1. INTESTINAL AMOEBIASIS an enteric disease Made and Presented by: Asiya Fazal

2. Contents Introduction Introduction Causative agent Causative agent Epidemiology Epidemiology Mode of transmission Mode of transmission Clinical sign and symptoms Clinical sign and symptoms Habitat of E.histolytica Habitat of E.histolytica Life cycle Life cycle Pathology Pathology Diagnosis Diagnosis Treatment Treatment Prevention Prevention References References

3. Intestinal Amoebiasis  Intestinal Amoebiasis,also called ‘’Amoebic Dysentery ’’. called ‘’Amoebic Dysentery ’’.  It is a disease characterized by inflammation of the by inflammation of the intestines,particularly the colon. intestines,particularly the colon.

4. Best known species of amoeba that parasitizes human. Global in its distribution,the incidence of infection exceeds 400 million cases (W.H.O). First discovered in Russia in 1873 by Losch.

5. Causative agent  The causative agent of Intestinal amoebiasis is the protozoan: agent of Intestinal amoebiasis is the protozoan: “ Entamoeba histolytica ”. “ Entamoeba histolytica ”. Scientific meaning, Scientific meaning, “Tissue dissolving ” “Tissue dissolving ”

6. Causative agent  Morphologic forms: E.histolytica has two forms. E.histolytica has two forms. 1 - Cyst (infective form) 2 - Trophozoite (active feeding form) (active feeding form)

7. Epidemiology  10% world population is infected with E.histolytica (W.H.O)  Amoebiasis is the third most common cause of death from parasitic disease. (next to malaria and schistosomes).  In Pakistan approx.17% people become infected with amoebic dysentery every year and the majority being children (N.I.H).

8. Mode of Transmission  Direct transmission: With contaminated hands. Indirect transmission: Indirect transmission: Contaminated food and Contaminated food andwater.  Other vital factors: Flies,vegetables,food handlers etc.

9. Clinical signs/symptoms  Influenced by severity of infection Acute Amoebiosis : Acute Amoebiosis : Severe dysentery Dehydration Severe dysentery Dehydration (Anorexia) (Anorexia) Blood & Mucus in faeces Blood & Mucus in faeces (Intense griping pain,frequently visits latrines straining blood & mucus) (Intense griping pain,frequently visits latrines straining blood & mucus) Prolapse of rectum Prolapse of rectum

10. Clinical sign/symptoms CHRONIC amoebiasis Abdominal pain Diarrhea Or Dysentery Mucous with blood In stool

11. Habitat of E.histolytica  E.histolytica inhibits large intestine.  Trophozoite lives in the intestinal lumen.  May invade the mucosa, where they feed on red blood cells and form ulcers.

12.  If intestinal motility is rapid, amoeba may be passed out in liquid or semisolid stool as trophozoite.  If intestinal motility is normal, amoeba will passed out as a resistant cyst.

13. Life cycle of E.histolytica Quadrinucleated cysts (Infective stages) Contamination of food & H 2 O Excystation in Small / large Intestine 4 Metacyclic Forms (Amoebules) 4 Metacyclic Forms (Amoebules)

14. Amoebules in Intestinal lumen Binary Fission 8 Amoebae Invade intestinal tissues (Trophozoites) Invade intestinal tissues (Trophozoites) Asexual reproduction by binary fission (Colonies of Amoebae: Increase in Population)

15. Asexual reproduction by binary fission (Increase in Population) (Increase in Population) Last generation before encystment:Precystic stage Last generation before encystment:Precystic stage Trophozoites Round up, Expel food particles Trophozoites Round up, Expel food particles Encystment & Cysts in lumen Encystment & Cysts in lumen Cysts in faeces Environmental contamination contamination

18. Pathology  Invasion of large intestine by the action of enzymes:  Cystein  Protease.  Becomes site of secondary infection for certain bacteria and viruses.

19. Pathology Invasion of Intestinal mucosa Multiply asexually: Binary fission Multiply asexually: Binary fission Invasion in deeper layers (Sub mucosa) Invasion in deeper layers (Sub mucosa) Spread laterally Spread laterally Flask shaped ulcers:Caecum & Ascending Colon

20. Pathogenesis

21. Diagnosis Diagnosis Diagnosis Stool microscopy SerologySigmoidoscopy

22. Treatments Treatments Metronidazole 500mg- 750mg 5-10 days Tinidazole 2g 3 days Paromomycin 500mg 10 days Diloxanide furoate 500mg 10 days Iodoquinol 650mg 20 days

23. Prevention  Wash hands with soap & water at least 10 seconds after using toilet.  Clean bathroom & toilets often.  Avoid sharing towels.  Avoid eating raw vegetables.  Boil water or treat with iodine tablets.  Health education and personal hygiene.

24. References  www.wikipedia.com www.wikipedia.com  www.sciencedirect.com www.sciencedirect.com  Foundations of parasitology.