Kingdom Protista

Parasitic protozoan

General characteristics
A diverse group of unicellular eukaryotic
organism, considered the simplest form of
animals
They exhibit considerable variations in size
(microscopic), shape
Many of which are motile- locomotor organelles
Pseudopodia- foot like structures that are temporary
extension of cell membranes. Not only for locomotion
but for feeding as well
Flagella- slender, whip like structures
Cilia- hair like structures similar to flagella

 Reproduction can be:

Asexual- (binary fission) in w/c one individual
divides into 2.
Sexual- (Multiple fission) in this type of
division the organelles and nucleus divide
repeatedly before cytokinesis ,thus producing
a large number of daughter cells. Merogony,
schizogony, sporogony, gametogony.
they absorb food via their cell membrane, engulfing
them (phagocytosis), mouth pores- sweeping the
food. Digestion occurs in stomach like compartments
known as vacoules

 They have organelles

Cell membrane- outer covering- lipid bilayer
Pellicle- thin layer supporting the cell membrane that
provides protection, allowing them to retain their shapeflexible, elastic and sometimes rigid (protein)
Glycocalyx- a glycoprotein surface coat- slime
Nucleus-genetic material
Cytoplasm- internal matrix
Mitochodria- powerhouse-TCA
Golgi apparatus- cytoplasmic saccules that manufactures
protein
Endoplasmic reticulum- transport proteins
Contractile vacoules- osmoregulation- hypertonic to their
environment, they imbibe water continously by osmosis

Life cycle
CYSTS- dormant stage.( closed sac
envelope-round w/ a distinct membrane)
That can survive harsh environmental
conditions- extreme temperature, harmful
chemicals, long periods w/out oxygen, water,
nutrients
TROPHOZOITES- proliferative stage/
feeding stage. ( Greek. Tropho= nourish)
Encystment/Encystation
Excystment/Excystation

Morphology
CYSTS

TROPHOZOITE

Encyst/excyst

General description- pg.12

Intestinal and Genital flagellates

Giardia Lamblia

Chilomastix mesnili
Trichomonas hominis
Trichomonas vaginalis
Dientamoeba fragilis
Amoebae
Endolimax nana
Iodamoeba butschlii
Entamoeba histolytica, dispar, moshkovskii,

Giardia lamblia pg. 49

Worlwide in distribution. Commonly found in

completely asymptomatic persons(carriers)
Children are more frequently affected than
adults
MOT:Major caused of diarrheal outbreaks from
contaminated water supplies. ( cysts can
withstand filtration and chlorination)
Travelers diarrhea- travelers to St. Peterburg,
Russia
zoonotic disease- reservoir host: beavers,
muskrats, water voles (US)

 Can be acquired by drinking

contaminated mountain streams by
campers,backpackers, mountain
climbers.
Switzerland- sheep, cattle, dog
MOT:Sexual contact- homosexual
males(anal-oral contact) may favor
transmission of this parasite

 Found in the upper part of the SI, where

they live closely applied to the mucosa
Penetrate down into the secretary
tubules of the mucosa
Found at times in the gallbladder and
biliary ducts
Sucking disk-provide attachment and
contributes to mechanical irritation as
well as the production of lectin

Morphology
trophozoite

Pear shaped, rounded anteriorly and pointed

posteriorly (attenuated)
Bilaterally symmetrical
9.5-21um x 5-15um
Progressive movement and erratic, w/ slow oscillation
about the long axis- falling leaf motion

cysts

Ovoidal, football shaped

8-12um x 7-10 um
Cystic wall has 2 layers
(double wall
Nuclei= 1-4 spherical in
shaped
Crossed fibrils arranged
in parallel pairs

trophozoite

Sucking disc occupies the

ventral portion w/c is pale
stained shallow, slightly
notched concavity

2 nuclei w/ central darkly

stained karyosome lie at
the anterior portion, one
on each side of the
midline ( old man w/
glasses)
4pairsFlagella: ant, lat,
vent, post.

cysts

stained
trophozoite

cysts

unstained
trophozoite

cyst

Life cycle

Pathology
Disease

Clinical features- S&S Dx test

T/P/C

Giardiasis

Diarrhea
abdominal cramps
Flatulence
steatorrhea
malabsorption

Ingestion of cysts

DFS
duodenal aspiratestring test
ELISA/ CIE

Metronidazole
Mebendazole
Albendazole
Tinidazole
Nitazoxanide

avoid drinking
contaminated water
Iodine- 20 mins.
Exposure at 20C

Chilomastix mesnili pg. 54

Non-pathogenic to humans
Lives in the cecum and colon of humans,
chimpanzees, orangutans, monkeys, pigs,
birds, reptiles, amphibians, fish, leeches, and
insects
Must be differentiated from other flagellates
occasionally seen in stool specimen
Incidence is indicative of unsanitary
conditions

Morphology
trophozoite

cyst

Asymmetrical, pear-shaped Lemon- shaped w/ nipple like

protuberance at the anterior
6-20um x 2-10um
portion
Cytoplasm is grayish violet,
7-10um x 4.5-6um
sometimes w/ food vacoules
longitudinal spiral groove in Definite cystic wall is observe
the surface in the middle of 1nucleus present occasionally
the body
2.
Flagella are rarely seen 3
Cytoplasm is clearly
ant. flagella
separated from the cyst wall
at the ant. portion

Images
trophozoite

cyst

stained
trophozoite

cyst

unstained
trophozoite

cyst

Trichomonas hominis pg. 55

Is a harmless commensal of the intestinal tract and
the most common intestinal flagellates of humans
Does not form cyst.
They can survive stomach acids and in formed
stool the organism is rounded and dormant but not
encysted (non moving)
Non-pathogenic. When found it is indicative of
direct fecal contamination-unsanitary conditions
Has been assigned to genus Pentatrichomonas
bec. It actually bear 5 ant. Flagella ( foundations of Parasitology
8th ed.)

Morphology
trophozoite

Pyriform (pear-shaped)
5-14um x 7-10um
Cytoplasm is grayish violet,
finely granular
A single nucleus at the ant.
End w/a central karyosome
The post. End of the
axostyle protrudes through
the post. Portion of the
parasite
Flagella,3-5 rarely seen

image

Trophozoite images
unstained

stained

Trichomonas vaginalis pg.56

Was first found by Donn in 1836 in purulent

vaginal secretions and in secretions from males
urogenital tract. 1837 he named it as such- (Greek.
thrix=hairs) (Foundations of Parasitology, 8 ed.)
A common sexually transmitted disease that causes
an estimated 2-3million symptomatic infections per
year among sexually active women in the US.
found in both men and women reproductive tracts
MOT: vaginal sexual contact. Men= prostate,
seminal vesicles, urethra. Women= vagina, urethra
th

 Does not form cyst

Generally similar in appearnce to T.
hominis from w/c they differ in having
a short undulating membrane that
extends only about half the distance
to the post. end of the body, w/ no
free flagellum
Both are site specific

Morphology
trophozoite

Pyriform(pear-shaped)
7-32um x 5-12um (ave. 5-15um)
Undulating membrane shorter
More granules along its axostyle and costa
4 ant. flagella and the 5th along the margin of the UM

Image

Trophozoite images
stained
stained

Trophozoite images
unstained

unsatined

Life cycle

Pathology
Disease

Clinical features- S&S

Dx test

T/P/C

Trichomoniasis

Vaginitisvaginal/urethral
discharge, burning,
itching, dysuria.
Cervical carcinoma
malesasymptomatic but,
becomes severe when
it involves major
reproductive organsenlargement of the
prostate, epididymitis,
thin discharge
CYSTITIS
mother to child
transmission- infected
birth canalconjunctivitis,
respiratory dse.

Urinalysis- jerky
nondirectional motility
Papanicolaou smear
urethral discharge,
prostatic secretions,
vaginal discharge
Culture methodsDiamonds med. &
Modified thioglycolate
med., w/ yeast extract,
horse serum and
antibiotic
Immunologic test
kits- EIA, DFA, LA
DNA probe

Metronidazole
Intravaginal estradiol
pellets- ameliorate the
infxn

vaginal sexual
intercourse/contact
trophozoites in
vaginal /urethral
discharge

avoid unprotected
sexual contact
Increases the rate of
HIV transmission by 2
folds

Trichomonas tenax pg.59

Also called T.buccalis resembles T. vaginalis.
small organism, oval shaped= 5-16um x 2-15 um
First discovered by O.F. Muller in 1773 when he
examined an aqueous culture of tartar from teeth.
worldwide distributed
a harmless commensal of the mouth. Although in
1942, 36 cases of pulmonary trichomoniasis have
been reported
They have been found in teeth and gums, tooth
cavities, pus pockets and crypts of tonsils

 Can live only in the mouth and cannot

survive passage through the digestive tract
Does not form cyst
MOT: Direct/ Indirect contact= kissing,
utensils and other fomites.
Good oral hygiene will eliminate the
infection
Infxn is common in immunocompromised
pts. w/ poor oral hygiene and those with
advance periodontal infxn
Metronidazole(Flagyl)

Morphology- T. tenax
trophozoite

trophozoite

Dientamoeba fragilis pg. 59

1940, Dobell-amoebaflagellate
Traditionally considered to be a member of the amoeba
family even despite the lack of flagella
binucleate and does not form cyst
known to live in the mucosal crypts of the large intestine.
Harmless commensal
can caused intestinal infection in some people.
Prevalence rate ranges from 1.5%-20%
can co-exist w/ other parasites such as A.lumbricoides
E.vermicularis, E. nana, E.coli, Giardia cysts.
Di=2 nuclei; Ent= enteric; Fragilis= fragile
trophozoite(delicate & disintegrate easily in stool and

Morphology
trophozoites

Irregular
3-22um (ave. 7-12um)
Pseudopodia are broad,
hyaline, and leaflike in
appearance
Cytoplasm is granular w/
granules containing bacteria
commonly 2 nuclei w/
karyosome consisting of 4-8
chromatin granules (I&H
stain)

image

Trophozoite images
stained
unstained

Life cycle

Pathology
Disease
Colitis
fecal-oral
route

Clinical features- S&S

Dx test

T/P/C

Diarrheabloody &mucoid
abdominal pain
flatulence
nausea,
vomiting, fatigue
weight loss

Stool examprogressive
movement
and active in
freshly
passed stool
stool
preserve in
PVA

Iron&Hematox
ylin stain

Iodoquinol
Tetracycline

Paramomycin
avoid
drinking
contaminated
water
maintain
environmental
sanitation

Balantidium coli pg. 62

Phylum Ciliophora- the only human pathogenic ciliate
The largest protozoan parasite of humans, common
in tropical regions most esp. in the Philippines
Lumen dwellers that feed on bacteria and occupies
the large intestine, cecum, and terminal ileum of
man, swine, guinea pigs, rats and many other
mammals
They can penetrate the intestinal mucosa and cause
ulceration

 Produce proteolytic enzymes (hyaluronidase) that

erodes/digest the hosts epithelial linings and facilitates
tissue invasion
Secondary bacterial invasion may occur following mucosal
invasion
mild colitis to severe diarrhea that closely simulate amoebic
dysentery
many patients are asymptomatic carriers of infxn
High prevalence rate among pigs in Japan=100% (foundations
of Parasitology, 8th ed.)

Generally the disease is considered rare and occurs in less

than 1% of the human population but high among mental
pts.
MOT: ingestion of contaminated food & or water

Morphology
trophozoites

Large, ovoid, pointed anteriorly

and broadly rounded posteriorly
50-200um x 40-70um
The entire body is covered w/
cilia
cytostome located at the anterior
end
Cytoplasm contains numerous
food vacoules
2 nuclei- a large bean
shaped=macronucleus and a
small rounded
structure=micronucleus (genetics

cyst
Spherical or ellipsoid

45-65um

Thick, refractile cyst wall

Cytoplasm is granular
Macro and micronucleus are present

Cilia may be present

Images
trophozoite

Images
cyst

Life cycle- B.coli

Pathology
Disease

Clinical features- S&S

Dx test

T/P/C

Balantidiasis

Diarrhea-bloody
&mucoid
colitis
abdominal pain
flatulence
nausea, vomiting,
fatigue
weight loss

Stool examWatery- easily

recognized bec. Of
their size, cilia,
motility like that of a
thrown football
Formed- cyst;
macronucleus are
seen w/in the cyst
wall

Iodoquinol
Oxytetracycline

ingestion of
contaminated
food& or
water
containing the
cyst

extraintestinal
infxn- mesenteric
nodes, liver, pleura,
lungs, appendix,
urogenital organs

avoid drinking
&eating
contaminated water
&food
maintain
environmental
sanitation especially
in slaughter houses
Hog farmers must
take necessary
precaution and
maintain proper
hygiene

Amoeba family
Endolimax nana
Iodamoeba buetschlii
Entamoeba spp.= histolytica,
hartmanii, coli, polecki,
moshkovskii,dispar, gingivalis

Life cycle

Differential images

Endolimax nana pg. 47

Lives in the human large intestine, mainly near the
cecum, and feeds on bacteria.
A commensal like the E. coli
Both species are commonly encountered in the stool
and must be identified to prevent false positive
diagnosis. (E. histolytica)
presence indicates ingestion of fecal contaminated
food and water- unsanitary conditions
Intermittent or chronic diarrhea
DFS

trophozoite

Morphology

Tiny irregular shape amoeba

6-15um (ave. 7um)
Pseudopodia are blunt and
hyaline
Movement is sluggish and
random
Cytoplasm contains food
vacoules w/ ingested bacteria
The nucleus is small and
contains a large centrally or
eccentrically located
karyosome

cyst
Smooth, w/ definite cystic wall

Oval

6- 10um
Cytoplasm contains glycogen granules,
chromatoidal bars

1- 4 nuclei

Images
trophozoite

cyst

Iodamoeba buetschlii pg. 45

Lives in the large intestine, mainly in the cecal
area and feeds on bacteria
Non-pathogenic amoeba
It infects humans, other primates, pigs and is
world wide distributed
It is the most common amoeba of swinedefinitive host. Possible infxn is acquired through
pig feces or human feces infected with cyst
indicates oral-fecal contamination-diarrhea

Morphology
Trophozoite

Irregular shaped
4-20 um (9-14um)
Granular , vacuolated cytoplasm w/c may contain
bacteria and yeast cell
Single , large nucleus w/ large central karyosome
sorrounded by a ring of small chromatin granules
Identification of unstained trophozoite is difficult

Cyst

Irregular in outline w/ much variation in shape

6-16um (ave. 9-10 um)

Glycogen vacuole is prominent even in the

unstained cyst

Contains 1, rarely 2 nuclei

When stained w/ Iodine the cyto-yellowish;

nucleus-may be visible; gly vacuole-dark brown

Images
trophozoite

cyst

Entamoeba histolytica pg.22

The only pathogenic Entamoeba
Described in 1875 , in a young russian peasant in the port of
Arkhangelsk, near the Artic circle
Found throughout the world with a prevalence rate of 1%-5%
of the population are infected.
Prevalence rates are highest in areas of crowding and poor
sanitation, notably in the tropics
Inhabits the Large intestine, where the trophozoites live in
the intestinal lumen and on occasion may invade the
mucosal crypts, where they feed on RBC, bacteria and form
ulcers

 This will give rise to amoebic dysenterythey have the ability to hydrolyze and invade
the host tissue.
Pseudopodia-provides attachment to the
host tissue
Cytotoxic subts- galactose-specific
membrane lectins- not only fxn in binding to
host cell but causes inflammation as well.
Trophozoites have active Cysteine
proteases(CP), enzymes that hydrolyzes the
host cell contributing to its invasive ability.

Trophozoite stained

Morphology

Irregular vary in size & form

10-60um
Cytoplasm is grayish violet with a clear demarcation
of the ectoplasm and endoplasm
Finger like sharply pointed pseudopods
Endoplasm is briefly granular w/ ingested RBC w/c
are bluish black in color w/ no ingested bacteria
Single spherical nucleus w/ fine, uniform chromatin
granules and a small centrally located karyosome

Cyst stained
Spherical

Bulls eye cyst

5-20um

Smooth, definite, relatively thin cystic wall

Nuclei range from 1-4 w/ a minute centrally located
karyosome
In younger cyst, chromatoidal bars w/ rounded ends
(sausage shaped) & glycogen mass may be
present. (1-2 nuclei) Bluish black in I&H stain, and
Red for Trichrome

Images-stained
Trophozoites
Cyst

Trophozoite- unstained
Cyst-unstained

Cyst wall is thin and refractile

cytoplasm ,colorless w/ ground glass

appearance
Nuclei rarely visible, glycogen mass clear or
empty space

Chromatoidal bars refractile

Size the same

Progressive uni-directional motility

Hyaline psuedopodia
Ingested bacteria
Nuclei not visible
Size the same

Images-unstained
Trophozoites

Cyst

Life cycle

Pathology
amoebiasis/amoebic dysentery
Asymptomatic-carriers
Symptomatic- sudden onset of severe disease
Incubation period= 8-10 days
Intermittent diarrhea- bloody & mucoid (dysentery); 4-6 watery
stool/ day, tenesmus
Abdominal pain, headache, fever
Cramping
Dehydration
Loss of blood
Death-peritonitis due to gut perforation, cardiac failure and
exhaustion.

Pathology

T/P/C

Metronidazole( not to be taken w/ alcohol)

Tetracycline+diidohydroxyquin
Ornidazole
Tinidazole-effective against amoebic liver abscess

Paramomycin
Maintain environmental and personal hygiene
Avoid using fecal material as fertilizers
Avoid eating fresh salad/fruits and foods sold by
street vendors

DX test
DFS- trophozoite w/ progressive unidirectional movement or cyst w/ 1-4 nuclei
FECT/ zinc sulfate flotation
Immunologic test kit- ELISA
X-ray, liver scan, CT scan etc.

Entamoeba coli pg.39

It is a non-pathogenic amoeba that closely
resembles E. histolytica
It coexist with E. histolytica and, in the living
trophozoite stage is difficult to distinguished
E.coli is a commensal that never lyses its hosts
tissues. It feeds on bacteria, other protozoa,
yeast, and occasionally blood cells.
E. coli is more common because of its ability to
withstand putrefaction
Must be correctly diagnosed otherwise the patient
will be subjected to unnecessary drug therapy. Its

Morphology
Trophozoite

Superficially identical to those of E. histolytica

15-50um (20-30um)
Cytoplasm is granular w/ no clear demarcation
between the ecto and endoplasm , highly vacuolated
with ingested bacteria
Pseudopodia are blunt, short. They are extruded
slowly an not hyaline
Nucleus is spherical w/ thick nuclear membrane lined
w/ coarse, irregular chromatin granules. Karyosome
is large and eccentrically located
Sluggish motility, non-directional

Cyst
Spherical
10-33um

Smooth, definite thick cystic wall

Nuclei range from 1-8 w/ an eccentric karyosome

In younger cyst chromatoidal bars w/ splintered

ends and glycogen mass may be present

Images
Cyst
Trophozoite

Other Entamoebas
E. moshkovskii and E. dispar (different), E. hartmanni- (small race)
Morphologically identical (indistinguishable) non-invasive species
(non-pathogenic)
other test must be performed to establish diagnosis- serologic testELISA, PCR- DNA probe
E.polecki - parasite of pigs, monkeys although on rare occasions it
occurs in human but generally non-pathogenic. Cyst is always
mononucleate
E. gingivalis- lives in the mouth (commensal)- surface of teeth and
gums, crypts of tonsils. Does not form cyst- transmitted through
kissing, droplet spray, utensils. Their number increases in presence
of food and in cases of gum and tonsil disease, but no evidence
shows that they cause this conditions. They are also present in other
primates, dogs and cats.

Phylum Apicomplexa-intestinal
(coccidian)sporozoa- pg. 65
The Apicomplexa (also referred to as Apicomplexia)
are a large group of protists, most of which possess a
unique organelle called apicoplast and anapical
complex structure involved in penetrating a host's cell.
They are unicellular, spore-forming, and exclusively [3]
parasites of animals. Motile structures such as
flagella or pseudopods are present only in certain
gamete stages. This is a diverse group including
organisms such as coccidia,gregarines, piroplasms,
haemogregarines, and plasmodia.

Ref: wikipedia
The name of the taxon Apicomplexa is derived
from two Latin words - apex (top)
and complexus (infolds) - and refers to a set of
organelles in thesporozoite. The older
taxon Sporozoa was created by Schrevel in 1971
and grouped the Apicomplexa together with the
Microsporidia and Myxosporida. This grouping is
no longer regarded as biologically valid and its
use is discouraged.[4]

Morphology

Apicomplexan structure: 1-polar ring, 2-conoid,

3-micronemes, 4-rhoptries, 5-nucleus, 6nucleolus, 7-mitochondria, 8-posterior ring, 9alveoli, 10-golgi apparatus, 11-micropore.

 The apical complex includes vesicles called

rhoptries and micronemes, which open at
the anterior of the cell. These secrete
enzymes that allow the parasite to enter
other cells. The tip is surrounded by a band
of microtubules, called the polar ring, and
among the Conoidasida there is also a
funnel of tubulin proteins called the conoid.[16]
Over the rest of the cell, except for a
diminished mouth called the micropore, the
membrane is supported by vesicles called
alveoli, forming a semi-rigid pellicle.

General life cycle

Generic life cycle of an apicomplexa: 1-zygote(cyst), 2sporozoites, 3-merozoites, 4-gametocytes.

Definition of terms

ZYGOTE- cell resulting from the union of male

and female gametes. (ookinetes)
SPOROGONY- sexual reproduction with the
development of spores(cysts) in
th
host. (multiple fission of a
zygote)
SPOROZOITE- daughter cell resulting from
sporogony.
SCHIZOGONY- the asexual reproduction of
sporozoa by fission resulting in
man
daughter cells at once taking
place i
the cells of the vertebrate
host
TROPHOZOITE- the vegetative or feeding stage of the

 SCHIZONT- cell undergoing schizogony (late

phase)
MEROZOITES- daughter cell resulting from
schizogony (final division of a
schizont)
GAMETOCYTES- a sexually differentiated
immature cell (cysts)- sexual
reproduction. Microgametocyte(male),
Macrogametocyte (female). Gametesmature sexual cells

Ref: wikipedia
Most members have a complex life-cycle, involving
both asexual and sexual reproduction. Typically, a host
is infected via an active invasion by the parasites
(similar to entosis), which divide to produce
sporozoites that enter its cells. Eventually, the cells
burst, releasing merozoites which infect new cells. This
may occur several times, until gamonts are produced,
forming gametes that fuse to create new cysts. There
are many variations on this basic pattern, however,
and many Apicomplexa have more than one host.
Obligate intracellular parasites

Isospora belli pg. 66

A parasite of the epithelial cells of the intestine
Which undergo repeated asexual development
causing considerable destruction of the
intestinal surface layer
It is predominantly an infection of people in the
developing world (Tropics& Sub-tropics).
MOT : ingestion of oocysts
Isosporiasis- Travelers diarrhea
The parasite can cause severe/chronic diarrhea,
fever, malaise, anorexia, Eosinophilia and even
death in AIDS patients (immuno-compromised)

 Loose pale yellow stool, and foul-smelling

stools are suggestive of malabsorptive
process- Fecal fats
Immature oocysts are released from the
intestinal wall, and have been reported to
persist in stool for as long as 120 days
All stages of oocyst development occur in
the stool
DX test; stool exam- FECT (stained
-Iodine, modified acid-fast, auraminerhodamine stain or unstained)

Morphology- immature oocyst

Elongate, ovoidal
20-33 um (10-19 um)
Cyst wall has 2 layers,
smooth, thin , and

colorless
Inside is the
sporoblast- a spherical
mass of granules

Morphology- mature oocysts

The sporoblast divides

Develop a heavy cyst wall- sporocysts

Life cycle

T/P/C
Trimethoprim-sulfamethoxazole
combination, is effective in treating
as well as prophylaxis.
Pyrimethamine-sulfadiazine
Avoid drinking contaminated watersprings, lakes, ponds
Environmental sanitation-prevent
water contamination

Sarcocystis spp.- pg.67

Human sarcocystosis is rare, especially in
temperate regions
A protozoan that parasitize mammals,
reptiles, birds
the organism was first recognize in mouse
by Miescher in 1843, similar structures were
later found in pig muscle in 1865, and later
was named in 1967 with the help of electron
microscope

S. suihominis- swine (pork)

S. hominis/bovihominis- cattle (beef)
Intermediate host- herbivores
Definitive host- man, carnivores
MOT: ingestion of infected
meat(pork/beef) containing mature
intramuscular cysts- zoitocyst
DX test: Muscle biopsy, stool
exam(fecalysis)

Life cycle

 once the zoitocysts/sarcocysts

(skeletal muscle, cardiac muscle,
brain) is consumed, its wall is digested
by enzymatic action
bradyzoites penetrate the intestinal
cells and transform into microgametes
and macrogametes
The zygote undergo oocyst wall
formation and sporogony

Morphology-oocysts passed in feces

Morphology
The oocysts are usually passed in the feces
fully developed with the sporocyst ruptured
out of the oocysts
Oocyst contain 1-2 sporocysts, each with 4

sporozoites

S.hominis- 13.1- 17um x 7.7-10.8um

S. suihominis- 11.6- 13.9um x 10.1-10.8um
Ingested by the IH
Man accidental IH-tissue

Sarcocyst

Morphology
Cylindrical, elongated lying along the
length of the infected muscle fibre
100um-5cm in length
Mieschers tubules
Filled with crescent shaped bradyzoites,
phozoites, each measuring 5-12um x 14um containing a single nucleus

Pathology
Disease

Clinical features- S&S

Intestinal
sarcocystosis

does not
Stool examproduce clinical sporocyst w/ 4
symptoms
sporozoites
nausea
abdominal pain
diarrhea lasting
for 48 hrs.

ingestion of
undercooked
pork/beef meat

Tissue
sarcocystis

Vasculitis
Myositiseosinophiliaswelling and
pain, dysnea,
wheezing

Dx test

Muscle biopsytongue (Mal.)

H&E stain

T/P/C

Albendazole
metronidazole
cotrimoxazolemyositis
corticosteroid

cooked meat
properly
freeze meat at
5 C for several
days will destroy
the cyst.
Environmental

Cryptosporidium parvum pg. 68

An oppurtunistic parasite of humans, both

immunodeficient (AIDS)and healthy individuals,
especially of young children
C.parvum-cattle; C.hominis- humans; C. murisrodents; C. felis-cats
A minute coccidian parasite with worlwide distribution
Parasitize a wide variety of mammals, birds, reptiles,
and fish- (reservoir host)
Infection by exposure to other host (zoonosis)
Infection can also be attributed to; swimming pools,
contaminated water source, unfiltered water (1um)

 MOT: ingestion of oocysts containing

sporozoites that have been passed in feces.
(fecal-oral contamination)
excystation of C. parvum in the surface layer
of the intestinal/ respiratory epithelial
cells(brush border) occurs.
the oocysts sporozoites are released and
enter the intestinal epithelial cells
Undergo 2 asexual generations; Merozonts
& gametogony
Sporulated oocysts with sporozoites(w/out

Life cycle

Morphology-oocysts

Round or slightly ovoidal refractile bodies

4-6um
encloses 4 spindle shaped bodies sporozoites
Red against a blue background (modified A-F
stain)

Morphology -oocysts

Pathology
Disease

Clinical features- S&S

diarrhea-2 wks
abdominal
discomfort
ingestion of
anorexia
oocysts from
fever
contaminated water nausea
source
weight loss
zoonosis-domestic AIDS: life
threateninganimals
malabsorption (625/day BMF) 1-17 ltsstool vol.
Profuse, watery
diarrhea lasting for
several months
also found in
sputum, lung
&duodenal biopsy,
biliary tract
Cryptosporidiosis

Dx test

T/P/C

Stool exam- oocysts

w/ 4 sporozoites.
FECT and stained
mod. A-F Tech.
air-dried methanolfixed fecal smears
with Giemsas stain
Biopsy materiallungs, trachea, larynx,
esophagus, intestine,
gall bladder, urinary
bladder

Nitazoxanide
boiling of water
(100C for 1 min.)
Pastuerization- 72C
for 15 sec.
maintain personal
hygiene
Environmental
sanitation- proper
disposal of waste

Blood & Tissue dwelling protozoans

Phylum Apicomplexa
Plasmodium sp.= ovale, malariae, falciparum, vivax
Toxoplasma= gondii
Babesia= microti
Phylum Sarcomastigophora- sub phylum Mastigophora

Lieshmania sp.= donovani, tropica, braziliensis

Trypanosomes sp.= cruzi, brucei gambiense, brucei
rhodesiense

Plasmodium- sporozoan; pg. 79

Malaria- has been known since antiquity;
recognizable descriptions of the disease were
recorded in various Egyptian papyri.
Human malarial parasites were first seen in 1880,
and their development both in the anopheline
mosquito and in the human bloodstream was well
understood in 1900. (Ronald Ross)
Thought to have originated in SEA-presumably
from simian species, from where it spread first to
Africa and then to Europe and then was introduce
in America in the 16th century.

Ref. wikipedia
The World Health Organization has estimated that in 2010,
there were 219 million documented cases of malaria.
That year, the disease killed between 660,000 and 1.2
million people,[1] many of whom were children in Africa,
aged >5 yrs. old
The actual number of deaths is not known with certainty,
as accurate data is unavailable in many rural areas, and
many cases are undocumented. Malaria is commonly
associated with poverty and may also be a major
hindrance to economic development.

Genus Plasmodium
member of Class Sporozoa
causes malaria in mammals and birds
the asexual cycle (schizogony) takes place in
the rbc of vertebrates (host)
the sexual cycle (sporogony) takes place in
mosquitoes (vector)

Four species
1. Plasmodium vivax- benign tertian malaria, bec. Fever
paroxysms typically recur every 48 hrs., a predominant
malarial parasite in most part of the world especially in
temperate regions- Asia, North Africa, accounts for about
43% of malaria cases in the world
2. Plasmodium ovale- mild tertian malaria, the rarest of
the 4 malaria. Widely distributed in tropical Africa, also
been reported occasionally from South America and
Asia. Difficult to diagnose bec. Of its similarity to P. vivax

1. Plasmodium malariae- Quartan malaria

with paroxysyms every 72 hrs. , accounts for
about 7% of malaria cases in the world.
Occurring primarily in regions of tropical
Africa, Myanmar, India, Sri lanka, Indonesia,
brazil, Panama, US. Can undergo dormant
stage of up to 53 yrs. After initial infxn-most
important cause of transfusion malaria.

1. Plasmodium falciparum Malignant

tertian malaria, subtertian,
estivoautomnal. Common during summer
or Autumn weather.
The most virulent of Plasmodium spp. In
humans and, the greatest killer of humanity
in tropical zones of the world today.
Accounting for about 50% of all malaria
cases.
Highly fatal form of malaria. Confined to the

Mosquito vector
MOT: Mosquito bite

Anopheles flavirostris principal

vector which breed
in slow, flowing, partly shaded
clean mountain streams in the
Philippines
A. mangyanus
- clean stream breeder
A. balabacensis
forest rain pool breeder
A. litoralis
brackish water
A. maculatus
- stream breeder

General life cycle

Stages of the life cycle

Asexual Cycle- Schizogony
- schizonts and
merozoites
- human host

Sexual Cycle - Sporogony

- gametes
- female anophiline
mosquito

Definition of terms
SPOROGONY sexual reproduction with the
development of spores, taking place
in the mosquito
GAMETE mature sexual cell
ZYGOTE the cell resulting from the union of
the male and female gametes
OOKINETE the motile vermicular zygote

SPOROZOITE the form which develops

within the sporocyst and infects the salivary
gland of the mosquito
SCHIZOGONY the asexual multiplication of
sporozoa by fission, taking place in the
vertebrate host
TROPHOZOITE the vegetative or feeding
stage of the parasite which contain one
nucleus and develops in the rbc.

SCHIZONT a stage following the trophozoite

stage of the parasite which contain

one nucleus and develops in the rbc

MEROZOITE the cell resulting from the final

division of a schizont
GAMETOCYTE- a sexually differentiated but

immature cell
1. Macrogametocyte immature female
cell
2. Microgametocyte immature male
cell

Asexual stage-host
PRE-ERYTHROCYTIC CYCLE (hepatic)
development of the parasite in the liver cells
prior to entry into rbc

ERYTHROCYTIC CYCLE
the development of the parasite inside rbc

EXO-ERYTHROCYTIC CYCLE (44-72 hrs.)

stage of development of the parasite
which takes place in the liver cells.
In this stage, the rupture of the hepatic cells releases
the merozoites into the circulation

 Some of these merozoites initiates a new

cycle of infection. (erythrocytic)
Some may undergo gametogony producing
macrogametocyte (female sex cell) and
microgametocyte (male sex cell)

ERYTHROCYTIC SCHIZOGONY
P. vivax & P. ovale
- young rbc
P. malariae
- older rbc
P. falciparum
- rbc of all stages

Sexual stage- Vector(sporogony)

GAMETOCYTES ingested by the female mosquito
differentiates to become a gamete
Exflagellation, the extrusion of motile delicate,
spindle-shaped microgametes
Motile ookinete, migrates outside the stomach wall
forming an oocyst
Within the oocyst, infective sporozoites are formed

STAGES FOUND IN THE CIRCULATING

BLOOD
Species

Stages found in the circulating blood

P. vivax

All stages. Wide range of stages may be seen on

given film

P. malariae

All stages. Wide variety of stages usually not

seen. Relatively few rings, gametocytes generally
present
All stages

P. ovale
P. falciparum

Rings and or gametocytes. Other stages develop in blood

vessels of internal organs but are not seen in peripheral
blood except in severe infections

Morphologic stages seen in blood:

Trophozoite or ring forms
a) young form is globose in shape with a

central vacuole, a red chromatin

mass
and a blue cytoplasm
- in stained smear, they appear signet
rings

b) Growing form
- single chromatin
mass with a more
abundant
cytoplasm
- cytoplasm may
appear compact or
irregular (ameboid)

c) Mature form
- single
chromatin mass but with an increase amount of
cytoplasm that partially fills the erythrocyte

COMPARISON OF PLASMODIUM SPECIES

AFFECTING HUMANS
Species

rbc stage

Size of rbc

Schuffners
stippling
+

P. vivax

Young rbc

enlarged

P. malariae

Mature rbc

normal

Ziemanns
dots

P. ovale

Young rbc

enlarged

P. falciparum

rbc of all
stages

Normal/
Multiple
infection

_
Maurers dots

Schuffners dots
Any of the fine, round,
uniformly red or redyellow staining dots
occurring in red blood
cells infected
with Plasmodium
vivax or P. ovale.Also
called Schffner's
granule.

APPEARANCE OF PARASITE
Species

P. vivax

Cytoplasm

Pigment

No. of
merozoites

Gametocytes

Irregular,
ameboid in
trophozoite,
has spread
out
appearance

Golden
brown,
inconspicuous

12-24
Average is
16

rounded

APPEARANCE OF PARASITE
Species

P.
malariae

Cytoplasm

Pigment

No. of
merozoites

Gametocytes

Rounded,
compact
trophozoite
with dense
cytoplasm/
band form
troph are
rarely seen

Dark
brown,
conspicuous

6-12
Average is
8, rosette
schizonts
are
sometimes
seen

rounded

APPEARANCE OF PARASITE
Species

P. ovale

Cytoplasm

Pigment

No. of
merozoites

Gametocytes

Rounded,
compact
trophozoit
e with
dense
cytoplasm
/ band
form troph
are rarely
seen

Dark
brown,
conspicuous

6-12
Average
is 8,
rosette
schizonts
are
sometime
s seen

rounded

APPEARANCE OF PARASITE
Species

Cytoplasm

Pigment

P.
Young
Black
falciparum rings are
coarse
small,
and
delicate,
consoften with picuous
double
in
chromatin gametoc
mass
yte

No. of
merozoites

Gametocytes

6-32
Average
is 20-24

Crescent,
sausageelongate
shape

Pathology
Clinical features of malarial attack
or paroxysms:
Fever =40C or higher
Shaking chills
diaphoresis

Periodicity of fever paroxysm

Vivax
Ovale
Malariae
Falciparum
Clinical comparison
of the types
of Malaria

Features

Incubation
pd.

10-17 days

10-17days

18-40 days

8-11 days

Prodromal
symptoms

Influenza
like in all
forms

Periodicity

44-48 hrs

48-50 hrs.

72 hrs.

36-48hrs.

Duration of
untreated
primary
attack

3-8 wks or
more

2-3 wks

3-24 wks

2-3 wks

Duration of
untreated
infxn

5-8 yrs.

12-20
months

20-50 yrs. or 6-17 months

more

Features

Vivax

Ovale

Malariae

Falciparum

++

++

++++

CNS
involveme
nt

++++

Nephrotic
syndrome

+++

Clinical comparison of the types of Malaria

Anemia

 P.ovale and P. vivax= a varying proportion of

the infecting sporozoites enter a resting stage
before undergoing asexual multiplication
The resting stage is known as HYPNOZOITE
Hypnozoite reactivation brings about relapses
RELAPSE- is a recurrence that takes place
after the dormant stage it also implies the
reinvasion of the bloodstream by the parasite
after the dormant pre-erythrocytic stages.

P. malariae and P. falciparum

- recurrences of fever is called
RECRUDESCENCE
- arise from increase in numbers of
persisting blood stage forms to
clinically detectable levels and not
from liver stage forms

Complications of malarial infxn-Pg. 89

Cerebral malaria
Hemolytic anemia
Renal disease
Blackwater fever
Dysenteric malaria
Algid malaria
Pulmonary Edema
Tropical splenomegaly syndrome

Hyperparasitemia
Hypoglycemia

Diagnostic test
Thick and Thin smear-(timing of blood
exam)
-Giemsa stain (BEST STAIN)
-Acridine orange staining
Serologic Tests
-Indirect Fluorescent Antibody
-ELISA

 Antigen or DNA Probe Detection Method

-Immunocapture Assay
detection of Plasmodium specific lactate

dehydrogenase

Dipstick Tests
-based on the detection of histidine-rich
P.falciparum antigen in whole blood
a)Parasite-F test (Becton Dickinson)
-may give false (+) result in rheumatoid
factor
b) ICT Malaria Pf test (ICT Diagnostics)

Methods of Counting Malaria Parasites in Thick Blood Films

A) Parasites per l
a practical method of adequate accuracy
it is based on the number of parasite per
l of blood in a thick film, these being
counted in relation to a predetermined
number of leukocytes
an average of 8000 leukocytes per l is
taken as the standard

Methods of Counting Malaria Parasites in Thick Blood Films

despite inaccuracies due to

variations in the number of
leukocytes between individuals
in normal health and greater
variations in ill health, this
standard allows for reasonable
comparisons

Methods of Counting Malaria Parasites in Thick Blood Films

before the counting begins, the

equivalent of 0.25 l of blood
( about 100 fields, using a 7 x
ocular and a 100 x oil-immersion
objective), should be examined
in the thick film to determine the
parasite species and stages that
may be present.

Methods of Counting Malaria Parasites in Thick Blood Films

A suitable counting method for positive

blood film is:
two tally counters are required to count
parasites and leukocytes separately
(a) if, after 200 leukocytes have been counted,
10 or more parasites have been identified ,
record the results in the record form, showing
parasites per 200 leukocytes

Methods of Counting Malaria Parasites in Thick Blood Films

(b) if, after 200 leukocytes

have been counted, 9 or less
parasites have been counted,
continue counting until 500
leukocytes have been counted
and record the parasites per
500 leukocytes

Methods of Counting Malaria Parasites in Thick Blood Films

in each case, the parasite count in relation to the

leukocyte count can be converted to parasite per l

by the simple mathematical formula:

number of parasites x 8000 = parasites per l

number of leukocytes
This means that if 200 leukocytes are counted, the
parasites are multiplied by 40, and if 500
leukocytes are counted the parasites are multiplied
by 16.

Methods of Counting Malaria Parasites in Thick Blood Films

It is normal practice to count all the species

present and to include both sexual and
asexual parasites together .
Occasionally a separate count is made of the
gametocytes of Plasmodium falciparum but
when this is done, they should still be included
in the general parasite count.
It is rarely possible to separate the
gametocytes of P. vivax or P. malariae from the
asexual parasites with sufficient accuracy to

Methods of Counting Malaria Parasites in Thick Blood Films

b) The Plus System

A more simplified method of
enumerating parasites in thick
blood films is to use the plus
system This indicates the relative
parasite count and entails using a
code of from one to four pluses, as
follows:

Methods of Counting Malaria Parasites in Thick Blood Films

+ =1-10 parasites/100 thick film

fields

++ =11-100 parasites/100 thick

films
+++ =1-10 parasites/one thick film
fields
++++ =more than 10 parasites/one
thick film field

Methods of Counting Malaria Parasites in Thick Blood Films

This system should be used only

when it is not possible to undertake
the more acceptable parasite per l
of blood.

KEY IN THE INDENTIFICATION OF PLASMODIUM SPECIES

IN THE THIN BLOOD FILMS

Any Plasmodium with more than one

nucleus is a schizont of P. vivax, P. ovale,
and P. malariae. P. falciparum schizonts are

found in the visceral blood.

Any Plasmodium with one nucleus,
numerous hematin granules and almost fills
up the infected rbc is a gametocyte of P.
vivax, P. ovale and P. malariae.
Gametocytes of P. falciparum are banana-

KEY IN THE IDENTIFICATION OF PLASMODIUM SPECIES IN

THE THIN BLOOD FILMS

Any Plasmodium with one nucleus, with

amoeboid cytoplasm and few pigments is a
growing trophozoite.
The ring forms are morphologically
characteristic for Plasmodia but species
identification cannot be made on this basis.
One has to see the different stages of the
parasite.

KEY IN THE INDENTIFICATION OF PLASMODIUM SPECIES

IN THE THIN BLOOD FILMS

Enlarged infected rbc is seen in P. vivax

infection.
Schuffners dots are seen in Plasmodium
vivax.
Plasmodium vivax has more than 12
chromatin masses in the mature

KEY IN THE INDENTIFICATION OF PLASMODIUM SPECIES

IN THE THIN BLOOD FILMS

Plasmodia found inside normal sized

infected rbc with stages older than the ring
form is Plasmodium malariae.
Plasmodium with a band form cytoplasm
is. Plasmodium malariae.
If all the malarial stages found in the
peripheral blood smear are of the ring form,
these could be Plasmodium falciparum.

Treatment

Quinine and Quinidine

Chloroquine
Primaquine
Amodiaquine
Pyrimethamine
Mefloquine
Halofantrine
Proguanil
Artemisinin

Prevention &control
Pest control measures
Mosquito net soaked in insecticide
Environmental sanitation- preventing
mosquito from breeding
Environmental control- preventing
continued destruction of forest area.

Babesia spp.- pg.150

Infection of rbc often producing febrile illness
Transmitted by ticks (Ixodes scapularis, Ixodes
pacificus) a parasite of domestic and wild
animals
Caused by Babesia microti
mulitiply in rbc by schizogony but do not
produce gametocytes
Appear as delicate ring forms that may easily
be confused with malaria

 Human babesiosis was first recognized and

reported from Europe in 1957
North America, Taiwan, Japan
Hamsters are susceptible to infection by
intraperitoneal inoculation of blood specimens.
organism can be detected 2-4 wks after
inoculation
Absence of hemozoin pigment in infected
erythrocytes

Babesia microti
The organisms
resemble P.falciparum
they vary more in
shape and in size; and
they do not produce
pigment (hemozoin)
evidence of Maltese
cross formation(appear
in pairs or tetrads)

MORPHOLOGY
Babesia microti - Trophozoite ring forms in RBC's

Babesia microti
TICK vector of Babesia
The organism belongs
to the genus Ixodes

The vector:
Dog tick

Life cycle

MALARIA

BABESIOSIS

Multiple rings

Large trophozoite

Gametocytes

Hemozoin
pigment

Pathology
Disease

Babesiosis

bite of
infected
Ixodes tick
(dog tick)

Clinical features- S&S

Dx test

T/P/C

rapidly

blood smear
Giemsa stained
serologic test
kit-immunoblot
PCR
Indirect
immunoflouresc
ence

Clindamycin +
quinine

progressive
infection
fever
Chills
headache
fatigue
anemia
Jaundice
Renal failure

maintain personal
hygiene
Pet hygiene
Environmental
sanitation-

Toxoplasma gondii pg. 140

Is a parasite of cosmopolitan distribution
First discovered in 1908 in a North African
rodent called GUNDI.
Definitive host: house cat and other felines
Intermediate host: Man, birds, wild animals,
domestic animals
Human infection are common in many parts of
the world, but most are benign or are completely
asymptomatic- Host defense mechanism

 Parasitize the small intestine of cats, the

organism develop to produce schizonts and
gametocytes
And finally oocyst, w/c are passed in feces
Two terms are used to name the
trophozoites/ merozoites-dessiminate into
the bloodstream w/c invade the cells
Tachyzoites- quickly multiplying forms responsible
for the spread of infection and tissue destruction
Bradyzoites- slow developing forms that form
cysts in the tissue in response to host immunity.
Characteristic of older infection.

Oocysts

Similar in appearance to I.belli

11-14um x 9-11um
Smaller , contain 2 sporocyts, each of w/c
encloses 4 sporozoites

Tachyzoites-merozoites
They are crescentic in
shape and, is seen
apparently free in the
peritoneal exudate of
experimentally infected
mice
4-6um x 2-3um
Single purplish nucleus at
the center surrounded by a
bluish cytoplasm
found in diff. tissues= lung,

Bradyzoites

Tissue cysts also known as zoitocyst

Cyst like accumulation of merozoites

Life cycle

Pathology
Disease
Toxoplasmosis

Clinical features- S&S

benign or
asymptomatic in Adult
Ingestion of infected Lymphadenopathy
meat or oocysts in cat fever
feces(congenital
pneumonia
infection)
eye and brain
Transplacental
damage
transmission/ organ
In newborns:
retinochoroiditis
transplant
transmission
blindness

hepatosplenomegalyjaundice
fever, convulsions
Pneumonitis
encephalomyelitismental retardation

Dx test

T/P/C

Serologic test- EIA

and indirect
fluorescent antibody
(IFA) test
IgG&IgM test kitELISA
PCR
Radiologycalcification of
zoitocyst
Examination of body
fluids and tissuetachyzoites

Pyrimethamine +
trisulfapyrimidines
cooked meat
properly
handle meat properly
to prevent
contamination
Environmental
sanitation- cat litter

Blood &tissue flagellates

Phylum Sarcomastigophora
Family Trypanosomatidae
Genus Leishmania
Genus Trypanosoma

They move by means of specialize structure

known as flagella.
It is a long threadlike extension of cytoplasm
that functions as a means of propelling the
organism
They arise from a small intracytoplasmic

Developmental stages

Leishmania spp.- pg. 127

Tissue flagellates
Parasite

DISEASE

MOT/VECTOR

L. tropica,
Cutaneous
L.braziliensis
Leishmaniasis
complexes, L.
mexicana
L. braziliensis complex Mucocutaneous
Leishmaniasis

Bite of infected sandfly

(Phlebotomus,
Lutzomyia)

L. donovani complex

Bite of infected sandfly

(Phlebotomus,
Lutzomyia)

Visceral
Leishmaniasis

Bite of infected sandfly

(Lutzomyia,
Pscyhodopygus)

Arthropod vector-sandfly
Phlebotomus

Lutzomyia

Life cycle

Developmental stage
Promastigote

Amastigote in the macrophages

Developmental stage-blood

Pathology
Parasite
L. tropica, L. mexicana, L.
braziliensis complex

Location of parasite in
humans

Clinical features

Skin- (intracellular)

Skin ulcers (single or multiple;

self-healing to incurable)

Skin and adjacent mucous

membranes (intracellular)

Ulcers of the skin and oral

and nasal mucosa

Liver, spleen, lymph nodes,

bone marrow (intracellular)

Hepatosplenomegaly,
anemia, fever, weight loss
Most severe and fatal

Cutaneous
L.braziliensis
Mucocutaneous

L.donovani (kala-azar)
Visceral- black fever,
dumdum fever

Leishmania lesions

Diagnosis
Parasite
L. tropica, L. mexicana, L.
braziliensis

DX test
Parasites in smears and culture
of ulcer aspirate, skin test,
serologic test

Na stibogluconatePENTOSTAM
meglumine antimoniateGLUCANTIME
Amphotericin B-IV
Oral ketoconazole

Parasite in smears and culture of

ulcer materials, skin test,
serologic test

Na stibogluconate-PENTOSTAM
Cycloguanil pamoate

Parasites in smears and culture

of bone marrow, hamster
inoculation, serologic test

Na stibogluconate-PENTOSTAM
Allopurinol- AIDS
Miltefosine (Impavido)
Amphotericin B

Cutaneous

L. braziliensis
Mucocutaneous

L. donovani
Kala-azar

Tx

Preventive measures

Pest control
Insect repellant
Kulambo
Avoid visiting endemic areas