PROTOZOANS

PART 1

Protozoans..
Kingdom

Protista Unicellular Eukaryotes Often transmitted by the fecal oral route Cyst Trophozoite

PROTOZOANS
AMOEBA FLAGELLATE CILIATE APICOMPLEXAN

Classification of Protozoan Parasites

Phylum Sarcomastigophora Sub phylum Sarcordina Species Acanthamoeba Endiolimax Entamoeba spp. Naegleria Chilomastix mesnilli Dientamoeba fragilis Trichomonas spp. Trypanosoma spp. Leishmania spp. Balantidium coli
Babesia microti Cryptosporidium spp. Cyclospora cayetanensis

Mastigophora

Ciliophora
Apicomplexa Coccidia

PROTOZOAN LIFE CYCLE

TROPHOZOITE PRECYSTIC CYST METACYST

STAGE

 ENCYSTATION

TROPHOZOITE - CYST CYST - TROPHOZOITE

EXCYSTATION

AMOEBAS

AMOEBA
TAXONOMIC CLASSIFICATION KINGDOM: PROTISTA

PHYLUM: SARCOMASTOGOPHORA
SUBPHLUM:

SARCORDINA

Amoebas ...
Intestinal

Extra - intestinal

Entamoeba histolytica Entamoeba hartmani Entamoeba dispar Entamoeba coli Iodamoeba butchlii Endolimax nana

Naegleria fowleri Acanthamoeba spp.

GENERALIZATIONS
ALL

AMOEBA ARE...

INTESTINAL DWELLERS EXCEPT ENTAMOEBA GINGIVALIS COMMENSALS EXCEPT. ENTAMOEBA HISTOLYTICA UNDERGO ENCYSTATION EXCEPT DIENTAMOEBA FRAGILIS, ENTAMOEBA GINGIVALIS

TROPHOZOITES...
POINTS OF DIFFERENTATION MOVEMENT
SHAPE OF PSEUDOPODIA RELEASE OF PSEUDOPODIA NUCLEUS

ENTAMOEBA HISTOLYTICA UNIDIRECTIONAL/ PROGRESSIVE

FINGER - LIKE ONE AT A TIME/ EXPLOSIVE MONONUCLEATED/ CENTRAL KARYOSOME CLEAN LOOKING/ RBC

ENTAMOEBA COLI SLUGGISH/ NON PROGRESSIVE

BLUNT SEVERAL AT A TIME/ SLOW MANNER MONONUCLEATED/ ECCENTRIC NUCLEUS DIRTY LOOKING/ BACTERIA

CYTOPLASM/ INCLUSION

CYST
POINT OF DIFFERENTIATION NO. OF NUCLEI CHROMATOIDAL BARS ENTAMOEBA HISTOLYTICA 1- 4 SAUSAGESHAPED/ CIGAR/ COFFIN LID WITH ROUNDED ENDS ENTAMOEBA COLI 48 WITCH BROOM STICK, NEEDLE LIKE

MORPHOLOGY

Source: CDC-DPDx

Source: CDC-DPDx

E. histolytica/E. dispar cyst with three visible nuclei (arrows) in saline wet mount

E. histolytica/E. dispar cyst with one visible nucleus and a glycogen vacuole (arrow) in saline wet mount

MORPHOLOGY

Source: CDC-DPDx

Source: CDC-DPDx

E. histolytica/E. dispar cyst with one visible nucleus and a glycogen vacuole (arrow) in iodine wet mount

E. histolytica/E. dispar cyst with two visible nuclei and a chromatoid body (arrow) in iodine wet mount

LIFE CYCLE

OTHER AMOEBA MISTAKEN AS ENTAMOEBA HISTOLYTICA

ENTAMOEBA

HARTMANNI SMALL E.HISTOLYTICA DISPAR MORPHOLOGY IS EXACTLY THE SAME WITH E. HISTOLYTICA BUT DIFFER IN THE BIOCHEMICAL CONTENT

ENTAMOEBA

PATHOLOGY
INSTETINAL

ASYMPTOMMATIC ACUTE AMOEBIC DYSENTERY AMOEBIC DIARRHEA AMOEBIC FLASK SHAPED ULCERS

PATHOLOGY
EXTARINTESTINAL

HEPATIC AMOEBIAIS PULMONARY AMOEBIASIS CEREBRAL AMOEBIASIS AMOEBIC PERICARDIATIS CUTANEOUS AMOEBIASIS GENITAL AMOEBIASIS

Amoebic dysentery Onset Gradual

Bacillary dysentery Acute

Signs/symptoms
Odor (feces) Blood and mucus pH Pus cells/PMN neutrophile Cellular exudates Pyknotic residues Charcoat Leyden crystals Pathogenic amoebae (motile amoebae containing red cells Bacteria Macrophages

No significant fever or vominting

Offensive (+) Acidic Few Scant Numerous Present Present

Fever and usually vomiting

Odorless Often watery and bloody Alkaline Numerous Massive Few Absent Absent

Few Absent

Numerous Present

VIRULENCE FACTOR
GAL

NAC LECTIN AMOEBA PORES CYSTEINE PROTEINASE

LABORATORY DIAGNOSIS

DFS

UNSTAINED STAINED

LUGOLS IODINE QUENSELS METHYLENE BLUE IRON HEMATOXYLIN BEST CARMINE TRICHROME STAIN

CONCENTRATION TECHNIQUES

MERTHIOLATE IODINE FORMALDEHYDE CT (MIFCT) FORMALIN ETHER CT (FECT)

LABORATORY DIAGNOSIS

CULTURE TECHNIQUES

BALAMUTHS MONOPHASIC MEDIUM BOECK/ DRBOHLAVS DIPHASIC MEDIUM ROBINSON AND INOKI MEDIUM
ENDOSCOPY LIVER ASPIRATE SEROLOGICAL TEST RADIOGRAPHIC NON INVASIVE TECHNIQUES

MISCELLANEOUS PROCEDURES

TREATMENT
METRONIDAZOLE DIOXANIDE

FUROATE

Intestinal Amoeba

Trophozoites E. histolytica

Cyst

Nucleus

E. coli

E. nana

I. buetschlii

Blastocystis hominis
Originally

classified as a yeast Stramenophiles Not merely a commensal but regarded as a potential pathogen Inhabitant of the lower intestinal tract MOT: Fecal oral route

Life Cycle

Pathogenesis
Blastocystosis GIT

disorders

Diagnosis
DFS/

Concentration techniques Hematoxylin or Trichrome stain Culture: Boeck/ Drbohlavs / Nelson and Jones media

Treatment
DOA:

Metronidazole Trimethropin sulfamethaxazole (TMPSMX)

FREE LIVING AMOEBA

NAEGLERIA

FOWLERI

PRIMARY AMEOBIC MENINGOENCEPHALITIS KERATITIS

ACANTHAMOEBA

SPP.

GRANULOMATOUS AMOEBIC MENINGOENCEPHALITIS

Amebas can be recovered by:

Intracerebral

inoculation of mice Growth in non-nutrient agar in connjunction with coliform growth At autopsy amebas abundant in the involved areas of the brain

FLAGELLATES

Flagellates

Intestinal
Giardia

lamblia Chilomastix mesnili Trichomonas hominis Dientamoeba fragilis

Urogenital
Trichomonas

vaginalis

Oral
Trichomonas

tenax

UST-FMS Dept. of Laboratory Medicine

FLAGELLATES
TAXONOMIC CLASSIFICATION

KINGDOM PROTISTA
PHYLUM:

SARCOMASTIGOPHORA

SUBPHYLUM: MASTIGOPHORA

PARTS OF THE BODY OF FLAGELLATES

FLAGELLA PARABASAL

BODY CYTOSOME (MOUTH) UNDULATING MEMBRANE AXOSTYLE COSTA

GIARDIA LAMBLIA
TROPHOZOITE PEAR SHAPED BILATERALLY SYMMETRICAL BODY 4 PAIRS OF FLAGELLA 2 VENTRAL SUCKING DISC WITH PARABASAL BODY 2 NUCLEI AND CENTRALLY LOCATED KARYOSOME COVERED WITH VARIANT SPECIFIC SURFACE PROTEIN (VSP) WHICH IS RESISTANT TO INSTETINAL PROTEASES

UST-FMS Dept. of Laboratory Medicine

GIARDIA LAMBLIA
CYST

OVOID, QUADRINUCLEATED INFECTIVE STAGE FLAGELLA RETRACTED AXONEME DEEPLY STAINED CURVE FIBRILS

CYST

UST-FMS Dept. of Laboratory Medicine

PATHOLOGY
MALABSORPTION

OF FATS/ STARCH TRAVELLERS DIARRHEA FAILURE TO THRIVE SYNDROME ROTTEN EGG SMELLING FLATUS GAY BOWEL SYNDROME

LABORATORY DIAGNOSIS
STOOL

EXAM DUDODENAL ASPIRATE BEALE STRINGS TEST/ ENTERO TEST SEROLOGICAL TEST

TREATMENT
QUINACRINE METRONIDAZOLE TINIDAZOLE

CHILOMASTIX MESNILII
TROPHOZOITE

CYST
UNINUCLEATED

3 ANTERIOR FLAGELLA 1 FLAGELLAR CYTOSOME CURVED CYTOSOMAL FIBRIL CORKSCREW MOTILITY

WITH DISTINCT ANTERIOR PROTRUBERANCE

UST-FMS Dept. of Laboratory Medicine

Dientamoeba fragilis
Considered

recently to have closer affinity to flagellates by virtue of electron microscope studies HABITAT

Mucosal crypts of the colon 3-18 mm, hyaline broad and leaflike pseudopodia, binucleate (arrested telophase), no cyst form

MORPHOLOGY

UST-FMS Dept. of Laboratory Medicine

 CLINICAL

MANIFESTATION

Mucoid diarrhea Anal pruritus Abdominal pain

UST-FMS Dept. of Laboratory Medicine

TREATMENT

Iodoquinol Tetracycline Paromomyin

UST-FMS Dept. of Laboratory Medicine

TRICHOMONADS
TRICHOMONAS

VAGINALIS TRICHOMONAS HOMINIS TRICHOMONAS TENAX

TRICHOMONAS VAGINALIS
TROPHOZOITE

PEAR SHAPED 4 ANTERIOR FLAGELLA SHORT UNDULATING MEMBRANE JERKY TUMBLING MOTILITY PROMINENT SIDEROPHIL GRANULES

UST-FMS Dept. of Laboratory Medicine

PATHOLOGY
SEXUALLY FEMALE

TRANSMITTED INFECTION

VAGINITIS ITCHINESS ( BURNING SENSATION) * STRAWBERRY CERVIX PROSTATIS

UTI

MALE

UST-FMS Dept. of Laboratory Medicine

LABORATORY TESTS
MICROSCOPY

MALE URINE, PROSTATIC FLUID, SEMINAL FLUID FEMALE URINE, VAGINAL DISCHARGE, VAGINAL SCRAPPINGS
DIAMONDS MODIFIED CULTURE MEDIUM FEINBERG WHITTINGTON CULTURE MEDIUM TRYPTICASE LIVER SERUM MEDIUM

CULTURE

FLAGELLATES

CILIATES

CILIATES
TAXONOMIC

PHYLUM:

CLASSIFICATION

KINGDOM PROTISTA
CILIOSPHORA

BALANTIDIUM COLI
LARGEST

INTESTINAL PROTOZOANS ONLY PARASITIC CILIATE RESERVOIR HOST: PIGS LYTIC ENZYME IN CILIA: HYALURONIDASE BASIC PART

CILIA CYTOSOME CYTOPHAGE

MORPHOLOGY
TROPHOZOITE
OVOIDAL PROMINENT

CYST
OVOID WELL

CYTOSOME 2 NUCLEI

DEFINED CYSTIC WALL INFECTIVE STAGE

MACRONUCLEUS MICRONUCLEUS

UST-FMS Dept. of Laboratory Medicine

Binary fission; conjugation

UST-FMS Dept. of Laboratory Medicine

PATHOLOGY
BALANTIDIASIS/

BALANTIDIAL DYSENTERY ULCER S DUE TO HYALURONIDASE DIARRHEA CILLIARY DYSENTERY INTESTINAL PERFORATIONS ACUTE APPENDICITIS

LABORATORY DIAGNOSIS
STOOL

EXAMINATION

TREATMENT
TETRACYCLINE METRONIDAZOLE

SOURCE

NOTES FROM THE FACULTY OF MEDICINE AND SURGERY (UNIVERSITY OF SANTO TOMAS) NOTES FROM MR GREGORIO MARTIN, RMT, MSMT, MPH AND HEATHER ABEGAIL GUTIEREZ BSMT STUDENT (UNIVERSITY OF SANTO TOMAS) HENRYS CLINICAL DIAGNOSIS BY LABORATORY METHODS NOTES FROM PWU CLASSMATES PARASITOLOGY FOR MEDICAL AND CLINICAL LABORATORY PROFESSIONALS