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Para2021-2 3

This document provides an overview of parasitology, focusing on protozoa. It discusses the classification, transmission, life cycles, morphology, and pathogenesis of important intestinal and urogenital protozoa like Entamoeba histolytica and Giardia lamblia. Key points include that protozoa have trophozoite and cyst stages, can be transmitted fecally-orally, and cause disease through invasion and damage to host tissues in the intestines or other organs. Laboratory diagnosis involves microscopic identification of protozoa in stool or tissue samples, and treatment focuses on eradicating clinical infections and asymptomatic carriage.

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Koko Hasham
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11 views

Para2021-2 3

This document provides an overview of parasitology, focusing on protozoa. It discusses the classification, transmission, life cycles, morphology, and pathogenesis of important intestinal and urogenital protozoa like Entamoeba histolytica and Giardia lamblia. Key points include that protozoa have trophozoite and cyst stages, can be transmitted fecally-orally, and cause disease through invasion and damage to host tissues in the intestines or other organs. Laboratory diagnosis involves microscopic identification of protozoa in stool or tissue samples, and treatment focuses on eradicating clinical infections and asymptomatic carriage.

Uploaded by

Koko Hasham
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© © All Rights Reserved
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Download as PPTX, PDF, TXT or read online on Scribd
You are on page 1/ 42

PARASITOLOGY

CONTENTS

▸ Intestinal protozoa
▸ Urogental protozoa

3
INTRODUCTION
▸ Protozoa (singular, protozoan), from the Greek ‘protos’ and
‘zoon’ meaning “first animal”, are members of eukaryotic
protists.
▸ Protozoa are found in all moist habitats.
▸ They are common in sea, in soil and in fresh water.
▸ These organisms occur generally as a single cell.
▸ Colonies of protozoa might also occur in which individual
cells are joined by cytoplasmic threads and form aggregates
of independent cells.
Transmission

▸ In most parasitic protozoa, the developmental stages are often


transmitted from one host to another within a cyst.
▸ protozoa can spread from one infected person to another by:
 Fecal–oral transmission of contaminated foods and water.
 Insect bite inoculums or rubbing infected insect feces on the
site of bite.
 Sexual intercourse
Protozoa
▸ Life Stages –
▹ Trophozoite -vegetative; feeding, mostly motile
▹ Cyst – dormant; protective thick wall
▸ Most are free living in water and soil
▸ Classified by motility & life cycle
▸ Subdivided by location in human host (GI,
blood, GU)
Diversity among Protozoa
CLASSIFICATION OF PROTOZOA

Protozoa of medical importance are classified based on their


morphology and locomotive system as described below:
 Amoebas: Entamoeba histolytica
 Flagellates: Giarda lamblia, Trichomonas vaginalis,
Trypanosoma spp, Leishmania spp
 Cliliophora: Balantidium coli
 Coccidian: Toxoplasma gondii and Plasmodium species
CLASSIFICATION OF PROTOZOA
▸ Protozoan pathogens can also be grouped according to
the location in the body where they most frequently cause
disease
▸ Intestinal tract : Entamoeba histolytica, Giardia and
Balantidium coli.
▸ Urogenital tract: Trichomonas vaginalis.
▸ Blood and tissue: Plasmodium species, Toxoplasma
gondii, Trypanasoma species
and Leishmania species
INTESTINAL PROTOZOA
▸ Intestinal protozoa are transmitted by the fecal-oral
route and tend to exhibit similar life cycles consisting of
a cyst stage and a trophozoite stage.
▸ Factors which increase the likelihood of ingesting
material contaminated with fecal material play a role in
the transmission of this intestinal protozoa .
▸ In general, situations involving close human-contact
and unhygienic conditions promote transmission.
Amoeba

▸ Entamoeba histolytica
▹ Amoebic dysentery

▸ Naegleria
▹ primary amoebic meningoencephalitis

▸ Acanthamoeba
▹ contact lens contaminant

Figure 12.18a
Amoebae
▸ Protozoa with no truly defined shape
▸ Move and acquire food through the use of
pseudopodia
▸ Found in water sources throughout the
world
▸ Few cause disease
Entamoeba histolytica

▸ One of the most important and


pathogenic parasites of humans

▸ It is transmitted from human to human


Epidemiology of E.histolytica

▸ worldwide distribution but is most common in the


tropical part of the world
▸ As many as 50% of population in some areas are
infected (average prevalence,10% to 15%)
▸ A number of outbreaks have resulted from a
breakdown in sanitation.
Epidemiology of E.histolytica

▸ Carried asymptomatically in the digestive tracts of


humans
▸ Many carriers asymptomatic; pass cysts in stool
(reservoir)
▸ Main source of food and water contamination is
asymptomatic carrier who passes cysts
Epidemiology of E.histolytica

▸ It is the most common enteric infection.


▸ The rate of incidence vary with the level of
sanitation,it is generally higher in tropic and
subtropics arias.
▸ Man the only source (not a zoonosis)
▸ Fecal-oral transmission
Morphology of Entamoeba histolytica

Two morphological stages: Trophozoite and cyst.


1.TROPHOZOITE:
▸ 20 to 30 µm in diameter;
▸ Cytoplasm consists of clear ectoplasm, finely granular endoplasm;
food vacuoles often containing rbc's .
▸ In living specimens show active, rapid movement, unidirectional
movement with pseudopodia
▸ Divides by binary fission.
▸ Primary habitat of the trophozoites is the large intestine (but can
metastasize to other organs)
Morphology of Entamoeba histolytica

2. CYST:
▸ Encystment is stimulated by dryness
▸ Trophozoite condenses into a sphere precyst, secretes cyst wall to form the round
cyst - 10 to 20 m in diameter
▸ Nuclear division begins after encystment: cyst contain from one to four nuclei.
chromatoid body
▸ It is inactive
▸ Resistant to unfavourable condition out side human body .can survive up to 30
days.
▸ This is the infective form resistant to stomach acid if swallowed.
▸ Excyst to trophozoite on passing through stomach
Entamoeba
histolytica life cycle
life cycle of E.histolytica
▸ Cysts and trophozoites are passed in feces.
▸ Cysts are typically found in formed stool, whereas trophozoites are
typically found in diarrheal stool.
▸ Infection by Entamoeba histolytica occurs by ingestion of mature cysts
in fecally contaminated food, water, or hands.
▸ Excystation occurs in the small intestine and trophozoites are released,
which migrate to the large intestine
▸ The trophozoites multiply by binary fission and produce cysts , and
both stages are passed in the feces .
▸ Because of the protection conferred by their walls, the cysts can survive days to
weeks in the external environment and are responsible for transmission. 

▸ Trophozoites passed in the stool are rapidly destroyed once outside the body, and if
ingested would not survive exposure to the gastric environment. 

▸ In many cases, the trophozoites remain confined to the intestinal lumen ( A  :
noninvasive infection) of individuals who are asymptomatic carriers, passing cysts
in their stool.
 
▸ In some patients the trophozoites invade the intestinal mucosa ( B : intestinal
disease), or, through the bloodstream, extraintestinal sites such as the liver, brain,
and lungs ( C : extraintestinal disease), with resultant pathologic manifestations
 
▸ Three types of amebiasis can result from infection:
1. Luminal amebiasis:
■ Least severe form that is asymptomatic
2. Invasive amebic dysentery:
■ More common form of infection
■ Characterized by bloody, mucus-containing stools and pain
3. Invasive extraintestinal amebiasis:
■ Trophozoites carried via the bloodstream throughout the body
▸ Maintaining clean water is important in prevention
Pathology of E.histolytica

Asymptomatic:
▸ Most infected people, perhaps 90%, are asymptomatic.
▸ In asymptomatic infections the amoeba lives by eating
and digesting bacteria and food particles in the gut. 
▸ It does not usually come in contact with the intestine
itself due to the protective layer of mucus that lines the
gut.
Pathology of E.histolytica

Symptomatic:
▸ In case of symptomatic cases, symptoms usually
develop in about two to four weeks.
▸ Disease occurs when amoeba comes in contact with
the cells lining the intestine.
▸ It then secretes the same substances it uses to digest
bacteria, which include enzymes that destroy 
cell membranes and proteins.
CONT, SYMPTOMATIC

▸ Symptoms can range from mild diarrhea to  


dysentery with blood and mucus.
▸ The blood comes from amoebae invading the
lining of the intestine.
▸ In about 10% of invasive cases the amoebae enter
the bloodstream and may travel to other organs in
the body.
▸ Symptoms can be summarized as follow:
1. COLONIZATION OF THE LARGE INTESTINE
Trophosoites digest mucosal cells of the colon resulting in primary ulcer.

2. COMPLICATIONS IN LARGE INTESTINE


A. Ulcers extend deep into the intestinal mucosa (flask shape ulcer)
and may extend completely through the large intestine causing acute
necrotizing colitis with perforation (bacterial infection in the abdominal
cavity) , this complication results in a high percentage of fatalities
B. Trophozoites invade the blood vessels of the submucosa and
metastasize to ectopic sites
3. EXTRA-INTESTINAL LESIONS:
occur in 3 ECTOPIC SITES :
A. HEPATIC AMEBIASIS
Trophozoites in submucosa are carried by hepatic portal vein to the
liver. Trophozoites digest away liver tissue forming abscess - some to
size of grapefruit
B. PULMONARY AMEBIASIS
Liver abscess ruptures Trophozoites in the blood stream reach the
lungs to form abscess
C. CEREBRAL AMEBIASIS
Trophozoites in bloodstream reach the brain & form fatal encephalitis
DIAGNOSIS

▸ Microscopic examination of stool allows identification of cysts


and trophozoites of E.histolytica
▸ Must differentiate from nonpathogenic and commensal species
of amebae
▸ Specific serologic tests can confirm diagnosis
▸ Examination of stool samples may be negative in
extraintestinal amebiasis
▸ Newer diagnostic approaches: fecal antigen,PCR, DNA
probeeither a pathogenic
DIAGNOSIS

▸ Laboratory diagnosis:
 In intestinal amoebiasis:
• Examination of a fresh dysenteric faecal specimen or rectal
scraping for trophozoite stage. (Motile amoebae
containing red cells are diagnostic of amoebic dysentery).
• Examination of formed or semiformed faeces for cyst stage.
(Cysts indicate infection with either a pathogenic
E.histolytica or non-pathogenic E.dispar.)
DIAGNOSIS
▸ Extraintestinal amoebiasis:
•Diagnosed by the use of scanning procedures for liver
and other organs.
•Specific serologic tests, together with microscopic
examination of the abscess material, can confirm the
diagnosis
TREATMENT

▸ Acute amebiasis is treated with metrondiazole followed


by iodoquinol
▸ asymptomatic carriage can be eradicated with iodoquinol,
diloxanide furoate or paramomycin
▸ The cysticidal agents are commonly recommended for
asymptomatic carriers who handle food for public use.
▸ Metronidazole, chloroquine, and diloxanide furoate can
be used for the treatment of extraintestinal amoebiasis.
CONTROL

▸ Sanitary sewage disposal.


▸ Protection and treatment of water supplies.
▸ Personal hygiene and hand-washing before preparing food and
eating.
▸ Eliminate fertilization of crops with human fecal material.
▸ Control flies around foods.
▸ Avoid raw vegetables when in endemic areas.
▸ Boil water or treat with iodine tablets.
Non-pathogenic Amoebae
▸ These non-pathogenic species are very similar morphologicaly so
can be confused with the potentially pathogenic  E. histolytica and
result in unnecessary drug treatment.
▸ In addition, such a misdiagnosis is also problematic in that the true
cause of the symptoms may be missed and the appropriate
treatment will be delayed.
▸ Entamoeba dispar  a non-pathogenic is indistinguishable by
microscopy and is a much more common intestinal protozoan than
Entamoeba histolytica.
▸ Antigen capture and PCR tests can distinguish E. dispar from E.
histolytica in heavier infections
Facultative Amoebae
Naegleria fowleri

▸ is a facultative amebae are normal inhabitants of


soil and water where they feed on bacteria.
▸ A few members have the ability to become
parasitic when an opportunity to enter a vertebrate
exists.
▸ They can infect humans and cause fatal disease.
Naegleria fowleri
▸ The parasite enter the nasal passages when a victim swims or dives into
freshwater.
▸ After entering the nose and nasal cavities, the trophozoites migrate to the
brain
▸ Ameboid trophozoites multiply rapidly by binary fission in the brain and
cause brain damage
▸ Symptoms include a headache, fever, neck rigidity, and mental confusion
followed by coma and death
▸ Disease is so rare and the brain tissue destruction is so rapid that
diagnosis is seldom made in time
Acanthamoeba

▸ Common inhabitants of natural waterways as well as artificial water


systems

▸ Contact lenses wearers who use tap water to wash their lenses can
become infected
▹ Infection occurs through cuts or scrapes, the conjunctiva, or through
inhalation
▹ Acanthamoeba keratitis results from conjunctival inoculation
▹ Amebic encephalitis is the more common disease
Acanthamoeba & Naegleria
▸ Naegleria disease
▹ Infection occurs when swimmers inhale
contaminated water
▹ Amoebic meningoencephalitis results when
trophozoites migrate to the brain
▸ Prevention is difficult because these organisms are
environmentally hardy
THANK YOU

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