Protozoa eukaryote..has genetic material encased in a nuclear membrane (unlike bacteria and viruses)..classified traditionally by morphology (eg. organelles of locomotion), life cycle and mechanisms of reproduction etc. Mastigophora: movement with flagella - e.g. Trichomonas,Giardia Sarcodina: pseudopodia, e.g. Entamoeba histolytica Apicomplexa: apical complex, no locomotor apparatus;sexual reproduction, e.g. cryptosporidium,malaria, toxoplasma Ciliophora: movement with cilia, e.g. Balantidium. INTESTINAL PROTOZOA Pathogenic Entamoeba histolytica Balantidium coli Giardia lamblia Dientamoeba fragilis Cryptosporidium parvum Enterocytozoon bieneusi Septata intestinalis Cyclospora cayetanensis Isospora belli Commensal Entamoeba hartmani Entamoeba dispar Entamoeba coli Endolimax nana Iodamoeba btschlii Chilomastix mesnili Trichomonas hominis Blastocystis hominis ENTAMOEBA HISTOLYTICA MORPHOLOGY Trophozoite: any stage in a protozoans life cycle which can ingest food. In practice also refers to the motile form. Cyst: the non motile form which is protected by a distinct membrane or cyst well. This is an infective stage of the parasite. Excystation: the process of emergence of the trophozoite from the cyst (vs.encystation) Pseudopod: literally means false foot; temporary cytoplasmic processes at the surface of the trophozoite Epidemiology of Entamoeba histolytica
Man the only source (not a zoonosis) Fecal-oral transmission Our understanding is in transition because of mis-identified cases. Seen in travellers Amoebiasis Entamoeba histolytica life cycle Entamoeba histolytica
Invasive and Non- invasive Amebiasis Amoebiasis Invasion Amoebiasis Entamoeba histolytica Signs and Symptoms Amebiasis (WHO 1969) 1. Asymptomatic infection 2. Symptomatic infections A. Intestinal amebiasis i. Dysenteric ii. Non dysenteric colitis B. Extraintestinal amebiasis i. Hepatic ii. -acute nonsuppurative -liver abcess i. Pulmonary ii. Other extraintestinal foci Amoebiasis Extension Amoebic liver abscess AMOEBIASIS
Presentation 1. persisting fever 2. RUQ or epigastric pain and/or shoulder pain 3. rarely diarrhea Diagnosis 1. ultrasound 2. raised WBC 3. serology 4. aspirate microscopy 5. response to metronidazole 750 t.i.d. Amebiasis - Diagnosis Laboratorium examination of E. histolytica Faecal examination Spesimen from : Sigmoidoscopi aspiration Aspirate of hepar abcess Serologisextra intestinalmonitoring th/ IHA ELISA IFA Kopro Ag Special technique Isoenzyme analysis DNA probe Sequential Stool Examination for E. histolytica I II III IV V direct 41 65 79 88 93 %
direct and concentration 21 38 51 61 69 % direct , concentration and stain 13 25 34 43 50 % Drugs for Entamoeba histolytica Tissue: ..metronidazole, tinidazole, secnidazole, ornidazole ..emetine ..dehydroemetine ..chloroquine Bowel lumen: ..paromomycin (Humatin) ..diiodochlorhydroxyquin (Diodoquin) ..diloxanide furoate (Furamide) Giardia epidemiology:
- faecal oral spread - prevalence 3-5% in Canada; increased in travellers, backpackers, institutions, daycare centres - zoonosis - found in most mammals; esp.beaver (beaver fever), cattle, cats, dogs, etc Giardiasis Giardia intestinalis =(lamblia) Trophozoites Cysts Giardia Life cycle GIARDIASIS
Symptoms diarrhea flatulence abdominal cramps decreased appetite + weight loss + nausea no fever Signs mild abdominal tenderness Laboratory no leukocytes in stool no mucous in stool giardia cysts intermittent in stool giardia cysts in duodenal aspirate Trichomonas vaginalis
Taxonomy: Mastigophora Epidemiology: reservoir is human urogenital tract Biology: causes inflamation of vaginal and urethral epithelium Clinical: vaginal discharge Treatment: metronidazole Trichomonas vaginalis Life Cycle Trichomonas - Pathogenicity Contact dependent cytotoxicity Trichomonas and HIV TOXOPLASMA GONDII Introduction Obligate intracellular parasite that infect a wide range of warm blooded vertebrates Toxoplasmosis is a classical zoonotic diseases Human infections are caused by accidental ingestion of oocysts, shed into environment by cats or tissue cysts contained in under cooked meat
Toxobogor2010 35
Cycle in humans (an accidental host) Infected by ingesting infective oocysts (in >4 day old cats feces) by ingesting tachyzoites or bradyzoites in rare meat by receiving blood or tissues with zoites congenitally by transplacental tachyzoites
Toxoplasma gondii Toxobogor2010 36 Epidemiology of Toxoplasma gondii Key figures (after 1 st infection of DH) Prepatent period (= time interval between infection and first oocyst shedding) - after infection with tissue cysts = 3-10 days - after infection with sporulated oocysts = 3-5 weeks
Patency: 1-21 days
Oocyst output 1.000.000 oocysts / g faeces 600.000.000 oocysts in total during patency Large contamination of the environment with oocysts
Siklus hidup Toxoplasma gondii Toxobogor2010 39 Gamogony Sporogony Merogony(ies) Life cycle of Toxoplasma gondii Sporulated oocyst with sporozoites in environment facultative heteroxenic cycle Unsporulated oocyst in faeces DH Endogenic cyst with bradyzoites Pseudocyst with tachyzoites in tissue cells IH Toxobogor2010 40 CLINICAL TOXOPLASMOSIS o Acquired o Congenital o Ocular o Immunocompromised patient INFECTION DURING PREGNANCY FIRST TRIMESTER:TRIAD TOXOPLAS MOSIS: RETINOCHOROIDITIS INTRA CRANIAL CALCIFICATION HYDROCEPHALUS MENTAL REARDATION LATE PREGNANCY ASYMPTOMATIC NEONATEDISORDER IN ADULT Anencephalus Microcephalus
Hydrocephalus HIDROSEFALUS
Gemelli, anophthalmia, malformation of faces RETINOCHOROIDITIS