Entamoeba histolytica

style="background:#Template:Taxobox colour;"|Entamoeba histolytica
Entamoeba histolytica cyst
style="background:#Template:Taxobox colour;" | Scientific classification
Domain: Eukaryota Phylum: Amoebozoa Class: Archamoebae Genus: Entamoeba Species: E. histolytica

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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 an anaerobic parasitic protozoan, part of the genus Entamoeba. It infects predominantly humans and other primates. It is estimated that about 50 million people are infected with the parasite worldwide. Diverse mammals such as dogs and cats can become infected but are not thought to contribute significantly to transmission. The active (trophozoite) stage exists only in the host and in fresh loose feces; cysts survive outside the host in water, soils and on foods, especially under moist conditions on the latter. When cysts are swallowed they cause infections by excysting (releasing the trophozoite stage) in the digestive tract.

E. histolytica, as its name suggests (histo–lytic = tissue destroying), causes disease; infection can lead to amoebic dysentery or amoebic liver abscess. Symptoms can include fulminating dysentery, diarrhea, weight loss, fatigue, abdominal pain, and amebomas. The amoeba can actually 'bore' into the intestinal wall, causing lesions and intestinal symptoms, and it may reach the blood stream. From there, it can reach different vital organs of the human body, usually the liver, but sometimes the lungs, brain, spleen, etc. A common outcome of this invasion of tissues is a liver abscess, which can be fatal if untreated. Ingested red blood cells are sometimes seen in the amoeba cell cytoplasm.

It can be diagnosed by stool samples but it is important to note that certain other species are impossible to distinguish by microscopy alone. Trophozoites may be seen in a fresh fecal smear and cysts in an ordinary stool sample. ELISA or RIA can also be used.

Life Cycle

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 lumenal 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

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Gallery

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  Entamoeba histolytica. From Public Health Image Library (PHIL).

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  Entamoeba histolytica. From Public Health Image Library (PHIL).

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  Entamoeba histolytica. From Public Health Image Library (PHIL).

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  Entamoeba histolytica. From Public Health Image Library (PHIL).

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  Entamoeba histolytica. From Public Health Image Library (PHIL).

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  Entamoeba histolytica. From Public Health Image Library (PHIL).

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  Entamoeba histolytica. From Public Health Image Library (PHIL).

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  Entamoeba histolytica. From Public Health Image Library (PHIL).

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  Entamoeba histolytica. From Public Health Image Library (PHIL).

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  Entamoeba histolytica. From Public Health Image Library (PHIL).

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  Entamoeba histolytica. From Public Health Image Library (PHIL).

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  Entamoeba histolytica. From Public Health Image Library (PHIL).

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  Entamoeba histolytica. From Public Health Image Library (PHIL).

Treatment

Antimicrobial Regimen

• Entamoeba histolytica

• 1. Amebic Liver Abscess

• Preferred regimen: (Metronidazole 750 mg PO tid for 10 days OR Tinidazole 2 g PO qd for 5 days) AND (Paromomycin 30 mg/kg/day PO tid for 5-10 days OR Diloxanide furoate 500 mg PO tid for 10 days)
• Alternative regimen (1): Nitazoxanide 500 mg bid for 10 days AND (Paromomycin 30 mg/kg/day PO tid for 5-10 days OR Diloxanide furoate 500 mg PO tid for 10 days)
• Alternative regimen (2): Tinidazole 2 g PO qd for 5 days AND (Paromomycin 30 mg/kg/day PO tid for 5-10 days OR Diloxanide furoate 500 mg PO tid for 10 days)
• Alternative regimen (2): Tinidazole 2 g PO qd for 5 days

• 2. Amebic Colitis

• Preferred regimen: Metronidazole 500-750 mg PO tid for 7-10 days. Pediatric dose: 35-50 mg/kg per day tid AND (Paromomycin 30 mg/kg/day PO tid for 5-10 days OR Diloxanide furoate 500 mg PO tid for 10 days)
• Alternative regimen: Tinidazole 2 g PO qd for 5 days AND (Paromomycin 30 mg/kg/day PO tid for 5-10 days OR Diloxanide furoate 500 mg PO tid for 10 days)

• 3. Asymptomatic Intestinal Colonization

• Preferred regimen: Paromomycin 30 mg/kg/day PO tid for 5-10 days
• Alternative regimen (1): Diloxanide furoate 500 mg PO tid for 10 days
• Alternative regimen (2): Diiodohydroxyquin 650 mg PO tid for 20 days for adults and 30 to 40 mg/kg per day tid for 20 days for children

References

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