CILIATES
BALANTIDIUM COLI
DISEASE
MORPHOLOGY
- Trophozoite
• Dimensions
o 30 to 300 um long
o 30 to 100 um wide
• has a cytosome – acquisition of food
• cytopyge – excretion of waste
PATHOGENESIS AND CLINICAL MANIFESTATION
• 2 dissimilar nuclei (macro- and micronucleus)
o macronucleus
bean-shaped
• B. coli is a tissue invader
• 2 contractile vacuoles • Trophozoites are capable of attacking the intestinal
• mucocysts – extrusive organelles which are located epithelium and creating characteristic ulcer with a
beneath the cell membrane rounded base and wide neck (vs. flask-shaped, narrow
o adhesion of parasitic ciliates (not proven) necked ulcers of amebiasis)
o Ulceration caused by hyaluronidase = enzyme
secreted by trophozoite
o Trophozoites are abundant in exudates on
mucosal surfaces
o Inflammatory cells and trophozoites are
numerous in the base of the ulcers
• Trophozoites also invade the submucosa and the
muscular coat, including the blood vessels and
lymphatics
o May spread to mesenteric nodes, pleura or the
liver
• many infected individuals are asymptomatic
- Cysts
• most common symptoms presented:
o diarrhea
o dysentery
• acute infection
o abdominal discomfort/pain associated with
nausea and vomiting
o 6 to 15 episodes of diarrhea per day
• Balantidial dysentery is indistinguishable from amebic
dysentery
• Dimensions o Diarrhea with bloody, mucoid stools
o 40 to 60 um in diameter • Chronic cases
• spherical and ovoid o Diarrhea may alternate with constipation
• covered with thick cell walls o Accompanied by anemia and cachexia
• unlike amoeba, encystations does not result in an o Associated with non-specific abdominal
increase in number of nuclei symptoms
• Fulminant disease occur in immunocompromised or
malnourished patients
LIFE CYCLE • Complications
o Intestinal perforation
• exhibits both trophozoite and cyst stages o Acute appendicits
• ingested cysts excyst in the small intestines and become
trophozoites
• trophozoites inhabit the lumen, mucosa and submucosa
of the large intestines, primarily the cecal region
• multiply by binary fission and cause pathologic changes
in the colonic wall and mucosa
• cysts formed as protection for survival outside host
• parasites encyst during intestinal transport or after
evacuation of semi-formed stools
• infective stage: cysts (remains viable for several
• Dimensions
o 9 to 12 um long
o 5 to 15 um wide
• pyriform or teardrop shaped
• pointed posteriorly
• pair of ovoidal nuclei
• dorsal is convex, ventral is concave with large adhesive
disc for attachment
• bilaterally symmetrical
• axostyle - distinct medial line
• erratic tumbling motion – propelled by 4 pairs of flagella
arising from superficial organelles in the ventral side
DIAGNOSIS
• divide by longitudinal binary fission
• microscopic demonstration of trophozoites and cysts in • covered with variant-specific surface proteins (VSPs) =
feces (DFS or concentration techniques) resistant to intestinal proteases
• sigmoidoscopy – biopsy specimens of lesions that show - cysts
presence of trophozoite
Sigmoidoscopy
TREATMENT
• dimensions
• tetracycline (adults and children) 500 mg 4x daily for 10 o 8 to 12 um long
days o 7 to 10 um wide
o contraindicated for children < 8 y/o and • young cysts have 2 nuclei
pregnant women • mature cysts have 4 nuclei
• Metronidazole 750 mg 3x daily for 5 days
• characterized by flagella retracted into axonemes
o Pediatric dose 35 to 50 mg/kg/day in 3 divided
(median body)
doses for 5 days
o Contraindicated in early pregnancy • deeply stained curved fibrils surrounded by a touch
• Iodoquinol 650 mg 3x daily for 20 days hyaline cyst wall secreted from condensed cytoplasm
o Pedia – 20 mg/kg/day in 3 divided doses for 20
LIFE CYCLE
days
FLAGELLATES
GIARDIA LAMBLIA
DISEASE
MORPHOLOGY
DIAGNOSIS
diagnostic of trichomoniasis
• T. vaginalis infections in females presents as
symptomatic vaginitis, chronic infection may be
asymptomatic
• In males, trichomoniasis is asymptomatic during the
acute stage
o Becomes a chronic urethritis
DIAGNOSIS
DIENTAMOEBA FRAGILIS
MORPHOLOGY
DISEASE
MORPHOLOGY
• Amastigotes
o Ovoid or rounded bodies
o 2 to 3 um in length
o lives intracellularly in the
monocytes,
polymorphonuclear leukocytes
or endothelial cells
o nucleus is large
o axoneme arises from the
kinetoplast and extends to the
anterior tip
PATHOGENESIS AND CLINICAL MANIFESTATIONS
• Promastigotes
• does not invade tissues but presence in the intestines o Single free flagellum
produces irritation of the mucosa arising from kinetoplast
o secretion of excess mucus at the anterior end
o hypermotility of the bowel o Measure 15 to 20 um in
• infections are usually asymptomatic length and 1.5 to 3.5 um
in width
• in symptomatic patients, onset of infection is
accompanied by colicky abdominal pain and loss of
appetite
o also complain of intermittent diarrhea w/ LIFE CYCLE
excess mucus
o abdominal tenderness • infective stage : promastigotes in the proboscis of the
o bloating sensation sand fly
o flatulence o injected into host skin during feeding
o anal pruritis (11% of patients) = may be due to • invade the reticuloendothelial cells
co-infection with Enterobius • become amastigotes
• peripheral eosinophilia observed in 50% • multiply by binary fission
• chronic infection • the parasitized cell ruptures
o mimic symptoms of diarrhea-predominant o amastigotes are released to invade new cells
irritable bowel syndrome (IBS)
o rule out infection with this protozoan before
L. tropica = lymphoid tissue of the
skin
diagnose patient as IBS
L. donovani = visceral organs
DIAGNOSIS L. braziliensis = skin and mucous
membranes
• observation of binucleate trophozoites in multiple fixed
and stained fresh stool samples • vector : sand fly Phebotomus spp.
• fresh stool since trophozoites degenerate after few o Takes up amastigotes during feeding
hours of stool passage • Amastigotes transforms into promastigotes in the gut
• Multiply by binary fission
• number of samples = rate of identification
• Migrate to pharynx
• easily overlooked by the examiner if he is not aware of
D. fragilis infection
• purged stool specimens are more suitable
• may be misdiagnosed for other amoebae
• prompt fixation with polyvinyl alcohol fixative or
Schaudinn’s fixative
TREATMENT
EPIDEMIOLOGY
Promastigote Amastigote
DIAGNOSIS
PATHOLOGY AND CLINICAL MANIFESTATION
• demonstration of Leishmania in tissue biopsies, skin for
1. Cutaneous leishmaniasis (Leishmania tropica) cutaneous leishmaniasis; bone marrow, spleen or lymph
nodes for visceral leishmaniasis
- incubation period ranges from 2 weeks to months • serology – used for supportive diagnosis when parasites
- skin ulcer with elevated and indurated margins are difficult to demonstrate
leaves ugly scar on healing • delayed hypersensitivity reaction to Leishmania antigen
- lesions may be local or metastatic usually develops in late stages of infection or following
- lesions are painless and do not result in cure and lasts for life
lymphadenopathy
- appearance of subcutaneous nodules EPIDEMIOLOGY
- no systemic signs and symptoms
- parasites found in macrophages and histiocytes • occur in southern regions of North America,
- ulceration secondary to anoxia or to an Mediterranean Basin, East and North Africa, The Caspian
immunoathologic reaction Littoral, Arabian Peninsula, Persian Gulf, Indian
- diffuse cutaneous leishmaniasis causes widespread subcontinent, China, Southern Soviet Union
thickening of the skin with lesions resembling
lepromatous leprosy • most severe forms found in Africa, Latin America and
- lesions do not heal spontaneously and tend to relapse India (yay! Wala sa pinas! )
after treatment • incidence of 400,000 cases per year, 12 million
- New World cutaneous leishmaniasis more severe and prevalence
chronic than Old World cutaneous leishmaniasis
- initially there are lesions resembling cutaneous TREATMENT, PREVENTION AND CONTROL
leishmaniasis
- after several decades, metastatic spread to the • antimony compounds
oronasal and pharyngeal mucosa o pentavalent antimonials sodium stiboglyconate
causes highly disfiguring leprosy-like and n-methyl-glucamine antimonite
tissue destruction and swelling • second-line drugs (antimicrobials)
(“Tapir nose”) o Amphoterecin B
- chiclero ulcer refers to the erosion of the pinna of the o Pentamidine (for Kala-azar)
ear of forest workers o Metronidazole
o Nifurtimox
3. Visceral leishmaniasis or Kala-azar (Leishmania • the presence of such organisms in the man serve as an
donovani) indicator of fecal contamination of ingested food or
water
• treatment is not necessary
- incubation period is long (1-3 months)
- prominent findings: • mode of transmission :
fever (2x daily elevations) o Cysts = Chilomastix
splenomegaly o Trophozoites = Trichomonas
cachexia
- other signs and symptoms • Trichomonads are easily recognized because of their
skin darkening anterior tuft of flagella, stout median rod (axostyle) and
hepatomegaly undulating membrane. 3 species found in man
lyphadenopathy o T. tenax
malaise o T. hominis
weight loss o T. vaginalis
loss of apetite
cough TRICHOMONAS TENAX
diarrhea
anemia • harmless commensal found in the oral cavity
• more frequently associated with people with poor dental o found in formed or semi-formed stools
hygiene and oral disease o pear or lemon-shaped, round at one end and
• found exclusively in mouth of humans and other conical at the other
primates; often associated with Entamoeba gingivalis o w/ knob-like protruberance (not always
visible)
• mode of transmission: direct by droplets, kissing or use o 7 to 16 um
of contaminated dishes and drinking glasses o w/ cytostome and 1 nucleus
MORPHOLOGY
• pyriform in shape
• measures 5 to 12 um
• organelles
o 4 free flagella
o undulating membrane that does not reach the
posterior end of the body
o 1 nucleus
o 1 cytosome
EPIDEMIOLOGY
• cosmopolitan distribution
• more prevalent in warm climates
• < 1% prevalence in the Philippines
disclaimers:
these are not notes from the lecture given by dr. pascual, these
were taken from various parasitology books. it’s up to you if you
LIFE CYCLE want to study this.
• lives in the tartar around the teeth, cavities of carious the same goes for lectures 7, 9 and 10… gawa ko lang po iyon…
teeth, gingivalis margins of the gums, in pus pockets in bahala na kayo mag fill-in ng mga kulang na details… tao lang po!
tonsillar follicles
• multiplies by binary fission Good luck!
• thrives on organisms found in its environment
Only 1 lecture to go!
Auds
audsmartinez@gmail.com
ustmedc3@yahoogroups.com
DIAGNOSIS
• swabbing
o tartar between the teeth
o gingival margin of the gums
o tonsillar crypts
CHILOMASTIX MESNILI
MORPHOLOGY
• trophozoites
o found in diarrheic or liquid stools
o pear-shaped and asymmetrical
o with spiral grooves extending through middle
portion
o size 6-10 um
o movement: boring or spiral forward movement
possible by 3 anterior free flagella
1 delicate flagellum w/in the
prominent cytostome
• cysts