Blastocystis hominis
currently classified as an amoeba, but rRNA analysis
indicates it is related to algae and water molds.
Associated with diarrhea and abdominal pain.
There is an outer ring of cytoplasm with several
nuclei around the central body
Morphology: the classic form varies in diameter from
4-50um and contains a large central body that fills
about 90% of the cell volume.
Transmission: through contaminated food and
water.
Diagnosis: microscopic examination of stool
sample
Pneumocystis jiroveci
Morphology
Formerly P. carinii
Fungus
Trophozoite simple, ovoid and ameboid
organism measuring 2-4 um with a single nucleus
Cyst roundish shape, contain four to eight
intracystic bodies (nuclei or trophozoites)
arranged in an organized fashion (rosette shape)
or unorganized ( scattered about the organism)
Trophs- toluidine blue
Cysts- Ag stain & Giemsa
Life cycle
Often how referred to as P. pneumonia. As
much as any recognized human pathogen. This is an
organism of uncertain affiliation. It has morphological,
biochemical and nuclei acid homological
characteristics that conflict to resemble both a
protozoan and a fungus. Transmission is person to
person via cough droplets.
Life cycle is still considered unknown
Presumed that once inside the host, it takes up
residence in the alveolar spaces of the lung tissue.
Mature cyst rupture and trophozoites are develop
Other sites are spleen, lymph nodes and bone
marrow.
Pathology/Clinical symptoms
Cause pneumocystosis, among the more common
causes of non-bacterial pneumonia
immunocompromised (IC) patients in the US, and is
a leading cause of death of AIDS patients.
Common symptoms include fever, non-productive
cough and hapatosplenomegaly. Histologically, a
characteristic alveolar exudate with a foamy or
honeycomb matrix property due to the presence of
cysts is recoverable. PCP can be rapidly fatal among
IC patients, but is treatable in the case of relatively
patients.
AIDS person infected with this fungus often also
suffer from Kaposis sarcoma, a malignant skin
disease.
Infected malnourished infants experience poor
feeding, loss of energy, a rapid respiration rate and
cyanosis
Onset is longer lasting several weeks
All infected patients exhibit an infiltrate on chest x-
ray
Breathing difficulties
The lack of proper oxygen and carbon dioxide
exchange in the lungs is the primary cause of death
Epidemiology
This an infection of immunosuppressed individuals,
particularly AIDS patients. Mortality is high due to
severely compromised state of most patients.
Prevalent in US, Asia and Europe
High risk group: malnourished children those with
predisposing conditions such as malignancy
Placental transfer can cause infection and stillbirth
Laboratory diagnosis
Medical history, x-ray, examination of respiratory
fluid or biopsy from lungs of affected individuals
stained with Gomori methanomine silver stain or
rapid toluidine blue stain.
Giemsa and iron hematoxylin may be also used
Monoclonal immunofluorescent stain have also
been proven helpful
Specimen for diagnosis: sputum, bronchoalveolar
lavage, tracheal aspirate, bronchial brushings,
and lung tissue.
Treatment, prevention and control
Trimethoprim-sulfamethoxazole (bactrim)
Personal protection from droplets
Use of protective gear (mask)
FLAGELLATES CLASS MASTIGOPHORA/
FLAGELLATE
3 basic group of flagellates
1. Intestinal flagellates
2. Tissue flagellates
(Leishmania)
3. Blood flagellates
(Trypanosoma)
is
General body structures of flagellates
1. Kinetosome granule to which the flagellum is
attached
2. Costa - rib-like structure within the cytostome at the
base of the undulating membrane of trichomonas
flagellates.
3. Cystostome - cytoplasmic body excluding the
nucleus
4. Cyststome differential region of the cystostome
through which food is ingested. This may or may
not be a definite opening.
Giardia lamblia/duodenalis
Final habitat: duodenum of the small intestine
Duodenal aspirate can be a laboratory sample.
Associated with malabsorption syndrome, and
steatorrhea (increase fats in stool)
It causes travelers diarrhea and epidemic diarrhea
First discovered by Leeuwenhoek in 1681
Discovered in 1859 by French scientist Dr. F. Lambl
(Cercomonas intestinalis)
In honor of Czechoslovakian scientist Dr. Giard
Stiles coined the term G. lamblia
Trophozoite
Pear-shaped; teardrop shaped
The only bilaterally symmetrical protozoan with
medial line called axostyle
Referred to as Old Mans Face/Old Man with
eyeglasses. Old man with whiskers, Cartoon
character monkeys face
FALLING LEAF MOTILITY
With 2 anterior nuclei; four pairs of flagella ( total of
8)
With 2 sucking disks (serve as nourishment point of
entry)
The axostyle is made up of two axonemes, defined
as the interior portion of the flagella
Two slightly curved rodlike structures, known as
median bodies, sit on the axonemes posterior to the
nuclei
Cyst
Football-shaped/ovoid
With 2-4 nuclei
Cytoplasm often appear retracted
Pathology
It causes travelers diarrhea and epidemic diarrhea
Associated with nausea, anorexia and crampy
stomach
The stool become light colored but not blood
streaked
The diarrhea may become persistent, chronic and
associated with malabsorption so that the stool may
become steatorrheic
Powerful sucking disc of the parasite may cause
mechanical irritation to the microvilli and destruction
of the digestive enzymes leading to more
malabsorption
Produce lectin which when activated by duodenal
secretions is able to facilitate attachment. Once
attached, it can avoid peristalsis by trapping itself in
between the villi and within the intestinal mucus.
Cause villous flattening and cysts hypertrophy.
These lead to decrease electrolytes, glucose and
fluid absorption and cause deficiencies in
disaccharide.
Typical incubation period is 10-36 days
Produce watery, foul-smelling diarrhea
Self-limiting condition that typically is over in 10-14
days after onset
Diagnosis
Demonstration of trophozoite and or cyst in the stool
in intestinal biopsy specimen in aspirates
Duodenojejunal aspiration
Biopsy
Entero test- patient swallows a gelatin capsule
containing a nylon string, with one end of the string
attached to the patients check. After 6-8 string
hours, the string is removed and any adherent fluid
is placed in the slide examination.
Antigen detection test, immunofluorescence,
immunochromatographic assays, direct
fluorescent antibody (gold standard), PCR
Epidemiology
The prevalence in the Philippines is less than 20%
and more common in children than un adults (6%)
Homosexual (oro-anal practices)
Cysts have been found in dogs, cats, farm animals
and some wild animals
Can be transmitted from fecally contaminated
food
Important risk factors include poor hygiene, poor
sanitation, overcrowding, immunodeficiency,
bacterial and fungal overgrowth in the small intestine
and homosexual practices. Related to gay bowel
syndrome
Treatment, prevention and control
METRONIDAZOLE, TINIDAZOLE, NITAZOXANIDE
Proper water treatment chemical therapy and
filtration
Proper disposal of feces to prevent contamination of
water supply
Prevent food from contamination due to the use of
human excreta as fertilizer for vegetables
Prevent food from contamination from flies and
infected food handlers
Avoidance of unprotected oral-anal sex
Chilomastix mesnili
Trophozoite
Pear-shaped
Large spherical nucleus
With a characteristic spiral groove curving across the
body
Spiral, boring, jerky movement, stiff rotary motility in
a directional pattern.
With 3 anterior flagella within the cytostome
Cyst
Lemon to oval shaped
With characteristic protrusion on one end
NIPPLE-LIKE CYST
Also contains a cytostome
Epidemiology:
Cosmopolitan prefers warm climates
Greatest risk: poor sanitary and poor personal
hygiene
Transmission: ingestion of cyst thru hand to
mouth contamination or via contaminated food
and drink
 Trichomonas species Epidemiology
Exist only in trophozoites, no cystic stage MOT: sexual intercourse, mothers birth canal,
Usually pear-shaped with 4-5 flagella via contaminated toilet articles and
JERKY/TUMBLING MOTILITY underclothing; sharing of douche supplies ,
WITH UNDULATING MEMBRANE MAIN communal bathing
IDENTIFYING FEATURE; AIDS IN LOCOMOTION Trophozoites are resistant to changes in
WITH COSTA- THICKENING OF THE OUTER environment , survive in urine, on wet sponges and
MEMBRANE on damp towels for several hours and in water for 40
minutes
FEATURES T. HOMINIS T. TENEX T. VAGINALIS The prevalence is 24% using microscopic
Habitat Intestine Oral cavity genitalia examination of vaginal swabs and 37% using
size Medium Smallest Largest Fienberg and Wittington culture among hospitality
Nucleus Ovoidal Rounded Ovoidal
girls. The prevalence in other groups of women
Undulating As long as 2/3 of the
of the costa range from 3-8%
membrane the costa costa
Inclusion Siderophil
none None
bodies granules Prevention and Control
Oral scrapings,
Urine, vaginal Avoid promiscuous sexual intercourse
swab/discharg
Specimen for tonsillar crypts Use of protective devices
stool e/prostatic
diagnosis and pyorrheal
secretion for Avoid sharing equipment
pockets
males
T. tenax
Trichomonas vaginalis life cycle
Causative agent of PING-PONG disease Mouth scavengers
Unable to survive the digestive process
Male-carrier, asymptomatic but can also manifest Multiply by longitudinal binary fission
Chronic urethritis or persistent urethritis (can inhabit
the ureter, prostate, and epididymis) Epidemiology
Symptoms include enlarged tender prostate, Exact transmission is unknown but maybe through
dysuria, nocturia and epididymitis contaminated dishes and utensils; droplet
With thin, white urethral discharge contamination; through kissing
Survive in drinking water for several hours
Female-reservoir Seen in patients with poor oral hygiene
Symptoms: green to yellow vaginal discharge; foul- T. tenax on rare occasion has been known to invade
smelling; burning, itching and chafing may also be respiratory tract
present
Urethral involvement, dysuria and increased Prevention and Control
frequency of urination practicing good oral hygiene

Diagnosis T. hominis
Demonstration of trophozoites in the urine and Epidemiology
urethral secretions, vaginal and cervical Worldwide distribution
Secretions and scrapings and in male including Children are infected than adults
semen and prostatic secretions MOT: ingestion of trophozoites; fecal-oral
Unstained, wet drop preparations of the specimen or transmission
stained using Giemsa Contaminated milk is suspected to be source of infection
Papanicolaou, Romanowsky and acridine orange In patients with achlorhydria, the milk acts as a shield for
can be examined under the microscope for trophozoite upon entry to the stomach
diagnosis
It can also be cultured using Diamonds modified
medium or Fienberg & Wittington culture medium
DNA based assay- Affirm VPIII
InPouch TV culture system
(can be used with vaginal swabs from women
urethral swabs from men, urine sediment and semen
sediment)
Requires incubation time and takes up to 3 days
before the result is determined