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SUBKI NGDOM PROTOZOA

 Subki ngdom Protozoa MORPHOLOGY
Phy l
um Sarcomast igophora  Thet rophozoi tesar edescr ibedas
Subphy l
um Mastigophor a hav i
nga' tear-dr op'shape.
ClassZoomast igophor ea  Bilat
erallysymmet rical,pyr
iformin
 Cl assZoomast i
gophor ea shape, roundedant eriorl
y,pointed
(chloroplastsabsent,onetomany posteriorly.
fl
agel l
a,amoeboi dformswi t
hor  Conv exdor sal side, concav eventral
withoutf l
agell
a) sidewi thlargeadhesi vediscf or
attachment .
A.SPECI ESWHI CHINHABI
TTHE  Measur es10t o20µm l ongand5t o
DIGESTI VETRACT 10µm wi de.
1.Giardi
alamblia  Cont ai
nt wonucl ei
,fourpai r
sof
2.Tri
chomonashomi ni
s fl
agel l
apr opellinganer rati
c
3.Chil
omast ixmesni
li tumbl i
ngmot ion, t
woaxonemes,
4.Retortamonasint
esti
nal
i
s andt wocur vedbodi escal l
edt he
5.Enteromonashomi ni
s medi anbodi es.
 Trophozoi tesar eusual lyfoundi n
B.SPECIESWHICHINHABITTHE diarrheicstool s.
ORALCAVITY
1. Tr i
chomonast
enax fl
agellateHABI TAT: duodenum, jejunum,
andupperi leum ofhumans.
A.SPECI ESWHI CHINHABITTHE
 Si mpl easexual li
fecy cle–
GENITALIA
trophozoi t
esat tachest otheupper
1. Trichomonasvagi
nal
is
i
nt estinal t
r act( optimum pH6. 4-7.
0
forsur vival)andi nfecti
vecy stsar e
Fl
agel
lat
es passedouti nf eces.
 Giardi
alambl
ia  Tr ophi cst agemul t
iplybybi nar y
 Acosmopol itandi seasei n fi
ssi oncausi ngt hepat hologi c
humanschar act erizedbya changesi ngi ardiasi s.Thi sphasei s
broadcl inicalspect rum of foundonl yi nt hesmal l
intest ines
acut etochr oni csy mpt oms andi nwat er yst ools.
rangi ngfrom di arrheat o
 Thecy sts, shownatr i
ght ,areov al
mal absor pti
onsy ndr ome.
measur ingf r
om 11t o14µm i n
 Gi ardialambl ia l
engt hand7t o10µm i nwi dth.
 Var iousl
yr eferredt oas:  Youngcy stshav e2nucl ei
.Mat ure
o G.duodenal i
s cy stshav e4.
o G.i ntestinalis
 Cy stscont ainf lagellaret r
act edinto
o Lambl iaintest inal
is
axonemes, themedi anbody ,&
 Discov eredbyAnt onv an deepl y-stainedcur vedfibrils
Leeuwenhoeki nhisown sur roundedbyat oughhy ali
necy st
stool s. wal lsecr etedf rom condensed
 Mostubi quitousf l
agel lat
ein cy toplasm.
thehumani ntest i
nal t
ract.  Of ten,thecy stwi l
lappearshr unken,
 Pr i
mar ycauseoft rav eler
’s pul l
ingawayf rom t hecy stwal l
.
diarrhea.
 Etiologicagenti nspor adic
out breaksofwat er-bor ne
transmi tteddi seases.

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 Highestprevalencei nplaceswi th
poorsani t
arypractices.
 Affectspeopleofal lages,frequent
i
ni nfants&childreninendemi c
areas–el ement aryschools,
orphanages, l
argef amili
es.
 Foodordr inkmaybet hesour ceof
i
nfect i
on.
 US–homosexual oro-
anal practi
ces
amongmal eadul ts

TREATMENT
 Metronidazol e,250mg3X/dayf or7
days.
PATHOLOGY
 Howev er,ther earereport
sofinvit
ro
&CLINI
CALMANI FESTATI ONS
&inv i
vor esistancetomet roni
dazol
e.
 Asy mpt omat i
c( cy stpasser s)
.
 Hence,phy siciansshouldnotgive
 Self-
limi t
ingacut eonsetdi arr
hea, lowdosesofmet r
onidazol
eorusing
withnausea, anor exi a,
&cr ampy , thedrugaspr ophyl
axis.
abdomi nalpain.
 Li
ght -coloredst oolsbutnotbl ood- PREVENTI ON&CONTROL
streaked.  Properorsani t
arydisposaldi
sposal
 Diarrheamaybecomeper sist
ent, ofhumanexcr etatoprevent
chroni c,&mal absor pti
on–st ools cont aminati
onofwat ersuppl
y.
becomest eatorrhei c.  Av oidfecalcontami nati
onoffood
 Power fulventralsucki ngdisccause (especiall
yv eggies)duetouseof
mechani calir
ritati
ont othemi cr
ovil
l
i nightsoilasf ert
ili
zer&
–def icienciesi ndi gesti
veenzy mes cont aminati
onf rom fli
esand
–mal absor pt
ion. infectedfoodhandl ers.
DI
AGNOSIS
NON-PATHOGENICFLAGELLATE
 Demonst rationoft r
ophozoitesand/
PROTOZOA
orcystsi nt hest ool orinduodeno-
 TheTri
chomonassp.donothavea
jej
unal aspirat eorbi opsyspeci mens.
cyststage.Thei
rpresenceinman
 Itmaybedi ffi
culttodet ectthe
serveasani ndi
cat
oroff ecal
organism i nt hef ecessincet he
contaminati
onofingestedfoodor
numberofcy stspassedcanv ary
water.Treatment,
howev er,i
snot
considerabl yf rom dayt oday .
necessary.
 Fail
ureofbi opsyandaspi r
ationto
 Tri
chomonashomi nis
confi
rmi nfect ionmaybel i
kel ydue
 Aharmlesscommensal ofthe
tothepat chynat ureoftheloci of
i
ntest
inal t
ractofman.Themost
inf
ection.
commonandt hemost
 Serol
ogi ct est s.
cosmopol i
tanoft heintesti
nal
 Testst odet ectci rculat
ing fl
agel
latesofman, nexttoG.lambli
a
anti
bodi esorcopr oanti
gens. andC.mesni l
i.
 Thepyri
f or
mt r
ophozoitehas
o acy tostome&nucl eusatt
he
anterior
.
EPI
DEMI
OLOGY
o anaxost yl
et hatextends

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fr
om theanteri
ortothe  Seldom seeni nformedst ools&are
poster
iorendalongthemi d- presumedt opassoutwi thdiarr
hei
c
axi
s stools.
o 4( 5)anteri
orfl
agell
a,&a  Commonhabi tat
:cecalareaofthe
poster
iorfl
agell
um proj
ecting l
argei ntesti
nesofman&ot her
fr
om anundulating primatespeci es.
membr anethatrunsthe  Transmi ssionoccursthrough
enti
relengt
hoft hebody. i
ngest i
onoft rophozoi
tesinf oodor
 Measuresfrom 5to15µm i nlength drinkcont aminat
edwi t
hhuman
andfr
om 7t o10µm i nwidth. feces.
 Transmi ssionoccursveryrapidl
yfor
 Chi lomast ixmesni l
i thetrophozoitescannotsur v
ivefora
 Anor mal i
nhabi tantoft hececal l
ongt i
meout sidethehumanbody .
regionoft hel ar gei ntest i
nes.I thas
well-def i
nedt rophi c&cy sticstages.  Tr
ichomonast
enax
Ithasacosmopol i
tandi st r
ibution  Ahar ml esscommensal foundi n
buti smor epr ev al entinwar m theor al cav i
tyofnor mal per sons
cli
mat es. butmor ef requent lyassoci ated
MORPHOLOGY i
npeopl ewi thpoordent al
 Thet rophozoi tesar epear -
shaped; hy gieneandor aldisease.
asymmet r
ical wi thspi r
al grooves  I twasf irstobser vedbyO.F.
extendi ngt hrought hemi ddl e Mul l
eri n1773i na4- day
portionoft hebody . aqueouscul tur eoft artart aken
 Measur ef rom 6t o24µm i nl ength from t eet h.
and4t o8µm wi de.  Thi sf lagel latel ivesi nt het ar tar
 Thesi nglenucl eususual lyhasa aroundt het eet h, i
ncav itiesof
promi nentkar y osome. car i
oust eet h, ingi ngival mar gins
 Thechar acteristicbor i
ngorspi ral oft hegumsori npuspocket sin
forwar dmov ementi smadepossi ble tonsi ll
arf olli
cl es.
by( 3)f reeant er iorf l
agel la&amor e  I tisf oundexcl usi velyi nt he
deli
cat eonewi thint hepr omi nent mout hofhumansandot her
cytost ome. pr i
mat es.
 Theor al groov e( cy tostome)i s  I sof tenassoci atedwi th
somet imesseenneart henucl eus. Ent amoebagi ngi valis.
 Chi lomast ixmesni l
icysti spear - MORPHOLOGY
shaped( l
emon- shaped) ;roundedat  Py r
ifor mt rophozoi temeasur es5- 12
oneend, conical att heot herend um.
withaknob- li
kepr otruber ance.  4f r
eef lagel la
 Measur es4t o6µm wi deand6t o  anundul at i
ngmembr anedoesnot
10µm l ong. reacht hepost er iorendoft hebody
 Ther ei sasi ngl enucl eusanda  asi ngl enucl eus
curvedcy t
ost omal fi
bril
 cal ledt he  acy tost ome.
shepher d'scr ook.  Tr ansmi ssi oni sdi rectthr ough
 Thei mageatr ighti sat ri
chr ome dropl ets, kissi ngorcommonuseof
stain( 1000x) . cont ami nat eddi shesanddr i
nki ng
 Thewhol eor gani sm isencl osedi na glasses.
deli
cat epl iablemembr ane, whi ch  Di agnosi si smadebyswabbi ngt he
enabl esi ttobur rowt hroughdense tart
arbet weent het eet hort he
medi a. gingiv almar ginoft hegumsor

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tonsi ll
arcr ypt s.  Youngchil
drenget sthei
nfecti
onby
 Tr ichomonasvagi nalis dir
ectcontactwit
hi nf
ect
edf emales
 Asexual ly-transmi tteddi seasewi th orcontaminatedtoil
etar
ti
cles.
wor ldwi dedi stribut ion.I nci dence Inf
ecti
oninbabiescouldhav ebeen
cor r elatesst rongl ywi tht henumber acqui
redthroughthebirt
hcanal.
ofsexual par tner s.
 Tr ichomonasvagi nal i
s DIAGNOSI S
 Asy mpt omat ici nf emal esbutcan -Unst ai
nedwetdr oppreparati
ons,st
ained
alsopr oducemi ldt osev ere smear susingGiemsa, Pappanicol
au,
vul v ovagi ni ti
s. Romanowsky ,&acri
dineorange
 I tr ar elypr oducesur ethr iti
sorot her -CultureinDiamond’smodi fi
edmedium or
sy mpt omsi nmal es. Feinberg&Whi tt
ingtonmedi um
 Wasf i
rstf oundbyDONNEi n1836i n
pur ulentv agi nal secr et i
onsandi n EPI
DEMI OLOGY
secr etionsf rom t hemal eur ogeni tal  Mostpr ev alentdur i
ngt he
tract . reproduct i
veper iodbet weenages
MORPHOLOGY 30-49i nwomen, especiallyingroups
 Thet rophozoi te( shownatr ight, i
nwhi chf emi ninehy gienei s
Gi emsast ai n)measur esabout15x def i
cient.
10µm.  Mor ecommoni nsoci et
ieswher e
 Theax ost y l
e( arrow)i sof tencl early therei smor esexual per mi ssi
veness
visi ble. wi t
hhi ghesti ncidencef oundi n
 Hasasi ngl enucl eus, 4ant erior popul ationsathi ghr iskf orother
flagel l
a, fifthf lagel lum embeddedi n venereal diseases.
theundul at i
ngmembr aneext ends  I nfectiont hroughar ti
f i
cial
abouthal fi tsl engt h. i
nsemi nat i
onhasal sobeen
 Theundul at i
ngmembr anei s suggest edf oll
owi ngobser v at
ions
somet i
mesv isibleandext ends thatT.v aginali
scansur v iv
e
abouthal fwaydownt hesi de. cryopr eser vati
onofhumansemen.
 T.v agi nal is i nfect ionsar egener ally
diagnosedbyexami ningwet -mount s PATHOLOGY
of  v agi nal di schar ge. &CLINI
CALMANI FESTATI ONS
 I tisi mpor tantt oexami net hese  Infl
ammat i
onoft hev aginal mucosa
sampl essoonaf tercol lectionso  Characteristi
cv aginal discharge
thatt hepar asi tesar est il
lmot i
le. containi
ngl argenumber sofPMNs
 I tiseasyt oconf usenonmot ieT.
l anddesquamat edepi thelialcel
ls.
vagi nal i
swi thWBCs.  Vaginalsecr eti
onsar eliquid,
 Tr ichomonasspp.donothavea greenishtoy ell
ow, veryirri
tati
ng
cy stst age. whichcausei ntensei tchinessanda
burningsensat ion.
 HABI TAT: sur faceoft hev agi nal
epi thel ium off emal es, epithel ium of  Speculum exami nat i
onr eveals
theur ethr a, epi didy mi s, andpr ostate punctatehemor rhagesoft hecerv
ix
glandsoft hemal es. (“st
rawber rycerv i
x”).
 Opt imum pHf orsur vival :5. 2-6.4in  Trophozoitesi nt heurine, uret
hral
mal es. secreti
ons, vaginal &cer vical
secreti
ons&scr apings/swabsi n
 Ki l
ledi nnor mal lyaci dv aginal
women, semen&pr ost ati
c
secr etions: pH3. 8- 4.4
secreti
onsi nmal es.
 Tr ansmi ssi oni sbysexual
i
nt er cour se.

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BRAI
N
1.Naegl
eri
aspp.
TREATMENT 2.Acant
hamoebaspp
 Or almetronidazole,250mg3X/day .
for7day s. Subor
derAcant hopodi na
 Shoul dSIMULTANEOUSLYi nvol
ve Genus:Acant hamoeba
bot hpartnerstoav oidpr
ompt OrderSchizopy r
enida
reinfect
ion. Fami lyVahlkamphidae
 Sexual i
nt er
courseshouldbe Genus: Naegleri
a
discourageddur ingtheperi
odof Fami lyHartmannelli
dae
treatment . Genus: Acanthamoeba
 Supposi tori
es&aci ddouchescanbe and
usef ul
. Hartmanel
l
a
Fami lyLeptomy xi
dae
PREVENTION&CONTROL Genus:Bal amuthia
 Reducet heri
skofexposureby  PATHOGENI CAMEBA
li
mitingthenumberofsexual Ent
amoebahi
stol
yti
ca
partners.  Apar asiteofhumans, other
 Protectiv
edevicessuchascondoms primates, dogs, cat s,pigsand
andsper mici
dalfoamsmayhelp. rodents
 Responsi blef orAMEBI ASI Swhi ch
AMOEBAE may
 TAXONOMI CCLASSI FI
CATION clinical l
ypr esenti nmanas:
Subki
ngdom Protozoa 1.I ntest i
nal amebi asis
Phyl
um Sarcomast i
gophor a 2.Ext ra-i
ntest i
nal amebi asis
Subphyl
um Sar codina  SYNONYMS:
SuperclassRhizopoda Amoebacol i(Losch, 1875)
ClassLobosea Amoebady sent eriae( Counci lman&
OrderAmoebi da Lafl
eur,
SuborderTubul
ina 1891)
Famil
yEntamoebidae Entamoebady senteriae( Cr ai
g, 1905)
Gener
a:Entamoeba/ Endolimax/Iodamoeba Entamoebat etragena
(Hartmann,1908)
Endamoebahi stolyti
ca(Schaudi nn,
 CLASSLOBOSEA 1903;
(Pseudopodiall
oboseormor eor Hickson,1909)
l
essf il
if
orm butextendedfrom a Endamoebady sent eria(Kof oid, 1920)
broaderhy al
i
nelobe) Entamoebadi spar( Br umpt ,1925)
A.SPECI ESWHI CHINHABI TTHE MORPHOLOGY
LARGEI NTESTI
NES  TROPHOZOI TE
1.Ent amoebahi stol
y t
ica - 10t o60um, av erage: 20um
2.Ent amoebacol i - v eget ative,mot il
e,activeor
3.Endol imaxnana feedingst age
4.I odamoebabut schlii  -t hin,finger li
keor
5.Di entamoebaf r
agili
s bladel i
keect oplasmi c
B.SPECI ESWHI CHINHABI TTHEORAL
CAVITY pseudopodi
agi
vesi
t
1.Ent amoebagi ngival
is arapidl
y
C.SPECI ESWHI CHINHABI TTHE
pr
ogr
essi
ve&

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di
recti
onal mot
ili
ty constri
cti
on)
 -fi
nelygranul
ated  Ext
ra-
intesti
nal:
endoplasm may o amoebi cli
verabscess(most
contai
n common)
o I nvasi
onbyt rophozoit
e
i
ngest
edRBC reaches:
- small
,cent
ral
l
ylocat
edor o liver-viaportalcir
cul
ati
on
bul
l
’seye o lungs–v i
adi rectext
ensi
on
ofal i
verabscess
karyosome/ endosomei n o br ain&otheror gans–
singlenucleus throughsystemi c
- f i
ne&r egularlyarranged
peripheralnucl ear circulati
on
chromatin o ski n–byi ntimat econt act
I
MMATURECYST  Compl i
cat ions:
 -chromat oidbodi esar eci gar o -per foration&secondar y
shaped, sausage- shaped, rod- bact erialper i
t onitis ( most
l
ike,oval,orwi throundedends serious)
 di f
fuse, mahogany o r uptur eintoper i
car dium
browngl ycogenmass and/ ori ntot hepl eur a
iniodine- t
reated o intraper i
toneal rupt ure
smear s o secondar yamebi c
CYST meni ngoencephal iti
s
 theinfectivestage o r are:r enal inv olvement&
 measur es10- 16um geni talinvolv ement
 1-4nuclei  Inv
asioni sf aci l
it
atedbyt he
 smoot h,refracti
ve, non-staini
ngcy st expressionofv i
rulencef act ors,
wal l namel y
:
 whi chis0. 5um thick o Gal / Gal NAcl ect i
nwhi ch
 roundorov alinshape medi ates adher encet o
 sameappear anceofnucl eusasin hostcel ls
troph o amebapor eswhi chf orm
poresi nhost
METACYSTICTROPHOZOITE  cel
l membr anes
 transi
ti
onal
stagei
nhost
’si
ntest
ines o cy st einepr otei naseswhi ch
are
PATHOGENESI S&  cytopathicf orhostt issues
CLI
NICALMANI FESTATI ONS
 Majori
tyofcasespr esentas DI
AGNOSI
S
asymptomat i
cinfecti
ons( cyst  Micr
oscopicDetection
carr
ier
sorcy stspassers) o -mi ni
mum of3f ecal
 Int
esti
nal: sampl escol l
ectedin
o char act
eristi
cintesti
nal diff
erent day s
lesion:fl
ask-shapedul cer o DFSusi ngsal i
ne, methyl
ene
o amebi cdy sentery blue,i
odinesmear s
o amebi ccol i
ti
s o -confirm usingconcent r
ation
o ameboma( “napkinri
ng” met hods( FECT& MIFC)
lesionor“ applecore” o useper manentst ai
ning
techniques

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o pr esenceofChar cot-Leyden o t hosei nment ali

nsti
tuti
ons,
cry stals prisons,&
 Stool Cultureusi ngRobi nson’sand  daycarecent ers
I
noki medi um  IMPACTofAMEBI ASI
S
 Mucosal scr apes&l iveraspirates  Esti
mat essuggest edtheexist
ence
(anchov ysauce) of500mi lli
oncasesi nthewor l
d!.
..
..
 Serological techniques–I HA, CIE,  The3rdleadingcauseofdeat haf t
er
AGD, IFA, ELI SA malari
a&schi stosomiasi
swi t
han
 Colonoscopyorsi gmoi doscopy annualmor tal
ityof40,000–110, 000
 Ultr
asonogr aphy ,CTscanorMRI persons!
 Todi sti
ngui shE.hi stolyt
icafrom the
mor phologi callysimil
arbut
harml esscommensal species:
 ELISA PREVENTI
ONANDCONTROL
 PCR  I mpr ov ementofenv i
ronment al
o Electrophor eticisoenzymeanal ysi
s sani tat i
on
ofzy modemes  Sani tar ydi sposal ofhuman
feces
TREATMENT  Awar enesst hatf liesand
EPI
DEMI OLOGY cockr oaches ser veas
 Atpr esenti sNOTCERTAI Nbecause mechani cal vector s
ofther ecentl
yappr eci
ated  Saf ef oodanddr inkingwat er
disti
nct ionbetweeni t&the  Pr operhy giene
harml esscommensal  Av oiduseofni ghtsoi l for
 Occurwor l
dwide,endemi cin fertili
zer
count rieswithlowsoci o-economic  Moni tor ingoff oodhandl er s
condi ti
ons  Ear l
ycasedet ectionand
 Prev alencev ar
iesfrom 1%i n treat mentat i ndividual level
i
ndust ri
ali
zedcount ri
esto50- 80%in  Heal theducat i
ont opr ev ent
thet ropics transmi ssionatt hecommuni ty
 Increasedr iskofsev er
edi sease& l
ev el
deat hamong:  Tr i
alsonr ecombi nantamebi c
o chi l
drenesp.neonat es ant i
gensas v accineson
o pr egnantwomen ani mal ar eon- goi ng
o womeni nthepostpar tum  Si gni ficanceoft hei raccur ate
peri
od diagnosi s:
 1)t heymaybemi stakenf or
o t hoseundert reatmentwi
th thepat hogeni cE.
 cort
icost eroids histol ytica
o t hosesuf f
eringfrom  2)t hei rpr esencei ndicat es
mal ignancies fecal cont ami nat ionof f ood
o t hosesuf f
eringfrom andwat er
mal nutrit
ion  Cr i
ter i
af ordif ferent i
ationf r om
 Highriskgr oups: E.hi st oly t
ica:
o t ravelers,immi gr
ants,  Si ze
mi grantwor kers
 Cy topl asmi cincl usions
o i mmunocompr omised
 Number&mor phol ogical
o sexual l
yact i
v emale
feat uresofnucl ei
homosexual s

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 Habi tat nat

ivesofPapuaNewGui nea.
COMMENSALAMEBAE MORPHOLOGY:
GENERALCHARACTERI STI CS Tophozoite,10-25um
MORPHOLOGY o nucl eussi
mi lartoE.
 -Al l member spossessaspher i
cal hist
olyt
ica
nucl euswi tha dist i
nct o coar sel
ygr anularendopl
asm
nucl earmembr aneandapecul iar o slowmov i
ng
kar yosome
 Trophozoi teshav e1nucl eus Immat ur
ecy st
 Cy stshav ev ar yingnumberofnucl ei o chromatoidbodiesofv
ary
ing
LI
FECYCLE sizes
 l
umendwel lersEXCEPTonespeci es
 -gener allyf ollowst hatofE. Cy st
,10-15um
histoly ti
caEXCEPT f ort he o uni nucleated,r
arel
y
absenceofext ra-intest inal i
nfect i
on binucleated
 Ent amoebadi spar  prominentnuclearmembr aneand
 -mor phol ogi callysi mi l
artoE. kary
osomei n stained
histoly ticabut smears
differi nt heirDNA &  maycont ainaspher i
calorov oi
dbut
ribosomal RNAandi soenzyme nor
pat ter n  sharpl
ydef i
nedi ncl
usi
onmass
 non- i
nv asi v e
 i st he“ HARMLESS  Ent amoebagi ngival i
s
COMMENSAL” !  Sy nony m: oralameba
 Ent amoebahar tmanni  Li vesongum andt eethsur faces,
o Sy nony m:“ smal lrace”E. gum pocket s, somet imesi nt he
hist olytica tonsill
arcr yptsi nt hemout h
o Mor phol ogy :  Associ at edwi thpooror al
o Tr ophozoi te, 4–10um hygieneandor aldi sease
o doesnoti ngestRBC MORPHOLOGY:
o mor esl uggi shmov ement  Tr ophozoi t e, 10–20um
o si ngl enucl eus, largeeccent r i
c  mov esqui ckl ywi thnumer ousbl unt
kar yosome pseudopodi a
o I mmat ur ecy st o -manyf oodv acuolescont ain
o 1or2nucl ei cellul ardebr isand
o cont ainsgl ycogenmass bact eria
o haschr omat oidal bar swhi ch  NOCYSTSTAGEhasbeen
may beshor twi th document ed.
 t aper edendsor  Tr ansmi ssi oni smostpr obabl y
thi nandbar -
like dir
ectthroughki ssi ng, droplet
orr icegr ain- spray,orbyshar ingut ensils.
 shapedorgr ape- l
i
ke  Ent amoebacol i
o Mat ur ecy st, 5-10um  Di stri
but ion: cosmopol itan
o quadr inucl eatedwi thcoar se  Speci esmostof t
enmi st akenf or
cy topl asm E.hist oly tica
MORPHOLOGY:
 Ent
amoebapolecki o Tr ophozoi te,10–55um
 Aparasi
teofpigsandmonkey
s o mor ev acuol at ed,coar sely
 Hadbeenreportedamong granul aror

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 “di
rt
y -
looking”endopl asm wi th  Sy nony m: “cross- eyed”cy st
bacteri
a& MORPHOLOGY:
 debrisbutnor edbl oodcel l
s  Tr ophozoi te, 6to15µm
o bl untorr ounded, broad&  sluggi shmov ement
mul t
iple  nucl eushasl argei r
regular
 pseudopods karyosome
o sl uggish, non-di
recti
onal  at ypical kar y
osomesr eported:
mot i
li
ty tr
iangul ar,a
o si ngl
enucl euswi thlarge,  bandofchr omat inacrosst he
eccent ri
c nucleus, &di screte
 kary
osome&t hick,coarseirregular  massonopposi tesidesoft he
 peri
pher alchromat i
n membr ane
o I mmat urecy st  noper ipher al nuclearchromat in
 -spl i
nter-l
i
ke, needle- granules
l
i
keorbr oomst ick  Cy sts, 5t o14µm
 quadr i
nucl eat ewhenmat ure
appear anceof o -nucel i
hav etendencyt o
chromat oidal
bodies ar ranget hemselvesat
o maycontainglycogenmass opposi t
esides
o Cy
st,10–33um oft hecy toplasm
o 1t
o8nucl ei,upto16or
more DIAGNOSISofCOMMENSALAMEBAE
o moregranularcytopl
asm  Stoolexaminati
onf orintesti
nal
 Iodamoebabut schlii amebae
 Synonym: i
odinecy st o DFS
MORPHOLOGY: o concentrat i
ont echniques
o Trophozoite,6-20µm o permanentst ainedsmear s
o lar
gev esi
cularnucleuswi t
ha  Formedst ool
sr ev eal cysts,
lar
gecent r
al trophozoi
tesrecov eredf rom water
y
 oreccent ri
c orsemi -
formedf eces.
endosome  Swabsorscr appingsofgumsand
(basketnucleus teethforE.gi
ngiv alist r
ophozoites
 sur roundedby TREATMENT:
achromat i
c Notnecessar ybecauset hese
granules(“
muddy ” amebaedonotcausedi sease.
 kar yolymphi niodi
ne
smears) EPI
DEMIOLOGY
o noper i
pheralchromat i
ngranules  Pr evalenceinsinglestool
onthe exami nati
onofov er30,000Fi l
ipi
nos:
nuclearmembr ane. o Ent amoebacol i,
21%
o Endol i
maxnana, 9%
o Cyst,5–18um o I odamoebabut schli
i,1%
o uni
nucleated(
sameappear
ance
 13. 5%ofOFWsscr eenedbyt he
astroph)
Depar t
mentofPar asitol
ogy ,UP
o l
argegl y
cogenbodywhi
chstai
ns
Mani l
ain1998har boredi nt
est i
nal
deeply
protozoancy st
s
wit
hi odi
ne
 Foodser v
iceworkersinat erti
ary
hospitalinManilarevealed:
 Endol
i
maxnana
o Endol i
maxnana, 20.3%

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o Ent amoebacoli
, 13.
6%  -ani nnerpolygonal
ly
-
 Foodhandlersinsel
ectedschool shapedwal l
canteensinManil
ashowedi nfect
ion (endocyst)
rat
esof : o -poresorost i
olesar
eseen
o Endol i
maxnana, 22.
8% atthepointof
o Ent amoebacoli
, 17.
9% contactbetweent wowall
s
o Ent amoebahartmani,0.8%  nucl
eussi
mi l
artotrophozoi
te
o I odamoebabutschli
i,0.
8%
PATHOGENESI S&CLI NI
CAL
PREVENTIONandCONTROL MANIFESTATIONS
 properdi
sposalofhumanwast
e  Granul
omat ousamebi cencephali
ti
s
 goodpersonalhygi
ene. (GAE)
o amongchr onical
lyil
l&
debil
it
atedindivi
duals
o t hosewithimpairedimmune
FREE-
LIVI
NGAMEBAE defense
 Mainlyfoundi
nsoil(
copr
ophil
ous)  mechanisms
andwat er o somewhoar eunder
 Butuponcontact
,maybecome immunosuppr essive
facul
tati
vepat
hogeni
cparasi
tesof  ther
apy
vert
ebrate  Non-specif
icmanifestat
ions:f
ever,
chil
l
s,fati
gue,
GenusACANTHAMOEBA  wei ghtl
oss
Eti
ologi
cagent sthathadbeeni denti
fiedi n
humant issues:  Commonsi gns: headache,
 A.cast ell
ani conf usi on, somnol ence, coma,
 A.cul bertsoni hallucinat ions, andsei zures
 A.r hy soides  Neur ol ogicsy mpt oms: focal
 A.hut chet ti hemi par esis,crani alnerv e pal sis,
 A.pol yphaga visual di sturbances, ataxia
MORPHOLOGY: (dependi ngonl ocationoft he
Trophozoite abscesses)
 smal l  Skinl esi ons–i mpor tantdi agnost i
c
 sl uggishwi thpol ydir
ect i
onal featur e
 mov ement  Primar ysi teofi nfection: eitherski n
 si ngle, largenucl euswi thalarge, orlungs
 cent rallyl ocat ed, denselystaining  Amebi cker ati
tis
nucleol us/ endosome o of tenconf usedwi thf ungal or
o -f inel ygranul atedcytopl asm herpetic
consi st s ofectopl asm  keratitis
&endopl asm  Signs: corneal ulceration,
 l argecont ract i
lev acuole progr essi ve cor nealinf i
ltr
at ionand
 exhi bitssmal lspi nyfil
ament sf or cloudi ng, iri
ti
sandscl eriti
s, sev ere
 l ocomot i
onknownasacant hopodi a pain, hy popy onandl ossofv ision
 f eedsongr am- negat i
vebact eria,  Althoughor i
ginal l
yassoci atedwi th
 bl ue-gr eenal gae, oryeasts theuseofsof tcont actlenses, or
Cyst thosewhohav ehadt raumat ot he
 doubl e-wal leddi splay i
ng: cornea, ther ear eot herpr edi sposi ng
 anout erwr i
nkl edwal l(ectocyst)and factor s, suchasi n

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i
mmunocompr
omi
sedpat
ient
s.  Aubiqui tousor gani sm….
 Fi
rstinfectionswer econfinedt othe
DI
AGNOSIS CNS
 GAE–aut opsyandbr ai nbi opsy  Sporadiccasesofker ati
ti
s( 1970s–
 Failur et odi agnoser esul tsf r
om: 1980s) ,
hal fwer er eportsfrom
 i niti
al lackof Europe.Lat err epor t
scamef r
om the
suspi ci on U.S.,
Japan, Kor ea,Sout hAmer i
ca
 i naccur ateear l
y andGer many .
clini
cal diagnosi s  Asof1996, 103casesofGAEhad
 r apidpr ogr essionof beenr eported.
thei l
lnesspr eventing  Earl
y1990sl ocal studieswer edone
 compl etionofdi agnost ict ests onlabor atoryani mal s.
 Speci men: CSFand/ ort i
ssue
sect ions PREVENTION&CONTROL
 Usi nghi stopat hologi cst ai
nsand  Therei shardlyanymeansof
mi croscopy preventinghumanexposur e.
 Axeni xcul tureempl oy ingPYGC  Iti
si mportanttoappr eciatethatnot
 (prot eose- pept one, y eastext ract, allspeciesarepat hogeni candt hat
glucoseand MOREHYGI ENI CPRACTI CEScould
 cyst eine)medi um bepr acti
calforpr ev enti
onand
 Amebi cker atitis control.
 -epi thelialbiopsyf orhi stologic  -boi l
ingwat er,
anal ysi sandi solationoft he wear ingofmasks, &
organi sm f rom l ensofcont actlens cont actlenswear er
s
wear ersf ollowedby cul t
ur e areadv i
sedt o
disinfecttheirl
enses
 Acant
hamoebacanbedet
ect
edby regular l
y
PCR.
Genus: NAEGLERI
A
TREATMENT&MANAGEMENT  SYNONYMS:
 GAE o Naegl
eri
aaerobi
a
o 5- fluorocy tosine  (Si
nghandDas,
1970)
o ket oconazol e o Naegl
eri
ainv
adens(
Chang,
o i tr
aconazol e 1971)
o pent ami dine
o amphot eri
cinB MORPHOLOGY
 Acanthamoebaker ati
ti
s o fr
ee-l
iv
ingamebo- f
lagell
ate
o Sur gical excisonoft he o AmebaorTr ophozoiteform
infectedcor neaandcor neal o 10–35um
transpl antation(ker atoplast
y) o el
ongate,broadant er
iorl
y,
o Recent :clotri
mazol e, i
n di
sti
nctlyt aperedpost er
ior
ly
combi nat i
onwi th o bl
unt,l
obose
pent ami dine, i
sethionateand monopseudopodi um
neospor in o di
recti
onalmot il
it
y
 Advancedker atiti
s o averypromi nentnucleuswith
o Sur gerycanbeper for medt o l
argecentrally
-l
ocatednucleolus
remov ei nfectedtissue.
o Fl
agell
ateorSwi
mmi
ngf
orm
EPI
DEMI
OLOGY o pear
-shaped

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 -has2long,equaland 0.
5ug/ ml ofhy perchl
ori
natedwater.
anter
ior
lyl
ocated  Pathogeni
cityof2Phi l
i
ppine
fl
agell
a i
solatesusingmi cecaused
Cy
st sl
uggishnessandr educedmot i
li
ty,
o 7t o10um bri
stli
ngoff urandmar kedspinal
 -r ound,singlenucl eus, fl
exionevent ual
lybrai
ninfect
ion.
simi l
artot r
ophozoi te
butsmal l
er DI
AGNOSIS
o cy stwal l i
ssmoot handheav y,  Actual presenceoft rophozoit
ein
perforated byost iol es brainandCSF
o mayhav espher i
cal chromat oid  Indi
rectev idence:
bodi es  CSFf indingsofpl eocytosi
swi th
 SPECIES: high%ofpol y
mor phonuclearcell
s,
 N.gr uber i–mostcommonl y hypopogl ycorachia,andelevated
studied non- proteinlevels.
pathogeni c  CultureusingBal amut horNelson
species medi um
 N.f owl eri-pathogeni cf or  PCR
animal s&
 ELISA
humans
 N.aust rali
ensis–
TREATMENT
pathogeni ctomi ce,hasbeen
 Amphot er
icinB
i
solatedf rom floodwat ersin
Australia  Tetrahydrocannabi nol
 N.phi li
ppinensis–l ocally  Azit
hr omy cin
occur ri
ng  Freechl or
ineat5ug/ ml
 Otherdi si
nfectantslikeozone,
species Deciquam 222, andBaquacil
 PATHOGENESI S&CLI NICAL  Element aliodineatdoseshi gher
MANI FESTATI ON than3. 4ug/ ml
 Humandi seasesr angef rom  Temper atur eshigherthan100º C
gastr
it
isanddi arrheat ofatal andl owert han65º C
pri
maryamebi c
meningoencephal it
is(PAM) . EPI
DEMI OLOGY
o Sy mpt omsofPAM:  I sol atedf rom t hermal wat ers,
 -f ever,headache, chl or i
nat edswi mmi ngpool s, f
resh
vomi ti
ng,signsof wat erl akes, domest icwat er
meni ngealirri
tat
ion suppl ies, sewage, soil,airhumi di
fier
(Kernig’
s),and sy stems, cellcul t
ures, humant hroat
andnasal cav i
ties
encephali
ti
s,with  Or gani smscanbei sol atedf rom
rapi
dprogressionto wat ersampl esbycent rif
ugat ionand
coma fil
trat ion
anddeath  Asof1996, 179casesofPAM wer e
 TrophozoitesofN.phili
ppinensis recor dedi nwi delysepar atedpar ts
havebeenshown tobe oft hewor l
di ncludingt heUS,
pathogenictomi ceatmassi ve Czechosl ov akia, Mexi co, Africa,New
doses. Zeal andandAust ralia.
 Pathogenicspeciessurviv
eel evat
ed  I nt hecount ry ,
t heamebacanbe
temperaturesupt o46ºCandupt o i
sol at edf r om moi stsoi land

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freshwaterhabitatsaswellasfrom casesofGAEduet
oBal
amut
hia.
thermallypoll
utedr i
ver
s,whether
naturalorindustri
al. PHYLUM CILI
OPHORA
CLASSKINETOFRAGMINOPHOREA
PREVENTI ON&CONTROL SUBCLASSVESTIBULI
FERI
A
 Ther ei snoknownmeansof ORDERTRICHOSTOMATIDA
prev entionandcont r
ol ofNaegl er
ia (Manyspeci
escommensali
nver
tebr
ate
infection host
)
 Todecr easethepossi bi
li
t yof
infection,oneshoul dAVOI Ddi ving  Bal
ant
idium col i
intoandswi mmi nginwar m and  Thel argestpr ot ozoanci liatet o
stagnantf reshwat erpool s, water inhabi tman.Thedi seasei s
dischar gepool s,unchlori
nat ed associ atedwi tht hosewhowor k
poor ly–mai ntainedswi mmi ngpools, inpi gger ies.
ormud- li
nedlakesandponds.  Thet rophozoi te, shownont he
 Onesuspect edhumancaseofPAM left,isov al andmeasur es
inthecount r
y,aboywi thr ecent appr oxi mat ely50t o100µm l ong
historyofswi mmi ngwasadequat ely and40t o70µm wi de.
cont roll
edbyamphot eri
cinB.  Ov oidorbean- shaped&cov ered
wi thcilia.
 Bal
amut hi amandr ill
ar i
s  Ant er i
ori ndent ati
onf ormst he
MORPHOLOGY cy tostomeorpr i
mi ti
v emout h;
 Tr ophozoi te–r elativel
yl ar ge,12– simi larindent at i
onatt he
60um post eriorendi st hecy t
opy geor
o mov esbybr oadpseudopodi a excr etor ypor e.
buti sal so  Has2nucl ei: l
ar gebean- shaped
 capabl eoff or mi ngf i
nger l
ike macr onucl eus&smal l
pseudopodsand mi cronucl eusl ocat edi nt he
 “ walki ng” acr ossacul turedi sh concav i
tyoft hef ormer .
o Recov er edf rom CNSt issue  Numer ousv acuol es&i ncl usions
 Cy st( nodi scussi oni nr eference) aref oundi nt hecy t
opl asm.
o al sooccur sinCNSt i
ssue  Duet oi tsl argesi ze, Bal ant i
di um
 Wasf irstisol atedi n1993by col iisoneoft heeasi erint estinal
culturingi tfrom t hebr ai nofa prot ozoat oi dent ify
.
baboont hathaddi edfr om  Thecy st,shownont her ight ,
meni ngoencephal i
tisinazoo measur esabout50t o70µm i n
 Subsequent lyt heamebawasshown diamet er. 
tocausePAM i nhumans, i
ncluding  Roundwi tht hi ckcel l wal l.
AIDSpat ient s  Thepar asit ei sal so
 I nfectionspr obabl yacqui redt hr
ough char act erizedbyt hepr esenceof
ther espirat oryt ract( mi cecanbe al argeki dney -shaped
i
nf ectedbyi ntranasal inject i
on)or macr onucl eus; mi cronucl eus
skinl esions maysomet i
mesbeobscur ed.
 Becausepat ientexhi bitsachr onic  Ci lia&cont ract il
ev acuol esmat
granul omat ousi nflammat ory stillbev i
sibl e.
response, thedi seasei scal l
edGAE
(si
mi lart ot hatcausedby PATHOLOGY&CLI NICAL
Acant hamoebaspp. ) MANIFESTATI
ONS
 Asof1996, ther ewer e63r eported  Trophozoit
essecr
etes

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hy aluroni daset hatcausecel l i

ntest i
nes;ency stati
onhappens
l
y sis&bur rowi ntocol onic duringintestinal transpor
t,or
mucosa. afterevacuat ionofsemi f
ormed
 Char acter isticul cer :rounded stools.
base&wi deneck.  Trophozoi tesi nhabitthelumen,
 Trophozoi tesabundanti nthe mucosa, submucosaoft helar
ge
exudat esont hemucosal i
ntest i
nes,primar i
lythececal
sur faces&i nt hebaseoful cer s. region.
 Inv adest hesubmucosa&t he  Cyst sarethei nf ecti
vestage&
muscul arcoati ncl udingbl ood remai nsv i
ablef orweeks.
vessel s&l y mphat ics.
 Secondar ybact erial i
nf ections PREVENTION&CONTROL
resul tst oabscesses.  Sameasamebi asi
s.
 Bal ant i
di al dysent ery–bl oody  Eduact
ethosewor ki
ngwi
thpi
gs
diar rheaordy sent er y aboutbal
anti
diasi
s.
o i ndi sti
ngui shabl ef rom
amoebi cdy sent er y PHYLUM API COMPLEXA
 Bloody ,mucoi dst oolswi th CLASSSPOROZEA
abdomi nal pain, nausea, SUBCLASSCOCCI DI A
vomi ti
ng, &t enesmus. ORDEREUCOCI DIIDA
 Acut ecasesmayhav e6- 15 SUBORDEREI MERI I
NA
stool sperday .  SUBORDEREI MERI INA
 Chr oni cdi seasehav edi arrhea o Zy got enotmot il
e,
alternat ingwi thconst ipat i
on, sporozoi test ypically
abdomi nal tender ness, anemi a,& enclosedi nspor ocy stwi thin
cachexi a. oocy st
 Ex traintest inal inv asioni srar e.  Cr yptospor idi um spp.
 DIAGNOSI S  I sospor aspp.
-Ident i
ficat ionoft r ophozoi t es/  Sar cocy stisspp.
cy stsi nst ool .  Toxopl asmagondi i
-mot i
let rophoz oi
t esar epr esent  SUBORDERHAEMOSPORI NA
i
ndy sent er i
cordi arrheicst ool s. o Zy got emot il
e( ooki net e),
-cy st sar eseeni nsemi -formed sporozoi tesnakedwi tht hree
orf or medst ool s. -membr anedwal l
 Pl asmodi um v i
v ax
EPI
DEMIOLOGY  Pl asmodi um
 Humani nfectionsaref ew& f
alcipar um
sporadi c–r esult
sfrom  Pl asmodi um mal ar i
ae
i
ngest ionoff oodand/orwat er  Pl asmodi um ov al e
contami nat edwi thfecalmat er
ial  Cr yptosporidi
um sp.
contg.B.col icysts.  Oneoft hemosti mpor tanti ntest i
nal
 Pr evalencei sassociatedwi th parasit
esi nt heU. S.I tisr elativ ely
poorenv ironment alsanitat
ion. commoni nt hei ntestinal &
 TREATMENT respir
atorytr actsofmammal s, birds,
-Tetracy cline500mg, 4X/dayf or &r ept
il
es.Andi sr ecogni zedasa
10day s. causativeagentofdi arrheai nbot h
-Met ronidazol e750mg, 3X/day immunocompet ent&
for7day s. immunodef i
ci entpat i
ent s.
 Ex cyst ationoccur sinthesmal l  Cr yptospor i
di um sp.ar eof ten

14
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detect edi nstool speci mensby pi

gs,t
urkeys,hens,bir
ds.
usingt heacidf astst ain. -Per
son-persontransmissi
on
 Wi ththi sstai
n, oocy stsof  the
parasi tesstainpi nkt or ed,andthey PATHOLOGY
measur eapproximat ely5µm i n  Incubat ionper i
odi s1-12day s,
diamet er. aver age7day s.
 Ov oidorspher i
cal ,thick-walledwi
th  Immunocompet entindv ls.maybe
4nakedspor ozoi tes. asy mpt omat i
corhav emi l
dt o
 Crypt ospor i
dium sp.ar eaboutthe sev ereself-li
mi tingdiarrhea.
samesi zeasy east .   Immunodef icientper sons
 Not et hebuddi ngy easti nthis (immunosuppr esivechemot herapy;
picture.   patient swi t
hAI DS)maysuf ferfr
om
 Cycl ospor asp.ar egener all
yacid prolonged, l
ife-threatening,cholera-
fastposi t
ivealso; Cycl osporaare l
ikei ll
nessl eadi ngt oexcessi ve
appr oxi matel
yt wicet hesizeof wat erloss.
Crypt ospor i
dium sp.  Infectionoft hebi l
iarytree&
gallbladderepi theli
um causi ngacute
LI
FECYCLE: &chr onicgangr enouschol ecysti
ti
s.
 Excystati
on–i nf
ect i
vespor oz
oit
es  Respi ratoryt ractinvolvementhas
arerel
easedf rom oocy st
s beenassoci atedwi thchr onic
 Merogony–asexual lyproduce coughi ng, dyspnea, bronchiolit
is&
meront s pneumoni tis.
o Ty peImer onts
 6-8mer ozoit
es TREATMENT, PREVENTI ON&CONTROL
o Ty peI Imeront s  Treat menti nimmunodef icient
 4mer ozoites personshasbeenunsuccessf ul.
 Gamet ogony  Onlyspi ramy cinhasr eported
o Mi cr
ogamet es& effi
cacyi nt r
eat i
ngintesti
nal
macr ogamet es cryptospor i
diosis.
 Fert
il
ization  Ant i
-diarr
heal compoundspr ov ides
o Zy gotes–oocy sts- sympt omat i
cr el
ief.
sporozoites  Oral/par enteralrehydrati
onmay
 Oocystwal l
format i
on helpsust aint henutri
tional statusof
 Sporogony thepat ient.
 Car eshoul dbet akent opr event
DI
AGNOSI
S: animal manur efrom contami nat i
ng
 Sheat her’sflotation food&wat er.
 For mal i
n-ethersedi ment ation  Env i
ronment alsanit
ation&per sonal
 Modi fiedKi nyoun’ sacid-fast hygienemustbeobser ved.
staini
ng.  Drinkingwat ermustbef i
lteredor
 Fl uorescent -taggedmonocl onal boiled.
antibodyt odet ectoocy stin  I
sospor
abel
li
stools&env i
ronment alsampl es.  Acocci di
anfoundi nt heint
esti
nal
 Bi opsyoft hei ntesti
nal mi crovil
li tractofvert
ebrat
es.
todemonst ratedev elopment al  Isosporabell
i
stagesoft hepar asit
e. -oocy stmeasure18- 33um Length&
 EPI DEMI OLOGY 13-16um Wi dth;
el ongatedwith
-zoonot ictransmi ssi
on: calv es, taperi
ngextremities.
kitt
ens, puppi es,rodent s,hor ses, -oocy stwal
lisclear&col orl
ess;

15
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asi
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ogy
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usual
lypassedoutwit
hthef
ecesi
n  Tri
methopri
m plus
theunsporul
atedst
age. sul
famethoxazole(
cotr
imoxazol
e
160mg/800mg)dai l
yfor10days.
PATHOLOGY&CLI NICAL  Toxopl
asmagondi
i
MANIFESTATI ONS  Acocci dianpr otozoawhose
 I.bell
i i
snotser iouslypathogeni
c characteristi
cf eatur
eisasexual
sincesomeoocy stpassersremai
n cycl
ei nthei ntesti
nalmucosaofthe
asympt omat i
c. vert
ebratehost .Sexual
 Associ atedwi thwat erydi
arr
hea& multipl
icationoccur sincat
s.
abdomi nalpainamongAI DS
patients&t hosewhoar e ASEXUALFORM
immunosuppr essed.  Cal l
edat achy zoiteisfoundsi nglyin
 Chroni cinfecti
onl eadsto bodyf l
uidsbutmor ecommonl yas
mal absor pti
onr esult
ingin ani ntracel l
ul arpar asit
e.
steatorrhea, weightloss&  Py ri
form, appr ox.3by6um,
electrolyt
ei mbal ance. cont ainsanucl eus&some
organel les.
DI
AGNOSIS  Theymul tiplyi nhostcel l
sby
 Demonst rati
onofunspor ulat
ed endody ogeny–2daught ercel l
s
oocy stinstool sampl es. form wi thinpar entcell
.
 Foundi nst ool saftersev eral
days  Accumul ationoft achyzoitesina
from theonsetofdi arr
hea. hostcel lwi thf ormat i
onofa
 Mat urati
onofoocy stcanbedoneby membr anear oundt heparasites
culturi
ngposi ti
v est ool
sin2.5% leadst ocy stf orm.
potassium di chr omat efor5-7days  Mal e&f emal egamet ocytesf ert
il
ize
atRT. &dev elopi nt ooocy stwhich
 Inli
ghti nfections, stoolsamplescan measur e10- 31um i ndiamet erwith
beconcent ratedusi ngSheather
’s 2-layeredwal l.
fl
otationtechni c.  Amat ur ecy sthas2spor ocy sts.
 Eosinophi l
ia&char cot-l
eyden
crystalsinst ool s. PATHOLOGY&CLI NICAL
MANIFESTATI ONS:
Char
cot-
Ley denCr ystal s  Parasitizesormaydest roy
 Char cot-Leydencr ystal
saref or
med monocy t
es, reticulo- endot hel i
alcel
ls
fr
om t hebreakdownofeosi nophil
s &par enchy mal ort issuecel ls.
andmaybeseeni nthestool or  Post natally-acqui redi nfect ions
sput um ofpat ientswithparasit
ic o Ly mphadenopat hy ,febril
eor
diseases.   afebr i
le
 Thecr ystal
sar eslenderandpoi nt
ed o Ty phus- l
ikeexant hem
andst ainpur plish-r
edinthe o Meni ngoencephal it
is
tr
ichr omest ain, asshownint hi
s o Chor ioretinitis
i
mage.    React i
v ationofcer ebr al
 Thesecr ystalscanappeari na toxoplasmosi sinpWA&ot her
varietyofsi zesandonl yindicat
ean immunocompr omi sedst at es.
i
mmuner esponse, butthecause  Intr
aut erineorcongeni t
all
y -acquir
ed
mayormaynotbeapar asit
ic inf
ect i
ons–v arieswi ththev ir
ulence
i
nf ection. oftheor gani sm &t het i
meof
 Not reat menti snecessar yifthe pregnancydur i
ngwhi cht hei nfecti
on
i
nf ectionismi ld. istransmi tt
ed.

16
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asi
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ogy
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o General
izedacut e
toxopl
asmosi s
o Subacute&chr oniccourse
withpathologyconf inedto
theCNS
o Chroni
ccongeni t
al
toxopl
asmosi s
 Hy drocephal us
 Epi lept icseizures
 Chor ior et
init
is
 Cer ebr al
calcifications

TREATMENT, PREVENTI ON&CONTROL

-Combi nationofpy ri
met hami ne25- 50mg
dail
yfor1mont h&t r
isulfapy r
imidines2- 6g
dail
y.
-Foli
nicacidi sgiventocount eractBM
depressioncausedbypy r i
met hamine.
-Protectfoodf rom cont ami nati
onwi thcat
feces.
-Pregnantwomenshoul dbepr otectedf r
om
exposuret oinfecti
on.
DIAGNOSI S
 Di agnosedbyser ology .
o Sabi n-
Feldmandy et est
 Basedont her eact
ion
ofa( +)ser um onl i
v e
Toxopl asma
tr
ophozoi tes.
o I FA, I
HA, ELI SA
 Par asit
ei sseldom demonst ratedin
t
issuespeci mens.

 Blastocystishomi ni s
 Thedi agnosticf orm ofBl astocysti
s
homi nisfoundi nt hest ool of
patientsvari
esi nsi zef rom 6t o40
µm.
 Thepar asit
ei schar acterizedbya
centralbodyt hatmor phol ogicall
y
resembl esav acuol e.Thecent ral
bodypushest henucl ei t
ot he
peripheryofthecel l.
 Thet axonomyof  B.homi nishas
beenconf using, itiscur rentl
y
consideredapr otozoan.

17