PROTOZOAN DISEASES AND HUMANS

DR.C.V.NARASIMHA MURTHY

The following points highlight the eight significant protozoan diseases caused in humans.
The diseases are: 1. Amoebiasis 2. Diarrhoea 3. Trypanosomiasis 4. Leishmaniasis 5. Trich
moniasis 6. Malaria 7. Toxoplasmosis 8. Balantidial Dysentery.

Protozoan Disease # 1. Amoebiasis:

Amoebiasis, also known as amoebic dysentery, is caused by Entamoeba histolytica. Infection

generally occurs through drinking water. The trophozoite of E. histolytica penetrates the wall of
the colon, secretes histolytic enzymes and feeds upon its cells causing ulcers.

These ulcers rupture and discharge mucus and blood into the intestine that pass along with stools
and results in amoebic dysentery. If the infection is allowed to continue the parasite may reach
the liver, lungs and brain where it causes abscesses which prove fatal.

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There is no intermediate host in the life cycle of E. histolytica. Transmission of the parasite from
man to man takes place through the tetra nucleate cysts. Before the cyst-formation the
trophozoite changes into a smaller minuta form, which then encysts to form a tetra nucleate cyst.

These tetra nucleate cysts are voided with the faecal and contaminated water and food and are
then transmitted into new hosts. Faecal contamination of drinking water, vegetables and food are
the primary causes. Eating of uncooked vegetables and fruits which have been fertilised with
infected human faeces has often led to the occurrence of disease.

Occasionally drinking water supply contaminated with infected faeces gives rise to epidemics.
Houseflies may transmit cysts while passing from faeces to unprotected foodstuffs. The cysts of
E. histolytica have been found in the droppings of cockroaches which also serve as a source of
infection.

Amoebiasis is endemic in tropical countries. It can be treated with Emetine, Fumagillin,

Metronidazole, Tinidazole, Terramycin, Erythromycin, Aureomycin and Chloroquine, etc.

Protozoan Disease # 2. Diarrhoea:

Diarrhoea, which is characterised by loose bowels, is caused by a flagellete parasite Giardia

(=Lamblia) intestinalis and a sporozoan Isopora hominis. Giardia intestinalis is a parasite in the
small intestine and colon of man.

It has an elliptical or pear-shaped body which is bilateraly symmetrical with dorsal side convex
and ventral side flattened and deepened anteriorly to form a concave sucking disc. It bears two
nuclei and four pairs of long flagella arranged symmetrically.

With the help of sucking disc the parasite attaches itself on to the convex surface of the epithelial
cells in the intestine and may cause a disturbance of intestinal function leading to malabsorption
of fat which causes diarrhoea. Consequently the patient may complain of persistent looseness of
bowels. The parasite is also capable of producing epigastric pain, abdominal discomfort, loss of
appetite, headache and toxic effect (allergy).

Infection in man is brought about by ingestion of cysts. Transmission of the parasite takes place
through cysts which are voided with faeces and are transmitted to new hosts with contaminated
water and food. The infection of Giardia is more common in children than in adults.

Atebrin, Chloroquine and Acranil are effective drugs in the treatment of Giardia. Metronidazole
has also been reported to be quite effective in its treatment.

Isopora hominis is a rare infectious parasite amongst human beings inhabiting the small intestine
of man and may cause intestinal symptoms like colic and diarrhoea. Dogs are supposed to be
reservoir hosts of I. hominis.

Protozoan Disease # 3. Trypanosomiasis:

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Trypanosomiasis is caused by the species of Trypanosoma which are flagellate parasites of blood
plasma (in vertebrate hosts) and gut (in invertebrate hosts). Trypanosoma is generally transmitted
by blood-sucking insects. It is the most dreadful of all pathogenic protozoans. Sleeping sickness
is a dangerous disease of man in Africa.

Three species cause sleeping sickness in man which are as follows:

(i) Trypanosoma gambiense is transmitted by tsetse flies, Glossina palpalis and G. tachinoides. It
causes Gambian or Central African sleeping sickness.

(ii) Trypanosoma rhodesiense is transmitted by tsetse fly Glossina morsitans. It causes

Rhodesian or East African sleeping sickness.

Both the above species of Trypanosoma are confined to those parts of Africa where tsetse flies,
their vectors, are found.

On infection by the parasite trypanosome fever is caused during which the parasite lives freely in
the blood, then the parasites collect in the lymph glands, spleen and liver causing their
enlargement, finally they enter the cerebrospinal fluid causing sleeping sickness which results in
coma and eventually in death.

Suramin and Pentamidine are considered to be the drugs of choice for early and acute infection.
As they cannot pass the blood-brain barrier, they are not of any value when the central nervous
system is involved in which case an arsenical is needed. The arsenicals include Tryparsamide,
Melarsen, Melarsoprol (Mel B) and Trimelarsen. Nitrofurazone, an oral trypanoside may be used
in cases resistant to arsenic.

(iii) Trypanosoma cruzi is transmitted by a bug called Triatoma megista. Transmission to man is
not due to bug’s bite but through its faeces. It causes Chagas’ disease or American
trypanosomiasis in South and Central America. Chagas’ disease is similar to sleeping sickness. It
causes continuous fever, lymph glands, spleen and liver are swollen with degeneration of
infected cells, and disorders of the nervous system.

Anaemia and injury to heart muscles lead to death. No permanent cure was suggested for this
disease. Recently Melzer and Kollert (1963) suggested successful treatment of a case of T. cruzi
with Nitrofurazone tablet, giving a total dosage of 18.375 gm in 27 days.

Protozoan Disease # 4. Leishmaniasis:

Leishmaniasis is caused by the species of Leishmania, the flagellate parasite in the

reticulendothelial cells of vertebrate host, man and in the gut of an invertebrate host, the blood
sucking fly, Phlebotomus.

The genus Leishmania includes three species which are common parasites of man, viz.:

(i) Leishmania donovani;

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(ii) Leishmania tropica and

(iii) Leishmania brasiliensis.

(i) Leishmania donovani causes kala-azar or visceral leishmaniasis which is widespread and
endemic in many places in India, China, Africa, Southern Europe, South America and Russia. Its
vector is a sand fly, Phlebotomus. In kala-azar the parasite attacks the endothelial cells, bone
marrow, liver, lymph glands and blood vessels of the spleen.

These organs are enlarged and there is a bloodlessness and high fever. If left untreated, 75 to 95
per cent of the patients die within a period of two years. Treatment with antimony compounds
proves successful. Urea stibamine, Aminostiburea, Neostibosan, Solistibosan, Sodium-antimony-
gluconate and Pentamidine isoethionate are most effective drugs.

(ii) Leishmania tropica causes Oriental sore (Tropical sore) or Delhi boil. The infection is limited
to a local lesion of the skin and subcutaneous tissues which turn into ulcerating wounds.

Its vector is Phlebotomus, a sandfly. This parasite is found along the shores of Mediterranean
through Syria, Arabia, Mesopotamia, Iran to Central Asia, the drier parts of Central and Western
India and also in many places of Central Africa. Treatment includes regular cleaning and
dressing of the boils, Pentavalent preparation of antimony.

Dehydroemetine orally in doses of 100 mg daily for 10-21 days has given satisfactory result.

(iii) Leishmania brasiliensis causes a disease called Espundia or American leishmaniasis

producing multiple sores over large areas of the skin and oro-nasal mucosa. Ulceration in nasal
cavities, mouth and pharynx is quite frequent. The vectors are anthropophilic sandflies.

The parasite is confined to Central and South America. Treatment includes Pentavalent
preparation of antimony. In resistant cases Pyrimethamine or Amphotericin B may be useful.

Protozoan Disease # 5. Trich moniasis:

Trichomoniasis is caused by the species of flagellate parasite, Trichomonas. Its body is pear-
shaped provided with one nucleus, an axostyle, a parabasal body, 3- 5 anterior free flagella, and
one backwardly directed flagellum along the side of the body. Trichomonas are parasites in
vertebrates and many invertebrates.

Three species are found in man which are:

(i) Trichomonas hominis,

(ii) Trichomonas lenax and

(iii) Trichomonas vaginalis.

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The most common pathogenic species is Trichomonas vaginalis. It inhabits the vagina of women
and causes vaginitis. The disease is characterised by inflammation of vaginal mucosa, burning
sensation, annoying itch and abnormal discharges.

Transmission of parasite is always during sexual intercourse by male members who act as
intermediaries. T. vaginalis is also found in urinary tract of men infecting the urethra and
prostate. Arsenic and iodine drugs and antibiotics such as Terramycin and Aureomycin have
proved useful in the treatment of the disease.

Protozoan Disease # 6. Malaria:

Malaria is caused by the species of a sporozoan parasite, Plasmodium. It is transmitted through

the bite of female anopheles mosquito. In man the parasite attacks the liver cells and red blood
cells. A toxic substance, the haemozoin, released by the parasite causes malaria.

There are following four species of Plasmodium which cause human malaria:

(i) Plasmodium vivax causes benign malaria in which fever comes on every 48 hours;

(ii) Plasmodium malaria causes quartan malaria in which fever comes every 72 hours;

(iii) Plasmodium falciparum causes malignant sub-tertian malaria in which the fever is more or
less continuous;

(iv) Plasmodium ovale causes mild tertian malaria in which fever comes on every 48 hours.

All the four species multiply asexually in cells of the liver and erythrocytes of man. In malaria
the spleen is enlarged, erythrocytes decrease in number, the blood becomes watery, pigment
granules collect in the spleen and there is high temperature accompanied by chills and shivering.

Malaria not only causes millions of deaths annually in the tropics but it also prevents the
cultivation of the most fertile regions of the earth. Various drugs which are now used for the
treatment of malaria include Quinine, Camoquine, Chloroquine, Plasmoquine, Resochin,
Pentaquine, Pamaquine, Paludrine, etc.

Protozoan Disease # 7. Toxoplasmosis:

Toxoplasmosis is caused by a sporozoan parasite, Toxoplasma gondii. Human infection of

Toxoplama gondii has been reported from European countries, Middle East, Sri Lanka, U.S.A,
Australia, Hawaii and many other places. The infection appears to be cosmopolitan.

The dissemination of the parasite occurs through the blood stream ultimately localising in
various organs such as brain, spinal cord, eyes, lungs, liver, spleen, bone marrow, lymph nodes,
heart muscles and skeletal muscles.

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The parasites multiply by endodyogeny but under certain conditions large cysts are also formed.
Symptoms of the disease are hydrocephalus and chorioretinitis. Infection occurring in early
months of pregnancy results either in abortion or still birth of the foetus. Pyrimethamine
(Daraprim) combined with Sulphadiazine have been found to be an effective remedy.

Protozoan Disease # 8. Balantidial Dysentery:

Balantidial dysentery is caused by a ciliate parasite, Balantidium coli. It inhabits the large
intestine of man. It may bore into the tissues of the intestine causing ulcers which results in
dysentery and diarrhoea. This may prove fatal. The transmission of the parasite to a new host
takes place through cysts in contaminated water and food.

Drugs used for the treatment are Carbarsone, Diodoquin and Oxytetracycline have been found to
be effective.

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