Advanced medical Parasitology

Chapter (3): Phylum

Sarcomastigophora Subphylum
Mastigophora

The
Flagellates'
‫السوطيات‬
1. Giardia lamblia
2. Trichomonas vaginalis
3. Blood and tissue

Leishmanial spp.

and Trypanasoma spp.

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Subphylum Mastigophora, the flagellates

These living organisms possess one or more than one flagellates. The
beating of the flagella enables them to move, swim and adapt to wider
range of environments.

Flagellates are inhabit the reproductive tract, alimentary canal and also the
blood stream, lymph vessels and cerebrospinal canal.

They are pathogenic or commensals

Digestive tract and urinogenital tract flagellates

1. Giardia lamblia, duodenal, pathogenic

2. Chilomastix mesnili, large intestine, commensal

3. Trichomonas hominis, large intestine, commensal

4. Trichomonas tenax, mouth, commensal.

5. Retortamonas intestinalis, intestine commensal

6. Enteromonas hominis, intestine commensal

7. Trichomonas vaginalis, vagina, urethra and sometimes prostate gland,

pathogenic.

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Cyst (Chilomastix mesnili)

trophozoite

Chilomastix mesnili commensals

Colon and caecum

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7-23 um x 6-8 Mm pathogenic.

Inhabits: vagina, urethra and prostate gland.

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Trichomonas hominis

5-14 X 7-10 Mm , commensals, large intestine.

Trichomonas tenax

4-16 X 2-15 um commensals , mouth, tartar.

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 Intestinal and luminal flagellates

Giardia lamblia

The cause of Giardiasis or Lambliasis

Hosts: human beings, pigs and monkeys.

Site of location (natural habitat): duodenum, (the upper small

intestine). Giardiasis is an infection of the small intestine that is caused by the
parasite, Giardia duodenalis, also known as Giardia lamblia and Giardia
intestinalis.

Distribution :( Cosmopolitan) world _wide distributed parasite.

Mode of infection: by contaminated food and drinks (via the mouth),

no intermediate host or vector, but insects may distribute this parasite
mechanically.

Morphology: trophozoite, 12_15 um, flatten pear_ shaped organism

with 8 flagella.

2 axostyles: there are two anteriorly located large sucking discs. Two
nuclei and two parabasal bodies. Multiply by binary fission inside the gut.

Cyst: 9-12 Mm in length, ellipsoidal in shape contains four nuclei. It is

the infective stage.

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Life cycle: infection occurs by ingestion of cysts, excystation occurs in
the duodenum and trophozoites colonize the upper small intestine, attach
to the submucosal epithelium via the ventral sucking discs.

The free trophozoites encyst as they move down and mitosis takes place
during the encystment. The cysts are passed in the stool.

Pathology and symptoms:

The parasites do not invade the tissues but feed on the mucous secretions.
In acute infection there is duodenal irritation with excess secretion of

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mucous and dehydration accompanied by dull epigastric pain. Flatulence
and chronic diarrhea with steatorrheic type (steatorrhea) of stool contain
mucous and fat but no blood. Loose of weight due to dehydration and poor
appetite.

Occasionally the parasites are found in the bile ducts and even in the
gallbladder. Gallbladder colic and jaundice, abdominal distension, nausea,
and vomiting. The more chronic stage is associated with vitamin B12
malabsorption, disaccharide deficiency and lactose intolerance.

Diagnosis:
1. Clinical symptoms

2. Stool examination to find cyst and trophozoite

3. Duodenal aspiration

Treatment:

1.Metronidazole

2. Dyrade M (Entamizole)

3. Tinidazole

4. Quninacrine (atabrine)

Immunology: infection with this parasite produces antibody. This

antibody is detectable which is useful in diagnostic the infection, but it is
not protective so re-infection is very likely.

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