Lesson 2

PARASITIC PROTOZOA
(PROTISTA)
5 phyla which include human parasites
Rhizopoda
Ciliophora
Apicomplexa
Polymastigota
Euglenozoa
(Class Kinetoplastida
Order Trypanosomatida
Trypanosoma brucei Trypanosoma cruzi Leishmania species)
 Phylum RHIZOPODA - Amoebozoa Rhizopods
Class Lobosea - Lobosea
Entamoeba coli - amoeba non-pathogenic
Entamoeba histolytica amoeba Amoebic dysentery, amoebiasis,
Class Heterolobosea
Naegleria fowleri naegleria Primary amoebic
or brain-eating amoeba meningoencephalitis (PAM)
Phylum POLYMASTIGOTA – Polymastigota

Class Diplomonadea, Order Diplomonadida

Giardia lamblia (Lamblia Giardiasis
intestinalis)
giardia or lamblia
Class Parabasalea
Trichomonas vaginalis Trichomoniasis
Phylum Rhizopoda
• The amoebic organisms exist in two
states. The vegetative state is called
trophozoite. This is the metabolic stage
of the protozoan which is very sensitive
to the environment changes.
• As unfavorable conditions set in, the
organisms go through a process called
encystation. The cyst is the resistant
state of amoebic organisms.
• Excystation takes place with the return of
favorable conditions.
• Some species in this class also use the
encystation process for the purpose of
reproduction.
 Phylum RHIZOPODA (Amoebozoa)
GENERAL CHARACTERISTICS: pseudopodia for locomotion

Entamoeba histolytica
TROPHOZOITE
GEOGRAPHICAL DISTRIBUTION:
Cosmopolitan prevalent in the
tropics and subtropics.
PATHOGENESIS: amoebic
dysentery, amoebiasis
HABITAT: Primary Site: colon and
caecum (intestine)
Secondary Site: liver, lungs, brain. CYST
INTERMEDIATE HOST: None.
RESERVOIR HOST: Other mamalls.
INFECTED FORM: Mature cyst.
DIAGNOSTIC FORM Cysts,
trophozoites
MODE OF INFECTION: Ingestion.
SPECIMEN SOURCE: Faeces,
contaminated water
 • E. histolytica had been first described by Friedrich
Losch (1840–1903) in 1875 in the faeces of a Russian
peasant from Arkhangelsk (Archangel), and liver
‘abscess’ had been described by William Budd (1811–
80) in 1845. C M Wenyon (1878–1948) and Clifford
Dobell (1886–1949) were later responsible for a great
deal of work on E. histolytica during the Great War
(1914–18).

From Cook G.C. 2007.

TROPICAL MEDICINE: AN
ILLUSTRATED HISTORY OF
THE PIONEERS

Friedrich Lösch (1840–1903) Trophozoite of E. histolytica in saline

From 1890 prof. Kyiv University preparation
to be the head of doctor society of Kyiv (1894-97) Rai et al. 1996 Atlas-of-Medical-Parasitology

Федір (Фердінанд) Олександрович Леш

Trophozoite of E. histolytica
 • E. histolytica trophozoites have an amorphous
shape and are generally 15-30 µm in diameter. The
trophozoites move by extending a finger-like
pseudopodium (psd) and pulling the rest of the body
forward (called ameboid movement). The
pseudopodia, and sometimes the outer edge of the
trophozoite, have a clear refractile appearance and is
referred to as the ectoplasm (ecto). The rest of the
cytoplasm has a granular appearance and is
called the endoplasm (endo). Nuclear (Nu)
morphology in stained specimens is characterized by
a finely granular ring of peripheral chromatin and a
centrally located karyosome (ka).

Using DNA-specific stains it is possible to

identify a small spherical DNA-containing
body 1–2 μm in size that corresponds The nucleus is not usually
to rudimentary mitochondria. visible

Ribosomes appear to be ordered

in helical arrays

/www.tulane.edu
 The cytoplasmic vesicles
sometimes contain ingested red
blood cells in various stage of
disintegration.
Biopsy specimen containing E. histolytica
trophozoites with ingested red blood cells.
Original image courtesy of Dr. William Petri,
University of Virginia
(Daniel J. Eichinger. 2009. Ch. 28. Amebiasis.
Medical Parasitology Ed. Satoskaret al. L A N D
E S B I O S C I E N C E.
Trophozoite of E. histolytica in sygmoidoscopied
material with prominent ingested
red blood cells (H & E stain).

Rai et al. 1996 Atlas-of-Medical-Parasitology

TROPHOZOITE
• SIZE: 20 to 40 (11 to 60 μm.) CYST
• SIZE: 10–16 (11 to 20 μm).
• SHAPE : Irregular. • SHAPE : Spherical (nonstaining wall about 0.5 μm
• NUCLEUS: Vesicular, dispersed (4-7 thick).
μm). • NUCEUS: mainly single nucleus, about one-third of
its diameter
• NUMBER: One • NUMBER: BUT! One to four; the mature cyst has
four and rarely more.
Uninucleate and binucleate cysts of Quadrinucleate cyst of E. histolytica
E. histolytica in iodine preparation. in iodine preparation.
Trophozoite of E. histolytica in saline Trophozoite of E. histolytica
preparation (Phase contrast microscopy). (Merthiolate-Formalin stain).

Rai et al. 1996 Atlas-of-Medical-Parasitology

 Entamoeba dispar (formerly known as
non-pathogenic E. histolytica)

E. dispar is the most frequently found Entamoeba both in humans and

primates. Entamoeba histolytica and Entamoeba dispar are morphologically
identical species. E. dispar does not cause disease in humans.

Farthing et al., 2008. Intestinal Protozoa. Cook_Zumla_eds.

BUT!
 Octonucleate cyst of E. coli in iodine preparation
Rai et al. 1996 Atlas-of-Medical-Parasitology

Entamoeba coli

Entamoeba histolytica -
 cysts larger, with eight nuclei when mature; small, oval cysts with
chromatoid bars are rarely present but, four nuclei but no
when they are, they are thin chromatoid
bars

uninucleate cyst, often containing a large

glycogen vacuole which stains dark brown
with iodine but appears clear in fresh
specimens

Schematic depictions of the morphology of the E. histolytica

trophozoite and cyst, as compared to other amoebae found in the human
intestine. Reproduced from Nappi AJ, Vass E, eds. Parasites of Medical
Importance. Austin: Landes Bioscience, 2002:20.
Entamoeba histolytica, Entamoeba dispar, Entamoeba moshkovskii, Entamoeba
polecki, Entamoeba coli, and Entamoeba hartmanni reside in the human intestinal
lumen

E. hartmanni:
cysts smaller
than those of
E. histolytica,
but with four
nuclei and
chromatoid
bodies of the
E. histolytica
type

Rashmi Fotedar et al., 2007. Laboratory Diagnostic Techniques for Entamoeba Species
Entamoeba histolytica
life cycle

Mammals such as dogs and

cats can also become infected
but do not contribute
significantly to transmission
 Amoebiasis
CLINICAL SYNDROMES
3 Severe disease
1 Asymptomatic carriage
• High fever
2 Mild disease
• Dehydration
• Loose stool (± blood)
• Severe bloody
• Low-grade fever,
diarrhoea
malaise, anorexia
• Abdominal pain;

FROM Matthews 2012 Tropical medicine notebook

Entamoeba histolytica location in human body

Trophozoite of E. histolytica in
liver tissue (H & E stain).
 Amoebic abscesses may be
found in all age groups, but are 10
times more frequent in adults than
in children and are more frequent in
males than in females. They are
more
common in the poorest sectors or
urban populations. Approximately
20% of patients have a past history
of dysentery. About
CT scan images of a patient with a 10% of patients have diarrhoea or
right lobe amoebic liver abscess dysentery at the time of diagnosis
Daniel J. Eichinger. 2009. Ch. 28. Amebiasis. Medical Parasitology Ed. of amoebic liver abscess.
Satoskar et al. L A N D E S B I O S C I E N C E.

FROM Matthews 2012 Tropical medicine

notebook
 Diagnosis and differential diagnosis

Detection of the parasite

• Amoebiasis, although often suspected clinically, requires confirmation in
the laboratory by finding cysts and trophozoites in the stools or
trophozoites in the various tissues. The detection of the organism depends
on appropriate specimen collection, processing and examination by
trained personnel.

DIAGNOSIS
• Stool microscopy (≥ 3 samples)
--‘Hot’ (fresh) stool needed to identify trophozoites
--Cysts are indistinguishable from E. dispar
• Faecal ELISA (enzyme-linked immunosorbent assay)
--Distinguishes between E. histolytica and E. dispar
• Serology
--Only useful in non-endemic areas
• Endoscopy
--For colitis ± ulceration
--Contraindicated in severe disease

FROM
Matthews 2012 Tropical medicine notebook
Map courtesy of Atlas of Human Infectious Diseases, Copyright © 2012 Blackwell Publishing Ltd.
Distribution map of amoebic dysentery

The disease is found worldwide, with possibly 500 million infected and an
incidence of 48 million new cases each year (although only ~10% are
symptomatic). It is found in deprived communities, being associated with poverty
and inadequate sanitation. It is a major health problem in parts of Africa, Asia and
Latin America, where highly virulent strains may exist. Around 70 000 deaths
probably occur each year. (Cook_Zumla (eds.) 2008 Manson's Tropical Diseases
22nd Edition)
 Phylum RHIZOPODA (Amoebozoa)
GENERAL CHARACTERISTICS: pseudopodia for locomotion

Entamoeba histolytica
TROPHOZOITE
GEOGRAPHICAL DISTRIBUTION:
Cosmopolitan prevalent in the
tropics and subtropics.
PATHOGENESIS: amoebic
dysentery, amoebiasis
HABITAT: Primary Site: colon and
caecum (intestine)
Secondary Site: liver, lungs, brain. CYST
INTERMEDIATE HOST: None.
RESERVOIR HOST: Other mamalls.
INFECTED FORM: Mature cyst.
DIAGNOSTIC FORM Cysts,
trophozoites
MODE OF INFECTION: Ingestion.
SPECIMEN SOURCE: Faeces,
contaminated water
 Phylum RHIZOPODA Amoebozoa - Rhizopods
Class Lobosea - Lobosea
Entamoeba coli - amoeba non-pathogenic
Entamoeba histolytica amoeba Amoebic dysentery, amoebiasis,

Phylum Percolozoa Class Heterolobosea

Naegleria fowleri naegleria Primary amoebic
or brain-eating amoeba meningoencephalitis (PAM)
Phylum POLYMASTIGOTA – Polymastigota

Class Diplomonadea, Order Diplomonadida

Giardia lamblia (Lamblia Giardiasis
intestinalis)
giardia or lamblia
Class Parabasalea
Trichomonas vaginalis Trichomoniasis
 Phylum RHIZOPODA Phylum Percolozoa
Naegleria fowleri
COMMON NAME: brain-eating amoeba
GEOGRAPHICAL DISTRIBUTION:
Australia, Europe, and America.
• PATHOGENESIS: Primary amebic
meningoencephalitis (PAM).
• HABITAT: Usually free living;
the meninges in humans.
• INTERMEDIATE HOST: None. Rai et al. 1996 Atlas-of-Medical-Parasitology
• RESERVOIR HOST: None known.
• INFECTED FORM: trophozoite.
• MODE OF INFECTION: Active
penetration through the nostrils.
• LABORATORY IDENTIFICATION:
the diagnosis can be made by
microscopic examination of
cerebrospinal fluid (CSF). A wet
mount may detect motile
trophozoites

N.fowleri (Amoebic form) in brain tissue section

Naegleria is an ameba commonly found in warm
freshwater, surfaces of vegetation and mud (feeding on
bacteria). Naegleria is heat-loving (thermophilic)
organism! Cyst form found in the same locations as
the trophozoite.
Only one species of Naegleria infects people, Naegleria
fowleri. It causes a very rare but severe brain infection.
Case fatal ratio is greater than 95%. Usually, victims die
not later than 14th day after infection.

Flagellate stage of Naegleria fowleri

Naegleria fowleri trophozoites, cultured from

cerebrospinal fluid. These cells have characteristically
large nuclei with a large, dark staining karyosome. The
amebae are very active and extend and retract
pseudopods.
From a patient who died from primary amebic
meningoencephalitis in Virginia.

Free-living Amoeba: Global Status

Gideon Informatics, Inc., Dr. Stephen Berger 2018.
FROM Mei-Yu Su et al., 2013. A Fatal Case of Naegleria fowleri Meningoencephalitis in Taiwan

Motile forms of Naegleria fowleri trophozoites in cerebrospinal fluid.

(A) A motile N. fowleri, showing directional movements by means of blunt, bulbous pseudopodia (arrowheads),
with granular cytoplasm (arrow).
(B) The trophozoite is characterized by a nucleus (arrow) and phagocytizing an erythrocyte (arrowhead).
Naegleria fowleri life cycle
• How does infection
with Naegleria occur?

• Naegleria infects
people by entering the
body through the the
olfactory epithelium of
the nose.

• Generally, this occurs

when people use warm
freshwater for activities
like swimming or diving.
The ameba travels up
the nostrils to the brain
and spinal cord where it
destroys the brain
tissue. Infections do not
occur as a result of
drinking contaminated
water.
 Flagellate stage of Naegleria fowleri.
(Environmental isolate)

N.fowleri (Amoebic form) in brain tissue section

Rai et al. 1996 Atlas-of-Medical-Parasitology

Naegleria fowleri in human brain section.

(Stained by specific fluorescent antibody
test.)

(David C. Warhurst Ch. 80. Cook_Zumla (eds.)

2008 Manson's Tropical Diseases 22nd Edition)
• The illness attacks persons after
3–7 days (range 1 to 9 days)
after infection. (headache,
nausea and slight pyrexia)
• Over the next 3 days - rising
fever, increasing headache,
vomiting and stiff neck, lack of
attention to people and
surroundings, loss of balance…
• Deep coma is followed by death
ensues.
• The fatality rate is over 97%.
Only 4 people out of 143 known
infected individuals in the United
States from 1962 to 2017 have
survived.
 Phylum RHIZOPODA Phylum Percolozoa

Naegleria fowleri
COMMON NAME: brain-eating amoeba
GEOGRAPHICAL DISTRIBUTION:
Australia, Europe, and America.
• PATHOGENESIS: Primary amebic
meningoencephalitis (PAM).
• HABITAT: Usually free living;
the meninges in humans.
• INTERMEDIATE HOST: None. Rai et al. 1996 Atlas-of-Medical-Parasitology
• RESERVOIR HOST: None known.
• INFECTED FORM: trophozoite.
• MODE OF INFECTION: Active
penetration through the nostrils.
• LABORATORY IDENTIFICATION:
the diagnosis can be made by
microscopic examination of
cerebrospinal fluid (CSF). A wet
mount may detect motile
trophozoites

N.fowleri (Amoebic form) in brain tissue section

Acanthamoeba is present in all types of environments throughout the world.
Five species of Acanthamoeba are recognized to cause keratitis, the most common are
A. castellani and A. polyphaga.
Acanthamoeba castellanii • Cyst (A), amoeboid stage (B)
and symptoms of infection with
Acanthamoeba castellanii.
• GAE, Granulomatous amoebic
encephalitis; H, cyst wall; K,
Keratitis in eye; N, Nucleus; P,
pseudopodia.

Acanthamoeba spp. as Agents of Disease in Humans. 2003.

Francine Marciano-Cabral and Guy Cabral
 Estelle Cateau et al., 2014. Free-living amoebae:
What part do they play in healthcare-associated
infections?

Scanning electron micrograph of an Acanthamoeba

trophozoite. Spiny surface structures called
acanthopodia (arrows) distinguish Acanthamoeba
from other free-living amebae that infect humans
Cyst of Acanthamoeba castellanii under
transmission electron microscopy.

Francine Marciano-Cabral, Guy Cabral. 2003. Acanthamoeba spp. as Agents of Disease in Humans
 Acanthamoeba has no
flagellate form. The
small pseudopodia are
multiple, thin, and
spike-like; they are
called acanthopodia.
Cysts are thick walled,
buoyant; their dispersal
may be wind-borne.

The type of lens and the way the

lenses are handled by the patient may be
crucial in raising the risk
of infection. Adequate means for lens
cleaning, disinfection,
rinsing and storage need to be available.
Oxford Textbook of Medicine 4th edition (March 2003): by
David A. Warrell (Editor), Timothy M. Cox (Editor), John D. Firth
(Editor), Edward J., J R., M.D. Benz
(Editor) By Oxford Press
David C. Warhurst Ch/ 80. 2008 Manson's Tropical Diseases
22nd Edition

• The major part of the increase in
developed countries is probably
related to contact lens use and is
related to direct inoculation of
amoebic trophozoites or cysts into
the cornea during insertion of the
contaminated lens.
Acanthamoeba
keratitis or
keratouveitis presents
a serious diagnostic
and treatment problem
to ophthalmologists.
Since the first reports
from the UK and the
USA in the early
1970s, many further
cases have been seen
in Europe, the USA
and other countries.
Oxford Textbook of Medicine 4th edition (March 2003): by
David A. Warrell (Editor), Timothy M. Cox (Editor), John D. Firth
(Editor), Edward J., J R., M.D. Benz
(Editor) By Oxford Press
David C. Warhurst Ch/ 80. 2008 Manson's Tropical Diseases
22nd Edition
 Acanthamoeba castellanii has been isolated from water, soil, air
(in association with cooling towers, heating, ventilation and air
conditioner [HVAC] systems), sewage systems, and drinking
water systems. Most people will be exposed to Acanthamoeba
during their lifetime and will not get sick. However,
Acanthamoeba is capable of causing several infections in
humans.

Acanthamoeba keratitis – A local infection of the eye that

Early
typically occurs in healthy persons and can result in
inflammation
permanent visual impairment or blindness.
caused by
Acanthamoeba
Granulomatous Amebic Encephalitis (GAE) – A serious
keratitis
infection of the brain and spinal cord that typically occurs
in persons with a compromised immune system.

Disseminated infection – A widespread infection that can

affect the skin, lungs and other organs independently or in
combination. It is also more common in persons with a
compromised immune system.
Acanthamoeba keratitis in young and Acanthamoeba keratitis, Insert: higher
healthy female patient, 6 weeks evolution magnification
time, edema, and central ulcer. showing epithelial irregularity in early
acanthamoeba keratitis

Ana Lilia Pérez-Balbuena et al., 2012. Therapeutic Elisabeth Karsten et al., 2012. Diversity of Microbial
Keratoplasty for Microbial Keratitis Species Implicated in Keratitis: A Review
 PARASITIC PROTOZOA
(PROTISTA)
5 phyla which include human parasites

Phylum Rhizopoda (Amoebozoa) Ciliophora

Entamoeba histolytica Apicomplexa
Acanthamoeba
Naegleria fowleri (Phylum Percolozoa)
Polymastigota
Giardia lamblia
Trichomonas vaginalis

Phylum Euglenozoa
(Class Kinetoplastidea
Order Trypanosomatida
Trypanosoma brucei Trypanosoma cruzi Leishmania species)
 Phylum POLYMASTIGOTA
Giardia lamblia
(Giardia intestinalis Lamblia intestinalis (syn.lamblia, duodenalis))

COMMON NAME: Giardia or lamblia

GEOGRAPHICAL DISTRIBUTION:
Cosmopolitan prevalent in the tropics
and subtropics.
PATHOGENESIS: Giardiasis
HABITAT: digestive system
INTERMIDIATE HOSTE None
RESERVOIR HOST: None
INFECTED FORM: cysts Scanning electron micrograph of three
Giardia intestinalis trophozoites on a jejunal
DIAGNOSTIC FORM: cysts and biopsy specimen from a patient with
trophozoites giardiasis.
MODE OF INFECTION: Ingestion.
SPECIMEN SOURCE: Feces,
contaminated water and food

Oxford Textbook of Medicine 4th edition (March 2003): by David A.

Warrell (Editor), Timothy M. Cox (Editor), John D. Firth (Editor), Edward J., J
R., M.D. Benz
(Editor) By Oxford Press
William Hillary M.D. (1697–1763) was an English physician, known as an author on
tropical diseases.
On returning to England from Barbados, William Hillary wrote, in 1759, one of the first
books in English solely devoted to medicine in a tropical location and he described a
syndrome that more likely to have been caused by Giardia lamblia infection.
From Cook G.C. 2007. TROPICAL MEDICINE: AN ILLUSTRATED
HISTORY OF THE PIONEERS

Anton Van Leuwenhoek first observed in 1681 in a sample of his own

diarrheal stool, and later described in greater detail by Czech physician
Vilem Lambl, as Cercomonas intestinalis.

Photini Sinnis. Giardiasis in Medical parasitology /

[edited by] Abhay R. Satoskar et al. 2009.

From 1860, when he accepted a position at Kharkiv University.

American zoologist Chares Wardell Stiles (1867–1941) in

honor of Lambl and French biologist Alfred Mathieu Giard
(1846–1908). Today the illness caused by the parasite is Vilém Dušan Lambl
called either "lambliasis" or "giardiasis".

But our knowledge of this parasite has expanded rapidly since it was first cultured in the
1970-90s.
Molecular and genetic analysis of the parasite has shown that Giardia has a
unique place in evolution as it is probably the first organism to
emerge from the prokaryotic to the eukaryotic state

Michael J. G. Farthing, Ana-Maria Cevallos

and Paul Kelly. Ch. 79. 2008 Manson's Tropical Diseases 22nd Edition
Giardia lamblia life forms and
location in human body
Giardia lamblia life cycle
•Giardia is common enough in man
all over the world, though it is
probably commoner in the warmer
countries. Some 5 to 16 % of people
examined have been found infected
with it and it is especially common in
children.
•Its life history is simple and direct.
In the human food canal it multiplies in
numbers, sometimes with great
rapidity by dividing longitudinally. Its
method of leaving one host to find
another is to enclose itself in a
protective cyst-wall and to pass out of
the host in its excreta. These oval
cysts, which are 10 to 14 micra long,
get into the food or drink of other
human beings, and thus infect them.
•Many quite healthy people carry it in
their food canals and do not suffer in
any way (asymptomatic carrier), but if
any other condition upsets the
processes of digestion, or sets up in
the duodenum conditions favorable to
the giardia multiplication
 Transmission
• Cysts can survive for long periods outside the
host in suitable environments (e.g. surface
water).
• Giardia cysts are NOT killed by chlorination.
• Infection follows ingestion of cysts in faecally
contaminated water (from humans or animal
hosts) or through direct person to person
contact.
• Partial immunity may be acquired through
repeated infections.

Oxford Handbook of Tropical Medicine. Fourth edition. 2014.

Ed. by
Robert Davidson, Andrew Brent, Anna Seale.
FROM Matthews 2012 Tropical medicine notebook
- Giardia lamblia is a small flagellate, which differs in
structure from most other Protozoa (!), because it is
bilaterally symmetrical and it has two sets of organs
in its body.
- Accordingly, some authors regard this species as a
'species complex', rather than a single species.
- With flagella Giardia swims along more or less in a
straight line, its body swaying from side to side as it
goes.
- It feeds by absorbing through its body surface nutritive
materials in the contents of the host’s food canal.
- Occurring in both industrialized and developing
countries.
- Estimated 2.8 million new cases annually infection
being initiated with as few as 10–100 cysts.

Scanning electron micrograph showing two

G. intestinalis trophozoites.

Michael J. G. Farthing, Ana-Maria Cevallos

and Paul Kelly. Ch. 79. 2008 Manson's Tropical Diseases 22nd Edition
Clinical Features:
The spectrum varies from asymptomatic
carriage to severe diarrhea and
malabsorption. Acute giardiasis develops
after an incubation period of 5 to 6 days
and usually lasts 1 to 3 weeks. Symptoms
include diarrhea, loose or watery stool,
stomach cramps abdominal pain,
bloating.

CLINICAL SYNDROMES
• Asymptomatic infection
common
• Non-bloody diarrhoea
• Abdominal cramps
• Nausea, belching
• Weight loss
• Lactose intolerance
• Failure to thrive in children

FROM Matthews 2012 Tropical medicine notebook

 Laboratory Diagnosis:
•Giardiasis is diagnosed by the identification of cysts or
trophozoites in the feces (concentration of
approximately

Rai et al. 1996 Atlas-of-Medical-Parasitology

150 000–200 000 cysts per gram of faeces).

Repeated samplings may be necessary. In addition,

samples of duodenal fluid (e.g., Enterotest) or
duodenal biopsy may demonstrate trophozoites.
Cyst of G. Iamblia (Iron haematoxyllin stain).

DIAGNOSIS
• Stool microscopy for cysts
--Excretion can be intermittent but >
90% of infections identified by
examining three samples
• Giardia antigen test
• Duodenal fluid aspiration/string test
(has also been used for diagnosis of
typhoid/strongyloides)
• Small bowel biopsy
--Villous flattening/crypt deepening
--Inflammatory infiltrate
-Trophozoites in intervillous spaces
FROM Matthews 2012 Tropical medicine notebook
 Rai et al. 1996 Atlas-of-Medical-Parasitology
G. Iamblia (Trophozoite) (Giemsa stain). Cyst of G. Iamblia in iodine preparation

Cyst of G. Iamblia (India ink stain). Cyst of G. Iamblia (Iron haematoxyllin stain).
 Phylum POLYMASTIGOTA
Trichomonas vaginalis
COMMON NAME: none
GEOGRAPHICAL DISTRIBUTION:
worldwide.
• PATHOGENESIS: trichomoniasis.
• HABITAT: genital tract
• INTERMEDIATE HOST: None.
• RESERVOIR HOST: None.
• INFECTED FORM: trophozoite
• no cysts
• MODE OF INFECTION: sexual direct
transmission

visualized on normal saline wet prep

microscopy. Image courtesy of Barbara Van
Der Pol. (Raymond M. JohnsonCh. 30.
Medical parasitology / [edited by] Abhay R.
Satoskar et al. 2009.)
 In 1836, he made one of his
greatest contributions to
medicine by discovering the
protozoon, Trichomonas
vaginalis

bacteriologist
French doctor
10–20 μm wide
 T .vaginalis (Scanning electron
microphotograph).

T .vaginalis in wet preparation

(Phase contrast microscopy).

Rai et al. 1996 Atlas-of-Medical-Parasitology

Trichomoniasis
•Causal Agent:Trichomonas vaginalis,
a most common pathogenic protozoan
of humans in industrialized countries.

•Life Cycle: Trichomonas vaginalis

resides in the female lower genital
tract and the male urethra and
prostate, where it replicates by binary
fission. The parasite does not appear
to have a cyst form, and does not
survive well in the external
environment. Trichomonas vaginalis
is transmitted among humans.

•Geographic Distribution: Worldwide.

Higher prevalence among persons
with multiple sexual partners or other
venereal diseases.
•In the 1970s, the World Health
Organization (WHO) estimated an
annual world incidence of 180 million
cases.
•About 170 million new cases each
year.
 •Clinical Features: Trichomonas vaginalis
Trichomoniasis infection in women is frequently symptomatic.
Vaginitis with a purulent discharge is the
prominent symptom, and can be accompanied by
vulvar and cervical lesions, abdominal pain,
dysuria and dyspareunia. The incubation period
is 5 to 28 days. In men, the infection is frequently
asymptomatic; occasionally, urethritis,
epididymitis, and prostatitis can occur.

•Laboratory Diagnosis: Microscopic examination

of wet mounts may establish the diagnosis by
detecting actively motile organisms. This is the
most practical and rapid method of diagnosis
(allowing immediate treatment), but it is relatively
insensitive. Direct immunofluorescent antibody
staining is more sensitive than wet mounts, but
technically more complex. Culture of the parasite
is the most sensitive method, but results are not
available for 3 to 7 days. In women,
examination should be performed on vaginal
and urethral secretions. In men, anterior
urethral or prostatic secretions should be
examined.

http://fac.ksu.edu.sa/sites/default/files/Laboratory%20diagnosis%20of%20pathogenic%20intestinal%20and%20urogenital%20flagellates.pdf
 PARASITIC PROTOZOA
(PROTISTA)
5-6 phyla which include human parasites

Phylum Rhizopoda (Amoebozoa)

Entamoeba histolytica
Acanthamoeba Ciliophora
Apicomplexa
Naegleria fowleri (Phylum Percolozoa)

Phylum Polymastigota
Giardia lamblia
Phylum Euglenozoa Trichomonas vaginalis
(Class Kinetoplastidea
Order Trypanosomatida
Trypanosoma brucei
Trypanosoma cruzi
Leishmania species)