Diseases: amebiasis

- intestinal parasite

Transmission:
- contaminated water/food
- flies
- hands of infected food handlers
- homosexuals
- direct transmission by cyst carriers

Clinical symptoms:
- abdominal discomfort, constipation, diarrhoea, chronic liver pain
- pulmonary amebiasis, brain and liver abscess
Entamoebae histolytica
Diagnosis: stool examination, serological assay
- immature uninucleated cyst, Trichome stained
- spherical or ovoidal, cyst wall not stained
- greenish cytoplasm contains reddish-purple colour
- cigar shaped chromatoid bar

Prevention:
- screen food handler, cover food, boil water
- proper sewage disposal
- don’t use faeces as fertilisers

Treatment:
- flagyl (metronidazole)

Symptoms:
- epigastric pain, flatulence, diarrhoea
- increased fat and mucus in stool, weight loss
- often in daycare

Diagnosis:
- stool examination
- serological assay
- string test
- duodenale aspirate
Giardia lamblia
Stool specimen, iron haematoxylin stained
- mature, infective cyst, containing 4 nuclei
- ellipsoidal
- straight axoneme running longitudinally and curved median bodies
- see part of cytoplasm separated from cyst wall

Stool specimen, wet mount, iodine stained

- mature infective cyst, 4 nuclei
- ellipsoidal
- refractile, curved median bodies
- see part of cytoplasm separated from cyst wall
Symptoms:
- most cases are asymptomatic
- persistent diarrhoea, occ. dysentery
- abdominal pain and weight loss
- make shallow ulcer in intestine = bleeding
Balantidium coli - symptoms can be severe in debilitated person
- large size
- presence of cilia on cell surface
- Have cytostome
- Bean shaped macronucleus and smaller, less conspicuous micronucleus

Transmission:
- faecal-oral
- person-to-person – nurseries, playgroups, within families, homosexual
Cryptosporidium
- animal-to-person – livestock pets, handling of infected animals
- Cryptosporidium parvum
- foodborne – raw veg, cold drinks, food handlers, contaminated water used in food
- Cryptosporidium meleagridis
production
- waterborne – portable water from community and private water systems
- recreational waters
 Risked group:
- young and older people
- immunocompromised, immunodeficient
- HIV positive
- transplant and other patients on immunosuppressive therapies
Diagnosis: detection of oocysts in stool
- phenol auramine (fluorescence
- modified Ziehl-Neelsen
- saffranine methylene blue
- Giemsa
- detection of Ag in faeces (ELISA) or nucleic acid by PCR
Tissue cyst forming coccidia
- cause very benign disease in immunocompetent adults

Definitive host (felines):

- adult form, sexual reproduction

Intermediate host (birds and mammals):

- immature forms and asexual reproduction
Diagnosis:
- seldom by direct parasite
- biopsy/inoculation into mice or cell culture
- serological test
- active (acute) v chronic infection – IgM > IgG; increased Ab titres

Prevention: cook meat thoroughly and clean cat shits

Treatment:
- anti-folates (pyrimethamine + sulfadiazine)
- clindamycin (children), spiramycin for prophylactic use during pregnancy
Tachyzoite stage:
- sporozoites -> merogony
- rapid replication
- dissemination via macrophages
- reticuloendothelial cells
- acute stage infection

Bradyzoite stage:
- dormant, slow replicating due to host immune response
- chronic or latent infection
Toxoplasma gondii
- tissue cysts in brain and muscle

Human transmission:
- ingestion of sporulated oocysts or zoite (undercooked meat)
- congenital infection (during acute stage)
- organ transplants and blood transfusions
Acquired postnatal toxoplasmosis
- acute parasitaemia persists for several weeks until development of tissue cysts
- often asymptomatic; common symptom is lymphadenopathy w/o fever
- occ. mononucleosis-like
- immunosuppression can lead to reactivation

Toxoplasmic encephalitis
- common complication assoc. w/ AIDS
- recrudescence of latent infection
-multifocal disease assoc. w/ immunosuppression
- lesions detectable w/ CT or MRI
-little spread to other organs
- lethargy, apathy, incoordination, dementia
- progressive disease -> convulsions

Congenital toxoplasmosis
- primary infection occurs during pregnancy
- severity varies with age of foetus (more severe early, more frequent later)
- infection can result in: spontaneous abortion, still birth, premature birth or full-term
overt disease
Typical disease manifestations – retinochoroiditis, psychomotor disturbances,
intracerebral calcification, hydrocephaly, microcephaly
 Ocular toxoplasmosis:
- retinochoroiditis – likely due to active parasite proliferation and immune
hypersensitivity
- generally a recrudescence – rarely from primary infection
- most lesions are focal and self-limiting
- rapidly destructive in AIDS patients
Trophozoite, Giemsa stained
- no cystic stage, pseudocyst
- tear drop shaped
- undulating memb. Running almost entire length of the body
- axoneme becomes free flagellum
- single nucleated, axostyle

Trichomonas vaginalis Female host -symptomatic

Male host - asymptomatic
Geographic distribution
- higher prevalence among ppl w/ multiple sexual partners or other venereal diseases
- infection in women frequently symptomatic (vaginitis)
- purulent discharge, accompanied by vulvar and cervical lesions
- abd pain, dysuria and dyspareunia
- in male frequently asymptomatic; occ. urethritis, epididymitis and prostatis
Morphology:
- amastigotes with large nucleus and kinetoplast
- amastigotes main live w/i RE system cells

- primarily a visceral infection

- vector – sand fly (Phlebotomus genus)
Pathogenesis:
- infection range from asymptomatic to progressive, fully developed kala-azar

Leishmania donovani Symptoms:

- low grade fever and malaise
- progressive wating, anaemia, and protrusion of abdomen (from enlarged liver and
spleen)
- fatal after 2-3 years if left untreated
- in acute cases w/ chills, high fever and vomiting; death w/i 6-12 months
- immediate cause of death is usually an invasion of a secondary pathogen the body
cannot combat
- hepatosplenomegaly and emaciation

African Sleeping sickness:

trypanosomiasis - Trypanosoma brucei
- difficulty waking up
Transmission:
- vector – bite from tse tse fly
- mother to child infection (perinatal death)
- blood transfusion
- sexual contact
- specific species of genus Glossina transmit parasite resulting in spotty distribution
through the fly belt
Life cycle
- fly ingest trypomastigotes when feed on infected indv.
- parasite reproduce asexually in fly’s gut (epimastigotes) migrates to salivary gland
(metacyclic trypomastigotes)
Trypanosomiasis
- fly injects metacyclic trypomastigotes when feeding
- trypomastigotes reproduce asexually in bloodstream
Prevention
- control in reservoirs (livestock and wildebeest)
- remove scrub (where tse tse flies reproduce)
- DDT
American Chagas disease:
trypanosomiasis - Trypanosoma cruzi

Transmission
- vector – genus Triatoma, Rhodnius and Panstrongylus “kissing bugs”
- ingestion of contaminated food
- blood transfusion
- fetal transmission
 Pathogenesis (acute)
- starts 1 week after infection
- fever, lymph node enlargement, unilateral swelling of eyelid (Romana’s sign)
-acute myocarditis, damaged muscle cells and edema

Chronic
- 2 mth s after initial infection
- intermediate form: 60-70% ppl w/ Chagas
- free of cardia, GI and neurological symptoms. 2-5% of patients convert to cardiac or
digestive forms each year
Cardiac manifestation (cardiac form)
- 30-40% of ppl w/ Chagas
- induce arrythmia, cardiac failure, thromboembolism, atrioventricular fibrillation,
ventricular hypertrophy

Gastrointestinal manifestation (digestive form)

-10% of ppl
- megaoesophagus 3%, megacolon and may be assoc. w/ cardiac form
- difficulty in swallowing, regurgitation, aspiration may cause pneumonia and death
- chronic constipation, fecal compacting -> perforation of colon
Treatment: no cure for disease

Prevention:
- elimination of “kissing bugs” env. w/ building structures or squish it
- avoid pets to limit attraction
- avoid building homes w/ palm roof and cracks
- insecticides
- free living amoeba.
- causes granulomatous amoebic encephalitis (GAE) in immunocompromised ppl
- found in soil; fresh, brackish and sea water; sewage; swimming pools; contact lens
Acanthamoeba sp.
equipment; medicinal pools
-mammalian cell cultures; vegetables; human nostrils and throat; and human and
animal brain, skin, and lung tissue
- trophozoites cultured from CSF
- have large nuclei w/ large dark staining karyosome
Naegleria fowleri
- active amoeba and extend and retract pseudopods
- patient can die from primary amoebic meningoencephalitis