بسم الله الرحمن الرحیم

1. بسم الله الرحمن الرحیم

2. Kingdom protista(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

3. Entamoeba gingivalis(non-pathogen) • -Prevalance rate • - Live site • - Morphology • - cytoplasm • Diagnosis: may be mistaken for E.histolytica from a pulmonary abscess

4. Entamoeba coli(non-pathogen) • Prevalance:1 to 50% • Morphology: trophozoite range 15-50µm • ( very closely resemble E.histolytica) • - cytoplasm • - Pseudopodia • Motility • *nucleus • *karyosome • *peripheral chromatin

5. Entamoeba hartmani • *small race of E.histolytica (morphologic similarity) • *size: trophozoite < 12 mμ , cyst < 10 mμ • *only clear-cut distinction between the two species is size • *trophozoite ingest bacteria but no RBC

6. Entamoeba dispare : *There is no morphologic differences between this amoeba with E.histolytica*This amoeba no ingest RBC Iodamoeba butschlii : *Trophozoite size(4-20μm), cytoplasm may be contain bacteria, large karyosome, small granules *Cyst size(9-10 μm): contain glycogen vacuole, sigle nuclei

7. Endolimax 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:

8. Free-Living Amebae(Opp0rtuistic Amebae) Family:Vahlkampfiidae Acathamoebidae Leptomyxidae Genus:Naegleria Acanthamoeba Balamuthia Species: fowleri castellani mandrillaris calbertsoni polyphaga Habitat: in fresh, brackish and salt water, moist soil and decaying vegetation History: Human infection were first reported by Fowler in 1965 Geographic distribution: The most cases were reported from; USA, Australia, Czech, Oslovakia, Belgium, India,…….. Epidemiology: Most cases have occurred during summer in young persons who swam or dived in swimming pools and during the ritual washing before prayer

9. Naegleria 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.

10. Naegleria forms

11. Naegleria cyst & trophozoite

12. Life cycle

13. 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.

14. 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

15. Acanthamoeba trophozoite

16. Free-living Amebae Life Cycle

17. 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

19. Keratitis

20. 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.