Protozoan Parasites

of Humans
Adelaida Gaytos Rosaldo, MD

Protozoan Parasites of
Humans
Protozoa that enter the body via ingestion have two
morphological forms
Trophozoite
Feeding and reproducing stage that lives within the host

Cyst
Infective form that survives in the environment
Undergo excystment when ingested developing into
trophozoites

Trophozoites undergo encystment before leaving the

host in feces
Parasites presented based primarily on their mode of
locomotion
Ciliates, amoebae, flagellates, and apicomplexans

Protozoan Parasites of
Humans
Ciliates
Protozoa that use cilia in their trophozoite stage
Balantidium coli
Only ciliate known to cause disease in humans
Commonly found in animal intestinal tracts
Humans infected by food or water contaminated with feces
containing cysts
Trophozoites attach to mucosal epithelium lining the
intestine
Infections generally asymptomatic in healthy adults
Balantidiasis occurs in those with poor health
Persistent diarrhea, abdominal pain, and weight loss

Balantidium coli

Protozoan Parasites of
Humans
Amoebae
Protozoa with no truly
defined shape
Move and acquire food
through the use of
pseudopodia
Found in water sources
throughout the world
Few cause disease

Protozoan Parasites of
Humans
Amoebae
Entamoeba
Carried asymptomatically in the digestive tracts of humans
No animal reservoir exists
Infection occurs by drinking water contaminated with feces
containing cysts
Three types of amebiasis can result from infection
Luminal amebiasis
Invasive amebic dysentery
Invasive extraintestinal amebiasis

Maintaining clean water is important in prevention

Entamoeba histolytica

Figure 23.2

Protozoan Parasites of
Humans
Amoebae
Acanthamoeba and Naegleria
Cause rare and usually fatal brain infections
Common inhabitants of natural and artificial water
systems
Individuals who wash their contact lenses with tap water
can become infected

Protozoan Parasites of
Humans
Amoebae
Acanthamoeba and Naegleria
Acanthamoeba disease
Occurs through cuts, scrapes, the conjunctiva, or inhalation
Acanthamoeba keratitis due to conjunctival inoculation
Amebic encephalitis is the more common disease

Naegleria disease
Infection occurs when swimmers inhale contaminated water
Amoebic meningoencephalitis can result

Prevention difficult since organisms are environmentally

hardy

Protozoan Parasites of
Humans
Flagellates
Protozoa that possess at least one flagellum
Number and arrangement of flagella important to
determining the species
The flagellates include members of the genera
Trypanosoma, Leishmania, Giardi, and Trichomonas

Protozoan Parasites of
Humans
Flagellates
Trypanosoma cruzi

Causes Chagas disease

Endemic in Central and South America
Opossums and armadillos are the primary reservoir
Transmission occurs through bite of insects in genus
Triatoma
Kissing bugsor Assasin bugs feed preferentially from blood
vessels in the lips

The life cycle of

Trypanasoma cruzi

Figure 23.3

Protozoan Parasites of
Humans
Flagellates
Trypanasoma cruzi
Chagas disease
Progresses thru stages:
A. Acute Chagas Disease
characterized
cutaneous edema
( chagomas)
Orbital edema
(Romaas sign)
1-2 wks later, fever,
lymphadenopathy,
hepatomegaly and
splenomegaly

B. Chronic Chagas Disease

Occurs 10-20 yrs
Classical Manifestations:
o Cardiac Ds
o Mega-esophagus or megacolon

Mature trypomastigotes of
Trypanasoma cruzi

Figure 23.4

Diagnosis
Parasitological Techniques:
1. Microscopy: Thick or thin films
2. Culture
3. Xenodiagnosis
4. Biopsy

 Other techniques:
1.Complement fixation test
2. ELISA
3. PCR

Treatment
Acute Stage
Nifurtimox
Benznidazole

Protozoan Parasites of
Humans
Flagellates
Trypanosoma brucei
T. brucei- domestic and wild animals
T. brucei gabiense- sleeping sickness in West and central Africa
T. brucei rodiense- sleeping sickness in East and Southern Africa

Causes African sleeping sickness

The insect vector is the tsetse fly (member of genus
Glossina)
Humans usually infected when bitten by infected tsetse
flies
In general, the infected areas are found south of the
Sahara and north of the Zambezi.

The life cycle of T.

brucei

Figure 23.5

Protozoan Parasites of
Humans
Flagellates
Trypanasoma brucei
African sleeping sickness
Early Stage
Site of the fly bite
trypanosomal chancre (T.b.
rhodiense)
-Appears 3 or
more days
Fever
Lymph gland enlargement
(Winterbottoms sign)
Infections characterized by
cyclical waves of parasitemia

 Late Stage
Disturbed cerebral function
Behavioral changes
Sleeps badly at night but falls asleep during
the day

Diagnosis
Early Stage
Stained or unstained thick blood films
Concentration methods
MHCT
QBC
MAEC

Bone marrow aspiration

Gland puncture

Diagnosis
Late Stage
Clinical dxs
CSF exam
Immunological Methods:

Card Agglutinatin Test for Trypanosomes

(CATT)

Card indirect agglutination test for

trypanosomes(CIATT)

Treatment
Early Stage
Suramin DOC
Pentamidine
Late Stage
Melarsoprol
Eflornithine

Protozoan Parasites of
Humans
Flagellates
Leishmania
Causes leishmaniasis
Endemic in parts of the tropics and
subtropics
Wild and domestic dogs and small
rodents are common hosts
Leishmania have two developmental
stages
Amastigotes
Multiply in hosts macrophages and
monocytes
Promastigotes
Develop extracellularly within a
vectors gut

The life cycle of Leishmania

Figure 23.6

Protozoan Parasites of
Humans
Flagellates
Leishmania
Three clinical forms of leishmaniasis often observed
Cutaneous leishmaniasis
Mucocutaneous leishmaniasis
Visceral leishmaniasis

Most cases of leishmaniasis heal without treatment

Prevention limited to reducing exposure to reservoir and
vector

Treatment for Cutaneous

leishmaniasis
Oral Treatment:
Ketoconazole
Itraconazole
Fluconazole
Miltefosine

Treatment for Cutaneous

leishmaniasis
Parenteral:
Pentavalent antimony therapy(SbV)
20mg/kg i.v/im for 28 days

Mucocutaneous
leishmaniasis

Figure 23.7

Post-kala-azar Dermal
leishmaniasiss
Occurs in 10% of patients in India, 2-10 yrs
after txt of VL
Macules and papules appear around the
mouth, gradually spreads over the face or
more widely over the trunk and limbs

Protozoan Parasites of
Humans
Flagellates
Giardia intestinalis
Found in intestinal tracts of animals and in the
environment
Causative agent of giardiasis
Common gastrointestinal disease in the United States
Ingest cysts in contaminated water or when swimming
Range from asymptomatic infection to gastrointestinal disease

Giardia have a life cycle similar to that of Entamoeba

Trophozoites multiply in the small intestines

Prevent infections in endemic areas by use of filtered

water

Clinical Features
Incubation: 7-10 days
Ranges: 3 days to several months
Symptoms develop after ingesting as few as
10 cysts
Symptoms: abrupt diarrhea, abdominal
cramps, bloating and flatulence
Associated: nausea, malaise and belching
accompanied by a taste of rotten eggs.

Diagnosis
Stool Exam
ELISA
Direct fluorescence antibody technique
EIA
Other:
Doudenal fluid aspirate string test
Small bowel biopsy

Management

Metronidazole 400mg three times daily for 5

days or 2g/day for 3 days
Tinidazole
Albendazole
Nitazoxanide

Trophozoite of Giardia
intestinalis

Figure 23.8

Protozoan Parasites of
Humans
Flagellates
Trichomonas vaginalis
Unicellular intracellular, anaerobic, flagellated
Lives in the genitourinary system of men and women
Transmitted almost exclusively via sex
Occurs in people with preexisting STD or multiple sex
partners
Infection of women results in vaginitis
Infection of men is typically asymptomatic
Prevention involves abstinence and safe sex

Trophozoite of Trichomonas
vaginalis

Figure 23.9

Parameter
Predominant symptom

Trichomoniasis
Profuse discharge

Characteristic discharge frothy

pH

>4.5

Gram stain

(-)

NSS mount

Flagellated protozoa

10% KOH

(-)

Other Laboratory Test

Culture DNA probe test

Treatment

Metronidazole

Protozoan Parasites of
Apicomplexans Humans
Alveolate protozoa
Infective form characterized by ornate complex of
organelles at their apical end
Parasites of animals
Life cycles involve at least two types of hosts
Schizogony is major feature of apicomplexan life
cycles
Multinucleate schizonts form before the cells divide

Four important apicomplexan parasites

Plasmodium, Toxoplasma, Cryptosporidium, and
Cyclospora

Protozoan Parasites of
Apicomplexans Humans
Plasmodium
Causative agent of malaria
Four species cause malaria
P. falciparum, P. vivax, P. ovale, and P. malariae, P. knowlesi

Malaria is endemic throughout the tropics and subtropics

Female Anopheles mosquitoes are vector for Plasmodium
The Plasmodium life cycle has three prominent stages

Protozoan Parasites of
Apicomplexans Humans
Toxoplasma
Most infections are asymptomatic
Toxoplasmosis develops in a small number of people
Fever-producing illness combined with other symptoms
Usually is a self-limited infection

Toxoplasmosis is more severe in two populations

AIDS patients
Fetuses

Prevent by cooking meats and avoiding contaminated soil

Pseudocysts of Toxoplasma
gondii

Figure 23.14

Protozoan Parasites of
Apicomplexans Humans
Cryptosporidium parvum
Causative agent of cryptosporidiosis (Cryptosporidum
enteritis)
Once thought to only infect livestock and poultry
Humans can carry the parasite asymptomatically
Infection usually results from drinking contaminated water
Fecal-oral transmission can occur
Causes severe diarrhea that can last up to two weeks
Chronic Cryptosporidum enteritis indicator a person has
AIDS
Infection of AIDS patients can be life threatening

Oocysts of Cryptosporidium
parvum

Figure 23.15

Protozoan Parasites of
Humans
Apicomlexans
Cyclospora cayetanensis
Water borne apicomplexan
Linked to raspberries imported from Central and South
America
Infection occurs from ingestion of oocysts in contaminated
food or drink
Environmental reservoir is unknown
Symptoms include cramps, watery diarrhea, myalgia, and
fever
AIDS patients can experience more severe disease
Thoroughly washing fruits and vegetables can prevent
infection