Protozoa

Causative Agent Life Cycle / Transmission / Signs & Symptoms / Pathology Diagnosis Treatment Prevention & Epidemiology /
Morphology Control Demographics
PROTOZOAN INFECTIONS: INTESTINAL AMOEBAE
Entamoeba MOT: *Oral-fecal, contaminated only member of the family to cause colitis Microscopic detection of Goals: Environmental Worldwide
histolytica water & food & liver abscess cysts & trophozoites on To cure invasive sanitation Prevalent in tropics
Subphylum: Common on day care centers, Amoebiasis stool specimens disease at both Proper waste Risks:
Sarcodina institutions (prisons, mental, home Asymptomatic: cyst passers / cyst Consistency / intestinal & extra- disposal children, pregnant
Superclass: for the aged), use of night soil carrier state (but can infect others) appearance: intestinal sites Safe drinking women & women in
Rhizopoda (vegetables), food & water Symptomatic: trophozoites Cyst (solid) To eliminates the water & food postpartum period
Class: Lobosea handlers, mechanical vectors (flies Diarrhea/dysentery Trophozoites (solid) passage of cysts from Proper food treated with
Order: Amoebida & cockroaches), sexual intimacy Ulceration (intestinal) die within 30 mins to the intestinal lumen handling corticosteroids,
Family: (homosexuals through oral & anal Extraintestinal: liver (common), lungs, 1 hour Hygiene malignancy &
Entamoebidae sex) brain, pericardium (serious case), skin -examine ASAP Cyst passers Avoid night soil malnutrition
Genus: venereal transmission through Virulence Factors: Contamination: urine & Metronidazole for fertilizer
Entamoeba fecal-oral contact lectin for adherence chlorine water may kill Diloxanide furoate Health education
direct colonic inoculation through secretion of proteolytic enzymes the trophozoite Colitis & promotion
contaminated enema equipment release of cytotoxins DFS 2mg stool Metronidazole
contact dependent cytolysis Best method in the Tiridazole
Isoenzymes: Phosphoglucomutase, phagocytosis recovery of trophozoites Liver abscess
hexokinase symbiosis of intestinal bacteria & cysts Tiridazole
Host Factors: Concentration Percutaneous
Cystic Stage: >10 um Nutrition: CHO, cholesterol diet (more techniques drainage of liver
infective stage favourable for colonization) FECT (Formaline Ether abscess
quadrinucleate cyst (1-4 nuclei) Stress Concentration Test) To those who do not
resistant to gastric acidity & Bacterial flora MIFC (Merthiolate respond to
dessication & can survive in a O2 tension (grows at the cecal region) Iodine Formaline metronidazole & for
moist environment for several CM: Concentration Test) prompt treatment of
weeks Diarrhea mucous Zinc Sulfate severe pain
central karyosome bulls eye Dysentery mucous & blood More sensitive than DFS
karyosome Loose bloody stools in the detection of cysts
chromatoidal bodies with Pain & cramps on abdomen Culture
rounded ends (cigar-shaped) Fever, tenesmus, wt loss, nausea, Stained smears
excystation occurs in the SI or LI, anorexia Gold standard
where a cyst undergoes nuclear Intestinal ulcer microscopically
followed by a cytoplasmic division Wide base with bottle neck ulcer H&E, PAS, Trichome
to form 8 trophozoites Deeper ulcer: intestinal perforation staining & Chlokasol
Liver/Amoebic abscess (R lobe usu Blackez Staining (?)
Trophozoite Stage: affected) Charcot Leyden Crystals
pseudopodium-long finger-like ALA (amoebic liver abscess) by-products of IgE
motility R hypochondriac pain, fever, jaundice, Aspirates liver/
cystoplasm with ingested RBCs leucocytosis pulmonary (wet-stained
1 nucleus with central karyosome ESR, alkaline phosphates smears)
Pleuro-pulmonary amoebiasis Serology
Cyst-cytoplasmic division carrying 1 Rupture of liver abscess at the R IHAT (Indirect
nucleus on the distal SI moves to hemidiaphragm, cough, pleuritic pain, Hemagglutination)
the colon with the undigested food dyspnea, chills/fever, leucocytosis IFAT (Indirect
descending colon (dry envt: Pericarditis rupture of the liver abscess Flourescent Atb Test)
trophozoites do not survive) starts at the L lobe. CIE (Counter
to vomit out what ingested pre- Rare. If occurs, serious complication Immunoelectrophoresis)
cystic stage trophozoites passed out Chest pains, CHF-like manifestation Atg detection (Stools):
in stool Brain Amoebiasis hematogenous route ELISA
Cutaneous amoebiasis PCR (Polymerase Chain
Reaction)
 COMMENSAL AMOEBA
Causative Agent Life Cycle / Transmission / Morphology Diagnosis Prevention & Epidemiology /
Control Demographics
Entamoeba coli Cyst: >10 um Stool examination Proper disposal of cosmopolitan in
bigger than the E. hystolitica Liquid to semi-formed stools will show trophozoites human waste distribution
1-8 nuclei Formed stools show cysts Good personal harmless inhabitant
Karyosome off center / eccentric hygiene of the colon
Chromatoidal bars: jagged-ends broomsticks- or needle sticks- DFS OFWs
or slinter- like Demonstrate trophozoites Food handlers

Trophozoites: Concentration techniques

Blunt / rounded & broader pseudopodia ZnSo4 & FECT
Slow motility (sluggish) Recovery of cysts
Thick, irregular, peripheral chromatin
Nucleus: large eccentric karyosome FECT & Iodine stain
No RBC on the cytoplasm but with vacuolated filling or granular To differentiate the species
endoplasm of undigested food, bacteria, etc.
Narrower, less differentiated ectoplasm Swab between gums & teeth
Entamoeba hartmanii Cyst: <10 um (5-10 um) To examine trophozoites for E. gingivalis
quadrinucleated
coarse cytoplasm
Similar to E. hystolitica but is much smaller & does not ingest RBCs
More sluggish in movement

Immature cysts:
Chromatoidal bars-short with tapered ends, or thin & bar-like
Entamoeba dispar Similar to E. hystolitica morphology but DNA & rRNA & isoenzyme
pattern are different
Entamoeba polecki Parasite of pigs & monkeys

Cyst:
Uninucleated
Nuclear membrane & karyosome are very prominent in fecal smears
Entamoeba gingivalis Found in the mouth (gum & teeth surface), gum pockets & tonsillar
crypts

MOT: Kissing, droplet spray or sharing utensils

Trophozoite: 10-20 um
Moves quickly & numerous blunt pseudopodia
Endolimax nana Cyst: 6-10 um in dm
Quadrinucleate when mature

Trophozoite: 6-15 um
Sluggish movement

Nucleus: vesicular, large & irregularly-shaped karyosome anchored to

the nucleus by achromatic fibrils
Iodamoeba butschilii Cyst:
Uninucleated, large glycogen body

Trophozoite: 9-14 um long (6-20 um)

Nucleus: large vesicular with large endosome surrounded by
achromatic granules
 CILIATES (Ciliophora)
Causative Agent Life Cycle / Transmission / Signs & Symptoms / Pathology Diagnosis Treatment Prevention & Epidemiology /
Morphology Control Demographics
Balantidium coli Trophozoite: 30-300 um long & 30- Balantidiasis/Balantidial dysentery Stool exam Tetracycline Proper sanitation Uncommon in
100 um wide Rare infection in man (occupational 90% trophozoites adults & older children Safe water temperate
Nucleus: macronucleus / hazard) 10% cysts (infrequent) CI: children <8 y/o & supply countries
micronucleus Common on pigs pregnant women Protection of Tropics: in
Macronucleus: kidney-shaped, Trophozoite can penetrate & produce DFS & Concentration Iodoquinol food from association with
horse-shoe-shaped necrosis/ulceration at the intestinal techniques Metronidazole contamination pigs
Cytosome: anterior indentation lumen (ulcers irregular, Demonstration of cysts & children Associated with
(mouth) undetermined edges: trophozoites in feces CI: early prenancy poor
Cytopyge: posterior indentation rounded/narrow base & wide environmental
(anus) neck) Culture sanitation
Mucocysts: extrusive organelles, Also invades the appendix Philippines: few &
beneath the cell membrane S/sx: sporadic
Cilia: hair-like projections, spiral, Intermittent diarrhea/constipation /
rolling motio tenesmus
Cyst: Diarrhea (6-15 episodes/day)
Infective Stage Abdominal pains / tenderness / colic
Anorexia, NV, wt loss, weakness
LC: same with Entamoeba Dysentery blood mucoid stools,
MOT: contaminated food & water perforation, haemorrhage & shock
containing cysts Fetid breath
IP: 4-5 days Extraintestinal: peritonitis, UTI,
Ingested cysts excyst in the SI inflammatory vaginitis
become trophozoites inhabit the
lumen, mucosa, & submucosa of the
LI (cecal region) multiply binary
fission pathologic changes in the
intestinal wall & mucosa
Cyst formed as protection for survival
outside the host encyst during
intestinal transport or after
evacuation of semiformed stools
FLAGELLATES (Mastigophora)
Causative Agent Life Cycle / Transmission / Signs & Symptoms / Pathology Diagnosis Treatment Prevention & Epidemiology /
Morphology Control Demographics
Gardia lamblia MOT: ingestion of food contaminated Known to cause epidemic & endemic Stool exam Metronidazole / Proper sanitary Associated with poor
with mature cysts diarrhea Demonstration of Tinidazole disposal of environmental
Other names: Gardiasis/Lambliasis trophozoites & cysts Should not be taken with human excreta sanitation
G. intestinalis, Cyst: 8-12 um long & 7-10 um wide Asymptomatic alcohol to prevent Food handlers
G. duodenalis, Double-walled usually ovoidal Symptomatic Duodenal Aspirate Exam AR: nausea, HA, contamination Increasing
Lamblia Axostyle-running across the Habitat: SI drowsiness, metallic taste of food & prevalence is
duodenalis, cytoplasm Impaired absorption of fat, D- Enter- test (String test) water supply attributed to
L. intestinalis Flagella: retracted into xylose & Vit. B12 May demonstrate Quinacrine Safe drinking homosexual oro-anal
axonemes, the median body & Acute: nausea, lassitude, trophozoites Alternative drug water (Boiling, practices
deeply stained curved fibrils anorexia, diarrhea, abdominal Swallows a gelatin SE: yellow staining of filtration, 2% Outbreaks: water-
surrounded by a tough hyaline distention, weight loss capsule containing a skin, pychosis iodine) borne
cyst wall secreted from condensed Flatus-rotten eggs smell nylon string Risk factors:
cytoplasm (hydrogen sulfite) Poor hygiene
Paired parabasal bodies Chronic: fatty stools (steatorrhea) DFS Poor sanitation
Nucleus-quadrinucleated (mature Trophozoites: floating Overcrowding
cysts); binucleated (young cysts) leaf-like motility Immunodeficiency
Bacterial & fungal
Ag detection test in stools overgrowth in the SI
 Trophozoite: 9-12 um long & 5-15 (ELISA) Homosexual
um wide Monoclonal Atb practices gay bowel
Pear-shaped / pyriform / tear syndrome
drop-shaped Ab dectection:
Axostyle-distinct medial line IFAT/ELISA
Parabasal bodies Direct fluorescent Atb
Curved / convex dorsal (pointed) assays
Concave ventral
Nucleus-binucleated, ovoidal
(one on each side of the midline
Organelle of attachment:
sucking disc (large adhesive disc)
Flagella: 4 pairs, falling leaf-like,
kite-like motion (erratic tumbling-
like motion)
Bilaterally symmetrical organism
Reproduction: longitudinal
binary fission
Found in diarrheic stools

Metabolism:
Glucose (Embden-Meyerhof)
Acetate, ethanol, alanine
Arginine/Alanine participates in
glucose metabolism
Cannot synthesize lipid (host gut)
Trichomonas General morphology of Male: Experimental results: Simultaneous for sexual Associated with
vaginalis Trichomonads: Asymptomatic: self-limiting, less survive in urine 9-20 partners venereal
Pear-shaped persistent hours transmitted
Axostyle: extended beyond the Symptomatic: discharge, pruritus Wash clothL 23 hours Nitro-imidazoles: diseases, STIs,
length of the organism (head of penis), burning sensation of Metronidazole / gonorrhoea (24-
5 Flagella: 4 in the anterior end, urination Specimen: discharge Imidazole 30%)
1 trails along the undulating Microscopy: fresh, Non-venereal:
membrane Female: tumbling/twitching motility virgins,
1 nucleus Asymptomatic: self-limiting, less Staining: Giemsa children/babies,
Cyclostome: less prominent persistent Pap Smear neonatal
Symptomatic: pruritus, vulvo- AO (Aquidine-Orange Worldwide
IP: 4-30 days after exposure vaginitis, vaginal discharge, painful Stain) distribution
Lumen flagellate coitus, vaginal odor Siderophil granules Both sexes affected
Die at 40C (with dessication Cervix-edematous, blisters, Incidence correlates
under sunlight) petechiae, strawberry cervix, Culture: in pouch system with the number of
Largest among trichomonads punctate hemorrhages sexual partners
Do not produce cysts, only Whiff test: 20% KOH, fishy Peak in age groups
trohozoites odor (+) 6-35 y/o
Ovoid nucleus Female:
Undulating membrane: <1/2 of 50-75% prostitutes
the axostyle 7-32% social / VD
Diagnostic feature: siderophil clinics
granules 5% family planning
Associated with: Non-specific clinics
NSV (vaginitis) Higher among post-
NSP (prostatitis) menstrual females
NSU (urethritis)
 INTESTINAL PROTOZOANS
Causative Agent Life Cycle / Transmission / Signs & Symptoms / Pathology Diagnosis Treatment Prevention & Epidemiology /
Morphology Control Demographics
Blastocystis Isolates form chicken, ducks, geese, Often non-specific s/sx Light microscopy (wet Difficult to eradicate Safe water Tropical, subtropical
hominis & sea snakes May include: diarrhea (sometimes mount with or without because they hide in the Environmental & developing
MOT: fecal-oral self-limiting), abdominal pain/cramps staining) intestinal mucus, sticks & sanitation countries
LC: Ingestion of cyst ruptures / discomfort, nausea Vacuolar forms may be holds on to intestinal
Handwashing Adults > children,
vacoular autoinfection Profuse, watery diarrhea destroyed by concentrated membranes
Not conclusively demonstrated Fatigue, anorexia, flatulence & other techniques or addition of DOC: Metronidazole / Prevention of food immunocompro-
4 Morphological Forms: non-specific GIT symptoms distilled water only the Iodoquinol contamination mised patients
Vacuolated or central body: 5- Correlates with: enteritis, terminal cyst Asymptomatic: not Sterilization (?) Incidence in Italy &
10 um in dm ileitis, colitis/ulcerative colitis, Immunologic treatment Cysts survive up China
Diagnostic feature arthritis techniques, Invasive TMP-SMX to 19 days in 40.7% food
Reproductive organelle Large cases present their stools as techniques (?) Trimethroprim- water at normal handlers in Manila
most predominant forms in fecal asymptomatic Sulfamethoxazole (Co-
temperature & tertiary hospitals
specimens Incidental finding/commensal trimoxazole),
Spherical Suggest possibility of asymptomatic Nitazoxamide Resistance to
Large central vacuole pushes the carriers Diet Mgt: diet in fiber, chlorine at the
cytoplasm & nuclei to the Associated with specific forms of B. lactose-free standard
periphery of the cell hominis & the immune status of the concentrations
Amoeba-like forms: patient
Undergoes mitosis
Occasionally observed in stool
samples
Exhibit active extension &
retraction of pseudopodia
Nuclear chromatin: peripheral
clumping
Intermediate stage between the
vacoular & pre-cystic form
Allows the parasite to ingest
bacteria to enhance encystment
Granular forms: 10-60 um
Observed from old cultures
Granular contents develop into
daughter cells of the amoeba
form when the cell ruptures
Multiple fission
Arise from vacuolated forms
Produce many vacuolated forms
Cystic form: 3-55 um
Prominent & thick osmophilic
electron dense wall
Demarcated polymorphic, oval or
circular
Dense body surrounded by a
loose outer membranous layer
Precyst undergoes schizogony
(creation of smaller version of
amoeba in the form of a cyst)
Thick-walled cyst: responsible for
the external transmission
Thin-walled cyst: cause of
reinfection within a hosts intestinal
tract
 FREE-LIVING PATHOGENIC AMOEBA
Causative Agent Life Cycle / Transmission / Signs & Symptoms / Pathology Diagnosis Treatment Prevention & Epidemiology /
Morphology Control Demographics
Naegleria The organism that can exist as an PAM (Primary Amoebic CSF exam of trophozoites Amphotecirin B: IV & Chlorination of 1965,
fowleri amoeba (trophozoite form) & as a Meningoencephalitis) Phase contrast of Giemsa intrathecal swimming pools meningoencepha-
flagellate (swimming form) Rare disease that leads to or Wright stain centrally May be combined with litis
MOT: swimming/inhaling inflammation of the brain & placed nucleus miconazole & rifampicin Isolated in soil &
contaminated water destruction of brain tissue PCR Assay: identifies N. freshwater, nasal
Portal of Entry: olfactory epithelium rapid onset of symptoms (24 hrs to fowleri DNA on the brain passages & throat
Habitat: Soil source of 02, water, 5-7 days) tissue samples of healthy
temperatures compatible with Early sx: HA, nuchal rigidity, NV, ELISA individual
survival & bacterial food supply restlessness Chlorinated
Late sx: photophobia, lethargy, swimming pools,
Cyst form: seizures, confusion, coma, diplopia freshwater lakes,
Double-thin walled, resistant CSF: pressure, gray to yellow- thermal springs,
Flagellate form: white, with RBCs & WBCs (PMNs) domestic water
Temporary, PP: lesions- base orbitofrontal & supplies, thermally
Trophozoite stage: temporal lobes polluted water,
Infective stage Brain affected filled with sewage, soil, air,
Free-living form fibrinopurulent exudate humidifier systems,
Can transform reversibly into a Large numbers of amoebic cell cultures
non-reproductive flagellate stage or trophozoites (no cysts) seen within Children & young
a resistant cyst edematous & necrotic neural tissue adults
Acanthamoeba Trophozoite stage: GAE (Granulomatous Amoebic Cranial CT Scan: large low- 5-flurocystosine, Precaution on use 1913
spp. Infective / vegetative / active Encephalitis) density lesions ketoconazole, of contact lenses Ubiquitous
feeding stage HA, stiff neck Cranial MRI: multiple ring- itraconazole, & hot-tub Jacuzzi, (everywhere) &
Reproduction: binary fission Cerebral hemisphere mostly affected enhancing lesions pentaminide, or etc. worldwide
fine, tapering, thorn-like (spiny) Edematous with extensive Histology: amoebic amphotericin B Found in soil, fresh
locomotion: acanthopodia that hemorrhagic necrosis trophozoites & brackish water
arises from the surface of the Cornea (Amoebic Keratitis): Keratitis: cotrimoxazole in
body trauma to cornea or contact lenses combnation with
moves sluggishly with pentamidinem, isethionate &
polydirectional movement Neosporin & avoidance of
uninucleated large with a centrally topical CS
located dense staining nucleus
large endosome, finely granulated
cytoplasm, large contractile
vacuole
host for Legionella spp.
Cyst stage:
Dormant, resistant
PAS: encysts containing cellulose
Double walled (ectocyst &
endocyst): outer wrinkled wall &
inner polygonal-shaped wall
Pores or ostioles: seen at the
point of contact of the 2 walls
*both are diagnostic stages

MOT: nasopharyngeal route through

breaks in the skin & inhalation
Isolated from air, bottled mineral
waterm soil, swimming pools, deep
well water, contact lens cleaning
solutions, etc.
 COCCIDIANS (Parasites & the Immunocompromised)
Causative Agent Life Cycle / Transmission / Signs & Symptoms / Pathology Diagnosis Treatment Prevention & Epidemiology /
Morphology Control Demographics
Cryptosporidium Exists primarily as oocyst Immunocompetent: Immunoflourence Nitazoxamide: initially Immunocompromis Worldwide
hominis Ingestion of water containing asymptomatic-diarrhea (1-3 weeks); microscopy used for tapeworms ed - handwashing Associated with
C. parvum sporulated cyst (infective stage) carrier state Usually of stools MOA: prevent anaerobic Practice safer sex AIDS
embryonated egg stage-like Immunocompromised: Visualize oocyts metabolism via inhibition (cryptosporidium Not uncommon in
Excystation happens in the SI, CD4 count of <200 Has higher sensitivity & of pyruvate ferredoxin can be 1st world countries
lungs releasing sporozoites Diarrhea, fever, NV, signs of specificity oxidoreductase (PFOR) transferred thru Outbreak in
Parasitism: invasion of epithelial dehydration, electrolyte imbalance Can Paramomycin - oro-anal sex, csyt Milwaukee, 1993
cells of SI (habitat) forming aminoglycoside stick on the inner Waterborne
trophozoites thigh, anus, diseases
Reproduction: knees of the Seen in recreational
Asexual produce schizonts & patient when water facilities,
merozoites (goes out, invade touching those contaminated
the epithelial cells & undergo parts) drinking water
another LC) Avoid touching (ground / bottled
Sexual microgametes (male) farm animals water),
macrogametes (female) (reservoir host) contaminated
Sporulation: produce sporulated Avoid touching undercooked food
oocysts stools of pets
Thin-walled cysts-capable of Avoid swallowing
autoinfection; remains in the water when
body; d/c if goes out (no swimming
support) (chlorine
Thick-walled cysts-goes out of resistance
the body Cryptoporidium)
Wash/cook food
properly
Drink safe water
Rolling boil for 1
min
Clean ice trays,
jars with soap
(spores tend to
stay there)
Water fillers:
reverse osmosis,
absolute 1
micron, standard
53, cyst reduction
removal
Cyclospora Unicellular coccidian Immunocompetent/ Microscopy TMP-SMX Handwashing Tropical &
cayetanensis Larger than cryptosporidian Immunocompromised: Usually of stools 2 synergistic drugs Wash / cook food subtropical
Exists as oocysts Severe diarrhea (10-12 weeks) Visualize oocysts Inhibits tetrahydrofolate properly All age groups at
Carrier state (?) controversial intermittently synthesis (needed for Drink safe water risk
LC: same ingestion, excystation, Anorexia, wt loss, low grade fever, Techniques used: DNA replication & Sanitation
reproduction abdominal pain Wet mount with UV transcription) Health education
Release: produce unsporulated fluorescence of DIC MOA: PABA analogues
oocyts which exists the host FECT used to collect
Sporulation: outside environtment minute amount of
T: 22-32C diarrheic stool
Modified Acid Fast /
No autoinfection
Safranin Test
Cystoisospora Unicellular coccidian Severe diarrhea of weeks Microscopy TMP-SMX Handwashing Tropical &
belli Exists as oocysts Anorexia, wt loss, low-grade fever, Usually of stools 2 synergistic drugs Wash / cook food subtropical
Other name: Least common among the three malabsorption, crampy abdominal Visualize oocysts Inhibits tetrahydrofolate properly Risk
Isospora belli Large ellipsoidal oocyst pain & Eosinophilia intermittently synthesis (needed for Drink safe water immunocompro-
(elongated) rice grain-, eyes-, Techniques used: DNA replication & Sanitation mised
cigar-shaped Wet mount with UV transcription) Health education Common in
fluorescence of DIC MOA: PABA analogues institutions
LC: same ingestion, excystation, FECT used to collect Affects humans &
reproduction minute amount of animals
Release: produce unsporulated diarrheic stool
oocyts which exists the host Modified Acid Fast /
Sporulation: outside environtment Safranin Test
Oocyst contain sporoblast Duodenal biopsy
mature to oocyst containing isospora tend to invade in
sporozoites the deep epithelial cells of
Less virulent than cyclospora SI causing eosinophilia
(other 2 organisms
superficial only)
String test (Enterotest)

Toxoplasma Tachyzoites (trophozoites) Immunocompetent Observation of various Pyrimethamine- Pregnant women One of the most
gondii Most common form seen on None, self-limiting, mild cases specimen Sulfadiazine (1 line) Gloves when common human
samples 10-20% develop flu-like illnesses Blood (routine method for 2 synergistic drugs handling soil infections
Pear-shaped Rarely, may develop chorioretinitis Dx) Inhibits tetrahydrofolate Avoid eating raw Worldwide
Mobile form, bends/curves Bronchioalveolar lavage synthesis (for DNA meat prevalence: 20-
sometimes Immunocompromised LN biopsy replication & Wash utensils & 75% (3 out of 4)
Oocyts: 10-13 um by 9-11 um HA, confusion, seizures (neurologic Other body fluids transcription) food Philippines:
Round / ovoid, thin wall sxs) Amniocentesis MOA: PABA analogues Dont drink around >25%
HIV pts: Neurologic Toxoplasmosis unpasteurized US: 60M (15% of
Definitive host: Cats (Felidae) Most common CNS mass lesion Other Methods: Special cases: milk female in
Intestinal epithelium: merozoites Occurs when CD4 <100 PCR, ELISA Ocular toxoplasmosis Cover childrens childbearing age)
multiply (schizogony) differentiation Tumor-like CNS s/sx Fundoscopy/Retinal TMP-SMX (alternative) sandboxes France: eating
into micro/ macrogametocytes
Death may occur: thru brain exam calcifications in CS (inflammation of Avoid cats undercooked meat
(gametogony)
herniations the retina retina) Central America:
Inside the mature oocyst, 2 sporocyst
(each having 4 sphorozoites) MRI encephalitis Pregnant women Cat lovers stray cats
Excretes unsporulated oocyst (no Congenital Toxoplasmosis UTZ for pregnant not routinely given Keep cats indoors Risks:
autoinfection) BW, hepatospleenomegaly, women because it is highly Dont feed cats Can be transmitted
Then eaten up by rats/mice jaundice, MR, hearing loss, teratogenic with raw meats from pregnant
Intermediate host: Rats / mice chorioretinitis (80%) may not be given during Dont adopt stray mother to the
Tachyzoites: fast-moving can be latent CM which you can organogenesis cats/kittens unborn child
trophozoite, able to feed acquire congenitally spiramycin Clean litter boxes (congenital
themselves (Macrolide) prevent properly toxoplasmosis)
Reside in neural tissues & muscular protein synthesis Change litter box Immunocompro-
tissues everyday mised pts
Then become tissue cysts Clean with
bradyzoites (both infective stage) scalding water
then ingested by the DH (oocyst resistant
Humans to soap)
MOT: food/drinks, litter boxes, Wear gloves
farm animals, organ Handwashing
transplantation, blood donation, after
transplacental/*vertical
transmission
Organs affected: brain, muscles,
eyes, heart
 PLASMODIUM Spp.
Causative Agent Life Cycle / Transmission / Signs & Symptoms / Pathology Diagnosis Treatment Prevention & Epidemiology /
Morphology Control Demographics
Plasmodium MOT: bite of female anopheles mosquito Pathology: r/o place travelled & P. falcifarum Control & Global Burden:
spp. Blood transfusion P. falcifarum blood smears Chloroquine (CQ) Prevention 109 endemic countries
P. falcifarum Sharing of IV needles Adherence to infected RBC to non- & Pyrimethamine Chemotherapy: & territories worldwide
P. vivax Transplacental: transmission upon birth infected RBC leading to rosette Clinical Diagnosis: Resistant to CQ if early diagnosis & 3.3 B at risk
P. ovale Neonatal malaria formation tissue anoxia Semi-immune: only HA given alone treatment Morbidity: approx. 247B
P. malariae Mother seems to be asymptomatic Cytoadherance infected RBC become Severe malaria: P. Long lasting annually
P. knowlesi sticky on the surface & walls of the falcifarum Uncomplicated P. insecticidal nets Mortality: approx. 1M
(DOH, 2009) Walking malaria carriers, endothelium diminishing the calibre Confusion, coma, falcifarum (LLIN) even upto deaths annually
asymptomatic Process results in: formation of red neurologic focal 1st line drug 5 years of use 91% Africa
Immunity on their RBCs cell aggregates & intravascular signs, severe anemia, combination Indoor residual 85% children (<5y/o)
Suppliers of malaria sequestration of RBCs that respiratory difficulties (Coartem) spraying (IRS)
You can find them thru Mass blood contain mature forms of the parasite Lab. Finding: because Artersiminins Vaccines MDG (Millennium
smear in vital organs (brain & heart) early clinical diagnosis (Artenether, Development Goals #6)
is not typical Artenusate, Malaria Control Goals for global
Mosquito Stage: P. vivax, P. malariae, P. ovale Dihydrocoteminin) reduce the impact importance
Sexual stage No sequestration Microscopy: + Lumetantrine not elimination To M/M
Sporogony P. vivax reticulocytes Thick & thin peripheral treat malaria cases Malaria has global
Mosquito infected with gametocytes P. malariae old RBCs blood smears P. vivax properly importance
(micro/macrogametocytes) female Quality of reagents CQ prevention: vector
only bites zygote ookinete Classis s/sx of Malaria: (early destroyed) control Top 5 Provinces:
oocyst containing sporozoites Triad: chills fever sweating Microscopy & Severe Malaria Prevent disease: Palawan, Isabela,
(infective stage) migrate in the HA, muscle pains experience of IV quinine & administration of Cagayan, Tawi-Tawi
salivary glands blood meal Merozoites: hypothalamus T microscopists quinidine anti-malarial drugs
causing chills fever sweating experience Pregnant: IV then IBT (Intermittent B Malaria free 22
Asexual Stage: Human Can mimic flu Standard Exam: oral Treatment) for provinces: all Visayas
Human Liver Stage: 1st: thick film 100 pregnant & children except Negros & Antique
Sporozoites liver (exoerythrocytic Severe Complications: microscopic fields, Gametocytes & Catanduanes,
schizoint) schizogony Cerebral malaria tissue anoxia magnification of 600 Hypnozoites Activities for Sorgogon, Samar,
trophozoite schizoint (containing (causes death), kidney failure to 700x Primaquine Malaria Control Leyte, Bohol, Cebu,
merozoites) liver cell ruptures end Advantages: simple, Health education Masbate, Mariduque,
up in RBC Uncomplicated Malaria: low cost, quality & Prophylaxis (IEC- Information Capiz, Aklan, Benguet
P. vivax & P. ovale: stops/sleeps in Classical malaria- attack last 6-10 quantity diagnosis Doxycycline Education
liver cells called hypnozoites stage hours Sensitivity of Communication) Control phase in the
Dormant stage Tertian: P. falcifarum, P. vivax, P. peripheral Philippines
Responsible for relapse of malaria ovale (every 2nd day) microscopists: 55% Barriers for Malaria Malaria not included in
Quartan: P. malariae (every 3rd Disadvantages: Control: 10 leading cause of
Human Blood Stage: day) labor intensive Drug resistant morbidity
Multiplication (doubling/ tripling) Insecticide resistant Indigenous cases
Erythrocytic schizony merozoites Severe/Complicated Malaria: Serologic Tests: Imported cases
trophozoites schizont Occurs to most persons who have to IFAT Ensuring Quality:
Specialized feature: gametocytes immunity to malaria RDT (Rapid Diagnostic Quality assurance Malariometric Indices:
(reproduction) process called Young children & pregnant women Test) TES (Therapeutic Slide Positivity Ratio:
gametogony Lateral flow Efficacy
P. falcifarum & P. vivax immunochromatogra Surveillance)
Malaria parasites: Recrudescence: no clearing phic assay Bioassay &
P. falcifarum & P. vivax most Submicroscopic threshold Test strips (dipsticks) susceptibility test Annual Parasite
infections worldwide Short term relapse (hours to days to Molecular Diagnosis monitoring for Incidence:
P. vivax & P. ovale dormant liver few weeks) PCR effective insecticides
stage (hypnozoites), can reactivate for LLIN & IRS
(relapse) & cause malaria for several P. vivax (parasites cleared) & P.
months to years after the infecting ovale
mosquito bite Parasitic relapse
 P. malaria long-lasting infections if
left untreated can persist
asymptomatically in the human host for
years & even lifetime; longest IP
P. falcifarum severe potentially fatal
malaria
Estimated 700,000-2,7M deaths
annually, most are children dying in
Africa
Frequent occurrence in the
Philippines (60-70%)
P. knowlesi monkey-type
(primates); thought it is P. malariae

Female Anopheles Mosquito

Of 430 known species of anopheles,
30-40 transmit malaria in nature
Developmental factors:
Ambient T & humidity
Higher T accelerate the parasite
growth in the mosquito
Whether the anopheles survives long
enough to allow the parasite to
complete its cycle
Anthropragic (human)
Rain-dependent (beginning & end of
the rainy season)
Behavior: partially exophilic &
exophagic

Breeding Sites:
Likes dark clothing
Bites at night
Slow-flowing, partly shaded stream
Shallow collections of fresh water like
puddles, ricefields & hoofprints