Clinical Parasitology

Lecture #3

PROTOZOA Encystation → the conversion of trophozoite to cysts.

Protozoa are unicellular organisms and the lowest form of

animal life. Known to have three phyla.

LABORATORY DIAGNOSIS

• Trophozoites are primarily recovered from stools

that are of soft, liquid, or loose consistency.

• Formed stool specimens are more likely to contain

cysts.

• Saline wet preparations are of value because they

will often show motility of the amebic trophozoites.

• The internal cytoplasmic, as well as the nuclear

The most important feature that separates amoebas from structures, may be more readily seen with the use
the other groups of unicellular Protozoa is the means by of iodine wet preparations.
which they move.
PATHOGENESIS AND CLINICAL SYMPTOMS
AMOEBAS
• In the United States, amebiasis is often found in
They are equipped with the ability to extend their immigrants from and people who have traveled to
cytoplasm in the form of pseudopods (false feet), which underdeveloped countries.
allows them move within their environment.
• Diarrhea
• Trophozoites, the form that feeds, multiplies, and
possesses pseudopods. ENTAMOEBA HISTOLYTICA

• Cysts, the nonfeeding stage characterized by a thick

MORPHOLOGY
protective cell wall designed to protect the parasite
from the harsh outside environment. TROPHOZOITE CYSTS

The trophozoite exhibits Young cysts

rapid, unidirectional, characteristically contain
progressive movement. unorganized chromatin
material that transforms
The nucleus contains a into squared or round
small central mass of ended structures call
chromatin known as a chromatoid bars, defined
karyosome (karyosomal as structures that contain
chromatin). condensed RNA material.

ENCYSTATION AND EXCYSTATION OF AMOEBAS The karyosome is RBCs, bacteria, yeast, and
surrounded by peripheral other debris are not found
Excystation → the morphologic conversion from the cyst chromatin. in the cyst stage.
form into the trophozoite form, occurs in the ileocecal area
of the intestine.
LABORATORY DIAGNOSIS
A special medium known at TYI-S33 supports E.
histolytica in culture.
Methods currently available include antigen tests,
enzyme linked immunosorbent assay (ELISA), indirect
hemagglutination (IHA), gel diffusion precipitin (GDP),
and indirect immunofluorescence (IIF).
In addition to the liver, E. histolytica has been known to
migrate to and infect other organs, including the lung,
pericardium, spleen, skin, and brain.
Men become infected with penile amebiasis after
experiencing unprotected sex with a woman who has
vaginal amebiasis.

EPIDEMIOLOGY
TREATMENT
Entamoeba histolytica infection occurs in as many as 10% Paromomycin Diloxanide Metronidazole
of the world’s population and is considered a leading furoate (Flagyl)
cause of parasitic deaths after only malaria. (Furamide)

Locations at which human waste is used as fertilizer,

areas of poor sanitation, hospitals for the mentally ill,
prisons, and day care centers tend to harbor E. ENTAMOEBA HARTMANNI
histolytica.

Several means of transmitting E. histolytica are known. MORPHOLOGY

TROPHOZOITE CYSTS
Ingestion of the infective stage, the cyst, occurs through
hand-to-mouth contamination and food or water The trophozoite exhibits Spherical cysts may have
contamination. nonprogressive motility. one, two, three, or four
nuclei.
In addition, E. histolytica may also be transferred via Cytoplasm of E. hartmanni
unprotected sex. does not contain ingested Young cysts have diffuse
red blood cells. glycogen mass and round-
Flies and cockroaches may also serve as vectors (living ended chromatoid bars,
carriers responsible for transmitting parasites from similar to those seen in E.
infected hosts uninfected hosts) of E. histolytica by histolytica.
depositing infective cysts on unprotected food.

Improperly treated water supplies are additional sources LABORATORY DIAGNOSIS

of possible infection.
Stool examination.
It is important to note that the size ranges of E. histolytica
and E. hartmanni overlap.
CLINICAL SYMPTOMS

Entamoeba histolytica is the only known pathogenic

intestinal ameba. EPIDEMIOLOGY
location/s of the parasite in the host
The geographic distribution of E. hartmanni is
the extent of tissue invasion
cosmopolitan.

Patients infected with E. histolytica who exhibit The ingestion of infected cysts present in contaminated
symptoms often suffer from amebic colitis, defined as an food or water accounts for the transmission.
intestinal infection caused by the presence of amoebas
exhibiting symptoms.

Amebic dysentery, condition characterized by blood and CLINICAL SYMPTOMS

mucus in the stool.
Typically asymptomatic
The formation of an abscess in the right lobe of the liver
and trophozoite extension through the diaphragm,
causing amoebic pneumonitis, may occur. TREATMENT
It is generally considered a nonpathogen and treatment The nuclear structures Although the cysts of E.
is usually not indicated. have features resembling polecki range in size from
both E. histolytica and E. 10 to 20 μm, the average
coli. is 12 to 18 μm.

ENTAMOEBA HARTMANNI The small central Non–glycogen containing

karyosome resembles that structure appears elusive
of E. histolytica. and does not have defined
MORPHOLOGY
borders. The makeup of
the inclusion mass is not
TROPHOZOITE CYSTS
known.
In unstained preparations, A thick cell wall surrounds
the karyosome and the round to spherical
surrounding peripheral cyst. LABORATORY DIAGNOSIS
chromatin appear as
refractile structures. As with the trophozoite, Stool examination.
the cyst nuclei are readily
In contrast to E. discernible.
histolytica, red blood cell
inclusions are not present Occasionally, large cysts EPIDEMIOLOGY
in the trophozoites of E. containing 16 or more
Primarily considered a parasite of pigs and monkeys.
coli. nuclei may be present
Human infections are relatively rare.

LABORATORY DIAGNOSIS Human to human as well as pig to human are the major
routes of parasite transmission.
Stool examination.

CLINICAL SYMPTOMS
EPIDEMIOLOGY
Most patients are asymptomatic.
E. coli is found worldwide. In addition to warm climates, Symptomatic patients are associated with diarrhea.
it also occurs in cold climates.

Geographic areas that have poor hygiene and sanitation TREATMENT

practices.
Metronidazole Diloxanide furoate
E. coli is transmitted through the ingestion of the infected
cyst through contaminated food/ drink.
ENDOLIMAX NANA

CLINICAL SYMPTOMS MORPHOLOGY

Typically asymptomatic TROPHOZOITE CYSTS

The single nucleus may or Chromatoid bars, such as

TREATMENT may not be visible in those often seen in the
unstained preparations. Entamoeba spp. cysts, are
Not usually indicated. not present.

ENTAMOEBA POLECKI LABORATORY DIAGNOSIS

Stool examination.
MORPHOLOGY

TROPHOZOITE CYSTS
EPIDEMIOLOGY
Found primarily in warm, moist regions of the world. CLINICAL SYMPTOMS

Areas in which poor hygiene and substandard sanitary Most patients are asymptomatic.
conditions exist.

Food or drink contaminated with infective cysts serve as TREATMENT

the major sources of parasite transmission.
Not usually indicated.

CLINICAL SYMPTOMS
ENTAMOEBA GINGIVALIS
Most patients are asymptomatic.

MORPHOLOGY
TREATMENT TROPHOZOITE CYSTS

Not usually indicated. The multiple pseudopods No known cyst stage.

IODAMOEBA BUTSCHLII
MORPHOLOGY
TROPHOZOITE
The trophozoites of
Iodamoeba butschlii
average 12 to 18 μm. preparations, may be seen
vary in their appearance
as the trophozoite moves.
The pseudopods may
appear long when seen at
one point in time and
short and blunt the next
time that they are seen.
CYSTS
It is important to note that
Achromatic granules, it is the only amoeba that
indistinct in iodine ingests wbc.
on one side of the
karyosome. LABORATORY DIAGNOSIS

A well-defined glycogen Mouth scrapings, particularly from the gingival area.

mass with definite borders
is characteristic and is Material from the tonsillar crypts and pulmonary
considered as an abscess, as well as sputum, may also be examined.
important diagnostic
feature of the I. butschlii Vaginal and cervical material may be examined to
cyst. diagnose E. gingivalis in the vaginal and cervical areas.

LABORATORY DIAGNOSIS
LIFE CYCLE
Stool examination.
Typically lives around the gum line of the teeth in the
Iodine wet preparation. tartar and gingival pockets of unhealthy mouths.

Trophozoites have been known to inhabit tonsillar crypts

EPIDEMIOLOGY and bronchial mucus.

Is found worldwide and has a higher prevalence in

Have also been recovered in vaginal and cervical
tropical regions than in temperate regions.
specimens from women who are using intrauterine
devices.
Transmission occurs when the infective cysts are
ingested in contaminated food or drink.

Hand-to-mouth transmission may also occur. EPIDEMIOLOGY

 Contracted via mouth-to-mouth(kissing) and droplet
contamination, which may be transmitted through
contaminated drinking utensils.
CLINICAL SYMPTOMS
Infections of E. gingivalis occurring in the mouth and in
the genital tract typically produce no symptoms.
The ameboid trophozoites of N. fowleri are the only form
known to exist in humans.
The cyst form is known to exist only in the external
environment.
Humans primarily contract this ameba by swimming in
contaminated water.

Nonpathogenic E. gingivalis trophozoites are frequently EPIDEMIOLOGY

recovered in patients suffering from pyorrhea alveolaris.
N. fowleri is primarily found in warm bodies of water,
including lakes, streams, ponds, and swimming pools.
TREATMENT
Prevalence is higher in the summer months of the year.
Not usually indicated. In addition to water sources, there have been cases of
contaminated dust. One such case occurred in Nigeria, a
country that has a warm climate.
NAEGLERIA FOWLERI

Primary amebic meningoencephalitis (PAM) CLINICAL SYMPTOMS

MORPHOLOGY
TROPHOZOITE
Amoeboid trophozoites
The anterior end is usually
broad, whereas the
posterior end is usually
tapered.
Flagellate forms
The pear-shaped flagellate
form, 7 to 15 µm
Two whiplike structures
that assist select parasites
in locomotion known as
flagella extend from the
broad end of the
organism.
Usually asymptomatic
Primary amebic meningoencephalitis (PAM) occurs when
CYSTS
the ameboid trophozoites of N. fowleri invade the brain,
causing rapid tissue destruction.
The cysts, measuring from
9 to 12 µm in size, are
generally round and have Kernig’s sign (defined as a diagnostic sign for meningitis,
thick cell walls. where the patient is unable to fully straighten his or her
leg when the hip is flexedat90degrees because of
Has one nucleus, hamstring stiffness).
consisting of a large,
centrally located
karyosome lacking TREATMENT
peripheral chromatin.
Amphotericin B
The cytoplasm is typically
granular and often
contains vacuoles.
ACANTHAMOEBA SPECIES
Granulomatous amebic encephalitis (GAE), Acanthamoeba
keratitis

Jerky movement or MORPHOLOGY

spinning.
TROPHOZOITE CYSTS

LABORATORY DIAGNOSIS Spinelike pseudopods, The inner smooth cell wall

known as acanthopodia is surrounded by an outer
CSF is the method of choice. jagged cell wall.
Samples of tissues and nasal discharge may also be
examined.
LABORATORY DIAGNOSIS

CSF is the method of choice.

LIFE CYCLE
Brain tissue may be examined.
Corneal scrapings for Acanthamoeba infection.

LIFE CYCLE

Humans may acquire Acanthamoeba in one of two ways.

One route consists of aspiration or nasal inhalation of the

organisms.

The second route of infection consists of direct invasion

of the parasite in the eye.

EPIDEMIOLOGY

Contact lens wearers, particularly those wearing soft

contacts, may be at risk of contracting Acanthamoeba
eye infections.

CLINICAL SYMPTOMS

Granulomatous amebic encephalitis. CNS infections with

Acanthamoeba are also known as granulomatous amebic
encephalitis (GAE). Symptoms of this condition develop
slowly over time and include headaches, seizures, stiff
neck, nausea, and vomiting.

Acanthamoeba keratitis. Acanthamoeba infections of the

cornea of the eye are known as amebic keratitis.
Common symptoms include severe ocular pain and vision
problems.

TREATMENT

Sulfamethazine Itraconazole,
ketoconazole, miconazole,
propamidine isethianate,
and rifampin