THE APICOMPLEXA (Sporozoa)

Intestinal Coccidia/Sporozoa in Human

Genera:
1. Cryptosporidium
2. Isospora
3. Sarcocystis
4. Cyclospora

= these parasites demonstrate the classic

sporozoan
alteration of asexual (schizogonic) and sexual
(sporogonic) life cycle
 Cryptosporidium

Specie:

Cryptosporidium parvum
= only specie recognized recently to cause
human
disease
= considered as natural parasite of animal
causing
diarrheal diseases
= infect variety of mammals, birds and
reptiles
= cosmopolitan in distribution
= first reported case in Philippines (1985)
Morphology:

= oocyst round or slightly oval-shaped, 4 –

6um
enclosing 4 spindle–shaped sporozoites
= no sporocyst
= found both in formed/watery stool
= highly resistant to chemicals used to treat
drinking
water (filtration important in water
treatment)
 Disease: Cryptosporidiosis

= self – limiting diarrhea seen in healthy people

= among immunocompromised individual (AIDS
patient)
chronic persistent diarrhea with abdominal
pain,
fever, anorexia are commonly seen and can
be
life-threatening
= human infection usually waterborne and are
acquired
by fecal-oral route
= highest prevalence of disease in areas with
unreliable water and food sanitation
= extraintestinal infection of the respiratory tract,
L. C.: (both asexual & sexual development occurs in
single host)
Asexual:
ingestion of oocyst → intestine → release of
sporozoite
from contaminated
food and water with
feces of man/animal invade the GIT
microvilli

developed into tropozoite

schizont (each mature

contains)
8 merozoite
merozoite start with
another schizogonic cycle schizogony
Sexual: = Gametogenesis and Fertilization of male and
female
gametocytes → zygote → development of
oocyst
→ sporogony → 4 sporozoites with in oocyst
→
passed out in feces

Pathogenesis:
= development of the parasite usually occurs in
the brush
border of the epithelial cell of the intestine
= intestinal biopsy of the ileum and jejunum
reveals
mucosal changes like:
1. atropy of villous
2. lengthening of the crypt and flattening of
 Diagnosis:
1) Direct exam. of fresh fecal specimen to
demonstrate oocyst
2) Microscopy – Modified Acidfast staining
demonstrating the oocyst (red
color) in feces,
doudenal aspirates and doudenal biopsy
3) Sheater Sugar Floatation Technique/
Zinc Sulfate Centrifugal Floatation
Technique

Treatment: None - Supportive (Self – limiting)

Prevention:
= Environmental and Personal Hygiene
= boiling drinking water for 1-3 minutes
= filter drinking water with device that can
 Isospora

Specie: Isospora belli

= intracellular parasite parasitic to human

= once considered a rare parasite
(very similar to Cryptosporidium)

Geog. Dist: Cosmopolitan

= often seen in warm region of the world
especially
N. America, Africa, Southeast Asia, rare –
U.S.
Morphology:
= immature oocyst elongate/ovoidal-shape
with
moderate constriction in one end giving
a
charac. “bottle with short neck”
appearance
= contains spherical mass of protoplasm which
divides to form sporoblast
= cyst wall smooth, thin, colorless
= mature oocyst contains 2 sporocyst and
each
contains 4 cresent-shaped sporozoites
Disease: Isosporosis/Intestinal coccidiosis
= infection often symptomatic and self-limiting
= charac. by mild gastrointestinal distress with
fever
colicky abdominal pain, severe diarrhea,
steatorrhea (fatty stool) and weight loss.
= predominantly and infection seen most often in
patient with AIDS
= transmitted fecally in contaminated food and
drink
with oocyst

Pathogenesis:
= jejunal biopsy reveals: villous atrophy in the
intestinal
mucosa associated with malabsorption
Lab. Diagnosis:
1) Demonstration of oocyst in feces by
Formalin – Ether Conc.Technique
(Unstained or Iodine stained)
2) Modified Acidfast staining of fecal material
3) Sheater Sugar Floatation Tech.
= most sensitive and accurate method to
detect Isospora in feces
4) Duodenal string test (Enterotest)

Treatment: = Combination of Sulfadiazine +

Pyrimethamine
(very effective)
= Combiantion of Cotrimoxazole (Trimethroprim)
+ Sulfamethoxazole (alternate drug)

Prevention:
 Genus Sarcocystis

Speices: S. hominis
S. Suihominis
S. lindemani
= parasite of human and domestic animals:
cattle, swine, sheep

Geog. Dist.: Cosmopolitan

Morphology:
= oocyst broadly oval or fusiform body with pointed
ends
= contains 2 large sporocyst (rainy corpuscles)
inside
tubular mass (Meischer tube) filled up with
4 mature cresent-shaped sporozoites
= banana-shape sporocyst with subspherical
 Disease: Sarcocystosis

= disease uncommon and rare in human

= generally does not produced clinical symptoms
= considered as zoonotic
= domestic animals are intermediate host of the
parasite
that pick up infective oocyst while grazing on
grasses contaminated with human excreta
= human infection are acquired through ingestion
of
uncooked meat (beef, pork, lamb) or
contaminated
food and drink containing the infective
sarcocyst
= clinical manifestation ncludes:
diarrhea, nausea, vomiting, abdominal pain
Lab. Diagnosis:
1. Demonstration of oocyst in feces/duodenal
aspirate
2. Biopsy of tissue of small intestine or colon
demonstrate Meischer tube

Treatment:
= None for tissue infection (Supportive – self-
limiting)
= For intestinal infection:
Trimethoprim + Sulfamethoxazole
Pyrimethamine + Sulfadiazine (alternate
drug)

Prevention:
= Avoid contact with infected animal host
= Adequate cooking of all meat
 Cyclospora

Specie: C. cayetanensis

= one of the medically important parasite

recognized today
= infect wide range of vertebrates including
reptiles, insect
and rodents
= established to cause human diarrhea in 1990
= 1st infection in human was diagnosed in 1977
= associated with cases of prolonged watery
diarrhea
 Morphology:
= unsporulated oocyst spherical-shaped 8-10um
dia.
with greenish central morula containing
membrane bound refractile granules,
sporulation requires 5 - 10 days
= sporulated/mature oocysts contains 2 sporocyst
4um dia, each with 2 cresent-shaped
sporozoite
= under UV illumination cyclospora appears
autofluoresce
Sporozoit Sporocyts
e (bluish green circles)
(Cryptosporidium & Isospora do not fluoresce under
UV light)
Disease: Cyclosporiasis

= clinically indistinguishable from cryptosporidiosis

and
isosporiasis
= charac. by a self-limiting persistent watery
diarrhea
that tends to recur in a relapsing pattern and
last
for 3-4 weeks followed by steatorrhoea
= associated with abdominal cramps, nausea,
vomiting,
low grade fever, weight loss & anorexia
= incubation is 2 - 11 days
Cyclospora cayetanensis (oocyst)
 Pathogenesis:
= infection typically is confined to the jejunum
= tissue biopsy of the jejunum reveals:
inflammatory changes with villous atrophy
and
hyperplasia of the jejunal tissue

Epidemiology:
= first case of cyclospora infection was reported in
Papua New Guinea (1979)
= subsequent cases has been reported from most
part of
the world
= infection caused by cyclospora is acquired by
drinking
water from contaminated water tank
= outbreak of the disease occurs in Chicago U.S.A.
Lab. Diagnosis:
1. Microscopic identification of oocyst in fecal
specimen
= demonstrate unsporulated oocyst with
greenish central morula containing
6-9 refractile globules
2. Formalin - Ether Concentration technique
3. Modified Acidfast staining
4. Autofluorescence test

Treatment:
Combination of Trimethoprim and
Sulfamethoxazole