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AMOEBA- characterized by the presence of hyaline fortlike extrusions from ectoplasm called pseudopodia.

Kingdom: Protista
Phylum: Sarcomastigophora
Subphylum: Sarcodina
Entamoeba histolytica
Pathology:
1. Intestinal Amoebiasis
a. Asymptomatic Intestinal Amoebiasis
- cyst passer
- no diarrhea
- has lesions
b. Acute Amoebic Dysentery
- bloody mucoid
- watery diarrhea
- stomach pain
- 20 times defecation
- hematophagous trophozoites
c. Amoebic Diarrhea
- no blood
- watery stools
- mimic cholera
- all trophozoites
d. Colonic Amoebic Ulcers
- Passing out all trophozoites
2. Extraintestinal Amoebiasis
a. Amoebic Live Abscess
- Anchovy sauce like aspirate
- Right lobe of liver
b. Pulmonary Splenic Cardio Amoebiasis
- Lungs,splee, heart
c. Cutaneous amoebiasis: skin
d. Genital amoebiasis: penis/ vagina
e. Cerebral amoebiasis: brain
f. Amoebic pericarditis: heart
Virulent factors:
1. Gal/ Gal Nac Lectin
- Cytoadherence
2. Amoebapores
- Pore formers
3. Cysteine proteinase
- Tissue invasiveness
Diagnostic:
1. Direct Fecal Smear
a. Unstained NSS
b. Stained
Lugols iodine- wet smear for cysts
Quensels Methylene blue- wet smear for trophozoites
Iron hematoxylin, trichrome stain, best carminepermanent stain for cyst and trophozoite

2. Concentration Techniques
a. Merthiolate Iodine Formalin Concentrated
Technique (MIFT)
b. Formalin Ether Concentrated Technique
(FECT)
3. Culture Technique
a. Balamuths monophasis medium
b. Boech Drnohlavs diphasic medium
c. Robinsons and Inoki medium
4. Misc. Procedure
a. Endoscopy
b. Liver aspiration biopsy
c. Serological test
i. Indirect Hemagluttination Test (IHAT)
ii. Indirect Fluorescent Ab. Test (IFAT)
iii.
Counter Immunoelectrophoresis (CIE)
iv.
Agar Gel Diffusion (AGD)
v. Enzyme-linked Immunosorbent Assay
(ELISA)
d. Radiographic non-invasive technique
- ultra-sound
- CT scan
- MRI
Treatment:
1. Metrodinazole- invasive amoebiasis
2. Diloxanide Furoate- asymptomatic cyst passer
Anaerobic parasites- thioglycolate base culture;
example: Shaffer- Ryden-Frye medium
Entamoeba coli
- common intestinal human dweller
non-pathogenic
- non tissue invader
stage
of
disease

cyst

trophozoite

specimen

technique

chronic

well
formed,
semiformed

ZnSO4 Conc.
Technique,
FECT, Kato
Tech
qualitative
Kato Katquantitattive

acute

watery
diarrhea,
mucoid
diarrhea,
bloody
defecation

Direct Fecal
Smear

Iodomoeba butschili
- non pathogenic
- mono nucleated
- large glycogen body/ vacuole
trop: finger like basket of flowers (nucleus)- due to
achromatic granules

Endolimax nana
- non pathogenic
- 4 nucleus
- big karyosome
- oval shape
- cross eyed cyst
- comma shaped chromatoidal bar
Dientamoeba fragilis (amoeba flagellate)
- mild, slight diarrhea
- non pathogenic, intestinal
- only trophozoite stage then flagellate
- particulate shape of karyosome
- leaf-like pseudopod
Entamoeba gingivatis
- pyorrhea- disease of gums
- habitat- mouth
- tartar of teeth and gingival pockets
- trophozoites only
- large food vacuoles
- finger-like pseudopods
- dot nucleus
FLAGELLATES- protozoans characterized by the
presence of whip- like locomotory organs called flagella.
Kingdom: Protista
Phylum: Sarcomastigophora
Subphylum: Mastigophora
Parts: flagella, parabasal body, undulating membrane,
cytosome,costa, axostyle (axial rod)
Giardia lamblia
- intestinal crypts, jejunum
- simple binary fission
- non tissue invading
- pathogenic
trophozoite
- old mans face with eyes glasses, falling leaf
motility, rotary / boring
- pear shaped / pyriform/ tear drop
- bilaterally symmetrical
- ventral sucking disc in the epithelial cell lining
the duodenum causing intense inflammation and
secretion of abundant mucus leading to
malabsorption of fats and starch
- 4 pairs of flagella
- 2 nuclei (central karyosome)
- axostyle and parabasal body present
- covered with variant specific surface proteins
(vsp) which are resistant to intestinal proteases
cyst
-

ovoid, quadrinucleated
flagella retracted into axoneme (median body)
deeply stained curved fibrils
infective stage (infective dose: 10 cysts)

Mode of Transmission:
Ingestion, excystation within 30 minutes in
duodenum
Laboratory Test:
1. stool exam
2. duodenal aspirate
3. Beale string test/ entero test
4. Immunochromatography Ag detection in stool
5. Direct Fluoroscent Ab Assay- gold standard
Pathology:
1. Malabsorption of fats and starch
2. Travellers diarrhea
3. Failure to thrive syndrome
4. Steatorrhea- fat in stool (chronic infection)
5. rotten egg- smelling flatus
6. gay bowel syndrome homosexual oro anal
practices
7. reduction of height of columnar cells
8. giardiasis- epigastric pain
Treatment:
1. Metronidazole
2. Tinidazole
3. Quinacrine
4. Paromomycin
Chilomastix mesnili
trophozoite
- cork screw, boring motility
- 3 anterior flagella
- 1 cytosomal fibril
- prominent spiral groove in midportion of body
cyst
-

american lemon shaped cyst


nipple like cyst
uninucleated
distinct anterior protuberance
cytosomal fibers: safety pin/ shepherd crook

CILIATES hair like ectoplasmic called cilia


Kingdom: Protista
Phylum: Ciliophora
Balantidium coli
Trophozoite
- thrown ball motility
- ovoidal/ bean shape
- covered with cilia
- cytostome (anterior part/ mouth- entry of food)
- cytopyge (posterior part/ anus- exit of food)
- contractile vacuoles
cyst
-

ovoid/spherical
thick cell wall
cilia enclosed in cystic wall

2 nuclei still present


Infective stage

3. Iodoquinol

macronucleus- kidney shaped


1. regulation of daily metabolic activities
(respiration/ digestion/protein synthesis)
2. asexual reproduction
3. cell phenotype
micronucleus- small round shape of dna
1. genetic reserve of cell
2. sexual reproduction
3. hereditary processes
Transmission:
Ingestion, incubation period- 4-5 days
Laboratory Test:
1. DFS
2. Concentration techniques
3. Biopsy
Pathology:
1. Balantidiasis/ balantidial dysentery
2. Flask shaped ulcer (wide neck rounded base)
due to hyaluronidase
3. Diarrhea
4. Ciliary dysentery (bloody and mucoid stool)
5. Complications can lead to intestinal perforation
and acute appendicitis
Treatment:
1. Tetracycline
2. Metronidazole

Diagnostic
Stage

Points of Difference

Entamoeba histolytica

Entamoeba coli

movement
shape of pseudopodia

unidirectional, progressive
finger- like
one at a time (explosive
manner)
mononucleated,central
karyosome
clean looking
rbc
4 if mature/ quadrinucleated
(center)

sluggish, not progressive


blunt
several at a time (slow
manner)
mononucleated, eccentric
karyosome
dirty looking
bacteria, food debris, yeast
> 4, 6-8 if mature,
octanucleated (eccentric)
witch broomstick
appearance, splintered/
needle-like

release of pseudopodia
trophozoite
nucleus
cytoplasm
inclusions
no. of nuclei
cyst
chromatoidal bars

sausage/ cigar shape, coffin


lid with round ends

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