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Coccidians

Coccidians

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Parasitology (dra Madrid)
Coccidians
20 February 08
 
CoccidiansCoccidian Parasites
Members of the class Sporozores (Phylum Apicomplexa)
Obligate intracellular protozoans
Gliding motility
Reproduction
o
Sexual phase: sporogony, gametogony
o
Asexual phase: schizogony, merogony(trophozoites, schizonts, merozoites)
Species included:
o
Isospora
o
Sarcocystis
o
Cryptosporidium
o
Cyclospora
o
 Toxoplasma
o
Pneumocystis
Isospora belli
Coccidian parasite
Infects epitheial cells of the small intestine
Infections usually in immunocompromised patients
Geographic distribution
o
Worldwide, in tropical and subtropical areas
o
High prevalence: Haiti and other tropical areaswith poor sanitary conditions
 Transmission: food and water
Dse common in children and male homosexuals especiallythose with AIDS
Definitive hosts: human and animalsPathogenesis
Parasites develop and multiply in the epithelial cells of thesmall intestine
 Trophozoites develop into schizonts(contain merozoites);rupture of schizonts release the merozoites
invade newepithelial cells, and continue the cycle of asexualmultiplication
After 1 week sexual stage begins: devt of male and femalegametocytes
fertilization
devt of oocysts
excreted inthe stool
Immature oocyst contains usually 1 sporoblast
furthermaturation
sporolast divides in 2 (oocyst now contains 2sporoblasts); sporoblasts secrete a cyst wall and becomessporocysts
sporocysts divide 2x to produce 4 sporozoiteseach
Infection occurs by ingestion of sporocyst-containingoocysts; sporocysts excyst in small intestine, release theirsporozoites
invade epithelial cells and initiate schozogonyIsospora belli (Life cycle)
At time of excretion, immature oocyst contains usually 1sporoblast
Sporoblast divides into two, secrete a cyst wall
sporocysts
Sporocyst divide to produce sporozoites
Infection occurs in ingestion of sporocyst containingoocyst(oocyst containing 2 sporocyst with each containing 4sporozoites)
Sporocyst excyst in small intestine
release sporozoites
enter epithelial cells of distal duodenum and proximal ileum
o
Invade new epithelial, continue asexualmultiplication
 Trophozoites develop into schizonts which contain multiplemerozoites
o
Rupture of schizonts
release of merozoites
invade new epithelial cells and continue of asexual multiplication
After 1 wk, sexual stage begins – male and femalegametocytes
o
Microgametocytes fertilize macrogametocytes
Fertilization product: oocyst excreted in stool
o
Oocyst mature in 48 hrs
oocyst initially has 1sporoblast
divides into 2 sporoblast
develop into sporocysts (2)
o
4 long and slender sporozoites develop withineach sporocyst
Oocyst of isospora contains 2 sporocysts, each with 4sporozoitesIsospora belli: Clinical Manifestations
Infections often asymptomatic even with excretion of oocysts
Symptomatic infections:
o
Diarrhea: intermittent for months
o
Fever, malaise, anorexia, abdominal pain,flatulence
o
Malabsorption along with weight loss and rarelydeath
o
In immunocompromised hosts, severe diarrhea
o
Eosinophilia
Intestinal biopsies show:
o
Mucosal lesions of shortened villi
o
Hypertrophied crypts
o
Infiltration of lamina propria with pmnleucocytes especially eosinophils
Dissemination to other organs: seen in AIDS patients
Prognosis is good but infection may last for monthsIsospora belli: diagnosis
Detection of oocysts in feces
Oocysts in stools: ellipsoidal shape
 
 YNA, joy, cams, shar – 2B11 of 7
 
Parasitology –
Coccidians
by 
 Dra Madrid 
Page
2
of 7
Isospora belli: treatment
Asymptomatic infections: bed rest and a bland diet
 Trimethoprim-sulfamethoxazole: drug of choice
Sarcocystis
Worldwide: infects humans and animals
Disease: sarcosporidiosis and sarcocystosis
Complex life cycle – involves intermediate hosts
Definitive hosts: man and carnivores (dog)
Human definitive hosts for 2 species:
o
Sarcocystis hominis
o
Sarcocystis suihominis
Humans can also act as intermediate hosts
 Take several forms
Simplest is called the zoite
o
Banana shaped cell with a pointed endequipped for entering host cells
Sporocysts are composed of 4 zoites
o
Oval; can survive on ground and infectintermediate hosts
Sporozoites are formed from sporocysts
Sarcocysts are formed from sporozoites
o
Composed of large numbers of zoitessurrounded by a cyst wall
o
 Those that can be seen by the naked eye arecalled macrocyst
o
Microcysts are sarcocysts that remain aboutthe same width as the muscle fiber and can beseen only under the microscopeSarcocystis (Life cycle)Definitive hosts are infected when they eat undercooked meatw/c contains sarcocyst
sarcocyst wall digested
release of zoites
enter intestinal cells and change into male and femaleforms
fertilization
sporocysts passed out in the feces of thehost (definitive host)Sporocysts ingested by intermediate hosts
sporozoites (w/care formed from sporocysts) penetrate intestinal epithelialtissues
hematogenous spread
brain, muscles and othertissues** sporozoites enter muscle cells, and encyst and develop intosarcocysts** in other tissues, sporozoites become schizonts and thenencystSarcocystis (Clinical Manifestations)
In humans,
o
Gastroenteritis, myalgia, weakness, mildincrease of creatine kinase
In the intermediate hosts, the brain, muscle, and kidneytissues can be damaged
o
Loss of appetite, fever, weight loss, andanemia;
o
Gait abnormalities, weakening of limbs, musclewasting, and head tilt
o
Infected animals have been observed to movein circles
Accidental ingestion of sporocysts results in direct infectionof humans without the intermediate host
o
Occurs rarely and is called humanintramuscular sarcocystisSarcocystis (diagnosis)
In the definitive host, demonstration of sporocysts in thefecal material using flotation method
In the intermediate host, detection of schizonts in theskeletal muscle or in brain tissue during autopsy
Detection of antibodies in serum or CSF using Western blot,IFA and ELISASarcocystis (treatment and prognosis)
No effective treatment known
Corticosteroid – to decrease muscular inflammation
 Trimethoprim-sulfamethoxazole – effective in treatingintestinal infections
In most animal infections due to this parasite do not causeserious pathologic changesSarcocystis (Epidemiology)
Worldwide geographic distribution
Few human cases, most from SE Asia
Prevalence may be high due to numerous asymptomaticinfections
Other animals w/c may be infected: cattle, horses, dogs,cats, rabbits, mice, and chicken
Infections in avian species have no known human threat
Sporocysts remain infective for many months in water at 4-10C; infectivity prolonged during the cooler months of theyear
Infected carcasses left unburied on farmland can remaininfective for cats and dogs for weeks on cool weather
Freezing does not prevent spread
Macrocysts from sheep have to be heated for 20 mins to killthemSarcocystis (prevention and control)
No known control methods
Uncooked dead animal should not be fed to other animals
Good sanitation and hygiene
 
Parasitology –
Coccidians
by 
 Dra Madrid 
Page
3
of 7
Cryptosporiosis
Cryptosporidium
Causal agent:
o
Many species exist that infect humans and awide range of animals
o
Although Cryptosporidium parvum andCryptosporidium hominis (formerly known as C.parvum anthroponotic genotype or genotype 1)are the most prevalent species causing diseasein humans, infections by C. felis, C.meleagridis, C. canis, and C. muris have alsobeen reported
C. parvum – now considered a parasite of bovines w/c caninfect humans
C. hominis – infect only humans
Prevalence in the Philippines has been reported to be low at2.6%
Coocidian protozoan
1907 – discovery of the organism
1976 – first case of human cryptosporidiosis
Infect several different hosts, can survive mostenvironments for long periods of time (“hard cysts”);inhabits all climates and locales
 Taxonomically classified as Sporozoa – oocyst releases 4sporozoites
Monoxenous life cycle – completes entire cycle w/in a singlehost
Sexual and asexual cycles
Six distinct developmental stagesCyptosporidium (Life cycle)
6 distinct developmental stages:
o
Excystation of the orally ingested oocyst in thesmall bowel with the release of 4 sporozoites
o
Invasion of intestinal epithelial cells; initiationof asexual intracellular multiplication stage
o
Differentiation of the microgametes (males)and macrogametes (females)
o
Fertilization initiating sexual replication
o
Development of oocysts
o
Formation of new, infectious sporozoite w/inthe oocyst, excreted in the stool
Sporulated oocysts, containing 4 sporozoites, are excretedthru feces (and possibly respiratory secretions)
Following ingestion, excystation occurs
sporozoites arereleased and parasitize epithelial cells of GIT (or othertissues)
undergo asexual (schizogony or merogony) andthen sexual multiplication (gametogony)
Fertilization of macrogamonts (female) by microgametes(male)
oocysts develop
sporulate in host, and excreted
o
Because oocysts sporulate inside host,autoinfection can occur
Oocysts are infective upon excretion, thus permitting directand immediate fecal-oral transmissionCryptosporidiosis (Clinical Manifestations)Immunocompetent:
Acute self-limiting diarrheal illness
1-2 week duration
Frequent, watery diarrhea
N/V, abdominal cramps, low grade feverImmunocompromised
Debilitating, cholera-like diarrhea (upto 20L/day)
Severe abdominal cramps
Malaise
Low grade fever
Weight loss
Anorexia
 
**Pa-add ng Cryptosporidosis epidemiology at yung personslikely to be infectedCryptosporidium: Transmission
Ingestion of fecally contaminated food and water
o
Drinking water taken from surface watersources such as lakes and river; swimmingpools and water park wave pools, untreatedwater
o
Cyst is resistant to various drinking waterfiltration treatments such as chlorination
o
Food can get contaminated; oocyst do notsurvive cooking but can occur in foods notheated or in foods not cooked after handling
Animal to person transmission
o
From household pets is rare
o
Definite correlation between calves shedoocysts and pathogen present in 90% of alldairy farms
Person to person
o
Occurs at a high frequency in day-care centers;clustered population
o
Nosocomial settingsCryptosporidium: Pathogenesis
Upon excystation, sporozoites released
o
Adhere to the surface of the intestinal mucosa
o
Sporozoite-specific lectin adherence factor:agent of attachment to the intestinal surface
o
Release of cytokines by mucosal cells
activate phagocytes to release soluble factorsthat increase intestinal secretion of water andchloride; inhibit absorption
Epithelial cells damaged via:
o
Direct result of parasite invasion
o
Damage through T cell-mediated inflammation,producing villus atrophy and crypt hyperplasia

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