2.2.

1 Intestinal Protozoa
Learning Objectives

• Recognize the names of pathogens associated

with characteristic diseases
• Recognise the morphology
• Remember the key features of the life cycles
(i.e., how do the parasite get from one host to the
next?)
• Remember the main mechanisms of disease
(i.e., how does damage to the host occur?)
• Lab diagnosis of parasitic disease (stages of
parasite seen in clinical samples & how to
differentiate from non-pathogenic types)
 INTESTINAL PROTOZOAL INFECTIONS
Name of disease

Amoebae
• Entamoeba histolytica Amebic dysentery
Flagellates
• Giardia lamblia Giardiasis
• Trichomonas species Trichomoniasis

Cilliates
• Balantidium coli

Sporozoa/Apicomplexa
• Cryptosporodium species Cryptosporidiosis
3
 E. histolytica - parasitic forms
Trophozoite: -Seen only in warm fresh stool
-Size 20-30 µm
-motility : active in one direction only
-cytoplasm granular with ingested RBC
-Nucleus: round with central karyosome

Cyst:- round 10-16 µm

-Immature cyst 1-2 nuclei, large glycogen
mass
-mature cyst 2-4 nuclei
Nuclei seen only in iodine prep
Entamoeba histolytica -- pathogenesis

• Trophozoites disrupt mucus layer

• Three key virulence factors:
• amebic lectin)toxin): binds parasite to galactose-containing sugars on
host cells
• amoebapores: adherence-dependent cytolysis
• cysteine protease : cleaves antibodies and C3
• Trophozoites ingest human cells (Erythrophagocystosis)
ingest RBC
• Colonic ulceration - portal parasitemia
Entamoeba histolytica Trophozoites
Life cycle of E. histolytica

• Humans are the only

reservoir excreting
amoebic cysts
• Cysts resist
environmental
conditions
• Fecal-oral transmission
(food, water)
• In response to gastric
acid, ingested cysts
release trophozoites in
 Amebiasis - clinical syndromes

• Intestinal
• Ranges from asymptomatic to chronic diarrhea to
amebic dysentery bloody stools
• Extraintestinal
• amebic liver abscess
• other metastatic foci (e.g., brain, lungs, skin..)
• Diagnosis: -
- identification of trophozoites or cysts in the stool,
- stool antigen tests,
- serology for anti Eh antibodies

- ? Stage seen in amoebic abscess aspirate……….

Trophozoites stage
Other amoebas in stool non
pathogenic
Differentiation of intestinal amoeba protozoa
Lab diagnosis
Two microscopically indistinguishable Entamoeba sp.

•E. histolytica pathogenic

•invades tissues
•should always be treated, even in asx patients
•E. dispar non pathogenic
•is non-pathogenic, even in AIDS
•should not be treated

➢? Differentiate
•Antigen specific ELISA
•PCR
 Giardiasis - life cycle

• G. lamblia is a zoonosis (infected small

mammals pass cysts and contaminate
surface waters)
• Waterborne transmission is most
common, but can also be spread
person-to person by children (e.g.,
day-care centers)
• Ingested as cysts
• Excystation of the trophozoite and
attachment to the mucosa occurs in the
upper small intestine.
• Parasites elicits localized hypersensitivity
• Intestinal villi become blunted
• Malabsorption develops
Giardia lamblia

Trophozoites in duodenum

Cyst in stool
 Giardiasis - clinical features

•Acute, self-limited diarrhea (traveler's

diarrhea)
•Chronic diarrhea with malabsorption,
steatorrhea, and weight loss
•Chronic asymptomatic cyst passage
 Lab Diagnosis and Prevention of Giardiasis

• Stool examination
• Wet preparation :fresh liquid stools for trophs,
cysts
• Stained fecal smears
• Duodenal/jejenal aspirate( Enterotest capsules)
• Stool antigen testing

Prevention
• Filtration of water
• Heating water to 50oC
• 2% iodine x 30 minutes
Non-pathogenic flagellate
Trichomonas vaginalis
Ciliates

g
Balantidium coli life cycle
4) Microsporidium sp.
 Generalizations about other intestinal
protozoa
(Cryptosporidium, Cyclospora, Microsporidia)

• All acquired by fecal-oral route

• All grow abundantly inside of mucosal
cells
• All cause watery diarrhea, cramps,
anorexia (not inflammatory) -
pathogenesis uncertain
• All require special stains or examinations
of stool for diagnosis.
Cryptosporidium parvum
•Associated with-
•prolonged self-limited diarrhea in
immunocompetent individuals
•traveler’s diarrhea
•chronic, unrelenting diarrhea in
AIDS
•Usual acquired from
•drinking water (e.g., Milwaukee,
1993)
•swimming pools
•Relative chlorine resistance
 Cryptosporidium

Iodine stain of stool Acid-fast stain of stool

Treatment of cryptosporidiosis

•Supportive (rehydration,
antimotility agents)
•No FDA-approved
treatment
•Nitazoxanide?
 Cyclospora

•Food and waterborne transmission

•recent series of outbreaks in U.S.
associated with Guatemalan raspberries.
•Also replicates within mucosal cells
•Diarrhea may persist for 1-2 months
without treatment
•Trimethoprim/sulfa x 7 days is effective
therapy
 Microsporidia

•Primitive protozoa with some features of

bacteria (e.g., no mitochondria)
•Long recognized as animal pathogens
•human cases in AIDS
•recent human cases also seen in
immunocompetent persons
•Hundreds of species identified
Intestinal Protozoa
800 MyHCT (800 69428)
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