RochLista [PARASITOLOGY]

CHAPTER 4
The Flagellates

Morphology and Life Cycle Notes o Enteromonas hominis

 Flagella: whiplike structures for o Retortamonas intestinalis
movement in their trophozoite form  Extraintestinal Species
 All flagellate life cycles consist of the o Trichomonas tenax
trophozoite form o Trichomonas vaginalis
 Cysts, are not known to exist in several
of the flagellate Giardia intertinalis
 flagellates reside mainly in the small  Common associated disease or
intestine, cecum, colon condition names:
o exception: Giardia intestinalis, o Giardiasis
in the duodenum o traveler’s diarrhea
 flagellate cysts are equipped with thick,  Also known as Giardia lambia and
protective cell walls Giardia duoenalis
 Initially known as Cercomonas
Laboratory Diagnosis intestinalis
 presence of either or both flagellate  Giardia trophozoites have often been
morphologic forms is diagnostic in stool referred to as resembling an old man
 undulating membrane: finlike structure with whiskers, a cartoon character,
connected to the outer edge of some and/or a monkey’s face
flagellates (also axostyle)  G. intestinalis and Trichomonas
 axostyle: rodlike support structure vaginalis are both known to be carriers
found in some flagellates of doublestranded RNA viruses
 Morphology: Trophozoites
Pathogenesis and Clinical Symptoms o Bilaterally symmetrical
 Flagellates are often recovered from trophozoite
patients suffering from diarrhea o has a characteristic tear drop or
without an apparent cause pear shape
 G. intestinalis: only intestinal flagellate o Falling leaf motility
o considered pathogenic

Overview:
 Morphology: with flagella
 Morphologic forms: Trophozoite, only
some are with cyst
 Laboratory diagnosis: trophozoite and
or cyst in stool samples
 Replication: excystation and
encystation

Classification
 Intestinal Species
o Giardia intestinalis
o Chilomasti mesnili
o Dientamoeba fragilis
o Trichomonas hominis
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 Morphology: Cysts
o Cystic forms are colorless, ovoid
and contains 2-4 nuclei
o Cytoplasm is retracted from cell
wall
Laboratory Diagnosis
 specimen of choice for the traditional
recovery technique of trophozoites and
cysts is stool
 DFS
 Concentration techniques
 Examination of duodenal contents for
trophozoites
 Entero-string test
 Duodenal biopsy
 ELISA using Gisrdial antigen in the stool
maybe uses
Epidemiology
 Found worldwide (lakes, streams, and
other water sources)
 considered to be one of the most
common intestinal parasites, especially
among children
 Ingestion of water contaminated with
G. intestinalis is considered to be the
major cause of parasitic diarrheal
outbreaks in the United States
 Cyst are resistant to chlorination
 May be transmitted through fecal oral
route
 Unprotected sex
 animal reservoir hosts: beavers,
muskrats, and water voles
Clinical Symptoms
 Asymptomatic Carrier State
 Giardiasis (Traveler’s Diarrhea)
o Patients suffering from a severe
case of produce light-colored
stools with a high fat content
that may be caused by
secretions produced by the
irritated mucosal lining
o exhibits steatorrhea
Treatment
 Metronidazole and Furazolidone (<5
years old)
Prevention and Control
 Proper water treatment
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 exercising good personal hygiene

 proper cleaning and cooking of food
 avoidance of unprotected oral-anal sex
 Campers and hikers are encouraged to
be equipped with bottled water

Chilomastix mesnili
 Common associated disease and
condition names:
o None (considered a
nonpathogen)
 Morphology: Trophozoites
o measures 5 to 25um long
o Has a characteristic pear
shaped
o stiff rotary motility
o broad anterior end tapers  Morphology: Cysts
toward the posterior end of the o have a characteristic lemon
organism shape with clear anterior
o structure bordering the hyaline knob
cytostome resembles a
shepherd’s crook and is the
most prominent of several
supporting cytostomal fibrils
o spiral groove
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Laboratory Diagnosis arranged in a symmetrical

 freshly passed liquid stools reveals only fashion
trophozoites o iron hematoxylin: stain of
 Formed stool samples reveal only cysts choice for distinguishing the
 Samples of semiformed consistency individual chromatin granules
may contain trophozoites and cysts
 encystation has been known to occur in
unformed samples

Epidemiology
 transmission occurs when infective
cysts are ingested
o hand-to-mouth contamination
o contaminated food or drink

Prevention and Control

 Proper personal hygiene
 public sanitation practices

Dientamoeba fragilis
 Common associated disease and
condition names:
o Dientamoeba fragilis infection
(symptomatic)
 was initially classified as an ameba
because this organism moves by means
of pseudopodia and does not have
external flagella
 differs from the amebic trophozoites
when mounted in water preparations
 Hakansson phenomenon: numerous
granules are present in this stage and  Morphology: Cysts
exhibit Brownian motion o Does not possess a cystic stage
o feature diagnostic for the
identification Laboratory diagnosis
 Morphology: Trophozoites  Examination of stool samples for the
o measures 5 to 18um presence of trophozoites is the method
o Has a progressive motility of choice
supported by a broad hyaline  has the ability to blend in well with the
pseudopodia background material in the sample
 seen in freshly passed  DFS and Iodine wet preparation
stool
o irregular and roundish in shape Life Cycle Notes
o has two nuclei, each consisting  D. fragilis resides in the mucosal crypts
of four to eight centrally of the large intestine
located massed chromatin  rarely been known to ingest red blood
granules that are usually cells
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 transmitted via the eggs of helminth

parasites such as Enterobius
vermicularis and Ascaris lumbricoides

Clinical Symptoms
 Asymptomatic Carrier State
 Symptomatic
o diarrhea
o abdominal pain

Treatment
 iodoquinol: treatment of choice
 Tetracycline
 Paromomycin (Humatin)

Prevention and Control

 maintaining personal and public
sanitary conditions
 avoidance of unprotected homosexual
practices
 eradication of the helminth eggs
(pinworm)

Trichomonas hominis
 Common associated disease and
condition names:
o None (considered as a
nonpathogen)
 Morphology: Trophozoites
o measures 7 to 20 um
o pear shaped
o Exhibit characteristic nervous
jerky motility
 accomplished with the
assistance of a full
body-length undulating  Morphology: Cysts
membrane o Does not possess a cystic stage
o costa: rodlike structure located
at the base of the undulating Laboratory Diagnosis
membrane  Stool examination
 connects the
undulating membrane Epidemiology
to the trophozoite body  frequency of infections is higher in
o Flagella: 3 to five anterior and 1 warm climates
posterior  children appear to contract this parasite
more often than adults
 Transmission most likely occurs by
ingesting trophozoites
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 Contaminated milk is suspected of  Morphology: Cysts

being one of the sources of infection o oval to elongated
 Fecal-oral transmission may also occur o has 1- 4 nuclei
o yeast cells may often be
Prevention and Control suspected
 Improved personal and public sanitary o binucleated cysts appear to be
practices the most commonly
encountered, quadrinucleated
Enteromonas hominis forms may also occur
 Common associated disease and
condition names:
o None (considered as a
nonpathogen)
 Morphology: Trophozoites
o measures 3 to 10 um long
o oval shaped
o may also be seen in the form of
a halfcircle
o Has a jerky motility
o Contains a single nucleus with a
centrally located karyosome
o Has four flagella

Laboratory DIagnosis
 Examination of stool samples

Epidemiology
 Ingestion of infected cysts appears to
be the primary cause of E. hominis
transmission

Prevention and Control

 proper personal hygiene
 public sanitation practices
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Retortamonas intestinalis
 Common associated disease and
condition names:
o None (considered as a
nonpathogen)
 Morphology: Trophozoites
o measures 3 to 7 μm
o ovoid trophozoite exhibits
characteristic jerky motility

Laboratory Diagnosis
 stained stool preparation is the best
sample to examine for the presence of
R. intestinalis trophozoites and cysts

 Morphology: Cysts
o lemon- to pear-shaped
o measure from 3 to 9 μm in
length
o single nucleus, consisting of a
central karyosome, may be
surrounded by a delicate ring of
chromatin granules
Epidemiology
 existence has been documented in
warm and temperate climates
throughout the world
 Transmission is accomplished by
ingestion of the infected cysts
 patients in psychiatric hospitals and
others living in crowded conditions,
have been known to contract infections
Prevention and Control
 improved personal and public hygiene
conditions
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Trichomonas tenax
 Common associated disease and
condition names:
o None (considered
nonpathogen)
 Smallest flagellate
 Morphology: Trophozoites
o measures 5 to 14um
o Oval or pear shape
o Central nucleus
o Contains 5 flagella
o Contains undulating membrane,
costa, axostyle and cytosome
 Morphology: Cysts
o No cystic stage present
as a Laboratory Diagnosis
 specimen of choice for diagnosing T.
tenax trophozoite is mouth scrapings
 Tartar between the teeth and gingival
margin of the gums are the primary
areas of the mouth that may also
potentially harbor this organism
Epidemiology
 use of contaminated dishes and
utensils, as well as introducing droplet
contamination through kissing, may be
the routes of transmission
 trophozoites appear to be durable,
surviving several hours in drinking
water
Trichomonas vaginalis
 Common associated disease and
condition names:
o Persistent urethritis
o persistent vaginitis
o infant Trichomonas vaginalis
infection
 Morphology: Trophozoites
o measures up to 30 um
o Has a characteristic ovoid,
round or pearl like shape
o Has a characteristic rapid jerky
motility
o Contains 4 to 6 flagella
o Possess an undulating
membrane, axostyle
o Has single nucleus
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Epidemiology
 primary mode of transmission of the T.
vaginalis trophozoites is sexual
intercourse
 trophozoites may also migrate through
a mother’s birth canal and infect the
unborn child
 known to be transferred via
contaminated toilet articles or
underclothing (rare)
 sharing of douche supplies, as well as
communal bathing

Clinical Symptoms
 Asymptomatic Carrier State: occur in
men
 Persistent Urethritis
o condition that symptomatic
men experience as a result of a
T. vaginalis infection
o patients often release a thin,
white urethral discharge that
contains the T. vaginalis
trophozoites
 Persistent Vaginitis
o in women
o characterized by a foulsmelling,
greenish-yellow liquid vaginal
discharge after an incubation
period of 4 to 28 days
Laboratory Diagnosis
 Infant Infections
 Specimens of choice:
o infants suffering from both
o female patients: urine, urethral
respiratory infection and
secretion, vaginal and cervical
conjunctivitis
secretions
o male patients: semen and
Treatment
prostatic secretions
 Metronidazole
 unstained wet preparations:
trophozoites
Prevention and Control
 can be stained
 Personal hygiene
 specimen may also be cultured
 Avoid unprotected and promiscuous
o Whittington culture media
sexual intercourse
o Diamond’s modified media
o Feinberg medium