AMOEBIASIS

Hafiizh Nur Perwira

The geographical distribution of
Amoebiasis
www.asnam.org
Etiology
Agent Entamoeba hystolitica
2 form
Trophozoite fragile, metabolically active:
potentially pathogenic form
Cyst hardy, infective, environmentally
resistant



DD: 1). E. dispar , 2) E. moshkovskii, 3). E. Hartmanni,
4). E.Coli, or other intestinal amoebaonly in human

Entamoeba lifecycle

Entamoeba lifecycle
Etiology
Entamoeba hystolitica
Entamoeba moshkovskii
Entamoeba dispar
Indistinguishable in its
cyst and trophozoite form
PCR the most sensitive to
indentify and differentiate
Entamoeba spesies
Recently :

Van Hal et al., 2007

Non patoghenic :
Entamoeba dispar
Entamoeba moshkovskii
Pathogenic :
Entamoeba hystolitica
Gut commensal
Free living ubiquitus
Based on study in Australia:



5921 Faecal samples of
diarrhea
177(3%) E Complex (+)
110 could be preserved
89 PCR+ samples
3 samples E. hystolitica
30 samples E. dispar
22 samples E. moshkovskii
32 samples E. dispar & E. moshkovskii
1 sample E. hystolitica & E. dispar
1 sample E. moshkovskii & E. hystolitica
Fotedar R et al, 2007
Clinical Decription
Most asymptomatic
they may excrete cyst for short period patient will be free within 12
months

Intestinal
Acute dysentery with fever,chills & bloody diarrhea,mild abdominal
discomfort cramps, tenesmus,bloody/mucous,alternating w/
flatulence,loose stool or Constipation/remission

Extraintestinal (liver, lung/brain abscesses can occur after
dissemination of parasites via blood stream).

Liver abscess (most common): fever, abd pain, weight loss; can concurrently
with colitis, >evidence: no history of intestinal inf. By E.histolytica.
Rupturedeath




Clinical Decription
Ameboma ( a chronic granulomatous lesion,
develops most frequently in
coecal/retrosigmoid region

Differential Diagnosis :
Amoebic colitis with inflammatory bowel disease
(ulcerative colitis). Ameboma in adult: carcinoma

Laboratory diagnosis
Microscopic
Trophozoite or cysts in: stool, aspirates, tissue or
tissue scrapings.
Differentiation of pathogenic E.histolytica from
nonpathogenic E.dispar
immunologic differences-based & isoenzymes
patterns & PCR
Serologic tests
available as adjuncts for extraintestinal amoebiasis
Entamoeba cyst
E. histolytica/E. dispar cyst with
three visible nuclei (arrows).

E. histolytica/E. dispar cyst with
one visible nucleus and a glycogen
vacuole (arrow).

E. histolytica/E. dispar cyst in
iodine with one visible nucleus
and a glycogen vacuole (arrow).

E. histolytica/E. dispar cyst in
iodine with two visible nuclei and
a chromatoid body (arrow).

Laboratory examination
E. histolytica/E. dispar trophozoite with a
progressive pseudopod (arrow).

E. histolytica/E. dispar cyst showing chromatoid
bodies with bluntly rounded ends
(arrow).

E. histolytica/E. dispar cyst showing a
chromatoid body with bluntly rounded
ends (arrow).

Entamoeba Trophozoit
E. histolytica trophozoite with an ingested
RBC (arrow).

E. histolytica trophozoite with an ingested
RBC (arrow).

E. histolytica trophozoite with six ingested
RBCs in the focal plane (arrows).

Treatment of amoebiasis
Asymptomatic carriage (treat with luminal amoebicide
ONLY)

Oral paromomycin* 500 mg three times daily for 7 days
Invasive disease (treat with tissue amoebicide and
luminal amoebicide)

Oral metronidazole 750800 mg three times daily for 6
10 days
OR

Oral tinidazole 2 g once daily for 23 days (up to 10 days)
and oral paromomycin* 500 mg three times daily for 7 days
Treatment of amoebiasis
Liver abscess (treat with tissue amoebicide and luminal
amoebicide)

Oral or intravenous metronidazole 750800 mg three times daily for 14 days
OR
Oral tinidazole 2 g once daily for 5 days and oral paromomycin* 500 mg three
times daily for 7 days
* Paromomycin is now the luminal agent of choice (Special Access
Scheme approval is required). Alternative luminal agents are
diloxanide furoate (however, production was ceased in 2003 and
the drug is unavailable in Australia) and iodoquinol (availability in
Australia is limited).
Traveler diseases