Intestinal and Genital Flagellates

All of these species are typically lumen and intestinal parasites. Those are commonly
occuring in man and are host specific. Others appear to be accidentally associated with the
intestinal tract and are coprozoites (feces feeders). Which are perhaps just beginning to become
adjusted to a parasitic environment. Although none of the members of the group are tissue
invaders, at times Giardia lamblia in the duodenum and trichomonas vaginalis in the vagina
erode the epithelial lining of their respective organs and evolve symptoms.

Giardia lamblia

Synonyms: Cercomonas intestinalis; Giardia intestinalis; Mega stoma enterica; Giardia enterica
Disease: Giardiasis, Lambliasis
Geographical distribution: Cosmopolitan but more common in the tropics and in children.
Morphology: The trophozoite is pear shaped, bilaterally symmetrical with a bored, rounded
anterior and a tapering posterior. It measures from 9-21 u in length and 5-15 u in width. The
dorsal surface is convex. An ovoid concavity with raised margins, the sucking disc, occupies
about three quarters of the flat ventral surface.
At the anterior end, there are two nuclei, each with a large karyosome lying within the
sucking disc. Below the nuclei running within the width of the trophozoite are two curved rods
(parabasal body). There is a pair of thickened axonemes originating from the blepharoplast above
the nuclei. Four pairs of flagella arise from the ventral side of the body, two from the anterior
end of the sucking disc, two from the mid portion of the sucking disc appearing as lateral
flagella, another arises from the sucking disc, and a terminal pair from the end of the axostyle.
The cysts are ovoid measuring 8-12 microns. Young cysts have two nuclei while the
mature cysts have four nuclei. In stained specimens the contents of the cyst may shrink from the
cyst wall, leaving a clear space, the axostyle is also prominently seen in cyst.

Epidemiology: Giardia lamblia is a parasite of the small intestine. It is the most widely
distributed of the intestinal flagellate in our country with the prevalence of 5-20%. Giardiasis is
most common in children who are closely associated with one another, as in asylums and in large
families.

Life Cycle: Infection is by ingestion of large viable cysts through contaminated food or drink.
The cysts pass unharmed through the gastric juices of the new host and upon reaching the upper
intestine undergo excystation. The trophozoite colonizes on the surface of the mucosa. They
reproduce by binary fission. Encystation occurs in the large intestine with the dehydration of
feces. Man is the natural host.

Pathology: In majority of infections. Giardia does not cause any damage. They do not invade
tissues. In some cases the attachment of the sucking disc on the epithelial cells lining the
duodenum provokes an intense inflammation, resulting in the secretion of the abundant mucus,
flatulence, hyper peristalsis, steatorrheic stool due to prevention in the absorption of fats and
dehydration. Most frequent symptom is the abdominal pain and persistent diarrhea, but
occasionally this infection may cause celiac syndrome.
Diagnosis: Laboratory diagnosis is based on the demonstration of the trophozoite and cyst in
stool. Trophozoites may not be found in stools unless it is persistently diarrheic or unless the
individual has been given saline cathartic, because of their location in the intestine. Therefore,
only cysts are found in the stools

Treatment: Mepacrine is an effective drug for treatment of giardiasis.

Atabrine is also indicated
Metronidazole- DOC

Prevention: Training children and adults to develop cleaner habits of personal and group
hygiene.

Trichomonas hominis

Synonyms: Cercomonas hominis, Trichomonas confuse, Trichomonas intestinalis, Trichomonas

fecalis.
Geographical Distribution: Cosmopolitan. Infections are common in the tropics and subtropics
than in temperate regions.
Morphology: All intestinal trichomonads irrespective of whether they have three, four or five
anterior flagella are designated as Trichomonas hominis.
The trophozoite is a pliable organism, assuming varied shapes. It usually measures 5-14u
in length. There may be anywhere from 3-5 flagella, with most organisms possessing five. It has
a large nucleus at the anterior portion end along the mid axis. A rather heavy aorta forms the
base of attachment for the undulating membrane that runs the length of the organism and trails
off into a free flagellum. Cyst stage for this organism is not known.

Transmission: Since there is no cyst stage, transmission occurs through ingestion of trophozoite
in food and drink contaminated with human feces. Filth flies may serve as mechanical vectors.

Pathology: There is no evidence that T. hominis is pathogenic or causes intestinal disturbance.

However, its presence may indicate an unnatural condition which requires medical attention.

Diagnosis: Study of suspected individuals by saline smears in the trophozoite is destroyed and is
distorted by the usual iodine stains and concentration procedures.

Treatment: There is no indication for specific treatment.

Prevention: This involves improvement in community sanitation and personal cleanliness.

Trichomonas tenax

Synonyms: Trichomonas elongate, Trichomonas buccalis, Tetra trichomonas buccalis

Geographical Distribution: Cosmopolitan
Morphology: It is a pyriform flagellate known only in the trophozoite stage. It measures 5-15 u
in length, is smaller than T. vaginalis. It possesses flagella of equal length and the fifth one on
the margin of the undulating membrane.

Life Cycle: The main habitat is the mouth of man particularly in the tartar of the teeth. The
trophozoite divides by binary fission of the nucleus and longitudinal division of the body.

Transmission: Although the exact method of transmission is not known, exposure results from
droplet spray of the mouth, kissing, or common use of contaminated dishes and drinking glasses.

Pathology: T. tenax is not pathogenic. It is a harmless commensal of the mouth, living in the
tartar of the teeth, in cavities of carious teeth, in the necrotic mucosal cells, in the gingival
margins of the gums and in pus pockets in tonsillar follicles. It is quite resistant to changes in
temperatures and will survive for several hours in drinking water.

Diagnosis: Direct smear of material from tartar of teeth, gums and tonsillar crypts.

Treatment: None indicated except better oral hygiene.

Trichomonas vaginalis

Synonyms: Trichomonas vaginalis. Trichomonas vaginae

Disease: Trichomonad vaginitis, Trichomoniasis
Geographical distribution: Cosmopolitan
Morphology: The organism resembles T. hominis in morphology except however, T. vaginalis is
usually larger and its undulating membrane does not exceed the entire length of the body. The
cytoplasm contains large amounts of siderophil granules.
Life Cycle: The normal habitats are the human vagina and the prostate gland. In the female the
organism typically feeds on the mucosal surface of the vagina, ingesting bacteria and the
leukocytes, and at times being phagocytosed by the macrophages. It prefers a medium slightly
alkaline or somewhat more acid than that of a healthy vagina. Similar information is not
available in this trichomonad in the infected male, from whom it may be demonstrated in the
urine. Urethral discharge or following massage of the prostate with emission of the prostatic
fluid. Not infrequently the organism is detected in microscopic examination of sedimented or
centrifuged urine of male and female hosts, in which it may remain active for hours, with
progressive undulating movements. In its habitats, T. vaginalis divides by longitudinal binary
fission
Transmission: the infective stage is the trophozoite stage, transmitted during sexual intercourse.
Once outside the body, the trophozoite is destroyed by temperature above 40 C , by drying and
direct sunlight. In water the trophozoite dies in half an hour so that infection while bathing in
swimming pools is not possible. Contaminated toilet seats and towels may occasionally cause
infection but the most common way is by sexual contact. A high percentage of men are
asymptomatic carriers and are the ones responsible for the spread of parasite. T, vaginalis is
specific for man.
Pathology: Infection in male is usually asymptomatic although at times it is associated with a
non specific urethritis. Symptoms may be slight in some female patients but quite serious in
others and particularly in expectant mothers and women with other gynecological complaints.
The cardinal sign is vaginal discharge in the form of leucorrhea accompanied by vaginal itching
and burning. The urethral discharge is characteristically yellowish frothy, Frequent micturition is
common and the vaginal mucosa may be hyperemic.
Diagnosis: In female, T. vaginalis may be found in sedimented urine, vaginal secretions or from
vaginal scrapings. In male, it may be found in the urine, prostatic secretions or following
massage of the prostatic gland. T. vaginalis exhibits typical nervous, jerky trichomonad
movement and possesses a characteristic undulating membrane. Specimens should always be
examined fresh.
Treatment: Metronidazole is the drug of choice and is usually given orally in doses of 250 mg.
3x a day x 7 – 10 days. This drug is also available as vaginal inserts which should be given
concurrently with oral therapy. Suppositories of diiodohydroxyquin are also helpful, as are
douches of vinegar or lactic acid to promote acid pH.
Prevention: Since infection is contracted almost exclusively through sexual contact, the infection
in symptomatic male must be diagnosed and cured. While trichomoniasis of the genitalia does
not have the stigma of syphilis or neisserian disease, its control and prevention require both
patience and strict discipline.