Protozoa

Causative Agent Life Cycle / Transmission / Signs & Symptoms / Pathology Diagnosis Treatment Prevention & Epidemiology /
Morphology Control Demographics
PROTOZOAN INFECTIONS: INTESTINAL AMOEBAE
Entamoeba MOT: *Oral-fecal, contaminated
MOT:  only member of the family to cause colitis Microscopic detection of Goals:  Environmental  Worldwide
histolytica water & food & liver abscess cysts & trophozoites on  To cure invasive sanitation  Prevalent in tropics
Subphylum:  Common on day care centers,  Amoebiasis stool specimens disease at both  Proper waste Risks:
Risks:
Sarcodina institutions (prisons, mental, home  Asymptomatic: cyst passers / cyst  Consistency / intestinal & extra- disposal  children, pregnant

Superclass: for the aged), use of night soil carrier state (but can infect others) appearance: intestinal sites  Safe drinking women & women in
Rhizopoda (vegetables), food & water  Symptomatic: trophozoites   Cyst (solid)  To eliminates the water & food postpartum period
Class: Lobosea handlers, mechanical vectors (flies  Diarrhea/dysentery   Trophozoites (solid) – passage of cysts from  Proper food  treated with

Order: Amoebida & cockroaches), sexual intimacy  Ulceration (intestinal) die within 30 mins to the intestinal lumen handling corticosteroids,
Family: (homosexuals through oral & anal  Extraintestinal: liver (common), lungs, 1 hour  Hygiene malignancy &
Entamoebidae sex) brain, pericardium (serious case), skin -examine ASAP Cyst passers  Avoid night soil malnutrition
Genus:  venereal transmission through Factors:
 Virulence Factors:  Contamination: urine &  Metronidazole for fertilizer
Entamoeba fecal-oral contact   lectin for adherence chlorine water may kill  Diloxanide furoate  Health education
 direct colonic inoculation through   secretion of proteolytic enzymes the trophozoite Colitis & promotion
contaminated enema equipment   release of cytotoxins DFS – 2mg stool  Metronidazole

  contact dependent cytolysis  Best method in the  Tiridazole

Isoenzymes: Phosphoglucomutase,   phagocytosis recovery of trophozoites Liver abscess

hexokinase   symbiosis of intestinal bacteria & cysts  Tiridazole

 Host Factors: Concentration Percutaneous

Cystic Stage: >10 um   Nutrition: ꜛCHO, ꜛcholesterol diet (more techniques drainage of liver
 infective stage favourable for colonization)  FECT (Formaline Ether abscess
cyst (1-4 nuclei)
 quadrinucleate cyst (1-4   Stress Concentration Test)  To those who do not
– resistant to gastric acidity &   Bacterial flora  MIFC (Merthiolate respond to
dessication & can survive in a   ꜜ O2 tension (grows at the cecal region) Iodine Formaline metronidazole & for
moist environment for several CM: Concentration Test) prompt treatment of
weeks Diarrhea – mucous  Zinc Sulfate severe pain
 central karyosome – “bull’s eye Dysentery – mucous & blood  More sensitive than DFS
karyosome   Loose bloody stools in the detection of cysts
 chromatoidal bodies with   Pain & cramps on abdomen Culture
rounded ends (cigar-shaped)   Fever, tenesmus, wt loss, nausea, Stained smears
 excystation occurs in the SI or LI, anorexia  Gold standard

where a cyst undergoes nuclear Intestinal ulcer microscopically

followed by a cytoplasmic division   Wide base with “bottle neck” ulcer  H&E, PAS, Trichome
to form 8 trophozoites   Deeper ulcer: intestinal perforation staining & Chlokasol
abscess (R lobe usu
Liver/Amoebic abscess (R Blackez Staining (?)
Trophozoite Stage: affected) Charcot Leyden Crystals
 pseudopodium-long finger-like   ALA (amoebic liver abscess) –by-products of IgE

motility   R hypochondriac pain, fever, jaundice, Aspirates – liver/

 cystoplasm with ingested RBCs leucocytosis pulmonary (wet-stained
 1 nucleus with central karyosome   ꜛESR, ꜛalkaline phosphates smears)
Pleuro-pulmonary amoebiasis Serology
Cyst-cytoplasmic division carrying 1   Rupture of liver abscess at the R  IHAT (Indirect

nucleus on the distal SI »moves to hemidiaphragm, cough, pleuritic pain, Hemagglutination)

the colon with the undigested food dyspnea, chills/fever, leucocytosis  IFAT (Indirect

»descending colon (dry env’t: Pericarditis – rupture of the liver abscess Flourescent Atb Test)
trophozoites do not survive) »starts at the L lobe.  CIE (Counter
to vomit out what ingested »pre-   Rare. If occurs, serious complication Immunoelectrophoresis)
cystic stage »trophozoites passed out   Chest pains, CHF-like manifestation  Atg detection (Stools):
in stool Brain Amoebiasis – hematogenous route ELISA
Cutaneous amoebiasis PCR  (Polymerase
 (Polymerase Chain
Reaction)
 COMMENSAL AMOEBA
Causative Agent Life Cycle / Transmission / Morphology Diagnosis Prevention & Epidemiology /
Control Demographics
Entamoeba coli Cyst: >10 um Stool examination  Proper disposal of  cosmopolitan in
 bigger than the E. hystolitica  Liquid to semi-formed stools will show trophozoites human waste distribution
 1-8 nuclei  Formed stools show cysts  Good personal harmless inhabitant
 Karyosome off center / eccentric hygiene of the colon
 Chromatoidal bars: jagged-ends “broomsticks-” or “needle sticks-” DFS  OFWs
or “slinter-” like  Demonstrate trophozoites  Food handlers

Trophozoites: Concentration techniques

 Blunt / rounded & broader ps eudopodia  ZnSo4 & FECT

 Slow motility (sluggish)  Recovery of cysts

 Thick, irregular, peripheral chromatin

 Nucleus: large eccentric karyosome FECT & Iodine stain

 No RBC on the cytoplasm but with vac uolated filling or granular  To differentiate the species
endoplasm of undigested food, bacteria, etc.
 Narrower, less differentiated ectoplasm Swab between gums & teeth
Entamoeba hartmanii Cyst: <10 um (5-10 um) To examine trophozoites for E. gingivalis
 quadrinucleated
 coarse cytoplasm

 Similar to E. hystolitica but is much smaller & does not ingest RBCs

 More sluggish in movement

Immature cysts:
Chromatoidal bars-short with tapered ends, or thin & bar-like
Entamoeba dispar Similar to E. hystolitica morphology but DNA & rRNA & isoenzyme
pattern are different
Entamoeba polecki   Parasite of pigs & monkeys

Cyst:
 Uninucleated
Nuclear membrane & karyosome are very prominent in fecal smears
Entamoeba gingivalis  Found in the mouth (gum & teeth surface), gum pockets & tonsillar
crypts

MOT: Kissing, droplet spray or s haring utensils

Trophozoite: 10-20 um
Moves quickly & numerous blunt pseudopodia
Endolimax nana Cyst: 6-10 um in dm
 Quadrinucleate when mature

Trophozoite: 6-15 um
 Sluggish movement

Nucleus: vesicular, large & irregularly-shaped karyosome anchored to

the nucleus by ac hromatic fibrils
 Iodamoeba butschilii Cyst:
 Uninucleated, large glycogen body

Trophozoite: 9-14 um long (6-20 um)

 Nucleus: large vesicular with large endosome surrounded by
achromatic granules
 CILIATES (Ciliophora)
Causative Agent Life Cycle / Transmission / Signs & Symptoms / Pathology Diagnosis Treatment Prevention & Epidemiology /
Morphology Control Demographics
Balantidium coli Trophozoite: 30-300 um long & 30- Balantidiasis/Balantidial dysentery Stool exam Tetracycline  Proper sanitation  Uncommon in
100 um wide  Rare infection in man (occupational  90% trophozoites  adults & older children  Safe water temperate
 Nucleus: macronucleus / hazard)  10% cysts (infrequent)  CI: children <8 y/o & supply countries
micronucleus  Common on pigs pregnant women  Protection of  Tropics: in
 Macronucleus: kidney-shaped,  Trophozoite can penetrate & produce DFS & Concentration Iodoquinol food from association with
horse-shoe-shaped necrosis/ulceration at the intestinal techniques Metronidazole contamination pigs
 Cytosome: anterior indentation lumen (ulcers – irregular,  Demonstration of cysts &  children  Associated with
(mouth) undetermined edges: trophozoites in feces  CI: early prenancy poor
 Cytopyge: posterior indentation rounded /narrow base & wide environmental
(anus) neck) Culture sanitation
 Mucocysts: extrusive organelles,  Also invades the appendix  Philippines: few &
beneath the cell membrane S/sx: sporadic
 Cilia: hair-like projections, spiral,  Intermittent diarrhea/constipation /
rolling motio tenesmus
Cyst:  Diarrhea (6-15 episodes/day)

 Infective Stage  Abdominal pains / tenderness / colic

 Anorexia, NV, wt loss, weakness

LC: same with Entamoeba  Dysentery – blood mucoid stools,

MOT: contaminated food & water perforation, haemorrhage & shock
containing cysts  Fetid breath
IP: 4-5 days  Extraintestinal: peritonitis, UTI,
Ingested cysts excyst in the SI inflammatory vaginitis
»become trophozoites »inhabit the
lumen, mucosa, & submucosa of the
LI (cecal region) »multiply binary
fission »pathologic changes in the
intestinal wall & mucosa
Cyst formed as protection for survival
outside the host »encyst during
intestinal transport or after
evacuation of semiformed stools
FLAGELLATES (Mastigophora)
Causative Agent Life Cycle / Transmission / Signs & Symptoms / Pathology Diagnosis Treatment Prevention & Epidemiology /
Morphology Control Demographics
Gardia lamblia MOT: ingestion of food contaminated Known to cause epidemic & endemic Stool exam Metronidazole /  Proper sanitary  Associated with poor
with mature cysts diarrhea  Demonstration of Tinidazole disposal of environmental
Other names: Gardiasis/Lambliasis trophozoites & cysts  Should not be taken with human excreta sanitation
G. intestinalis, Cyst: 8-12 um long & 7-10 um wide  Asymptomatic alcohol to prevent  Food handlers
G. duodenalis,  Double-walled usually ovoidal  Symptomatic Duodenal Aspirate Exam  AR: nausea, HA, contamination  Increasing

Lamblia  Axostyle-running across the  Habitat: SI drowsiness, metallic taste of food & prevalence is
duodenalis, cytoplasm  Impaired absorption of fat, D- Enter- test (String test) water supply attributed to
L. intestinalis  Flagella: retracted into xylose & Vit. B12  May demonstrate Quinacrine  Safe drinking homosexual oro-anal
axonemes, the median body &  Acute: nausea, lassitude, trophozoites  Alternative drug water (Boiling, practices
deeply stained curved fibrils anorexia, diarrhea, abdominal  Swallows a gelatin  SE: yellow staining of filtration, 2%  Outbreaks: water-

surrounded by a tough hyaline distention, weight loss capsule containing a skin, pychosis iodine) borne
cyst wall secreted from condensed  Flatus-rotten eggs smell nylon string Risk factors:
cytoplasm (hydrogen sulfite)  Poor hygiene

 Paired parabasal bodies  Chronic: fatty stools (steatorrhea) DFS  Poor sanitation

 Nucleus-quadrinucleated (mature  Trophozoites: floating  Overcrowding

cysts); binucleated (young cysts) leaf-like motility  Immunodeficiency

 Bacterial & fungal

Ag detection test in stools overgrowth in the SI
 Trophozoite: 9-12 um long & 5-15 (ELISA)  Homosexual
um wide  Monoclonal Atb practices “gay bowel
 Pear-shaped / pyriform / tear syndrome” 
drop-shaped Ab dectection:
 Axostyle-distinct medial line IFAT/ELISA
 Parabasal bodies  Direct fluorescent Atb
 Curved / convex dorsal (pointed) assays
 Concave ventral

 Nucleus-binucleated, ovoidal

(one on each side of the midline

 Organelle of attachment:
sucking disc (large adhesive disc)
 Flagella: 4 pairs, falling leaf-like,
kite-like motion (erratic tumbling-
like motion)
 Bilaterally symmetrical organism

 Reproduction: longitudinal

binary fission
 Found in diarrheic stools

Metabolism:
 Glucose (Embden-Meyerhof)

 Acetate, ethanol, alanine

 Arginine/Alanine – participates in
glucose metabolism
 Cannot synthesize lipid (host gut)

Trichomonas General morphology of Male:  Experimental results: Simultaneous for sexual  Associated with
vaginalis Trichomonads:  Asymptomatic: self-limiting, less survive in urine 9-20 partners venereal
 Pear-shaped persistent hours transmitted
 Axostyle: extended beyond the  Symptomatic: discharge, pruritus  Wash clothL 23 hours Nitro-imidazoles: diseases, STIs,
length of the organism (head of penis), burning sensation of  Metronidazole / gonorrhoea (24-
 5 Flagella: 4 in the anterior end, urination Specimen: discharge Imidazole 30%)
1 trails along the undulating Microscopy: fresh,  Non-venereal:
membrane Female: tumbling/twitching motility virgins,
 1 nucleus  Asymptomatic: self-limiting, less  Staining: Giemsa children/babies,
 Cyclostome: less prominent persistent  Pap Smear neonatal
 Symptomatic: pruritus, vulvo-  AO (Aquidine-Orange  Worldwide

IP: 4-30 days after exposure vaginitis, vaginal discharge, painful Stain) distribution
 Lumen flagellate coitus, vaginal odor  Siderophil granules  Both sexes affected

 Die at 40C (with dessication  Cervix-edematous, blisters,  Incidence correlates

under sunlight) petechiae, “strawberry cervix”, Culture: in pouch system with the number of
 Largest among trichomonads punctate hemorrhages sexual partners
 Do not produce cysts, only Whiff test: 20% KOH, fishy  Peak in age groups

trohozoites odor (+) 6-35 y/o

 Ovoid nucleus Female:
 Undulating membrane: <1/2 of  50-75% prostitutes

the axostyle  7-32% social / VD

 Diagnostic feature: siderophil clinics

granules  5% family planning

 Associated with: Non-specific clinics

 NSV (vaginitis)  Higher among post-

 NSP (prostatitis) menstrual females

 NSU (urethritis)
 INTESTINAL PROTOZOANS
Causative Agent Life Cycle / Transmission / Signs & Symptoms / Pathology Diagnosis Treatment Prevention & Epidemiology /
Morphology Control Demographics
Blastocystis Isolates form chicken, ducks, geese,  Often non-specific s/sx  Light microscopy (wet  Difficult to eradicate  Safe water  Tropical, subtropical
hominis & sea snakes  May include: diarrhea (sometimes mount with or without because they hide in the  Environmental & developing
MOT: fecal-oral self-limiting), abdominal pain/cramps staining) intestinal mucus, sticks & sanitation countries
LC: Ingestion of cyst »ruptures  / discomfort, nausea  Vacuolar forms may be holds on to intestinal
 Handwashing  Adults > children,
»vacoular »autoinfection  Profuse, watery diarrhea destroyed by concentrated membranes
 Prevention of food immunocompro-
 Not conclusively demonstrated  Fatigue, anorexia, flatulence & other techniques or addition of  DOC: Metronidazole /
4 Morphological Forms: non-specific GIT symptoms distilled water – only the Iodoquinol contamination mised patients
 Vacuolated or central body: 5-  Correlates with: enteritis, terminal cyst  Asymptomatic: not  Sterilization (?)  Incidence in Italy &
10 um in dm ileitis, colitis/ulcerative colitis,  Immunologic treatment  Cysts survive up China
 Diagnostic feature arthritis techniques, Invasive  TMP-SMX to 19 days in  40.7% food
 Reproductive organelle  Large cases present their stools as techniques (?) Trimethroprim- water at normal handlers in Manila
 most predominant forms in fecal asymptomatic Sulfamethoxazole (Co-
temperature & tertiary hospitals
specimens  Incidental finding/commensal trimoxazole),
 Spherical  Suggest possibility of asymptomatic Nitazoxamide  Resistance to
 Large central vacuole pushes the carriers  Diet Mgt: ꜛdiet in fiber, chlorine at the
cytoplasm & nuclei to the  Associated with specific forms of B. lactose-free standard
periphery of the cell hominis & the immune status of the concentrations
 Amoeba-like forms: patient
 Undergoes mitosis

 Occasionally observed in stool

samples
 Exhibit active extension &

retraction of pseudopodia
 Nuclear chromatin: peripheral

clumping
 Intermediate stage between the
vacoular & pre-cystic form
 Allows the parasite to ingest
bacteria to enhance encystment
 Granular forms: 10-60 um

 Observed from old cultures

 Granular contents develop into

daughter cells of the amoeba

form when the cell ruptures
 Multiple fission

 Arise from vacuolated forms

 Produce many vacuolated forms

 Cystic form: 3-55 um

 Prominent & thick osmophilic

electron dense wall
 Demarcated polymorphic, oval or
circular
 Dense body surrounded by a

loose outer membranous layer

 Precyst undergoes schizogony

(creation of smaller version of

amoeba in the form of a cyst)
 Thick-walled cyst: responsible for

the external transmission

 Thin-walled cyst: cause of

reinfection within a host’s intestinal

tract
 FREE-LIVING PATHOGENIC AMOEBA
Causative Agent Life Cycle / Transmission / Signs & Symptoms / Pathology Diagnosis Treatment Prevention & Epidemiology /
Morphology Control Demographics
Naegleria  The organism that can exist as an PAM (Primary Amoebic  CSF exam of trophozoites Amphotecirin B: IV & Chlorination of  1965,
fowleri amoeba (trophozoite form) & as a Meningoencephalitis)  Phase contrast of Giemsa intrathecal swimming pools meningoencepha-
flagellate (swimming form)  Rare disease that leads to or Wright stain – centrally  May be combined with litis
MOT: swimming/inhaling inflammation of the brain & placed nucleus miconazole & rifampicin  Isolated in soil &
contaminated water destruction of brain tissue  PCR Assay: identifies N. freshwater, nasal
Portal of Entry: olfactory epithelium  rapid onset of symptoms (24 hrs to fowleri DNA on the brain passages & throat
Habitat: Soil – source of 02, water, 5-7 days) tissue samples of healthy
temperatures compatible with  Early sx: HA, nuchal rigidity, NV,  ELISA individual
survival & bacterial food supply restlessness  Chlorinated
 Late sx: photophobia, lethargy, swimming pools,
Cyst form: seizures, confusion, coma, diplopia freshwater lakes,
 Double-thin walled, resistant  CSF: ꜛpressure, gray to yellow- thermal springs,
Flagellate form: white, with RBCs & WBCs (PMNs) domestic water
 Temporary,  PP: lesions- base orbitofrontal & supplies, thermally
Trophozoite stage: temporal lobes polluted water,
 Infective stage  Brain affected filled with sewage, soil, air,
 Free-living form fibrinopurulent exudate humidifier systems,
 Can transform reversibly into a  Large numbers of amoebic cell cultures
non-reproductive flagellate st age or trophozoites (no cysts) seen within  Children & young
a resistant cyst edematous & necrotic neural tissue adults
 Acanthamoeba Trophozoite stage: GAE (Granulomatous Amoebic Cranial CT Scan: large low- 5-flurocystosine,  Precaution on use  1913
 spp.  Infective / vegetative / active Encephalitis) density lesions ketoconazole, of contact lenses  Ubiquitous
feeding stage  HA, stiff neck Cranial MRI: multiple ring- itraconazole, & hot-tub Jacuzzi, (everywhere) &
 Reproduction: binary fission  Cerebral hemisphere mostly affected enhancing lesions pentaminide, or etc. worldwide
 fine, tapering, thorn-like (spiny)  Edematous with extensive Histology: amoebic amphotericin B  Found in soil, fresh
locomotion: acanthopodia that hemorrhagic necrosis trophozoites & brackish water
arises from the surface of the  Cornea (Amoebic Keratitis): Keratitis: cotrimoxazole in
body trauma to cornea or contact lenses combnation with
 moves sluggishly with pentamidinem, isethionate &
polydirectional movement Neosporin & avoidance of
 uninucleated large with a centrally topical CS
located dense staining nucleus
 large endosome, finely granulated

cytoplasm, large contractile

vacuole
 host for Legionella spp.
Cyst stage:
 Dormant, resistant

 PAS: encysts containing cellulose

 Double walled (ectocyst &

endocyst): outer wrinkled wall &
inner polygonal-shaped wall
 Pores or ostioles: seen at the
point of contact of the 2 walls
*both are diagnostic stages

MOT: nasopharyngeal route through

breaks in the skin & inhalation
 Isolated from air, bottled mineral

waterm soil, swimming pools, deep

well water, contact lens cleaning
solutions, etc.
 COCCIDIANS (Parasites & the Immunocompromised)
Causative Agent Life Cycle / Transmission / Signs & Symptoms / Pathology Diagnosis Treatment Prevention & Epidemiology /
Morphology Control Demographics
Cryptosporidium  Exists primarily as oocyst  Immunocompetent:  Immunoflourence Nitazoxamide: initially Immunocompromis  Worldwide
hominis  Ingestion of water containing asymptomatic-diarrhea (1-3 weeks); microscopy used for tapeworms ed - handwashing  Associated with
C. parvum sporulated cyst (infective stage) – carrier state  Usually of stools  MOA: prevent anaerobic  Practice safer sex AIDS
 “embryonated egg stage-like”   Immunocompromised:  Visualize oocyts metabolism via inhibition (cryptosporidium  Not uncommon in
 Excystation happens in the SI,  CD4 count of <200  Has higher sensitivity & of pyruvate ferredoxin can be 1st world countries
lungs releasing sporozoites  Diarrhea, fever, NV, signs of specificity oxidoreductase (PFOR) transferred thru  Outbreak in
 Parasitism: invasion of epithelial dehydration, electrolyte imbalance  Can… Paramomycin - oro-anal sex, csyt Milwaukee, 1993
cells of SI (habitat) forming aminoglycoside stick on the inner  Waterborne
trophozoites thigh, anus, diseases
 Reproduction: knees of the  Seen in recreational
 Asexual – produce schizonts & patient when water facilities,
merozoites (goes out, invade touching those contaminated
the epithelial cells & undergo parts) drinking water
another LC)  Avoid touching (ground / bottled
 Sexual – microgametes (male) farm animals water),
macrogametes (female) (reservoir host) contaminated
 Sporulation: produce sporulated  Avoid touching undercooked food
oocysts stools of pets
 Thin-walled cysts-capable of  Avoid swallowing

autoinfection; remains in the water when

body; d/c if goes out (no swimming
support) (chlorine
 Thick-walled cysts-goes out of resistance
the body Cryptoporidium)
 Wash/cook food

properly
 Drink safe water

 Rolling boil for 1

min
 Clean ice trays,

 jars with soap

(spores tend to
stay there)
 Water fillers:
reverse osmosis,
absolute 1
micron, standard
53, cyst reduction
removal
Cyclospora  Unicellular coccidian Immunocompetent/  Microscopy TMP-SMX  Handwashing  Tropical &
cayetanensis  Larger than cryptosporidian Immunocompromised:  Usually of stools  2 synergistic drugs  Wash / cook food subtropical
 Exists as oocysts  Severe diarrhea (10-12 weeks)  Visualize oocysts  Inhibits tetrahydrofolate properly  All age groups at
 Carrier state (?) controversial intermittently synthesis (needed for  Drink safe water risk
LC: same ingestion, excystation,  Anorexia, wt loss, low grade fever,  Techniques used: DNA replication &  Sanitation
reproduction abdominal pain  Wet mount with UV transcription)  Health education

 Release: produce unsporulated fluorescence of DIC  MOA: PABA analogues

oocyts which exists the host  FECT – used to collect

 Sporulation: outside environtment minute amount of

 T: 22-32C diarrheic stool
 Modified Acid Fast /
 No autoinfection
Safranin Test
 Cystoisospora  Unicellular coccidian  Severe diarrhea of weeks  Microscopy TMP-SMX  Handwashing  Tropical &
belli  Exists as oocysts  Anorexia, wt loss, low-grade fever,  Usually of stools  2 synergistic drugs  Wash / cook food subtropical
Other name:  Least common among the three malabsorption, crampy abdominal  Visualize oocysts  Inhibits tetrahydrofolate properly  Risk
 Isospora belli  Large ellipsoidal oocyst pain & Eosinophilia intermittently synthesis (needed for  Drink safe water immunocompro-
(elongated) “rice grain-, eyes-,  Techniques used: DNA replication &  Sanitation mised
cigar-shaped”   Wet mount with UV transcription)  Health education  Common in
fluorescence of DIC  MOA: PABA analogues institutions
LC: same ingestion, excystation,  FECT – used to collect  Affects humans &
reproduction minute amount of animals
 Release: produce unsporulated diarrheic stool
oocyts which exists the host  Modified Acid Fast /

 Sporulation: outside environtment Safranin Test

 Oocyst contain sporoblast  Duodenal biopsy –
»mature to oocyst containing isospora tend to invade in
sporozoites the deep epithelial cells of
 Less virulent than cyclospora SI causing eosinophilia
(other 2 organisms
superficial only)
 String test (Enterotest)

Toxoplasma Tachyzoites (trophozoites) Immunocompetent Observation of various Pyrimethamine- Pregnant women  One of the most
 gondii  Most common form seen on  None, self-limiting, mild cases specimen Sulfadiazine (1 line)  Gloves when common human
samples  10-20% develop flu-like illnesses  Blood (routine method for  2 synergistic drugs handling soil infections
 Pear-shaped  Rarely, may develop chorioretinitis Dx)  Inhibits tetrahydrofolate  Avoid eating raw  Worldwide

 Mobile form, bends/curves  Bronchioalveolar lavage synthesis (for DNA meat prevalence: 20-
sometimes Immunocompromised  LN biopsy replication &  Wash utensils & 75% (3 out of 4)
Oocyts: 10-13 um by 9-11 um  HA, confusion, seizures (neurologic  Other body fluids transcription) food  Philippines:

 Round / ovoid, thin wall sxs)  Amniocentesis  MOA: PABA analogues  Don’t drink around >25%
 HIV pts: Neurologic Toxoplasmosis unpasteurized  US: 60M (15% of

Definitive host: Cats (Felidae)  Most common CNS mass lesion Other Methods: Special cases: milk female in
 Intestinal epithelium: merozoites  Occurs when CD4 <100  PCR, ELISA Ocular toxoplasmosis  Cover children’s childbearing age)
multiply (schizogony) » differentiation  Tumor-like CNS s/sx  Fundoscopy/Retinal  TMP-SMX (alternative) sandboxes  France: eating
into micro/ macrogametocytes
 Death may occur: thru brain exam – calcifications in  CS (inflammation of  Avoid cats undercooked meat
(gametogony)
herniations the retina retina)  Central America:
 Inside the mature oocyst, 2 sporocyst
(each having 4 sphorozoites)  MRI – encephalitis Pregnant women Cat lovers stray cats
 Excretes unsporulated oocyst (no Congenital Toxoplasmosis  UTZ – for pregnant  not routinely given  Keep cats indoors Risks:
autoinfection)  ꜜBW, hepatospleenomegaly, women because it is highly  Don’t feed cats  Can be transmitted

 Then eaten up by rats/mice

 jaundice, MR, hearing loss, teratogenic with raw meats from pregnant
Intermediate host: Rats / mice chorioretinitis (80%)  may not be given during  Don’t adopt stray mother to the
 can be latent CM which you can organogenesis cats/kittens unborn child
 Tachyzoites: fast-moving
trophozoite, able to feed acquire congenitally  spiramycin  Clean litter boxes (congenital
themselves (Macrolide) –prevent properly toxoplasmosis)
 Reside in neural tissues & muscular
protein synthesis  Change litter box  Immunocompro-

tissues everyday mised pts

 Clean with
 Then become tissue cysts »

bradyzoites (both infective stage) scalding water

»then ingested by the DH (oocyst resistant
Humans to soap)
 Wear gloves
 MOT: food/drinks, litter boxes,
farm animals, organ  Handwashing

transplantation, blood donation, after

transplacental/*vertical
transmission
 Organs affected: brain, muscles,
eyes, heart
 PLASMODIUM Spp.
Causative Agent Life Cycle / Transmission / Signs & Symptoms / Pathology Diagnosis Treatment Prevention & Epidemiology /
Morphology Control Demographics
Plasmodium MOT: bite of female anopheles mosquito Pathology: r/o place travelled & P. falcifarum Control & Global Burden:
 spp.    Blood transfusion P. falcifarum blood smears  Chloroquine (CQ) Prevention  109 endemic countries

P. falcifarum    Sharing of IV needles  Adherence to infected RBC to non- & Pyrimethamine  Chemotherapy: & territories worldwide
P. vivax    Transplacental: transmission upon birth infected RBC leading to rosette Clinical Diagnosis:  Resistant to CQ if early diagnosis &  3.3 B at risk
P. ovale    Neonatal malaria formation –tissue anoxia  Semi-immune: only HA given alone treatment  Morbidity: approx. 247B
P. malariae    Mother seems to be asymptomatic  Cytoadherance infected RBC become  Severe malaria: P.  Long lasting annually
P. knowlesi sticky on the surface & walls of t he falcifarum Uncomplicated P. insecticidal nets  Mortality: approx. 1M

(DOH, 2009) Walking malaria – carriers, endothelium diminishing the calibre  Confusion, coma, falcifarum (LLIN) – even upto deaths annually
st
asymptomatic  Process results in: formation of red neurologic focal  1 line drug 5 years of use  91% Africa

   Immunity on their RBCs cell aggregates & intravascular signs, severe anemia, combination  Indoor residual  85% children (<5y/o)

   Suppliers of malaria sequestration of RBCs that respiratory difficulties (Coartem) spraying (IRS)
   You can find them thru Mass blood contain mature forms of the parasite  Lab. Finding: because  Artersiminins  Vaccines MDG (Millennium
smear in vital organs (brain & heart) early clinical diagnosis (Artenether, Development Goals #6)
is not typical Artenusate, Malaria Control  Goals for global

Mosquito Stage: P. vivax, P. malariae, P. ovale Dihydrocoteminin)  reduce the impact importance
 Sexual stage  No sequestration Microscopy: + Lumetantrine not elimination  To ꜜM/M

 Sporogony  P. vivax – reticulocytes  Thick & thin peripheral  treat malaria cases  Malaria has global

 Mosquito infected with gametocytes  P. malariae – old RBCs blood smears P. vivax properly importance
(micro /macrogametocytes) »female  Quality of reagents  CQ  prevention: vector

only bites »zygote » ookinete » Classis s/sx of Malaria: (early destroyed) control Top 5 Provinces:
oocyst containing sporozoites  Triad: chills » fever » sweating  Microscopy & Severe Malaria  Prevent disease: Palawan, Isabela,
(infective stage) » migrate in the  HA, muscle pains experience of  IV quinine & administration of Cagayan, Tawi-Tawi
salivary glands » blood meal  Merozoites: hypothalamus » ꜛT microscopist’s quinidine anti-malarial drugs
causing chills » fever » sweating experience  Pregnant: IV then  IBT (Intermittent B Malaria free 22
Asexual Stage: Human  Can mimic flu  Standard Exam: oral Treatment) for provinces: all Visayas
st
Human Liver Stage:  1 : thick film – 100 pregnant & children except Negros & Antique
 Sporozoites » liver (exoerythrocytic Severe Complications: microscopic fields, Gametocytes &  Catanduanes,

schizoint) » schizogony »  Cerebral malaria – tissue anoxia magnification of 600 Hypnozoites Activities for Sorgogon, Samar,
trophozoite » schizoint (containing (causes death), kidney failure to 700x  Primaquine Malaria Control Leyte, Bohol, Cebu,
merozoites) » liver cell ruptures » end  Advantages: simple,  Health education Masbate, Mariduque,
up in RBC Uncomplicated Malaria: low cost, quality & Prophylaxis (IEC- Information Capiz, Aklan, Benguet
  P. vivax & P. ovale: stops/sleeps in  Classical malaria- attack last 6-10 quantity diagnosis  Doxycycline Education
liver cells called hypnozoites stage hours  Sensitivity of Communication)  Control phase in the
  Dormant stage  Tertian: P. falcifarum, P. vivax, P. peripheral Philippines
  Responsible for relapse of malaria ovale (every 2nd day) microscopists: 55% Barriers for Malaria  Malaria not included in
rd
 Quartan: P. malariae (every 3  Disadvantages: Control: 10 leading cause of
Human Blood Stage: day) labor intensive  Drug resistant morbidity
 Multiplication (doubling/ tripling)  Insecticide resistant  Indigenous cases
 Erythrocytic schizony » merozoites Severe/Complicated Malaria: Serologic Tests:  Imported cases
» trophozoites » schizont  Occurs to most persons who have to  IFAT Ensuring Quality:
 Specialized feature: gametocytes immunity to malaria  RDT (Rapid Diagnostic  Quality assurance Malariometric Indices:
(reproduction) process called  Young children & pregnant women Test)  TES (Therapeutic Slide Positivity Ratio:
gametogony  Lateral flow Efficacy
P. falcifarum & P. vivax immunochromatogra Surveillance)
Malaria parasites:  Recrudescence: no clearing phic assay  Bioassay &

 P. falcifarum & P. vivax – most  Submicroscopic threshold  Test strips (dipsticks) susceptibility test Annual Parasite
infections worldwide  Short term relapse (hours to days to  Molecular Diagnosis monitoring – for Incidence:
 P. vivax & P. ovale –
dormant liver few weeks)  PCR effective insecticides
stage (hypnozoites), can reactivate for LLIN & IRS
(relapse) & cause malaria for several P. vivax (parasites cleared) & P.
months to years after the infecting ovale
mosquito bite  Parasitic relapse
 P. malaria – long-lasting infections if
left untreated can persist
asymptomatically in the human host for
years & even lifetime; longest IP
 P. falcifarum severe potentially fatal
–

malaria
  Estimated 700,000-2,7M deaths

annually, most are children dying in

Africa
  Frequent occurrence in the

Philippines (60-70%)
 P. knowlesi monkey-type
–

(primates); thought it is P. malariae

Female Anopheles Mosquito

 Of 430 known species of anopheles,
30-40 transmit malaria in nature
 Developmental factors:

  Ambient T & humidity

  Higher T accelerate the parasite

growth in the mosquito

  Whether the anopheles survives long
enough to allow the parasite to
complete its cycle
  Anthropragic (human)

  Rain-dependent (beginning & end of

the rainy season)
  Behavior: partially exophilic &
exophagic

 Breeding Sites:
  Likes dark clothing

  Bites at night

  Slow-flowing, partly shaded stream

  Shallow collections of fresh water like

puddles, ricefields & hoofprints