Sasha Anne L.

Valdez
OUTLINE FOR MODULE 7

1. Giardia lamblia

2. Trichomonas vaginalis

3. Chilomastix mesnili

4. Balantidium coli
Module 7: Protozoans (Flagellates and Ciliates)

Module Objectives:

1. Identify the major characteristics of specific

flagellates affecting humans.

2. Identify the major characteristics of Balantidium

coli (ciliate) affecting humans.
 http://thunderhouse4-
https://mykindofscience.com/2016/11/23/life- yuri.blogspot.com/2014/04/chilomastix
https://en.wikipedia.org/wiki/Trichomonas under-the-microscope-giardia-lamblia/ -mesnili.html
https://www.slideshare.net/AryaAnish/classification-of-flagellates-and-
giardia-lamblia

• Flagellates possess one or more

long, slender flagella used for
locomotion.

• They multiply by binary fission

& some species posses cyst
stages.
Giardia lamblia Trichomonas vaginalis
Chilomastix mesnili

https://www.labpedia.net/giardia-
lamblia-diagnosis/
 https://en.wikipedia.org/wiki/Giardia

• Formerly Lamblia
intestinalis and also
known as Giardia
duodenalis and G.
intestinalis.

KINGDOM Protista
SUBKINGDOM Protozoa
PHYLUM Sarcomastigophora
SUBPHYLUM Mastigophora
CLASS Zoomastigophora
ORDER Diplomonadida
FAMILY Hexamitidae
GENUS Giardia
SPECIES lamblia cause GIARDIASIS or
BACKPACKERS FEVER
https://www.slideshare.net/AryaAnish/classification-of-flagellates-and-giardia-lamblia
https://mykindofscience.com/2016/11/
23/life-under-the-microscope-giardia-
lamblia/
https://healthjade.net/giardia-duodenalis/

• resembles
a smiley
face.

“Old man
https://www.cdc.gov/dpdx/giardia
sis/index.html

People who see it

wearing under the
microscope often

eyeglasses” say that it

appears that the
trophozoites are
"staring back at
https://www.news-medical.net/health/Giardiasis-Intestinal-Infection.aspx them."
https://www.slideserve.com/buckminster-haney/protozoan-parasites
https://slideplayer.com/slide/4354620/
https://www.slideshare.net/NoeMendez9/giardia-lamblia-68686854

http://thunderhouse4-
yuri.blogspot.com/2010/
06/giardia-lamblia.html
https://www.onlinebiologynotes.com/giardia-lamblia-morphology-life-cycle-pathogenesis-clinical-manifestation-lab-
diagnosis-and-treatment/
 • have a distinct "tear-drop“/ half-pear shape and 2
nuclei with distinct karyosomes.

https://www.slideshare.net/NoeMendez9/giardia-
lamblia-68686854

http://www.atlas-
protozoa.com/gallery.php?SOT_C
AP=F_GIARD&link=index.php
http://www.atlas-
protozoa.com/gallery.php?SOT_CAP=F_GIAR
D&link=index.php#20
https://slideplayer.com/slide/7224561/

https://cmr.asm.org/content/13/1/35
1) two nuclei (Nu) with central
karyosomes (k),
2) fibrils running the length
of the parasite – axonemes
(Ax), and
3) Median Bodies (MB)
the axostyle does not disappear
during mitosis, otherwise playing a
fundamental role in this process; c)
axostyles participate in the
changes in the cell shape,
contortion of the anterior region of
the cell, and karyokinesis
 The median bodies are a
pair of curved rod-shaped
structures which lie
posterior to the nuclei.

• The function of the median

bodies are not known, but
most believe they are
somehow involved with the
adhesive disk and its
formation.

Their main food source is glucose.

Giardia obtains glucose from the
lumen of the small intestine by means
https://cmr.asm.org/content/13/1/35
of diffusion or pinocytosis.
 karyosome

An adhesive disk (AD),

not always visible by
light microscopy,
occupies the ventral side
also called ventral disk, sucking disk, https://en.wikipedia. of the anterior end.
sucker, striated disk org/wiki/Giardia_du
odenalis

Trophozoites exhibit a distinctive erratic
twisting motion, sometimes compared to
that of a falling/tumbling leaf.
Trophozoites are predominantly found
attached to epithelial cells of the small
intestine (especially the duodenum and
jejunum) and are rarely found in stools,
except in the cases of severe diarrhea.

Adhesive disk - this

structure plays a role in
the attachment of the
trophozoite to the
intestinal epithelium.

https://www.researchgate.net/figure/Giardia-lamblia-on-the-surface-of-the-villi-The-
trophozoites-are-variable-in-shape-The_fig3_7102458
PATHOGENESIS:
• Does not invade the tissues of the small
intestine. However, the trophozoites do
adhere closely to the lining of the small
intestine, & in heavy infections much of
the lining of the small intestine can be
covered with trophozoites.

• Covering of the intestinal epithelium by

the trophozoite & flattening of the
mucosal surface results in
malabsorption of nutrients.
http://www.medical-labs.net/giardia-intestinalis-g-lamblia-1335/
 • Optimal induction of encystment is obtained by
depriving the trophozoites of bile at pH 7
followed by an exposure to high concentrations of
bile at pH 7.8.

• The lack of bile at neutral pH mimics the conditions

https://www.researchgate.net/figure/Giardia-sp-life-cycle-Giardia-cysts-shed-in-
the-feces-are-infectious-Infection-occurs_fig4_234087025
under the mucus blanket adjacent to the intestinal
epithelial cells, wheras exposure to high
concentrations of bile at more alkaline pH is
analogous to the intestinal lumen.
 https://www.cbsnews.com/news/nature-up-
close-beavers-the-master-engineers/

https://daily.jstor.org/the-
busy-beneficial-beaver/

Zoonotic transmission is also possible,

and therefore Giardia infection is a concern for
people camping in the wilderness or swimming in
contaminated streams or lakes, especially the
artificial lakes formed by Beaver dams (hence
the popular name for giardiasis, "Beaver Fever").
 EPIDEMIOLOGY

• Man is the primary host although dogs,

cats, beavers, bears, pigs & monkeys
are also infected & serve as reservoirs.
• In the Philippines, it is the most widely
distributed intestinal flagellate with a
prevalence rate of 5-20 %.

• Giardiasis (GEE-are-DYE-uh-sis) is the

most frequent cause of non-bacterial
diarrhea in North America.
• Cysts also survive in water, e.g. in fresh
water lakes & streams.

• As a result, giardiasis is the most

common cause of water-borne,
parasitic illness in the United States.

• Giardiasis also has occurred as outbreaks

from recreational water sources such as
swimming pools, water parks, & hot tubs,
most likely because of an infected user
rather than a source of water that was
contaminated.
• Up to 20% of the world’s population is
chronically infected with Giardia lamblia
• most prevalent in developing countries
– poor sanitary conditions
– poor water quality control
– overcrowding
• more prevalent in children than in adults
• 25% of gastrointestinal diseases
• afflicts many homosexual men
• common in child day care centers
• many cases of "traveler's diarrhea" are
caused by Giardia.
 • Some have no symptoms at all
CLINICAL FEATURES • can cause a variety of intestinal symptoms

Traveler's
Diarrhea

https://www.researchgate.net/figure/Stages-and-symptoms-of-Giardiasis_tbl2_236920230
 • Diarrhea (sudden, explosive and
watery)

• steatorrhea (pale, foul smelling,

greasy stools)

• Gas or flatulence
https://www.dhaendoscopy.com/
blog/post/treating-chronic-
diarrhea.html • Stomach cramps

• Upset stomach or nausea

it takes ingestion of only
ten cysts to cause • Bloating, foul sulfuric belching
infection.

If not treated,
giardiasis can
last for months,
or even years.
 LABORATORY DIAGNOSIS

• identification of G lamblia trophozoites

or cysts in the stool via a stool ova and
parasite examination in stained
preparations or unstained wet mounts
with the aid of a microscope.

• aspiration of duodenal contents and

demonstration of trophozoites
 https://www.amazon.com/Potable-
Aqua-Purification-Tablets-
neutralizing/dp/B0009I3T3S

TREATMENT
• metronidazole
• quinacrine hydrochloride
 PREVENTION
• Practice good hygiene.
• Avoid water that might be contaminated.
- Heat the water to a rolling boil for at least 1 minute.
- Use a filter that has an absolute pore size of at
least 1 micron or one that has been rated
for "cyst removal."
- If you cannot heat the water to a rolling boil or
use a recommended filter, then try
chemically treating the water by chlorination
or iodination.
• Avoid food that might be contaminated.
• Avoid fecal exposure during sexual activity.
https://www.slideshare.net/drsomeshwaranamsana/free-living-
amebae-naegleria-fowleri-acanthamoeba-balamuthia-mandrillaris-
trichomonas-vaginalis-giardiasis
 Human Trichomonas Species

T. tenax oral cavity

T. hominis large intestine

T. vaginalis uro-genital
tract
Three Trichomonas species infect humans
and each inhabits a different anatomical
location.

a) T. tenax, also called T. buccalis, is

found in the tartar and around the
gums, as well as in the nasopharygeal
region.
- It is not considered pathogenic, but
it presence is usually indicative of
poor oral hygiene.
b) T. hominis is likely a non-pathogenic
commensal of the large intestine.

c) T. vaginalis is definitively associated

with human pathology and disease.
 pyriform/pear
in shape

https://twitter.com/ghayda_basfar/status/1045075671603703808
 - Jerky rapid motility or “bobbling” motility
in wet mounts.

https://www.slideshare.net/kamran66/toxoplasmatrichomonas
a lateral
expansion of the
plasma membrane
in some - Undulating memb. is
flagellates that is shorter
usually associated
with a flagellum. - Nuclear chromatin is
uniformly distributed

- cytoplasm contains
granules

- cytostome is less
prominent.

- 7 to 23 µm long w/ 4
anterior flagella and
a 5th forming the outer
edge of a short
undulating membrane. A
slender rod, the
axostyle, extends the
length of the body &
protrudes posteriorly.
Can survive outside the body at temperature as low
as 15 degrees C for up to 48 hours.
http://www.medical-labs.net/trichomonas-vaginalis-trophozoites-1190/
• T. vaginalis, despite its name, infects both men and women.

• In females the organism inhabits the vagina.

• In males it is usually found in the urethra, prostate, seminal vesicles or

epididymis.

https://www.britannica.com/science/Trichomonas-vaginalis
 • The life cycle consists only of a
trophozoite stage which is
transmitted by direct contact
during sexual intercourse.

• Non-venereal transmission is
rare, but possible since the
Main habitats: trophozoites can survive 1-2
days in urine and 2-3 hours
Male: Prostate on wet sponge.
Gland, urethra,
Seminal Vesicles • In addition, neonatals
Female: Vagina & have been infected
during the birth
urethra process.

• The trophozoites live

closely associated
or attached to the
Once outside epithelium of the
the body, the urogenital tract,
troph. is where they replicate
by binary fission.
destroyed by
temps.
above 40
degrees C, by
drying https://web.stanford.ed
& direct u/group/parasites/Para
Sites2005/Trichomonia
sunlight. sis/lifecycle.htm
https://www.slideshare.net/meducationdotnet/microbiology-
bacteria-fungi-yeasts-and-viruses
• The epidemiology of trichomonasis
exhibits features similar to other
sexually transmitted diseases and
incidence correlates with the number
of sexual partners.

• co-infection with other STDs is common.

https://www.drawittoknowit.c
om/course/immunology/glos
sary/immunology-
microbiology/trichomoniasis
- Most infections are asymptomatic or mild.

- Symptomatic infection is common in women, rare in

men.

- Trichomoniasis in women is frequently chronic & is

characterized by vaginitis, a vaginal discharge, &
dysuria.

- The inflammation of the vagina is usually diffuse & is

characterized by hyperemia of the vaginal wall (w/
or without small hemorrhagic lesions) & migration of
PMN leukocytes into the vaginal lumen.
 - Disease is produced when normal cell
destruction in the infected vagina is
unable to provide glycogen for normal
pop’lns of bacillus. These bacteria
metabolize glycogen to lactic acid thus
keeping the normal pH acid. With this
change in pH, opportunist bacteria &
trichomonads can survive.

https://www.cell.com/trends/parasitology/fulltext/S1
471-4922(18)30115-6
 • a "strawberry cervix" due
to a trichomoniasis.

• The term "strawberry

cervix" is used to describe
the appearance of the
cervix due to the presence
of T vaginalis protozoa.

• The cervical mucosa

reveals punctate
hemorrhages along with
https://quizlet.com/55368229/pathology-
gynaecology-flash-cards/
accompanying vesicles or
papules.
 Clinical Manifestations
Females Males

• asymptomatic (15%*) • asymptomatic (50-90%*)

• vaginal discharge (50- • urethral discharge (50-
75%*) 60%**)
• dyspareunia (50%*) – • dysuria (12-25%**)
[painful intercourse] [pain or discomfort in
• pruritus (25-50%*) urinating]
[or itch] • urethral pruritus
(25%**)
*% of infected; **% of symptomatic
https://www.pinterest.ph/pin/710513278694482563/
- Direct smear of sedimented urine vaginal
secretions or scrappings (in females).

- Direct smear of sedimented urine &

prostatic secretions (in males).

https://www.verywellhealth.com/how-is-
trichomoniasis-treated-3133273
https://www.slideshare.net/SumanChaudhary15/trichomonas-vaginalis-86895853
is a nonpathogenic intestinal
commensal of humans.

http://www.medical-labs.net/chilomastix-
mesnili-3241/
https://www.shutterstock.com/search/chilomastix+mesnili
 Blepharoplast - A cylindrical basal body of flagellates that
is composed of parallel peripheral rods connected to the
axial filaments of flagella or cilia.

https://www.pinterest.ph/mayelinmartin
ez/chilomastix-mesnili/

https://quizlet.com/515290094/parasit
https://slideplayer.com/slide/4886392/ ology-exam-3-flash-cards/
https://www.slideshare.net/MicrobeswithMorgan/parasitology-update-2018
 - 7 by 16 u; pear or lemon-shaped &
rounded in 1 end with a conical knob-like
protruberance at the other end & giving
it a nipple-like appearance; single
nucleus.

http://www.med-
chem.com/para-
site.php?url=org/chilm
ast

https://www.pinterest.ph/pin/38
https://www.slideserve.com/brad/trichomonas-vaginalis
1680137148688932/
 Trophozoite

The cytosome is evident with a curved

shepherd’s crook fibril. It also has a
characteristically coiled filament which
when stained is darker in colour.
https://www.slideserve.com/brad/trichomonas-vaginalis
 Trophozoites live on
bacteria found
in the lumen.

Divides by simple
binary fission.

https://www.shutterstock.com/image-vector/chilomastix-mesnili-parasitic-
microscope-371831749
PATHOGENESIS:
- A harmless commensal & does not
cause any symptoms.

DIAGNOSIS/TREATMENT/PREVENTION:

- Direct fecal smear flotation techs.

are applicable. Treatment is not
indicated. Preventive measures
follow those for amoebiasis.
https://en.wikipedia.org/wiki/Balantidium_coli
Balantidium coli

https://en.wikipedia.org/wiki/Balantidiasis

Kingdom: Protista
Phylum: Ciliophora
Class: Kinetofragminophorea
Subclass: Vestibulifera
Order: Trichostomatida
Family: Balantidiidae
Genus: Balantidium
Species: coli
https://slideplayer.com/slide/7531642/
 https://www.pinterest.ph/pi
https://www.pinterest.ph/MLA
n/381680137148691110/
B1231/balantidium-coli/

• surrounded by a vacuole & also contains a

large macronucleus & a small micronucleus.

https://www.slideshare.net/AhmedAhmed683/phylum-ciliophora-balantidium-coli
 https://www.veterinaryparasitology.com/balantidium.html

They are covered in

longitudinal rows of
cilia and have boring
or rotary motility.

https://www.slideshare.net/PakRose1/balanti
https://www.pinterest.ph/pin/1268
04545744176660/ dium-coli-31611889
https://www.slideshare.net/AhmedAhmed683/phylum-ciliophora-balantidium-coli
https://healthjade.net/balantidiasis/
https://www.slideshare.net/AhmedAhmed683/phylum-ciliophora-balantidium-coli
https://www.slideserve.com/slade/balantidium-coli
http://web.stanford.edu/group/parasites/ParaSites2003/Balantidiu
m/Life_Cycle.htm
• Infection occurs mostly in farm workers & other rural dwellers by ingestion
of cysts in fecal material of farm animals.

• Man-to-man transmission is rare but possible.

• has a worldwide distribution.
• more common in the tropics.
• easily transmitted to humans from swine by ingestion of cysts.

https://www.slideshare.net/NoeMendez9/balantidium-coli-68686775
https://slideplayer.com/slide/10412550/
https://www.slideserve.com/slade/balantidium-coli
CLINICAL SIGNS
• After ingestion of an infective Balantidium
coli cyst days to weeks may pass before
infection occurs.
• Common symptoms of Balantidiasis
– chronic diarrhea
– occasional dysentery
– nausea
– foul breath
– colitis
– abdominal pain
– weight loss
– deep intestinal ulcerations
– possibly perforation of the intestine
 degrade intestinal
tissue & facilitates
penetration of the
mucosa causing flask-
shaped ulcer

• trophozoites can invade the mucosa of the

large intestine and cause ulcerations.

https://www.slideserve.com/slade/balantidium-coli
• Many people clear the infection
spontaneously without treatment.

• If left untreated, balantidiasis can

become chronic.
– persistent diarrhea can lead to
high fluid loss and dehydration
– abdominal bleeding can lead to
death

https://www.slideserve.com/slade/balantidium-coli
https://www.slideshare.net/PakRose1/balantidium-coli-31611889