By Rusul Anwar

PROTOZOAL DISEASES

1.In The Blood:-

- Malaria
- Trypanosomiasis

2.In the gut:-

- Amoebiasis

- Giardiasis

3.In the tissues :-

- Toxoplasmosis

- Leishmaniasis
 AMOEBIASIS

- caused by = Entamoeba Histolytica

- spread between humans by = its cysts.

PATHOGENESIS
Cysts of E. Histolytica are ingested in contaminated water and
food.
In the colon, vegetative trophozoite emerge from the cysts where
they may invade the mucous membrane producing flask shaped
ulcers.
Localized granuloma (( AMOEBOMA)) is a rare complication
amoebic ulcers may cause severe hemorrhage but rarely perforate
the bowels

CLINICAL FEATURES
- Incubation period from 2 weeks to many years
- Abdominal pain
- Diarrhea with mucous and blood & offensive odors = (bloody
diarrhea )
- Tenderness over the line of the colon
- Diarrhea alternating with constipation is common
DIAGNOSIS
- Clinical
- GSE: motile trophozoites containing RBCs
- Sigmoidoscopy: typical flask shaped ulcers,
- In endemic area one third of the population are symptomless
( cyst passer )

TREATMENT
- Oral metronidizole 800 mg/8hr. for 5 days. OR
- Tinidazle 2 gm / day for 3 days
- Diloxanide furoate 500 mg /8 hr. for 10 days to eliminate
luminal cysts

Amoebic Liver Abscess:

50% has no history of recent diarrhea
Trophozoites may enter the portal venous radicale and carried to
the liver causing an amoebic abscess
The liquid content at first pinkish colure which may later change
to chocolate brown colure.
Usually single and mainly in the right lobe.
CLINICAL FEATURES
- Asymptomatic,
- local discomfort
- malaise
- later swinging temperature and sweating but the patient not
toxic.
- *Enlarged tender liver
- Cough
- right shoulder pain.
- **Large abscess may penetrate the diaphragm and rupture
into the lung or to the pleural cavity, peritoneal cavity or rarely
to the pericardial sac.

DIAGNOSIS
- Clinical
- High WBC count predominantly neutophilia
- CXR shows elevated right dome of diaphragm
- Abdominal ultrasound
- Aspirated pus shows characteristic appearance and rarely
amoeba
- Antibodies detected by IFAT in 95% of the cases.
 TREATMENT:
- Early: metronidazole 800mg / 8hr. for 5 days or
tinidazole 2 gm / day for 3 days.
- If the abscess is large or threaten to burst or if not
responding to medical therapy, aspiration is required
- Rupture to the pleura, peritoneal cavity or pericardial sac
necessitates immediate aspiration or surgical drainage

GIARDIASIS
It is caused by Giardia Lamblia
The cysts remain viable in water for up to 3 months and infection
usually occur by ingestion of contaminated water.
The flagellate attach to the mucosa of the duodenum and
jejuenum.

CLINICAL FEATURES:
- Incubation period 1 – 3 weeks
- Diarrhea, abdominal pain,
- weakness,
- anorexia,
 - nausea and vomiting..
- O/E there may be abdominal distention and tenderness
- Some patients run in chronic phase with lethargy, flatulence
and loss of weight & malabsorption.

INVESTIGATIONS:
- GSE for the cyst ± flagellate
- Duodenal or jejunal fluid exam for the parasite
- Jejunal biopsy may shows partial villous atrophy and may
shows Giardia on the surface of the epithelium.

TREATMANT:
- Single dose of tinidazole 2 gm OR
- Metronidazole 2 gm once daily for 3 days OR
- Metronidazole 400mg/ 8 hr. for 10 days. OR
- Albendazole 400mg / day for 5 days.

All the best