Quiz Answers

The amoeba associated with hemophagocytosis

● E. histolytica
The amoeba with dirty cytoplasm and 8 nuclei
● Entamoeba coli
The only amoeba with no cyst stage
● E. gingivalis
Described as uninucleated with a large glycogen body
● Iodamoeba butschlii
Amoeba with thorn-like appendages
● Acanthamoeba
Largest protozoan parasite affecting humans
● Balantidium coli
The parasite that is said to be the most common nonviral STI
● T. vaginalis
Flagellate that presents with steatorrhea
● G. duodenalis
Parasite that presents with strawberry cervix, green yellow discharge with
fishy odor
● T. vaginalis
TOXOPLASMA

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 Toxoplasma gondii
● coccidian
● worldwide distribution
● infects humans and many species of
animals
● The infective stages:
○ tachyzoite
○ bradyzoite
○ oocyst
● The extraintestinal stages are the
asexual stages:
○ tachyzoites
○ bradyzoites.
 Life Cycle
Only known definitive host: Cats and their
relatives
1. Unsporulated oocysts are shed in
the cat’s feces
2. Oocysts take 1–5 days to sporulate in
the environment and become
infective.
3. Intermediate hosts in nature
(including birds and rodents)
become infected after ingesting soil,
water or plant material
contaminated with oocysts
 Life Cycle

4. Oocysts transform into tachyzoites

shortly after ingestion.

5. These tachyzoites localize in neural and

muscle tissue and develop into tissue
cyst bradyzoites.

6. Cats become infected after consuming

intermediate hosts harboring tissue cysts
Tachyzoites
 Transmission Routes

● Eating undercooked meat of animals harboring tissue cysts.

● Consuming food or water contaminated with cat feces or by contaminated
environmental samples (such as fecal-contaminated soil or changing the litter box
of a pet cat) .
● Blood transfusion or organ transplantation .
● Transplacentally from mother to fetus .
 Toxoplasma gondii
Trophozoites (Tachyzoites)
● 4 to 8 μm in length, 2 to 3 μm width.
● It is crescent-shaped with a pointed
anterior and a rounded posterior end.
● Organelles, such as rhoptries and
micronemes, which are associated
with cell penetration, are found in a
short conoid on the anterior end.

Pseudocysts
● contains proliferating tachyzoites
● seen in tissue sections taken from
patients suffering from acute
infection.
 Toxoplasma gondii

Cysts
● contains bradyzoites
● seen during chronic infections
● can be found in the brain, skeletal
and heart muscles, and retina.
Toxoplasma gondii

Cyst in Brain Tissue Unstained Cyst

Toxoplasma gondii

Sporulated oocyst Unsporulated oocyst

 Clinical Manifestations
Asymptomatic
● commonly asymptomatic as long as the immune system of the patient is
functioning well.
Symptomatic
● symptoms appear when there is relapse of chronic infections as a result of a
suppressed immune system
● Among the immunocompromised, the most common manifestation is
encephalitis.
● Among the immunosuppressed, Clinical manifestations include:
○ retinochoroiditis
○ lymphoreticular hyperplasia with enlargement of the posterior cervical lymph node
○ hepatitis
○ splenomegaly
○ pneumonia
○ extramedullary hematopoiesis
○ failure to gain weight.
Clinical Manifestations

Toxoplasma in pregnancy
● Stillbirth and abortion may result
when mothers acquire the infection
during the first trimester of
pregnancy.
● Babies may exhibit clinical
manifestations like chorioretinitis,
epileptic seizures, jaundice,
hydrocephaly, and microcephaly.
● Death of the infected newborn
babies is usually due to anemia with
pneumonia.
Blastocystis hominis

● Previously classified as yeast under

the genus of Schizosaccharomyces,
while other suggest that it is under
Blastomyces

● Light electron microscope has

shown that the organism has:
○ Nuclei
○ Endoplasmic reticulum
○ Golgi complex
○ Mitochondria like elements
● It has pseudopods and does not
grow in fungal culture media
Blastocystis hominis

● Life cycle is unclear

○ Begins with ingestion of cysts from
contaminated food or water
○ Through oral fecal route
● Multiplication is by binary fission
● Occur in four forms:
○ Vacuolated (most predominant)
○ Amoeba - like
○ Granular
○ Multiple fission
Blastocystis hominis

● Vacuolated forms
○ Spherical, 5 to 10 um
○ Has vacuole that pushes the nuclei
and cytoplasm to the periphery
○ Vacuole = reproductive organelle
○ Main form that causes diarrhea
● Amoeba - like
○ 2.5 to 8 um
○ Extension and retraction of
pseudopodia
○ Clumping of chromatin
○ Intermediate stage between
vacuolar and precystic form
Blastocystis hominis

● Granular form
○ Multinucleated and observed from
old cultures
○ 10 - 60 um
○ Granular contents develop into
daughter cells of amoeba form

● Cystic form
○ Resistant, oval or circular, 3 - 10 um
○ One or two nuclei
○ Prominent and thick osmophilic
electron dense wall
Blastocystis hominis

● GI pathology is controversial
● Flatulence, mild diarrhea, nausea,
vomiting, low grade fever and
malaise
● Lasts about 3 - 10 days
● Immunosuppression?
● Clinical diagnosis is difficult
● Lab diagnosis is needed for
confirmation
Dientamoeba fragilis
Dientamoeba fragilis
● Originally described an amoeba
● Actually a flagellate
● Thrives in mucosal crypts of
appendix cecum, upper colon
● Does not invade tissues, but
produces irritation of mucosa with
secretion of excess mucus and bowl
hypermotility
● Usually asymptomatic
● Chronic infection mimics
Inflammatory Bowel Syndrome (IBS)
 LIFE CYCLE

Life cycles is
unknown

Direct human to
human
transmission via
fecal-oral route of
E. vermicularis
containing D.
fragilis flagellates

Animal reservoirs
may also be
potential sources
of human
infections
BIOLOGY
● 7 to 12 um
● Flagellate with only trophozoite
stage (despite the absence of
flagellum)
● One (mononucleated) or two
(binucleated) rosette-shaped nuclei
● No peripheral chromatin
● Karyosome consists of 4 to 6
granules
● Cytoplasm may contain vacuoles
with ingested debris
DIAGNOSTICS
● Binucleate trophozoites in multiple
fixed and stained fresh stool
samples
● Trophozoites degenerate after a few
hours (“fragilis”)
● Multiple samples increase sensitivity
of detection
● Not detected by stool concentration
methods
● Fixation with PVA or Schaudinn’s has
been found helpful
Sarcocystis Species
Sarcocystis
● A genus of intracellular protozoa
● Reported to infect humans (rare) and animals worldwide
● Infection with this parasite- sarcosporidiosis or sarcocystosis.
● Occurs in tropical or subtropical countries.
○ Muscular sarcocystosis–Southeast Asia
● Infect animals such as birds, reptiles, and mammals.
● Most people infected with Sarcocystis do not have symptoms.
● Two types of the disease can occur
○ 1) Intestinal type: (for example infection caused by S. hominis and S. suihominis)
■ Causes diarrhea, mild fever, and vomiting
○ 2) Muscular Tye:
■ Causes muscle pain, transitory edema, and fever
Life Cycle
● Humans- definitive hosts for the two
species (S. hominis and S. suihominis)
● Occasionally, humans- intermediate
hosts.

Intestinal Type: ingestion of undercooked meat containing

the parasite.
Muscular Type: ingesting the form of the parasite that has
been passed in animal feces (most likely by inadvertently
ingesting the parasite when it has contaminated water or
food).
Morphology
● Zoite
○ Simplest form,
banana-shaped
○ Anterior end with
rhoptries, micronemes,
micropores for host cell
penetration
● Sporulated Oocyst ● Sporocysts
○ produces 2 sporocysts ○ contains 4 sporozoites,
through sporogeny can survive on the ground
and thus infect
intermediate hosts
Sarcocysts of Sarcocystis sp. in muscle tissue, stained with
hematoxylin and eosin (H&E). Notice the bradyzoites within
each sarcocyst.

● Sarcocysts
○ begin as unicellular bodies containing a single metrocyte.
○ Through repeated asexual multiplication, numerous metrocytes
accumulate and the sarcocyst increases in size.
● Bradyzoites
○ as sarcocysts mature, the small, rounded, non-infectious
metrocytes give rise to infectious, crescent-shaped bodies
Diagnostics
● Presumptive diagnosis of human intestinal sarcocystosis- based on symptoms and history of recent consumption of raw or
undercooked meat.
● Identification of sporocysts in feces- may require several stool examinations
○ Sporocysts of S. hominis are first excreted 14 to 18 days after ingesting raw beef
○ Sporocysts of S. suihominisare excreted 11 to 13 days after ingesting raw pork
● A fecal flotation wet mount is usually done to visualize sporocysts using bright-field microscopy
○ based on high-density solutions incorporating sodium chloride, cesium chloride, zinc sulfate, sucrose, Percoll, Ficoll-Hypaque,
and other density gradient media are preferred over formalinether/ethyl acetate and other sedimentation methods.
● Species cannot be distinguished from one another solely by microscopy because sporocysts of different species overlap in size and
shape.
● Definitive diagnosis- through biopsy of an infected muscle.
○ Sarcocysts of S. hominis are microscopic in muscles of cattle,
○ Sarcocysts of S. suihominis are macroscopic in muscles of swine.
○ Sarcocysts are identifiable with hematoxylin and eosin stain.
○ Confirmatory staining with the periodic acid-Schiff (PAS) can be performed as the walls stain positively.
■ The walls of the sarcocyst may be used in species diagnosis
● PCR
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