PROTOZOA

CILIATES (CILIOPHORA)

MLS 211: MEDICAL PARASITOLOGY I

Mme Sandie Sorelle (BIAKA UNIVERSITY) 1

CILIATES (CILIOPHORA)
• The ciliates (phylum Ciliophora) form a natural group distinguishable
from other protozoa by a number of specialized features, including the
possession of cilia, which are short hair-like processes, at some stage
in their life cycle and the presence of two types of nuclei one
macronucleus and one or more micronuclei).

• Only one ciliate, Balantidium coli, infects humans.

Dr Sandie Sorelle (BIAKA UNIVERSITY) 2

Balantidium coli
• It is the only ciliated protozoan known to infect humans and is the largest protozoan infecting humans
and non-human primates.

• Balantidiosis (disease caused by B. coli) is a zoonotic disease and is acquired by humans via the fecal-
oral route from the normal host, the pig, where it is asymptomatic.

• Water is the vehicle for most cases of balantidiosis.

• A distinctive feature on the morphology of Balantidium coli is the presence of a depression, or

peristome, leading into the cytosome.

• B. coli is commonly considered a pathogen of humans that also parasitizes pigs and monkeys. Some
investigators, however, classify the organism parasitic to pigs as a distinct species, B. suis.
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Classification
• Phylum: Ciliophora

• Class: Kinetofragminophorea

• Order: Trichostomatida

• Family: Balantidiidae

• Genus: Balantidium

• Species: Balantidium coli

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Different stages of Balantidium coli
• B coli has two (02) stages: trophozoite and cyst.

• Trophozoites live in the large intestines of the host. They are covered with cilia
and have boring or rotary motility.

• Balantidium coli is known for being the largest protozoan parasite of humans,
and it is for the trophozoite stage that it earns this distinction. Trophozoites can
measure between 50-130 mm long by 20-70 mm wide.

• In trophozoites, the two nuclei are clearly visible. The macronucleus is long and
kidney-shaped, and the spherical micronucleus is found next to it.
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Different stages of Balantidium coli
• The cyst is the infective stage of the Balantidium coli life cycle.

• Encystation is the process of forming the cyst; this event takes place in the
rectum of the host as faeces are dehydrated or soon after the faeces have been
excreted.

• Excystation produces a trophozoite from the cyst stage, and it takes place in the
large intestine of the host after the cyst has been ingested.

• Cysts are smaller than trophozoites, measuring 40-60 mm across. Cysts are
round and have a tough, heavy cyst wall made of one or two layers.
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Differences betwenn trophozoite and cyst of B coli
Trophozoite Cyst
Shape Oval, pointed at anterior end Spherical
Size 50-130 mm long by 20-70 mm wide 40-60 mm across

Surface Covered in cilia Covered with thick, hard cyst wall

with cilia sometimes visible
underneath
Motility Rotary or boring motility, “like a Non-motile
thrown football”
Infectious Not infective Infective
Reproduction By binary fission or conjugation Non-reproductive

Nuclei Macronucleus (kidney-shaped) and Only macronucleus (kidney-

micronucleus (spherical, next to shaped) visible; contractile
macronucleus) visible vacuole visible in young cysts; in
older cysts, organelle structures
look granular
Important Funnel-shaped cytostome (cell Cyst wall made of one or two
cell mouth) near anterior end; 2 layers
structures contractile vacuoles
Diagnosis Occasionally found in feces, often Diagnostically found in feces of
found in tissue biopsies of infected infected individuals
individuals
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Morphology

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 Life cycle of B coli
• Balantidium has a simple life cycle, as follows:

• Dormant cyst to trophozoite and trophozoite to cyst.

• Transmission is direct, from a contaminated water or food supply to humans.

No intermediate host, as occurs with many other parasitic species, is needed.

• The trophozoites and cysts are shed in feces (1), and if the cysts, in particular,
contaminate drinking water or food, the infection can be spread to other
humans (2). Fruits and vegetables may also be contaminated by cysts and
serve as a means of transmission
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Mme Sandie Sorelle (BIAKA UNIVERSITY) 10
 Epidemiology
• Balantidiosis is most often found in tropical regions throughout the world; however, with an infection
rate of less than 1%, it is not a common human disease.

• The parasite, while non-pathogenic in pigs, is far more common among these animals than among humans
in these regions, with a prevalence among pigs ranging from 20% to 100%.

• Human infection is most common where malnutrition is widespread, where pigs share habitation with
human families, and where fecal contamination of food and water occurs.
• The major factors leading to human balantidiosis include
• (i) close contact between pigs and humans,
• (ii) a lack of appropriate waste disposal such that swine and human excrement contaminate drinking water
sources (e.g., wells and streams) and food, and
• (iii) subtropical and/or tropical climatic conditions (e.g., warmth and humidity) favoring survival of cysts.
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Clinical Manifestation
• Balantidiosis has a range of mild to severe clinical presentations. The following three clinical
manifestations of balantidiosis can occur:

• (i) asymptomatic hosts who are carriers of disease and serve as reservoirs of infection in the
community;
• (ii) chronic infection that presents with non-bloody diarrhea, cramping and abdominal pain secondary
to trophozoite invasion of the large intestine; and
• (iii) patients with fulminating balantidiosis passing mucoid, bloody stools. The most severe
presentation of B. coli occurs with weight loss and bloody stools.

• Factors that can contribute to the development of the disease: Nutritional status, intestinal bacterial
flora, parasite load, achlorhydria (absence of hydrochloric acid in gastric secretions), alcoholism, or
any chronic disease may affect the severity of disease.
• Some degree of immunity may be present in populations that are exposed to Balantidium on a regular
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basis.
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Laboratory diagnosis
• Because of their large size and spiraling motility, balantidia can readily be
recognized in wet mount slide preparations, even at a low magnification.

• This is the case with freshly collected diarrheic stool samples, which are
likely to contain actively swimming trophic ciliates.

• Stool samples for examination should be collected over several days

because excretion of parasites can be erratic (unpredictable). Cyst stages
are more common in formed stools.

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Prevention of infection
• The best means of protecting human populations from balantidiosis is by
providing a source of clean, uncontaminated water for drinking and other
purposes.

• Chlorine, at the concentrations normally used for ensuring water safety, is not
effective against cysts of Balantidium.

• Pigs should not be allowed to roam in and around feeder streams or rivers that
empty into reservoirs that are used for providing municipal water supplies.

• Do not use human feces as fertilizers.

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 Treatment
• Tetracyclines and metronidazole are treatments of choice for
human Balantidium infection.

• For metronidazole (Flagyl), the treatment is typically 5 days in contrast to

tetracycline treatment which is over 10 days.

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