Cours de Medcine
Cours de Medcine
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Lecturer: Huda R. Sabbar Medical microbiology
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Lecturer: Huda R. Sabbar Medical microbiology
Mechanisms of pathogenesis
Much of the damage done by Acanthamoebatrophozoites in the course of
corneal or brain infections is probably the result of several different pathogenic
mechanisms. Acanthamoeba undergoes certain morphological changes when
associated with hamster cornea in vitro, and produces amoebastome-like
(foodcup) surface structures that ingest detached epithelial cells and thus aid in
phagocytosis. Several studies have described enzymes secreted by
Acanthamoeba, which may facilitate the spread of amoebae by opening avenues
for invasion, and providing nutrients in the form of lysed host cells. The
pathogenic species A. culbertsoni excretes more phospholipase enzyme into the
culture medium than does the nonpathogenic species.
Naegleriafowleri
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Lecturer: Huda R. Sabbar Medical microbiology
Mechanisms of Pathogenesis
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Lecturer: Huda R. Sabbar Medical microbiology
The portal of entry into the CNS is the olfactory neuroepithelium. It is believed
that the sustentacular cells lining the olfactory neuroepitheliumphagocytose the
amoebae that enter the nasal passages of the victims while indulging in aquatic
activities. The amoebic trophozoites pass through the sieve-like cribriform plate
and penetrate into the subarachnoid space and continue on to the brain
parenchyma.
The incubation period of PAM varies depending on the size of the inoculum,
and on the virulence of the particular strain of infecting amoebae.
Naegleriafowleri when inoculated into tissue culture cells destroy the cell
monolayer by causing a cytopathic effect or CPE. The amoebae produce sucker-
like appendages or amebostomes that ‘nibble’ away at the tissue culture cells.
Other possible factors involve the production of: (i) phospholipase A and B
activity or a cytolytic factor causing destruction of cell membranes;
(ii)neuraminidase or elastase activity facilitating destruction of tissue culture
cells; (iii) a perforin-like, pore-forming protein that lyses target cells; and (iv)
the presence within Naegleria amoebae of a cytopathic protein that triggers the
apoptosis pathway in susceptible tissue culture cells.
Treatment
Few patients have survived PAM. the survivor were aggressively treated with
intravenous and intrathecalamphotericin B, intravenous and
intrathecalmiconazole, and oral rifampin.
EmtamoebaDispar
Non invasive protozoan , has recently been separated from E. histolytica . The
two parasite are morphologically identical species but genetically distinct
species . Is predominant cause of colonization in many asymptomatic (cyst
passers) in developing countries ,as well as in sexually active male homosexuals
in developed countries .
Morphology :
The are two species of Entamoeba only one of these caused disease in human ,
Other non pathogenic , species E. dispar . The inability to differentiate between
these two species by morphological or biological means until recently led to
significant debate on this topic . Isoenzymes typing could be used to distinguish
the pathogenic fromnon – pathogenic species of EntamoebaToday the two
species are classified as E.histolytica and E . Dispar
Pathogenesis:
E. dipar has never been documented to cause colitis or liver abscess BecauseE
.dispar colonization is more common than E. histolytica infection and not need
treated . an important clinical advance has been the
development of Ag detection test that differentiate between themStating that the
E . Dispar infection doesnot need to be treated ,and E. dispar is capable of
killing target cells such as neutrophils
Clinical features:
Although colonization with E . Dispar is known to occur , the organismhas
never been known to cause disease . In patients with HIV infection no
correlation has been established between the presence of E. dispar and
gastrointestinal symptoms.
Diagnosis:
Entamoebadispara non-pathogen is indistinguishable bymicroscopy and is a
much more common intestinal protozoan than Entamoebahistolytica.
Antigen capture and PCR tests can distinguish E. disparfrom E. histolytica in
heavier infections
EntamoebaGingivalis
General characterized :
1- was the first amoeba ofman to be described .
2- it is global in distribution .
3- this type is seen in tooth .
4- no cyst in stool .
morphology:
This species of amoeba is no cyst stage is seen Only troph of this parasite are
seen . The troph is 10 -20mm in diameter , Activelymotile with multiple
pseudopodia .The cytoplasm contains food vacuoles with ingested bacteria .
ingested Leukocytes and epithelial cell . The nucleus is round , with central
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Lecturer: Huda R. Sabbar Medical microbiology
Clinical Disease
It is commensal organism , and not considered to cause any disease ,It lives in
the gingival tissues . It has been misdiagnosed in various condition .
A- in periodontal disease where it is just accidently present and has no
pathogenic role .
B- itmultiplies in bronchialmucosa and appears in sputum where itmight be
mistaken for E . histolytica from a pulmonary abscess .
C- it has been recovered fromvaginal and cervical smears of woman using
intrauterine devices but has on pathogenic role.
Entamoeba Coli
Non pathogenic amoeba (can not produce virulent factor ). Found in healthy
stool . Normally present in intestine . That very closely resembles
Entamoebahistolytica .
Morphology:
There are three stages in this type: Trophozoites. Pre cyst. Cyst.
Characterized of trophozoites
The troph range in size from15 – 50mm . There is single nucleus with enteric
karyosome and unevenly distributed peripheral chromatin . The cytoplasm is
granular . The trophmove by short multiple pseudopodia( multi– directional). No
RBC are present. Ability to ingested multiple type of bacteria can be
causesmany disease.
Characterized of pre cyst and cyst
1- pre cyst :
This stage is very transitory
2- cyst
measure 10 – 35mm in diameter . The average diameter is definitely greater
than the cysts of thenucleus vary in number from 1 – 8 pathogenic amoeba .The
karyosome can be frequently distinguish even in unstained amoebae . Peripheral
Chromatin are unevenly distributed.
Life cycle
Human infected occurs through ingestion of food or water contaminated by cyst
bearing faeces . Eight nucleatedmetacyst is excycted in intestine , After a series
of cytoplasmic division eight to fewer metacystictrophozoites are formed and
develop in to mature troph in caecum, Trophmultiply by binary fission .
Clinical features : Entamoeba coli is non – pathogenic No clinical manifestation
results.
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Lecturer: Huda R. Sabbar Medical microbiology
Endolimax nana
Non pathogenic amoeba , classified within intestinal amoeba , They are found
only in lumen cavity of the intestinal tract, These nonpathogenic protozoa do not
causes any disease.
Morphology
The troph exhibit non progressive motility which is achieved by blunt hyaline
pseudopodia . The single nucleusmay or not be visible in stained preparation ,
The karyosome is typically large and irregularly shaped , and is often described
as “blot like “ in appearance . Absence of peripheral chromatin is key in trophs
identification. The cytoplasm is granular , vacuolated and usually contains
bacteria . Non pathogenic amoeba , classified within intestinal amoeba , They
are found only in lumen cavity of the intestinal tract. These nonpathogenic
protozoa do not
causes any disease . Infection with this parasite by ingesting food or water that is
contaminated with feces. This is called fecal-oral transmission.
E. nana
DientamoebaFragilis
Amoebic – flagellated parasite This parasite is classified as an amoeba
because this organismmoves by pseudopodia and does not have external
flagella.
Morphology
Only troph is present in the life cycle . The troph is irregular and roundish in
shape . Motility is progressive and accomplished by broad hyaline pseudopodia ,
The topical troph has 2 nuclei each consisting of 4-8 centrally located massed
chromatin granules , No peripheral chromatin is present . most troph are
binucleated , therefore this parasite named Dientamoeba . Vacuoles containing
bacteriamaybe present in the cytoplasm of these troph . No cyst is seen The
specimen of choice for recovery Dientamoeba is the stool . It is known that this
parasite resides in themucosal crypts of the large intestine . There is no evidence
to suggest that D . Fragilistrophinvade their surrounding tissues, and has only
rarely been known to ingest R.B.Cs . It is estimated that the majority of persons
with D. fragilis infectious remain asymptomatic
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Lecturer: Huda R. Sabbar Medical microbiology
Life cycle
the cyst stage has not been identified in D. fragilislife cycle, and the trophozoite
is the only stage found in stools of infected individuals . D. fragilisis transmitted
by fecal-oral route and transmission via helminthes eggs (e.g., Ascaris,
Enterobiusspp.)
Clinical feature
Trophozoites of D. fragilishave characteristically one or two nuclei , and it is
found in children complaining of intestinal (diarrhea, abdominal pain) and other
symptoms ( nausea, anorexia, fatigue, malaise, poor weight gain). Other
documented symptoms that may occur include bloody or mucoid stools Some
patients experience diarrhea with constipation .
Treatment
The drug are used in this infection is Iodoquinol.
Iodamoebabutchlii
The trophozoites are 9–14 micrometres in diameter. Trophozoites are one of the
two forms of I.bütschlii. This form has a pseudopodia for locomotion. The
pseudopodia is short and blunt. It moves in a slow manner. The trophozoite has
a single nucleus, prominent for nuclear endosome and many cytoplasmic
vacuoles. The ectoplasm and the granular endoplasm are often hard to
distinguish. The nucleus is fairly large and vesicular, containing a large
endosome, surrounding by light staining granules about midway between it and
the nuclear membrane. Achromatic strands stretch between the endosome and
nuclear membrane without any peripheral granules. Food vacuoles are
commonly filled with bacteria and yeast. Trophozoites are often identified by a
stool smear, found in loose stools.
The cysts are 8–10 micrometres in diameter, with a thick wall and a
large glycogen vacuole that stains darkly with iodine. Usually harmless, it may
cause amebiasis in immunologically compromised individuals. As the second
form of I. butschlii, cysts have an oval shaped- single nucleus with a prominent
nuclear endosome. This form is also large, single, glycogen-filled vacuole called
iodinophilous vacuole (glycogen stains with iodine). Cysts are the infective
stage of I. bütschlii. Unlike trophozoites, cysts are often found in formedstool
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Lecturer: Huda R. Sabbar Medical microbiology
cyst of I. butchlii
Entamoebahartmanii
This organism belongs to the amebae, is a nonpathogen, and causes no disease.
Both the trophozoite (usual size, 4-12 µm) and cyst forms (usual size, 5-10 µm)
can be found in clinical specimens.
Life Cycle:
Large bowel, organisms passed in feces
Acquired:
Fecal-oral transmission via cyst form; contaminated food and water
Epidemiology:
Worldwide, primarily human-to-human transmission
Clinical Features:
None
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