OPPORTUNISTIC PROTOZOANS

MICRO 20 / PROF. ??? / SEPTEMBER 18, 2019

1st SEMESTER – 2ND YEAR | COLLEGE OF NURSING 2022

CRYPTOSPORIDIUM SPP.

´ Protozoan of man and animals

o A coccidian parasite
o Microscopic, spore-forming, single-celled obligate intracellular
protozoan
´ Formerly considered non-pathogenic until it was found to occur in patients
with HIV/AIDS
o Opportunistic, causes infection with immunocompromised individuals
´ Responsible for outbreaks of waterborne diarrhea in communities and
diarrhea among travelers and children
´ Found in the microvilli, part of mucosal cells responsible in absorption
´ Sporozoans
o Enterocyte is the target cell
o Intracellular location (variable)
o Spores/oocysts are shed
o Autoinfection in some cases
´ C. parvum
o 1-3% in Europe/America
o 5-10 in Asia and Africa
o 32 to 58% with antibodies even in low prevalence areas
o Prevalence in the Philippines
§ PGH – 1-5%
§ San Lazaro – high

L IFE CYCLE
´ Alternation of sexual and asexual
multiplication
o Sexual cycle or sporogony à produces
oocysts
o Asexual cycle or schizogony à
produces schizonts à merogony
(rupture of the schizonts) à
merozoites
o Gametogony à development of male
(micro) and female (macro)
gametocytes
´ All stages are completed in the intestinal
tract of the host

STAGES
´ Oocyst
o Infective stage
o Ovoid or spherical
o 3-6 micra
o Contains 4 naked sporozoites – real
infective stage
o Stained with acid-fast as well
o Found in feces
´ After ingestion, oocyst excysts and
releases 4 sporozoites, penetrate the
enterocyte
´ The sporozoites develop into trophozoites
(intracellular but extra-cytoplasmic)
´ Trophozoites multiply by
schizogony/merogony to produce
merozoites yet again

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OPPORTUNISTIC PROTOZOANS
MICRO 20 / PROF. ??? / SEPTEMBER 18, 2019

1st SEMESTER – 2ND YEAR | COLLEGE OF NURSING 2022

´ Merozoites either invade other enterocytes or undergo sexual reproduction (through the fertilization of the
macrogametocyte by the microgametocyte), forming oocysts
´ Oocyst
o Thin-walled oocysts (20%) cause autoinfection
§ Responsible for the chronicity of the infection among the immunocompromised
o Thick walled oocysts (80%) are excreted in feces
§ Spread into the environment and contaminate water, infect other individuals and animals

SUMMARY
Oocyst (ingested by
host)

Sexual Oocyst excysts and

reproduction, release 4
produce oocyst sporozoites

Development of Sporozoites develop

gametocytes to trophozotes

Trophozoites
undergo merogony
or merogony

TR ANSMISSION
´ Person to person
´ Animal to humans or vice versa
´ Human and animal fecal contamination of the environment
PA THOGENESIS
´ Cholera-like jejunal secretory state or hypersecretion of fluid and electrolytes
o Rice, cloudy, watery stool
o Clinical presentation of AIDS patients, those receiving immunosuppressive drugs and those with
hypogammaglobulinemia
´ In chronic cases: diarrhea is remitting and relapsing
´ In immunocompetent: infection asymptomatic, mild and self-limiting
´ Other organs affected include gall bladder, biliary tree, etc.
o May lead to cholecystitis
o Varying degrees of malabsorption
D IAGNOSIS
´ Microscopic identification of stained oocysts (Auramine, modified Ziehl-Neelsen or Kinyoun acid fast staining)
o Oocysts show as round, red bodies against a green background
´ Immunofluorescence using MAbs to oocysts
E PIDEMIOLOGY
´ Higher prevalence in children (may be due to play habits)
´ Generally lower prevalence in adults
T RE ATMENT, PREVENTION, AND CONTROL

´ Spiramycin – only drug that showed some efficacy

o Make sure that patients are compliant
´ F&E replacement with oral rehydration solutions or IV fluids
´ At risk people (immunocompromised) should boil all drinking water and avoid swimming in public water

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OPPORTUNISTIC PROTOZOANS
MICRO 20 / PROF. ??? / SEPTEMBER 18, 2019

1st SEMESTER – 2ND YEAR | COLLEGE OF NURSING 2022

TOXOPLASMA GONDI

´ Parasite of cats
o Definitive host, infect other animals and humans with oocyst stage
excreted in fecal matter
H UMAN INFECTION
´ Oocyst – excreted in feline fecal matter
o Contains two sporocysts, each containing 4 sporozoites
o Food, like vegetables, can be infected
´ Tissue cysts – from meat
o Undercooked, raw meat
´ Both transform into tachyzoites after ingestion, which then localize in neural
and muscle tissue à tissue cyst bradyzoites
o If pregnant, fetus can be infected with tachyzoites via bloodstream
(congenital transmission)
´ Infected human cells
o Macrophages
o Tissue cysts – may contain up to 3000 bradyzoites
§ Wall is a combination of host and parasitic components
PA THOLOGY AND CLINICAL MANIFESTATIONS
´ Typhus-like exanthem
´ Febrile/afebrile lymphadenopathy
´ Meningo-encephalitis
o Early signs include headache
o Late signs include seizures and motor dysfunction
´ Chorio-retinitis
´ Toxoplasmosis with AIDS
o Pneumonia
o Toxoplasmic encephalitis – most common cerebral opportunistic infection
o Cerebral toxoplasmosis
´ Congenital toxoplasmosis
o Sabin syndrome – internal hydrocephalus, choriodorentinitis, convulsions, cerebral
calcification
D IAGNOSIS
´ Sabin-Feldman dye test
o Uses live trophozoite stages
´ Complement fixation
´ IFA
´ ELISA
o Toxoplasma gondii specific IgM
´ Latex agglutination
´ Frenkel skin test
´ Biopsy (tachyzoites in tissue cysts), animal inoculation, culture
TR EATMENT
´ Pyrimethamine (Fansidar) 50 mg initial, 25 mg after 6 hours and 25 mg daily for 2 weeks
PR EVENTION AND CONTROL
´ Oocytes
o Hygiene
o Proper sanitation
o Boil or filter drinking water
´ Tissue cysts
o Cook meat properly
´ Pet infection care
´ Rodent control

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