parasites infection

• Parasitic diseases remain a significant global health problem causing

approximately
• one million deaths per year and
• affecting more than 1.7 billion people worldwide.
 1. Protozoan disease: giardiasis

• Giardia lamblia is a flagellated protozoan and

• is the most frequently identified intestinal parasite
• There are two stages in the life cycle of G. lamblia:
• the trophozoite and
• the cyst.
• G. lamblia, which is found in the small intestine,
gallbladder, and biliary drainage, is a pear-shaped
trophozoite with four pairs of flagella.
 Pathophysiology

• Giardiasis results from ingestion of G. lamblia cysts in fecally

contaminated water or food.
• Person to-person and animal-to-person transmission has been
reported, but is rare.
• The protozoan cysts are moderately tolerant to chlorinated water
and release trophozoites in low gastric pH.
• Ingestion of as few as 10 cysts may cause infection and those
infected may shed 108 to 109 cysts in their stool per day for
months
• Colonization and multiplication of the trophozoite lead to
• mucosal invasion,
• localized edema, and
• flattening of the villi,and
• nutrient malabsorption.
• Lactose intolerance precipitated by giardiasis and iron deficiency
can persist even after eradication of the protozoan
 Clinical presentation

ACUTE:
• Diarrhea:
• foul-smelling, copious, lightcolored, fatty stools
• Cramp-like abdominal pain, bloating, and flatulence
• Malaise, anorexia, nausea, and belching
CHRONIC:
• Periods of diarrhea alternating with constipation
• Weight loss,
• lactose intolerance,
• vitamin B12, and fat-soluble vitamin deficiencies
• Diagnosis: S/E
 Treatment

• adequate oral or intravenous fluids to maintain hydration, correct

electrolyte abnormalities,
• The antimotility agent loperamide and the antisecretory agent
bismuth subsalicylate are available without a prescription, but are
not recommended
• 1 line: metronidazole 500 mg(10mg/kg/dose) po TID for5-7 day
st

• Alternative: tinidazole 2gm(50mg/kg if >3yrs) po stat after food

• Paromomycin is a safe agent in all pregnancy trimesters because it
is not systemically absorbed.
• Metronidazole has been used in the second and third trimesters of
pregnancy. but, not used in 1st TMP
 Amebiasis

• E. histolytica is the major causative organism in amebiasis.

• Infection occurs when one ingests food or water contaminated
with E. histolytica cysts.
• E. histolytica invades mucosal cells of colonic epithelium,
producing necrotizing ulcers in the submucosa.
• The trophozoite has a cyto lethal effect on cells through a toxin.
• If the trophozoite gets into the portal circulation, it will be carried
to the liver, where it produces abscess and periportal fibrosis.
 Clinical presentation

• Diarrhea: bloody (heme-positive in 100%of cases) with mucus

• Vague abdominal discomfort to severe abdominal cramps,
flatulence
• Right upper quadrant pain, hepatomegaly, and liver tenderness
with referred pain to left or right shoulder
• When amebic liver abscess is suspected from initial physical
examination and history, confirmatory diagnostic procedures will
include serology and liver scans (using isotopes by ultrasound or
computed tomography [CT]) or magnetic resonance imaging.
• Leukocytosis (more than 10,000/mm3[more than 10 × 109 /L])
and an elevated alkaline phosphatase concentration (more than
75%) are common findings.
• Tinidazole 2 grams daily × 3-5 days or Metronidazole 750 mg
orally or iv every 8 hours × 7-10 days,
• Patients with severe intestinal disease or liver abscess should
receive metronidazole or tinidazole followed by a course of one of
the luminal agents (Paromomycin 8-12 mg/kg orally every 8 hours
× 7 days, iodoquinol,)