Amoebiasis

Pathophysiology
When cyst is swallowed, it passes through the stomach unharmed and shows no activity while in an acidic
environment. When it reaches the alkaline medium of the intestine, the metacyst begins to move within the cyst
wall, which rapidly weakens and tears. The quadrinucleate amoeba emerges and divides into amebulas that are
swept down into the cecum. This is the first opportunity of the organism to colonize, and its success depends on
one or more metacystic trophozoites making contact with the mucosa.
Mature cyst in the large intestines leaves the host in great numbers (the host remains asymptomatic. The cyst
can remain viable and infective in moist and cool environment for at least !" days, and in water for #$ days.
The cysts are resistant to levels of chlorine normally used for water purification. They are rapidly killed by
purification, desiccation and temperatures below % and above &$ degrees.
The metacystic trophozoites of their progenies reach the cecum and those that come in contact with the oral
mucosa penetrate or invade the epithelium by lytic digestion.
The trophozoites burrow deeper with tendency to spread laterally or continue the lysis of cells until they reach
the sub'mucosa forming flash'shape ulcers. There may be several points of penetration.
(rom the primary site of invasion, secondary lesions maybe produced at the lower level of the large intestine.
)rogenies of the initial colonies are squeezed out to the lower portion of the bowel and thus, have the
opportunity to invade and produce additional ulcers. *ventually, the whole colon may be involved.
*. histolytica has been demonstrated in practically every soft organ of the body.
Trophozoites which reach the muscularis mucosa frequently erode the lymphatics or walls of the mesenteric
venules in the floor of the ulcers, and are carried to the intrahepatic portal vein.
+f thrombi occur in the small branches of the portal veins, the trophozoites in thrombi cause lytic necrosis on the
wall of the vessels and digest a pathway into the lobules.
The colonies increase in size and develop into abscess.
The life'cycle of * histolytica begins with ingestion of focally'contaminated food or water.
The infective cyst form of the parasite survives passage through the stomach and small intestine. +t e,cysts in
the bowel lumen to form motile and potentially invasive trophozoites.
+n most infections, the trophozoites aggregate in the intestinal mucin layer and form new cysts, resulting in a
self'limited and asymptomatic infection. -owever, galactose./'acetyl'galactosamine (0al.0al/1c lectin'
mediated adherence to and lysis of the colonic epithelium can initiate trophozoite invasion into the colon in
some cases.
/eutrophils responding to invasion contribute to cellular damage at the site of invasion. 2nce the intestinal
epithelium is invaded, e,traintestinal spread into the peritoneum, liver, and other sites is possible.
(actors controlling invasion versus encystation include parasite quorum sensing signaled by the 0al.0al/1c
lectin interactions of amoebae with the bacterial flora of the intestine, and host innate and acquired immune
responses.
Trophozoites are always present in the gut in patients with amoebic diarrhoea and dysentery (diarrhea with
blood or mucus, and diagnosis should concentrate on identifying the parasite in stool by antigen detection and
the serum antibody response against the invasive parasite.
+nvasion of the trophozoites through the intestinal epithelium leads to amoebic diarrhoea and colitis
Primary Cause of Amoebiasis
Transmission of an infectious agent by another person by one or more of the following3 saliva, air, cough, fecal'
oral route, surfaces, blood, needles, blood transfusions, se,ual contact, mother to fetus, etc.
Treatment List for Amoebiasis
Metronidazole