[Protzoans]

i.

Terminology
1. Definitive host
a. Host that harbors adult stage of a helminth or sexual stages of a protozoan
2. Intermediate host
a. Host that harbors the larval stage of a helminth or ASEXUAL stages of a protozoan
3. Reservoir host
a. Vertebrae animal, usually other than human
b. Harbors a parasite
c. Potential source of infection to humans
4. Zoonosis
a. Disease of lower vertebrates that is transmissible to humans

ii.

Dx & Tx
1. Microscopy
a. Fecal samples (O&P)
i. Usage: intestinal parasites
a. Protozoa: Cryptosporidium, Entamoeba, Giardia
b. Helminth (eggs): Ascaris, Trichuris, Hookworms, Flukes (Schistosomes), some tapeworms
c. Helminths (adults): Strongyloides, some tapeworms
ii. Collection & preservation
a. Fecal samples should be transported & examined by lab w/i 30 mins 2 hrs
i. If cant, need preservatives!
1. 10% formalin
2. Polyvinyl alcohol
3. Na acetate-formalin
iii. Concentration
a. Separate eggs from other fecal material
b. Methods:
i. Zinc sulfate floatation
ii. Formalin-ethyl acetate sedimentation
iv. Microscopic examination
a. Wet mounts
b. Stool samples diluted w/ normal saline
v. Stains
a. Increases contract, improves detection, prepares permanent slides for archival purposes
b. Examples:
i. Trichome & Giemsa (works for most parasites)
ii. Iodine
iii. Modified acid-fast
1. Good for Crypto!
iv. Iron hematoxylin
v. Calcofluor white

ii.

iii.

iv.
v.
vi.

vi. Ag-detection kits Abs to major parasite Ags can be used with high sensitivity
a. ELISA, Western blotting, immunofluorescence microscopy
Perianal specimens
1. Good for PINWORMS! (Enterobius)
2. Clear cellophane tape to perianal folds microscope slide see eggs on tape
3. Done in morning, before bathing
Intestinal sampling Sigmoidoscopy/Endoscopy
1. Used if fecal method cannot confirm
2. Sample from multiple sites
3. Sigmoidoscopy: good for Entamoeba histolytica
4. Endoscopy of duodenum: good for Strongyloides, Giardia, Cryptosporidium
Urogenital Urine, vaginal, prostatic secretions
1. Good for Trichomonas vaginalis, Schistosomes
Blood films
1. Good for malaria, trypanosomiasis, fliariasis, leishmaniasis
2. Thin & thick films
Other
1. CSF: Naegleria, Toxoplasma
2. Liver abcess bx: Entamoeba
3. Lymph node bx: Toxoplasma, Leishmania
4. Muscle bx: Trichinella

B. Immunodiagnostics
i. Presence of Ab in serum
1. Tested by EIA
2. Unable to distinguish b/t acute vs. chronic vs. recently cleared
ii. Presence of Ag in serum
1. Tested by EIA
2. Requires a lot of material
3. More indicative of acute infxn than Ab test
iii. Immunofluorescence
1. Uses fluorescently-labeled Abs on fecal samples
2. Good for intestinal parasite
3. Increased visibility improves detection
C. Molecular approaches
i. Detection of parasite nucleic acids via PCR
ii. High specificity & sensitivity
D. Culture
i. NOT USEFUL for most parasites (diff. from fungal & bacterial!)
E. No immunization available for parasites
F. Improved sanitation & control of vectors/intermediate hosts best approach

iii. Protozoan Parasites

o Single-celled

1. Intestinal Protozoa
a. Stages:
i. Trophozoite
a. Cause pathology
ii. Cysts
a. Involved in transmission
b. Transmission
i. Fecal-oral
a. Contaminated drinking water
b. Close-contact settings
i. Daycare
ii. Hospital
ii. Do not have intermediate hosts
iii. Some found in animals
c. Life cycle

d. Infection vs. carriage

i. Asx carriage w/ eventual clearance: 50%+
ii. Children, elderly, immunocompromised more likely be to be symptomatic
3

2. Endemic Extraintestinal Protozoa

a. Vector transmission & tissue tropism
i. NOT transmitted by vectors & do NOT have prominent bloodstream phase
ii. Primary infection site:
a. Brain & eyes
i. Trichomonas, Naegleria, Acanthamoeba
b. GU tract
i. Trichomonas
b. Geographic range
i. Worldwide
ii. Toxoplasmosis & trichmoniasis prevalent in US
c. Toxoplasma gondii

3. Non-endemic Extraintestinal Protozoa

a. Transmission
i. Contact w/ intermediate host
a. Arthropod hosts = vectors
b. Person-person transmission usually not possible (except: blood transfusions)
b. Life cycles
i. More complex vs. intestinal protozoa
a. Different stages of life cycle occurring in different hosts
c. Important of public heath measures
i. Most important: vector control through sanitation, draining of insect breeding grounds, insecticide spraying

4. Extraintestinal protozoans (cont) & Helminths

a. Extraintestinal protozoans

[Helminths]

vertebrate worms are multi-cellular animals with complex body plans

haracterization (by taxonomy & morphology)

A. Nematodes
i. Roundworms
1. Pinworms, roundworms, whipworms, filariasis
B. Trematodes
i. Flatworms
1. Intestinal or liver flukes
C. Cestodes
i. Tapeworms
1. Beef, fish, pork tapeworms
a. Based on intermediate hosts from which infection is acquired

ategorization (by anatomical site)

A. Extraintestinal rare group by taxonomy

fe Cycles
A. Developmental Stages
i. Most have egg, larval, and adult stages
1. Infectious forms almost always: larval or egg stages
B. Hosts
i. For most: human is host of adult stage
ii. Most also have intermediate and/or reservoir hosts
1. Intermediate hosts frequently required for completion of life cycle
C. Sexual cycles
i. Generally have complete sexual cycles
ii. Some spp. have bigender (M & F) system, other are hermaphroditic

athology
A. Characteristic of both bug & infection site

evention
A. Transmission
i. Few: vector-borne
ii. Most: fecal-oral route
B. Public health measures most important means of control
i. Adequate sanitation
C. Several tapeworms acquired via incompletely cooked meats or fish

A.Nematodes
i.

RULE: Sexual reproduction between M & F

1. Exception: Strongyloides
a. Parthenogenic (uniparental development)

B.Trematodes
i.
ii.
iii.
iv.
v.
vi.
vii.

Flukes
Flat, leaf-shaped worms
Most are hermaphrodites
1. Schistomsoma is bisexual
Definitive host = humans
Intermediate host = snails or freshwater fish
1. Or water plants in contact with snails
2. Infections result from contact with these
Reservoir = Several mammals
Classified by anatomical infection site
1. Sx depends on particular site

C.Cestodes
i.

ii.
iii.
iv.
v.

Characteristics
1. Flat, segmented worms
a. Segments
i. Each contain complete sexual organs & can produce fertile eggs
ii. Can detach from adult worm
2. All are hermaphrodites
3. Hooklets & suckers on head (scolex) enable attachment to host
Adult worms usually found in intestines & generally tolerated
Larval worms can be extraintestinal & cause Sx based on tissue site
Diagnosis
1. Both proglottid segments & eggs can be found in feces
Found worldwide

10

[Fungi]

morphic Fungi
A. General
i. Pathogenic dimorphic fungis phases regulated by temperature
1. Saprophytic or environmental phase (25C)
a. Fungi grow as moulds
2. Tissue or parasitic phase (35-37C)
a. Fungi grow as yeasts or yeast-like
b. NOT necc. component of life cycle
i. Adaptive response to altered growth environment
B. Disease characteristics
i. Portal of entry is respiratory tract
1. Infection is acquired via inhalation on conidia produced by mold phase
ii. Tissue phase NOT transmissible
1. No person-to-person spread of infection
iii. Primary infections most commonly occur in respiratory tract
1. Usually benign & self-limiting
iv. Some infected individuals will progress to serious pulmonary or even disseminated disease with multi-organ involvement
1. Extent of disease is regulated by immunological response of host
a. Humoral response (specific Ab)
i. Minimal role in protection
ii. May sometimes increase disease severity (hypersensitivity rxns)
iii. Measurement of Ab titers is occasionally useful for diagnosis & prognosis
b. Cell-Mediated Response
i. T-cells, cytokines, activated macrophages
ii. Primary protective mechanism & major determinant of disease severity
v. Infections caused by different dimorphic fungi are distributed in specific geographic locations
1. Endemic areas are a reflection of the environmental habitats of the mold phase of these fungi

11

pportunistic Fungi
A. General
i. More than 90% of fungal infections occurring in hospitalized individuals
1. Most d/t Candida
ii. Ubiquitous & low virulence

12