AMEBA SPECIES AND THEIR MORPHOLOGY

INTESTINAL SPECIES TROPHOZOITES MORPHOLOGY CYSTS MORPHOLOGY

E. histolytica Size range 8-65 µm Size range 8-22 µm
Avg: 12-25 µm Avg: 12-18 µm
ASSOCIATED DISEASES Motility Rapid, unidirectional, Shape Spherical to round
- Intestinal amebiasis, amebic progressive
colitis, amebic dysentery and movement, finger-like
extraintestinal amebiasis hyaline pseudopods
# of nuclei 1 # of nuclei 1-4
LABORATORY DIAGNOSIS Karyosome Small and central Karyosome Small and central
- Specimen: Stool sample, material Peripheral chromatin Fine and evenly Peripheral Fine and evenly
form sigmoidoscopy procedure distributed chromatin distributed
and hepatic abscess material Cytoplasm Finely granular Cytoplasm Finely granular
- Standard method: Wet prep + Cytoplasmic Ingested RBC Cytoplasmic - Chromatoid bars,
permanent staining inclusions inclusions rounded ends in young
- Alternative method: Wet prep + cysts
permanent staining + a special - Diffuse glycogen mass
medium for culture TYI-S-33 in young cysts

LIFE CYCLE NOTES

1. Ingestion of infective cyst from
contaminated food
2. Excystation of cyst in the Small
intestine
3. 1 cyst: 8 trophozoites
4. 8 trophozoites settle in L.I.’s
lumen and replicate by binary
fission and feed on living host
cells
5. If trophozoites migrate to other
organs and not return to
lumen, life cycle ceases
6. Encystation occurs in intestinal
lumen and cyst formation is
complete when four nuclei is
present
7. Passed out to environment in
human feces (can survive
there for 1 month)

EPIDEMIOLOGY TREATMENT PREVENTION AND CONTROL

- leading cause of parasitic deaths For asymptomatic: paromomycin, diloxanide - Uncontaminated water (accomplished by
after malaria furoate (furamide), or metronidazole (flagyl) boiling it or treating with iodine crystals)
- prevalent in homosexual communities
For symptomatic: Iodoquinol, paromomycin, or - Properly washed food products
-exist colder climate
diloxanide furoate - Good personal hygiene
- common transmissions: hand-to-
For extraintestinal amebiasis: Metronidazole or - Sanitation practices
mouth and food or water contamination
tinidazole
 AMEBA SPECIES AND THEIR MORPHOLOGY
INTESTINAL SPECIES TROPHOZOITES MORPHOLOGY CYSTS MORPHOLOGY
Entamoeba coli Size range 12-55 µm Size range 8-35 µm
Avg: 18-27 µm Avg: 12-25 µm
ASSOCIATED DISEASES Motility Nonprogressive, Shape Round to spherical
- Intestinal amebiasis, amebic colitis, blunt pseudopods
amebic dysentery and extraintestinal # of nuclei 1 # of nuclei 1-8
amebiasis Karyosome Large, irregular Karyosome Large, irregular shape, eccentric
shape, eccentric
LABORATORY DIAGNOSIS Peripheral Unevenly Peripheral Unevenly distributed
- Specimen: Stool sample chromatin distributed chromatin
- Non-pathogenic but presence of Cytoplasm Coarse and Cytoplasm Coarse and granulated
Entamoeba coli suggests ingestion of granulated
contaminated food or drink Cytoplasmic Vacuoles Cytoplasmic - Thin chromatoid bars with pointed
- Clinical symptoms: Asymptomatic inclusions containing inclusions to splintered ends in young cysts
bacteria often - Diffuse glycogen mass in young
NOTES OF INTEREST AND visible cysts, may displace nuclei (often
NEW TRENDS seen in cysts with two nuclei) to
- The morphologic differentiation of opposite ends of the cyst
Entamoeba coli from E. histolytica, as
well as pathogenicity was not
established until early 1900s

VERY EASY TO DISTINGUISH AS ITS

CHARACTERISTICS IS ALMOST THE
EXACT OPPOSITE OF E. histolytica

(Entamoeba coli cyst in trichrome stain)

EPIDEMIOLOGY TREATMENT PREVENTION AND CONTROL

- Entamoeba coli is found worldwide No treatment as it is considered a - Adequate control of human feces
- Can occur in warm and cold non-pathogen - Proper personal hygiene practices
climates (Alaska) - Protection of food and drink from flies and
-Greatest risk of becoming endemic cockroaches
for this parasite are areas with poor
hygiene and sanitation practices
 AMEBA SPECIES AND THEIR MORPHOLOGY
INTESTINAL SPECIES TROPHOZOITES MORPHOLOGY CYSTS MORPHOLOGY
E. hartmanni Size range 5-15 µm Size range 5-12 µm
Avg: 8-12 µm Avg: 7-9 µm
ASSOCIATED DISEASES Motility Nonprogressive, Shape Spherical
- Intestinal amebiasis, amebic fingerlike pseudopods
colitis, amebic dysentery and # of nuclei 1 # of nuclei 1-4
extraintestinal amebiasis Karyosome Small and central Karyosome Small and central
Peripheral Fine and evenly Peripheral Fine and evenly
LABORATORY DIAGNOSIS chromatin distributed chromatin distributed
- Specimen: Stool sample (note: Cytoplasm Finely granular Cytoplasm Finely granular
size ranges of E. histolytica and E. Cytoplasmic Ingested bacteria may Cytoplasmic - Chromatoid bars,
hartmanni overlap, thus inclusions be present inclusions rounded ends in
identification through size is young cysts
impossible) - Diffuse glycogen
- Clinical Symptoms: Infections of mass in young cysts
this parasite are asymptomatic

NOTES OF INTEREST AND

NEW TRENDS
- E. hartmanni was designated as
a “small race’ of E. histolytica
because of the many similarities
between the two

MAIN DIFFERENCE: Trophozoites

of E. hartmanni do not contain
ingested RBC.
EPIDEMIOLOGY TREATMENT PREVENTION AND CONTROL
- Prevalence of E. hartmanni No treatment as it is considered a non- - Good sanitation
appears to be similar to E. pathogen - Personal hygiene practices
histolytica - Protection of food from flies and
cockroaches
 AMEBA SPECIES AND THEIR MORPHOLOGY
INTESTINAL SPECIES TROPHOZOITES MORPHOLOGY CYSTS MORPHOLOGY
E. polecki Size range 8-25 µm Size range 10-20 µm
Avg: 12-20 µm Avg: 12-18 µm
ASSOCIATED DISEASES Motility Normal stool: Shape Spherical or oval
- None (nonpathogen) Sluggish,
nonprogressive
LABORATORY DIAGNOSIS Diarrheal stool:
- Specimen: Stool sample Progressive,
- Clinical symptoms: unidirectional
Asymptomatic, associated # of nuclei 1 # of nuclei 1
discomfort include: Diarrhea Karyosome Small and central Karyosome Small and central
Peripheral chromatin Fine and evenly Peripheral Fine and evenly
EPIDEMIOLOGY distributed chromatin distributed
- Considered a parasite of pigs Cytoplasm Granular and Cytoplasm Granular
and monkeys for many years vacuolated
- Human infections are rare Cytoplasmic Ingested bacteria, Cytoplasmic - Chromatoid bars,
- Found in selected areas only inclusions other food particles inclusions angular or pointed in
(highest prevalence in Papua, young cysts
New Guinea) - Glycogen mass in
- All reported cases in 1985 in young cysts
US occurred in Southeast asian - Inclusion mass
refugees who settled in =
Rochester, Minnesota
- Major routes of MOT:
Ingestion, human to human and
pig to human transmission

TREATMENT PREVENTION AND CONTROL

- combination of Metronidazole (Flagyl) and Dioxide furoate (Furamide) - Improving personal hygiene and
- Metronidazole alone is also effective sanitation practices
- Education programs regarding routes of
its transmission are also essential
 AMEBA SPECIES AND THEIR MORPHOLOGY
INTESTINAL SPECIES TROPHOZOITES MORPHOLOGY CYSTS MORPHOLOGY
Endolimax nana Size range 5-12 µm Size range 4-12 µm
Avg: 7-10 µm Avg: 7-10 µm
ASSOCIATED DISEASES Motility Sluggish, Shape Spherical, ovoid, ellipsoid
- None (nonpathogen) Nonprogressive,
blunt pseudopods
LABORATORY DIAGNOSIS # of nuclei 1 # of nuclei 1-4, 4 most common
- Specimen: Stool sample Karyosome Large, irregular, Karyosome Large, blotlike, usually
- Clinical symptoms: blotlike central
Asymptomatic Peripheral Absent Peripheral Absent
chromatin chromatin
EPIDEMIOLOGY Cytoplasm Granular and Cytoplasm Granular and vacuolated
- E. nana found primarily in vacuolated
warm moist regions Cytoplasmic Bacteria Cytoplasmic - Chromatin granules
- Also in areas with poor inclusions inclusions - Nondescript small mass
hygiene and substandard - Diffuse glycogen mass in
sanitary condition exist young cysts
- Food or drink contamination
of its cyst serves as major
sources of transmission

(E. nana cyst in trichrome stain)

TREATMENT PREVENTION AND CONTROL

No treatment as it is - Good sanitation
considered a non-pathogen - Proper personal hygiene practices
- Protection of food and drink from flies and cockroaches
 AMEBA SPECIES AND THEIR MORPHOLOGY
INTESTINAL SPECIES TROPHOZOITES MORPHOLOGY CYSTS MORPHOLOGY
Iodamoeba bütschlii Size range 8-22 µm Size range 5-22 µm
ASSOCIATED DISEASES Avg: 12-18 µm Avg: 8-12 µm
- none (considered as nonpathogen) Motility Sluggish, progressive Shape Ovoid, ellipsoid, triangular,
other shapes
LABORATORY DIAGNOSIS # of nuclei 1 # of nuclei 1
-Diagnostic technique of choice: Stool Karyosome Large, usually central Karyosome Large, eccentric, achromatic
examination refractive achromatic granules on one side may be
-Iodine wet preps often prove to be of granules may or may present
benefit, particularly in the identification of I. not be present
bütschlii cysts. Peripheral Absent Peripheral Absent
-Glycogen mass typically picks up the chromatin chromatin
iodine stain. Cytoplasm Coarsely granular and Cytoplasm Coarsely granular and
-Another feature that aids in the vacuolated vacuolated
identification is that glycogen mass Cytoplasmic Bacteria Cytoplasmic Well-defined glycogen mass
remains unstained following trichrome inclusions Yeast cells inclusions Granules may be present
staining. Other debris

EPIDEMIOLOGY CLINICAL SYMPTOMS AND PREVENTION AND CONTROL

TREATMENT
-higher prevalence in tropical regions. - I. bütschlii is a nonpathogenic -upgrading personal hygiene and sanitation
-the frequency appears to be much less intestinal ameba practices in areas of high prevalence
than that of E. coli and E. nana. -treatment is usually not indicated
- common transmissions: hand-to-mouth
and food or water contamination
 AMEBA SPECIES AND THEIR MORPHOLOGY
INTESTINAL SPECIES TROPHOZOITES FLAGELLETE FORM CYSTS MORPHOLOGY
MORPHOLOGY
Naegleria fowleri Size range 8-22 µm Size range 7- 15 µm Size 9 -12 µm
ASSOCIATED DISEASES range
- Primary amebic Motility Sluglike, blunt Motility Jerky Shape Round
meningoencephalitis pseudopods movements or Have thick
(PAM) spinning cell walls
LABORATORY DIAGNOSIS # of 1 # of nuclei 1 # of 1
- Diagnostic technique of nuclei nuclei
choice: Microscopic Karyosom Large, usually Karyosome Large and Karyosom Large and
examination of CSF e centrally centrally located e centrally
-Preparing and scanning located located
saline and iodine wet Peripheral Absent Peripheral Absent Peripheral Absent
preparations of the CSF chromatin chromatin chromatin
-Samples of tissue and Cytoplasm Granular, Cytoplasm Granular, Cytoplas Granular,
nasal discharge may be usually usually m usually
examined vacuolated vacuolated vacuolated
-Clinical specimens may
be cultured
- Shows trailing effect
when placed on agar
plates that have been
inoculated with gram-
negative bacilli
LIFE CYCLE NOTES
1. Replication of the
ameboid trophozoites
occurs by simple binary
fission.
2. Ameboid trophozoites
transform into flagellate
trophozoites in vitro.
3. The flagella
trophozoites lose their
flagella and convert back
into the ameboid form
4. Cyst exist only in the
external environment.
 EPIDEMIOLOGY CLINICAL SYMPTOMS TREATMENT PREVENTION AND
CONTROL
-found in warm bodies of Asymptomatic-Patients who -Prompt and aggressive -Posting-off limits signs
water inc. lakes, streams, contract N. fowleri resulting treatment are ineffective with around known sources of
ponds, and swimming in colonization of the nasal amphotericin B may be of contamination
pools. sages. benefit to patients -Educating the medical
-contaminated dust in Primary Amebic -Amphotericin B with rifampin community and public
Nigeria Menignoencephalitis- or miconazole has proved to -Swimming pools and
-enter the human body occurs when it invades the be effective hot tubs be adequately
through nasal mucosa brain, causing rapid tissue - Amphotericin B and chlorinated.
-sniffing contaminated destruction. miconazole: damage the cell -Cracks found in the
water SYMPTOMS: wall of Naegleria, inhibiting walls of pools, hot tubs,
• Fever, headache, the biosynthesis of ergosol and baths should be
sore throat, nausea, and resulting increased repaired immediately.
and vomiting membrane permeability
• Neck and seizures -Rifampicin: inhibits RNA
• Often experience synthesis
smell and taste
alterations, blocked
nose, Kernig’s sign
 AMEBA SPECIES AND THEIR MORPHOLOGY
INTESTINAL SPECIES TROPHOZOITES MORPHOLOGY CYSTS MORPHOLOGY
Acanthamoeba spp. Size range 12-45 µm Size range 8-25 µm
ASSOCIATED DISEASES Avg: 25 µm
- Granulomatous amebic Motility Sluggish, spinelike Shape Roundish with ragged edges
encephalitis (GAE), pseudopods
Acanthamoeba keratitis (known as
acanthopodia)
LABORATORY DIAGNOSIS # of nuclei 1 # of nuclei 1
-Specimen of choice: Karyosome Large, Karyosome Large and central
Cerebrospinal fluid. Brain Peripheral Absent Peripheral Absent
tissue may also be examined. chromatin chromatin
-Corneal scrapings are the Cytoplasm Granular and Cytoplasm Disorganized, granular,
specimen of choice for vacuolated sometimes vacuolated
recovery of Acanthamoeba Other features Double cell wall—smooth
keratitis. inner cell wall and outer
-Histologic examination jagged cell wall
-Calcofluor white may be
used to stain cysts present in
corneal scrapings.
-Indirect immunofluorescent
assay antibody staining is the
technique of choice for
speciating Acanthamoeba.
LIFE CYCLE NOTES
1.One route consists of
aspiration or nasal inhalation.
2. Enter the lower respiratory
tract or via ulcers in the
mucosa or skin.
3. Migrate via hematogenous
spread—transported thru the
bloodstream
4. Second route is direct eye
invasion, contact lens wearers
and experienced trauma to
the cornea
5. Associated with
contaminated saline
 EPIDEMIOLOGY CLINICAL SYMPTOMS TREATMENT PREVENTION AND
CONTROL
-Contact lens wearers, ® Granulomatous amebic • Sulfamethazine -Eye infections may be
particularly those wearing soft encephalitis: CNS infection for GAE prevented by following
contacts, may be at risk. As with Acanthamoeba. • For all manufacturer-
well as poor hygiene SYMPTOMS: headaches, Acanthamoeba established protocols
practices, especially the use seizures, stiff neck, nausea, keratitis, associated with the use
of homemade saline rinsing and vomiting. several of contact lenses. Avoid
solutions. ® Acanthamoeba keratitis medications using homemade
-Animals such as rabbits, known as amebic keratitis include nonsterile saline
beavers, cattle, water buffalo, SYMPTOMS: Severe ocular itraconazole, solutions
dogs, and turkeys. pain and vision problems. ketoconazole,
It may result as subsequent miconazole,
loss of vision. propamidine
® Acanthamoeba invade other (best
areas of the body including medication)
kidneys, pancreas, prostate, isethionate, and
and uterus, and form similar rifampin
granulomatous lesions
 AMEBA SPECIES AND THEIR MORPHOLOGY
INTESTINAL SPECIES TROPHOZOITES MORPHOLOGY
Entamoeba gingivalis Size range 8-20 µm
ASSOCIATED DISEASES Motility Active, varying pseudopod appearance
- none (considered as nonpathogen) # of nuclei 1
Karyosome Centrally located
LABORATORY DIAGNOSIS Peripheral Fine and evenly distributed
-Diagnostic technique of choice: Mouth chromatin
scrapings particularly from the gingival area Cytoplasm Finely granular
-Material from the tonsillar crypts and Cytoplasmic Leukocytes
pulmonary abscess, as well as sputum, inclusions Epithelial cells
may also be examined Bacteria
-Vaginal and cervical areas

LIFE CYCLE NOTES

-Typically lives around the gum of the teeth
in the tartar and gingival pockets of
unhealthy mouths.
-Trophozoites have been known to inhabit
tonsillar crypts and bronchial mucus.
-Existing as a scavenger, the trophozoites
feed on disintegrated cells and multiply by
binary fission.
-Trophozoites will not survive following
contact with stomach juices.
-Vaginal and cervical specimens from
women who are using intrauterine devices

EPIDEMIOLOGY CLINICAL SYMPTOMS AND TREATMENT PREVENTION AND NOTES OF INTEREST

CONTROL AND NEW TRENDS
-are contracted via mouth-to-mouth and -Nonpathogenic E. gingivalis trophozoites -Improved oral -Discovered in 1849,
droplet contamination, which may be are frequently recovered in patients hygiene accomplished E. gingivalis was the
transmitted through contaminated drinking suffering from pyorrhea alveolaris, but do by the proper care of first ameba recovered
utensils. not produce symptoms of their own. the teeth and gums from a human
-there is no treatment -Prompt removal of specimen.
IUDs in infected
patients