COCCIDIA Sexual cycle

- Gamtogenesis – formation of zygote -> oocyst w/ 4

Composition of apical complex: sporozoites
Polar ring – encircle the ant. Portion - Sporozoites undergoes endogenous sporolation (inside
Conoid – cones spirally withing polar ring the host) -> infective to intestinal epithelium
Subpellicular microtubules – runs post. Parallel to body axis; - Oocyst -> feces (infective to next host)
- locomotor fxn
Rhoptries – penetration Diagnosis
Micronemes – small convulated enlongated bodies extend 1. wet mount – fresh fecal – oocyst
posteriorly 2. biopsy – trop, schizont, merozoite – most reliable
3. staining of oocyst from feces, doudenal aspirates (modified
Morphology: kinyoun or ZN staining) – quickest and cheapest
- Banana shaped body 4. stool concentration – sheater sugar floatation/zinc sulfate
- Ant. End – attenuated – apical complex
- Post. End – crystalline bodies and granules Treatment
- None, supportive
- Spiramycin – immunocompromised
Cryptosporidium - Paramomycin & clarithomycin – diarrhea

Species:
C.hominis – infect human only
C.parvum – bovine and human Isospora

Moprhology: Specie: Isospora belli

- Similar to cryptosporidum
Oocyst - Intestinal infxn
- Round, oval-shaped - Warm region
- 4 spindle-shaped sporozoites
- No sporocyst Morphology
- Watery/formed stool - Elongate-ovoidal shape
- Resistant to chlorine - Sporoblast divides into 2 sporocyst
- Sporocyst contains 4 cresent-shaped sporozoite
Disease: cryptosporidiosis
- Assc. With aids Disease: Isosporosis/intestinal coccidiosis
- Self limiting, non-bloody diarrhea; 1-2 wks - Asymptomatic/self limiting
- Abd. Pain, anorexia, nausea, fever, weight loss - Ingestion of fecally contaminated food/drink w/ oocyst
- Immunocompetent – short term enteropathy - Mild gastro distress w/ fever, colicky diarrhea
- Immunocompromises - chronic diarrhea, malabsorption - Mal absorption w/ wight loss
- Waterborne
- Extraintestinal infxn – Respi tract, biliary, pancreas Pathology
- Children>adult - Jejunal biopsy reveals: shortened intestinal villous,
- Appears like giardiasis hypertrophied crypt and infiltration of PMN leukocyte
and eosinophils in lamina prorpia
Pathology
- Occurs in the brish border of epitithelial cell of intestine Lab diagnosis
- Intestinal biopsy of ileum and jejunum 1. direct microscopy –immature oocyst
- May alos involve epithelium of stomach, bile, gallbladder, 2. modified acid fast staining of fecal material
apncreas 3. stool conenctration (Sheater sugar floatation technique)
- most sensitive/accurate – detect isospora in feces
Life cycle: 4. doudenal string test
- Involves schizogonic and sporogonic stages
Treatment
Asexual cycle - Mild – not necessary
- Infxn occurs in human and other animals - Cotrimoxazole + sulfamethazole – immunocompromised
- Ingestion of oocyst from food and water - Sulfadiazine + pyrimethamine – alternate
- Oocyst in intestine released 4 sporozoite -> invade GI
microvilli
- Sporozoite -> trophozoite -> schizont
- Mature schizont – 8 merozoite
- Some merozoite goes to gametocytes -> starts sexual
cylce
Sarcosystis
Species:
S. hominis
s. suihominis – human and domestic animals: cattle, swine, sheep
geog. Dist.: southeast asia
morphology
- Oocyst boradly oval or fusiform lying along infected
muscle fibers, hyaline appearance enclose in a membrane
- 2 large sporocyst inside a tubular mass (meisher tube)
filled up with 4 mature cresent shape sporozoites
- Oocyst and sporocyst – infected stage to intermediate
host (cattle and swine)
- Man – definitive host
Life cycle
- Herbivores and omnivores – I.host
- Ingestion of oocyst containing 2 sporocyst w/ 4
sporozoites
- Sporocyst -> excystation in small intestine -> sporozoites
which enter epithelial cell of doudenum and ileum
- Trophozoites -> merozoites by schizogony
- Schizont ruptures -> tropozoites, merozoites, schzont
- After 1 wk, sexual cycle begins -> gametocytes
- Microgametocyts fetilizes macro w/ formation of zygote
- Zygote -> oocyst that leave intestinal mucosa and
excreted in the feces
Disease: sarcocystosus/sarcosporidosis
- Rare in human; does not produce clinical symptoms
- Zoonotic
- Intermediate host – pick up oocyst
- Human infection – ingestion of uncooked meat of I.host
or contaminated food/drink with infective oocyst
- Diarrhea, vomiting, abd. Pain 1-2 days after ingestion
Lab diagnosis
1. oocyst in feces/ doudenal aspirate – direct microscopy
2. modified acidfast staining (kinyoun)
3. enterotest – doudenal aspirate
Treatment
- Self limiting/ none
- Intestinal infxn: trimethropin + sulfathoxazole (DOC)
- Pyrimethamine + sulfadiazin (alternate)
Cyclospora
Specie: cyclospora cayetanensis
- Originally calle cyanobacterium-like body
- Asexual/sexual
- Vertebrates including reptiles, insect, rodents
- Human diarrhea 1990
- Assoc. watery diarrhea among AIDS patient
Morphology
Unsporulated 0ocyst
- Spherical shape, greenish central morula
- Sporulation requires 5-10 days
Sporulated/mature 0ocyst
- 2 sporocyst, each with 2 cresent-shaped sporozoite which
flouresce bluish green under uv light
- (cryptosporidium and isospora do not flouresc under uv)
Disease: cyclosporosis
- Human disease; no animal reservoir
- Indistinguishable from cryptosporidiosis and isosporiasis
- Onset 12-14 hrs after swallowing contaminated water
- Self limiting chronic persistent watery diarrhea, in
relapsing pattern for 3-4 wks followed by steatorrhea
- Assoc. abdominal cramps, nausea, vomiting, low grade
fever, weight loss, anorexia, some malabsorption
- AIDS patient – severe
Pathogenesis
- Infxn in jejunum
- Inflammatory changes with villous atrophy and
hyperplasia
Lab diag.
1. direct microscopy – oocyst in fecal smear
2. formalin – ether concentration technique
3. modified acidfast stain
4. demonstration of oocyst by autoflouresnce test
Treatment
- Unnecessary/ self limiting
- Trimethoprim + sulfamethoxazole
Microsporidia

Characteristic
- Eukaryotic, unicellular organism
- Obligate, spore forming intracellular parasite
- Invades vertebrate and invertebrate host
- Parasite of fish, birds, insects
- Multiply by binary or multiple fission
- Rapid emergenc assoc with aids
- Lack mitochondria, golgi membrane
- Possess ribosome similar to prokaryote
- Spores – resistant to environmental condition

Specie of medical importance

1. encephalitozoon intestinalis
2. enterocytozoon bieneusis
- both common in aids patient
- chronic intractable diarrhea
- watery, non bloody stool, nausea and anorexia, no fever
- fat malabsorption
- E.intestinalis can dissiminate to other sites – kidney

Life cycle

Exhibits 3 phases:
1. infective phase/ first phase

- Spore ingested or inhaled by host

- Once in the host cell, GIT initiate spore leading to rapid
envision of the polar filaments which elongates its tip in
host cell
2. proliferative

- Sporoplasm develop either by merogony (binary fission)

or schizogony (multiple fission)
- Takes place in cytoplasm of the host cell or in
parasitophorous vacuole
3. sporogony

- Meronts undergoe changes that transfer then into

sporoblast and mature into spores
- As spores formed host cell continues to expand until
ruptures, releasing the spore to initiate infection

Spores are released by:

1. into environment to facilitate horizontal transmission
2. undergo entire cycle when release from the cell

Lab diag.
1. fecal exam/light microscopy – spore with polar granule
2. electron microscopy – definitive diagnosuis –gold standard
3. pcr

Treatment
- Albendazole (DOC)