Other intestinal protozoa

Balantidium coli Cryptosporidium parvum Isospora belli

Balantidium coli

Primarily a zoonotic intestinal parasite: Horses, cows, pigs Farm workers at risk Symptoms similar to amebiasis except, No abscesses in peripheral organs

Balantidium coli
morphology

Balantidium is the largest protozoan and only ciliate known to parasitize humans

Balantidium coli
life cycle

Contracted by consumption of material contaminated with feces of some farm animals. Cyst is the infective stage Trophozoites reside in the lumen of large intestine where they divide by transverse binary fission. Encystation is triggered by dehydration of intestinal content, it may also occur outside of the host.

Balantidium coli
Diagnosis
History, symptoms and finding the typical trophozoites and cysts in the stool

Prevention and treatment

Balantidium coli

Prevention

Treatment Tetracycline Iodoquinol Metronidazole

Avoid ingestion of material contaminated with animal feces

Cryptosporidium parvum
Major cause of epidemic diarrhea Animal reservoir (domestic animals) Severe diarrhea and invasive infection in AIDS patients
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Cryptosporidium parvum

Cryptosporidium is typically a acute short term infection. The parasite is transmitted by oocysts that, once infected, excyst in the small intestine.
The trophozoites (5 mm in diameter) multiply by sexual reproduction.

Cryptosporidium parvum
Treatment and control

Self limiting in normal individuals

Severe and prolonged disease in AIDS patients Nitazoxanide Proper sanitation and clean water supply

Isospora belli

I. Belli is a protozoan of cosmopolitan distribution occurring especially in warm region of the world. II. It multiplies both sexually and asexually

Microscopic demonstration of the oocysts with one sporocyst. Oocysts are thin walled transparent and ovoid in shape 10

Isospora belli

Causes giardiasis-like but milder symptoms

Self limiting in normal individuals Severe and prolonged disease in AIDS patients

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Isospora belli

Diagnostic stage of I. Belli in fresh stool oocyst with 1 sporocysts

Treatment: Trimethoprim Sulphamethoxazole

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Trichomonas vaginalis
morphology

Trichomoniasis: one of the most widespread sexually transmitted disease world wide Human parasite only World-wide 5% in normal population 70% among prostitutes

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Trichomonas vaginalis
Symptoms

Male
Rarely symptomatic Occasionally mild urethritis and/or prostatitis

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Trichomonas vaginalis
Symptoms Women
Often asymptomatic Mild to severe vaginitis in heavy infections Copious fowl-smelling yellow discharge Growth of the organism favored by high pH: >5.9 (N=3.5-4.5)
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Trichomonas vaginalis
Diagnosis

Giemsa stained T. vaginalis (vaginal swab) 16

Trichomonas vaginalis diagnosis

Fresh vaginal swab sample examined under the microscope showing one trophozoite
There is no cyst in the life cycle, transmission is via trophozoite stage

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Trichomonas vaginalis
Diagnosis

T. hominis

T. vaginalis 18

Trichomonas vaginalis
Prevention Treatment
Prevention:
Personal hygiene Condom use

Treatment
(decreases pH)
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Metronidazole Vinegar douche

Metronidazole: Mechanism of action-

Metronidazole is nitroimidazole compound Pfizer markets the drug under the trade name Flagyl Metronidazole is a prodrug. The nitro group of the compound is reduced by ferredoxin and the resulting products are responsible for disrupting the DNA helical structure which leads to inhibition of nucleic acid synthesis

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Trimethoprim: Mechanism of action-

Trimethoprim belongs to chemotherapeutic agents known as dihydrofolate reductase inhibitors Trimethoprim acts by interfering with the action of dihydrofolate reductase enzyme which prevents formation of tetrahydrofolic acid Tetrahydrofolic acid is required to synthesize thymidine (component of DNA). Therefore, inhibition of the enzyme prevents replication of DNA

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Sulfamethoxazole: Mechanism of action-

Sulfamethoxazole is a sulfonamide. It is most often used as part of a synergistic combination with trimethoprim Sulfonamides are structural analogs of paraaminobenzoic acid (PABA) They inhibit normal utilization of PABA for the synthesis of folic acid which is an important component of DNA synthesis

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Mechanism of action- continued

Dihydropteroate diphosphate + PABA

Dihydropteroate diphosphate synthetase X sulphonamides

Dihydropteroic acid

Dihydrofolic acid
Dihydrofolate reductase
X trimethoprim

Tetrahydrofolic acid
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Nitazoxanide: mechanism of action

Nitazoxanide: Following oral administration in humans, nitazoxanide is rapidly hydrolyzed to an active metabolite tizoxanide The anti-protozoal activity of tizoxanide is believed to be due to interference with pyruvate-ferredoxin oxidoreductase (PFOR) dependent electron transfer reaction which is essential to anaerobic energy metabolism

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Intestinal & uro-genital protozoa of man: summary

Organism Transmission Symptoms
Entamoeba histolytica

Diagnosis

Treatment

Oro-fecal.

Dysentery with blood and necrotic tissue. Chronic: abscesses

Stool: cysts with GI: Iodoquinol or 1-4 nuclei and/or Metronidazole trophs. Abscess: Metronidazole

Giardia lamblia

Oro-fecal.

Fowl-smelling, bulky diarrhea; blood or necrotic tissue rare.

Stool: typical old Iodoquinol or man giardia Metronidazole. troph and/or cyst.

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Intestinal & uro-genital protozoa of man: summary

Continued organism Transmission
oro-fecal; zoonotic.

symptoms
Same as amebiasis, but no abscesses

diagnosis

Treatment

B. coli

Stool: ciliated trophs and/or cysts

Metronidazole

C. parvum

Oro-fecal zoonotic

Diarrhea; no mucus or blood

Oocyst in stool
Oocysts in stool

Nitazoxanide Sulpha drugs

I. belli
T. vaginalis

Oro-fecal
Sexual

Same as giardiasis
Vaginitis; occasional urethritis/prostatitis

Flagellate in vaginal/ Metronidazole urethral smear

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Blood and tissue protozoa of man

Organism
T. brucei
T. cruzi L. donovani L. tropica

Disease
sleeping sickness Chagas disease visceral leishmaniasis cutaneous leishmaniasis

Epidemiology
Central Africa: 10x106 South/Central America: 20x106 Asia: 10x106 Mediterranean: 5x106

L. Braziliensis and other

mucocutaneous leishmaniasis

South/Central America: 10x106

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Blood and tissue protozoa of man

Organism
P. falciparum, P. ovale, P. vivax, P. malariae

Disease
malaria

Epidemiology
Tropics and subtropics: 200x106 world wide: opportunistic North America and Europe

T. gondii
B. microti

Toxoplamosis babesiosis, anemia

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Trypanosomiasis
African trypanosomiasis (sleeping sickness)
T. brucei, rhodesiense T. brucei gambiense

American trypanosomiasis (Chagas disease)

T. cruzi

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general morphology

Trypanosome

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geographic distribution of T. brucei

African trypanosomiasis

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Trypanosoma brucei
morphological forms

Epimastigote (crithidial form) in the insect Trypomastigote (trypanosomal form) in the mammalian host
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Trypanosoma brucei
life cycle

Tsetse fly
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Symptoms of African trypanosomiasis

Stage
Bite reaction

Organ Involved
Skin

Symptoms
Non pustular (bumps without pus), itchy, painful chancre; no scar

Parasitemia

Blood circulation and lymph nodes

Malaise, lassitude, insomnia, fever, edema, lymphadenopathy

CNS stage

Personality changes, CNS (T. gambiense) Heart (T. rhodesiense) shuffling gait, lack of interest, tremulous speech, mental retardation, sleepiness, cardiac failure.
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Winterbottoms sign

T. Brucei :

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T. Brucei :
coma

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pathology and Immunology Immunology

Pathology

T. Brucei :

Inflammation Antigenic change CNS damage by the organisms

Antibodies are not protective due to antigenic change Polyclonal B cell expansion; Hyper-IgM hypocomplementemia Immunosuppression

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antigenic variation

T. Brucei :

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T. Brucei :
diagnosis

History of travel and fly-bite Symptoms Blood smear and/or CSF

Anionic support concentration Bioassay (mouse) IF

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Prevention and treatment

Prevention
No effective vaccine
(changing VSG)

T. Brucei :

Treatment
Acute disease
Suramin Pentamidine

Tsetse fly control Insect-bite avoidance Suramin or pentamidine

Chronic (CNS) disease

Melarsoprol (arsenic)
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