The Animal Parasites of Man. Max Braun

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      Fig. 11.—Entamœba kar­tu­lisi, Dofl., from the pus of an ab­scess in the lower jaw, show­ing dif­fer­ent stages of move­ment. (After Kartulis.)

      Doflein gave this name to amœbæ, from 30 µ to 38 µ in diameter, which Kartulis (1893) found on examining the pus of an abscess in the right lower jaw of an Arab, aged 43, and in a portion of bone that had been extracted. The movements of the amœbæ (fig. 11) were more active than those of “dysenteric amœbæ.” Their coarsely granular cytoplasm contained blood and pus corpuscles, and a nucleus was generally only recognizable after staining. Vacuoles were not seen with certainty. Flexner reported upon a similar case, and Kartulis published five additional cases. As in these cases dental caries was present the infection is likely to have proceeded from the oral cavity as a result of the carious teeth. Craig31 (1911) considers that this parasite is probably identical with Entamœba histolytica.

      In the literature the following species have been reported as occurring in the oral cavity of man:—

      Amœba gingivalis, Gros, 1849. [? identical with Entamœba buccalis.] Amœba buccalis, Sternberg, 1862. Amœba dentalis, Grassi, 1879.

      Far too little, however, is known concerning these to regard them as definite species, that is, independent organisms; Grassi thinks it even possible there may have been a confusion in their case with salivary corpuscles. If they really are amœbæ they are all of them probably identical with Entamœba buccalis.

      Genus Paramœba, Schaudinn, 1896.

      Schaudinn established the genus Paramœba for a marine rhizopod which multiplied by division, became encysted at the end of its vegetative life and then segmented into swarm bodies with two flagella. These multiplied by longitudinal fission, and finally passed into the condition of Amœbæ. Whether the human parasite described by C. F. Craig (1906) as

      Paramœba hominis.

      belonged to this genus was for a time uncertain. It is now placed in a new genus Craigia, Calkins, 1912, since it possesses only one flagellum.32

      In the amœbic stage it is 15 µ to 25 µ in diameter; ecto- and endo-plasm during rest are indistinguishable. The body substance is granular, with a spherical, sharply contoured nucleus and an accessory nuclear body. No vacuoles are present, but occasionally the endoplasm contains red blood corpuscles. The pseudopodia are hyaline, finger- or lobe-shaped, and are protruded either singly or in twos. Multiplication is by binary fission and by the formation of spherical cysts (15 µ to 20 µ in diameter) in which occurs successive division of the nuclei, ultimately forming ten to twelve roundish bodies each of which soon develops a flagellum. The flagellate stages have similarly a spherical shape and attain a diameter of 10 µ to 15 µ. They also occasionally contain red blood corpuscles and pass either directly or after longitudinal division into the amœboid phase.

      Craig found these Amœbæ and the flagellate stage belonging to them in six patients in the military hospital at Manila (Philippine Islands), five of whom were suffering from simple diarrhœa whilst the sixth exhibited an amœbic enteritis and contained also Paramœba hominis, with Entamœba histolytica, Schaudinn. In one of the other cases, Trichomonas intestinalis was present.

      B. Amœbæ from other Organs.

      Entamœba pulmonalis, Artault, 1898.

      Artault33 discovered a few amœboid forms with nucleus and vacuole in the contents of a lung cavity. In the fresh condition they were distinguishable from leucocytes by their remarkable capacity of light refraction. They were also much slower than the latter in staining with methylene blue or fuchsine. Their movements became more lively in a strong light. Water and other reagents killed them, and then, even when stained, they could not be distinguished from leucocytes. They have also been seen by Brumpt. R. Blanchard found amœbæ which may belong here in the lungs of sheep. A. pulmonalis is perhaps the same as Entamœba buccalis. Smith and Weidman34 (1910, 1914) described an entamœba, E. mortinatalium, from the lungs and other organs of infants in America.

      Amœba urogenitalis, Baelz, 1883.

This species was found in masses in the sanguineous urine as well as in the vagina of a patient in Japan, aged 23. Shortly before the death of the patient, which was caused by pulmonary tuberculosis, hæmaturia with severe tenesmus of the bladder had set in. The amœba, which showed great motility, and had a diameter of about 50 µ when quiescent, exhibited a granular cytoplasm and a vesicular nucleus. Baelz is of opinion that these parasites were introduced into the vulva with the water used for washing the parts, and thence had penetrated into the bladder and vagina. Doflein places the organism in the genus Entamœba, and it is perhaps identical with E. histolytica.

      Similar cases are also reported (1892–3) by other authors: Jürgens, Kartulis, Posner, and Wijnhoff. Jürgens found small mucous cysts, filled with amœboid bodies, in the bladder of an old woman suffering from chronic cystitis; they were also found in the vagina. The amœba observed by Kartulis in the sanguineous urine of a woman, aged 58, suffering from a tumour of the bladder, measured 12 µ to 20 µ, and exhibited slow movements by protruding short pseudopodia. The vacuoles and nucleus became visible only after staining with methylene blue.

      Posner’s case related to a man, aged 37, who had hitherto been quite healthy and had never been out of Berlin. Suddenly, after a rigor, he passed urine tinged with blood. This contained, besides red and white blood corpuscles and hyaline and granular casts, large granular bodies (about 50 µ in length and 28 µ in breadth), which slowly altered their shape, and contained red blood corpuscles in addition to other foreign matter. These bodies exhibited one or several nuclei and some vacuoles. From the course of the disease, which extended over a year, and during which similar attacks recurred, Posner came to the conclusion that the amœbæ which had originally invaded the bladder had penetrated into the pelvis of the kidney, where they probably had settled in a cyst, and thence induced the repeated attacks.

      Wijnhoff observed four cases of amœburia in Utrecht.

      Amœba miurai, Ijima, 1898.