PARASITOLOGY

PRELIMS/LECTURE SECOND SEMESTER

CILIATES AND FLAGELLATES

CILIATES
● Balantidium coli

FLAGELLATES CLINICAL MANIFESTATION

● Giardia duodenalis
● Trichomonas vaginalis
● Trichomonas hominis
● Trichomonas tenax ● Balantidiasis – attacks intestinal epithelium
● Intestinal Ulceration: caused by hyaluronidase
(secretes by the parasite to destroy the
NON-PATHOGENIC FLAGELLATES epithelium)
○ Rounded base and wide neck
● Chilomastix mesnili
● 3 forms
○ Asymptomatic carrier
○ Fulminant (sudden onset of balantidiasis
CILIATES ex. Diarrhea with bloody mucoid stools)
■ Immunocompromised and
malnourished patients
Balantidium coli ○ Chronic form (diarrhea is alternate by
constipation, and the patient have
anemia)
● Causes BALANTIDIASIS (balantidiosis or
balantidial dysentery
★ CACHEXIA – wasting syndrome
● LARGEST PROTOZOAN PARASITE affecting
humans
● ONLY CILIATE capable of causing DISEASE to
HUMANS
● Normal host: PIGS
● Accidental host: HUMANS
● Reservoir host: MONKEYS, BATS AND PIGS
● INCUBATION PERIOD: 4-5 days
● Infective stage: MATURE CYST STAGE

TROPHOZOITE
● Longitudinal pattern cilia (extends from oral to
caudal)
● CYTOSTOME – food acquisition
● CYTOPYGE – waste excretion
● 2 nuclei DIAGNOSTIC TEST/S
○ Macronucleus: bean shaped
(vegetation) ● DFS & Concentration techniques:
○ Micronucleus: round-shaped ○ Microscopic demonstration of
(reproduction) Trophozoites and Cysts
● 2 contractile vacuoles (osmo-regulatory
○ Repeated stool examination
organelle) – regulates the osmosis inside the
● Lesions from sigmoidoscopy and
parasite
bronchoalveolar washings: trophozoite in
● Mucocysts
● Football/throwball motility biopsy specimens

CYST
● Spherical/ ovoid
● Covered with thick cell walls or refractile double
wall

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LIFE CYCLE ● Dorsal: convex
● Ventral: concave with sucking disk (large
adhesive disk used by the parasite to attach in
the intestine )
● Axostyle (middle line)
● Considered BILATERALLY SYMMETRICAL
● 4 pairs of flagella
○ Floating leaf-like motility

CYST
● Nucleus
○ Immature: 2
○ Mature: 4
● Shape: ovoid

TREATMENT

★ TETRACYCLINE: contraindicated in children <8

years of age
★ METRONIDAZOLE: contraindicated in early
pregnancy
★ IODOQUINOL

FLAGELLATES

● Flagellates were refracted in the axonemes

Giardia duodenalis

● MOST COMMON cause of DIARRHEA
WORLDWIDE (epidemic and endemic diarrhea)
● Causes GIARDIASIS
● ONLY protozoan that is BILATERALLY SIMILAR
● Other name: Giardia intestinalis, Giardia lamblia
● 1859- ANTONIE VAN LEEUWENHOEK: first
one to discover on his own stool
● Grows in duodenum, jejunum and upper ileum of
the intestine
● Infection can occur – as few as 10 CYSTS
● Each CYST produces 2 TROPHOZOITES
● Infective stage: MATURE CYST STAGE
● 4 pair of trophozoite
TROPHOZOITE
● Pyriform (pear) or teardrop shaped
● Nucleus
○ 2 ovoidal nuclei each with a large
karyosome – “old man with
eyeglasses”
CLINICAL MANIFESTATION
➢ Ability to alter mucosal intestinal cells once it
has attached to the apical portion of the
enterocyte (cell found in intestine)
1. Maximal at body temperature (37C) and stable
at a pH of 7.8 to 8.2
2. Production of lectin
3. Decreased maltase and sucrase activities
(malabsorption and maldigestion)
4. Rearrange the cytoskeleton in human colonic
and duodenal monolayers
5. Disrupt cellular tight junction and increase
epithelial permeability
★ INCUBATION PERIOD: 1-4 weeks (ave. of 9
days)
➢ ACUTE: flatus with an odor of “rotten eggs” (due
to hydrogen sulfide) abdominal bloating, nausea,
anorexia, diarrhea (most common), malaise
○ Recovery period: within 6 weeks
➢ CHRONIC: steatorrhea (mucus or fatty stool) ,
weight loss, profound malaise, and low-grade
fever – “failure-to-thrive syndrome”

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 DIAGNOSTIC TEST/S

● Parasitic diagnosis
● Specimen: Stool, Duodeno-jejunal Aspirates
1. Method of Examination
● Stool microscopy
● Direct wet mount examination
● Concentration techniques
2. Entero-test (string test)
● Demonstrate Giardia trophozoites
3. Immunochromatographic Assays
● Detect Giardia antigen in stool (Cyst
Wall Protein 1 -CWP1)
4. Direct Fluorescent Antibody Assays
● Gold Standard
● Highest combinations of Sensitivity and
Specificity DIAGNOSTIC TEST/S

● Persistent vaginitis in women

TREATMENT
○ characterized by foul-smelling, greenish
yellow vaginal discharge
★ METRONIDAZOLE: oral, 250mg (3x a day for
5-7 days) ● Speculum examination: “strawberry cervix”
(due to hemorrhage of genitals)
ALTERNATIVE DRUGS: ● Prostatitis: most common complication
★ TINIDAZOLE ○ Mostly asymptomatic and latent (men)
★ FLURAZOLIDONE
★ ALBENDAZOLE ★ SPECIMEN OF CHOICE: URINE

Trichomonas vaginalis DIAGNOSTIC TEST/S

● Trichomoniasis (Ping-Pong’s disease)

● MOT: Sexually transmitted ● Saline preparation of vaginal fluid (quickest and
● Habitat: Uro Genital Tract/Genitalia/Gut inexpensive test)
● WOMEN: Vagina-renal pelvis ● Culture: gold standard (takes 2-5 days)
● MEN: Urethra, prostate and epididymis ○ Diamond’s modified medium
● ONLY TROPHOZOITE ○ Feinberg and Whittington
● DOES NOT HAVE CYST FORM ○ InPouchTM TV Test
● ONLY KNOWN HOST: Humans
● Multiply by LONGITUDINAL BINARY FISSION ● Permanent stained smears using Giemsa,
● Motility: JERKY ● Papanicolaou, Romanowsky & Acridine orange
stains
● PAP smear
TROPHOZOITE ● Antigen detection tests and PCR
● Pyriform shape (pear)
● SINGLE NUCLEUS
● Undulating membrane: ½ of the body TREATMENT
● Median axostyle
● 5 flagella (4 free anterior flagella and the fifth
embedded in the undulating membrane ) ★ METRONIDAZOLE & TINIDAZOLE
➢ CYTOSTOME – food acquisition ○ 2g as a single dose
➢ CANNOT LIVE OR SURVIVED IN THE ★ METRONIDAZOLE
EXTERNAL ENVIRONMENT ○ Drug of choice in pregnant women

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LIFE CYCLE

NON-PATHOGENIC FLAGELLATES

Chilomastix mesnili

● Habitat: cecal region of the large intestine

● MOT: ingestion of cysts in food and drinks

TROPHOZOITE
● Asymmetrically pear-shaped
○ “boring and spiral forward”
movement

● 3 anterior free flagella and 1 within the

prominent cytostome

CYST
● Pear-or lemon-shaped
● Hematoxylin and eosin: single large vestibular
nucleus, cytostome and fibril on either side of
the cytostome

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 FEATURES

SPECIES HABITAT SIZE NUCLEUS UNDULATING INCLUSIONS

MEMBRANE BODIES

Trichomonas Intestine 7-17um Ovoidal As long as the NONE

hominis body

Trichomonas tenax Oral cavity 5-12um Rounded ⅔ of the body NONE

(droplets,
kissing,
sharing of
contaminated
utensils)
Can be
commensal on
human mouth

Trichomonas Genitalia/ Gut 7-23um Ovoidal ½ of the body Siderophil Granules

vaginalis

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