Entamoeba histolytica/e. dispar. A. Haghighi,

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1 Entamoeba histolytica/e. dispar A. Haghighi, Wednesday, February 14, 2018

2 Classification of Protozoa? The protozoa are generally unicellular and may be divided for convenience, into four distinct groups based on method of locomotion: حرکت 1. Mastigophora (Flagella)/Metamonada 2. Sarcodina (Pseudophora)/ Amoebazoa 3. Apicomplexa (microtubule complex) 4. Ciliophora (Ciliates)

3 Human species of Amoebae

4 The important intestinal amoeba in human Phylum: Sarcomastigophora / Amoebazoa Genus: 1- Entamoeba Species: - Entamoeba histolytica - Entamoeba dispar - Entamoeba moshkovskii - Entamoeba coli - Entaomeba hartmanni - Entamoeba gingivalis Genus: Species: Genus: Species: 2- Endolimax Endolimax nana 3- Iodamoeba Iodamoeba butschlii

5 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

6 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)

7 Entamoeba histolytica << HISTORY>> 1875 Fedor Aleksandrovich Losch Amoeba coli 1903 Fritz Schaudinn Entamoeba histolytica 1925 Emile Brumpt E. dysenteriae (Craig 1905) 1912 Von Prowazek E. dispar (= different) Small Race (E. hartmanni) 1957, 1959 Burrows 1973 Martinez-Palomo Two species? Peter Sargeant and 1993 Louis Diamond & C.G. Clark E. histolytica pathogen E. histolytica nonpathogen E. histolytica E. dispar 1997 WHO meeting in Mexicocity

8 E. histolytica

9 20 to 30% in the tropics area And 5% in temperature climate nations E. histolytica/e. disbar prevalence (Schoudinn 1903/ Brumt 1925) 10% of world population (about millions) 10% E. histolytica (50-70,000,000) Therefore Only 1% of world population Infected with E. histolytica (Amebiasis) 90% E. dispar ( ,000,000) <Non pathogen> No Treatment 5-10% (5-7,000,000) With symptoms 45-65,000,000 Cyst passers? 90-95% 45-65,000,000 asymptomatic Cyst passers 5-7,000,000 Intestinal and Extra intestinal Amebiasis About 10% (700,000) Extra intestinal Amebiasis About 90% (4.500, ,000) Intestinal amebiasis Great geographical virulence and symptomes in the world, ranging from 1% in Greece to 21% in Egypt, average 10% of infected patients) * Up to 100,000 deaths, second after malaria in protozoan parasites

10 Transmission routes Feces (Person to person by the oro-fecal route) Agent of transmission Trophozoit Cyst Finger Food Fluid (Water) Flies

11 E. histolytica and E. dispar << Morphology and life cycle>> Ch. body (10-20 m) Nucleus Lung Trophozoite Brain Metacystic development Oral infection Cell wall Karyosome Cyst Encystation Galactose/N-acetylgalactoseamine (Gal/GalNAc) lectin protein Large intestine Clumps of glycogen Endoplasm Liver Ectoplasm Trophozoite (Haematophge) m

12 Pathogenicity A- (Intestinal diseases) or << Intestinal amoebiasis>> B- (Extraintestinal diseases) << Extraintestinal amoebiasis>>

13 Frequently: - Anti-amoebic Ab is + - and Stool Ag test is + Diarrhea, Dysentery, weight loss, fever, tenterness, Heme + 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 facilitates A rapid, correct diagnosis

14 Extraintestinal amoebiasis? Brain Amoebic Liver Abscess (ALA) Lung abscess Lung Brain abscess Splenic abscess Subdiaphragmatic.Large intestine ab Liver Amebiasis cutis Genitourinary abscess

15 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) Cultivation Staining Based on : (Three alternate stool tests are recommended)

16 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

17 Diagnosis of amebic liver abscess Cinical symptoms Lesion in the liver Positive amebic serology *****

18 Medical recommendation for diagnosis and treatment WHO News and activities Bulletin of the WHO, 1997, 75 (3); 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

19 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.

20 In symptyomatic individuals the presence of high titers of specific antibody is also strongly correlated with invasive amoebiasis.

21 Optimally, E. histolytica should be specifically identified, and infections, if present, treated is recommended.

22 If only E. dispar is identified, no treatment is necessary. If the infected individual has gastrointestinal symptoms, other causes should be sought.

23 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.

24 Treatment 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. 24

25 Treatment Luminal agents : Diloxanide furoate Paromomycine Iodoquinol Tissue agents : Bowel wall only - Tetracycline -Erythromycine All tissues -Metronidazile -Tinidazole -Emetine hydrochloride -Dehydroemetine A: In E. histolytica cyst passers (Asymptomatic intestinal colonization) B: Invasive rectocolitis (Amoebic colitis) C- Extraintesinal diseases (Amoebic liver abscess)

26 A: In E. histolytica cyst passers 1. Diloxanid foroate 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 mg qid for 10 days then Iodoquinol, 650 mg tid for 20 days 4. Metronidazol mg tid for 10 days.

27 B: Invasive rectocolitis 1. Metronidasol 2. Tetracycline, 3. Dehydroemetine

28 C- Extraintesinalis treatment 1. Metronidasol 2. Tinidazol 3. Dehydroemetine Treatment should be follow with one of the effective medicines on the cyst

29 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

30

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