Dr. Amr M.

Mohamed
Professor Laboratory Medicine
Faculty of Applied Medical Sciences
Umm Al-Qura University
 Phylum: Sarcomastigophora
SubPhylum: Mastigophora

Flagellates
Intestinal Flagellates (Giardia lamblia)
Urogenital Flagellates (Trichomonas vaginalis)
Blood and Tissue Flagellates (Leishmania spp.
& Trypanosoma spp.)
 Giardiasis
 Giardiasis is an intestinal parasitic infection caused
by flagellated protozoa Giardia lamblia (also called G.
intestinalis & G. duodenalis).

 It is cosmopolitan, but more prevalent in regions with

poor hygiene, particularly of water sanitation. It is known
to cause epidemic, endemic or traveler’s diarrhea
through the world.

 DH: Man (more common in children).

*Giardia affects many animals as well.
 Transmission
o Via fecal-oral route by ingestion of contaminated
water & food, or by person-to-person contact (eg. in
day care centers).

o Contaminated water is the most common source

of infection.

o It is unclear whether or not humans can contract

the infection from animals.

*Giardia cysts survive outside the body for several

months, and are also relatively resistant to chlorination.
 Life cycle
 Infection occurs after ingestion of
mature quadrinucleate cysts (IS) in
contaminated water or food.
 Cysts release trophozoites that
multiply actively by longitudinal
binary fission in the duodenum.
these live free in the lumen of the
small intestine or attached to its
mucosa by a ventral sucking disk.
Parasites encystation occurs
when they transit toward the colon.
 Trophozoites are passed in liquid
stool and cysts in formed stool.
Morphology
Trophozoite
Trophozoites are 10-20 µm long,
teardrop shaped and have:
. Two nuclei with central karyosome
. 4 pairs of flagella
. 2 longitudinal axostyles crossed by
2 parabasal bodies.

oConvex dorsal surface & flat/concave

ventral surface with an adhesive disc
Morphology
Cyst
Mature cysts are 8–12 µm long, ovoid,
with a granular cytoplasm containing:
- . 4 nuclei
- . median bodies
- . longitudinally oriented fibrils.
 Pathogenesis & clinical picture
 Giardiasis is Not invasive. Trophozoites inhabit the
duodenum and jejunum (occasionally the bile duct).
 May feed on mucous secretions  giving no symptoms.

* In heavy infections, the mucosa

is carpeted by trophozoites

 Trophozoites attach to the surface

of mucosa and induce mucosal
abnormalities:
 Pathogenesis & clinical picture (cont.)

 Mechanical irritation and toxic effects  cause duodenitis [epigastric

pain, diarrhea & flatulence].
 Physical obstruction  blockage of nutrients uptake, reduction of
enzymes secretion & interference with fat-soluble vitamins absorption
(eg. B12)  maldigestion & malabsorption  Steatorrhea (fatty
diarrhea).
 Severe symptoms occur with impaired immunity  persistent
diarrhea, steatorrhoea, hypoproteinaemia & fat-soluble vitamins
deficiencies.
 Trophozoites may reach the biliary passage  cholecystitis &
cholangitis  jaundice & biliary colic.
Diagnosis
 Clinical diagnosis: Clinical picture.

 Laboratory diagnosis:

1. Stool examination:
 Macroscopically: the stool is foul–smelling pale
yellow, loose, frothy & floats.
 Microscopically: trophozoites are found in
diarrheic stool and cysts in more consistent
specimens.
- Directly or concentration methods (floatation).
- Wet mount and/or permanent stained films.
 Diagnosis (cont.)
2. Examination of duodenal aspirate
 String Test (Entero-test):
A gelatin capsule attached to a long string
is swallowed by the patient and the free
end of the string is taped to his cheek.
The capsule dissolves in the stomach and
the fuzzy part of the string passes into the
small bowel.
After 4h, it is removed and the collected
material (mucus, secretions, etc.) is
examined for trophozoites.
 Diagnosis (cont.)
3. Alternative methods
Coproantigens detection tests:

 ELISA

 Immunochromatographic
assays (rapid tests).
Treatment

Metronidazole (Flagyl)
OR
Tinidazole (Fasigyn).
 Prevention & Control

 Safe water supply & proper waste disposal.

Cysts are resistant to chlorination  boil suspected

water or treat with iodine tablets.

 Washing food (raw vegetables) with clean water.

 Avoid use of human feces as fertilizer.

 Health Education (good personal & community

hygiene).
Trichomoniasis
 Trichomoniasis is a sexually transmitted urogenital
parasitic disease caused by flagellated protozoa
Trichomonas vaginalis.

 It is cosmopolitan.

 Host: Man.

 Habitat in females: Vagina, urethra & urinary bladder.

 Habitat in males: Urethra, urinary bladder, prostate &
seminal vesicle.
 Life cycle
 Mode of transmission
 Sexual intercourse.
 Contact with contaminated
under wear or W.C. seats.
 During passage through
the birth canal in newborns.

 Reproduction:
By longitudinal binary fission.
 Morphology Trophozoite
 T. vaginalis exists only as a trophozoite stage, which:
 is pear-shaped, ~15x8 µm in size.
has 5 flagella (4 anterior free & 1
marginal) & an undulating membrane.

 has a very small antero-

lateral cytostome & a nucleus.

 has an axostyle extending

from anterior to posterior ends
& protrude outside.

Trophozoite is the IS & DS

Pathogenesis & Clinical Picture
Infection occurs when vaginal pH becomes less acidic.
Mechanical & toxic irritation of the mucosal epithelium
by trophozoites produce inflammation.

 in female: infection may be asymptomatic or the

patient suffers from irritating vaginal discharge
(leucorrhoea) associated with itching, odor, burning
sensation and dysuria.
*on examination: there are erythema of the vulva,
excessive vaginal discharge with inflammation.

 in male: Infection is mainly symptomless. There

may be thin discharge, dysuria with pain in the groin.
Diagnosis
I- Clinical diagnosis: symptoms and signs.
II- Laboratory diagnosis:
 Microscopic examination:
of wet films prepared from vaginal, urethral & prostatic
discharge or urine sediment  showing trophozoites
with fast active movement.
 Culture: on suitable media.

 Immunological tests: for detection of T. vaginalis

antigens in discharge.
 molecular techniques.
Treatment

Flagyl oral tablets

or
Flagyl vaginal insert for married females

Both sexual partners must be treated.

 Prevention & Control

 Treatment of patients, both sexual partners and

asymptomatic males.

 Good personal hygiene, avoidance of shared

toilet articles & under-clothes.