Free Living Pathogenic Amoebae-2

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9/26/2010

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FREE LIVING PATHOGENIC AMOEBAE

Acanthamoeba spp

Nigleria fowleri

Balamuthia madrillaris

Naegleria fowleri

PARASITE BIOLOGY

Amoebic Trophozoite: Characterized by a lobose monopseudopodium (phase contrast

microscope) and a very prominent nucleus with centrally locatednucleolus.

SIZE: 10 to 25 µ.

SHAPE : Elongated to oval,

NUCLEUS: Vesicular, dispersed.

NUMBER: One.

PERIPHERAL CHROMATIN: Finely granular and evenly distributed.

KARYOSOME: Some small but larger than E. histolytica.

NUCUEOPLASM: Clean to dirty.

APPEARANCE: Finely granular.

INCLUSIONS: Cellular debris.

MOBILITY: Nondirectional and sluggish.

PARASITE BIOLOGY

Free living Flagellate Trophozoite

Has a pair of flagella at the tip of a pear shape cell body

SHAPE: Pear shape.

FLAGELLA--ANTERIOR: 2 to 4.

Indistinguishable from N. gruberi, a free living organismisolated from soil.

PARASITE BIOLOGY

Cyst Form Round with eccentric nucleus

SIZE: 8 to 12 µ.

SHAPE : Oval to spherical.

NUCLEUS: Vesicular, dispersed. NUMBER: One.

PERIPHERAL CHROMATIN: Finely granular &evenly distributed.

KARYOSOME: Some small but larger than E. histolytica.

NUCUEOPLASM: Clean to dirty.

CYTOPLASM:

CHROMATOID BODIES: None detected.

GLYCOGEN: Diffuse

LI

F

E

CY

C

L

E



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IMPORTANT INFORMATION

Reproduction: Binary Fission Infective stage: Biflagellate Trophozoite

Diagnostic stage: Biflagellate Trophozoite

Mode of Transmission: Oral and Intranasal whileswimming is contaminated water source

More common in warm water

Can survive at 46°C but not 100°C

Can survive in hyperchlorinated water except for cyst

PATHOGENESIS AND CLINICAL MANIFESTATION

Primary Amebic Meningoencephalitis (PAM) Characterized by fever, headache, vomiting,

encephalitis that will rapidly progress to coma.

Increased PMN in CSF

Increased protein

hypoglycorrhachia

Gastritis

Diarrhea

DIAGNOSIS

Microscopy

Specimen brain or CSF (aspirate)

Culture

Bacterized agar culture medium look for troph

The ability of the parasite to transform from trophozoiteto flagellate when transferred from culture medium to

distilled water Confirmatory Test

Autopsy

TREATMENT

Polytene antibiotic amphotericin B – drug of choicefor PAM

Cotrimazole – exhibits amebicidal activity

Trimetoprim – prevents folic acid metabolism

EPIDEMIOLOGY

Common in area with lots of swimming pool, freshwater lakes, thermal springs and other water source

In the Philippines, amoeba can be isolated in moistsoil and fresh water habitats as well as from

thermally polluted rivers, whether natural orindustrial.



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PREVENTION AND CONTROL

Do not swim in endemic areas

SUMMARY

COMMON NAME: None. GEOGRAPHICAL DISTRIBUTION: Australia, Europe,

and America.

PATHOGENESIS: Primary amebic meningoencephalitis(PAM).

HABITAT: Usually free l iving; the meninges in man.

INTERMEDIATE HOST: None.

RESERVOIR HOST: None known.

INFECTED FORM: Biflagellatedtrophozoite.

MODE OF INFECTION: Active penetration through thenostrils.

LABORATORY IDENTIFICATION:

SPECIMEN SOURCE: Cerebral spinal fluid.

Acantamoeba spp.

Oppurtunistic parasite

PARASITE BIOLOGY

Trophozoite

Feeds on gram negative

bacteria

encystations happens in the

environment when nutrients are

depleted

Motility: Sluggish, polydirectional

Nucleus: one, centrally located

Cytoplasm: Finely granulated

Contractile vacuoles: large

Distinguishing feature: small spiny filaments for

locomotion

acanthapodia

PARASITE BIOLOGY

Cyst

Double-walled displaying an outer wrinkled wall andinner, polygonal-shaped wall

Pores or ostioles are seen at the point of contact of the

two walls

LIFE CYCLE



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Infective stage:Trophozoite

Diagnostic Stage:

Cyst and Trophozoite

Mode of Transmission:

Unknown

Speculations: thrueyes, nostrils, andopen skin

PATHOGENICITY AND CLINICAL MANIFESTATION

GranulomatousAmebic Encephalitis (GAE) -Fever, Chills, Fatigue, Weight loss, Papilledema(Increase intracranial pressure)

Skin Lesions

Acanthamoebakeratitis – corneal ulceration,progressive corneal infiltration and clouding, iritisscleritis, severe pain, hypopyon and loss of vision

Note: Fetal outcome: 3-40 days

DIAGNOSIS

Autopsy

Electron microscopy

Cultivation: use PYGC medium containing antibiotics

(PYGC – Proteose-Peptone, yeast extract, glucose and cysteine)

Indirect fluorescence antibody test

TREATMENT

Amphotericin B

5-flourocytosine

Ketoconazole

Itraconazole

Corneal transplantation

EPIDEMIOLOGY

Isolated in fresh water, sea water, ocean sediment,frozen swimming water, bottled mineral water, andother water area



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Boil water Clean surrounding cause dust also carries parasite

Disinfect contact lens regularly

Balamuthia madrillaris

Opportunistic parasite

PARASITE BIOLOGY

• pleomorphic

• 2-60 um

• uninucleated/binucleated

• 2-3 nucleolar bodies

Trophozoite

PARASITE BIOLOGY

• Uninucleated

• Spherical

• 12-30 um

• appears doubled walled(inner-waxy, outer-wavy)

• ultrastructurally, itappears three-walled(outer-thin and irregularectocyst, inner-thickendocyst, middle-amorphous fibrillarmesocyst)

Cyst


Infective stage: Trophozoite

Diagnostic Stage: Cyst and Trophozoite

Mode of Transmission:

Unknown

Speculations: thru eyes, nostrils, and open skin

Infected kidneys of dogs



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PATHOGENICITY AND CLINICAL MANIFESTATION

GranulomatousAmebic Encephalitis (GAE) -Fever, Chills, Fatigue, Weight loss, Papilledema(Increase intracranial pressure)

DIAGNOSIS

Autopsy Electron microscopy

Cultivation: use PYGC medium containing antibiotics

(PYGC – Proteose-Peptone, yeast extract, glucose and cysteine)

Indirect fluorescence antibody test

TREATMENT

Amphotericin B


Proper sanitation and hygine

THE END

Free Living Pathogenic Amoebae-2

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