Intestinal Protozoan infections

Invasive:

– AMOEBIASIS

Noninvasive:

– GIARDIASIS

– CRYPTOSPORIDIASIS

– CYCLOSPORIASIS
 AMEBIASIS

Entamoeba dispar
Entamoeba histolytica
 Epidemiology

• Man is the only host

• 10% of world population is infected

• 100 000 people die each year

• Endemic in countries with poor hygiene and

sanitation
 Epidemiology
• 90 % e.histolytica and 100 % of e.dispar infections
are asymptomatic

• All age groups are affected

• No sex difference

• Childhood amebiasis is relatively less common

• 30% homosexuals pass cysts in stools

• More common among asylums

• Significant problem in HIV

 Transmission

• By faecal contamination of drinking water

and foods

• Direct contact with contaminated hands or

objects

• Homosexual contact.

• Geophagy is a common route of infection

Faeco oral transmission: 5 Fs

– Finger

– Food

– Fluid

– Flees

– Fomites
 Clinical manifestations
• asymptomatic carrier state
• acute amoebic dysentery (proctocolitis)
• amoebic liver abscess
• amoeboma
• Lung abscess
• Cerebral abscess
• Poor host defense is still a mystery
 Amebic dysentery
• Initially watery diarrhea with fever and
dehydration; diffuse abdominal pain
• Later recurrent episodes of bloody diarrhea
• Can lead to fulminant colitis with increased
mortality; flask shaped ulcers
• Intestinal perforation and peritonitis
• Less commonly colonic strictures and peri anal
ulcers
 Ameboma

• Localized amebic infection

• Usually in caecum or ascending colon

• Clinically a palpable painful abdominal mass

in lower right abdominal quadrant

Extra intestinal amebiasis
 Liver abscess
• Fever
• Right upper quadrant tenderness
• Referred pain to right shoulder
• Hepatomegaly
• Jaundice and diarrhea rare
• Can rupture into pleural cavity or peritoneal cavity →
peritonoitis
 Lung abscess
• Hematogenous spread
• Caugh
• Dyspnea
• Pleuritic pain
• Pleural effusion
 Other complications

– Cerebral abscess - hematogenous

– Genitourinary amebiasis – rupture of abscess

– Pericarditis- hematogenous or rupture of

abscess
 Diagnosis
• Live motile trophozoites containing RBCs in
wet preparation of minimum 3 stool samples

• Specific antigen detection differentiates from

E.dispar-Enzyme immuno assay

• Colonoscopy and biopsy

• Barium enema studies are contraindicated

• Aspiration of liver abscess

Lab-diagnosis
 Treatment
• Asymptomatic:
– Paromomycin : 25mg/day in 3 divided doses for 7 days
– Diloxanide furoate: 20 mg/kg/day in 3 divided doses for 10
days

• Intestinal and hepatic:

– Metronidazole 40 mg/kg in 3 divided doses for 10 days
– Tinidazole 50 mg/kg in 2 divided doses for 3 days
Giardiasis
• Single Cell Protozoa
with 4 pairs of flagella

• Tear drop shape

• Freely motile

• Cyst contains 4 nuclei

 Epidemiology
• 15% or higher in developing countries
• Lives up to 2 months in cold water
• Colonizes in the intestines of mammals, birds, reptiles
• epidemics in orphanages and asylums
• Common in agamma globulinemeia and cystic fibrosis
• HIV is not a special risk
• breast milk protects infants
 Transmission

• Transmission by cysts

• Feco oral

• Swimming pools

• Sexual transmission
 Symptoms

• No symptoms in 25%

• Acute self limited diarrhea

• Chornic diarrhea syndrome

 Symptoms of chronic diarrhea
• Incubation 1-2 weeks
• Greasy foul smelling stools
• Abdominal distension
• Flatulence
• Abdominal cramps
• Malaise and weight loss
• Intermittent constipation
Giardiasis- malabsorption

• Reduces intestinal
absorptive surface
• Steatorrhea
• Lactose intolerance
• Vit.A and B12 deficiency
• Failure to thrive
 Lab findings

• Live motile parasites in stools and duodenal

aspirates

• Detection of cysts in stools

• Giardia antigen detection (ELIZA)

 Treatment

• Metronidazole: 5 mg/kg 3 times/day for 5

days

• Tinidazole: 50 mg/kg single dose

• Nitazoxanide 100 to 200 mg BD for 3 days

• Furazolidine 1.5 mg 4 times/day for 7-10 days

 Cryptosporidiasis
• Cryptosporidium parvum

• Intracellular protzoan

• Infects animals and

humans

• Significant in HIV patients

 Transmission

• Transmission by oocysts

• Contaminated water supplies

• Swimming pools

• Lake water

• From infected humans and cattles

 Clinical

• Self limiting diarrhea in normal people

• Chronic course in HIV

• Fever nausea and vomiting

• Cholecystitis in immune compromised

 Treatment
Lab:
– Parasites in feces
– Demonstration of specific antibodies

Treatment:
– Nitazoxanide
 Cyclosporiasis
• Infects human and animals

• Worldwide distribution

• Feco oral transmission

• Watery diarrhea alternating with constipation

• Severe in immune compromised people

• Diagnosis by oocysts in stools

• Treatment: Cotrimoxazole
 Enteric potozoan

• A disease of open air defecation; poor hand

washing and anal sex

• HIV, immune deficient disorders a special risk

• Epidemics among Children in orphanage

 Prevention
• Sanitation- sanitary latrines

• Safe water

• Cooked food

• Peeled vegetables and fruits

• Hand washing

• Avoid food sold by street

vendors.