بسم اللة الرحمن الرحيم
DESCRIPTION
بسم اللة الرحمن الرحيم. Protozoa Intestinal Amoeba. Causal Agent: Several protozoan species in the genus Entamoeba infect humans, but not all of them are associated with disease. - PowerPoint PPT PresentationTRANSCRIPT
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Causal Agent:• Several protozoan species in the genus
Entamoeba infect humans, but not all of them are associated with disease.
• Entamoeba histolytica is well recognized as a pathogenic ameba, associated with intestinal and extra-intestinal infections.
• The other species are important because they may be confused with
E. histolytica in diagnostic investigations.
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Introduction Entamoeba histolytica
1. The only pathogenic amoeba among all of the intestinal amoebae.2. Infecting perhaps 10% of the
world's population.3. Lead to invasive amoebiasis.
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Entamoeba histolytica
•Worldwide, with higher incidence of amoebiasis in developing countries.
• risk groups include male homosexuals, travelers and recent immigrants, and institutional
populations.
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morphology
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Life cycle• Infection by Entamoeba histolytica
occurs by ingestion of mature cysts in fecally contaminated food, water, or hands.
• Excystation occurs in the small intestine and trophozoites are released, which migrate to the large intestine.
• The trophozoites multiply by binary fission and produce cysts.
• Cysts and trophozoites are passed in feces Cysts are found in formed stool, whereas trophozoites are found in diarrheal stool.
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E.dispar has similar live cycle but non invasive ,not pathogenic.
Via polluted water; infected food handler, flies contaminating food, soil cultivation, direct contact
Viability : -Moist ,cool condtion Up to 12days -In water 9-30 day
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transmission. • the cysts can survive days to weeks
in the external environment (protection by cyst walls) and are responsible for transmission.
• Trophozoites in the stool are rapidly destroyed outside ,and if ingested not survive in the gastric juice.
• In many cases, the trophozoites remain confined to the intestinal lumen of individuals who are known as (non-invasive infection) cyst passer.
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1- the primary ulcer invasion of mucosa via crypts repair may occur.2- extension in mucosa muscularis mucosa relatively resistant. 3-formation of sinus accumulation of amoebae superficial to muscularis mucosa with lateral extension of lytic necrosis; abscesses may coalesce under intact mucosa , mucosa may slough with widespread ulceration 4-deep extension muscularis mucosa eventuallypierced (direct or via blood)deep necrosis of sub-mucosa even muscle and sub-serosa
1
2
3
4
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Complications and squeals
-Pretonitis haemorrhag
-Surronging inflammatory reaction
-A mass under oedemotous mucosa
Amoeboma clinically simulates neoplasm
-Extraintestinal lesion
-Perforation hemorrhage (rare)
-Secondary infection
Amoeboma
Obestraction
intusssception
-Invasion of blood vessels.
-Direct extension outside bowel
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-Ulcer with peritonitis - hemorrhage - surrounding inflammatory
reaction and fibroplastic proliferation a mass formed under edematous mucosa amoeboma (simulate
carcinoma)
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Extra intestinal extension
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Extra intestinal extension
Liver involvement
- Secondary to
- Concomitant with
-Independent of
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.
A B
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• the pathogenic E. histolytica is not morphologically differs from the nonpathogenic E. dispar!
• Each trophozoite has a single nucleus, which has a centrally karyosome and uniformly distributed peripheral chromatin.
• The cytoplasm has a granular or "ground-glass" appearance.
• Entamoeba histolytica / E. dispar trophozoites measure usually 15 to 20 µm (range 10 to 60 µm), tending to be more elongated in diarrheal stool.
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C D
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f e
erythro-phagocytosis,
Trophozoites of Entamoeba histolytica with ingested erythrocytes .The ingested erythrocytes appear as dark inclusions.
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•Erythro-phagocytosis is the only morphologic
characteristic that can be used to differentiate E. histolytica from the non-pathogenic
E. dispar
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•The nuclei of Entamoeba histolytica have characteristically centrally located karyosomes, and fine, uniformly distributed peripheral chromatin.
• The cysts contain chromatoid bodies , with typically blunted ends. •Entamoeba histolytica cysts
usually measure 12 to 15 µm.
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MatureEntamoeba histolytica cysts usually measure 12 to 15 µm. cysts have 4 nuclei.
h
I
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Entamoeba coli
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Trophozoites of Entamoeba coli
A
B
C
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•Entamoeba coli -Trophozoites each have one nucleus
with a large, eccentric karyosome and coarse, irregular peripheral chromatin.
-The cytoplasm is coarse , vacuolated (dirty cytoplasm). - Cytoplasm contains ingested
bacteria , yeasts or other materials. - The trophozoites of E. coli measure
usually 20 to 25 µm, but it can reach up to 50 µm.
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•Mature cysts typically have
8 nuclei, and measure about
20-25 µm (range 10 to 35 µm). • Chromatoid bodies are seen
less frequently than in E.histolytica. they are splinter like with pointed ends.
• N.B. chromatoid bodies of E.histolytica have rounded ends.
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DF
E
Entamoeba coli cyst
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Clinical Features:A wide spectrum, from asymptomatic infection ("luminal amebiasis"), to invasive intestinal amebiasis (dysentery, colitis, appendicitis, toxic megacolon, amebomas), to invasive extra-intestinal amebiasis
(liver abscess, peritonitis, pleuropulmonary abscess, cutaneous and genital amebic lesions).
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pinpoint lesion on mucous membrane
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flask-shaped (Ulcers)
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Amoebic abscess in liver
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Pathogenesis: Clinical classification Intestinal • Asymptomatic infection (carrier) 85-95 % of cases.• Sympomatic cases 5-15%
a. Intestinal amoebiasis - a. dysentery (blood and mucus in stool) - b. non-dysenteric colitis - c. amoeboma
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b.Extra-intestinal amoebiasis
a. Hepatic (1) acute non suppurative hepatitis (2) liver abscess b. Pulmonary c. Brain, Skin, Other extra- intestinal amoebiasis.
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Hepatic amoebiasis:
sing & symptoms•Local discomfort.•Malaise, fluctuant temperature
• Toxemia.• Pain in right shoulder.
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Diagnosis : intestinal Direct
_ Microscopic identification of cysts
and trophozoites in the stool _ trophozoites can also be identified in aspirates or biopsy samples obtained during colonoscopy or surgery.
Indirect by immunodiagnosis (elisa)
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Diagnosis: of Amoebic liver abscess
•X-ray or ct scan show raised diaphragm•Blood picture –leucoytosis.•Serological test (elisa).•Examination of aspirate if
indicated as treatment.
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•Treatment:-For asymptomatic infections, (furamide) is the drugs of choice.
-For symptomatic intestinal disease,
or extra intestinal, infections (e.g. hepatic abscess), the drugs
of choice are metronidazole or tinidazole, immediately followed by treatment with diloxanide furoate.
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Prevention•human feces should not be
used as fertilizer• food and drinks must be
protected from flies.
(mechanical transmission)•personal hygiene. wash hands after defecation
and before meals. (autoinfection)
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in summary pinpoint lesion on mucous membrane •flask-shaped Ulcers•Amoebic liver abscess• anchovy sauce sputum (lung) • brain , spleen , genito-urinary tract• amoeboma simulate carcinoma.- Cyst carrier is a healthy persons
(trophozoite only in intestinal lumen -Lumenal form).
- Pre-employments Stool analysis was done for food handler.
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FREE-LIVING PROTOZOA Ameba Diseases•Naegleria fowleri PAM•Acanthamoeba spp. GAE, skin or lung lesions, amebic keratitis.
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Acanthameoba• Have only 2 stage cyst And trophozoite.•Trophozoite and cyst are infective form.
•portal of entry unknown, possibly respiratory tract, eyes, skin.
• presumed hematogenous dissemination to the CNS.
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Acanthamoeba Encephalitis• infection associated with
debilitation or immunosuppression. opportunistic parasitic inf.
• chronic GAE (granulomatous amebic encephalitis). the organisms cause a granulomatous encephalitis that leads to death.
•occurred in wearers of contact lenses.
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Amebic Keratitis• Predisposing factors ocular trauma, contact lens (contaminated cleaning solutions).• Symptoms ocular pain, corneal
lesions (refractory to usual treatments).
• Diagnosis demonstration of amebas in corneal
scrapings.• Treatment difficult, limited success corneal grafts often required.
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Naegleria fowleri
• found in fresh water.• ameba with loblose Pseudopodia.• motile bi-flagellated form.• PAM first recognized by Fowler (1965).
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Primary Amebic Meningoencephalitis
(PAM)
• Symptoms usually within a few days after swimming in warm still waters.
• Infection believed to be introduced through nasal
cavity and olfactory bulbs.• Symptoms include headache,
disorientation, coma.
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Clinical picture A-Asymptomatic infection majority , about 80% B-Symptomatic infection: 1* typical picture most of symptomatic cases: incubation period 1-2 weeks followed by diarrhea for bout 6 weeks. 2* atypical picture - malabsorption in children - fatty diahrrea - Sever diarrhoea.
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Laboratory diagnosis- Stool examination daily for three
days .- Examination of duodenal aspirate,
or by string (enterotest)
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No cyst form
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Trichomonas vaginalis
•Transmission :sexual intercourse or contact with contaminated objects.
•Pathology: • Female: vaginitis ,profuse thin
yellowish discharge with bad smell.
• Male : invasion of urethra ,prostate and seminal vesicles ,causing urethritis but mostly asymptomatic.
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•Diagnosis :
identification of parasites by microscopy of discharge.
(Examination of vaginal or uretheral discharge for T.vaginalis).
•N.B. No cyst stage Imp
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Cryptosporidium Cryptosporidium parvumparvum
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Cryptosporidiosis zoonosis,cosmopolitan,most human and animals infected by Cryptosporidium .
Life cycle• Infective stage : oocyst
with4sporozoites passed in feces.• Upon ingestion sporozoites are
released.•Sporozoite penetrate intestinal
epithelial cells and undergo two cycle :
1-schizogony 2-gametogony.•Sporulated oocyst ,4-5M (with 4
sporozoites) are passed in feces.
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duodenal biopsy sample from a patient with AIDS and cryptosporidiosis
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Pathology & clinical picture:
• Immunocopetent persons asymptomatic or mild enterocolitis ,last about 2 weeks.
• Immunodeficient persons sever diarrhoea with malabsorption.
Diagnosis & morphology:
• duodinal biopsy :gametes or schizont (4-8 merozoites) in epithelial cells.
• Stools :oocyst 4-5 m with 4 sporozoites (without sporocyst).
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•Treatment - Self limited in immunocomptant
persons ,no effective drugs in cases of AIDS.
- Management of fluid and electrolytes loss.
•Prevention and control: -person-to person or animal to
person transmission controlled by sanitation.
-Identify common sources e.g. contaminated water
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