MISCELLANEOUS

PROTOZOA
 Miscellaneuos Protozoa
 Four groups of miscellaneuos protozoa:
A. Ciliata
 Balantidium coli
B. Sporozoa sub. Coccidia
 Isospora belli
 Sarcocystis species
 Crypotosporidium parvum
 Toxoplasma gondii
C. Blastocystea
 Blastocystis hominis
D. Pneumocystis jiroveci
Balantidium coli
 Largest protozoan known to infect human.
 Causes Balantidiasis.
 MOT: Oral-Fecal Route
 Reproduction: Sexual and Asexual
 Pigs are reservoir host
 Human are accidental host
Balantidium coli
 Trophozoite:
 28-152 um in length (ave. 35-50 um)
 22-123 um wide (ave. 40 um)
 Motility: Rotary and Boring
(Ciliated)
 Number of nuclei: 2
 Vacuoles: 1 to 2 visible
contractile vacuoles
Balantidium coli

 Cyst : 45-66 um
 Infective stage; Non-motile stage
 Number of nuclei: 2 (1 kidney-shaped macronucleus & 1
small spherical micronucleus)
 Vacuoles: 1 to 2 visible contractile vacuoles in young
cyst
 Cyst wall:
Trophozoite vs Cyst
 B. coli Life Cycle
 The cyst is the infective stage of
B.coli.
 Ingestion of cysts via fecal-oral route
(either food or water)
 Passes through the host digestive
system.
 Excystation takes place in small
intestine & produces a trophozoite
from cyst stage.
 Encystation occurs in lumen &
produces cysts from trophozoite
stage.
 Food- Fecal contamination with cyst
may infect another host.
B. coli Clinical Symptoms
 Clinical Symptoms:
a. Asymptomatic Carrier State
b. Balantidiasis

 Balantidiasis – Large-intestinal
infection which causes
mild colitis and diarrhea
to full blown clinical
balantidiasis (dysentery)
B. coli Laboratory Diagnosis
 Laboratory Diagnosis:
 Direct Fecal Smear
 Permanent staining
 Sigmoidoscopy
B. Sporozoa
 Intestinal and tissue-dwelling in nature.
 Coccidia – a group of protozoan in which asexual
replication occurs outside a human host and sexual
replication occurs inside a human host.
 Isospora belli
 Sarcocystis species
 Crypotosporidium parvum
 Toxoplasma gondii
Isospora belli
 Causes Isosporiasis.
 No intermediate host
 Human serves as the definitive host.
 I.belli Life Cycle
 Initiated by ingestion of sporulated
oocyst in contaminated food or water.
 Sporozoites emerge after excystation
of oocyst in small intestine.
 Schizogony resulting in merozoites
occurs in cells of intestinal mucosa.
 Gametogony takes place in same area.
 Gametocytes develop and unite to
form oocyst.
 Excretion of oocyst in stool.
 Maturity of oocyst takes place in
outside environment.
 I.belli Clinical Symptoms

 Isosporiasis – characterized by chronic

diarrhea.
 Patient also shows mild G.I discomfort to
severe dysentery, weight loss, anorexia
and malaise.
 Eosinophilia may occur.

 Charcot-Leyden Crystals may form.

 Fecal Fat is increased

 Oocyst shedding in stool took for as long

as 120 days
 I.belli Laboratory Diagnosis

 Fresh feces & duodenal

contents – specimen of choice
 Enterotest
 Sheater’s Sugar Floatation
Technique
 Iodine Wet Preparation
 Auramine-Rhodamine
permanent stain
 Modified acid-fast stain –
confirmatory
I.belli Treatment and Prevention
 Treatment:
 Chemotherapy

 Trimethoprim and Sulfamethoxazole

 Pyrimethamine and Sulfadiazine

• Prevention:
 Personal Hygiene

 Sanitation Practicesa

 Protected Sex
 Miscellaneuos Protozoa

 Four groups of miscellaneuos protozoa:

A. Ciliata
 Balantidium coli
B. Sporozoa sub. Coccidia
 Isospora belli
 Sarcocystis species
 Crypotosporidium parvum
 Toxoplasma gondii
 Cyclospora cayatenensis
C. Blastocystea
 Blastocystis hominis
D. Pneumocystis jiroveci
 Sarcocystis species

 Causes Sarcocystitis
 Sarcocystis hominis – Cattle
 Sarcocystis suihominis – Pigs
 Sarcocystis lindemanni – Humans

 Mature Oocyst
 Oval in shape
 Has two mature sporocysts, each average from 10-18 um in
length.
 Four sausage shape sporozoites
 Double-layered colorless & clear cell wall.
Sarcocystis Clinical Symptoms
 Usually asymptomatic
 Symptoms only documented to
immunocompromised
 Muscle tenderness cause by invasion of striated
muscles.
Sarcocystis Laboratory Diagnosis
 Stool – Specimen of choice
 DFS
 Routine histologic methods
 Miscellaneuos Protozoa

 Four groups of miscellaneuos protozoa:

A. Ciliata
 Balantidium coli
B. Sporozoa sub. Coccidia
 Isospora belli
 Sarcocystis species
 Crypotosporidium parvum
 Toxoplasma gondii
 Cyclospora cayatenensis
C. Blastocystea
 Blastocystis hominis
D. Pneumocystis jiroveci
Cryptosporidium parvum
 Causes Cryptosporidosis.
 Oocysts:
 Round; 4-6 um (confused with yeast)
 Has four small sporozoites

 One to Six granules may be seen

 Schizonts & Gametocytes

2 to 4 um
 4 to 8 merozoites

 Micro-and Macrogametocytes
Cyclospora cayatenensis
 C.cayatenensis infection is similar to
cryptosporidosis
 Oocyst (7-10 um diameter) form two sporocysts
each containing only two sporozoites.
 Lab Diagnosis: Floatation method and Modified
AFS
 Clinical symptoms – usually asymtomatic but
sometimes could cause chronic diarrhea.
 Prevention – proper sanitation and treatment of
drinking water
Toxoplasma gondii
 Definitive host:
 Members of the Felidae family
 Intermediate host:
 Rats, mice and man (accidental)
 Infective stages:
 oocyst and tissue cyst
Toxoplasma gondii
 MOT:
 Contact with infected feces
 Ingestion of undercooked meat
 Transplacental
 Blood transfusion

 Parasite stages in human

 Tachyzoite

 Bradyzoite
Toxoplasma gondii
Toxoplasma gondii
 Disease Manifestations:
 Mimic symptoms of Infectious Mononucleosis
 Fatigue, Chills, lymphadenitis, fever, headache and myalgia.
 Chronic– Maculopapular rash, encephalomyelitis,
myocarditis and/or hepatitis.
 Retinochoroiditis

 Congenital Toxoplasmosis

 Cerebral toxoplasmosis (AIDS patients)

T. gondii
 Laboratory Diagnosis:
 Sabin Feldman test
 Serological test

 Biopsy

 IgG or IgM studies

T. gondii
 Treatment:
 Trisulfapyrimidines and pyrimethamine
 Spiramycin (alternative for pregnant)

 Corticosteroids

 Folinic Acids (For AIDS patients)

 Prevention:
 Avoid contact with cat feces.
 Avoid eating raw meat
Blastocystis hominis
 Causes Blastocystis hominis infection.
 May cause diarrhea to some patients
 Treament: Iodoquinol and metronidazole
 Prevention: Proper hygiene
Pneumocystis jiroveci
 Formerly known as Pneumocystis carinii
 Causes pneumocystosis and atypical interstitial
plasma cell pneumonia.
 Now considered a fungus.
 Trophozoites: most commonly seen form. It is a
simple amoeboid organism with single nucleus.
 Cysts: has 4-8 intracystic bodies (in rosette shape
or scattered/unorganized)
P. jirovecii Clinical Symptoms
 Pneumocystosis: Atypical Interstitial Plasma Cell
Pneumonia.
 Severe symptoms occurs only in
immunocompromised patients.
 Kaposi’s sarcoma (AIDS patients only)
P. jirovecii Treatment
 Trimethoprim-sulfamethoxazole – first line of Tx
 Pentamidine isethionate
 Cotrimoxazole
P. jirovecii
 Hematoxylin stains
 Gomori’s methenamine silver nitrate stain
 Immunofluorescent stains
 Specimen may be submitted:
 Sputum

 Bronchoalveolar lavage
 Tracheal aspirate
 Brochial brushings

 Lung tissue