الرحیم الرحمن الله الرحیم بسم الرحمن الله بسم

Kingdom protistaKingdom protista(classification of protozoa)(classification of protozoa)

• Subk.: Protozoa • phylum: Apicomplexa Ciliophora Sarcomstigophora Microspora

• Subph: Sarcodina Mastigophora

(Amebae) (Flagellates) Parasitic Amebae Free-living Amebae

Family: Endamoebidae Leptomyxidae Acanthamoebidae Vahlkampfidae

Genus: Entamoeba Iodamoeba Endolimax gingivalis butschlii nana Sp. Hartmani histolytica coli dispare

Entamoeba gingivalisEntamoeba gingivalis(non-pathogen)(non-pathogen)

• -Prevalance rate

• - Live site

• - Morphology• - cytoplasm

• Diagnosis: may be mistaken for E.histolytica from a pulmonary abscess

Entamoeba coliEntamoeba coli(non-pathogen)(non-pathogen)

• Prevalance: 1 to 50%

• Morphology: trophozoite range 15-50µm

• ( very closely resemble E.histolytica)

• - cytoplasm

• - Pseudopodia

• Motility

• *nucleus

• *karyosome

• *peripheral chromatin

Entamoeba hartmaniEntamoeba hartmani

• *small race of E.histolytica (morphologic similarity)

• *size: trophozoite < 12 mμ , c yst < 10 mμ

• *only clear-cut distinction between the two species is size

• *trophozoite ingest bacteria but no RBC

•

Entamoeba dispareEntamoeba dispare : :*There is no morphologic differences between this amoeba with E.histolytica*There is no morphologic differences between this amoeba with E.histolytica*This amoeba no ingest RBC*This amoeba no ingest RBC

Iodamoeba butschliiIodamoeba butschlii : : **Trophozoite size(4-20Trophozoite size(4-20μμmm), cytoplasm may be contain bacteria, large karyosome, small ), cytoplasm may be contain bacteria, large karyosome, small granulesgranules

*Cyst size(9-10 *Cyst size(9-10 μμmm): contain glycogen vacuole, sigle nuclei

Endolimax nanaEndolimax nana

• *most common of the smaller intestinal amaeba

• *Size: trophpozoite and cyst is similar to theat of E.hartmani

• *Motility: sluggish

• pseudopodia extruded rapidly

• *Cytoplasm:

• Nucleus: contain large karyosome

• *Cyst:

Free-Living AmebaeFree-Living Amebae(Opp0rtuistic Amebae)(Opp0rtuistic Amebae)

Family:Family: Vahlkampfiidae Acathamoebidae Leptomyxidae Vahlkampfiidae Acathamoebidae Leptomyxidae

GenusGenus:: Naegleria Acanthamoeba BalamuthiaNaegleria Acanthamoeba BalamuthiaSpecies:Species: fowleri castellani mandrillaris fowleri castellani mandrillaris calbertsonicalbertsoni polyphagapolyphaga

HabitatHabitat: : in fresh, brackish and salt water, moist soil and decaying vegetationin fresh, brackish and salt water, moist soil and decaying vegetation

History: History: Human infection were first reported by Fowler in 1965Human infection were first reported by Fowler in 1965

Geographic distributionGeographic distribution: The most cases were reported from; USA, Australia, : The most cases were reported from; USA, Australia, Czech, Oslovakia, Belgium, India,……..Czech, Oslovakia, Belgium, India,……..

Epidemiology: Epidemiology: Most cases have occurred during summer in young persons who Most cases have occurred during summer in young persons who swam or dived in swimming pools and during the ritual washing before prayerswam or dived in swimming pools and during the ritual washing before prayer

Naegleria fowleriNaegleria fowleri

• Morphology , Biology and Life cycle: • flagellate form

• *Life cycle stage consist: -motile trophozoite: • -nonmotile cysts ameboid form

• *Reproduction: simple binary fission

• *Ameboid form: found in tissue , forms a single pseudopod,

• dimensions 7 by 20μm, With a nucleus contain a large central karyosome

• *Flagellate form: with two flagella, pear-shaped, do not divided

• *Cyst form: uninucleate, circular 7-10μm in diameter, nucleus is similar to troph.

•

Naegleria forms

Naegleria cyst & trophozoite

Life cycle

Symptoms and pathogeesis

• Primary Amebic Meningoencephalitis(P.A.M.) :

• Symptoms; headache, fever, nausea

• and vomiting accompanied by signs

• of meningitis with involvement of the

• olfactory, frontal, temporal, and

• cerebral areas

• Death : occurs early; the entire

• clinical course seldom extends

• beyond 3 to 6 days.

Acanthamoeba( Hartmanella) spp.• Morhology, Biology and Life cycle:

• These amebae are similar in appearance to the ameboid stage of Naegleria but have no flagellate stage.

• Cyst & Trophozoite may be found in tissue, but cysts are never seen in Naegleria infections.

• Pseudopods are acanth forms

Acanthamoeba trophozoite

Free-living Amebae Life Cycle

Symptoms & Pathogenesis• Granulomatous Amebic Encephalitis( GAE):• *Invasion of the CNS is not associated with swimming but is secondary to

infection elsewhere in the body .

• Amebae reach the brain by way of blood stream, likely from lung or through ulcer the skin or mucosa

• Occurs most often in debilitated or immunocompromised persons• A. astronyxis and A. palestinensis associated only with CNS infection

• Acanthamoeba Keratitis:• * Affects healthy person, increase in the number of cases in the recent years has

been linked to the wearing of contact lenses, especially soft ones.

• A. polyphaga and A.hatchetti only with eye infection.

• Chronic granulomatous infection of the skin• A. castellani, A. culbertsoni ,….. Have causea both CNS and eye infections

Keratitis

Diagnosis of PAM and GAE:

*A patient’s history of having been swimming in water 3 to 6 days prior to onset of symptoms of PAM suggest a possible diagnosis.

* In brain tisse is made by microscopic identification of living or Wright-stained amebae in the patient’s CSF or trophozoites and cysts of Acanth..

* by cultivation of cerebrospinal fluid in medium non-nutrient agar seeded with living Escherichia coli for PAM and corneal scraping cultured for Acanth. Keratitis.

• Treatment: At present there is no satisfactory treatment fir PAM and GAE.

• *Amphotericin B, is administered intravenously in large doses; 1 to 1.5 mģ/kg body weight daily for 3 days, followed by 1 mg/kg daily for 6 days.

• *Miconazole and Rifampin are other alternative drugs.