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Protozoans : unicellular eukaryotic organisms Name Entamoeba histolytica Transmission Fecal-oral Contaminated water, fresh fruits, vegetables Amoeba

Sexual Intestine >> Liver Lungs Brain Heart Site Morphology Motile trophozoits Bulls eye shaped nucleus (sharp central karyosome & radial chromatin spokes) with RBC in cytoplasm Microscopic Diagnosis Trophozoits and/or cysts in feces Abdominal CT for abscesses Pathology Disease Worldwide prevalence with 90% asymptomatic Amebiasis Bloody dysentery Inverted flask-shaped lesions in LI Liver abscesses Giardia lambia G. intestinalis G. duodenalis Fecal-oral Contaminated water from streams, food with oocysts Intestine: Duodenum Jejunum Falling leaf motility Happy face Fecal antigen test (string test) abdominal gassy distension Malabsorption Trophozoits and/or cysts in feces Traveler's diarrhea foul smelly & greasy (high fat content) Metronidazole Treatment Metronidazole (10 days) followed by Iodoquinol (20 days)

Flagellate Balantidium coli

Contaminated water/food Intestine with pigs fecal material with oocysts

Horseshoe shaped nucleus Macronucleus is long and sausage-shaped, and the spherical micronucleus is nested next to it

Cysts in feces

Balantidiasis Common parasite of animals (Pigs) Diarrhea Endemic in Philippines

Tetracycline Metronidazole

Ciliate Cyclospora cayetanensis

Oocyst in water

Intestine (epithelium)

Acid fast spherical oocysts that fluorescence under UV light in feces 2 sporocysts with 2 sporozoites each

Watery diarrhea + nausea/vomiting Self-limiting diarrhea in normal host Severe/prolonged diarrhea in AIDS Linked to imported raspberries & strawberries Cryptosporidiosis Self-limiting watery diarrhea, vomiting, abdominal pain in healthy Severe to life threatening diarrhea in immunocompromised Diarrhea in AIDS patients mimicking Giardia infection Malabsorption syndrome

Trimethoprim Sulfamethoxazole

Cryptosporidium parvum C. hominis Sporozoa / Apicomplexa (Intestinal)

Undercooked meat Non-chlorinated swimming pool

Acid fast oocysts in stool 4 sporozoites Obligate intracellular parasite Biopsy of intestinal epithelium shows dots on the intestinal glands Acid fast oocysts in stool 2 sporocysts with 4 sporozoits each Obligate intracellular parasite Biopsy shows eosinophilia G+, acid fast spores in stool

No effective therapy Nitrazoxanide Puromycin Azithromycin

Isospora belli

Fecal oral

Trimethoprim Sulfamethoxazole

Microsporidia

Spores ingested

Microsporidiosis: Diarrhea in AIDS

No effective therapy

Trichomonas vaginalis Flagellate

Sexual transmission (trophozoite form) Fomites towel sharing

GU, vagina

Motile trophozoites Corkscrew motility Cant live outside body because no cysts stage

Motile organisms in vaginal smear

Trichomoniasis Yellow green frothy vaginal discharge Fish odor, strawberry vagina Burning on urination Painful vaginal itching Amebic meningoencephalitis Severe prefrontal headache, nausea, fever, altered sense of smell Rapidly fatal within days

Metronidazole Treat patients sexual partners as well! Amphotericin B (rarely successful)

Naegleria fowleri

Diving in warm fresh water lakes infested with amoeba

water shoots up the Motile trophozoites nose > Cribriform plate > CNS Trails left on agar when coculture with G- bacteria

Amoeba in CSF & brain biopsy

Amoeboflagellates

Acanthamoeba culbertsoni

Fresh water lakes Contaminated contact lens solution (airborne) Respiratory tract, ulcerated skin Vector transmission via tsetse fly Vector transmission via reduviid/kissing/ triatomine bug Vector transmission via Phlebotomine sand fly Reservoirs: rodents Vector transmission via Anopheles(female) mosquito 2 life cycles: Sporogny (sexual) in definitive host (mosquito) Schizogony (asexual) in intermediate host (vertebrates)

CNS via hematologic spread CNS via hematologic spread Saliva of tsetse fly

Star shaped cysts on biopsy

Granulomatous amoebic encephalitis Corneal keratitis Fatal within an year Granulomatous amoebic encephalitis Fatal

GAE: ketoconazole Keratitis: propamdine isothionate, imidazole Ketoconazole Rarely successful Suramin (no CNS effect) Melarsoprol (treat CNS) Acute: Nitrofurtimox Benzimidazole Stibogluconate sodium

Balamuthia mandrillaris Trypanosoma gambiense T. rhodesiense Trypanosoma cruzi

Scratching implants feces in mucosa

Trypomastigote in blood and/or Amastigote in tissue cells High Ig in CSF

Blood smear Serology (high IgM) Blood smear Xenodiagnosis Amastigote inside macrophages in liver, bone marrow, spleen

African sleeping sickness

Chagas disease

Hemoflagellates

Leishmania tropica Leishmania brasiliensi Leishmania donovanii Plasmodium falciparum

Cutaneous: ulcer -> depigmented scar Mucocutaneous: nasal septum erosion Visceral (kala-azar): fatal Malaria Periodic episodes of high fever and chills followed by episodes of profuse sweating +/Anemia Hepatomegaly Splenomegaly Irregular fever spikes Brain, lung, kidney damage Recrudescence Tertian: 48 hr fever spikes Latent in liver, relapses Tertian: 48 hr fever spikes Latent in liver, relapse Quartan: 72 hr fever spikes Recrudescence Toxoplasmosis Healthy: flu-like + lymphadenopathy Congenitally acquired (TORCH)::: Early: still birth, chorioretinitis, convulsions, retardation, microcephaly Late: progressive blindness from chorioretinitis by teens AIDS: MCC focal CNS disease

Plasmodium vivax Plasmodium ovale Plasmodium malariae Sporozoa / Apicomplexa (Blood/Tissue) Toxoplasma gondii

Bite > exoerythrocytic sporozoites > invasion of Liver (parenchymal cells), hypnozoites > trophozoite in RBC (erythrocytic) > sexual & asexual cycles after RBC lysis (merozoites) Asexual cycle determines febrile episodes

Multiple ring form crescentshaped gametes in RBC

Blood smear Fluorescence labeled Ab to identify species

Chloroquine resistant: Qunine + pyrimethaminesulfadoxine Chloroquine (gametocidal) then primaquine (exoerythrocytic)

Oval, jagged, infected RBC Bar and band forms, Rosette schizonts Cysts in muscle tissue, nervous tissue, motile tachyzoites in blood obligate intracellular parasite IgM or IgG serology CT scan shows ring/contrast enhanced lesions in brain

Chloroquine Pyrimethamine + folinic acid Sulfadiazine

Raw pork meat Contact with cat feces Vertical transmission if mothers primary infection Cat is definitive host

Tissue, CNS

Babesia spp.

Vector transmission via Ixodes (ticks)

RBC

Giemsa stain of thin smear or hamster inoculation

Maltese cross formations in red blood cell smear

Babesiosis Clindamycin + Malaria like disease, hemolytic Quinine Coinfection with Borrelia (lyme disease)

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