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Protozoan Parasites

of Humans
Adelaida Gaytos Rosaldo, MD

Protozoan Parasites of
Humans
• Protozoa that enter the body via ingestion have two
morphological forms
• Trophozoite
• Feeding and reproducing stage that lives within the host

• Cyst
• Infective form that survives in the environment
• Undergo excystment when ingested developing into
trophozoites

• Trophozoites undergo encystment before leaving the
host in feces
• Parasites presented based primarily on their mode of
locomotion
• Ciliates, amoebae, flagellates, and apicomplexans

Protozoan Parasites of
Humans
• Ciliates
• Protozoa that use cilia in their trophozoite stage
• Balantidium coli
• Only ciliate known to cause disease in humans
• Commonly found in animal intestinal tracts
• Humans infected by food or water contaminated with feces
containing cysts
• Trophozoites attach to mucosal epithelium lining the
intestine
• Infections generally asymptomatic in healthy adults
• Balantidiasis occurs in those with poor health
• Persistent diarrhea, abdominal pain, and weight loss

Balantidium coli

Protozoan Parasites of
Humans
• Amoebae
• Protozoa with no truly
defined shape
• Move and acquire food
through the use of
pseudopodia
• Found in water sources
throughout the world
• Few cause disease

• Protozoan Parasites of Humans Amoebae • Entamoeba • Carried asymptomatically in the digestive tracts of humans • No animal reservoir exists • Infection occurs by drinking water contaminated with feces containing cysts • Three types of amebiasis can result from infection • Luminal amebiasis • Invasive amebic dysentery • Invasive extraintestinal amebiasis • Maintaining clean water is important in prevention .

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2 .Entamoeba histolytica Figure 23.

• Protozoan Parasites of Humans Amoebae • Acanthamoeba and Naegleria • Cause rare and usually fatal brain infections • Common inhabitants of natural and artificial water systems • Individuals who wash their contact lenses with tap water can become infected .

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the conjunctiva. or inhalation • Acanthamoeba keratitis due to conjunctival inoculation • Amebic encephalitis is the more common disease • Naegleria disease • Infection occurs when swimmers inhale contaminated water • Amoebic meningoencephalitis can result • Prevention difficult since organisms are environmentally hardy . scrapes.• Protozoan Parasites of Humans Amoebae • Acanthamoeba and Naegleria • Acanthamoeba disease • Occurs through cuts.

Giardi. and Trichomonas . Leishmania.• Protozoan Parasites of Humans Flagellates • Protozoa that possess at least one flagellum • Number and arrangement of flagella important to determining the species • The flagellates include members of the genera Trypanosoma.

• Protozoan Parasites of Humans Flagellates • Trypanosoma cruzi • • • • Causes Chagas’ disease Endemic in Central and South America Opossums and armadillos are the primary reservoir Transmission occurs through bite of insects in genus Triatoma • “Kissing bugs”or “Assasin bugs” feed preferentially from blood vessels in the lips .

The life cycle of Trypanasoma cruzi Figure 23.3 .

fever. lymphadenopathy.• Protozoan Parasites of Humans Flagellates • Trypanasoma cruzi • Chagas’ disease • Progresses thru stages: A. hepatomegaly and splenomegaly . Acute Chaga’s Disease  characterized cutaneous edema ( chagomas)  Orbital edema (Romaña’s sign)  1-2 wks later.

B. Chronic Chaga’s Disease  Occurs 10-20 yrs  Classical Manifestations: o Cardiac Ds o Mega-esophagus or megacolon .

Mature trypomastigotes of Trypanasoma cruzi Figure 23.4 .

Xenodiagnosis 4.Diagnosis • Parasitological Techniques: 1. Microscopy: Thick or thin films 2. Culture 3. Biopsy .

• Other techniques: 1. PCR .Complement fixation test 2. ELISA 3.

Treatment • Acute Stage • Nifurtimox • Benznidazole .

sleeping sickness in East and Southern Africa • Causes African sleeping sickness • The insect vector is the tsetse fly (member of genus Glossina) • Humans usually infected when bitten by infected tsetse flies • In general. brucei gabiense. the infected areas are found south of the Sahara and north of the Zambezi.domestic and wild animals • T. .• Protozoan Parasites of Humans Flagellates • Trypanosoma brucei • T.sleeping sickness in West and central Africa • T. brucei. brucei rodiense.

The life cycle of T.5 . brucei Figure 23.

rhodiense) -Appears 3 or more days • Fever • Lymph gland enlargement (Winterbottom’s sign) • Infections characterized by cyclical waves of parasitemia .b.• Protozoan Parasites of Humans Flagellates • Trypanasoma brucei • African sleeping sickness • Early Stage • Site of the fly bite – trypanosomal chancre (T.

• Late Stage • Disturbed cerebral function • Behavioral changes • Sleeps badly at night but falls asleep during the day .

Diagnosis Early Stage • Stained or unstained thick blood films • Concentration methods • MHCT • QBC • MAEC • Bone marrow aspiration • Gland puncture .

Diagnosis Late Stage • Clinical dxs • CSF exam Immunological Methods: • Card Agglutinatin Test for Trypanosomes (CATT) • Card indirect agglutination test for trypanosomes(CIATT) .

Treatment Early Stage • Suramin –DOC • Pentamidine Late Stage • Melarsoprol • Eflornithine .

• Protozoan Parasites of Humans Flagellates • Leishmania • Causes leishmaniasis • Endemic in parts of the tropics and subtropics • Wild and domestic dogs and small rodents are common hosts • Leishmania have two developmental stages • Amastigotes • Multiply in host’s macrophages and monocytes • Promastigotes • Develop extracellularly within a vector’s gut .

The life cycle of Leishmania Figure 23.6 .

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• Protozoan Parasites of Humans Flagellates • Leishmania • Three clinical forms of leishmaniasis often observed • Cutaneous leishmaniasis • Mucocutaneous leishmaniasis • Visceral leishmaniasis • Most cases of leishmaniasis heal without treatment • Prevention limited to reducing exposure to reservoir and vector .

Treatment for Cutaneous leishmaniasis Oral Treatment: • Ketoconazole • Itraconazole • Fluconazole • Miltefosine .

v/im for 28 days .Treatment for Cutaneous leishmaniasis Parenteral: • Pentavalent antimony therapy(SbV) 20mg/kg i.

Mucocutaneous leishmaniasis Figure 23.7 .

gradually spreads over the face or more widely over the trunk and limbs .Post-kala-azar Dermal leishmaniasiss • Occurs in 10% of patients in India. 2-10 yrs after txt of VL • Macules and papules appear around the mouth.

• Protozoan Parasites of Humans Flagellates • Giardia intestinalis • Found in intestinal tracts of animals and in the environment • Causative agent of giardiasis • Common gastrointestinal disease in the United States • Ingest cysts in contaminated water or when swimming • Range from asymptomatic infection to gastrointestinal disease • Giardia have a life cycle similar to that of Entamoeba • Trophozoites multiply in the small intestines • Prevent infections in endemic areas by use of filtered water .

abdominal cramps. .Clinical Features • Incubation: 7-10 days • Ranges: 3 days to several months • Symptoms develop after ingesting as few as 10 cysts • Symptoms: abrupt diarrhea. bloating and flatulence • Associated: nausea. malaise and belching accompanied by a taste of rotten eggs.

Diagnosis • Stool Exam • ELISA • Direct fluorescence antibody technique • EIA Other: • Doudenal fluid aspirate “string test” • Small bowel biopsy .

Management • Metronidazole 400mg three times daily for 5 days or 2g/day for 3 days • Tinidazole • Albendazole • Nitazoxanide .

Trophozoite of Giardia intestinalis Figure 23.8 .

anaerobic. flagellated • Lives in the genitourinary system of men and women • Transmitted almost exclusively via sex • Occurs in people with preexisting STD or multiple sex partners • Infection of women results in vaginitis • Infection of men is typically asymptomatic • Prevention involves abstinence and safe sex .• Protozoan Parasites of Humans Flagellates • Trichomonas vaginalis • Unicellular intracellular.

Trophozoite of Trichomonas vaginalis Figure 23.9 .

Parameter Predominant symptom Trichomoniasis Profuse discharge Characteristic discharge frothy pH >4.5 Gram stain (-) NSS mount Flagellated protozoa 10% KOH (-) Other Laboratory Test Culture DNA probe test Treatment Metronidazole .

and Cyclospora . Toxoplasma.• Protozoan Parasites of Apicomplexans Humans • Alveolate protozoa • Infective form characterized by ornate complex of organelles at their apical end • Parasites of animals • Life cycles involve at least two types of hosts • Schizogony is major feature of apicomplexan life cycles • Multinucleate schizonts form before the cells divide • Four important apicomplexan parasites • Plasmodium. Cryptosporidium.

knowlesi • Malaria is endemic throughout the tropics and subtropics • Female Anopheles mosquitoes are vector for Plasmodium • The Plasmodium life cycle has three prominent stages . P. malariae. falciparum. ovale. P.• Protozoan Parasites of Apicomplexans Humans • Plasmodium • Causative agent of malaria • Four species cause malaria • P. and P. vivax. P.

• Protozoan Parasites of Apicomplexans Humans • Toxoplasma • Most infections are asymptomatic • Toxoplasmosis develops in a small number of people • Fever-producing illness combined with other symptoms • Usually is a self-limited infection • Toxoplasmosis is more severe in two populations • AIDS patients • Fetuses • Prevent by cooking meats and avoiding contaminated soil .

14 .Pseudocysts of Toxoplasma gondii Figure 23.

• Protozoan Parasites of Apicomplexans Humans • Cryptosporidium parvum • Causative agent of cryptosporidiosis (Cryptosporidum enteritis) • Once thought to only infect livestock and poultry • Humans can carry the parasite asymptomatically • Infection usually results from drinking contaminated water • Fecal-oral transmission can occur • Causes severe diarrhea that can last up to two weeks • Chronic Cryptosporidum enteritis indicator a person has AIDS • Infection of AIDS patients can be life threatening .

15 .Oocysts of Cryptosporidium parvum Figure 23.

• Protozoan Parasites of Humans Apicomlexans • Cyclospora cayetanensis • Water borne apicomplexan • Linked to raspberries imported from Central and South America • Infection occurs from ingestion of oocysts in contaminated food or drink • Environmental reservoir is unknown • Symptoms include cramps. myalgia. and fever • AIDS patients can experience more severe disease • Thoroughly washing fruits and vegetables can prevent infection . watery diarrhea.