Subphylum Mastigophora

(Atrial Flagellates)
Atrial Flagellates
 Generally have one to several long
flagella in trophozoite form (
except D. fragilis: pseudopodia)
 Some species have rudimentary
mouth called cytostome
 Neuromotor apparatus consists of
kinetoplast and axoneme
 Reproduction is through binary
fission.
 G.lamblia and C.mesnili have cyst
and troph forms, the others exist in
trophozoite stage only.
Atrial Flagellates
PATHOGENIC
- Giardia lamblia
- Trichomonas vaginalis

NON-PATHOGENIC
- Chilomastix mesnili
- Trichomonas hominis
- Trichomonas tenax
  Also known as:
 Giardia intestinalis
Giardia lamblia  Giardia duodenalis
 Lamblia duodenalis
 Lamblia intestinalis
 First discovered by Antoine Van
Leeuwenhoek
 First described by French scientist
Dr. F. Lambl and Czechoslovakian
scientist Dr. Giard: Cercomonas
intestinalis
 Stiles coined Giardia lamblia
 Giardia lamblia
(Trophozoite)
PARAMETER DESCRIPTION
Size range: 8-10 um long
5-16 um wide
Shape: Pear-shaped, teardrop
Motility: Falling-leaf
Appearance: Bilaterally symmetrical
Nuclei: Two ovoid-shaped, each
a large karyosome
No peripheral chromatin
Flagella: Four pairs,origination of each:
one pair, anterior end
one pair, posterior end

👴
two pair, central, extending
laterally
Other structure: Two median bodies
Two axonemes
Sucking disk
 Giardia lamblia
(Cyst)

PARAMETER DESCRIPTION

Size range: 8-17 um long

6-10 um wide

Shape: Ovoid

Nuclei: Immature cyst, two

Mature cyst, four
Central karyosomes
No peripheral chromatin

🏈
Cytoplasm: Retracted from cell wall

Other structure: Median bodies: two in

immature cyst or four
Interior flagellar
structures
Life cycle
  🔬 Stool examination
 flatus smell like rotten eggs:
hydrogen sulfide
Diagnosis  Formed stool: cyst
 Liquid, soft stool: trophozoites
 💉 Duodenal aspirate
 💉 Biopsy
 🎈 Enterotest™
 ✨ Direct Fluorescence
 🖥 EIA and ELISA
 🖥 Western Blot
 🖥 R-T PCR
Epidemiology

 Found world-wide in lakes, streams,

and other water sources.
  Considered to be a non-pathogen.
This organism is now considered to
be the only known pathogenic
Clinical symptoms
intestinal flagellates:
-🤷 Asymptomatic Carrier State
- 🤷 Giardiasis ( Traveler's
Diarrhea / Gay bowel syndrome)
 villous flattening and crypt
hypertrophy
 decreased electrolyte, glucose, fluid
absorption.
 Deficiencies in disaccharidases
Treatment

 Metronidazole
 Tinidazole
 Nitazoxanide
Prevention and control  🌬Proper water treatment and control
 🙋Exercising good personal hygiene
 🍖 Proper cleaning and cooking of
food
 👬 Avoidance of unprotected anal and
oral sex
Trichomonas vaginalis
 Trichomonas vaginalis
(Trophozoite)
PARAMETER DESCRIPTION
Size range: 5-14 um long
Shape: ovoid, round or pear-shaped
Motility: Rapid, jerky

Nuclei: One, ovoid, nondescript

Flagella: all originating anteriorly

3-5 extending anteriorly
one extending posteriorly
Other structure: undulating membrane
extending half of body
length
prominent axostyle that often
curves around nucleus
granules maybe seen along
axostyle
Life cycle
  🔬 Examination of saline wet prep
Diagnosis  💁 Papanicolaou smear
 🚽 Urinalysis
 🖥 Culture: InPouch TV (3 days)
 🖥 Molecular techniques: Affirm VPIII
(DNA)
 ✨ Fluorescent stains
 🖥 monoclonal antibody assays,
enzyme immunoassays,
Epidemiology  🌏 Infection with T. vaginalis occur
worldwide.
 👫 Sexual intercourse is the primary
mode of transmission
 🚽 Known to be transferred via
contaminated toilet articles or
underclothing.
Specimens for
identification
 🚽urine (SOC)
 💁vaginal secretions
 🤷 scrappings
 🙋cervical swabs
 🙌prostatic secretions
Clinical symptoms  Asymptomatic Carrier state – most
frequently in men
 Persistent Urethritis
 Persistent Vaginitis
 🍓 strawberry cervix
 👶 Infant infection: conjunctivitis,
respiratory infection
 TREATMENT

Treatment

Metronidazole: DOC
Treatment of sexual partners is
recommended
Prevention and control

 👰🤵 Practice safe, monogamous sex

and good personal hygiene
 👦 Prompt treatment of cases and
asymptomatic male patients
 📖 Public education
Trichomonas hominis
 Trichomonas hominis
(Trophozoite)
PARAMETER DESCRIPTION
Size range: 7-20 um long 5-18 um wide
Shape: pear-shaped
Motility: Nervous, jerky
Nuclei: One, with a small central
karyosome
no peripheral chromatin
Flagella: 3-5 anterior
1 posterior extending from the
posterior end of the undulating
membrane
Other structure: axostyle that extends beyond
the posterior end of the body
full body length undulating
membrane
conical cytostome cleft in
anterior region ventrally loc.
opposite the undulating
membrane
Diagnosis

 🚽 Stool examination: trophozoites

Epidemiology
 🌏 T. hominis is found worldwide
 🙇 Transmission mostly occurs by
ingesting trophozoites
 🍼 Contaminated milk is one of the
source of infection
Clinical symptoms

 Asymptomatic
 TREATMENT

Treatment

 No need to treat
 Commensal or non-pathogenic
 Prevention

Prevention

 🕺 Proper sanitation
 🛀 Good personal hygiene
Trichomonas tenax
 Trichomonas tenax
(Trophozoite)
PARAMETER DESCRIPTION
Size range: 5-14 um long
Shape: oval or pear-shaped
Nuclei: One, ovoid nucleus; consist of
vesicular region filled with
chromatin granules
Flagella: 5 total, all originating anteriorly
4 extended anteriorly
1 extends posteriorly
Other structure: undulating membrane
extending 2/3 of body
length with accompanying
costa
thick axostyle curves around
nucleus:
extends beyond body length
small anterior cytostome
opposite undulating membrane
Diagnosis

 👄 Specimen of choice is mouth

scraping
Epidemiology  The exact mode of transmission is
unknown
 🍽 Some evidence suggesting that the
use of contaminated dishes and
utensils
 💏 Introducing droplet contamination
through kissing
Clinical symptoms

 Has been known to invade the

respiratory tract
Treatment

 Nonpathogenic
 PREVENTION

Treatment

 Proper and good oral hygiene

Chilomastix mesnili
 Chilomastix mesnili
(Trophozoite)
PARAMETER DESCRIPTION
Size range: 5-25 um long
5-10 um wide
Shape: pear-shaped
Motility: Stiff, rotary, directional
Nuclei: One, with small central or
eccentric karyosome
No peripheral chromatin
Flagella: four
3 extending from anterior
to end
1 extending posteriorly from
cytostome region
Other structure: prominent cytostome
extending 1/3 to 1/2 body
length
spiral groove
 Chilomastix mesnili
(cyst)

PARAMETER DESCRIPTION

Size range: 5-10 um long

Shape: lemon-shaped, with clear

hyaline knob extending
from the anterior end

Nuclei: One, with large central

karyosome
no peripheral chromatin

Other structure: well-defined cytostome

located on one side of the
nucleus
LIFE CYCLE

Life cycle
Diagnosis

 🚽 Traditional examination of
freshly passed liquid stool
 Iodine wet preparation
Epidemiology
 🌤C. mesnili is cosmopolitan in its
distribution and prefers warm
climate
 This may occur primarily through
hand-to-mouth contamination or via
contaminated food or drink
Clinical Symptoms

 Asymptomatic
Treatment

 No treatment is necessary
Prevention and Control

 🕺 Proper personal hygiene

 🛀 Public sanitation practices
  First discovered by Wenyon
 described by Pepps and Dobell
 originally described as an ameba
Dientamoeba fragilis  no cyst stage identified
 co-infection with Enterobius
vermicularis
 life cycle is unknown
 Hakansson phenomenon: D. fragilis
differs from the amebic trophozoites
when mounted in water preparations.
Although both types of organisms
swell and rupture under these
conditions, only D. fragilis returns to its
normal size. Numerous granules are
present in this stage and exhibit
Brownian motion.
 Dientamoeba fragilis
(Trophozoite)
PARAMETER DESCRIPTION
Size range: 5-18 μm

Shape: Irregularly round

Motility: Progressive, broad hyaline

pseudopodia

Nuclei: Two, each consisting of

massed clumps of four to
eight chromatin granules
No peripheral chromatin

Cytoplasm: Bacteria-filled vacuoles

common
Diagnosis
 🚽 Traditional examination of
freshly passed liquid stool
 Fixed stool with polyvinyl alcohol
or Schaudinn’s fixative
 🖥 Molecular techniques: RT-PCR
  D. fragilis is transmitted via the eggs
Epidemiology of helminth parasites such as
Enterobius vermicularis and Ascaris
lumbricoides
 exact mode of D. fragilis
transmission remains unknown
 risk of contracting D. fragilis: children,
homosexual men, those living in semi
communal groups, and persons who
are institutionalized
Clinical Symptoms

 Asymptomatic
Treatment

Iodoquinol
Tetracycline
Metronidazole
Prevention and Control

 🕺 Proper personal hygiene

 🛀 Public sanitation practices
  Enteromonas hominis
READ  Retortamonas intestinalis