INTESTINAL ORAL AND

GENITAL FLAGELLATES

DR MONIKA RAJANI
ASSOCIATE PROFESSOR
DEPT OF MICROBIOLOGY
DR MONIKA RAJANI
CIMSH ,LKO
 Intestinal oral and genital flagellate

Parasitic protozoa that possess whip like

flagella as their organ of locomotion.

Unicellular
eukaryotic-
protista kingdom

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 PHYLUM
SARCOMASTIGOPHORA

MASTIGOPHORA
SARCODINA
1-INTESTINAL
EG:Entamoeba
histolytica FLAGELLATE-Giardia
intestinalis
2-GENITAL FLAGELLATE-
Trichomonas
vaginalis
3-BLOOD AND TISSUE
FLAGELLATES-
Trypanosoma
Leishmania
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 Examples
• Intestinal flagellate:
-Genus Giardia: Giardia lamblia (duodenum)
-Genus Chilomastix: Chilomastix mesnili (caecum)
:harmless commensal
-Genus Trichomonas: Trichomonas hominis (ileocaecal)
: harmless commensal
• Genital flagellate:
-Trichomonas vaginalis(vagina)
• Oral flagellate:
-Trichomonas tenax(teeth and gums)
-harmless commensal

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 General characters
• All have a trophozoite and a cystic phase except trichomonads.
• Trophozoites have multiple flagella that arise from
blepharoplasts.
• May or may not have undulating membrane.
• Axostyle and cystosome may be present in some
spp.
• reproduction occures by binary fission
• Encysment occures as protective process
• Mature cysts liberated in faeces are infectious
stages

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 General characters
• Mature cysts when swallowed with food liberate the
trophozoites in small or large intestine.
• Life cycle completed in single host.
• Second host required for continuation of species.
• Can be readily cultivated in artificial media

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DR MONIKA RAJANI
 Giardia lamblia

• First observed by Dutch

scientist Antony Von
Leeuvenhoek in his own
stools.
• World wide in distribution
• Habitat: duodenum and
upper part of jejunum in
man.
• Morphology: trophozoite
and cyst
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Trophozoite
• Tennis or badminton racket shaped.
• Bilaterally symetrical
• All organs of body are paired
• Dorsal surface:convex
• Ventral surface:concave with a
sucking disc.
• 14 x 7 microns
• Ant end:broad and rounded
• Posterior end:tapers sharply
• Two axostyles,two nuclei and four
pairs of flagella
• “Falling leaf motility”
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 Cyst
• Infective form of parasite
• Oval in shape,12 x 7 microns
• Axosyles present diagnally
• Axostyles form a dividing line within cyst wall.
• Four nuclei present
• Remains of flagella and margins of sucking disc seen
within cytoplasm.

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Trophozoite and cyst

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 Cultivation of Giardia

• Grows well in a medium of chick embryo

extract,human serum,tryptic meat digest and Hanks
solution.
• Can be cultivated together with a yeast-Candida
guellermondi

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 LIFE CYCLE
• Only one host required
• Mode of infection: ingestion of cysts with contaminated food and
water
• Direct person to person transmission in children and male
homosexuals
• Enhanced susceptibility : blood gp A
:Achlorohydria
:Chronic pancreatitis
:Malnutrition
:hypogammaglobulinemia

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Life cycle

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 Pathogenicity

• Parasite attatches itself to convex surface of

epithelial cells of intestine by its sucking disc.
• Does not invade tissue.
• Leads to disturbance of intestinal function
• Malabsorption of fat is a common feature.

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 Clinical features
• Silent asymptomatic cases.
• Intestinal:chronic enteritis and acute enterocolitis.
: persistent loose stools
:Steatorrhoea(yellowish and greasy stools with excess of
fat)
• General:fever,anaemia and allergic manifestations (due to toxic
and irritative effects of intestine)
• Chronic cholecystopathy,biliary colic,jaundice.
• Malabsorption of vit A,protein,sugars
• Weight loss
• Sprue like syndrome
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 Lab diagnosis
• Specimen:1-freshly passed stool
• Receptacle must be clean and dry
• no antiseptics should be used to wash it
• oil and oily emulsion ,barium or bismuth salts must not be
given to patient before examination.
• Alternatively stool may be collected by soft rubber catheter
inserted into rectum.
• specimen 2 :bile
• Gross appearance of stool:offensive odour
:Pale coloured ,fatty stool

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 Microscopy
• Microscopy:saline and iodine mounts
:demonstration of cyst in formed stool
:Demonstration of trophozoites in diarrheal
stool.

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 Comparison
Saline mount Iodine mount
• Motile trophozoites better • Kills parasite so motility of
appreciated trophozoite is lost.
• Chromatid bars better seen • Nuclear character better
• Cysts visualised seen
• Identification of spp
• Glycogen mass better seen

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 Stool concentration techniques

• Should be used if negative result is obtained on

direct smear
• Method applicable only to formed stool
• Only cystic stages are detected as trophozoites are
destroyed by this process.
• Floatation and sedimentation techniques.
• Formalin ether method used commonly

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 Stool preservation

• About 1-2 gm of faeces are treated with 8-10 ml of 10%

formalin
• Preserved in a screw capped vial.
• Before opening the vial,it should be thorougly shaken to
get a uniform emulsion.

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 Other diagnostic tests
• Entero test(string test)
• Direct fluoroscent antibody staining of cysts
• Giardia stool antigen detection: ELISA(Prospect T-GIARDIA
KIT)
:ICT
• Duodenal biopsy
• Molecular tests

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 Entero test
• Entero-Test (string test) is performed when a physician
suspects a parasite infection, but no parasites were found
in a stool sample
• Giardia, larvae of Strongyloides, H pylori

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 Principle

• A string test involves swallowing a string with a weighted

gelatin capsule, to obtain a sample from the upper part of the
small intestine. The capsule is swallowed and one end of the
string is taped to the side of the patient’s face.
• The capsule dissolves in the stomach and the string, which is
weighted at its distal end, passes into the duodenum.
• Following a period of approximately 4 hr, the string and any
adsorbed gastrointestinal fluid is withdrawn through the
mouth.
• Any bile, blood, or mucus attached to the string is examined
under the microscope as a wet preparation for the presence
of intestinal parasites (organisms/eggs)
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 Treatment

• Metronidazole(250 mg TDS) for 5-7days

• Furazolidone and nitazoxamide are prefered in
children
• Parmomycin in pregnant females
• Personal hygiene
• Prevention of food and water contamination
• Chlorination of water is ineffective for killing cysts
• Boiling and membrane filters must be used.

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 Genus Trichomonas:T vaginalis

• present in female Genital

tract.
• Also present in urinary
tract of both males and
females.
• Seen in prostrate and
preputial sac.
• Only trophozoite phase
• NO CYSTIC PHASE.

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Trophozoite
• Pear shaped
• single ovoid nucleus
• cystosome present
• 3-5 anterior flagella that are free.
• one thick flagellum passes backwards
along side of body and forms
undulating membrane and comes out
free at posterior end.
• Undulating membrane is supported at
base by rod like stucture called costa.
• Axostyle runs in middle of body and
ends in a pointed tail like extremity.
• Jerky or twitching motility

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 Life cycle
• In single host either male or female.
• Sexual transmission
• Babies may get infected during birth
• Fomites like towels are implicated in
transmission.
• Trophozoites are infective stages
• They divide by binary fission.

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 Clinical features

• Sexually transmitted disease.

• Often asymptomatic particularly in males.
• Females:Inflammation of vaginal mucosa.(stawberry
mucosa)
• Chicken like epithelium-intracellular edema
:Leucorrhoeic discharge-offensive,yellow green and
frothy discharge
:dysuria,dyspareunia
:cervical erosions,endometritis,pyosalpingitis.
• Males:Urethritis,epididymitis,prostatitis.
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 Lab diagnosis

• Specimen:vaginal discharge,urethral discharge

:urine
:prostatic secretions
• Microscopy:saline and iodine mounts

:demonstration of trophozoites.
:jerky or twitching motility

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 Lab diagnosis

• Permanent smears stained with acridine orange,giemsa

stains
• Direct fluoroscent antibody staining (DFA) of
trophozoite.
• Culture:cysteine peptone liver maltose (CPLM)
medium.
:Plastic envelope medium(PEM).
• Serology: antigen demonstration in secretions by ELISA.
• PCR

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 TREATMENT

• Simultaneous treatment of both partners is

recommended.
• Metronidazole is the drug of choice.
• Avoidance of sexual contact with infected partners.

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 Protozoa transmitted by sexual contact

• Trichomonas vaginalis
• Giardia lamblia
• Entamoeba histolytica.

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THANK YOU

DR MONIKA RAJANI