CILIATES ..dr. cabugaoBalantidium coli [Paramoecium coli]

considered as the largest protozoan infective for human

distributed worldwide although rare in US

2 stages

tropozoite

large, ovoid pointed anteriorly and broadly roundedposteriorly

size 30-150 u L, 40-70 u W

entire covered with uniform length short cilia

cytostome- slightly covered, conical depression at theanterior end

cytopyge- small opening at the posterior end

cytoplasm contains numerous food vacuole with one or twocontractile vacuoles

2 nuclei present-macronucleus [large bean or kidney- shaped]-micronucleus [small rounded structure]found within the concavity of the macronucleus

cyst

round/ spherical, thick-walled double layered

smaller in size 45-65 u diameter

cytoplasm is granular

macro and micronucleus present

cilia inside

habitat

large intestine [man, pigs]

reproduce by transverse binary fission

clinical infection

Balantidiasis/ Balantidial Dysentery

MOT:

ingestion of cyst [infective stage]

epidemiology

pigs considered as source of human infection

although rare in human, B. coli is common in hogsthroughout the world

infection most prevalent in tropics where pigs sharehabitation with people

pathology and symptomatology

occurs in cecal area and large intestine

mucosal layer penetrated by both boring action and byaction of enzyme hyaluronidase



ulcer formation at all areas of large intestine

inflammatory reactions noted around the organism

life cycle

both stages present in the life cycle

human become infected when cyst are ingested either:drinking contaminated water fecal- oral contamination[feces, fingers, food, fomites and flies]

←↓

cyst passed to small intestinewhere excystation occur

↓

trophozoite in small intestine[multiply by binary fission]

↓

colon



mucosal epithelium



large intestine



tissue invader

diarrhea common

anemia or mild leukocytes may occur- some patient

laboratory diagnosis

- stool examination- finding chac trophozoite/ cyst stage

treatment

- tetracycline [drug of choice]- metronidazole/ iodoquinone [can also be used]- carbarsone [reccurence]

prevention

- avoid pollution of food and drinks

INTESTINAL COCCIDIA

Genera1.Cryptosporidium2.Isospora3.Sarcocystis

CRYPTOSPORIDIUMspecies

C. garnhaniC. parvum

1976 considered as natural parasite of animal causingdiarrheal diseases

infect variety of mammals, birds, and reptiles

cosmopolitan in distribution

1985 first reported case in Philippines

associated with intractable diarrhea in AIDS patient

oocyst

round or slightly ovoidal

4-6 u diameter

oocyst red color and enclosed 4 spindle-shapedsporozoites

diseaseCryptosporidiosis

chac by self-limiting diarrhea in healthy people

immunocompromised people [AIDS patient]



causeschronic persistent diarrhea with abdominal pain, fever,anorexia



weight loss and death [criteria for dx of AIDS]

human infection usually waterborne

highest prevalence of disease in areas with unreliable water and food sanitation

extraintestinal infection of the respiratory tract, biliary tractand pancreas may occur

habitat

mucosal epithelium crypts of colon and villi smallintestine

2 types of reproductive cycle1.sexual - sporogony2.asexual – schizogony- infection initiated by ingestion of oocyst



sporozoites liberated

↓

trophozoite

↓

division

↓

schizont

♂

sporogony

↓

macrogamete

↑

schizogony



merozoite



zygotemicrogamete

♀

diagnosis

direct exam of fresh fecal specimen by indirect



immunoflourescence

microscopy: modified ziehl-neelsen stainingdemonstrating the oocyst [red color] in feces, duodenalaspirates, and duodenal biopsies3.sucrose – floatation technique

none – supportive [self-limiting]

prevention

environmental and personal hygiene

not killed by chlorination of water

removed from drinking water by flocculation or filtration

ISOSPORAspecies

Isospora belli

once considered a rare parasite, now known to becosmopolitan in distribution

often seen in warm region of the world especially in NorthAmerica, Africa, Southeast Asia, rare – US

no known intermediate host, human only definitive host

oocyst

elongate ovoidal

20-33 u L

10-19 u W

2 layered cyst wall – [smooth, thin, and colorless]

inside are 2 sporoblast and each sporoblast contains 4crescent- shaped sporozoites

diseaseIsosporosis

mild self-limiting infection chac by fever, colicky, abdominalpain, severe diarrhea, steatorrhea [fatty stool], and weightloss

seen most often in patient with AIDSlife cycleboth in sporogony and schizogony occurs in manoocyst in feces



contaminate food and drink



ingested

↑

nucleus of sporocyst divide

↓

into 4 sporozoites in each sporocystsmall intestine and cecum

↑ ↓

sporocyst penetrate cell of villi

↑ ↓

nucleus divide into 2 sporoblasttransform into trophozoites

↑

[schizogony- asexual cycle]oocyst mucosal cell

↑

macrogamete

↓

zygote



merozoite



schizontrupturemicrogamete

pathology and symptomatology

several species colonizes mammals but only I.belliinfects human

parasite is transmitted in fecally contaminated food or drink with oocyst

intracellular development occurs in the intestinal mucosa



mucosal atrophy

laboratory diagnosis

1.demonstration of oocyst in feces Formalin- Ether conc/ ZincSulfate Flotation technique [unstained or iodine stained]2.modified ziehl-neelsen staining of fecal smear

combination of Sulfadiazine + Pyrimethamine [veryeffective]

Co-trimoxazole [trimethroprim + sulfamethoxazolecombination]- alternative drug

prevention

- avoid drinking and eating contaminated food

SARCOCYSTISspecies

S. hominis [cattle]S. suihominis [swine]- parasite of human and domestic animals cattle, swine, sheep

oocyst

broadly oval shape lying along infected muscle fibers

contains 2 sporocyst each of which are filled with 4mature crescent shaped sporozoites

measuring 9-16 u L by 8-12 u W

diseaseSarcocytosis

disease uncommon, human infection rare