Entamoeba histolytica/E. disparparasitology.sbmu.ac.ir/uploads/293_1527_1551772184873_2...General...
Transcript of Entamoeba histolytica/E. disparparasitology.sbmu.ac.ir/uploads/293_1527_1551772184873_2...General...
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A. Haghighi,
Entamoeba histolytica/E. dispar
Tuesday, March 05, 2019
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Classification of Protozoa ?
• The protozoa are generally unicellular and may
be divided for convenience, into four distinct
groups based on method of locomotion:
1. Mastigophora (Flagella)/Metamonada
2. Sarcodina (Pseudophora)/ Amoebazoa
3. Apicomplexa (microtubule complex)
4. Ciliophora (Ciliates)
حرکت
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Human species of
Amoebae
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The important intestinal amoeba in human
Phylum: Sarcomastigophora / AmoebazoaGenus: 1- Entamoeba
Species: - Entamoeba histolytica
- Entamoeba dispar
- Entamoeba moshkovskii
- Entamoeba coli
- Entaomeba hartmanni
- Entamoeba gingivalis
Genus: 2- Endolimax
Species: Endolimax nana
Genus: 3- IodamoebaSpecies: Iodamoeba butschlii
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Classification based on number of nuclei in the mature cyst:
1. Octonucleate cyst group:
- E. coli
2. Quadrinucleate cyst group:
- E. histolytica
- E. dispar
- E. hartmanni
- E. moshkovskii
- Endolimax nana
3. Uninucleate cyst group:
- Iodamoeba buetschlii
4. No cyst
- E. gingivalis
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General characteristics of amoebas
1- Active form (Trophozoite) has no cell wall
2- The cytoplasm of active form consists of two parts,
Ectoplasm and Endoplasmic
3- Movement is performed by forming a pseudopod in the active form
Amoeba = Variable
4- There is no particular way to get food (No mouth)
5- They do not have a fixed shape, because they create pseudopod for
locomotion and to get food.
6- They are Anaerobic, Therefore, Lack of mitochondria, endoplasmic
network and Golgi apparatus. (New molecular findings suggest traces of
these organelles)
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Entamoeba histolytica<< HISTORY>>
• 1875 Fedor Aleksandrovich Losch Amoeba coli
• 1903 Fritz Schaudinn Entamoeba histolytica
• 1925 Emile Brumpt E. dysenteriae (Craig 1905)
• 1912 Von Prowazek
• 1957, 1959 Burrows
• 1973 Martinez-Palomo
• 1978-1988 Peter Sargeant and …
• 1993 Louis Diamond & C.G. Clark
• 1997 WHO meeting in Mexicocity
E. dispar (= different)
Small Race (E. hartmanni)
E. histolytica pathogen E. histolytica nonpathogen
Two species?
E. histolyticaE. dispar
E. dispar (= different)
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E. histolytica
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E. histolytica/E. disbar prevalence(Schoudinn 1903/ Brumt 1925)
10% of world population(about 500-700 millions)
10% E. histolytica(50-70,000,000)
90% E. dispar(450-650,000,000)<Non pathogen>
ThereforeOnly 1% of world population
Infected with E. histolytica(Amebiasis)
5-10% (5-7,000,000)
With symptoms
90-95%45-65,000,000asymptomaticCyst passers
5-7,000,000Intestinal and Extra intestinal
Amebiasis
45 - 65,000,000Cyst passers
?
About 10% (700,000)Extra intestinalAmebiasis
About 90%(4.500,000-6.500,000)Intestinal amebiasis
* Up to 100,000 deaths, second after malaria in protozoan parasites
NoTreatment
20 to 30% inthe tropics area
And 5%in temperatureclimate nations
Great geographical virulence and symptomes in the world, ranging from 1% in Greece to 21% in Egypt, average 10% of infected patients)
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Transmission routes.1Feces (Person to person by the oro-fecal route)
.2Finger
.3Food
.4Fluid (Water)
.5Flies
Trophozoit Cyst
Agent of transmission
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E. histolytica and E. dispar<< Morphology and life cycle>>
Large intestine
Brain
Liver
Lung
15-60 m
Trophozoite (Haematophge)
Metacysticdevelopment
Encystation
Cyst
Ch. body
Cell wall
Nucleus
Endoplasm
Ectoplasm
Karyosome
Oral infection
(10-20m)
Clumps of glycogen
Galactose/N-acetylgalactoseamine(Gal/GalNAc) lectin protein
Trophozoite
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Pathogenicity
A- (Intestinal diseases) or
<< Intestinal amoebiasis>>
B- (Extraintestinal diseases)
<< Extraintestinal amoebiasis>>
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Intestinal amoebiasis ?• Asymptomatic infection
• Symptomatic noninvasive infection
• Acute rectocolitis (dysentery)
• Fulminant colitis with perforation
• Ameboma
• Chronic nondysenteric colitis
• Perianal ulceration Flask form ulcers
Familiarity with these diverse manifestations and epidemiologic risk factors greatly facilitatesA rapid , correct diagnosis
Frequently:- Anti-amoebic Ab is +- and Stool Ag test is +
Diarrhea, Dysentery, weight loss, fever, tenterness, Heme +
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Extraintestinal amoebiasis ?
• Amoebic Liver Abscess (ALA)
• Lung abscess
• Brain abscess
• Splenic abscess
• Subdiaphragmatic
• .Large intestine ab
• Amebiasis cutis
• Genitourinary abscess
Brain
Liver
Lung
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Diagnosis methods• Intesinal amoebiasis
• Extraintestinal amoebiasis
1- Doctor: Pay attention to clinical findings, geographical location,history of illness and findings Epidemiologic
2- Parasitological methods: Detection of trophozoite or cysts in feces or abscesses by:
- Wet mount stool exam- Stool concentration (Formalin-ether technique)
(Three alternate stool tests are recommended)
Cultivation Staining
Based on :
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3. Serologically tests:
* IFA
* ELISA (Sensitive tests)
* IHA
* CIE or GD : Non sensitive for acute diseases
* Antigen capture (TechLab)
4. Bichemical or Biological methods:
- PCR
- Zymoden analysis
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Diagnosis of amebic liver abscess
Cinical symptoms
Positive amebic serology
*****
Lesion in the liver
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WHO News and activities
Bulletin of the WHO, 1997, 75
(3); 291-292
Medical recommendation for
diagnosis and treatment
When diagnosis is made by light microscopy,
the cysts of two species (10-20 um in diameter)
are indistinguishable and should be reported
as:
E. histolytica/E. dispar
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Trophozoites with ingested red blood cells in
fresh stool or other specimens and
trophozoites in tissue biopsies are both
strongly correlated with the presence of
E. histolytica and invasive disease.
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In symptyomatic individuals the presence of
high titers of specific antibody is also
strongly correlated with invasive
amoebiasis.
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Optimally, E. histolytica should be
specifically identified, and
infections, if present, treated is
recommended.
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If only E. dispar is identified, no treatment is
necessary. If the infected individual has
gastrointestinal symptoms, other causes
should be sought.
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If E. histolytica/E. dispar has been detected in
symptomatic patients, it should not be assumed
that E. histolytica is the cause of symptoms and
other explanations should also be considered.
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• There are two classes of antiamoebic drugs:
a) Tissue amoebicies (Such as 5-nitoimidazole; e.g. Metronidazole)
b) and luminal amoebicides (such as diloxanide furoate and
paromomaycine).
Invasive disease should be treated with a tissue amoebiside
followed by a luminal amoebicide. Tissue amoebicides are not
appropriate for treatment of asymptomatic individuals, unless
there is other evidence for invasive amoebiasis.
• Chemoprophylaxis is never appropriate.
Treatment
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A: In E. histolytica cyst passers
(Asymptomatic intestinal colonization)
B: Invasive rectocolitis
(Amoebic colitis)
C- Extraintesinal diseases
(Amoebic liver abscess)
Luminal agents :
Diloxanide furoate
Paromomycine
Iodoquinol
Tissue agents : Bowel wall only- Tetracycline-ErythromycineAll tissues-Metronidazile-Tinidazole-Emetine hydrochloride-Dehydroemetine
Treatment
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A: In E. histolytica cyst passers
1. Diloxanid foroate
- 500 mg orally 3 times a day for 10 days
2 . Paromomycine
- 30 mg/kg/days in 3 divided doses for 5-10 days
3. Tetracycline
- 250 mg qid for 10 days then Iodoquinol, 650 mg tid for 20 days
4. Metronidazol
- 750 mg tid for 10 days.
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B: Invasive rectocolitis
1. Metronidasol
2. Tetracycline,
3. Dehydroemetine
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C- Extraintesinalis treatment1. Metronidasol
2. Tinidazol
3. Dehydroemetine
Treatment should be follow with one of the effective
medicines on the cyst
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Prevention
1- Individual health (hand wash with soap, Destroying the flies and
cockroaches, Using healthy food and especially vegetables)
2- Public Health (Proper disposal of waste, Environmental improvement,
Health improvement, Proper disposal of sewage)
3- Health Education (Use of Mothers' Breastfeeds, Health Education
in Schools, Health education through radio and television)
Vaccination: Researching on 3 genes
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