Entamoeba histolytica: Difference between revisions

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|width="400pt" align="center"| 'Ring and dot' nucleus and chromatoid bodies
|width="400pt" align="center"| 'Ring and dot' nucleus and chromatoid bodies
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==Differential diagnosis==
Entamoeba histolytica must be differentiated from other causes of viral, bacterial, and parasitic gastroentritis.
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
! colspan="3" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;"|Organism
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;"|Age predilection
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;"|Travel History
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;"|Incubation Size (cell)
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;"|Incubation Time
! colspan="3" align="center" style="background:#4479BA; color: #FFFFFF;"|History and Symptoms
! colspan="4" align="center" style="background:#4479BA; color: #FFFFFF;"|Diarrhea type8
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;"|Food source
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;"|Specific consideration
|-
!style="background:#4479BA; color: #FFFFFF|Fever
!style="background:#4479BA; color: #FFFFFF|N/V
!style="background:#4479BA; color: #FFFFFF|Cramping Abd Pain
!style="background:#4479BA; color: #FFFFFF|Small Bowel
!style="background:#4479BA; color: #FFFFFF|Large Bowel
!style="background:#4479BA; color: #FFFFFF|Inflammatory
!style="background:#4479BA; color: #FFFFFF|Non-inflammatory
|-
| rowspan="4" align="center" style="background:#4479BA; color: #FFFFFF;"|'''Viral'''
| colspan="2"  style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Rotavirus]]
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |<2 y
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |<10<sup>2</sup>
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |<48 h
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Mostly in day cares, most common in winter.
|-
| colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Norovirus]]
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Any age
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |10 -10<sup>3</sup>
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |24-48 h
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Most common cause of gastroenteritis, abdominal tenderness,
|-
| colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Adenoviridae|Adenovirus]]
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |<2 y
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |10<sup>5</sup> -10<sup>6</sup>
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |8-10 d
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |No seasonality
|-
| colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Astrovirus]]
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |<5 y
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |72-96 h
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Seafood
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Mostly during winter
|-
| rowspan="11" align="center" style="background:#4479BA; color: #FFFFFF;"|'''Bacterial'''
| rowspan="5" style="padding: 5px 5px; background: #DCDCDC;" align="center" |''[[Escherichia coli]]''
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[ETEC]]
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Any age
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |10<sup>8</sup> -10<sup>10</sup>
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |24 h
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Causes travelers diarrhea, contains heat-labile toxins (LT) and heat-stable toxins (ST)
|-
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[EPEC]]
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |<1 y
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |10<sup>†</sup>
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |6-12 h
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Raw beef and chicken
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|-
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[EIEC]]
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Any ages
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |10<sup>†</sup>
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |24 h
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Hamburger meat and unpasteurized milk
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Similar to [[shigellosis]], can cause bloody diarrhea
|-
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[EHEC]]
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Any ages
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |10
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |3-4 d
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Undercooked or raw hamburger (ground beef) 
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Known as ''[[Escherichia coli O157:H7|E. coli]]'' [[Escherichia coli O157:H7|O157:H7]], can cause [[Hemolytic-uremic syndrome|HUS]]/[[TTP]].
|-
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[EAEC]]
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Any ages
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |10<sup>10</sup>
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |8-18 h
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |May cause prolonged or persistent diarrhea in children
|-
| colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |''[[Salmonella|Salmonella sp.]]''
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Any ages
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |1
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |6 to 72 h
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Meats, poultry, eggs, milk and dairy products, fish, shrimp, spices, yeast, coconut, sauces, freshly prepared salad.
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Can cause [[salmonellosis]] or [[typhoid fever]].
|-
| colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |''[[Shigella|Shigella sp.]]''
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Any ages
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |10 - 200
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |8-48 h
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Raw foods, for example, lettuce, salads (potato, tuna, shrimp, macaroni, and chicken)
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Some strains produce enterotoxin and Shiga toxin similar to those produced by E. coli O157:H7
|-
| colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |''[[Campylobacter|Campylobacter sp.]]''
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |<5 y, 15-29 y
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |10<sup>4</sup>
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |2-5 d
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Undercooked poultry products, unpasteurized milk and cheeses made from unpasteurized milk, vegetables,  seafood and contaminated water.
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |May cause [[bacteremia]], [[Guillain-Barré syndrome]] (GBS), [[Hemolytic-uremic syndrome|hemolytic uremic syndrome]] (HUS) and recurrent [[colitis]]
|-
| colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |''[[Yersinia enterocolitica]]''
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |<10 y
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |10<sup>4</sup> -10<sup>6</sup>
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |1-11 d
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Meats (pork, beef, lamb, etc.), oysters, fish, crabs, and raw milk.
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |May cause [[reactive arthritis]]; [[glomerulonephritis]]; [[endocarditis]]; [[erythema nodosum]].
can mimic [[appendicitis]] and mesenteric [[lymphadenitis]].
|-
| colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |''[[Clostridium perfringens]]''
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Any ages
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |> 10<sup>6</sup>
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |16 h
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Meats (especially beef and poultry), meat-containing products (e.g., gravies and stews), and Mexican foods.
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Can survive high heat,
|-
| colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |''[[Vibrio cholerae]]''
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Any ages
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |10<sup>6</sup>-10<sup>10</sup>
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |24-48 h
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Seafoods, including molluscan shellfish (oysters, mussels, and clams), crab, lobster, shrimp, squid, and finfish.
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Hypotension]], [[tachycardia]], decreased [[Turgor|skin turgor]]. Rice-water stools
|-
| rowspan="7" align="center" style="background:#4479BA; color: #FFFFFF;"|'''Parasites'''
| rowspan="4" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Protozoa
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |''[[Giardia lamblia]]''
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |2-5 y
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |1 cyst
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |1-2 we
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Contaminated water
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |May cause [[malabsorption syndrome]] and severe [[weight loss]]
|-
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |''[[Entamoeba histolytica]]''
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |4-11 y
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |<10 cysts
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |2-4 we
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Contaminated water and raw foods
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |May cause intestinal amebiasis and amebic liver abscess
|-
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |''[[Cryptosporidium parvum]]''
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Any ages
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |10-100 oocysts
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |7-10 d
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Juices and milk
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |May cause copious diarrhea and [[dehydration]] in patients with [[AIDS]] especially with  180 > [[CD4|CD<sub>4</sub>]]
|-
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |''[[Cyclospora cayetanensis]]''
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Any ages
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |10-100 oocysts
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |7-10 d
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Fresh produce, such as raspberries, basil, and several varieties of lettuce.
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |More common in rainy areas
|-
| rowspan="3" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Helminths
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |''[[Trichinella]]'' [[Trichinella|spp]]
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Any ages
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Two viable larvae (male and female)
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |1-4 we
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Undercooked meats
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |More common in hunters or people who eat traditionally uncooked meats
|-
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |''[[Taenia (tapeworm)|Taenia]]'' [[Taenia (tapeworm)|spp]]
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Any ages
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |1 larva or egg
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |2-4 m
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Undercooked beef and pork
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Neurocysticercosis]]: Cysts located in the brain may be asymptomatic or [[seizures]], increased [[intracranial pressure]], [[headache]].
|-
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |''[[Diphyllobothrium|Diphyllobothrium latum]]''
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Any ages
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |1 larva
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |15 d
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Raw or undercooked fish.
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |May cause vitamin B<sub>12</sub> deficiency
|}
<br><br>
<small><small>
8'''Small bowel diarrhea''': watery, voluminous with less than 5 WBC/high power field
'''Large bowel diarrhea''': Mucousy and/or bloody with less volume and more than 10 WBC/high power field<br>
† It could be as high as 1000 based on patient's immunity system.
</small></small>
'''The table below summarizes the findings that differentiate inflammatory causes of chronic diarrhea'''<ref name="pmid8209928">{{cite journal| author=Konvolinka CW| title=Acute diverticulitis under age forty. | journal=Am J Surg | year= 1994 | volume= 167 | issue= 6 | pages= 562-5 | pmid=8209928 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8209928  }} </ref><ref name="pmid16151544">{{cite journal| author=Silverberg MS, Satsangi J, Ahmad T, Arnott ID, Bernstein CN, Brant SR et al.| title=Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. | journal=Can J Gastroenterol | year= 2005 | volume= 19 Suppl A | issue=  | pages= 5A-36A | pmid=16151544 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16151544  }} </ref><ref name="pmid16698746">{{cite journal| author=Satsangi J, Silverberg MS, Vermeire S, Colombel JF| title=The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications. | journal=Gut | year= 2006 | volume= 55 | issue= 6 | pages= 749-53 | pmid=16698746 | doi=10.1136/gut.2005.082909 | pmc=1856208 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16698746  }} </ref><ref name="pmid12700377">{{cite journal| author=Haque R, Huston CD, Hughes M, Houpt E, Petri WA| title=Amebiasis. | journal=N Engl J Med | year= 2003 | volume= 348 | issue= 16 | pages= 1565-73 | pmid=12700377 | doi=10.1056/NEJMra022710 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12700377  }} </ref><ref name="pmid12700377">{{cite journal| author=Haque R, Huston CD, Hughes M, Houpt E, Petri WA| title=Amebiasis. | journal=N Engl J Med | year= 2003 | volume= 348 | issue= 16 | pages= 1565-73 | pmid=12700377 | doi=10.1056/NEJMra022710 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12700377  }} </ref>
{| class="wikitable"
!Cause
!History
!Laboratory findings
!Diagnosis
!Treatment
|-
|[[Diverticulitis]]
|
* [[Bloody diarrhea]]
* Left lower quadrant [[abdominal pain]]
* [[Abdominal tenderness]] on [[physical examination]]
* Low grade [[fever]]
|
* [[Leukocytosis]]
* Elevated serum [[amylase]] and [[lipase]]
* [[Sterile]] [[pyuria]] on [[urinalysis]]
|Abdominal [[CT scan]] with oral and intravenous [[Contrast medium|(IV) contrast]]
|bowel rest, [[Intravenous fluids|IV fluid]] resuscitation, and [[Broad-spectrum antibiotic|broad-spectrum antimicrobial therapy]] which covers [[Anaerobic organism|anaerobic]] [[bacteria]] and [[gram-negative]] [[Bacteria|rods]]
|-
|[[Ulcerative colitis]]
|
* [[Diarrhea]] mixed with blood and [[mucus]], of gradual onset.
* Signs of [[weight loss]]
* [[Rectal pain|Rectal urgency]]
* [[Tenesmus]]
* [[Blood]] is often noticed on underwear
* Different degrees of [[abdominal pain]]
|
* [[Anemia]]
* [[Thrombocytosis]]
* A high [[platelet]] count
* Elevated [[ESR]] (>30mm/hr)
* Low [[albumin]]
|[[Endoscopy]]
|Induction of  [[Remission (medicine)|remission]] with [[mesalamine]] and [[corticosteroids]] followed by the administration of [[sulfasalazine]] and [[Mercaptopurine|6-Mercaptopurine]] depending on the severity of the [[disease]].
|-
|[[Entamoeba histolytica]]
|
* [[Abdominal cramps]]
* [[Diarrhea]]
** Passage of 3 - 8 semiformed [[stools]] per day
** Passage of soft [[stools]] with [[mucus]] and occasional [[blood]]
* [[Fatigue]]
* [[Intestinal]] gas (excessive [[flatus]])
* [[Rectal pain]] while having a [[bowel movement]] ([[tenesmus]])
* Unintentional [[weight loss]]
|cysts shed with the stool
|detects ameba [[DNA]] in feces
|[[Amebic dysentery]]
* [[Metronidazole]] 500-750mg three times a day for 5-10 days
* [[Tinidazole]] 2g once a day for 3 days is an alternative to [[metronidazole]]
Luminal amebicides for ''[[E. histolytica]]'' in the [[colon]]:
* [[Paromomycin]] 500mg three times a day for 10 days
* [[Diloxanide furoate]] 500mg three times a day for 10 days
* [[Iodoquinol]] 650mg three times a day for 20 days
For [[Amoebiasis|amebic liver abscess]]:
* [[Metronidazole]] 400mg three times a day for 10 days
* [[Tinidazole]] 2g once a day for 6 days is an alternative to [[metronidazole]]
* [[Diloxanide furoate]] 500mg three times a day for 10 days must always be given afterwards.
|}
|}


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style="background:#Template:Taxobox colour;"|Entamoeba histolytica
Entamoeba histolytica cyst
Entamoeba histolytica cyst
style="background:#Template:Taxobox colour;" | Scientific classification
Domain: Eukaryota
Phylum: Amoebozoa
Class: Archamoebae
Genus: Entamoeba
Species: E. histolytica
Error creating thumbnail: File missing
Life-cycle of the Entamoeba histolytica
This page is about microbiologic aspects of the organism(s).  For clinical aspects of the disease, see Amoebiasis.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Jesus Rosario Hernandez, M.D. [2]

Overview

Entamoeba histolytica is a an anaerobic parasitic protozoan that is responsible for the development of amoebiasis.

Higher Order Classification

Cellular organisms; Eukaryota; Protista; Amoebozoa; Archamoebae; Entamoeba

Natural Reservoir

  • Usually humans (only)
  • Reports of animals as natural reservoirs of E. histolytica have been described.

Structure and Genome

  • The exact number of chromosomes in E. histolytica is still unknown.
  • The cysts of E. histolytica contain 4 nuclei with even distribution of chromatin between the nuclei.
  • The trophozoites are spherical/oval shaped with a thin cell membrane and a single nucleus.
  • E. histolytica is able to move using pseudopods.

Life Cycle

Life cycle of E. histolytica
Retrieved from the Centers for Disease Control and Prevention



  • Cysts and trophozoites are passed in human feces. Cysts are typically found in formed stool, whereas trophozoites are typically found in diarrheal stool.
  • Infection by Entamoeba histolytica occurs by ingestion of mature cysts in fecally contaminated food, water, or hands.
  • Excystation occurs in the small intestine and trophozoites are released, which migrate to the large intestine.
  • The trophozoites multiply by binary fission and produce cysts, and both stages are passed in the feces.
  • Because of the protection conferred by their walls, the cysts can survive days to weeks in the external environment and are responsible for transmission.
  • Trophozoites passed in the stool are rapidly destroyed once outside the body, and if ingested would not survive exposure to the gastric environment.
  • In many cases, the trophozoites remain confined to the intestinal lumen (A: noninvasive infection) of individuals who are asymptomatic carriers, passing cysts in their stool.
  • In some patients the trophozoites invade the intestinal mucosa (B: intestinal disease), or, through the bloodstream, extraintestinal sites such as the liver, brain, and lungs (C: extraintestinal disease), with resultant pathologic manifestations.
  • It has been established that the invasive and noninvasive forms represent two separate species, respectively E. histolytica and E. dispar. These two species are morphologically indistinguishable unless E. histolytica is observed with ingested red blood cells (erythrophagocystosis).
  • Transmission can also occur through exposure to fecal matter during sexual contact (in which case not only cysts, but also trophozoites could prove infective).

Microbiological Characteristics

Genus and Species Entamoeba histolytica
Etiologic Agent of: Amoebiasis; Amoebic dysentery; Extraintestinal Amoebiasis, usually Amoebic Liver Abscess = “anchovy sauce”); Amoeba Cutis; Amoebic Lung Abscess (“liver-colored sputum”)
Infective stage Cyst
Definitive Host Human
Portal of Entry Mouth
Mode of Transmission Ingestion of mature cyst through contaminated food or water
Habitat Colon and Cecum
Pathogenic Stage Trophozoite
Locomotive apparatus Pseudopodia (“False Foot”)
Motility Active, Progressive and Directional
Nucleus 'Ring and dot' appearance: peripheral chromatin and central karyosome
Mode of Reproduction Binary Fission
Pathogenesis Lytic necrosis (it looks like “flask-shaped” holes in Gastrointestinal tract sections (GIT)
Type of Encystment Protective and Reproductive
Lab Diagnosis Most common is Direct Fecal Smear (DFS) and staining (but does not allow identification to species level); Enzyme immunoassay (EIA); Indirect Hemagglutination (IHA); Antigen detection – monoclonal antibody; PCR for species identification. Culture: From faecal samples - Robinson's medium, Jones' medium
Treatment Metronidazole for the invasive trophozoites PLUS a luminal amoebicide for those still in the intestine (Paromomycin is the most widely used)
Trophozoite Stage
Pathognomonic/Diagnostic Feature Ingested RBC; distinctive nucleus
Cyst Stage
Chromatoidal Body 'Cigar' shaped bodies (made up of crystalline ribosomes)
Number of Nuclei 1 in early stages, 4 when mature
Pathognomonic/Diagnostic Feature 'Ring and dot' nucleus and chromatoid bodies

Differential diagnosis

Entamoeba histolytica must be differentiated from other causes of viral, bacterial, and parasitic gastroentritis.

Organism Age predilection Travel History Incubation Size (cell) Incubation Time History and Symptoms Diarrhea type8 Food source Specific consideration
Fever N/V Cramping Abd Pain Small Bowel Large Bowel Inflammatory Non-inflammatory
Viral Rotavirus <2 y - <102 <48 h + + - + + - Mostly in day cares, most common in winter.
Norovirus Any age - 10 -103 24-48 h + + + + + - Most common cause of gastroenteritis, abdominal tenderness,
Adenovirus <2 y - 105 -106 8-10 d + + + + + - No seasonality
Astrovirus <5 y - 72-96 h + + + + + Seafood Mostly during winter
Bacterial Escherichia coli ETEC Any age + 108 -1010 24 h - + + + + - Causes travelers diarrhea, contains heat-labile toxins (LT) and heat-stable toxins (ST)
EPEC <1 y - 10 6-12 h - + + + + Raw beef and chicken -
EIEC Any ages - 10 24 h + + + + + Hamburger meat and unpasteurized milk Similar to shigellosis, can cause bloody diarrhea
EHEC Any ages - 10 3-4 d - + + + + Undercooked or raw hamburger (ground beef)  Known as E. coli O157:H7, can cause HUS/TTP.
EAEC Any ages + 1010 8-18 h - - + + + - May cause prolonged or persistent diarrhea in children
Salmonella sp. Any ages + 1 6 to 72 h + + + + + Meats, poultry, eggs, milk and dairy products, fish, shrimp, spices, yeast, coconut, sauces, freshly prepared salad. Can cause salmonellosis or typhoid fever.
Shigella sp. Any ages - 10 - 200 8-48 h + + + + + Raw foods, for example, lettuce, salads (potato, tuna, shrimp, macaroni, and chicken) Some strains produce enterotoxin and Shiga toxin similar to those produced by E. coli O157:H7
Campylobacter sp. <5 y, 15-29 y - 104 2-5 d + + + + + Undercooked poultry products, unpasteurized milk and cheeses made from unpasteurized milk, vegetables, seafood and contaminated water. May cause bacteremia, Guillain-Barré syndrome (GBS), hemolytic uremic syndrome (HUS) and recurrent colitis
Yersinia enterocolitica <10 y - 104 -106 1-11 d + + + + + Meats (pork, beef, lamb, etc.), oysters, fish, crabs, and raw milk. May cause reactive arthritis; glomerulonephritis; endocarditis; erythema nodosum.

can mimic appendicitis and mesenteric lymphadenitis.

Clostridium perfringens Any ages > 106 16 h - - + + + Meats (especially beef and poultry), meat-containing products (e.g., gravies and stews), and Mexican foods. Can survive high heat,
Vibrio cholerae Any ages - 106-1010 24-48 h - + + + + Seafoods, including molluscan shellfish (oysters, mussels, and clams), crab, lobster, shrimp, squid, and finfish. Hypotension, tachycardia, decreased skin turgor. Rice-water stools
Parasites Protozoa Giardia lamblia 2-5 y + 1 cyst 1-2 we - - + + + Contaminated water May cause malabsorption syndrome and severe weight loss
Entamoeba histolytica 4-11 y + <10 cysts 2-4 we - + + + + Contaminated water and raw foods May cause intestinal amebiasis and amebic liver abscess
Cryptosporidium parvum Any ages - 10-100 oocysts 7-10 d + + + + + Juices and milk May cause copious diarrhea and dehydration in patients with AIDS especially with 180 > CD4
Cyclospora cayetanensis Any ages + 10-100 oocysts 7-10 d - + + + + Fresh produce, such as raspberries, basil, and several varieties of lettuce. More common in rainy areas
Helminths Trichinella spp Any ages - Two viable larvae (male and female) 1-4 we - + + + + Undercooked meats More common in hunters or people who eat traditionally uncooked meats
Taenia spp Any ages - 1 larva or egg 2-4 m - + + + + Undercooked beef and pork Neurocysticercosis: Cysts located in the brain may be asymptomatic or seizures, increased intracranial pressure, headache.
Diphyllobothrium latum Any ages - 1 larva 15 d - - - + + Raw or undercooked fish. May cause vitamin B12 deficiency



8Small bowel diarrhea: watery, voluminous with less than 5 WBC/high power field

Large bowel diarrhea: Mucousy and/or bloody with less volume and more than 10 WBC/high power field
† It could be as high as 1000 based on patient's immunity system.

The table below summarizes the findings that differentiate inflammatory causes of chronic diarrhea[1][2][3][4][4]

Cause History Laboratory findings Diagnosis Treatment
Diverticulitis Abdominal CT scan with oral and intravenous (IV) contrast bowel rest, IV fluid resuscitation, and broad-spectrum antimicrobial therapy which covers anaerobic bacteria and gram-negative rods
Ulcerative colitis Endoscopy Induction of remission with mesalamine and corticosteroids followed by the administration of sulfasalazine and 6-Mercaptopurine depending on the severity of the disease.
Entamoeba histolytica cysts shed with the stool detects ameba DNA in feces Amebic dysentery

Luminal amebicides for E. histolytica in the colon:

For amebic liver abscess:

Gallery

References

  1. Konvolinka CW (1994). "Acute diverticulitis under age forty". Am J Surg. 167 (6): 562–5. PMID 8209928.
  2. Silverberg MS, Satsangi J, Ahmad T, Arnott ID, Bernstein CN, Brant SR; et al. (2005). "Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology". Can J Gastroenterol. 19 Suppl A: 5A–36A. PMID 16151544.
  3. Satsangi J, Silverberg MS, Vermeire S, Colombel JF (2006). "The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications". Gut. 55 (6): 749–53. doi:10.1136/gut.2005.082909. PMC 1856208. PMID 16698746.
  4. 4.0 4.1 Haque R, Huston CD, Hughes M, Houpt E, Petri WA (2003). "Amebiasis". N Engl J Med. 348 (16): 1565–73. doi:10.1056/NEJMra022710. PMID 12700377.
  5. 5.00 5.01 5.02 5.03 5.04 5.05 5.06 5.07 5.08 5.09 5.10 5.11 5.12 "Public Health Image Library (PHIL)".


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