Lesson 6: Coccidian Parasites
Coccidian parasites
- Under class Sporozoa (Phylum Apicomplexa)
In class Sporozoa, the life cycle is characterized by an
alternations of generation:
1. Sexual : Sporogony – production of oocyst
2. Asexual : Schizogony (Merogony) – producing
merozoites (meronts)
COMMON COCCIAN PARASITES:
Cystoisospora belli (Isospora belli)
Cryptosporidium hominis
Cyclospora cayetanensis
Toxoplasma gondii
Sarcocystis hominis and Sarcocystis suihominis
 Cystoisospora belli
MORPHOLOGY
Infective stage: sporulated oocyst
MOT: ingestion of oocyst (contains 2 sporocyst with 4
sporozoites each) = 8 sporozoites
- Disease is common to children and male
homosexuals with AIDS
- Oocyst are being passed out by feces
LIFE CYCLE
Oocysts in feces  Immature oocysts with sporozoblast
 Immature oocysts with sporozocysts  Mature
oocysts with sporozoites (infective stage)  Human 
sporozoites will release (asexual reproduction) 
Macrogamete and microgamete (fertilization) 
Oocysts
PATHOLOGY
 Infection is usually asymptomatic. (among
immunocompent individuals or it may present
itself a self-limiting gastroenteritis)
 Symptomatic: diarrhea, fever, malaise,
abdominal pain and flatulence
 In AIDS patients, reports on dissemination of
parasite to other organs are present
*Stool – may contained Charchot-Leyden crystals
compared to Entameoba histolytica
- Flattened or damaged villi as compared to Gargia
lamblia
DIAGNOSIS
1. Direct microscopy
2. Concentration technique (FECT, ZnSO4 and
sugar floatation)
3. Staining techniques (Iodine, Kinyoun,
Auramine-Rhodamine)
4. Enterotest and duodenal aspirate
5. Molecular testing
NOTE:
- Ziehl-Neelsen method: granular red color
against a green background
- Almost all coccidian are acid-fast positive
TREATMENT
Asymptomatic: bland diet (soft foods) and bed rest
Symptomatic: Trimethoprim/Sulfamethoxazole
PREVENTION AND CONTROL
• Good sanitary practices
• Thorough washing and cooking of food
• Provision for safe drinking water
 Cryptosporidium hominis
MORPHOLOGY
Infective stage: oocyst (thick-walled)
NOTE:
- Thin walled oocyst: infect other enterocytes thus
resulting to autoinfection
- Thick walled oocyst: passed out with the feces
- 4 sporozoites
LIFE CYCLE
Thick walled Oocyst (4 sporozoites)  attach to
the surface of the epithelial cells of GIT  small
tropozoites (divide by schizogony) 
Merozoites  Gametocytes  Microgamete and
macrogamete  (fertilization)  Zygote  either
thin walled or thick walled oocysts (repeat)
PATHOLOGY
• Immunocompetent: self-limiting diarrhea within
2-3 weeks
• Immunocompromised: severe diarrhea, bile duct
and gallbladder maybe heavily infected, blunted
intestinal villi, varying degrees of malabsorption
land excessive fluid loss
• AIDS patient: severe form of diarrhea,
progressively worse and life-threatening
SOURCES OF INFECTION
• Faulty water purification system
• Swimming in contaminated recreation water
• One person to another: infected food handlers
• Nosocomial infection
DIAGNOSIS
1. Sheather’s sugar floatation or FECT
2. Kinyoun’s modified acid-fast stain (oocyst
appear as red-pink doughnut-shaped circular
organisms) – cheapest and simplest method of
diagnosis
3. IFA
4. DNA probe
TREATMENT
 No acceptable treatment yet
 Nitazoxanide – said to be effective in preliminary
studies
 Bovine colostrum, paromomycin and
clarithromycin  treatment of severe diarrhea
PREVENTION AND CONTROL
• Chlorination is NOT effective
• Use of multiple disinfectant and combined water
treatment
• Proper disposal of human and animal excreta
 Cyclospora cayetanensis
MORPHOLOGY
Infective stage: oocyst
Disease is usually self-limiting
MOT: ingestion
- Auto-fluorescent when viewed under ultraviolet
microscopy
 (A) An unsporulated oocyst, with undifferentiated
cytoplasm, is shown (far left), next to a sporulating
oocyst that contains two immature sporocysts.
(B) An oocyst that was mechanically ruptured has
released one of its two sporocysts.
(C) One free sporocyst is shown as well as two free
sporozoites, the infective stage of the parasite.
(D) Oocysts
(E) Auto-fluorescent when viewed under ultraviolet
microscopy

TREATMENT
• No treatment needed
• If pharmacologic treatment is warranted,
Cotrimoxazole is given.
- Immature oocysts are released –
PREVENTION AND CONTROL
ENVIRONMENTAL CONTAMINATION 
Sporolated oocysts • Good sanitary practices
• Access to safe and clean drinking water
PATHOLOGY
• Proper food preparation
• Chronic and intermittent watery diarrhea occurs in
early infection and may alternate with
constipation.  Toxoplasma gondii
• Fatigue, anorexia, weight loss, nausea, abdominal
pain, flatulence, bloating and dyspnea may MORPHOLOGY
develop. Infections are usually self-limiting.
Infective stages: tachyzoite, bradyzoite and the oocyst
• No death is associated
- Can be passed from mother to baby and blood Definitive host: Cats
transfusion
Complete life cycle occurs in cats
DIAGNOSIS
Humans – accidental/ incidental host
1. DFS
2. Concentration techniques
3. Kinyoun stain Clinical manifestation is apparent if immune system is
4. Fluorescent microscopy suppressed  AIDS patient
5. Safranin staining
- Cats are members of the Felidae family
6. PCR
  Sarcocystis hominis & Sarcocystis
suihominis
• S. hominis from cattle
• S. suihominis from pigs
• Definitive host: humans

LIFE CYCLE
Sporocysts  ingested by cow or pigs  enters
endothelials cell of the blood vessels (Schizogony)
 schizonts  Merozoites  penetrate muscle
cells  cysts with bradyzoides (infective stage)

LIFE CYCLE
Sporozoite  Tachyzoite (found during initial and - Ingestion of undercooked meat
acute stages of infection) – fast multiplying  - Ingestion of sporocysts
small multiplying bradyzoites (slow)  oocysts
PATHOLOGY
• Toxoplasmosis commonly asymptomatic, if
immune system is good.
• Encephalitis-most common manifestation

DIAGNOSIS
1. Biopsy- stained through hematoxylin and eosin
stain
2. Serodiagnostic methods- positive titer or a
four-fold rise in the titer
3. Sabin-Feldman methylene blue dye test – very
specific and sensitive
4. IHAT
5. ELISA
6. PCR

TREATMENT
• Pyrimethamine and Sulfadiazine
• These drugs keeps the Toxoplasma under control PATHOLOGY
but does not kill it.
• Sarcosporidiosis and sarcocystosis
PREVENTION AND CONTROL • Gastroenteritis, diarrhea, myalgia, weakness, fever
• For intermediate host, brain, muscle and kidney
• Good sanitation and hygiene
tissues maybe
• Proper food preparation
• damaged
• Pregnant women should avoid contact with cats • May cause abortion to cows
DIAGNOSIS
1. Fecal floatation methods  sporocysts will be
seen
2. Necropsy  schizonts will be seen
3. Western blot
4. Serologic tests (IFA, ELISA)
5. PCR (amplification of the 18S rRNA)

NOTE:

• Fecal flotation wet mount: to visualize sporocysts

using bright-field microscopy
• Flotation methods based on high density solutions
incorporating sodium chloride, cesium chloride, zinc
sulfate, sucrose, Percoll, Ficoll-Hypaque and other
density gradient media
• Identifiable with hematoxylin and eosin staining.
• Confirmatory staining: Periodic Acid Schiff (PAS)

TREATMENT
• No effective treatment is known
• Corticosteroids were found to be useful in muscular
inflammation
• Trimethoprim-sulfamethoxazole – seen as
potentially effective in treating intestinal infections

PREVENTION AND CONTROL

• Uncooked animal carcass should not be fed to other
animals
• Thoroughly cooking and freezing meat to kill
bradyzoites
Lesson 6: Coccidian Parasites
Coccidian parasites
- Under class Sporozoa (Phylum Apicomplexa)
In class Sporozoa, the life cycle is characterized by an
alternations of generation:
3. Sexual : Sporogony – production of oocyst
4. Asexual : Schizogony (Merogony) – producing
merozoites (meronts)
COMMON COCCIAN PARASITES:
Cystoisospora belli (Isospora belli)
Cryptosporidium hominis
Cyclospora cayetanensis
Toxoplasma gondii
Sarcocystis hominis and Sarcocystis suihominis
 Cystoisospora belli
MORPHOLOGY
Infective stage: sporulated oocyst
MOT: ingestion of oocyst (contains 2 sporocyst with 4
sporozoites each) = 8 sporozoites
- Disease is common to children and male
homosexuals with AIDS
- Oocyst are being passed out by feces
LIFE CYCLE
Oocysts in feces  Immature oocysts with sporozoblast
 Immature oocysts with sporozocysts  Mature
oocysts with sporozoites (infective stage)  Human 
sporozoites will release (asexual reproduction) 
Macrogamete and microgamete (fertilization) 
Oocysts
PATHOLOGY
 Infection is usually asymptomatic. (among
immunocompent individuals or it may present
itself a self-limiting gastroenteritis)
 Symptomatic: diarrhea, fever, malaise,
abdominal pain and flatulence
 In AIDS patients, reports on dissemination of
parasite to other organs are present
*Stool – may contained Charchot-Leyden crystals
compared to Entameoba histolytica
- Flattened or damaged villi as compared to Gargia
lamblia
DIAGNOSIS
6. Direct microscopy
7. Concentration technique (FECT, ZnSO4 and
sugar floatation)
8. Staining techniques (Iodine, Kinyoun,
Auramine-Rhodamine)
9. Enterotest and duodenal aspirate
10. Molecular testing
NOTE:
- Ziehl-Neelsen method: granular red color
against a green background
- Almost all coccidian are acid-fast positive
TREATMENT
Asymptomatic: bland diet (soft foods) and bed rest
Symptomatic: Trimethoprim/Sulfamethoxazole
PREVENTION AND CONTROL
• Good sanitary practices
• Thorough washing and cooking of food
• Provision for safe drinking water
 Cryptosporidium hominis
MORPHOLOGY
Infective stage: oocyst (thick-walled)
NOTE:
- Thin walled oocyst: infect other enterocytes thus
resulting to autoinfection
- Thick walled oocyst: passed out with the feces
- 4 sporozoites
LIFE CYCLE
Thick walled Oocyst (4 sporozoites)  attach to
the surface of the epithelial cells of GIT  small
tropozoites (divide by schizogony) 
Merozoites  Gametocytes  Microgamete and
macrogamete  (fertilization)  Zygote  either
thin walled or thick walled oocysts (repeat)
PATHOLOGY
• Immunocompetent: self-limiting diarrhea within
2-3 weeks
• Immunocompromised: severe diarrhea, bile duct
and gallbladder maybe heavily infected, blunted
intestinal villi, varying degrees of malabsorption
land excessive fluid loss
• AIDS patient: severe form of diarrhea,
progressively worse and life-threatening
SOURCES OF INFECTION
• Faulty water purification system
• Swimming in contaminated recreation water
• One person to another: infected food handlers
• Nosocomial infection
DIAGNOSIS
5. Sheather’s sugar floatation or FECT
6. Kinyoun’s modified acid-fast stain (oocyst
appear as red-pink doughnut-shaped circular
organisms) – cheapest and simplest method of
diagnosis
7. IFA
8. DNA probe
TREATMENT
 No acceptable treatment yet
 Nitazoxanide – said to be effective in preliminary
studies
 Bovine colostrum, paromomycin and
clarithromycin  treatment of severe diarrhea
PREVENTION AND CONTROL
• Chlorination is NOT effective
• Use of multiple disinfectant and combined water
treatment
• Proper disposal of human and animal excreta
 Cyclospora cayetanensis
MORPHOLOGY
Infective stage: oocyst
Disease is usually self-limiting
MOT: ingestion
- Auto-fluorescent when viewed under ultraviolet
microscopy
 (F) An unsporulated oocyst, with undifferentiated
cytoplasm, is shown (far left), next to a sporulating
oocyst that contains two immature sporocysts.
(G) An oocyst that was mechanically ruptured has
released one of its two sporocysts.
(H) One free sporocyst is shown as well as two free
sporozoites, the infective stage of the parasite.
(I) Oocysts
(J) Auto-fluorescent when viewed under ultraviolet
microscopy

TREATMENT
• No treatment needed
• If pharmacologic treatment is warranted,
Cotrimoxazole is given.
- Immature oocysts are released –
PREVENTION AND CONTROL
ENVIRONMENTAL CONTAMINATION 
Sporolated oocysts • Good sanitary practices
• Access to safe and clean drinking water
PATHOLOGY
• Proper food preparation
• Chronic and intermittent watery diarrhea occurs in
early infection and may alternate with
constipation.  Toxoplasma gondii
• Fatigue, anorexia, weight loss, nausea, abdominal
pain, flatulence, bloating and dyspnea may MORPHOLOGY
develop. Infections are usually self-limiting.
Infective stages: tachyzoite, bradyzoite and the oocyst
• No death is associated
- Can be passed from mother to baby and blood Definitive host: Cats
transfusion
Complete life cycle occurs in cats
DIAGNOSIS
Humans – accidental/ incidental host
7. DFS
8. Concentration techniques
9. Kinyoun stain Clinical manifestation is apparent if immune system is
10. Fluorescent microscopy suppressed  AIDS patient
11. Safranin staining
- Cats are members of the Felidae family
12. PCR
  Sarcocystis hominis & Sarcocystis
suihominis
• S. hominis from cattle
• S. suihominis from pigs
• Definitive host: humans

LIFE CYCLE
Sporocysts  ingested by cow or pigs  enters
endothelials cell of the blood vessels (Schizogony)
 schizonts  Merozoites  penetrate muscle
cells  cysts with bradyzoides (infective stage)

LIFE CYCLE
Sporozoite  Tachyzoite (found during initial and - Ingestion of undercooked meat
acute stages of infection) – fast multiplying  - Ingestion of sporocysts
small multiplying bradyzoites (slow)  oocysts
PATHOLOGY
• Toxoplasmosis commonly asymptomatic, if
immune system is good.
• Encephalitis-most common manifestation

DIAGNOSIS
7. Biopsy- stained through hematoxylin and eosin
stain
8. Serodiagnostic methods- positive titer or a
four-fold rise in the titer
9. Sabin-Feldman methylene blue dye test – very
specific and sensitive
10. IHAT
11. ELISA
12. PCR

TREATMENT
• Pyrimethamine and Sulfadiazine
• These drugs keeps the Toxoplasma under control PATHOLOGY
but does not kill it.
• Sarcosporidiosis and sarcocystosis
PREVENTION AND CONTROL • Gastroenteritis, diarrhea, myalgia, weakness, fever
• For intermediate host, brain, muscle and kidney
• Good sanitation and hygiene
tissues maybe
• Proper food preparation
• damaged
• Pregnant women should avoid contact with cats • May cause abortion to cows
DIAGNOSIS
6. Fecal floatation methods  sporocysts will be
seen
7. Necropsy  schizonts will be seen
8. Western blot
9. Serologic tests (IFA, ELISA)
10. PCR (amplification of the 18S rRNA)

NOTE:

• Fecal flotation wet mount: to visualize sporocysts

using bright-field microscopy
• Flotation methods based on high density solutions
incorporating sodium chloride, cesium chloride, zinc
sulfate, sucrose, Percoll, Ficoll-Hypaque and other
density gradient media
• Identifiable with hematoxylin and eosin staining.
• Confirmatory staining: Periodic Acid Schiff (PAS)

TREATMENT
• No effective treatment is known
• Corticosteroids were found to be useful in muscular
inflammation
• Trimethoprim-sulfamethoxazole – seen as
potentially effective in treating intestinal infections

PREVENTION AND CONTROL

• Uncooked animal carcass should not be fed to other
animals
• Thoroughly cooking and freezing meat to kill
bradyzoites