Numerous protozoa inhabit the gastro- intestinal tract of humans (see Box). This list includes representatives from many diverse protozoan groups. The majority of these protozoa are non- pathogenic commensals, or only result in mild disease. Some of these organisms can cause severe disease under certain circumstances.

example, Giardia lamblia can cause severe acute diarrhea which may lead to a chronic diarrhea and nutritional disorders;Entamoeba histolytica can become a highly virulent and invasive organism that causes a potentially lethal systemic disease. Apicomplexa and microsporidia species (discussed elsewhere), which normally do not evoke severe disease, can cause severe and life-threatening diarrhea in AI DS

within the gastro-intestinal tract, but is often discussed with the intestinal flagellates. It infects the urogenital tract and and causes a sexually- transmitted disease.

Entamoeba hartmanni
Entamoeba polecki
Entamoeba gingivalis(o r al)
Endolimax nana
Iodamoeba b\u00fctschlii

Cryptosporidium parvum Cyclospora cayetanensis Isospora belli

Intestinal protozoa are transmitted by the fecal-oral route and tend to exhibit similar life cycles consisting of a cyst stage and a trophozoite stage (Figure). Fecal-oral transmission involves the ingestion of food or water contaminated with cysts. After ingestion by an appropriate host, the cysts transform into trophozoites which exhibit an active metabolism and are usually motile. The parasite takes up nutrients and undergoes asexual replication during the trophic phase. Some of the trophozoites will develop into cysts instead of undergoing replication. Cysts are characterized by a resistant wall and are excreted with the feces. The cyst wall functions to protect the organism from desiccation in the external environment as the parasite undergoes a relatively dormant period waiting to be ingested by the next host. Factors which increase the likelyhood of ingesting material contaminated with fecal material play a role in the transmission of this intestinal protozoa (see Box). In general, situations involving close human-human contact and unhygenic

\u2022Trichomoniasis
\u2022Balantidosis
\u2022Am ebiasis
\u2022Non-Pathogenic Commensals

that colonizes the upper portions of the small intestine. It has a worldwide distribution and is the most common protozoan isolated from human stools. In fact, it was

\u2022poor sanitation
\u2022lack of indoor plumbing
\u2022 end e m ic
\u2022 travelers' diarrhea

\u2022 E nta m o eba = no
\u2022Cryptosporidium = yes
\u2022 Gi a rd i a = controversial

notes). The incidence is estimated at 200 million cases per year. TypicallyGi a r d i a is non-invasive and quite often results in asymptomatic infections.

The infection is acquired through the ingestion of cysts. Factors leading to contamination of food or water with fecal material are correlated with transmission (Box). For example, giardiasis is especially prevalent in children and particularly those children in institutions or day-care centers. In developing countries, poor sanitation contributes to the higher levels of giardiasis, and water- borne outbreaks due to inadequate water treatment have also been documented. Backpackers in areas of no human habitation are believed to acquire from drinking from streams and some data suggest that beavers are the reservoir. However, the zoonotic transmission ofGi a r d i a is controversial and has not been unambiguously demonstrated. It is not clear whetherGi a r d i a

of animals, or whether each host has their own 'pet'Gi a r d i a. Evidence indicating thatGi a r d i a transmission between dogs and humans is quite rare favors the latter. Molecular evidence suggests that some isolates exhibit narrow host ranges whereas others exhibit wide host ranges (see notes on taxonomy). Regardless of whether zoonotic transmission is possible, person-to-person transmission is the most prevalent mode of transmission and the risk factors are close human contact combined with unhygenic conditions.

The ingested cyst passes through the stomach and excystation takes place in the duodenum. Excystation can be induced in vitro by a brief exposure of the cysts to acidic pH (~ 2) or other sources of hydrogen ions. This exposure to the acidic pH mim ics the conditions of the stomach and probably functions as an environmental cue for the parasite. Flagellar activity begins within 5-10 minutes following the acid treatment and the trophozoite emerges through a break in the cyst wall. The breakdown of the cyst wall is believed to be mediated by proteases. The trophozoite will undergo cytokinesis (cell division without nuclear replication) within 30 minutes after emerging from the cyst resulting in two binucleated trophozoites.

TheGi a r d i a trophozoite exhibits a characteristic pear, or tear-drop, shape with bilateral symmetry when viewed from the top (Figure). It is typically 12-15 \u00b5m long, 5-10 \u00b5m wide, and 2-4 \u00b5m thick. Characteristic features of the stained trophozoite include: two nuclei