Intestinal flagellates

Dientamoeba Fragilis
Pathogenic - Hakanson’s dse
- Troph. –infective stage
Giardia lamblia - 1-2 rosette-shaped nuclei, no peripheral chromatin
- Troph and cyst - Motility: non prgoressive
- Habitat: doudenum, jejunum, upper ileum - Cytoplasm: ingest bacteria and other debris
Troph: - Habitat: mucosal crypt of large intestine
- Diarrheic stool - Assoc. w/ E.vermicularis
- Pear or pyriform, broad ant. Attenuated post. - Inmate, students, military recruits
- Smiling face appearance - Dx: trichrome-stained smear – binucleate nuclei
- No peripheral chromatin - Tx: Iodoquino – DOC; Tetracyclin/metronidazole
- Sucking disk –ant.portion of ventral surface
- Axostyle/axoneme – divides body to half Non-pathogenic
- Sucking disk & axoneme – criteria for ID
- 4 pairs of flagella, 2 pairs blepharoplast Chilomastix mesnili
- Erratic jerky or falling leaf motility - Troph and cyst
Cyst - Cecal region of large intestine
- Ovoidal/ellipsoidal Troph:
- Young cyst – 2 nuclei, mature – 4 - Diarrheic stool
Life cycle - Pear-shaped w/ flattend ant. Pointed end
- Ingestion of mature cyst –infective stage - 1 nucleus, eccentric karyosome
- Excyst in doudenum - Cytotostome & spiral groove – criteria for ID
- Reproduce by binary fission - 3 blepharoplast; 6 flagellae
- Encyst in large intestine - No undulating membrane and axostyle
Dse - Motility: boring spiral forward movement
- Loose, non-bloody, malodorous, fatty stool Cyst
- Self limiting 10-15 days - Semi formed stool
- Non invasive - Pear/lemon shaped, hyaline knob/nipple like protuberance
Lab - Shephered crook
- Stool exam –falling leaf – trophozite - 1 nucleus without perpheral chromatin
- Biposy Dse
- String test – troph doudenal fluid - Assoc w/ immunosupressed pt.
- Immunoflourescenc – troph and cyst in stool - Ingestion of food/drink – cyst
- Direct flourescent antibody assay – gold standard Lab
Tx - Microscopy of stool
- Metronidazole – DOC
- Tinidazole – alternate
Trichomonas hominis Trichomonas vaginalis
- Troph only – diarrheic stool - Closely rel. to T.hominis
- Pear shaped, round ant. Pointed post - Cell detaching factor
- 1 nucleus, 1 pair blepharoplast, 4 ant flagella - Trop only – infective stage
- Motility: jerky non directional - 1 nucleus, short undulating membrane
- Diagnostic: axostyle from ant. To post. Along mid axis and prtrudes as - 4 ant flagella, 1 post
sharp pointed tail – diagnostic - Costa
- Undulating membrane – criteria for ID - Motility: jerky non directional
- Cecal area of LI - Vaginal discharge – MC complain
- Dx: stool exam - Frothy creamy foul smelling green to yellow, itch
- Strawberry cervix
Enteromonas hominis - Dx: wet film
Troph - Tx: metronidazole
- Pear oval shape w/ one side flattened
- 1 nucleus. Large karyosome, 1 bleph. 3 ant flagella
- No cytostome Trichomonas tenax
Cyst - Troph only
- Elongated ovoidal, 1-4 nuclei - Pear/pyriform shape
- Resembles E.nana - 1 nucleus; 4 ant flagella; 1 bleph
Dse - Resp. jerky rapid motility
- Cecal region of LI - Presence of costa same length of undulating membrane
- Ingestion of cyst from contaminated food or drink - Teeth and gums, tooth cavities, tonsillar crypt
Dx - Assoc. with pulmonary trichomoniasis
- Stool exam – troph and Cyst - Dx: direct microscopy

Retortamonas intestinalis
Troph
- Ovoid/tear shaped, round ant. Attenuated post
- 1 nucleus, fine chromatic granules
- 1 bleph. 2 flagella
Cyst
- Pear shaped, 1 nucleus
- Bird beak fibrillar arrangement – diagnostic
 2nd line – amphotericin B
Blood and tissue flagellates
Mucocutaneous leishmaniasis
Genus leishmania
- Flagellated obligate intracellualr Lesihmania braziliensis – mc causative agent
- Reservoir: canine and rodents Site: mucos membrane of nose, mouth, throat, skin – disfigurement
- Intermediate: sandflies Insect vector: genus Lutzomyia
- Transmitted from animal to human or human by bite of sand fly s/sx: fever, wight loss, hepatosplenomegaly
tx and lab: same with cutaneous leishmaniasis
2 stages
1. amastigote stage
-ovoid shape, present in vertebrate host (human) Visceral lesihmaniasis
-found in monocytes, PMN, leukocyte, EC
2. promastigote MC causative agent: L. donovani, L.chagasi, L.infantum
-intervertebrate host Most severe form of leishmaniasis
-midgut of sandfly Insect vector: L.donovani & infantum – genus phlebotomus
-no undulating membrane, 1 nucleus w/ central karyosome L.chagasi – genus lutzomyia
Habitat: EC ofvisceral organ, slpeen, liver, intestinal mucosa, messenteric glands
Cutaneuos leishmaniasis Main focus of infection: visceral organ
- Insect vector: sandfly – genus phlebotomous Most assoc: splenomegaly
Lab diagnosis
Types 1.parasite in blood, bone marrow, LN, liver
1. oldworld cutenueous leishmaniasis 2. splenic puncture
L tropica – dry, urban, ulceralte months to year 3. bone marrow aspiration – diagnostic
L major – wet,rural, lower limbs, moist 4. culture – NNN
5. serology – ELISA
2. new world cutaneuos Tx:
L mexicana – chiclero ulcer, bay ulcer – ear cartilage 1.pentostam –DOC
L braziliensis complex – Uta, skin that heals itself 2. amphotericin B – resistant
Miltefosine – india 1st line
Dx: skin biposy – stained with wright giemsa – amastigote stage Interferon gamma – amastigote killing
Culture –NNN, serology – indirect flourescent antibody test
Montenegro test

Tx:
1st line – sodium stiboglocunate (pentostam) DOC
Meglumine antimonate – alternate
Genus trypanosoma Trypanosoma brucei rhodience
-reservoir: domestic cattle and wild animals - East african sleeping sickness
-elongate spindle, 1 nucleus w/ 1 karyosome center - Resembles t.brucei gambiensce
-ant flagellum, undulating membrane - Faster onset
-MOT: bite of bug, tsetsefly, ingest feces, inoculation - More severe
- Pt die early if there is CNS involvement

Trypanosoma brucei gambiense

-west african sleeping sickness Trypanosoma cruzi
- American sleeping sickness
2 stages: - Insect vector: reduvid bug
1. epimastigote – invertebrate host (tsetse fly) – (infective) - Chagas disease
2. trypomastigote – vertebrate host (human, dog, goat, cattle) (diagnostic) - MOT: bite; ingestion; blood transfusion
- Morph: spindel shape body C or S form
Habitat: trypomastigote in blood, LN, CSF - Seen in trypomastigote stage
MOT: bite of fly; congenital; human-fly-human
Dse: 2 stages
-acute stage: inflammatory nodule or chancre at site of bite 1. amastigote – intracellular macrophages and tissue cells in human (diagnostic)
-chronic: CNS – sleeping sickness 2. trypmastigote – in midgut then feces of bug (infective)
-winterbuttom sign – enlargement of post cervical LN
-kerandel sign – pain along course of nerve in CNS Dse
-painful reddish nodule – chagoma- ulcerate
Dx -eyelid (Romanas sign)
1.microscopy –trypanosome -enlargement of liver and spleen, lympadenopathy
2. serological – detect anti-trypanosome AB -encephalities and myocardities
a. immunoflourecns test
b. indirect hemagglutination test Lab
1. microscopic demo
Rx 2. xenodiagnosis – best choice for chronic cases
1. pentamidine & suramin – acute stage 3. serological – indirect hemaglutination
2. tryparsamide Immunoflourescent antibody test
3. metarsoprol – late stage CNS involvemnt Complement fixation test

TX: nifurtimox – DOC

premaquine