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Intestinal Flagellates

Intestinal Flagellates



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Published by: dhainey on Mar 02, 2009
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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
a protozoan flagellate considered as one of the morecommon cause of infectious diarrhea throughout theworld
Synonym: Cercomonas intestinalisMegastoma enterica
Geog. Dist: Worldwide (tropical and subtropical region)
Disease: Giardiasis, Lambliasis, Traveler’s diarrhea
exhibit the trophozoite and cyst stages
-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)
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
2 pairs of blepharoplast: 1 pair at anterior end 1 pair atcaudal end
2 oval-shaped nuclei with large central karyosome oneach side near the anterior end
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
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
most prevalent disease in areas with poorenvironmental sanitation and personal hygiene
one of the most common cause of travelers andepidemic diarrhea
considered to be a major cause of diarrheal outbreakfrom contaminated water supplies
transmitted by fecal-oral route
foods and drinks may be a source of infection
all age group are affected, but attack rate is morecommon in children (90%) than adult
disease may be asymptomatic or may manifest as aself-limiting acute onset of diarrhea associated withnausea, anorexia and crampy abdominal pain
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)
demonst. pear-shaped body with progressivefalling leaf motility - trophozoite2. Intestinal biopsy
shortening and blunting of intestinal villi due tomucosal invasion of the organism3. String test (Entero test); Fecal antigen test4. Serological – ELISA, Immunofluorescence test
Metronidazole (Flagyl) - DOC 40mg TID for 7days
Prevention and Control:
proper disposal of human excreta to preventcontamination of water supply
protect food from contamination (from infected foodhandlers and flies)
Dientamoeba fragilisGeog. Dist
: Cosmopolitan
only trophozoite stage known
very small with an ave. size of 5-12um dia.
nuclear membrane without peripheral chromatin
majority are binucleated (2 nuclei) with large centralkaryosome composed of 4-8 chromatin granulesarranged symmetrically
motility non-progressive and very active in a freshlypassed stools
cytoplasm finely granular and vacuolated withingested bacteria and other debris
habitat: mucosal crypt of large intestine
oral transmission not established
commonly associated with ova of E. vermicularis
infective stage Trophozoite
Pathogenesis and Symptomatology:
pathogenicity disputed
does not invade tissue but causes superficial irritationof the intestinal mucosa resulting in excess secretion of mucus, hypermotility of bowel and diarrhea
abdominal ternderness and pain are also present
anal pruritus has been observed
all manifestation are referred to as Dientamoebiasis orHakanssons syndrome
Direct fecal smear of diarrheic stool stained withiron-hematoxylin
Iodoquinol Tetracycline (alternate drug)
Same with amoebiasis
NON – PATHOGENIC FLAGELLATESChilomastix mesniliSynonym:
Cercomonas intestinalisMacrostoma mesnili
Geog. Dist:
Worldwide (more prevalent in warm than in) coolclimate
exhibit both trophozoite and cyst stage
found in diarrheic or liquid stools
assymetrically pear-shaped/elongate rounded flattenedanterior end and pointed posterior end measures 6 –20um L X 3-10u W
body marked externally by a spiral groove across theventral surface (diagnostic feature)
cytoplasm finely granular and vacuolated
cytostome large, cleft-like and occupies the anteriorhalf of the body
single nucleus with minute central or eccenterickaryosome
3 pairs of blepharoplast near the anterior pole of nucleus from where the flagellae arises
2 short anterior flagella and 1 short posterior flagellumlying near the cytostome
motility is progressive and boring spiral forwardmovement
no undulating membrane and axostyle
found in formed or semi-formed stools
pear/lemon-shaped rounded anteriorly with anteriorhyaline knob/nipple-like protuberance (very prominent)
measures 7 – 10um L X 4.5 – 6um W
cyst wall thicker at the anterior end
rudimentary cytostome with prominent cytostomalfibrils curving posteriorly around the cytostome whichresembles a “shepherd crook”
single spherical nucleus with central karyosome
Pathogenesis and Epidemiology:
considered as normal inhabitant of cecal region of thelarge intestine (harmless parasite)
transmission thru ingestion of cyst in food or drinkscontaminated with human feces
prevalence rate in the Phil. is less than 1%
Lab. Dx:
Stool examination-diarrheic stool trophozoite-formed stool cyst-semi-formed both
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
exhibit trophozoite stage only
pear-shaped, rounded anterior and pointed posteriorly
size 7-15um L X 3-4um W
cytostome at ventral side near the ant. end of thebody
single nucleus with small central karyosome near the
anterior end close to the margin of the anterior flagella
chromatin granules unevenly distributed
cytoplasm finely granular and vacuolated
blepheroplast lying between the nucleus and anteriorend of the body giving rise to the flagella, axostyle andundulating membrane
4 anterior flagella (serves for propulsion) and recurrentflagellum that runs to the posterior end and forms theouter edge of the undulating membrane
axostyle (slender rod) extend through the body fromanterior to the posterior end and protrudes as a sharppointed tail (diagnostic)
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
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:
pear/oval shaped with one side flattened
measures 4-10uL X 3-6u W (small flagellate)
single nucleus near the anterior end of the body withcentral karyosome
2 blepharoplast adjacent to the nucleus which givesrise to 3 anterior flagella w/c enhance jerky forwardmovement and 1 posterior flagellum
no cytostome
entire cytoplasm vacuolated and contains numerousbacteria
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:
parasites is a commensal in the cecal region of thelarge intestine
no proof provided of its pathogenicity
infection is the result of ingestion of cyst fromcontaminated food and drink
Lab. Diag.:
Demonstration of characteristic trophozoite andcyst by stool exam
= None (no therapy indicated)
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
exhibit both trophozoite and cyst stage
pear/oval shaped attenuated posteriorly
size from 4 – 10um L X 3-4um W
nucleus, single and large at the anterior end withcentral karyosome
lateral to the nucleus is a pair of blepharoplast givingrise to 2 flagella (1 long anterior and 1 short) posteriorflagellum
cytoplasm finely granular and vacuolated
prominent cleft-like cytostome at the anterior end of the body about half of the length of the organism

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