Amoebic dysentry

Dr. Tjatur Winarsanto SpPD

RST Ciremai
Cirebon

Introduction
1. The only pathogenic amoeba among al
l of the intestinal amoebae
2. Infecting perhaps 10% of the world's p
opulation.
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 a

re above 60 micrometers.
(2) Pseudopodium(ectopalsmic protrusion):
A. broad or finger-like in form
B. thrust out quickly
C. firstly, formed with ectoplasm, secondly, e
ndoplasm 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 cy
st-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 fun
ction is not known

The single nucleus wi

th its central endosom
e and regularly distrib
uted chromatin is visi
ble. The dark "rods" i
n the cytoplasm are th
e chromatoid bars; ap
proximate size = 18
m.

This is a mature cys

t and contains four
nuclei. However, o
nly two nuclei are v
isible in this plane
of focus, and a chro
matoid bar is still p
resent; approximate
size = 17 m.

Life Cycle
1

infective stage: mature cyst

2 access: mouth
3 ecological niches: large intestine; liver, l
ung 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% cas

es (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 w
ithout feces). fever, dehydration, and electrolyte ab
normalities. Tenesmus and abdominal tenderness.
b. non-dysenteric colitis
c. appendicitis
d. amoeboma:may become the leading point of
an intussusception or may cause intestinal obst
ruction.

B. Extra-intestinal amoebias
is
a. Hepatic
(1) acute non-suppurative
(2) liver abscess: right upper quadrant pa
in, referred to the right shoulder. tender.
b. Pulmonary

B. Extra-intestinal amoebias
is
c. Brain
d. Skin, perianal infection
e. Other extra-intestinal amoebiasis

Diagnosis
1.Stool examination

specimen
method

diseases

remarks

trophozoite

cyst

feces

feces

direct smear with normal

saline

direct smear with iodine

stain

amoebic dysentery

chronic intestinal
amoebiasis or carriers

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 hemagglutina

tion, skin tests, ELISA and latex agglutinati
on.
3.Tissue examination: sigmoidoscopic bio
psy, 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 flie
s
Personal hygiene: wash hands after defecat
ion and before meals.