COMMENSAL AMEBAE

Intestinal Protozoa - The Amoebae

General Life cycle
The definitive host ingests the infective cyst
stage from fecal contamination in
environment.
The cyst passes into the small intestine &
excystation occurs with transformation to the
trophozoite stage.
Trophozoites colonize the host, multiplying
asexually via binary fission. They can remain
near the lumen (non-pathogens) or invade the
wall of the intestine & multiply (pathogens).
Cysts and trophozoites are passed in the feces
of the infected host.

Entamoeba histolytica

Epidemiology - Occurs worldwide; the

highest incidence and prevalence is in
areas with poor sanitation.
Pathology and Clinical
Manifestations - the most pathogenic
of all; causes amoebic dysentery; can
become extra-intestinal; can be fatal.
Hepatic abscess is the most common
and dangerous complication.
Chronic infections may last for years;
often confused with colitis, cancer.
Distribution - worldwide, mostly in
tropics and sub-tropics.

Entamoeba histolytica
Morphology & Laboratory
Identification - trophozoites range 12 to
30 microns in diameter; nucleus has an
even distribution of peripheral chromatin
and a small, compact, centrally located
karyosome; cytoplasm is smooth and
granular; inclusions, if present, are red
blood cells; cysts range 10 to 20 microns in
diameter and contains four nuclei when
mature. Cigar-shaped chromatoid bars may
be present in some cysts.

Entamoeba hartmanni
Epidemiology

- similar to E.

histolytica
Formerly called the small race of
Entamoeba histolytica.
Technologists must be able to
differentiate this organism from E.
histolytica because E. hartmanni is
non-pathogenic.
Morphology & Laboratory
Identification - This organism is
morphologically similar to E.
histolytica. The difference lies in the
sizes of the respective organisms.
Trophozoites will measure less than 12
microns, while cysts will measure less
than 10 microns.

Entamoeba coli

Significance - this is a harmless commensal;

must be differentiated from pathogens.
Morphology - trophozoites range from 10 to
35 microns in diameter; cysts range from 10
to 30 microns in diameter and contain 8 to 16
nuclei when mature; the nucleus exhibits an
eccentric karyosome with irregular, coarse
chromatin. The cytoplasm is heavily
vacuolated, containing yeast, bacteria, and
debris.

Entamoeba gingivalis
Infective site - the mouth; the
organism thrives in diseased gums,
but is not considered a causal agent.
It is destroyed in stomach if
swallowed.
Transmission - contact with
fomites (drinking glasses, eating
utensils, etc.); kissing.
Morphology - resembles E.
histolytica, but has no cyst stage. It
is the only species which ingests
leucocytes.

Endolimax nana
Occurrence

- occurs in about 14% of

the US population; 21% worldwide.
Pathogenicity - none.
Morphology - trophozoites range
from 5 to 10 microns in diameter. The
nucleus contains a large, blot-like
karyosome; there is little or no
peripheral chromatin. Cysts are
usually sub-oval, measuring 4 to 6 by
6 to 10 microns.

Iodamoeba btschlii
Pathogenicity

- none.
Morphology - the cyst is often
called the iodine cyst due to the
presence of a large glycogen vacuole
which stains dark brown with iodine.
Trophozite is usually 9 to 14 m
long, ranging from 6-20 m.

Entamoeba polecki
- is a parasite of pigs and monkeys.
Rarely, it may infect humans. It can be
distinguished from E. histolytica in that
its cyst is consistently uninucleated. In
stained fecal smears, the nuclear
membrane andd kayosome are very
prominent.
Trophozoite
Size: 10 to 25m; usual range, 12-18m.
Motility: similar to that of Entamoeba
coli.

DIAGNOSIS
Diagnosis is made through stool examination.
Liquid stools will show trophozoites, while formed
stools will show cysts. Direct fecal smears may be
done to demonstrate trophozoites. Formalin-ether
concentration technique and iodine stain are useful
o differentiate species.

TREATMENT
No treatment is necessary because these
amebae do not cause disease.

EPIDEMIOLOGY
In single stool examinations of over 30,000
Filipinos, the prevalence of Entamoeba coli was
about 21% Endolimax nana about 9% and
Iodamoeba butschlii, 1%.

PREVENTION AND CONTROL

Infection may be prevented through proper
disposal of human waste and good personal
hygiene.