溶组织内阿米巴

溶组织内阿米巴
Entamoeba histolytica
     
流实致生形前
行验病活态言
与诊 史
防断
治

山东大学寄生虫学教研室
何深一
 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
 Morphology

 Payyour attention to stages that have

diagnostic value
Parasites stained with hematoxylin is
described here.
 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.
Phase contrast photomicrograph of cultured
Entamoeba histolytica trophozoites.
 Charcot Leyden Crystal
 These diamond shaped
crystals are often seen
in amoebic dysentery
faeces and may also be
present in other
parasitic infections.
They are absent in
bacillary dysentery.
Interference contrast.
×400. Enlarged by 9.6
Movement of E. histolytica
进行性和定向阿米巴运动
progressive and directional
 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
µm.
 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 µm.
 Entamoeba coli
 Gut commensal
 Trophozoite & cyst
 Slow “lazy” movement
 Oral-faecal transmission
 E. histolytica v E. coli
 Trophozoite
– 10-40um – 15-30um
– delicate nuclear – coarse nuclear
structure structure
 Cyst
– 9.5-15.5um – 10-30um
– 4 nuclei – 8 nuclei
– Broad, blunt chromatid – thin, sharp chromatid
bodies bodies
Entamoeba coli
Entamoeba coli
 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 pathogenic-

nonpathogenic complex.
 Entamoeba histolytica
Entamoeba dispar
 2. Symbiotic bacteria
 3. Defence barrier immunity
 This cytolytic
event is a result of
incorporation in
the host cell
membrane of an
ameba-produced,
pore-forming
protein,
Amoebapore.

This protein forms ion channels in lipid cell membranes and results in cell
death within minutes of cell contact with the ameba. Amoebapore has been
isolated, synthesized and well characterized. Non-pathogenic strains of E.
histolytica can also produce amoebapore but are much less efficient at its
production and the molecule is not exactly similar to that produced by virulent
strains.
 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.
Histopathology of a typical
flask-shaped ulcer of
intestinal amebiasis
 A Micro Abscess in the
submucosa .
 Containing a large
number of E.
histolytica
trophozoites mostly
at the periphery .H
and E. ×400.
Enlarged by 5.4.
 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
Amoebic Liver Abscess
 Gross pathology of liver
containing amebic abscess 
Gross pathology of amebic abscess of
liver. Tube of "chocolate" pus from
abscess. 
 An Amoebic Liver Abscess
Being Aspirated.
 Note the reddish
brown color of the pus
(‘anchovy-sauce’).
This color is due to the
breakdown of liver
cells. Enlarged by 5.4
X-ray of a Large Amoebic Liver
Abscess.
A fluid level
has formed
after aspiration
due to entry of
air
 Diagnosis
1.Stool examination
trophozoite cyst

feces feces
specimen

method direct smear with normal direct smear with iodine

saline stain

diseases chronic intestinal

amoebic dysentery
amoebiasis or carriers
1.container must clean
2.examined soon after they 4.keep specimen warm.
remarks
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
 Epidemiology

 Distribution: all climates, arctic to tropical.

Media: flies; black beetles etc.
 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.