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INTESTINAL FLAGELLATESCommon intestinal flagellates
Giardia lamblia , Chilomastrix mesneli , Trichomonas hominis,Deintamoeba fragilis
Occasionally encountered intestinal flagellates
Enteromonas hominis, Retortamonas intestinalis= no evidence that any of this organism can cause diseaseexcept G. lamblia and D. fragilis= Pathogenic Trichomonads:1. Trichomonas vaginalis - found in the urogenital tract2. Trichomonas tenax - commensal found in the mouth
Giardia lamblia
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a protozoan flagellate considered as one of the morecommon cause of infectious diarrhea throughout theworld
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Synonym: Cercomonas intestinalisMegastoma enterica
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Geog. Dist: Worldwide (tropical and subtropical region)
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Disease: Giardiasis, Lambliasis, Traveler’s diarrhea
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Morphology:
exhibit the trophozoite and cyst stages
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Trophozoite:
-found in diarrheic stool-pear or pyriform shaped-rounded anteriorly and pointed posteriorly-bilaterally symmetrical-size 9-20um L X 5 - 15um W-sucking disc occupying 1/2 - 3/4 of the ventralsurface (used for attachment of organism)
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axoneme (axostyle) found at the anterior endterminating posteriorly-4 pairs of lateral flagella, 2 ventral and 2 caudal(enhance erratic jerky motion) or falling leaf movement
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2 pairs of blepharoplast: 1 pair at anterior end 1 pair atcaudal end
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2 oval-shaped nuclei with large central karyosome oneach side near the anterior end
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2 deeply stained (parabasal bodies) found posterior tothe sucking disc
Cystic stage:
= ovoidal/ellipsoidal – shaped= thick wall and doubly contour= size 8-12um L X 7 - 10um W= contains 2-4 nuclei located at one end= axoneme, parabasal bodies and other remnant organellesof the trophozoite are also found inside the cyst
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Habitat: duodenum and jejunum
Life Cycle:
Ingestion of viable cyst (infective stage)
→
cyst undergoexcystation in duodenum
→
becomes a trophozoit
→
colonizemucosa of duodenum
→
Reproduce by binary fission
→
encystations in the largeintestine
→
cyst in feces
Epidemiology:
 
Giardiasis
 
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most prevalent disease in areas with poorenvironmental sanitation and personal hygiene
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one of the most common cause of travelers andepidemic diarrhea
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considered to be a major cause of diarrheal outbreakfrom contaminated water supplies
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transmitted by fecal-oral route
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foods and drinks may be a source of infection
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all age group are affected, but attack rate is morecommon in children (90%) than adult
Pathologenesis:
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disease may be asymptomatic or may manifest as aself-limiting acute onset of diarrhea associated withnausea, anorexia and crampy abdominal pain
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diarrheic stool is non-bloody, foul smelling andsteatorrheic (fatty stool) containing large amount of fats and mucus
→
Malabsorption syndrome
Lab. Diag:
1. Stool examination (unstained preparation)
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demonst. pear-shaped body with progressivefalling leaf motility - trophozoite2. Intestinal biopsy
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shortening and blunting of intestinal villi due tomucosal invasion of the organism3. String test (Entero test); Fecal antigen test4. Serological – ELISA, Immunofluorescence test
Treatment:
Metronidazole (Flagyl) - DOC 40mg TID for 7days
Prevention and Control:
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proper disposal of human excreta to preventcontamination of water supply
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protect food from contamination (from infected foodhandlers and flies)
Dientamoeba fragilisGeog. Dist
: Cosmopolitan
Morphology:
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only trophozoite stage known
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very small with an ave. size of 5-12um dia.
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nuclear membrane without peripheral chromatin
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majority are binucleated (2 nuclei) with large centralkaryosome composed of 4-8 chromatin granulesarranged symmetrically
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motility non-progressive and very active in a freshlypassed stools
 
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cytoplasm finely granular and vacuolated withingested bacteria and other debris
Epidemiology:
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habitat: mucosal crypt of large intestine
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oral transmission not established
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commonly associated with ova of E. vermicularis
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infective stage Trophozoite
Pathogenesis and Symptomatology:
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pathogenicity disputed
 
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does not invade tissue but causes superficial irritationof the intestinal mucosa resulting in excess secretion of mucus, hypermotility of bowel and diarrhea
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abdominal ternderness and pain are also present
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anal pruritus has been observed
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all manifestation are referred to as Dientamoebiasis orHakanssons syndrome
Diagnosis:
Direct fecal smear of diarrheic stool stained withiron-hematoxylin
Treatment:
Iodoquinol Tetracycline (alternate drug)
Prevention:
Same with amoebiasis
NON – PATHOGENIC FLAGELLATESChilomastix mesniliSynonym:
Cercomonas intestinalisMacrostoma mesnili
Geog. Dist:
Worldwide (more prevalent in warm than in) coolclimate
Morphology:
exhibit both trophozoite and cyst stage
Trophozoite:
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found in diarrheic or liquid stools
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assymetrically pear-shaped/elongate rounded flattenedanterior end and pointed posterior end measures 6 –20um L X 3-10u W
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body marked externally by a spiral groove across theventral surface (diagnostic feature)
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cytoplasm finely granular and vacuolated
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cytostome large, cleft-like and occupies the anteriorhalf of the body
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single nucleus with minute central or eccenterickaryosome
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3 pairs of blepharoplast near the anterior pole of nucleus from where the flagellae arises
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2 short anterior flagella and 1 short posterior flagellumlying near the cytostome
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motility is progressive and boring spiral forwardmovement
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no undulating membrane and axostyle
Cyst:
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found in formed or semi-formed stools
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pear/lemon-shaped rounded anteriorly with anteriorhyaline knob/nipple-like protuberance (very prominent)
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measures 7 – 10um L X 4.5 – 6um W
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cyst wall thicker at the anterior end
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rudimentary cytostome with prominent cytostomalfibrils curving posteriorly around the cytostome whichresembles a “shepherd crook”
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single spherical nucleus with central karyosome
Pathogenesis and Epidemiology:
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considered as normal inhabitant of cecal region of thelarge intestine (harmless parasite)
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transmission thru ingestion of cyst in food or drinkscontaminated with human feces
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prevalence rate in the Phil. is less than 1%
Lab. Dx:
Stool examination-diarrheic stool – trophozoite-formed stool – cyst-semi-formed – both
Treatment:
None
Prevention:
Good sanitation and personal hygiene reduceincidence of infection
Trichomonas hominisSynonym:
Cercomonas hominis Trichomonas confusa
Geog. Dist
: = Worldwide; most common intestinal flagellatesfound in humans; has little evidence of pathogenicity for human
Morphology:
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exhibit trophozoite stage only
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pear-shaped, rounded anterior and pointed posteriorly
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size 7-15um L X 3-4um W
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cytostome at ventral side near the ant. end of thebody
 
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single nucleus with small central karyosome near the
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anterior end close to the margin of the anterior flagella
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chromatin granules unevenly distributed
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cytoplasm finely granular and vacuolated
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blepheroplast lying between the nucleus and anteriorend of the body giving rise to the flagella, axostyle andundulating membrane
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4 anterior flagella (serves for propulsion) and recurrentflagellum that runs to the posterior end and forms theouter edge of the undulating membrane
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axostyle (slender rod) extend through the body fromanterior to the posterior end and protrudes as a sharppointed tail (diagnostic)
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undulating membrane at the dorsal surface of the bodyand impart the rotatory motion of the organism (jerkynon-directional)
Pathogenesis and Epidemiology:
evidence of pathogenicity insufficient, howeverorganism is always associated with diarrhea
acquired through ingestion of food and drinkscontaminated with the trophozoite
 Lab. Diag.: Stool Examination
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demonstration of trophozoite from diarrheic stool(jerky, non-directional movement of the undulating)membrane and protrusion of the axostyle
Rx: No indication for specific treatmentPrevention:1. Improvement of community sanitation2. Personal hygieneEnteromonas hominisSynonym: Trichomonas intestinalisGeog. Dist: Worldwide; more widely distributedthroughout tropicalareas and temperate regionMorphology: exhibit both stages: Trophozoite and CystTrophozoite:
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pear/oval shaped with one side flattened
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measures 4-10uL X 3-6u W (small flagellate)
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single nucleus near the anterior end of the body withcentral karyosome
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2 blepharoplast adjacent to the nucleus which givesrise to 3 anterior flagella w/c enhance jerky forwardmovement and 1 posterior flagellum
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no cytostome
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entire cytoplasm vacuolated and contains numerousbacteria
Cyst:
elongate-ovoidal shaped
6-8um W X 5um L
cyst wall well-defined
contains 1-4 nuclei usually 2 lying at opposite end
resembles E. nana cyst 
Pathogenesis and Epidemiology:
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parasites is a commensal in the cecal region of thelarge intestine
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no proof provided of its pathogenicity
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infection is the result of ingestion of cyst fromcontaminated food and drink
Lab. Diag.:
Demonstration of characteristic trophozoite andcyst by stool exam
Treatment:
= None (no therapy indicated)
Prevention:
Good personal and community hygiene
Retortamonas intestinalisSynonym:
Waskia intestinalisEmbadomonas intestinalis
Geog. Dist.:
China, Malaysia, Philippines, Egypt, Brazil, USAand probably cosmopolitan in warm climates= harmless commensal of the intestine of man
Morphology:
exhibit both trophozoite and cyst stage
Trophozoite:
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pear/oval shaped attenuated posteriorly
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size from 4 – 10um L X 3-4um W
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nucleus, single and large at the anterior end withcentral karyosome
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lateral to the nucleus is a pair of blepharoplast givingrise to 2 flagella (1 long anterior and 1 short) posteriorflagellum
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cytoplasm finely granular and vacuolated
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prominent cleft-like cytostome at the anterior end of the body about half of the length of the organism
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