Amoebic dysentry

Dr. Tjatur Winarsanto SpPD RST Ciremai Cirebon

Introduction
1. The only pathogenic amoeba among all of the intestinal amoebae 2. Infecting perhaps 10% of the world's population. 3. Lead to invasive amoebiasis.

Entamoeba histolytica Entamoeba dispar

Major pathogen
world-wide distribution (10%) 5% in some developed countries 100 deaths in Chicago 1930

Trophozoite & Cyst

oral-faecal transmission

Trophozoite (active form)

(1) Size: 10-40 micrometers in diameter, some are above 60 micrometers. (2) Pseudopodium(ectopalsmic protrusion): A. broad or finger-like in form B. thrust out quickly C. firstly, formed with ectoplasm, secondly, endoplasm flows slowly into it. D. motility is progressive and directional.

Trophozoite (active form)

(3) Endoplasm: red blood cells may be found in it. (4) Nucleus (vesicular type) It is not visible in an unstained specimen; but its clear structure can be seen when stained with hematoxylin. A: membrane: distinct line B: chromatin granules: fine and uniformly arranged in the inner surface of the nuclear membrane. C: karyosome: small and centrally located.

Cyst (non-motile)
(1) 10-20 mocrometers in size (2) spherical in shape (3) 1-2 nuclei (immature cyst); 4 nuclei (mature cyst-infective stage). (4) inclusions:(become smaller and smaller as the cyst ages) glycogen vacuole appears as a clear space; food reservoir chromatoid body dark blue rods or dots; its function is not known

The single nucleus with its central endosome and regularly distributed chromatin is visible. The dark "rods" in the cytoplasm are the chromatoid bars; approximate size = 18 m.

This is a mature cyst and contains four nuclei. However, only two nuclei are visible in this plane of focus, and a chromatoid bar is still present; approximate size = 17 m.

Life Cycle

1 infective stage: mature cyst 2 access: mouth 3 ecological niches: large intestine; liver, lung and other organs. 4 pathogenic stage: trophozoite 5 diagnostic stage: cyst; trophozoites

Pathogenic factors

1. Toxicity of parasites pathogenicnonpathogenic complex. Entamoeba histolytica Entamoeba dispar 2. Symbiotic bacteria 3. Defence barrier immunity

Pathology and Clinical Manifestation

Pinpoint lesion on mucous membrane Flask-shaped crateriform ulcers

Clinical classification

Asymptomatic infection (carrier) >90% cases (E. dispar?) Sympomatic cases <10%
8-10% dysentery, colitis, etc 2% invasive amoebiasis 0.1% deaths

A. Intestinal amoebiasis

a. dysentery: dysenteric stools (pus and blood without feces). fever, dehydration, and electrolyte abnormalities. Tenesmus and abdominal tenderness. b. non-dysenteric colitis c. appendicitis d. amoeboma:may become the leading point of an intussusception or may cause intestinal obstruction.

B. Extra-intestinal amoebiasis

a. Hepatic (1) acute non-suppurative (2) liver abscess: right upper quadrant pain, referred to the right shoulder. tender. b. Pulmonary

B. Extra-intestinal amoebiasis

c. Brain d. Skin, perianal infection e. Other extra-intestinal amoebiasis

Diagnosis
1.Stool examination
trophozoite
specimen

cyst

feces
direct smear with normal saline amoebic dysentery

feces
direct smear with iodine stain chronic intestinal amoebiasis or carriers

method

diseases

remarks

1.container must clean 2.examined soon after they 4.keep specimen warm. have been passed. 3.select bloody and 5.drug using histry. mucous portion.

Diagnosis

2. Serologic studies: indirect hemagglutination, skin tests, ELISA and latex agglutination. 3. Tissue examination: sigmoidoscopic biopsy, aspiration 4. DNA probe

Treatment and Prevention

Treatment:

Diodoquin-carriers Metronidazole-dysentery, liver abscess

Prevention

Human feces should not be used as fertilizer Food and drinks must be protected from flies Personal hygiene: wash hands after defecation and before meals.