Para2021-3 2

PROTOZOAN PARASITES
PATHOGENIC FLAGELLATES
INTRODUCTION
• Flagellates are unicellular microorganisms. Their locomotion is by
lashing a tail-like appendage called a flagellum or flagella and
reproduction is by simple binary fission.
• There are three groups of flagellates:

 Luminal flagellates
Giardia lamblia
 Genital flagellates
Trichomonas vaginalis
 Hemoflagellates
Trypanosoma species.
Leishmania species.
Flagellates
• Giardia lamblia
– intestinal malabsorption
– Traveler's diarrhea, day care
centers, hikers
• Trichomonas vaginalis
– no cyst stage
– Trichomoniasis - STI
Figure 12.17b-d
Hemoflagellates
– Trypanosoma
• African sleeping
sickness or Chagas
disease
• Transmitted by tsetse
flies or reduviid bugs
– Leishmania
• leishmaniasis –
“Baghdad Boil”-
• Transmitted by sand fly
vector
Giardia lamblia
Giardia lamblia
• Giardia lamblia is
a flagellated
protozoan parasite that
colonises and reproduces in
the small intestine,
causing giardiasis
• The giardia parasite attaches
to the epithelium by
a ventral adhesive disc, and
reproduces via binary
fission.
Giardia lamblia
• Giardiasis does not spread
via the bloodstream, nor
does it spread to other
parts of the gastro
intestinal tract, but
remains confined to
the lumen of the small
intestine.
• Giardia
trophozoites absorb their
nutrients from the lumen
of the small intestine.
Morphology
• Occurs as both a flagellated trophozoite and a
non-flagellated cyst form.
• Trophozoite (9-21 µm long), motile, with 8 long
flagella, ventral sucker which attaches to
duodenal mucosa; lives only in small intestine;
non invasive.
• Cyst (8-12 µm); resistant to external
environment, to chlorination; intermittently
expelled in stool.
Giardiasis
• Clinical Manifestation:
• Colonization of the gut results in inflammation
and villous atrophy, reducing the gut's absorptive
capability.
• In humans: symptoms appear after 1 to 2 weeks.
• 50% of infected are asymptomatic carriers
• The symptomatic disease, ranging from mild
diarrhea to a severe malabsorptionsyndrome
• Symptoms of infection include :
 Excessive gas (often flatulence or a foul or sulphuric-tasting belch,
which has been known to be so nauseating in taste that it can
cause the infected person to vomit).
 Diarrhea (pale, foul smelling, greasy ), epigastric pain, bloating,

nausea, diminished interest in food, possible (but rare) vomiting
which is often violent, and weight loss.
 Pus, mucus and blood are not commonly present in the stool.
• Infection is not fatal. In healthy individuals, the condition is
usually self-limiting, although the infection can be prolonged in
patients who are immunocompromised .
• Some studies have shown that giardiasis should be considered as
a cause of Vitamin B12 deficiency, this a result of the problems
caused within the intestinal absorption system.
Diagnosis
 Stool examination
 Duodenal fluid (aspirate )
 Giardia antigen detection in stool
Diagnosis
• Giardia lamblia infection in humans is frequently
misdiagnosed.
• Accurate diagnosis requires Detection of Giardia fecal
antigen by enzyme immunoassay, immunofluorescent
microscopy.
• Multiple stool examinations are recommended, since
the cysts and trophozoites are not shed consistently.
• Given the difficult nature of testing to find the
infection, including many false negatives, some
patients should be treated on the basis of empirical
evidence; treating based on symptoms.
Epidemiology
• common disease throughout the world
• faecal oral spread
• prevalence in institutions, day cares and any
groups with increased fecal-oral spread.
• - zoonosis - found in most mammals; esp. beaver,
cattle, cats, dogs, etc.
Treatment
• Drug of choice for treatment of giardiasis
(both symptomatic patients and carriers):
metronidazole or nitazoxanide, alternatives:
furazolidone, tinidazole, paromomycin,
albendazole, quinacrine
Treatment
• Human infection is conventionally treated
with Metronidazole.
• Although Metronidazole is the current first-
line therapy, it is mutagenic in bacteria
and carcinogenic in mice, so should be
avoided during pregnancy.
Prevention
• Asymptomatic reservoirs of infection should
be identified & treated.
• Avoidance of contaminated food and water.
• Drinking water from lakes and streams should
be boiled, filtered and/or iodine treated.
• Proper waste disposal and use of latrine.
Genital flagellates
Trichomonas vaginalis
INTRODUCTION
• Trichomonas vaginalis, an anaerobic, parasitic
flagellated protozoan, is the causative agent
of trichomoniasis and is the most
common pathogenic protozoan infection of humans
in industrialized countries.
• Infection rates between men and women are the
same with women showing symptoms while
infections in men are usually asymptomatic.
• Transmission takes place directly because
the trophozoite does not have a cyst..
Morphology
A unicellular (av. 13 µm)
flagellate which moves with 3-4
terminal flagella and a flagella
in an undulating membrane
- no cystic form.
- multiples by binary fission
- lives in close association
with vaginal, urethral and
prostatic tissue
• Transmission is by sexual
intercourse
Life Cycle
• Trophozoites occur in the urogenital system.
• Trophozoites multiply by binary fission.
• The parasite does not have a cyst form, and
does not survive well in the external
environment.
• Trophozoites are transmitted from one person
to another primarily by sexual intercourse
Clinical maanifestation
 asymptomatic - vast majority
 symptomatic – vaginitis : inflammation of the vagina
with increasing number of organisms, greenish-yellow
frothy vaginal secretions and itching .
• In male infection is usually asymptomatic, but severe
infection result in inflammation of the prostates, with
thin discharge containing the parasite.
• Some of the symptoms include low birth weight, and
increased mortality as well as predisposing
to HIV infection, AIDS, and cervical cancer.
Epidemiology
The WHO has estimated that 180 million cases
of infection are acquired annually worldwide
- increased in STD clinics (50%).
- only in humans; no animal reservoir
- sexual transmission,
- can persist for 2 years in host
Diagnosis
• "wet mount" of vaginal secretions, urine
sediment or prostatic massage; characteristic
fast (darting) movement.
Treatment
Metronidazole.
Prevention
• Personal hygiene
• Condom use.
• Vinegar wash (decreases chance of infection).

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PROTOZOAN PARASITES

• There are three groups of flagellates:

 Diarrhea (pale, foul smelling, greasy ), epigastric pain, bloating,

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