PROTOZOA
INTESTINAL AMEBAE
Entamoeba histolytica
COMMENSAL AMEBAE
Entamoeba dispar
Entamoeba moshkovskii
Entamoeba hartmanni
Entamoeba coli
Entamoeba polecki
Entamoeba chattoni
Entamoeba gingivalis
Endolimax nana
Iodamoeba butschlii
FREE-LIVING PATHOGENIC
AMEBAE
Acanthamoeba spp.
Naegleria fowleri
CILIATES AND FLAGELLATES
Balantidium coli
Giardia duodenalis (G. lamblia, G.
intestinalis)
Trichomonas vaginalis
NON-PATHOGENIC FLAGELLATES
Trichomonas hominis
Trichomonas tenax
Chilomastix mesnili
COCCIDIANS
Cryptosporidium hominis
Cyclospora cayetanensis
Cystoisospora belli
Toxoplasma gondii
Sarcocystis spp.
OTHER INTESTINAL PROTOZOA
Blastocystis hominis
Dientamoeba fragilis
MALARIA
Plasmodium falciparum
Plasmodium vivax
Plasmodium ovale
Plasmodium malariae
Plasmodium knowlesi
***
COMMON NAME PATHOGNOMONIC
Amebiasis, Amebic liver abscess (ALA),
Amebiasis
Ameboma
Nonpathogenic
Nonpathogenic
Nonpathogenic
E. cli (Nonpathogenic)
Nonpathogenic NON-PATHOGENIC
Nonpathogenic
Nonpathogenic
E. nana (Nonpathogenic)
I. butschlii (Nonpathogenic)
Granulomatous amebic Acanthamoeba keratitis (AK),
encephalitis (GAE) Granulomatous amebic encepahilitis (GAE)
Primary amebic
Primary amebic meningoencephalitis (PAM)
meningoencephalitis (PAM)
Balantidiasis (Fulminant, Acute, Chronic
(Paramecium coli)
forms); Balantidial dysentery
Diarrhea most common symptom;
- Chronic case: steatorrhea
Traveler’s diarrhea
- Acute case: abdominal pain, cramping;
excessive flatus with “rotten egg” odor
Inflammation of vaginal mucosa
- “Strawberry cervix” due to hemorrhage
Trich of cervix
- liquid vaginal secretions (green/yellow
color)
NON-PATHOGENIC
Acute and gangrenous cholecystitis;
NONE
malabsorption and excessive fluid loss
NONE; Cyanobacterium- Malaise and low-grade fever; D-xylose
like body (CLB) malabsorption
Self-limiting gastroenteritis; severe diarrhea
and fat malabsorption
NONE
- stools have undigested food, mucus, and
Charcot-Leyden crystals
Toxoplasmosis (asymptomatic)
- encephalitis, myocarditis, focal
Toxoplasma
pneumonia
- stillbirth and abortion
- Rare, invasive form: vasculitis and
myositis
(Isospora hominis)
- Intestinal form: nausea, abdominal pain,
diarrhea
Blastocystis; internal disorders (diarrhea
Blastocystis
without fecal WBCs or blood), nausea,
(Nonpathogenic)
vomiting, malaise
Mucosal irritation and bowel hypermotility
- Anal pruritus (co-infection with
Dientamoeba
Enterobius vermicularis)
- Peripheral eosinophilia
Malignant Tertian Malaria
Benign Tertian Malaria Malaria
Ovale Malaria - Cerebral malaria
Quartan Malaria - Malaria with acute renal failure
Macaque’s Malaria

Babesia spp.
BLOOD AND TISSUE FLAGELLATES
Trypanosoma cruzi
Trypanosoma brucei gambiense
Trypanosoma brucei rhodesiense
Leishmania tropica complex
Leishmania major
Leishmania mexicana
Leishmania mexicana complex
Leishmania braziliense complex
Leishmania donovani
PROTOZOA
INTESTINAL AMEBAE
Entamoeba histolytica
COMMENSAL AMEBAE
Entamoeba dispar
Entamoeba moshkovskii
Entamoeba hartmanni
Entamoeba coli
Entamoeba polecki
Entamoeba chattoni
Entamoeba gingivalis
Endolimax nana
Iodamoeba butschlii
FREE-LIVING PATHOGENIC
AMEBAE
Acanthamoeba spp.
Naegleria fowleri
CILIATES AND FLAGELLATES
Balantidium coli
Giardia duodenalis (G.
lamblia, G. intestinalis)
Trichomonas vaginalis
NON-PATHOGENIC
FLAGELLATES
Trichomonas hominis
Trichomonas tenax
Chilomastix mesnili
COCCIDIANS
Cryptosporidium hominis
Cyclospora cayetanensis
Cystoisospora belli
Toxoplasma gondii
Sarcocystis spp.
Babesiosis
NONE; Nantucket fever - Smaller forms are more pathogenic,
while larger forms are less virulent
Chagas’ Disease (American
Chagas’ disease; American trypanosomiasis
trypanosomiasis)
West African sleeping West African sleeping sickness
sickness (trypanosomiasis) (trypanosomiasis)
East African sleeping East African sleeping sickness
sickness (trypanosomiasis) (trypanosomiasis)
Oriental boil
Rural oriental sore Cutaneous leishmaniasis (CL)
Chiclero ulcer
New World Leishmaniasis,
Diffuse cutaneous Diffuse cutaneous leishmaniasis (DCL)
leishmaniasis
New World Leishmaniasis
Visceral leishmaniasis (VL)
Kala-Azar
INFECTIVE STAGE DIAGNOSTIC STAGE MODE OF TRANSMISSION
Cysts and trophozoites in Cysts and trophozoites in
Ingestion of contaminated
feces; mature cysts of feces; mature cysts of
food/drink with cysts from feces
infection infection
Cysts and trophozoites in Cysts and trophozoites in
Ingestion of contaminated
feces; mature cysts of feces; mature cysts of
food/drink with cysts from feces
infection infection
Cysts and trophozoites in Enter through the eye, nasal
Trophozoite
tissue passages, broken skin
Trophozoites in CSF and
Trophozoite brain tissue; flagellated Penetration of the nasal mucosa
forms in CSF
Ingestion of contaminated
Cyst Cyst
food/drink
Transmitted to mouth by
Cyst Mature cyst
contaminated hands, food/drink
Trophozoite in vagina or Trophozoite in vaginal
Sex
urethra orifices secretions and urine
Fecal contamination of
food/drinks
Droplet spray from mouth,
kissing, and use of contaminated
utensils
Ingestion of contaminated
Cyst
food/drink
Thick-walled oocyst Thick-walled oocyst
ingested by host (sporulated)
Sporulated oocyst Unsporulated oocyst Ingestion of contaminated
Mature oocyst or food/drink
Oocyst in feces
Sporozoites
Cyst bradyzoites Unsporulated oocyst
Cysts with bradyzoites, Cysts with bradyzoites,
Ingestion of raw or uncooked
sporozoites, and thin- sporozoites, and thin-
meat
walled oocysts walled oocysts
OTHER INTESTINAL
PROTOZOA
Blastocystis hominis
Dientamoeba fragilis
MALARIA
Plasmodium falciparum
Plasmodium vivax
Plasmodium ovale
Plasmodium malariae
Plasmodium knowlesi
***
Babesia spp.
BLOOD AND TISSUE
FLAGELLATES
Trypanosoma cruzi
Trypanosoma brucei
gambiense
Trypanosoma brucei
rhodesiense
Leishmania tropica complex
Leishmania mexicana
complex
Leishmania braziliense
complex
Leishmania donovani
PROTOZOA
INTESTINAL AMEBAE
Entamoeba histolytica
FREE-LIVING PATHOGENIC
AMEBAE
Acanthamoeba spp.
Naegleria fowleri
CILIATES AND FLAGELLATES
Balantidium coli
Giardia duodenalis (G. lamblia, G.
intestinalis)
Trichomonas vaginalis
NON-PATHOGENIC FLAGELLATES
Trichomonas hominis
Trichomonas tenax
Chilomastix mesnili
COCCIDIANS
Cryptosporidium hominis
Cyclospora cayetanensis
Cystoisospora belli
Toxoplasma gondii
Sarcocystis spp.
Trophozoites, schizonts, Bite of infected female
Sporozoite
and gametocytes Anopheles mosquito
Bite of infected Ixodes spp. ticks
Sporozoite Trophozoite
or hard ticks
Amastigotes Bite of infected Triatomine bugs
Metacyclic
Circulating
trypomastigotes Bite of infected Tsetse fly
trypomastigotes
Promastigotes Amastigotes Bite of infected sand fly
DIAGNOSIS TREATMENT
Microscopic examination of trophozoites
Metronidazole
and cysts in stool (minimum of 3 samples)
AK: epithelial biopsy or corneal scrapings AK: surgical excision of infected
GAE: made post-mortem in most cases cornea
Demonstration of trophozoites in the brain
and CSF
Amphotericin B with Clotrimazole
- can be identified by the blunt, lobose
pseudopodia and directional motility
Direct examination or concentration
Tetracyline or Metronidazole
techniques of trophozoites and cysts
Microscopic examination of trophozoites
Metronidazole
and cysts in stool
Saline preparation of vaginal fluid
Metronidazole or Tinidazole
- Gold: Culture (2-5 days)
NON-PATHOGENIC NON-PATHOGENIC
Swabbing the tartar between teeth, gingival
Metronidazole
margin, or tonsillar crypts
Microscopic examination of trophozoites
and cysts in stool
Sheather’s sugar flotation and formalin-
ether/ethyl acetate concentration technique NONE
(FECT)
Direct microscopic examination of fecal
NONE
smears under 400x
Asymptomatic: bed rest and
Direct microscopic examination or FECT of bland diet
oocysts in feces Symptomatic: Trimethoprim-
sulfamethoxazole
Examination of tissue imprints stained with
Pyrimethamine and sulfadiazine
Giemsa or hematoxylin-eosin
History of raw or undercooked meat
consumption RARE
- Fecal flotation wet mount
OTHER INTESTINAL PROTOZOA
Blastocystis hominis
Dientamoeba fragilis
MALARIA
Plasmodium falciparum
Plasmodium vivax
Plasmodium ovale
Plasmodium malariae
Plasmodium knowlesi
***
Babesia spp.
BLOOD AND TISSUE
FLAGELLATES
Trypanosoma cruzi
Trypanosoma brucei gambiense
Trypanosoma brucei rhodesiense
Leishmania tropica complex
Leishmania mexicana complex
Leishmania braziliense complex
Leishmania donovani
PROTOZOA
INTESTINAL AMEBAE
Entamoeba histolytica
COMMENSAL AMEBAE
Entamoeba dispar
Entamoeba moshkovskii
Entamoeba hartmanni
Entamoeba coli
Entamoeba polecki
Entamoeba chattoni
Entamoeba gingivalis
Endolimax nana
Iodamoeba butschlii
FREE-LIVING PATHOGENIC
AMEBAE
Acanthamoeba spp.
Naegleria fowleri
CILIATES AND FLAGELLATES
Balantidium coli
Giardia duodenalis (G. lamblia, G.
intestinalis)
Trichomonas vaginalis
NON-PATHOGENIC FLAGELLATES
Trichomonas hominis
Trichomonas tenax
Chilomastix mesnili
COCCIDIANS
Cryptosporidium hominis
Cyclospora cayetanensis
Detection of organism from stool
Metronidazole
- Direct fecal smear
Observation of binucleate trophozoites in Antimicrobial therapy with
fresh stool samples Iodoquinol
Microscopic identification of malarial
parasites in thick and thin blood smears Chloroquine
stained with Giemsa or Wright’s stain
Direct microscopic examination of Giemsa-
Clindamycin and Quinine
stained peripheral blood smears
Azithromycin and Atovaquinone
- Gold: Polymerase Chain Reaction
Acute phase: direct visualization of parasites
in thick and thin blood smears using Giemsa
stain Nifurtimox and benznidazole
Chronic phase: Enzyme-linked
immunosorbent assay (ELISA)
Early: Intravenous suramin
Demonstration of highly motile
sodium
trypomastigotes in expressed fluid from
Late: Intravenous melarsopol
chancre, lymph node aspirate, CSF
Gambian: Intramuscular
- Thick and thin smears, Giemsa stained
pentamidine
Microscopic demonstration from lesion and Sodium stibogluconate and N-
tissue scrapings, aspirates, or biopsy methyl-glucamine (meglumine)
HABITAT IN HUMAN VECTORS & HOSTS
Mucosa and sub-mucosa of the large
RH: Humans
intestine
Large intestine
Eyes
Brain and brain tissues
Large intestine
Duodenum, jejunum, and upper ileum
of small intestine
Urogenital tract
- Women: vagina and renal pelvis
- Men: urethra, prostate,
epididymis
Cecal area of large intestine
Tartar around teeth, cavities if carious
teeth, necrotic mucosal cells in
gingival glasses
Cecal region of large intestine
Gastrointestinal tract and Lungs
Small intestine
 Cystoisospora belli Epithelial cells of the small intestine
Skeletal muscle, myocardium, brain,
Toxoplasma gondii
and eyes
Sarcocystis spp. Skeletal or cardiac muscle
OTHER INTESTINAL PROTOZOA
Blastocystis hominis Intestine
Mucosal crypts of appendix, cecum,
Dientamoeba fragilis
upper colon
MALARIA
Plasmodium falciparum
Plasmodium vivax Female Anopheles mosquito
Plasmodium ovale Liver cells, then RBCs (PH: Anopheles minimus var.
Plasmodium malariae flavirostris)
Plasmodium knowlesi
***
Babesia spp. RBCs Ixodes spp. ticks or hard ticks
BLOOD AND TISSUE
FLAGELLATES
Reduviid bugs (Triatoma; triatomine
Trypanosoma cruzi Heart, nervous and digestive systems
bugs)
Trypanosoma brucei gambiense Blood in reticular of lymph and spleen;
Tsetse fly (Glossina spp.)
Trypanosoma brucei rhodesiense CSF
Leishmania tropica complex
Entire body (spleen, liver, and bone Sand flies (Phlebotomus – New
Leishmania mexicana complex
marrow) World; Lutzomyia – Old World)
Leishmania braziliense complex
Leishmania donovani

PROTOZOA TROPHOZOITES CYSTS

INTESTINAL AMEBAE
Entamoeba histolytica
COMMENSAL AMEBAE
Entamoeba dispar
Entamoeba moshkovskii
Entamoeba hartmanni
Entamoeba coli
Entamoeba polecki
Entamoeba chattoni
Entamoeba gingivalis
Endolimax nana
Iodamoeba butschlii
FREE-LIVING PATHOGENIC
AMEBAE
Acanthamoeba spp.
Naegleria fowleri
- Spherical and quadrinucleated
- Highly motile and have pseudopodia - Resistant to gastric activity and
for locomotion desiccation
- Invade large bowel - Have highly refractile hyaline cyst
- Reproduce by BINARY FISSION wall
- Rod-/cigar-shaped chromatoidal bars
- More vacuolated with bacteria debris
- Larger in size
- Narrower, less-differentiated
- 8 nuclei
ectoplasm
- More granular cytoplasm
- Pseudopodia for feeding
- Splinter-like chromatoid bodies
- Sluggish, undirected movements
- Sluggish - Uninucleated (1 nucleus)
- Small karyosome centrally in nucleus - Angular or pointed chromatoid bars
NONE
- Small
- Sluggish movement - Same size with trophozoite
- Have blunt, hyaline pseudopodia - Quadrinucleated when mature
- Large nucleus, irregular karyosome
- Have large, vesicular nucleus
- Large central karyosome surrounded - Uninucleated
by achromatic granules - Has a large glycogen body
- No peripheral chromatin granules
- “Thorn-like” appendages
(acanthopodia)
- Single nucleus
- Highly resistant
- Large endosome, finely granulated
- Transforms when environment is
cytoplasm
unfavorable
- Has small, spiny filaments for
locomotion
- Replicate by MITOSIS
- Turn into temporary non-feeding

CILIATES AND FLAGELLATES
Balantidium coli
Giardia duodenalis (G. lamblia, G.
intestinalis)
Trichomonas vaginalis
NON-PATHOGENIC FLAGELLATES
Trichomonas hominis
Trichomonas tenax
Chilomastix mesnili
COCCIDIANS
Cryptosporidium hominis
Cyclospora cayetanensis
Cystoisospora belli
Toxoplasma gondii
Sarcocystis spp.
OTHER INTESTINAL PROTOZOA
Blastocystis hominis
Dientamoeba fragilis
MALARIA
Plasmodium falciparum
Plasmodium vivax
Plasmodium ovale
Plasmodium malariae
Plasmodium knowlesi
***
Babesia spp.
BLOOD AND TISSUE
FLAGELLATES
Trypanosoma cruzi
Trypanosoma brucei gambiense
Trypanosoma brucei rhodesiense
Leishmania tropica complex
Leishmania mexicana complex
Leishmania braziliense complex
Leishmania donovani
flagellated forms
- Found in CSF and tissue
- Have blunt, lobose pseudopodia
- Directional motility
- Covered with cilia for locomotion - Spherical to slightly ovoid
- Has cytosome and cytopage - Double-walled
- 2 dissimilar nuclei (macro- and micro-
nucleus)
- 2 contractile vacuoles
- Mucocysts
- Reproduce by asymmetric BINARY
FISSION or by CONJUGATION
- Pyriform or teardrop-shaped
- Have 2 ovoidal nuclei
- Ovoid
- Dorsal side is convex, ventral is
- Young ones have 2 nuclei; mature
concave
ones have 4
- Bilaterally symmetrical, with axostyle
- Flagella retracted into axonemes
- 4 pairs of flagella
- Has an erratic tumbling motion
- Pyriform shape
- 4 free anterior flagella from a simple
stalk NONE
- 4 nuclei
- Median axostyle
- Pyriform shape
- 5 anterior flagella and 1 posterior
flagellum
- Cystosome and nucleus at anterior end
- Pyriform in shape NONE
- 4 free, equal flagella with 5th on margin
of undulating membrane
- Single nucleus and cytosome
- Replicates by BINARY FISSION
- Pear-shaped, asymmetrical - Pear- or lemon-shaped
- Has spiral groove - Broadly round at one end, and
- Boring, spiral forward movement bluntly conical at other
UNCLEAR UNCLEAR
- Have 1-2 rosette-shaped nuclei
NONE
- No flagellum