Microbiology/Parasitology

Flagellates

20 February 2008

DIENTAMOEBA FRAGILIS - Pseudopodia are clear and indented,

producing a cloverleaf-like appearnace

Treatment:
• Iodoquinol
• Paromomycin
• Tetracycline

The complete life cycle of this parasite has not yet

been determined, but assumptions were made Intestinal Entamoeba Species
based on clinical data. To date, the cyst stage has E. dispar E. coli E. hartmanni
not been identified in D. fragilis life cycle, and the
TROPHOZOITES
trophozoite is the only stage found in stools of
- 15-20 um - 20-25 um - 8-10 um
infected individuals . D. fragilis is probably - Extend - Broad, - Less
transmitted by fecal-oral route and transmission pseudopod blunt progressive
via helminth eggs (e.g., Ascaris, Enterobius spp.) ia pseudopodi than E.
has been postulated . Trophozoites of D. fragilis - Progressiv a dispar
have characteristically one or two nuclei ( , ), e - Sluggish,
and it is found in children complaining of intestinal movement no-
(e.g., intermittent diarrhea, abdominal pain) and directional
other symptoms (e.g., nausea, anorexia, fatigue, movt
malaise, poor weight gain). CYST
- 12-15 um - 15-25 um - 6-8 um
Transmission: - 4 nuclei - 8 nuclei - 4 nuclei
• Speculated: via egss of intestinal - Blunt - Pointed - Blunt
helminthes chromotoid chromatoid chromatoid
bodies bodies bodies
Clinical symptoms: - CB persist
• Recurring episodes of lower in mature
abdominal discomfort cysts
• 2-3 loose, “mushy” stools per day - * E.
• Flatulence, nausea, fatigue Hystolytica
• NO mucus, blood or inflammatory - ** invasive
exudates E.
hystolytica
FORM: no known cyst stage can be .
TROPHOZOITE 20mm
- 5-15 um, binucleate
- Karyosome composed of groups of chromatin Other Intestinal Amoeba Species
granules Endolimax Iodoamoeba Dientamoeba
- Granular cytoplasm butschii fragilis
- Non-progressive motility TROPHOZOITES
- 8-10 um - 12-15 um - 8-10 um
JoY, ShaR, YnA, CamS 1 of 5
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- Often • Others: flatulence, bloating, anorexia)

binucleated cramps, foul sulfuric belching (purple blurbs)
- Fragment
karyosome Severe infection: partial villous atrophy -> flat villi
CYST • Protracted diarrhea &/or steatorrhea
- 6-8 um - 10-12 um - No cyst
- 4 nuclei - 1 nuclei - *A Malabsorptive syndrome: severe form steatorrhea,
- Glycogen flagellate disaccharide deficiency, B12 malabsorption
vacuole possibly
related to Severe dse: Lactase deficiency
the
trichomona
ds

GIARDIA LAMBLIA
Disease: Giardiasis, flagellate diarrhea

Size:
• Cysts: 8-12 um
• Trophozites: 12-15 um

Site:
• Upper SI, attach to intestinal mucosa
• Occasionally in bile ducts and
gallbladder

Port of Entry: Mouth

Epidemiology:
• causes endemic and epidemic dse Cysts are resistant forms and are responsible for
worldwide transmission of giardiasis. Both cysts and
• major cause of waterborne intestinal trophozoites can be found in the feces (diagnostic
dse stages) . The cysts are hardy and can survive
• high rate of person to person several months in cold water. Infection occurs by
transmission the ingestion of cysts in contaminated water, food,
or by the fecal-oral route (hands or fomites) . In
Increased Risk: the small intestine, excystation releases
• poor hygiene/sanitation; homosexual trophozoites (each cyst produces two trophozoites)
(gay bowel syndrome); overcrowding; . Trophozoites multiply by longitudinal binary
immunodeficiency; kids in daycare; fission, remaining in the lumen of the proximal
food handlers; mental institutions; small bowel where they can be free or attached to
travelers to endemic areas; campers the mucosa by a ventral sucking disk .
Encystation occurs as the parasites transit toward
Reservoirs: the colon. The cyst is the stage found most
• humans commonly in nondiarrheal feces . Because the
• beavers in watershed area cysts are infectious when passed in the stool or
• muskrats: dogs shortly afterward, person-to-person transmission is
possible. While animals are infected with Giardia,
CLINICAL PRESENTATION: their importance as a reservoir is unclear.
Asymptornatic
Form:
• First signs: nausea, anorexia, UGI uneasiness, 1. CYST
sudden onset of explosive, watery, foul
smelling diarrhea - 8-12 by 7-10 um
• Stools: loose, bulky, frothy &Ior greasy with - shape usually ovoidal, occasionally spherical
(-) of blood or mucus - YOUN€: 2nuclei
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- MATURE: 4 nuclei, usually located at one end

- flagella retracted into axonemes
- median body & deeply stained curved fibrils
surrounded by hyaline cyst wall
• Survives in the environment
• Acquired by ingestion of fecally contaminated
food or water TRICHOMONAS VAGINALIS
• Contains chitin
Disease: parasitic vaginalis
• Resistant to chlorine and cold water
• Killed by heat and desiccation Size:
• Removed by filtration Cysts: NO cyst
trophozoites: 15-24 um

2. TROPHOZITES
- 9 – 12 by 5 – 15um
- pyriform or tear shaped, “falling
leaf”, ointed posteriorly
- two well defined ovoidal nuclei
- deep staining axonemes (esp with
iron hematoxylin)
- four pair of flagella
• Active, motile feeding stage -> cause
pathology in SI
• Anaerobic; no mitochondria
• Does not cause invasive dse
• Attaches between microvilli via the
adhesive disk
• Cannot survive in the envt
Site:
• vagina - female
• prostate, urethra – maIe
Portal of Entry: genitalia
Source of Infection:
• trophs of vaginal and prostatic secretions
• non-venereal – rare but possible
• trophs can survive in:
- urine: 1-2days ,
- wet sponge: 2-3hrs
• neonates: during deIivery

Diagnosis:
1. three warm stool samples q2 days (wet
mount or stained)
a. single specimen: detect 50-70%
b. 3 specimens: 90% Trichomonas vaginalis resides in the female lower
2. Antigen detection: ELISA, IF genital tract and the male urethra and prostate ,
3. Duodenal sampling (String Test-Enterotest) where it replicates by binary fission . The parasite
does not appear to have a cyst form, and does not
Treatment: survive well in the external environment.
1. Metronodazole Trichomonas vaginalis is transmitted among
2. Others: quinacrine humans, its only known host, primarily by sexual
Tinidazole intercourse .
Furazolidone
Paromomycin – useful during Clinical Manifestation:
pregnancy FEMALES MALES
Human Trichomonas Species - asymptomatic - asymptomatic
(15%) (50-90%)
T. tenax oral cavity
T. hominis large
intestine
T. vaginalis uro-
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- vaginal d/charge - urethral d/charge - 5th flagella altered to form the undiulating
(50-75%) (50-60%) membrane (extends along the full length of
- dyspareunia - dysuria (12-25%) the organism)
(50%) - urethral pruritus - Prominent axostyle runs longitudinally and
- pruritus (25-50%) (25%) projects from the posterior margin
- Anterior, round to ovoid nucleus, central
Diagnosis: karyosome lies adjacent to the axostyle
1. trophs in vaginal, urethral, prostatic fluid,
urine Diagnosis:
2. jerky, rapid motility Trophs in feces using:
3. short, undulating membrane • Direct wet film preps with saline and
4. anteriorly placed nucleus and flagella iodine
• Concentration procedures
Treatment: • Permanent stains
• Metronidazole (treat sexual partners)
• Tinidazole
BLASTOCYSTIS HOMINI

Other Intestinal Flagellates Disease: blastocystosis

Trophozites Cysts
size flagella size flagella Size:
Trichomao 6-14 4 ante No cyst • Cyst-like stage: 4-35 um round (5-15)
nas um 1 poste satge • Large central body with rim of
hominis cytoplasm
Chilomast 10-15 3 ante 7-9 um 1 Site: Intestinal tract
ix mosnili um 1 in
cytoso Portal of Entry: mouth
me Epidemiology
Enteromo 6-8 um 3 ante 4-8 um 1-4 • Can survive up to 19 days in water at
nas 1 poste normal temperature
hominis • Resistant to chlorine
Retortam 4-10 1 ante
onas um 1 poste Forms:
intestinali 1. Vacuolated
s • most predominant
• spherical in shape
TRICHOMONAS HOMINIS • 5-10 um diameter
• Large central vacuole pushes the
Size: cytoplasm and nuclei to the periphery
• Cyst: has not been described of the cell
• Trophozites: 8-12 um • Central vacuole: reproductive organelle
• Main type causing diarrhea
Site: intestine, chiefly colon 2. Ameba-like
• exhibit active extension and retraction
Portal of entry: mouth
of pseudopodia
• nuclear chromatin shows peripheral
Source of infection: Fecal – oral
clumping
Contaminated food, water
Clinical Symptom: non-pathogenic • intermediate stage between vacuolar
and pre-cystic form
Form: • allows the parasite to ingest bacteria to
TROPHOZOITE enhance encystment
- pear-shaped 3. Granular
- wet mounts: quick, jerky motility • mainly observe from old cultures
- 4 flagelle projecting anteriorly • 10-60 um in dameter
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• Granular contents develop into

daughter cells of the amoeba form
when the cell ruptures
4. Multiple fission
• Arise from vacuolated forms
5. Cyst
• 3- 55 um
• very prominent and thick osmophilic
electron dense wall
• sharply demarcated polymorphic,
mostly dense body, surrounded by a
loose outer membrane layer (easiest to
identify)
6. Avacuolar

Source of Infection:
• life cycle is totally not understood
• hand to mouth transmission
• food/water contamination (fecal
droppings of home visitors – house
lizards and cockroaches)
Clinical Manifectaions:
• N/V, diarrhea, cramps
• Bloating, flatulence
• Low grade fever
• Abdominal pain, malaise
Diagnosis:
1. topl exam – cyst like structure; large central
vacuole and multiple nuclei at the periphery
2. central body appears gray0green in
Trichome stain
Treament
• difficult ( hides in intestinal mucus, sticks
and holds on to membrane)
• metronidazole
• iodoquinol
• TMP-SMX