PARA 10

PARASITOLOGY FOR NURSES

~ CILIATES AND FLAGELLATES ~

CILIATES
 Balantidium coli
o Only ciliate and the largest protozoan to infect humans
 Colon, especially cecum
o Zoonotic parasite (pigs, monkeys, rats)
 Man as accidental host
 Close contact with pigs
 Poor sanitation, crowding
o Morphology
 Cyst – spherical to ovoid, double walled
 Trophozoite – longitudinal covered with cilia from oral to caudal region
 (+) cytostome (oral apparatus) at the tapered end
 (+) cytopuge (excretory part) at the rounded posterior end
 (+) bean-shaped macronucleus with adjacent micronucleus
 (+) contractile vacuole/s acting from osmoregulation
o Balantidiasis
 Ingestion of contaminated food or water (cysts)
 Fecal matter from humans or animals
 Resistant to routine chlorination, sensitive to hear and 1% NaClo
 Incubation period is 4-5 days
 Excystation in the small intestines
 Trophozoite invasion of colonic wall
 Asymmetric (transverse) binary fission +/- conjugation (less often)
 Encystation with transport or after passage of semi-formed stools
o Dehydration contributes to encystation  low water  encystation
 Disease spectrum
 Asymptomatic colonization
o Most common
o With malnutrition, dysbiosis, co-infections, achlorhydria,
alcoholism, and chronic disease, manifestation may occur
 Fulminant balantidiasis/balantidial dysentery
o Bloody, mucoid stools, colonic ulceration +/- perforation
 Chronic balatidiasis
o Diarrhea alternating with constipation, anemia, and cachexia
 Extra-intestinal balantidiasis
o Appendix, liver, GUT, lungs
 Difference from amebiasis
 Balantidiasis
o Round-based, wide necked ulcer via action of hyaluronidase
 Amebiasis
o Flask-shaped ulcer

FLAGELLATES
 Have flagella (mastix)
o Whip like locomotory organs with central supporting rod (axostyle)
 Types
o Lumen-dwelling – alimentary and urogenital tracts
o Hemoflagellates – blood and tissues
 Giardia duodenalis
o Sole protozoan parasite in small intestine lumen
 Duodenum, jejunum, upper ileum
 Prevalence: children > adults, male > female
 Risk factors: poor sanitation, mental illness, anal-oral sex
o Outbreaks through recreational or drinking water
o Morphology
 Cyst – ovoid with two (immature) to four (mature) nuclei
 Diagonal axostyle, median/parabasal body
 Trophozoite – teardrop, tennis racket shaped pointed posteriorly
 Bilaterally symmetrical at axostyle
 Two ovoidal nuclei, ventral adhesive disk, 4 pairs of flagella
 Posterior sausage-shaped parabasal, median bodies
 Falling leaf-like motility
 o Giardiasis
 Ingestion of food and/or water with mature cysts
 Contamination by food handlers, flies, human feces, night soil
 Resistant to ordinary chlorination
 Institutionalized patients, day care attendees and workers
 Incubation period: 1 to 4 weeks (average – 9 days)
 Excystation in the duodenum
 Longitudinal binary fission of trophozoites
 Attachment to gut villi via adhesive disk (body temp, pH = 7.8 – 8.2)
 Encystation with dehydration in the colon
 Types
 Asymptomatic
 Self-limiting gastrointestinal disease (2-6 weeks)
o Diarrhea with excess flatus with “rotten egg” odor
 Chronic giardiasis and complicated giardiasis
o Steatorrhea alternating with constipation
o Failure-to-thrive (for infants), weight loss, cholecystitis
 Treatment
 String test
 Cyst wall protein 1 and Gairdia specific antigen 65
 Direct fluorescent antibody assays
 Trichomonas vaginalis
o Most prevalent non-viral STI
 Vulva, vagina, cervix, urethra in women
 Urethra, prostate, and epididymis in men
o Commonly affects women of childbearing age
o Prevalence: commercial sex workers, those with multiple sexual partners
o Morphology
 Exists only in the trophozoite stage, obligate parasite of humans
 Trophozoite
 Pyriform, pear-shaped
 Median axostyle, single nucleus with 4 anterior flagella + 1 flagellum
embedded in undulating membrane supported by flexible rod called the costa
 Jerky or twitching movement
o Life cycle
 Sexual intercourse
 Infectious: trophozoite
o Trichomoniasis
 Asymptomatic
 Usually in males
 Incubation (4-28 days)
 Longitudinal binary fission
 Desquamation and inflammation of mucosa, decreased vaginal pH
 Acute inflammation
 Greenish or yellowish secretions, pruritus, and burning sensation
 Strawberry cervix with punctate hemorrhages
 Chronic trichomoniasis
 Less purulent secretions and dysuria
 Vulvitis, endometritis, pyosalpingitis (in females)
 Recurrent urethritis, epididymis and prostatis (in males)
o Diagnosis
 Wet mount
 Pap smear
 Culture: Diamond’s modified, Feinberg or Whittington medium
 Antigen detection tests and PCR (in males)
 Prevention
o Limiting the contact of pigs with water sources - Balantidium
o Avoiding the use of pig feces as fertilizer - Balantidium
o Discouraging the use of night soil – Balantidium/Giardiasis
o Use of 1% sodium hypochlorite – Balantidium/Giardiasis
o Limiting number of sexual partners - Trichomonas
o Use of barrier methods of contraception - Trichomonas
o Simultaneous treatment of sexual partners - Trichomonas