‭➢‬ ‭Associate‬‭disease‬‭:‬

‭Lesson‬‭02:‬ ‭CLASSIFICATION‬‭OF‬‭FLAGELLATES‬ ‭○‬ ‭Traveler’s‬‭diarrhea‬

‭THE‬‭FLAGELLATES‬
‭■‬ ‭Loose‬‭Stools‬
‭■‬ ‭Stomach‬‭Cramps‬
‭INTESTINAL‬
‭FLAGELLATES‬ ‭■‬ ‭Flatulence‬
‭‬
● ‭ iardia‬‭Intestinalis‬
G ‭■‬ ‭Gay‬‭Bowel‬‭Syndrome‬
‭●‬ ‭Chilomastix‬‭Mesnili‬
‭ eneral‬ ‭characteristics‬ ‭of‬ ‭the‬ ‭flagellated‬
G
‭●‬ ‭Dientamoeba‬‭Fragilis‬
‭protozoa‬ ‭are‬ ‭usually‬ ‭similar‬ ‭to‬ ‭Amebas‬ ‭(e.g.,‬ ‭Transmitted‬‭by:‬ ‭Specimen:‬
‭●‬ ‭Trichomonas‬‭Hominis‬
‭nuclear‬‭characteristics‬‭of‬‭cyst‬‭and‬‭trophozoites,‬ ➢
‭ ‬ I‭ngestion‬ ➢
‭ ‬ S‭ tool‬
‭●‬ ‭Enteromonas‬‭Hominis‬
‭process‬‭of‬‭excystation‬‭and‬‭encystation‬‭).‬ ‭➢‬ ‭Sexual‬‭Practice‬ ‭➢‬ ‭Duodenal‬
‭●‬ ‭Retortamonas‬‭Intestinalis‬
‭(Human-human)‬ ‭Aspirates‬
‭➢‬ ‭Fecal-oral‬
‭EXTRAINTESTINAL‬
‭Flagellated‬‭protozoa‬
‭➢‬ ‭Most‬‭lack‬‭a‬‭known‬‭cyst‬‭stage‬‭;‬‭instead;‬ ‭‬ T
● ‭ richomonas‬‭Tenax‬ ‭Test:‬ ‭Treatments:‬
‭●‬ ‭Trichomonas‬‭Vaginalis‬ ‭➢‬ I‭ntestinal‬ ‭➢‬ M ‭ etronidazole‬
‭Trophozoites‬ ‭Biopsies‬ ‭(Flagyl)‬
‭➢‬ ‭are‬ ‭considered‬ ‭more‬ ‭resistant‬ ‭to‬ ‭➢‬ ‭Enterotest‬ ‭➢‬ ‭Tinidazole‬
‭destructive‬ ‭forces‬‭,‬ ‭enabling‬ ‭survival‬ ‭INTESTINAL‬‭FLAGELLATES‬
‭➢‬ ‭DFS,‬‭EIA,‬‭ELISA,‬ ‭➢‬ ‭Nitazoxanide‬
‭during‬ ‭passage‬ ‭into‬ ‭the‬ ‭stomach‬ ‭PCR‬
‭following‬‭ingestion.‬
‭I‬ ‭GIARDIA‬‭INTESTINALIS‬
‭➢‬ ‭Two‬‭morphological‬‭forms‬‭:‬ ‭Recommended:‬
‭○‬ ‭Cyst‬ ‭➢‬ ‭3‬‭stool‬‭examinations‬‭on‬‭alternate‬‭days‬
➢
‭ ‬ ‭ .k.a.‬‭“G.‬‭lamblia”‬‭or‬‭“G.‬‭duodenalis‬‭”‬
A
‭○‬ ‭Trophozoites‬
‭➢‬ ‭“‭O ‬ ld‬‭man‬‭with‬‭whiskers‬‭”‬
‭Clinical‬‭Symptoms:‬
‭➢‬ ‭“‭O‬ ld‬‭man‬‭with‬‭Sunglasses‬‭”‬
‭Flagella‬ ‭➢‬ ‭Watery‬
‭➢‬ ‭“‭M
‬ onkey‬‭face‬‭”‬
‭➢‬ ‭whip-like‬ ‭structures‬ ‭that‬ ‭enable‬ ‭the‬ ‭➢‬ ‭Foul-Smelling‬‭Diarrhea‬
‭➢‬ ‭Only‬‭pathogenic‬‭flagellate‬
‭movement‬‭of‬‭flagellated‬‭protozoa‬ ‭➢‬ ‭Steatorrhea‬
‭➢‬ ‭Flatulence‬
‭Presence‬‭of‬‭the‬‭following‬‭structures:‬ ‭➢‬ ‭Abdominal‬ ‭Cramping‬
I‭ ncubation‬‭Period:‬‭10-36‬‭days‬‭before‬‭onset‬‭of‬
‭Undulating‬‭Membrane‬ ‭symptoms‬
‭➢‬ ‭fin-like‬ ‭extension‬ ‭of‬ ‭the‬ ‭plasma‬ ‭Usual‬‭Duration:‬‭0-14‬‭days‬‭after‬‭onset‬‭of‬‭symptoms‬
‭membrane‬ ‭located‬ ‭on‬ ‭the‬ ‭side‬ ‭of‬ ‭the‬
‭organism‬ ‭Epidemiology:‬
‭➢‬ F
‭ ound‬ ‭worldwide;‬ ‭lakes,‬ ‭streams‬‭,‬ ‭other‬
‭Axostyle‬ ‭water‬‭sources‬
‭➢‬ ‭rod-like‬‭support‬‭structure‬

‭GRESOLA,‬‭R.‬‭D.‬‭P.‬ ‭|‬ ‭BSMT2-B‬

 ‭GIARDIA‬‭i.‬‭FORM‬ ‭L‬ ‭TROPHOZOITE‬‭Intestinalis‬ ‭l‬
‭GIARDIA‬‭Int.‬‭LIFE‬‭CYCLE‬

‭L‬ ‭CYST‬‭Giardia‬‭I.‬ ‭l‬

‭Size‬ ‭8-20‬‭µm‬‭long‬‭,‬‭5-16‬‭µm‬‭wide‬
‭Size‬ ‭8-17‬‭µm‬‭long‬‭,‬‭6-10‬‭µm‬‭wide‬
‭Shape‬ ‭Pear/teardrop‬‭shaped‬
‭Shape‬ ‭Ovoid‬
‭Motility‬ ‭Falling‬‭Leaf‬
‭Nuclei‬ I‭ mmature‬‭Cyst:‬‭2‬
‭Mature‬‭Cyst:‬‭4‬ ‭Symmetry‬ ‭Bilaterally‬‭Symmetrical‬

‭Karyosome‬ ‭Central‬ ‭Nuclei‬ ‭2‬‭(Ovoid‬‭shaped)‬

‭Chromatin‬ ‭No‬‭peripheral‬ ‭Karyosome‬ ‭Large‬

‭Cytoplasm‬ ‭Retracted‬‭from‬‭cell‬‭wall‬ ‭Chromatin‬ ‭No‬‭peripheral‬

‭I‬ ‭CHILOMASTIX‬‭MESNILI‬
‭Median‬‭Bodies‬ I‭ mmature‬‭Cyst:‬‭2‬ ‭Flagella‬ ‭‬
8
‭Mature‬‭Cyst:‬‭4‬ ‭-‬‭1‬‭pair,‬‭anterior‬‭end‬ ‭➢‬ G
‭ enerally‬ ‭considered‬ ‭a‬ ‭nonpathogen‬
‭-‬‭1‬‭pair,‬‭posterior‬‭end‬ ‭and‬‭treatment‬‭is‬‭not‬‭usually‬‭indicate‬
‭Other‬ ‭Interior‬‭Flagellar‬‭Structure‬ ‭-‬‭2‬‭pairs,‬‭central‬

‭Median‬‭Bodies‬ ‭2‬ ‭Transmitted‬‭by:‬ ‭Specimen:‬

‭➢‬ ‭Ingestion‬ ‭➢‬ ‭Stool‬
‭Axonemes‬ ‭2‬
‭Test:‬ ‭Habitat‬‭in‬‭Host:‬
‭Other‬ ‭ ucking‬‭Disk‬
S
‭➢‬ ‭DFS‬ ‭➢‬ ‭Cecum‬
‭-‬‭Attachment‬‭to‬‭get‬‭nutrients‬

‭GRESOLA,‬‭R.‬‭D.‬‭P.‬ ‭|‬ ‭BSMT2-B‬

 ‭L‬ ‭TROPHOZOITE‬‭C.‬‭Mesnili‬ ‭l‬
‭I‬ ‭DIENTAMOEBA‬ ‭FRAGILIS‬

➢
‭ ‬ N ‭ o‬‭Cyst‬‭Form‬
‭➢‬ ‭Most‬‭patients‬‭are‬‭asymptomatic‬‭;‬‭cause:‬
‭○‬ ‭Diarrhea‬
‭○‬ ‭Abdominal‬‭pain‬
‭➢‬ ‭Diagnostic‬‭Feature:‬
‭○‬ ‭HAKANSSON‬‭PHENOMENON‬
‭■‬ ‭Characteristics‬ ‭of‬
‭parasites‬ ‭going‬ ‭back‬‭to‬
‭its‬‭actual‬‭size‬
‭CHILOMASTIX‬‭MESNILI‬‭FORM‬ ‭○‬ ‭Rosette‬‭Formation‬

‭L‬ ‭CYST‬‭C.‬‭Mesnili‬ ‭s‬ ‭Note:‬

‭➢‬ S
‭ tructure‬ ‭bordering‬ ‭cytostome‬
‭resembles‬‭a‬‭SHEPHERD's‬‭CROOK‬

‭Size‬ ‭5-25‬‭µm‬‭long‬‭,‬‭5-10‬‭µm‬‭wide‬

‭Shape‬ ‭Pear–shaped‬

‭Motility‬ ‭Stiff,‬‭Rotary,‬‭Directional‬

‭Nuclei‬ ‭1‬‭(one)‬

‭Karyosome‬ ‭Small,‬‭Centraal/Eccentric‬
‭Transmitted‬‭by:‬ ‭Specimen:‬
‭Size‬ ‭5-10‬‭µm‬‭long‬ ‭➢‬ ‭Unknown‬ ‭➢‬ ‭Stool‬
‭Chromatin‬ ‭No‬‭peripheral‬

‭Shape‬ ‭ emon-shaped‬‭w/‬‭clear‬
L ‭Flagella‬ ‭ ‬‭(four)‬
4 ‭Studies‬‭suggest:‬ ‭Habitat‬‭in‬‭Host:‬
‭anterior‬‭hyaline‬‭knob‬ ‭-‬‭3,‬‭anterior‬‭end‬ ‭➢‬ ‭Fecal-oral‬
‭➢‬ ‭Duodenum‬
‭-‬‭1‬‭,‬‭posterior‬‭end‬ ‭➢‬ ‭Oral-anal‬
‭Nuclei‬ ‭1‬‭(one)‬
‭Cytostome‬ ‭1/3‬‭-‬‭1/2‬‭of‬‭body‬‭length‬ ‭Test:‬ ‭Treatment‬
‭Karyosome‬ ‭Large,‬‭Central‬
➢
‭ ‬ D‭ FS‬ ➢
‭ ‬ I‭odoquinol‬
‭Groove‬ ‭Spiral‬ ‭➢‬ ‭Permanent‬‭Stain‬ ‭➢‬ ‭Tetracycline‬
‭Chromatin‬ ‭No‬‭peripheral‬
‭➢‬ ‭Paromomycin‬
‭Cytostome‬ ‭ ell-defined‬‭located‬‭on‬
W ‭Stain‬‭of‬‭Choice:‬
‭one‬‭side‬‭of‬‭the‬‭nucleus‬ ‭➢‬ ‭Iron‬‭Hematoxylin‬

‭GRESOLA,‬‭R.‬‭D.‬‭P.‬ ‭|‬ ‭BSMT2-B‬

 ‭D.‬‭FRAGILIS‬‭FORM‬ ‭L‬ ‭TROPHOZOITE‬‭Enteromonas‬‭h.‬ ‭l‬
‭I‬ ‭ENTEROMONAS‬‭HOMINIS‬

‭L‬ ‭TROPHOZOITE‬‭D.‬‭Fragilis‬ ‭l‬

‭Transmitted‬‭by:‬ ‭Specimen:‬
‭➢‬ ‭Ingestion‬ ‭➢‬ ‭Stool‬

‭Test:‬ ‭Prevention‬‭and‬‭Control:‬
‭➢‬ D
‭ FS‬‭(Direct‬ ➢
‭ ‬ G‭ ood‬‭Hygiene‬
‭Fecal‬‭Smear)‬ ‭➢‬ ‭Public‬‭Sanitation‬
‭Practices‬

‭Habitat‬‭in‬‭Host:‬
‭➢‬ ‭Duodenum‬
‭Size‬ ‭3-10‬‭µm‬‭long‬‭,‬‭3-7‬‭µm‬‭wide‬

‭Shape‬ ‭Oval;‬‭sometimes‬‭half-circle‬
‭Size‬ ‭5-18‬‭µm‬ ‭ENTEROMONAS‬‭h.‬‭FORM‬
‭Motility‬ ‭Jerky‬
‭Shape‬ ‭Irregularly‬‭Round‬
‭L‬ ‭CYST‬‭Enteromonas‬‭h.‬ ‭l‬ ‭Nuclei‬ ‭1‬‭(One)‬
‭Motility‬ ‭ rogressive,‬‭Board‬‭Hyaline‬
P
‭Karyosome‬ ‭Central‬
‭pseudopodia‬
‭Chromatin‬ ‭No‬‭peripheral‬
‭Nuclei‬ ‭ ‬‭(Two)‬
2
‭Each‬‭consisting‬‭of‬‭4-8‬‭massed‬ ‭Flagella‬ ‭ ‬‭(Four)‬
4
‭clumps‬‭of‬‭chromatin‬‭granules‬ ‭-‬‭3‬‭,‬‭anterior‬‭end‬
‭-‬‭1‬‭,‬‭posterior‬‭end‬
‭Chromatin‬ ‭No‬‭peripheral‬

‭Cytoplasm‬ ‭Has‬‭bacteria-filled‬‭vacuoles‬

‭Size‬ ‭3-10‬‭µm‬‭long‬‭,‬‭4-7‬‭µm‬‭wide‬

‭Shape‬ ‭Oval-elongated‬

‭Nuclei‬ ‭1-4‬‭located‬‭at‬‭opposite‬‭ends‬

‭Karyosome‬ ‭Central‬

‭Chromatin‬ ‭No‬‭peripheral‬

‭GRESOLA,‬‭R.‬‭D.‬‭P.‬ ‭|‬ ‭BSMT2-B‬

 ‭L‬ ‭TROPHOZOITE‬‭Retortamonas‬‭Int.‬ ‭l‬
‭I‬ ‭RETORTAMONAS‬ ‭INTESTINALIS‬

‭Transmitted‬‭by:‬ ‭Specimen‬
‭➢‬ ‭Ingestion‬ ‭➢‬ ‭Stool‬

‭Test:‬ ‭Prevention‬‭and‬‭Control‬
‭➢‬ D
‭ FS‬‭(Direct‬ ➢
‭ ‬ G‭ ood‬‭Hygiene‬
‭Fecal‬‭Smear)‬ ‭➢‬ ‭Good‬‭Sanitation‬

‭RETORTAMONAS‬‭Int.‬‭FORMS‬

‭L‬ ‭CYST‬‭Retortamonas‬‭Int.‬ ‭l‬ ‭Size‬ ‭3-7‬‭µm‬‭l‬‭ong‬‭,‬‭5-6‬‭µm‬‭wide‬

‭Shape‬ ‭Ovoid‬

‭Motility‬ ‭Jerky‬

‭Nuclei‬ ‭1‬‭(one)‬

‭Karyosome‬ ‭Central‬

‭Chromatin‬ ‭ ing‬‭of‬‭chromatin‬‭granules‬‭may‬
R
‭Granules‬ ‭be‬‭on‬‭nuclear‬‭membrane‬
‭Size‬ ‭3-9‬‭µm‬‭long‬‭;‬‭up‬‭to‬‭5‬‭µm‬‭wide‬
‭Flagella‬ ‭ ‬‭(two)‬
2
‭Shape‬ ‭Lemon/pear-shaped‬ ‭-‬‭2,‬‭anterior‬‭end‬

‭Nuclei‬ ‭1‬‭(one)‬‭located‬‭in‬‭anterior‬‭end‬ ‭Cytostome‬ ‭ xtending‬‭halfway‬‭down‬‭body‬

E
‭length‬
‭Karyosome‬ ‭Central‬
‭Fibril‬ ‭Border‬ ‭ pposite‬‭the‬‭nucleus‬‭in‬‭the‬
O
‭Others‬ ‭ ay‬‭be‬‭surrounded‬‭by‬‭a‬
M ‭anterior‬‭end‬
‭delicate‬‭ring‬‭of‬‭chromatin‬
‭granules‬

‭Fibrils‬ ‭ ‬‭(two),‬‭Fused‬
2
‭Resembling‬‭BIRD’s‬‭BEAK‬

‭GRESOLA,‬‭R.‬‭D.‬‭P.‬ ‭|‬ ‭BSMT2-B‬

 ‭I‬ ‭Nuclei‬ ‭1‬‭(one)‬ ‭T.‬‭TENAX‬‭FORM‬
‭TRICHOMONAS‬‭HOMINIS‬

‭➢‬ ‭No‬‭cyst‬‭form‬ ‭Karyosome‬ ‭Small,‬‭Central‬

‭L‬ ‭TROPHOZOITE‬‭T.‬‭Tenax‬ ‭l‬
‭Chromatin‬ ‭No‬‭peripheral‬
‭Transmitted‬‭by:‬ ‭Specimen‬
➢
‭ ‬ I‭ngestion‬‭(Milk)‬ ‭➢‬ ‭Stool‬ ‭Flagella‬ ‭ -6‬
4
‭➢‬ ‭Fecal-oral‬ ‭-‬‭3-5‬‭,‬‭anterior‬‭end‬
‭Habitat‬‭in‬‭Host:‬ ‭-‬‭1‬‭,‬‭posterior‬‭end‬
‭➢‬ ‭Cecum‬
‭Cytostome‬ ‭ onical,‬‭cleft‬‭in‬‭anterior‬‭end‬
C
‭located‬‭opposite‬‭the‬‭undulating‬
‭Test:‬ ‭Prevention‬‭and‬‭Control‬
‭membrane‬
‭➢‬ D
‭ FS‬‭(Direct‬ ➢
‭ ‬ P‭ ersonal‬‭and;‬
‭Fecal‬‭Smear)‬ ‭➢‬ ‭Public‬‭sanitary‬ ‭ ndulating‬
U ‭Full‬‭body‬‭length‬
‭Membrane‬

‭TRICHOMONAS‬‭h.‬‭FORM‬ ‭Axostyle‬ ‭Extends‬‭beyond‬‭the‬‭posterior‬‭end‬

‭Size‬ ‭5-14‬‭µm‬‭long‬
‭L‬ ‭TROPHOZOITE‬‭T.‬‭Hominis‬ ‭l‬
‭EXTRAINTESTINAL‬‭FLAGELLATES‬ ‭Shape‬ ‭Oval,‬‭Pear-Shaped‬

‭Nuclei‬ ‭ ‬‭(one)‬
1
‭E‬ ‭TRICHOMONAS‬‭TENAX‬ ‭-‬‭Vesicular‬‭regions‬‭filled‬‭w/‬
‭➢‬ ‭No‬‭cyst‬‭stage‬ ‭chromatin‬‭granules‬

‭Flagella‬ ‭ ‬‭(five)‬
5
‭Transmitted‬‭by:‬ ‭Specimen:‬ ‭-‬‭4‬‭,‬‭anterior‬
‭➢‬ D ‭ irect‬‭Contact‬ ‭➢‬ ‭Mouth‬‭Scrapings‬ ‭-‬‭1‬‭,‬‭posterior‬
‭(‭K‬ issing‬‭)‬
‭➢‬ ‭Use‬‭of‬ ‭Habitat‬‭in‬‭Host‬ ‭ ndulating‬
U ‭2/3‬‭of‬‭body‬‭length‬
‭contaminated‬ ‭➢‬ ‭Oral‬‭Cavity‬ ‭Membrane‬
‭Utensils‬
‭Axostyle‬ ‭ hick‬‭curves‬‭around‬‭nucleus;‬
T
‭Test:‬ ‭Prevention‬‭and‬‭Control:‬ ‭extends‬‭beyond‬‭body‬‭length‬
‭Size‬ ‭7-20‬‭µm‬‭long‬‭,‬‭5-18‬‭µm‬‭wide‬
‭➢‬ ‭Microscopy‬ ‭➢‬ ‭Good‬‭Oral‬
‭Cytostome‬ ‭ mall‬‭anterior,‬‭opposite‬‭of‬
S
‭➢‬ ‭Culture‬ ‭Hygiene‬
‭Shape‬ ‭Pear-Shaped‬ ‭undulating‬‭membrane‬

‭Motility‬ ‭Nervous,‬‭Jerky‬

‭GRESOLA,‬‭R.‬‭D.‬‭P.‬ ‭|‬ ‭BSMT2-B‬

 ‭E‬ ‭T.‬‭VAGINALIS‬‭FORM‬
‭TRICHOMONAS‬‭VAGINALIS‬ ‭T.‬‭VAGINALIS‬‭LIFE‬‭CYCLE‬

➢
‭ ‬ N‭ o‬‭cyst‬‭stage‬ ‭L‬ ‭TROPHOZOITE‬‭T.‬‭Vaginalis‬ ‭l‬
‭➢‬ ‭Associated‬‭Disease:‬
‭○‬ ‭Persistent‬‭urethritis‬‭and‬
‭vaginitis‬‭(‬‭STRAWBERRY‬
‭CERVIX‬‭)‬
‭○‬ ‭Infant‬‭Trichomonas‬‭vaginalis‬
‭infection‬

‭Transmitted‬‭by:‬ ‭Specimen:‬
‭➢‬ S ‭ exual‬ ➢
‭ ‬ ‭ rine‬
U
‭Intercourse‬ ‭➢‬ ‭Vaginal‬‭Discharge‬
‭(‭P ‬ ingpong‬ ‭➢‬ ‭Urethral‬‭Discharge‬
‭Disease‬‭)‬ ‭➢‬ ‭Prostatic‬‭Secretions‬
‭Size‬ ‭Up‬‭to‬‭30‬‭µm‬‭long‬
‭➢‬ ‭Mother-Infant‬
‭➢‬ ‭Used‬‭of‬ ‭Shape‬ ‭Round/‬‭Oval/‬‭Pear-Shaped‬
‭contaminated‬
‭toilet‬‭and‬ ‭Motility‬ ‭Rapid,‬‭Jerky‬
‭undergarments‬
‭Nuclei‬ ‭1‬‭(one)‬‭,‬‭Ovoid,‬‭Nondescript‬
‭Test:‬ ‭Treatment:‬
‭➢‬ S
‭ aline‬‭wet‬ ‭➢‬ M
‭ etronidazole‬ ‭Flagella‬ ‭ -6‬
4
‭preparations‬ ‭(Flagyl)‬ ‭-‬‭3-5‬‭,‬‭anterior‬
‭-‬‭1‬‭,‬‭posterior‬
‭Habitat‬‭in‬‭Host:‬ ‭Prevention‬‭and‬‭Control:‬
‭➢‬ V ‭ aginal‬ ‭➢‬ A
‭ voidance‬‭of‬ ‭ ndulating‬
U ‭1/2‬‭of‬‭body‬‭length‬
‭epithelium‬ ‭unprotected‬‭sex‬ ‭Membrane‬
‭➢‬ ‭Urethra‬ ‭and‬‭sharing‬‭of‬
‭Axostyle‬ ‭ rominent,‬ ‭often‬‭curves‬‭around‬
P
‭➢‬ ‭Prostate‬‭Gland‬ ‭communal‬‭bathing‬
‭nucleus‬

‭Others‬ ‭Granules‬‭may‬‭be‬‭seen‬

‭GRESOLA,‬‭R.‬‭D.‬‭P.‬ ‭|‬ ‭BSMT2-B‬