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Atrial Flagellates
 Generally have one to several long
flagella in trophozoite form ( except D.
fragilis: pseudopodia)
 Some species have rudimentary mouth
Subphylum Mastigophora called cytostome
 Neuromotor apparatus consists of
(Atrial Flagellates) (Atrial Flagellates) kinetoplast and axoneme
 Reproduction is through binary
fission.
 G. duodenalis and C.mesnili have cyst
and troph forms, the others exist in
trophozoite stage only.

PATHOGENIC
Atrial Flagellates
o Giardia lamblia
 Also known as:
Trichomonas vaginalis  Giardia duodenale
Giardia duodenalis  Giardia intestinalis
NON-PATHOGENIC  Giardia lamblia
(Atrial Flagellates) o Chilomastix mesnili  Lamblia duodenalis
LEGEND o Retortamonas intestinalis  Lamblia intestinalis
o Intestinal parasite o Pentatrichomonas hominis  First discovered by Antoine Van Leeuwenhoek
 Vaginal parasite
 Gingival parasite Trichomonas tenax  First described by French scientist Dr. F.
Lambl and Czechoslovakian scientist Dr.
Questionable pathogenicity Giard: Cercomonas intestinalis
o Dientamoeba fragilis  Stiles coined Giardia lamblia

Giardia duodenalis
(Trophozoite)
kinetoplast
PARAMETER DESCRIPTION
Size range: 8-10 um long
5-16 um wide

costa Shape: Pear-shaped, teardrop

Motility: Falling-leaf
Appearance: Bilaterally symmetrical
Nuclei: Two ovoid-shaped, each
a large karyosome
No peripheral chromatin
Flagella: Four pairs,origination of each:
one pair, anterior end
axoneme one pair, posterior end
two pair, central, extending
laterally
Other structure: Two median bodies
Two axonemes
Sucking disk

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Giardia duodenalis
(Cyst) Life cycle
PARAMETER DESCRIPTION

Size range: 8-17 um long

6-10 um wide

Shape: Ovoid

Nuclei: Immature cyst, two

Mature cyst, four
Central karyosomes
No peripheral chromatin

Cytoplasm: Retracted from cell wall

Other structure: Median bodies: two in

immature cyst or four
Interior flagellar
structures

 Asymptomatic Carrier State

 Villous flattening and crypt hypertrophy
 Giardiasis
Epidemiology
 Acute

 Found world-wide in lakes, streams,  Abdominal pain

and other water sources.
Clinical  Malaise and Flatulence
symptoms  Odor of rotten egg flatus (Hydrogen sulfide)
 Chronic
 Steatorrhea (greasy, frothy stool that floats)
 Failure to thrive syndrome
 Malabsorption of electrolyte, glucose, fluid
 Gay Bowel Syndrome

 🔬 Non-invasive procedure
 Stool examination
 Enterotest

 🔬 Invasive procedure
Diagnosis of  Duodenal aspirate
Giardia  Biopsy
duodenalis  🔬 Immunologic and Molecular methods
 Direct Fluorescent Antibody – gold standard
 EIA and ELISA
 Western Blot
 PCR

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Giardia duodenalis

 Metronidazole
 Tinidazole
Treatment
 Nitazoxanide

🔬
🔬
Proper water treatment and control
Exercising good personal hygiene
Chilomastix mesnili
Prevention and 🔬 Proper cleaning and cooking of food
control 🔬 Avoidance of unprotected anal and oral sex

Chilomastix mesnili Chilomastix mesnili

(Trophozoite) (cyst)
PARAMETER DESCRIPTION
PARAMETER DESCRIPTION
Size range: 5-25 um long
5-10 um wide
Size range: 5-10 um long
Shape: pear-shaped
Motility: Rotary, Cork screw, Jerky movement Shape: lemon-shaped, with clear hyaline knob
extending from the anterior end
Nuclei: One, with small central or eccentric karyosome
No peripheral chromatin

Flagella: Four (total) Nuclei: One, with large central karyosome

3 extending from anterior to end no peripheral chromatin
1 extending posteriorly from cytostome region

Other structure: well-defined cytostome

Other structure: Prominent cytostome (extending 1/3 to 1/2 located on one side of the nucleus
body length)
Spiral groove

LIFE CYCLE Life cycle Chilomastix mesnili

C. mesnili is cosmopolitan in its distribution and prefers warm climate.
Epidemiology This may occur primarily through hand-to-mouth contamination or via
contaminated food or drink
Traditional examination of freshly passed liquid stool
Diagnosis Iodine wet preparation for demonstration of cyst.
Clinical
Asymptomatic
Symptoms

Treatment No treatment is necessary

Proper personal hygiene

Prevention and Public sanitation practices
control

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 Originally described as an ameba, but

molecular study, ultrastructure observation
through electron microscope and presence of
no cystic stage determines that it is closely
Dientamoeba fragilis related to the trichomonads (flagellate).
 Common in mental institutions, missionaries,
pediatric population and patients younger than
Characteristics 20 years old. Sometimes isolated in homosexual
Dientamoeba fragilis men that are symptomatic.
 Co-infection with Enterobius vermicularis
 Hakansson phenomenon: D. fragilis differs
from the amebic trophozoites when mounted in
water preparations. Although both types of
organisms swell and rupture under these
conditions, only D. fragilis returns to its normal
size. Numerous granules are present in this
stage and exhibit Brownian motion.

Dientamoeba fragilis
(Trophozoite)  Life cycle is unknown.
PARAMETER DESCRIPTION  Exact transmission is not yet well understood; no
Size range: 5-18 μm fecal-oral, foodborne or waterborne
transmission has been documented, but
Shape: Irregularly round
transmission is associated to helminthic eggs
Motility: Progressive, broad hyaline pseudopodia especially Enterobius vermicularis (Pinworm)
Clinical eggs.

Nuclei: One or Two (most of the time), each

symptoms  The parasite is isolated from both asymptomatic
consisting of massed clumps of and symptomatic patients, so many still argues
four to eight chromatin granules
No peripheral chromatin about the pathogenicity of this parasite. New
studies shows its role as a pathogen.
Cytoplasm: Bacteria-filled vacuoles common
 Symptomatic patients have intermittent diarrhea
and fatique in young population [Irritable bowel
syndrome (IBS)]

 NO available rapid test kit. Dientamoeba fragilis

 Microscopic evaluation of freshly Diiodohydroxyquin

Diagnosis passed liquid stool is still the
Treatment Tetracycline
Metronidazole
standard procedure.
 Fixed stool with polyvinyl alcohol Fecal-oral transmission has not been documented but is
associated to helminthic eggs.
or Schaudinn’s fixative Prevention and Proper hygiene.
control Public sanitation practices
 Permanent stained smear: Iron
hematoxylin.
 Molecular techniques: RT-PCR

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Retortamonas intestinalis
(Trophozoite)
PARAMETER DESCRIPTION
Size range: 3-7 um long
5-6 um wide
Shape: ovoid
Motility: Jerky movement
Nuclei: One, with small central karyosome

Retortamonas intestinalis Ring of chromatin granules may be on nuclear

membrane
Flagella: Two anterior

Other structure: Cytostome extending halfway down body length

with well-defined fibril border opposite the
nucleus in the anterior end

Retortamonas intestinalis Retortamonas intestinalis

(cyst)
Rarely reported. Documented in warm and temperate climates
PARAMETER DESCRIPTION throughout the world. Poor sanitation and hygiene in
Epidemiology
psychiatric hospitals may lead to infection by ingestion of
Size range: 3-9 um long; 5 um wide infective cysts.
Shape: lemon-shaped, pear-shaped Permanently stained smear (Iron hematoxylin) is the best
Diagnosis
method for stool samples.
Clinical
Asymptomatic
Symptoms
Nuclei: One, located in anterior-central region with
central karyosome
With delicate ring of peripheral chromatin
Treatment No treatment is necessary

Other structure: two fused fibrils resembling bird’s beak

Proper personal hygiene
Prevention and Public sanitation practices
control

Enteromonas hominis
(Trophozoite)
PARAMETER DESCRIPTION
Size range: 3-10 um long
3-7 um wide
Shape: oval
Motility: Jerky movement
Nuclei: One, with small central karyosome

Enteromonas hominis No peripheral chromatin granules

Flagella: Four (total)

3 directed anteriorly
1 directed posteriorly

Other structure: None

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Enteromonas hominis Enteromonas hominis

(cyst)
Documented in warm and temperate climates throughout the
Epidemiology
PARAMETER DESCRIPTION world. Transmitted through ingestion of infective cysts.
Stool sample for wet mount or permanently stained smear is
Size range: 3-10 um long; 4-7 um wide
Diagnosis recommended.
Shape: oval, elongated May be missed by medtech because of small size.
Clinical
Asymptomatic
Symptoms
Nuclei: One to four, binucleated or quadrinucleated
located at opposite ends Treatment No treatment is necessary
Central karyosome, no peripheral chromatin

Proper personal hygiene

Other structure: None Prevention and Public sanitation practices
control

Pentatrichomonas hominis
(Trophozoite)
PARAMETER DESCRIPTION

Pentatrichomonas hominis Size range:

Shape:
7-20 um long 5-18 um wide
pear-shaped
Motility: Nervous, jerky
Nuclei: One, with a small central karyosome
No peripheral chromatin

Flagella: 3-5 anterior

1 posterior extending from the posterior end of
the undulating membrane

Other structure: axostyle that extends beyond the posterior end of

the body full body length undulating
membrane conical cytostome cleft in
anterior region ventrally located opposite the
undulating membrane

Pentatrichomonas hominis
🔬 P. hominis is found worldwide
Epidemiology 🔬 Transmission mostly occurs by ingesting trophozoites
🔬 Contaminated milk is one of the source of infection Trichomonas vaginalis
Stool sample for wet mount or permanently stained smear is
Diagnosis
recommended.
Clinical
Asymptomatic
Symptoms

Treatment No treatment is necessary

Proper personal hygiene

Prevention and Public sanitation practices
control

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Trichomonas vaginalis
(Trophozoite)
PARAMETER DESCRIPTION
Size range: 5-14 um long
Shape: ovoid, round or pear-shaped
Motility: Rapid, jerky Life cycle
Nuclei: One, ovoid, nondescript

Flagella: all originating anteriorly

3-5 extending anteriorly
one extending posteriorly
Other structure: Undulating membrane
Extending half of body length
Prominent axostyle that often
curves around nucleus granules maybe seen
along axostyle

 Men
 🔬 Infection with T. vaginalis occur  Asymptomatic Carrier state
worldwide.  Parasite resides in Prostate

Epidemiology  🔬 Sexual intercourse is the primary Clinical symptoms

 Women
 Optimum vaginal pH for infection: >6.0
mode of transmission.
 Parasite reside in vagina

 Men are asymptomatic (carrier) and  Persistent Urethritis (pyuria, dysuria)

 Persistent Vaginitis (yellow-green malodorous discharge)
Women are symptomatic. Infected
 strawberry cervix
women are usually 15-24 years of age.  Dyspareunia
 🔬 Can survive moist environment over  Complications:
 Neonatal infection during birth
extended periods of time like toilet
 Cervical cancer
utilities, damp towels, or underclothes.  Predisposition to HIV
 Neonatal infection: conjunctivitis, respiratory infection

🔬 Urine (SOC)
 🔬 Vaginal Secretions  🔬 Examination of saline wet prep

 🔬 Vaginal Scrapings Diagnosis  🔬 Papanicolaou smear (Best) or Giemsa smear

Specimens for
 🔬 Cervical Swabs  🔬 Urinalysis (seen during microscopic exam)
 🔬 Culture: InPouch TV (3 days), Modified Diamond
identification  🔬 Prostatic Secretions medium, Feinberg-Whittington medium
 🔬 Monoclonal antibody assays, Enzyme
Wet mount examination should immunoassays

be done within 10-20 minutes  🔬Fluorescent stains

from sample collection.  🔬 PCR Molecular techniques: Affirm VPIII (DNA)

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TREATMENT

Treatment Prevention and control 🔬 Practice safe, monogamous sex

and good personal hygiene
Metronidazole: DOC
🔬 Prompt treatment of cases and
Treatment of sexual partners is asymptomatic male patients
recommended
🔬 Public education

Trichomonas tenax
(Trophozoite)
PARAMETER DESCRIPTION
Size range: 5-14 um long
Trichomonas tenax Shape: oval or pear-shaped
Nuclei: One, ovoid nucleus; consist of
vesicular region filled with
chromatin granules
Flagella: 5 total, all originating anteriorly
4 extended anteriorly
1 extends posteriorly
Other structure: Undulating membrane extending 2/3 of body
length with accompanying costa
Thick axostyle curves around nucleus extends
beyond body length
Small anterior cytostome opposite to undulating
membrane

Trichomonas tenax
The exact mode of transmission is unknown
Some evidence suggesting that the use of contaminated dishes
Epidemiology
and utensils
Introducing droplet contamination through kissing
Diagnosis Specimen of choice is mouth scraping.Wet mount smear.
Clinical
Asymptomatic but is known to invade the respiratory tract
Symptoms

Treatment No treatment is necessary

Prevention and Proper and good oral hygiene

control