MTY1206 CLINICAL PARASITOLOGY (LABORATORY)

W11
Harada Mori
Ms. First Name Last Name, RMT | FEU BS Medical Technology 2023 L9
o Ovoid
FLAGELLATES o 2 - 4 nuclei, 4 median bodies
 Flagella (in the trophozoite stage) Long thread-like  Immature – 2 nuclei
extensions of the cytoplasm  Mature – 4 nuclei
 Cytostome Rudimentary mouth (Some species o Retracted cytoplasm (diagnostic
have simple mouth called cytostome) Features
 Mode of Reproduction: longitudinal binary fission  Habitat: Small intestine, Gall bladder and biliary
 Giardia lamblia have cyst and trophozoite forms. drainage
 Mode of Transmission:
MASTIGOPHORA o Ingestion of cysts
 Mastigophora (Flagellate) The following are the o Fecal-oral (outbreaks in daycare centers
clin. Important species and institutions)
 General Characteristics: o Oral-anal (homosexual)
o Classified into two major groups: Intestinal  Reservoir: beavers muskrats water voles
and Atrial  G. Intestinalis and T. vaginalis are known to be
o Movement is accomplished by the carriers of dsRNA viruses
presence of flagella (in the trophozoite
stage) Long thread-like extensions of the
cytoplasm
o Includes special organs such as sucking
disc, axostyle and undulating membrane.
o Absence of cystic stage in some members
of the group
o Giardia lamblia have cyst and trophozoite
forms.

The spectrum varies from asymptomatic carriage to

severe diarrhea and malabsorption. Acute giardiasis
develops after an incubation period of 1 to 14 days
Giardia Intestinalis (average of 7 days) and usually lasts 1 to 3 weeks.
 Old name: Cercomonas intestinalis Symptoms include diarrhea, abdominal pain, bloating,
 Other name: Giardia lambia (in honor of Dr. F. nausea, and vomiting. In chronic giardiasis the
Lambl and Dr. Giard.); Giardia diodenale (synonym) symptoms are recurrent and malabsorption and
(Atrial or lumen flagellates) debilitation may occur.
 Guardiasis / Traveller’s diarrhea
 Inf. stage: cyst
 M.O.T: ingestion, anal-oral sex
 Habitat: Intestine
 Pathogenic stage: trophozoite
Morphology
 Trophozoite
o Bilateral symmetry, 2 nuclei, tear drop /
pear shape
o Old man with eyeglasses / old man with
whiskers
o Monkey’s face
o Ventral sucking disc –for the point of entry
of food (Attached in the intestinal villi
o Axoneme- interior portions of the flagella
o Parabasal bodies or median bodies – for
energy, metabolism and support
o Sucking disc
o 4 pairs of flagella
o Falling leaf / kite-like / gliding motility
 Cyst

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 Cysts are resistant forms and are responsible for • Prevent insects serving as phoretic
transmission of giardiasis. vectors to come into contact with
 Both cysts and trophozoites can be found in the food (infected beavers, muskrats,
feces (diagnostic stages) . and other mammals is the source
 The cysts are hardy and can survive several of infection in hikers and campers
months in cold water.
 Infection occurs by the ingestion of cysts in Chilomastix mesnili
contaminated water, food, or by the fecal-oral route • Commensal parasite
(hands or fomites) . • Infectious Stage: cyst
 In the small intestine, excystation releases • M.O.T: Ingestion of cyst
trophozoites (each cyst produces two trophozoites). • Habitat: cecum
 Trophozoites multiply by longitudinal binary fission, • Pathogenic stage: None
remaining in the lumen of the proximal small bowel • Locomotory apparatus: Flagella
where they can be free or attached to the mucosa Morphology
by a ventral sucking disk . • Trophozoite
 Encystation occurs as the parasites transit toward  Pear-shape
the colon.  Presence of spiral grove
 The cyst is the stage found most commonly in  Cystostome -Hour glass shape / shepherd’s
nondiarrheal feces . crook
 Because the cysts are infectious when passed in  Cork screw / boring motion
the stool or shortly afterward, person-to-person  Stiff rotary movement
transmission is possible.  Cytostome with fibrils
Clinical Manifestations • Cyst
• Symptoms begin 1-3 weeks after exposure  Lemon shape
• Watery diarrhea  Nipple like projection
• Malabsorption syndrome Pathogenicity
o Abdominal cramps, foul-smelling  Chilomastix mesnili is considered nonpathogenic.
stools, flatulence and steatorrhea The presence of cysts and/or trophozoites in stool
• Leningraud’s curse specimens can however be an indicator of fecal
o Giardiasis with severe diarrhea contamination of a food or water source, and thus
 Infections are often asymptomatic (but become does not rule out other parasitic infections.
carriers)  The cyst stage is resistant to environmental
 Giardiasis (Traverl’s diarrhea) pressures and is responsible for transmission
 Watery diarrhea (mild) of Chilomastix.
 Malabsorption syndrome (severe)  Both cysts and trophozoites can be found in the
 steatorrhea (fat in stool); with flatulence feces (diagnostic stages) .
 Patients who are at risk (susceptible): IgA  Infection occurs by the ingestion of cysts in
deficiency contaminated water, food, or by the fecal-oral
 Leningraud’s curse route (hands or fomites).
 Giardiasis with severe diarrhea  In the large (and possibly small) intestine,
 Long ago, visitors to Soviet Union who became ill excystation releases trophozoites.
due to giardiasis with severe diarrhea were said to  Chilomastix resides in the cecum and/or colon;
be suffering from what was called as “Leningrad’s  Generally, this is considered as a commensal
curse.” (one species derives some benefit while the
Diagnosis other is unaffected.
• String test method (old)
o String test with gelatin capsule Diantamoeba fragilis
o (+) trophozoite  Binucleated trophozoite (Dientamoeba);
o patient is asked to swallow a piece of string mononucleated form, three or four nuclie may also
with a gelatin capsule used as weight. exist
o The string is withdrawn the next day and  No cyst stage
the bile-stained part, likely to contain
 Formerly classified underAmoeba (Amoebo-
trophozoites, is washed with saline.
flagellates)
• DFS, Fluoroscopy.
Morphology
o Specimen of choice: Stool
• Trophozoite
o (Other book) Duodenal aspirate is the
o 5-12mm (dia.), w/ ecto/endoplasm
preferred specimen to recover the
o Broad Hyaline pseudopodia, which may be
trophozoites.
lobose, angular, broad, or leaf-like with serrated
• RT- PCR (Real time PCR)
margin
o The newest form used
o 2 nuclei
Treatment, Prevention and Control
o Tetracoccic karyosome
• Treatment
o Progressive motility
• Metronidazole, tinidazole and nitazoxanide
 “fragilis” = fragility; Which is NOT true of this
• Prevention and Control
parasite, since it is not easily destroyed
• Drink only safe and clean H2O
 4-8 cocci – like beads chromatin granules
• Boiling, Filtration and iodination of water

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 Exhibits Hakansson phenomenon  These three species colonize and replicate in the
 Transmitted via eggs of helminth parasites (E. large intestine, where they are regarded as
vermiculars and A. lumbricoides) commensal organisms and are not known to cause
 Dientamoeba fragilis is primarily a parasite of disease.
humans. Trophozoites have been identified in some  Humans are the primary host for these NP
other mammals (e.g., non-human primates, swine), flagellates
but the epidemiologic significance of these hosts is  They are considered non-pathogenic.
unknown.  The presence of cysts and/or trophozoites in stool
 The reported clinical manifestations have specimens can however be an indicator of fecal
sometimes been described as similar to those of contamination of a food or water source, and thus
colitis, appendicitis, or irritable bowel syndrome. does not rule out other parasitic infections.
Features
 Trophozoites are found in the lumen of the large
intestine, where they multiply via binary fission, and Retormonas intestinalis
are shed in the stool.  Non-pathogenm asymptomatic
 Historically, only the trophozoite stage of D. Morphology
fragilis had been detected. However, rare putative
cyst and precyst forms have been described in  Trophozoite
human clinical specimens; whether and in what o Ovoid
settings transmission to humans occurs via o 1 nucleus w/ small central compact
ingestion of such forms in contrast or in addition to karyosome
other fecal-oral transmission routes is not yet o 2 flagella
known . Transmission via helminth eggs (e.g., o Cytostome with well-defined fibril border
via Enterobius vermicularis eggs) has been o Jerky motility
postulated  Cyst
o Pear shape / lemon-shaped
NON-PATHOGENIC FLAGELLATES o 1 w/ central karyosome
(ENTEROMONAS) o nucleus w/ 2 fused fibrils
1. Non-pathogenic flagellates  Retort – a sharp, angry reply
2. Commensal, asymptomatic  Ring of chromatin granule on nuclear membrane
3. Fecal contaminant of food, water and/ or fomites (both on cyst and troph)
 Single nucleus 2 fused fibrils (resembles bird’s
Enteromonas hominis beak) (fiber)
TRICHOMONADS
Morphology  Trichomonas exists in trophozoite form
• Trophozoite  4 flagella; the 5th flagella is an undulating
o Oval shape membrane (it goes up and down/ rising/ falling)
• sometimes half-circle (flattened in one
 Trichomonas species exhibit habitat specificity, i.e.
side)
they have maximum ability to survive and establish
o Jerky motility
a colony if they are in their particular habitat.
o 1 nucleus, centrally located karyosome
o Has four flagella Trichomonas hominis
o No peripheral chromatin
 T. hominis- lives in the large intestine; habitat
• Cyst
cecum
o Oval to elongate
 Mode of Reproduction: longitudinal binary fission.
o 1 - 4 nuclei (Binucleated and quadrinucleated
nuclei located at opposite ends)  Infectious stage: Trophozoite
o No peripheral chromatin  Specimen: (for diagnosis): Stool
o Yeast cells may often be suspected  Treatment: No specific drug
o The size of E. hominis cysts overlaps with the  Motility: Jerky , non-directional movement
size of E. nana cysts
Features
 Both cysts and trophozoites of Enteromonas Morphology
hominis and Retortamonas intestinalis are shed in • Pear shape
feces; • Nervous jerky motility
o only trophozoites of Pentatrichomonas • 1 nuclei, small central karyosome, no peripheral
hominis (no known cyst stage) are shed in chromatin
feces . • 3 – 5 flagella
 Infection occurs after the ingestion of cysts (E. • Possess a structure known as costa
hominis, R. intestinalis) or trophozoites (P. • Conical cytostome
hominis) in fecally contaminated food or water, or • Undulating membrane with spike-like axostyle
on fomites. • It does not invade the intestinal mucosa
 Excystation of E. hominis and R.
intestinalis releases trophozoites into the large
intestine;

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Trichomonas tenax  Itchiness with dysuria, red vaginal

 Habitat: Mouth (Tartar of the teeth, gums, tonsils) mucosa
o Associated with oral spirochete in  burning sensation, “strawberry cervix”
Vincent’s angina o Male
o Common in people with poor oral hygiene  Asymptomatic
 M.O.T:  urethra, prostate, epididymis
o Droplet spray form the mouth of infected  may involve urethra, seminal vesicle
individual and prostate (enlarged)
o Use of contaminated eating utensils and Features
drinking glasses, contaminated dishes  Trichomonas vaginalis resides in the female lower
 Diagnosis: I.D. from mouth scrapings (tartar of the genital tract and the male urethra and prostate ,
teeth (mouth, gingiva, tonsilar crypts) where it replicates by binary fission . The parasite
 Prevention: Proper and good oral hygiene does not appear to have a cyst form, and does not
survive well in the external
Morphology environment. Trichomonas vaginalis is transmitted
• Oval or pear shape among humans, its only known host, primarily by
• 5 flagella sexual intercourse
• 1 Central anterior nucleus Laboratory Diagnosis
• Vesicular region filled with chromatin granules • Specimen:
• Thick axostyle • Discharge
• nucleus is located at the central anterior part • Urine for both sexes
• Penile discharge (men)
Trichomonas vaginalis • vaginal discharege (women)
• Culture:
 pingpong infection • Diamond’s culture
o due to recurrences among females since • Serologic test:
males are often asymptomatic thus, may • IHA and GD
not be given attention during treatment. • indirect hemagglutination test (IHA)
 Infections in vagina (vaginitis), urethra (urethritis), • gel diffusion test (GD)
prostate (prostatovesiculitis; prostate and nerby
structures) and cervix (cervicitis) • Treatment:
 Male are asymptomatic • Metronidazole
 pH environment: Slightly Alkaline/ Acidic (Prefers • Prevention and Control:
slightly alkaline environment or somewhat more • Safe sex, Treatment of partner and Public
acidic than that of the healthy vagina.) education
• Practice safe, monogamous sex and good
 Trichomonas vaginalis, a flagellate, is the most
personal hygiene.
common pathogenic protozoan of humans in
• If only the patient is treated, there is great possibility
industrialized countries.
for re-infection (basis for the term “ping-pong
infection”).
Morphology
• Ovoid, round or pear shape
• Rapid jerky tumbling motility
• 3 to 5 flagella
• Prominent curve axostyle
• Hydrogenosomes
• Pearl-like shape
• Possess an undulating membrane, axostyle
• Has a single nucleus
• Siderophil granules for cellular energy (produces
ATP) and metabolism
Manner of Transmission

• Non-venereal or Nonsexual transfer:

o communal bathing, Sharing of toiletries, or
sharing of douche equipments,
o Toilet articles
o direct contact
o May survive in urine, wet sponge and damp
towels for several hours
o Direct contact (can migrate through mother’s
birth canal and infect the unborn child)
• Venereal transfer:
o Female
 Foul smell, greenish yellow vaginal
discharge
 Vulvar itchiness

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