PARASITOLOGY: CILIATES & ATRIAL FLAGELLATES

DR. DELA ROSA – JAN. 30, 2018

CILIATES
Balantidium coli LIFE CYCLE
 Habitat: large intestine
 Disease: “Balantidiasis”
 Life cycle: Same as Entamoeba histolytica
 Largest intestinal protozoa parasitizing man
 Worldwide distribution, commonly found in tropical regions,
PATHOGENESIS
although not very common
 Pathogenic stage: trophozoite
 Secretes hyaluronidase that digests the tissues
MORPHOLOGY
 Pathogenesis is the same with Entamoeba histolytica
CYST
 Infective stage
DISEASE
 Round, ovoid
 Intestinal and extraintestinal balantidiasis
 With retracted cilia at the periphery
 Symptomatic and asymptomatic balantidiasis
 Granular cytoplasm
 S/S: same as Entamoeba histolytica
 Has 2 nuclei
 Macronucleus
DIAGNOSIS, TREATMENT AND PREVENTIVE MEASURES:
 Compact type
 Same as Entamoeba histolytica
 Kidney-shaped
 Drug: Metronidazole
 Micronucleus
 Round, small
 Near the concavity of macronucleus DIFFERENCE BETWEEN ENTAMOEBA HISTOLYTICA AND
BALANTIDIUM COLI
 Compact type
 In Balantidium coli there is no increase in the number of nuclei
 Diagnostic feature: micronucleus and macronucleus from trophozoite to cyst stage (always 2)
 Type of encystment in Balantidium coli is protective
TROPHOZOITE  2 Types of Encystment
 Elongated  Protective
 With cytostome (cell mouth) & cytopyge (cell anus)  Only one organism emerges from cyst
 Cilia (protective)
 Reproductive
 Organ of locomotion
 Reproduction takes place during the trophozoite
 Arise from basal granules
stage thru binary fission
 Under it is the plasma membrane
 Lesions
 It is all over and not only on the side  Lesion of Amoebiasis (Entamoeba histolytica)
 It is longer and thicker in the cytostome  Flask – shaped
 Granular cytoplasm  Small opening [pepsi cola]
 Has 2 nuclei  Long neck
 Macronucleus  Lesion of Balantidiasis (Balantidium coli)
 Kidney shaped  Big lesions
 With big openings [coca-cola] and large rounded end
 Micronucleus
 May have 1 or 2 contractile vacuoles near the
posterior end FLAGELLATES
 If there are 2, the other one is near the center  Organ of locomotion is flagella
 Function: osmoregulation
Chilomastix mesnili
 Worldwide in distribution, more common in the tropical
region but as not as common as the others
 Non-pathogenic (no pathogenic stage)

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“Vitanda est improba siren desidia”
PARASITOLOGY | CILIATES AND ATRIAL FLAGELLATES
DR. DELA ROSA – JAN. 30, 2018

MORPHOLOGY  Retracted cytoplasm: there is a space between

CYST cytoplasm and cyst wall (“umurong”)
 Infective stage  Pair of axonemes
 Ovoid; lemon shaped because of a nipple-like protuberance  Nucleus
 Granular cytoplasm with space near the protrusion  2 nuclei in newly formed cyst
 Single nucleus & karyosome: vesicular type  4 nuclei in mature cyst
 With cytostome that is hour-glass shaped
TROPHOZOITE
TROPHOZOITE  Symmetrically pear shaped
 Asymmetrically pear shaped due to  No spiral groove  tumbling motility (?)
spiral groove  At the anterior half they have sucking disc for attachment
 Because of the spiral groove the  With a pair of axonemes
characteristic motility is:  With parabasal body
corkscrew/boring motion  2 nuclei
 Rotate on longitudinal axis  Gives old man with eye-glass
during movement appearance
 Organ of locomotion: Flagella  Flagella
 With granular cytoplasm  Organ of locomotion
 1 nucleus  4 pairs of flagella
 With karyosome: near the rounded end (anterior end)  Characteristic motility: falling-leaf
 With cytostome that is hour-glass shaped (“umalagwang sarangola”)

LIFE CYCLE LIFE CYCLE

 Life cycle: same as Entamoeba histolytica  Manner of transmission: via the ingestion of the cyst
 Reproduction: Binary Fission through contaminated food and drink
 Habitat: large intestine (same as Entamoeba histolytica)  The cyst will then go into the esophagus, stomach, small
intestine (duodenum)
PATHOGENSIS  In the small intestine excystation takes place
 Infective Stage: Cyst  The trophozoite will then stay in the duodenum (small
 S/S: none because it is non-pathogenic intestine – habitat) specifically in the “duodenal crypts”
 As it is carried to the large intestine, encystation occurs,
DIAGNOSIS, TREATMENT AND PREVENTIVE MEASURES:  Cyst is evacuated in the stool where it goes into the soil
 Diagnostics: Stool examination  It then contaminates food and drinks
 Treatment: No specific treatment
 Preventive measures: same as Entamoeba histolytica PATHOGENESIS
 The trophozoites attachs to duodenum and coat or carpet
Giardia lamblia the interstinal mucosa
 Worldwide, more common in tropical regions but also found  It takes so many parasite to coat the wall of entire
in temperate regions intestinal mucosa and produce disease, therefore
 Pathogenic but non-invasive medtechs won’t be able to miss it
 Disease: Giardiasis, Traveler’s diarrhea, Leningrad’s curse  If the trophozoites are numerous they can even overlap
(Russia), St. Petersburg curse thereby, preventing absorption of food and other
 Associated among homosexual, in US substances  malabsorption
 Steatorrheic or gruelly stool is due to malabsorption of
MORPHOLOGY fat
CYST  There is irritation of the intestinal mucosa  abdominal pain
 Ovoidal and diarrhea
 Infective stage  They can even involve the gallbladder
 Diagnostic feature:

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“Vitanda est improba siren desidia”
PARASITOLOGY | CILIATES AND ATRIAL FLAGELLATES
DR. DELA ROSA – JAN. 30, 2018

DIAGNOSIS, TREATMENT AND PREVENTIVE MEASURES:

 Diagnostic exam:
 Stool exam
 Entero or String test
 Capsule with long strip
 Patient is asked to swallow the capsule
 Pull the remaining string and examine the string if
the trophozoites is attached to it
 Drug: Metronidazole
 Preventive measure: same as E. histolytica Note:
 In practice it is hard to find this features because the they all look
the same
Trichomonas spp.
 Thus in practice we look at where the specimen came from and
 Includes: make use of its habitat
 Trichomonas tenax  Mouth: Trichomonas tenax (along tartar of teeth, gums and
tonsil
 Trichomonas hominis
 Stool: Trichomonas hominis (intestine:cecum)
 Trichomonas vaginalis  Urine: Trichomonas vaginalis (vagina, urethra, prostate
 Demonstrated only in trophozoite stage, no cystic stage gland)
 Like Entamoeba gingivalis (occurs only in trophozoite  It is important that you have proper collection of specimen
stage) because stool may be contaminated with urine or urine may be
contaminated with stool (especially among females)
 Ovoidal shape
 Organ of locomotion: flagella
 With axostyle and costa Trichomonas tenax
 Motility: tumbling, jerking motion  It is associated with Entamoeba gingivalis
 Because Trichomonas tenax also inhabit the oral cavity
Trichomona Trichomonas Trichomonas  Common in person with poor oral hygiene and w/
s tenax hominis vaginalis inflammation of the mouth “pyuria alveolaris”
+ + +
 Habitat: Oral Cavity
One side One side One side
 Along the tartar of the teeth, gums and the tonsils
attached to attached to attached to
costa, costa, another costa, another  Preventive measures: Good oral hygiene
Undulating another side side attached to side attached
membrane attached to flagellum to flagellum MORPHOLOGY
flagellum TROPHOZOITE
With posterior
 Ovoidal
trailing
flagellum  Organ of Locomotion: Flagella
Moving + + +  Infective stage: trophozoite
+ + +  Pathogenic stage: none
Axostyle
(rigid)  Manner of transmission:
Nucleus + + +  Droplet spray
+ + +
 Sharing of food and utensils
(in its nucleus,
Chromatin  3rd and 4th stage of Kissing
there is one that
granules
looks like a  3rd stage  dislodged tartar
karyosome)  4th stage  suck this tartar
Siderophil - - +
granules (along a costa)
- + - Trichomonas hominis
Cytostome
(conspicuous)  Infective stage: Trophozoite stage
 Habitat: Large intestine (cecum)
 Manner of transmission: ingestion of contaminated food and
drink
 Seen in patients with achlorhydria  without acid

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“Vitanda est improba siren desidia”
PARASITOLOGY | CILIATES AND ATRIAL FLAGELLATES
DR. DELA ROSA – JAN. 30, 2018

 Non – pathogenic  Treatment:

 Carried out by the stool  Treat the patient as well as the partner to prevent “ping-
 Diagnosis: stool exam pong infection”
 Treatment: no specific treatment  Preventive Treatment
 Control and prevention: same as E. histolytica  Be morally upright (only one partner)
 Practice safe sex
Trichomonas vaginalis
 Worldwide in distribution Dientamoeba fragilis
 Disease: Trichomoniasis, urethritis, Trichomonas vaginitis  Said that the name fragilis is inappropriate because it
 “Ping – Pong Infection” survives better than other trophozoites
 Transfer of infection between partners  Used to be an amoeba
 Man can have Trichomonas infection  It is transferred in Trichomonas group of organism
 Caused by: Trichomonas vaginalis because just like Trichomonas they occur only in
 Trichomonas vaginalis is always in female causing trophozoite stage
vaginitis/urethritis  No cystic stage
 Habitat: Vaginal mucosa and Prostate
 Infection common between 15-35 years of age (peak of MORPHOLOGY
sexual activity) TROPHOZOITE
 Manner of transmission: thru sexual contact (most common)  Infective stage
 Non – venereal transmission:  With granular cytoplasm, irregular in shape
 Communal bathing  2 nuclei “beaded”
 Contaminated toilet seats  Karyosome (bigger) in the form
 Thru the birth canal of infected mother during delivery of 4-8 beads
of a baby girl (mother-to- fetus transmission)  Tetracocci karyosome
 Sharing of douche equipment  Manner of transmission:
 Pathogenic but non-invasive (like Gardia lamblia, Entamoeba  Ingestion of trophozoite thru the
histolytica and Balantidium coli) eggs of Enterobius vermicularis
 Habitat: Large Intestine
PATHOGENESIS & DISEASE  Pathogenic but non-invasive
 Irritates the vaginal mucosa  Like Giardia lamblia and Trichomonas vaginalis
 Producing vaginal pruritus/itchiness  Produce irritation of intestinal mucosa
 As well as a creamy, frothy vaginal discharge  Mucous secretion
 Don’t mistake with infection of Candida albicans  Mucoid diarrhea
(fungus)  Characteristic of Disease: mucoid diarrhea
 Males: usually or essentially asymptomatic
 Can become latent, producing a burning sensation DIAGNOSIS, TREATMENT AND PREVENTIVE MEASURES:
while urinating  Diagnostics: Stool exam
 Females: presence of signs and symptoms  Treatment: Metronidazole
 Preventive measures: same as Entamoeba histolytica
DIAGNOSIS, TREATMENT AND PREVENTIVE MEASURES:
 Diagnosis: SUMMARY
 Females: Specimen is urine vaginal discharge/scraping Trophozoite is the infective Organisms with cytostome
 Males: Urine and prostatic secretions (massage the stage  C. mesnili – at both cyst
prostate)  Entamoeba gingivalis and trophozoite
 Drug of choice: Metronidazole  Trichomonas tenax  B. coli – at trophozoite
 Other: vaginal tablet composed of metronidazole and  Trichomonas hominis  T. hominis
 Trichomonas vaginalis
tetracycline
 Dientamoeba fragilis

Source: Lecture, Jcelimpin notes, Pics from internet only

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