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eFigure 35–17. Life cycle of Entamoeba histolytica. Transmission of infective cysts of this abundant amebic parasite of humans (with pathologic results in 10–20% of infections) may involve fecally contaminated flies, water, fingers, or food. The damage caused by these parasites can involve ulceration of the colon or passage through the intestinal mucosa and spread to other organs. Ingested cysts are acted on by stomach and duodenal enzymes and rapidly excyst. The tetranucleated trophozoite (1) separates into four uninucleated amebae (2), each of which divides mitotically, resulting in eight uninucleated amebulae (3). Occasionally, trophozoites penetrate the mucosa, ingest red blood cells (4), and initiate the ulceration process, which may spread extraintestinally. Normally, the trophozoites multiply in the lumen of the colon and form a commensal colony, feeding on fecal bacteria (5). The trophozoites complete their vegetative phase and begin cyst formation by a process consisting of loss of water and rounding up (6), formation of a central vacuole with chromatoidal particles (7), an early cyst maturation stage with development of typical round-ended chromatoidals (binucleated stage) (8), and final maturation, often completed after passage in the feces, to form the tetranucleated cyst (9), which loses its chromatoidals and becomes infective to humans. (Reproduced, with permission, from Goldsmith R, Heyneman D [editors]. Tropical Medicine and Parasitology. Originally published by Appleton & Lange. Copyright © 1989 by The McGraw-Hill Companies, Inc.)

Current Medical Diagnosis & Treatment 2018 > Protozoal & Helminthic Infections

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