion of faeces
• (approximately 2 mg which is about the
size of a match head) and add it to the
drop of saline: repeat and add it to the
drop of iodine. Mix the faeces with the
drops to form suspensions
• Cover each drop with a coverslip by
holding the coverslip at an angle,
touching the edge of the drop, and
gently lowering the coverslip onto the
slide so that air bubbles are not
produced.
• (Note: ideal preparations containing 2 mg
of faeces are uniform - not so thick that
faecal debris can obscure organisms, nor
so thin that blank spaces are present.)
• Examine the preparations with the 10X
objective or, if needed for identification,
higher power objectives of the microscope
in a systematic manner so that the entire
coverslip area is observed.
• When organisms or suspicious objects
are seen, one may switch to higher
magnification to see the more detailed
morphology of the object in question.
 Protozoan saline test
• In saline mounts, trophozoites and cysts of
amoebae (cysts of Isospora belli) and
flagellates may be seen. Cysts will appear as
round or oval, refractile structures;
• the trophozoites of amoebae may be round
or irregular; the trophozoites of flagellates are
usually pyriform (elongated, pear-shaped).
• In freshly passed faeces (the stool must not
be more than an hour old), motile
trophozoites may be seen.
• Motility can be very helpful in identifying
species, especially in the case of flagellates.
• A motile amoebic trophozoite containing red
blood cells is immediately identifiable as E.
histolytica.
• Motile amoebic trophozoites that do not
contain ingested erythrocytes are more
difficult to classify and are best diagnosed in
permanently stained smears as all cysts are
observed.
• Although experienced technologists can often
identify species accurately in wet mount
faecal preparations, permanently stained
smears are superior to saline- or iodine-
stained wet mounts.
 Formaline-ether Concentration
method
• formalin-ether/ethyl-acetate/gasoline
concentration procedure
• With an applicator stick, add 1.0 to 1.5 g faeces
to 10 ml formalin in a centrifuge tube, stir, and
bring into suspension.
• Strain suspension through the 400 µm mesh
sieve or 2 layers of wet surgical gauze directly
into a different centrifuge tube or into a small
beaker. Discard the gauze.
 Formaline-ether Concentration
method
• Add more 10% formalin to the suspension in the
tube to bring the total volume to 10 ml .
• Add 3.0 ml of formalin-ether (or ethyl-
acetate or gasoline) to the suspension in
the tube and mix well by putting a rubber
stopper in the tube and shake vigorously
for
10 seconds.
• Place the tube with the stopper removed
in centrifuge; balance the tubes and
centrifuge at 400-500 x g for 2-3
minutes.
• Remove the tube from the centrifuge;
the contents consist of 4 layers: (a) top
layer of formalin-ether (or ethyl-acetate
or gasoline);
• (b) a plug of fatty debris that is adherent
to the wall of the tube;
• (c) a layer of formalin, and (d) sediment.
• Gently loosen the plug of debris with an
applicator stick by a spiral movement
and pour off the top 3 layers in a single
movement, allowing to drain inverted for
at least five second.

• When done properly, a small amount of

residual fluid from the walls of the tube
will flow back onto the sediment.
• Mix the fluid with the sediment (sometime it is
necessary to add a drop of saline to have sufficient
fluid to suspend the sediment) with a disposable
glass pipette.
• Transfer a drop of the suspension to a slide for
examination under a coverslip; an iodine-stained
preparation can also be made.
• Examine the preparations with the 10X objective or,
if needed for identification, higher power objectives
of the microscope in a systematic manner so that
the entire coverslip area is observed.
• When organisms or suspicious objects are seen,
one may switch to higher magnification to see more
detailed morphology of the material question.
 Laboratory lessons of
protozoan infections

• Trophozoites and cysts of the intestinal amoebae, flagellates and

ciliates can be found and identified best in permanently stained
faecal smears.
• Trophozoite stages are most often found in watery or diarrhoeic
faecal specimens and usually cysts are not seen in such
specimens.
• Cysts are the stage typically found in formed faecal specimens. A
mixture of trophozoites and cysts may occur in softer and semi-
formed faeces.
 Life cycle and transmission 1
• Entammoeba histolytica has a biphasic life cycle, existing in
two forms; as an infectious cyst and an amoeboid trophozoite

Mouth - Cyst
ingested Excyst to trophozoite
Passed in stool

Amoebic
disease
Cys Trophozoit
t e

Invades gut mucosa – cyst

formation
Introduction Disease biology Epidemiology Clinical Summary
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Pathogenesis 2
Hepatic Pathology
Causative • Trophozoites invading the colonic mucosa may enter the hepatic
Organism circulation and reach the liver
•Well circumscribed abscesses are
Life Cycle and formed in the liver containing
transmission 1 liquefied cells surrounded by
inflammatory cells and trophozoites
Life Cycle and
•Adjacent parenchyma is usually
transmission 2 unaffected
Amoebic liver abscess
Pathogenesis 1

Pathogenesis 2

Self Assessment

Histological cross section of classical flask Amoebic colitis with multiple ulcer formation
shaped amoebic ulcer in colonic mucosa.
 Limitations of microscopy fecal
examination

• Excretion of the cyst of E. histolytica is

intermittent,
• At least three specimens on separate days are
required to minimize the presence of false
negatives
• The differentiation of E. histolytica from other
cells in faeces is tedious
• Frequently leukocytes in the stool are mistakenly
• identified as E. histolytica
• More sensitive have been used…
• PCR to distinguish Entamoeba hystolitica
from
• E. dispar in formalin fixed faecal samples
• Entamoeba hystolitica/dispar
• E. dispar
• E. hystolitica
• negative controls
Emmuno-enzymatic-assay (ELIZA)
• The technique,
• which they named ENZYMEBA, is based on
• immuno-enzymatic capture of histolysaine, a
cysteine
• proteinase of E. histolytica first described by
• AL Luaces and AJ Barret (1988 Biochem J 250:
• 903-907). Taking into account the advantages of
• ENZYMEBA method, included its ability to
perform
• Amebiasis (Entamoeba histolytica/dispar)
• • There are two morphologically indistinguishable
• amoebas:
1. Entamoeba histolytica the pathogenic species
2. Entamoeba dispar the non-pathogenic or low
pathogenic
• species
• • These two species can be easily distinguished
• between them only by molecular or biochemical
• methods
Diagnosis of Entamoeba histolytica
• Microscopical examination of faeces is the
most widely used laboratory method for
the diagnosis of intestinal amoebiasis
• Entamoeba histolytica exist as complex
• of two species morphologically identical
• with different pathogenecity,
1. Entamoeba histolytica, and
2. Entamoeba dispar.
• Stool microscopy, due to its low cost and
capacity for detecting different parasitic
protozoa and
• helminths in the same assay, will continue
to play an essential role in supporting the
physicians in the diagnosis of intestinal
parasitism
• Accordingly,
• the improvement of the technician’s
competence
• to execute the microscopical
examination of faeces
• remains a necessary approach to the
reduction of the overdiagnosis of
intestinal amoebiasis
• Diagnostic procedures to be performed at different levels
•
• Level 1: Peripheral level
•
• Smear examination for intestinal protozoa and Helminths
• Smear examination for P. carinii
• Smear examination for Cryptosporidia
•
• Level 2: Intermediate level (regional hospital, provincial hospital
/university)
•
• Histopathology for P. carinii, T. gondii
• Antigen demonstration
• Special stains for Microsporidia, Cryptosporidia,
• Cyclospora, Isospora, P. carinii and T. gondii
•
• Level 3: Central level (reference laboratories and centres of excellence)
•
• Demonstration of antigen by ELISA, PCR and probes
• Strain differentiation
 Assurance and Quality Control
• To ensure accurate and reliable results, good laboratory
practices must be applied to laboratory procedure for
diagnosing parasitic infections.
• Quality assurance must apply to collection of specimens,
preparation of reagents, performance of the techniques,
examination of the preparations and reporting.
• National level laboratories may be motivated to organize
National External Quality Assessment Schemes for
strengthening the quality assurance programme
especially Internal Quality Control for the
regional/peripheral laboratories.
• Organisms may be detected with the low-power 10x
objective, but a high-power, dry objective will be necessary
to reliably identify the structure as a cyst or trophozoite.
• With the high-power, dry objective, you can see motility,
inclusions like erythrocytes and yeast in amoebic
trophozoites, chromatoid bodies in amoebic cysts, and the
shape and structural details (e.g. sucking discs, spiral
grooves, or filaments) of flagellate trophozoites and cysts
• Oocysts of Isospora belli are ellipsoidal, 22-33 x 12-15 µ m
size, containing two sporocysts each. You will not be able
to see any detail in the nucleus in saline mounts.
• However, it is necessary to regulate the microscope
illumination carefully so that the objects appear clearly. Too
much or too little light will interfere with your observations.
• It is also necessary to focus up and down to see all the
layers (levels) of the specimen.
• Remember to examine the whole coverslip area in a
systematic manner to reduce the chances of overlooking
organisms.
• Technique
•
• 1. Label two 20-ml vials with patient’s name or number. Write F in
the upper right-hand corner of the label on one vial.
• 2. Fill the "F" vial about half full with 10% formalin.
• 3. With an applicator stick, pick up a portion of the stool to
include areas from the inside and edges of the sample and mix with
the 10% formalin. Be sure to mix very well; break up lumps. Use
enough, but not too much stool so that the mixture will occupy about
2/3 to 3/4 of the vial.
• 4. Screw the caps of the vials securely. Wrap a piece of adhesive
tape around the top of each vial to prevent leaking.
• 5. Pack the vials carefully in a box or shipping container and
send to the reference laboratory. Be sure that the vials are
surrounded by absorbent materials (e.g. cotton wool, newspaper)
and are packed so they will not break.
• 6. Be sure to include the necessary information: patient’s name
or number, date of shipping, organisms you found.
 Materials and reagents

• 1. Adhesive tape
• 2. Applicator sticks, wooden
• 3. Bottles, 1000 ml
• 4. Labels
• 5. Pen or marker for labeling
• 6. Vials, 20 ml, with tight-fitting screw-caps
• 7. 10% formalin (formaldehyde)
 Reporting procedure

•
• Reporting should include appearance of specimen:
•
• Consistency
• Blood, mucus, pus
• Worms or worm fragments
•
• The written report should include WBCs, erythrocytes,
and organisms detected. The written report should be
submitted within 24-72 hours. In urgent cases the result
should be reported immediately by telephone (if
available) or personally.
• Iodine wet mount
• Iodine mounts are examined for protozoa and coccidian cysts. They
can be detected with the 10x objective, but they are not as refractile
as in saline mounts. High-power dry magnification must be used to
see the characteristics of the cysts and they must be measured to
ensure correct identification. In the iodine mount, cytoplasm of the
cysts will stain yellow or light brown and nuclei will stain dark brown.
• In iodine-stained cysts of Entamoeba, the arrangement of the
peripheral chromatin and the position of the karyosome can be
seen. (If the peripheral chromatin is not present, the cyst is not
Entamoeba species.) These peripheral chromatoid bodies stain light
yellow and may not be very clear. Sometimes, young cysts contain
glycogen; this stains dark brown with iodine.
QUESTIONS
2. Explain why it is important to understand amoeba commensals in
the study of intestinal amoebiasis. Give three species names of
such commensals
• Which is the main characteristics for differentiating different species
of amoeba
• a) Karyosome, b) Nucleus, c) endoplasma, d) ectoplasma
3. Karyosome in Entamoeba coli is: a) Centrally located and small, b)
eccectric located and large c) Large on peripheral, d) Small on the
peripheral
4. Which of the following amoeba species has no cyss? A) Dietamoeba
fragilis. B) Iodamoeba bueschlii, c) Endolimax nana, d) Entamoiba
polecki
5.Entamoeba gingivalis ……………..is the only alimentary canal
amoeba of the buccal cavity of humans
cvcv cvcv cvcv cvcv cvcv

Questions

1) Which of the following organisms is the pathogenic causitive

agent of amoebiasis, and which is a commensal?
• Entamoeba histolytica ………………………………………….
• Entamoeba dispar ……………………………………………….
2) Draw a simple diagram oulining the life cycle of entamoeba
histolytica.
3) Which two organs does E. histolytica primarily invade?
4) What is the name and mechanism of action of the peptide
responsible for cell lysis and apoptosis in the mucosa?
5) What is the name of the enzyme group released by
trophozoites to digest the extra-cellular matrix
Which cvcv cvcv
of the following organisms cvcv
is the pathogenic cvcv
causitive cvcv
agent of amoebiasis,
Answers
and which is a commensal?
Entamoeba histolytica ……………Pathogen…………….
Entamoeba dispar ……………Commensal……………….
Draw a simple diagram oulining the life cycle of entamoeba histolytica.
Mouth - Cyst
ingested Excyst to
Passed in
stool trophozoite

Amoebic
disease
C Troph
y ozoite
st
Invades gut mucosa –
cyst formation

) Which two organs does E. histolytica primarily invade?

Colon and liver
What is the name and mechanism of action of the peptide responsible for cell lysis
and apoptosis in the mucosa?
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Questions
1) How many deaths are caused by amoebiasis each year?
a) 1000 – 5000 b) 40,000-100,000 c) 500,000-1,000,000

2) Which part of the world is amoebiasis primarily found?

a) Developed countries b) Tropical and subtropical c)Cold climates

3) Does amoebiasis affect males or females more?

4) Apart from poor sanitation, what other risk factor pre-dispose to amoebiasis
infection?
Introduction Disease biology Epidemiology Clinical Summary
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Answer
1) How many deaths are caused by amoebiasis each year?
a) 1000 – 5000 b) 40,000-100,000 c) 500,000-1,000,000

2) Which part of the world is amoebiasis primarily found?

a) Developed countries b) Tropical and subtropical c)Cold climates

3) Does amoebiasis affect males or females more?

Thought to affect both sexes equally, however, anecdotal evidence
suggests a male predominance.
4) Apart from poor sanitation, what other risk factor pre-dispose to amoebiasis
infection?
Other risk factors include oral and anal sex, and contact with contaminated
enema apparatus.
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Questions
1) What are the symptoms of gastrointestinal amoebiasis?
2) What are the symptoms of hepatic amoebiasis?
3) What investigations can be performed to confirm a diagnosis?
4) Name two drugs and dosage regimes that can be used to treat amoebiasis.
5) Is the following statement true or false?
“chlorine and iodine can be used to decontaminate water of E.histolytica with 100%
effectiveness”
7) Does Gal-lectin induce a Th1 or Th2 cell mediated immune response?
cvcv cvcv cvcv cvcv cvcv
Answers
1) What are the symptoms of gastrointestinal amoebiasis?
Gradual onset (weeks) of bloody diarrhoea, abdominal pain and tenderness, fever present in <40% of patients, weight
loss and anorexia, amoebomas, may cause obstructive symptoms.
2) What are the symptoms of hepatic amoebiasis?
Sudden onset of upper abdominal pain with fever. Pain may radiate to right shoulder or be exacerbated by repiratory
movements.
Hepatic tenderness may be present. Jaundice is unusual
3) Why is a good travel history important in diagnosis of amoebiasis?
A good travel history is vital to ascertain whether a patient has visited an endemic area. The disease may develop
over a year after travel.
4) What investigations can be performed to confirm a diagnosis?
Demonstration of E. histolytica in stool by microscopy (old), or ELISA assay for antigen detection. Colonoscopy may be
performed to check for colitis and biopsy. Check for liver abscess with USS or CT.
5) Name two drugs and dosage regimes that can be used to treat amoebiasis.
Nitroimidazole (e.g.metronidazole)– 800mg t.d.s for 10 days. This is followed by a luminal agent (e.g.diloxanide
furoate) 500mg t.d.s for 10 days.
6) Is the following statement true or false?
“chlorine and iodine can be used to decontaminate water of E.histolytica with 100% effectiveness”
Boiling is the most effective methos for water decontamination
7) Does Gal-lectin induce a Th1 or Th2 cell mediated immune response?
Th1 cell mediated response