Parasitology

Lec # 3
Protozoa III

Parasitology -2021
 Case I
2

 a 38-year-old Nigerian woman presented to a local rural

health center with 2 months of fever, headache, and joint
pain. She did not seek medical advice during this period
but self-treated with antipyretics; On presentation at the
provincial hospital, she was treated presumptively for
malaria. The following day she remained febrile and
started to show abnormal behaviour. She was transferred
to the Hospital for Tropical Diseases. A thick blood film
was prepared, stained with Giemsa stain and examined
for blood parasites on the same day. The blood film
demonstrated the presence of haemoflagellates.
Parasitology -2021
 Case I
3

Parasitology -2021
 Case I
4

 Suggest the name and causative agent of the disease

Name of disease: African trypanosomiasis (Sleeping
sickness) T. brucei
Is their further complications for such disease
. In central nervous system: Symptoms include headache,
abnormal behavior, unconsciousness and coma before
death
 Suggest a drug for treatment
Infection in the Blood (early stage): Pentamidine
isothionate
Infection of Central Nervous System(late stage):Melarsoprol
Parasitology -2021
 Case II
5

 A 20-month-old boy presented to his primary physician

with a history of failure to thrive. Poor weight gain was
first noticed around 9 months. He passed stools four or
five times per day, which smelled quite badly. The family
lived in a rural community in western United States and
used municipal water for drinking. Stool cultures for
bacteria were negative. However, wet mount stool
examination revealed many cysts

Parasitology -2021
 Case II
6

Parasitology 2021
 Case II
7

 Suggest the name and causative agent of the disease

Giardiasis caused by Giardia lamblia
 Mention the main route of transmission and the
infective stage of the disease
Ingestion of food or water contaminated with cyst (infective
stage)
 What is the drug of choice for such infection?
Metronidazole and albendazole.

Parasitology 2021
 Sporzoans
8

This is a unique group because all members are parasitic

(most are intracellular).
• The group includes Plasmodium sp. & Toxoplasma
gondii
• They lack any visible means of locomotion.
• They have complex life cycles involving sexual and
asexual reproduction and require 2 hosts for reproduction
• They can produce large numbers of stages among which
are the sporocysts (and/or oocysts) which produce the
infectious sporozoites.

Parasitology -2021
 Blood sporozoa
9
In
Disease
Egypt
• Plasmodium species cause malaria.
• The four principal species are P. falciparum, P. vivax, P.
ovale and P. malariae
P. falciparum is the main cause of severe malaria and
death.
• The parasites are insect-borne; the vector being is the
female Anopheles mosquito that inhabits stagnant water.
Infected pregnant women may have a dead baby or a baby
born early (P. falciparum)

Parasitology -2021
 Malaria (Plasmodium)
10

Parasitology -2021
 Plasmodium spp.

Pathology and Parasitology 401-2018 11 7/2/2018

 Malaria (Plasmodium)
12

Life cycle
The life cycle involves three stages in two hosts:
• Two stages in human (Asexual):
- Exoerythrocytic schizogony (liver phase).
- Erythrocytic schizogony (blood phases).

• One stage in mosquito (Sexual):

- Sporogony (Extrinsic cycle in mosquito).

Parasitology 2021
 Malaria (Plasmodium)
13

Exo-erythrocytic schizogony (human)

• after biting, sporozoites infect liver cells and mature
into schizonts, rupture and release merozoites.
Erythrocytic schizogony
asexual multiplication in erythrocytes. Merozoites infect red
blood cells.
• Some parasites differentiate into sexual erythrocytic
stages (gametocytes).

Parasitology 2021
 Malaria (Plasmodium)
14

Sporogonic cycle (mosquito)

 The gametocytes, are ingested by an Anopheles
mosquito.
 In the mosquito's stomach, the microgametes penetrate
the macrogametes generating zygotes. become motile
and elongated (ookinetes), invade the midgut wall of the
and develop into oocysts.
 The oocysts grow, rupture, and release sporozoites, which
go to the mosquito's salivary glands.

Parasitology 2021
Parasitology 2021 15
 Malaria (Plasmodium)
16

Clinical symptoms
They are 3 stages known as malarial paroxysm:
a. first stage, cold stage: shivering and cold feeling (15-60
min).
b. second stage, hot or febrile stage, intense headache
and fever (with flushed face, dry skin, nausea) due to
release of merozoites from RBCs.
c. third stage, sweat stage fever drops rapidly.
• Malarial paroxysm relapses periodically.
• Anemia results due to disruption of RBCs.

Parasitology 2021
 Malaria (Plasmodium)
17

 In untreated P. falciparum will give complicated malaria.

This includes
i)hyper-parasitaemia

ii) brain involvement, causing abnormality of mental status

(cerebral malaria)

iii) Kidney damage and high levels of free hemoglobin

causing blackwater fever.

Parasitology 2021
 Malaria (Plasmodium)
18

Laboratory diagnosis:
• Microscopic examination blood smears showing different
stages of the parasite within RBCs.
• Antibody detection for past (not necessarily active)
infection.
Treatment
• Chloroquine is the drug of choice
• Primaquine to reduce the liver stages
• Resistant strains are treated with sulfadoxine and
pyrimethamine (Fansidar); Fansidar resistant strains are
treated with mefloquine.
Parasitology 2021
 Babesia sp
19

 Babesia parasite invades the red blood cells and can destroy them.
The disease is known as babesiosis or redwater fever due to
presence of hemoglobin in urine.
 Babesia is insect-borne; introduced in human by hard tick’s bite,
which inoculate sporozoites (hence the disease is also referred to as
tick’s fever)
 Morphology and life cycle are probably like those of plasmodia.
 The infection closely resembles malaria in the invasion of RBCs,
which are then burst, producing close symptoms.
 Diagnosis is similar as in case of malaria.
 Disease is usually curable. The treatment of choice is clindamycin
plus quinine.

Parasitology 2021 7/2/2018

 Tissue sporozoa
20

Toxoplasma gondii
Geographic Distribution
Worldwide, common in warm climates
Disease
• Toxoplasmosis (acquired or a congenital disease).
Epidemiology
• The parasite infects most warm-blooded animals,
including humans.
• Toxoplasma gondii is an obligatory intracellular protozoan
parasite.
Parasitology 2021
 Toxoplasma gondii
21

With sporozoites
Sporozoites Tachyzoites and invade body tissues

burst
Parasitology 2021
cyst
 Toxoplasmosis
22

Humans can acquire infection either orally or parentrally:

a. Oral route:
1) Accidental ingestion of the oocysts from hands or food
contaminated with cats’ feces when cleaning the cat's
litter box.
2) Ingestion of the tachyzoites in milk of infected mother.
3) Ingestion of the tissue cyst in undercooked or raw meat.

Parasitology 2021
 Toxoplasmosis
23

b. Parenteral route:
1) Transplacentally, leading to stillbirth or severe birth
defects.
2) Transplantation of infected organ
3) Blood transfusions from an infected donor.

Parasitology 2021
 Toxoplasmosis
24

Habitat:
a. in definitive host (cat): the habitat is the intestinal
epithelium
b. in intermediate host: the habitat is cells of different
tissues as lung, heart, lymphoid organs, CNS and eye
Symptoms
• Most Toxoplasma infections are asymptomatic or mild.
• Complications are limited to pregnant women and
immunodeficient hosts.

Parasitology 2021
 Toxoplasmosis
Acquired toxoplasmosis: 25

Acute: in a host other than cat, most common symptoms are

flu-like as swollen lymph glands, fever, headache and anemia.

Sub-acute: tachyzoites continue to destroy tissues; lesions in

heart, liver, lung, brain and eyes.

Chronic: the bradyzoites form cyst remain dormant and intact

for years. If, the host’s immune response is depressed the
cysts burst and the bradyzoites are released to reinfect other
tissues, especially brain causing meningoencephalitis, eye =
blindness; heart damage = myocarditis and lung damage.
Parasitology 2021
 Toxoplasmosis
26

Congenital toxoplasmosis:
The severity of fetal damage is higher when infection occurs
early in pregnancy.
The possible effects on fetus are:
a) Stillbirths and spontaneous abortions.
b) CNS affection and mental retardation as complication.
c) Eye affection: the babies will have visual handicaps.

Parasitology 2021
 Toxoplasmosis
27

Diagnosis
• Isolation and microscopic examination of the organism
(cyst) from tonsil or lymph gland biopsy.
• X-ray
• Serology
Treatment
Acute infections: pyrimethamine or sulphadiazine.
Spiramycin is a successful alternative.

Parasitology 2021
 In your opinion, why the frequency of pyrexia
(elevation of body temp.) differ from one
specie to another in plasmodium spp.
infection???????

Parasitology 2021 28
 Protozoa Infecting Brain and Meninges
Naegleria fowleri and Acanthamoeba spp.

N. fowleri infection which is always fatal begins when amoeba enter

during swimming into human nasal passages, where nasal mucosa is
a good habitat.
The amoeba multiplies and trophozoite (not cyst) migrates into the
brain.
Acanthamoeba infection begins with a different portal of entry,
mainly broken skin, conjunctiva and urogenital epithelia.

29
N. fowleri produces an acute, and usually lethal CNS disease called
primary amoebic meingoencephalitis (PAM) involving convulsions
and death.
Acanthamoeba spp. causes chronic brain disturbances, possibly
focal granulomatous amebic encephalitis (GAE) in individuals with
compromised immune systems, ocular infections (conjunctivitis)
which can destroy the eye.

Diagnosis
History of swimming in public swimming pools or polluted canal
water.
Examination of CSF, where mobile amoeba are often found.
Treatment
N. fowleri: Amphotericin B and clotrimazole.
Acanthamoeba spp.: Sulfadiazine has been used successfully.

30