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Protozoa

Dr DAA Sri Laksmi, M.Sc


Taxonomy
Kingdom Animalia
Subkingdom Protozoa
Phylum Sarcomastigophora
Phylum Apicomplexa
Phylum Ciliophora
Phylum Microspora
Subkingdom Metazoa
Phylum Nematoda
Phylum Platyhelminthes
Taxonomy

Kingdom Animalia
Subkingdom Protozoa
Phylum Sarcomastigophora
Subphylum Sarcodina Entamoeba
Subphylum Mastigophora Giardia
Phylum Apicomplexa malaria
Phylum Ciliophora Balantidium
Phylum Microspora microsporidium
Classification
protozoa INTESTINE
Entamoeba histolytica
Giardia
Isospora
Cryptosporidium
Cyclospora
Nematodes
Strongyloides
Ascaris
Trichuris
Hookworm
pinworm

Cestoda
tapeworms




Trematodes
intestinal flukes
SYSTEMIC



Toxoplasma
malaria






filaria








Toxocara
hydatid cysts
cysticercosis


Schistosoma
liver flukes
lung flukes

Protozoa
eukaryote..has genetic material encased in a
nuclear membrane (unlike bacteria and
viruses)..classified traditionally by morphology
(eg. organelles of locomotion), life cycle and
mechanisms of reproduction etc.
Mastigophora: movement with flagella - e.g.
Trichomonas,Giardia
Sarcodina: pseudopodia, e.g. Entamoeba
histolytica
Apicomplexa: apical complex, no locomotor
apparatus;sexual reproduction, e.g.
cryptosporidium,malaria, toxoplasma
Ciliophora: movement with cilia, e.g.
Balantidium.
INTESTINAL PROTOZOA
Pathogenic
Entamoeba histolytica
Balantidium coli
Giardia lamblia
Dientamoeba fragilis
Cryptosporidium parvum
Enterocytozoon bieneusi
Septata intestinalis
Cyclospora cayetanensis
Isospora belli
Commensal
Entamoeba hartmani
Entamoeba dispar
Entamoeba coli
Endolimax nana
Iodamoeba btschlii
Chilomastix mesnili
Trichomonas hominis
Blastocystis hominis
ENTAMOEBA HISTOLYTICA
MORPHOLOGY
Trophozoite: any stage in a protozoans life cycle
which can ingest food. In practice also refers to
the motile form.
Cyst: the non motile form which is protected by a
distinct membrane or cyst well. This is an
infective stage of the parasite.
Excystation: the process of emergence of the
trophozoite from the cyst (vs.encystation)
Pseudopod: literally means false foot; temporary
cytoplasmic processes at the surface of the
trophozoite
Epidemiology of Entamoeba histolytica

Man the only source (not a zoonosis)
Fecal-oral transmission
Our understanding is in transition because of
mis-identified cases.
Seen in travellers
Amoebiasis
Entamoeba histolytica life cycle
Entamoeba histolytica

Invasive
and Non-
invasive
Amebiasis
Amoebiasis
Invasion
Amoebiasis
Entamoeba histolytica
Signs and Symptoms Amebiasis
(WHO 1969)
1. Asymptomatic infection
2. Symptomatic infections
A. Intestinal amebiasis
i. Dysenteric
ii. Non dysenteric colitis
B. Extraintestinal amebiasis
i. Hepatic
ii. -acute nonsuppurative
-liver abcess
i. Pulmonary
ii. Other extraintestinal foci
Amoebiasis
Extension
Amoebic liver abscess
AMOEBIASIS

1) assymptomatic carrier state
2) acute amoebic dysentry
3) amoebic liver abscess
4) amoeboma
AMOEBIC LIVER ABSCESS

Presentation
1. persisting fever
2. RUQ or epigastric pain and/or shoulder pain
3. rarely diarrhea
Diagnosis
1. ultrasound
2. raised WBC
3. serology
4. aspirate microscopy
5. response to metronidazole 750 t.i.d.
Amebiasis - Diagnosis
Laboratorium examination of E. histolytica
Faecal examination
Spesimen from :
Sigmoidoscopi aspiration
Aspirate of hepar abcess
Serologisextra intestinalmonitoring th/
IHA
ELISA
IFA
Kopro Ag
Special technique
Isoenzyme analysis
DNA probe
Sequential Stool Examination for E.
histolytica
I II III IV V
direct 41 65 79 88 93 %

direct and concentration 21 38 51 61 69 %
direct , concentration and stain 13 25 34 43 50 %
Drugs for Entamoeba histolytica
Tissue: ..metronidazole, tinidazole, secnidazole,
ornidazole
..emetine
..dehydroemetine
..chloroquine
Bowel lumen: ..paromomycin (Humatin)
..diiodochlorhydroxyquin (Diodoquin)
..diloxanide furoate (Furamide)
Giardia epidemiology:

- faecal oral spread
- prevalence 3-5% in Canada; increased in
travellers, backpackers, institutions, daycare
centres
- zoonosis - found in most mammals;
esp.beaver (beaver fever), cattle, cats, dogs,
etc
Giardiasis
Giardia intestinalis =(lamblia)
Trophozoites Cysts
Giardia Life cycle
GIARDIASIS

Symptoms
diarrhea
flatulence
abdominal cramps
decreased appetite
+ weight loss
+ nausea
no fever
Signs
mild abdominal
tenderness
Laboratory
no leukocytes in stool
no mucous in stool
giardia cysts intermittent in stool
giardia cysts in duodenal aspirate
Trichomonas vaginalis

Taxonomy: Mastigophora
Epidemiology: reservoir is human urogenital
tract
Biology: causes inflamation of vaginal and
urethral epithelium
Clinical: vaginal discharge
Treatment: metronidazole
Trichomonas vaginalis Life Cycle
Trichomonas - Pathogenicity
Contact dependent cytotoxicity
Trichomonas and HIV
TOXOPLASMA GONDII
Introduction
Obligate intracellular parasite that infect a
wide range of warm blooded vertebrates
Toxoplasmosis is a classical zoonotic diseases
Human infections are caused by accidental
ingestion of oocysts, shed into environment
by cats or tissue cysts contained in under
cooked meat

Toxobogor2010 35

Cycle in humans (an accidental host)
Infected
by ingesting infective oocysts (in >4 day old cats feces)
by ingesting tachyzoites or bradyzoites in rare meat
by receiving blood or tissues with zoites
congenitally by transplacental tachyzoites

Toxoplasma gondii
Toxobogor2010 36
Epidemiology of Toxoplasma gondii
Key figures (after 1
st
infection of DH)
Prepatent period
(= time interval between infection and first oocyst shedding)
- after infection with tissue cysts = 3-10 days
- after infection with sporulated oocysts = 3-5 weeks

Patency: 1-21 days

Oocyst output
1.000.000 oocysts / g faeces
600.000.000 oocysts in total during patency
Large contamination
of the environment
with oocysts

Siklus hidup Toxoplasma gondii
Toxobogor2010 39
Gamogony
Sporogony
Merogony(ies)
Life cycle of Toxoplasma gondii
Sporulated oocyst
with sporozoites
in environment
facultative heteroxenic cycle
Unsporulated
oocyst in faeces
DH
Endogenic cyst
with bradyzoites
Pseudocyst
with tachyzoites
in tissue cells
IH
Toxobogor2010 40
CLINICAL TOXOPLASMOSIS
o Acquired
o Congenital
o Ocular
o Immunocompromised patient
INFECTION DURING PREGNANCY
FIRST TRIMESTER:TRIAD TOXOPLAS MOSIS:
RETINOCHOROIDITIS
INTRA CRANIAL CALCIFICATION
HYDROCEPHALUS
MENTAL REARDATION
LATE PREGNANCY
ASYMPTOMATIC NEONATEDISORDER IN ADULT
Anencephalus
Microcephalus

Hydrocephalus
HIDROSEFALUS


Gemelli, anophthalmia, malformation
of faces
RETINOCHOROIDITIS