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B11MicroParaL4B - Intestinal Protozoans PDF
B11MicroParaL4B - Intestinal Protozoans PDF
MICRO-PARA
Lecture 4B
Block 11
Module 2
11/ 03/ 17
Dr. Melanie Jane Tendencia
TOPIC OUTLINE
I. Intestinal Protozoans (FECAL-ORAL) TRANSMISSION FACTORS
II. Types of Intestinal Protozoans 1. Poor personal hygiene
A. Flagellates a. Food handlers
B. Amoeba
C. Apicomplexa b. Institutions
III. Types of Diarrhea Caused by Intestinal Protozoans c. Children in day care centers
IV. Diagnosis 2. Developing Countries
V. Treatment
a. highly endemic
VI. Parasitic Enteritis
A. Human Coccidiosis b. poor sanitation
B. Isosporiasis c. Travelers Diarrhea
C. Cyclosporiasis 3. Water-borned epidemics
D. Giardiasis
E. Intestinal Amoebiasis
4. Male homosexuality
Supplementary Notes a. oral-anal contact
Review Questions
References
PREVENTION AND CONTROL
Appendices
Improve personal hygiene - especially in institutions
LECTURER BOOK REFERENCE OLD TRANS
Treat asymptomatic carriers - e.g. family members
Health education
Hand-washing
I. DEFINTION: INTESTINAL PROTOZOANS Sanitation
Unicellular eukaryotic organisms which includes Food handling
members from flagellates (e.g. Giardia lamblia), Protect water supply
Amoeba (e.g. Entamoeba histolytica, E. dispar, E. coli), Treat water if questionable
Apicomplexa (e.g. Cryptosporidium hominis, Boiling
Cryptosporidium parvum) and others (e.g. Balantidium Iodine
coli). Not chlorine
CCetC Group 25 1 of 10
MD 2 Lacierda, Lavilla, Lunar
II. TYPES OF INTESTINAL PROTOZOANS Possible Mechanisms
Mechanical irritation
FLAGELLATES Obstruction of absorption
GIARDIA LAMBIA
Worldwide distribution
Higher prevalence in developing countries (20%)
1-6% in temperate countries
Most common protozoa found in stools
~200 million clinical cases/year
Giardiasis
Often asymptomatic
Acute or chronic diarrhea
Fecal oral life cycle (*refer to Fig. 2)
Cyst - infective stage; passed in feces
Trophozoite replicating stage; found in small
intestine
Subacute/Chronic Symptoms Figure 2. Life Cycle of Giardia sp. (Upclass Trans, CDC)
Recurrent diarrheal episodes
Cramps uncommon Life Cycle
Sulfuric belching, anorexia, nausea frequent Cysts are resistant forms and are responsible for
Can lead to weight loss and failure to thrive transmission of giardiasis. Both cysts and trophozoites
can be found in the feces (diagnostic stages) (1). The
Acute Symptoms cysts are hardy and can survive several months in cold
1-2 week incubation water.
Sudden explosive, watery diarrhea Infection occurs by the ingestion of cysts in
Characteristics: bulky, frothy, greasy, foul- contaminated water, food, or by the fecal-oral route
smelling stools (hands or fomites) (2).
No blood or mucus In the small intestine, excystation releases trophozoites
Upper gastro-intestinal uneasiness, bloating, (each cyst produces two trophozoites) (3).
flatulence, belching, cramps, nausea, vomiting, Trophozoites multiply by longitudinal binary fission,
anorexia remaining in the lumen of the proximal small bowel
Usually clears spontaneously (undiagnosed), but can where they can be free or attached to the mucosa by a
persist or become chronic ventral sucking disk. (4)
Encystation occurs as the parasites transit toward the
Pathogenesis colon. The cyst is the stage found most commonly in
Epithelial damage causing villus blunting, crypt cell nondiarrheal feces (5).
hypertrophy, cellular infiltration Because the cysts are infectious when passed in the
Malabsorption stool or shortly afterward, person-to-person
Enzyme deficiencies (e.g. lactase deficiency transmission is possible. While animals are infected with
causing lactose intolerance) Giardia, their importance as a reservoir is unclear.
Giardia adheres to the mucosal lining of the GIT
(masking effect) causing damage of the villus and Source: ( http://www.cdc.gov/dpdx/giardiasis/ )
malabsorption of nutrients
Source:
(http://www.cdc.gov/parasites/amebiasis/biology.html)
Pathogenesis
NON-INVASIVE
Amoeba colony on intestinal mucosa
Asymptomatic cyst passer
Non-dysenteric diarrhea, abdominal cramps, other GI
symptoms
INVASIVE
Necrosis of mucosa ulcers, dysentery
Ulcer enlargement dysentery, peritonitis
Metastasis extraintestinal amebiasis
Cessation of cyst production
Figure 3. Life Cycle of Entamoeba histolytica (Upclass Trans, CDC)
Presentation ulcers with raised borders with little
Cysts and trophozoites are passed in feces (1). Cysts
inflammation between lesions
are typically found in formed stool, whereas
Facultative Pathogenicity
trophozoites are typically found in diarrheal stool.
85-90% of infected individuals are symptomatic
Infection by Entamoeba histolytica occurs by ingestion
10% of the symptomatic will develop severe invasive
of mature cysts (2) in fecally contaminated food, water,
disease
or hands.
Excystation (3) occurs in the small intestine and
Histology
trophozoites are released (4), which migrate to the large
Flask-shaped ulcer
intestine.
Trophozoites at boundary of necrotic and healthy tissue
The trophozoites multiply by binary fission and produce
Trophozoites ingesting host cells
cysts (5), and both stages are passed in the feces (1).
Dysentery (blood and mucus in feces)
Because of the protection conferred by their walls, the
Source:
(http://www.cdc.gov/parasites/crypto/biology.html)
Treatment
Trimethoprim-sulfamethoxazole
Effective in AIDS patients
multiple courses of suppressive therapy
CRYPTOSPORIDIASIS - CRYPTOSPORIDIUM
Protozoan parasite
Severe chronic diarrhea in immunocompromised
patients
Typically self-limited 204 weeks in normal hosts
Usually infect only the surface of the mucosal epithelium
(process is less inflammatory)
Diagnosis
sugar flotation or modified acid fast stains of fecal
specimen
CYCLOSPORIASIS - CYCLOSPORA
Persistent diarrhea in travelers, those living in tropical
areas, health care workers and AIDS patients
caused by infection with Cyclospora
cayetanensis, a pathogenic protozoan
transmitted by feces or feces-contaminated fruits
and vegetables
VI. PARASITIC ENTERITIS outbreaks have been reported due to contaminated
fruits and vegetables
HUMAN COCCIDIOSIS - ISOSPORA BELLI it is not spread from person to person, but can be a
Isospora belli
hazard for travelers as a cause of diarrhea
should be considered in patients (PWAs) with chronic
Tx: co-trimoxazole
diarrhea of obscure origin and eosinophilia
Manifestations: weight loss, fever, headache, colicky
GIARDIASIS - GIARDIA LAMBLIA
abdominal pain, steatorrhea, and malabsorption Severe infection, steatorrhea
Answer: c, a, b, b, d, d, a, b, b, a
REFERENCES
Dr. Tendencias lecture
Upclass Notes
APPENDICES
Figure 6. Giardia life cycle - the cyst is the infective stage and the
trophozoite is the replicative state. (Dr. Tendencias lecture)