Chapter 4
Chapter 4
Chapter 4
CHAPTER 4
The Flagellates
Overview:
Morphology: with flagella
Morphologic forms: Trophozoite, only
some are with cyst
Laboratory diagnosis: trophozoite and
or cyst in stool samples
Replication: excystation and
encystation
Classification
Intestinal Species
o Giardia intestinalis
o Chilomasti mesnili
o Dientamoeba fragilis
o Trichomonas hominis
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Laboratory Diagnosis
specimen of choice for the traditional
recovery technique of trophozoites and
cysts is stool
DFS
Concentration techniques
Examination of duodenal contents for
trophozoites
Entero-string test
Duodenal biopsy
ELISA using Gisrdial antigen in the stool
maybe uses
Morphology: Cysts
o Cystic forms are colorless, ovoid Epidemiology
and contains 2-4 nuclei Found worldwide (lakes, streams, and
o Cytoplasm is retracted from cell other water sources)
wall considered to be one of the most
common intestinal parasites, especially
among children
Ingestion of water contaminated with
G. intestinalis is considered to be the
major cause of parasitic diarrheal
outbreaks in the United States
Cyst are resistant to chlorination
May be transmitted through fecal oral
route
Unprotected sex
animal reservoir hosts: beavers,
muskrats, and water voles
Clinical Symptoms
Asymptomatic Carrier State
Giardiasis (Traveler’s Diarrhea)
o Patients suffering from a severe
case of produce light-colored
stools with a high fat content
that may be caused by
secretions produced by the
irritated mucosal lining
o exhibits steatorrhea
Treatment
Metronidazole and Furazolidone (<5
years old)
Chilomastix mesnili
Common associated disease and
condition names:
o None (considered a
nonpathogen)
Morphology: Trophozoites
o measures 5 to 25um long
o Has a characteristic pear
shaped
o stiff rotary motility
o broad anterior end tapers Morphology: Cysts
toward the posterior end of the o have a characteristic lemon
organism shape with clear anterior
o structure bordering the hyaline knob
cytostome resembles a
shepherd’s crook and is the
most prominent of several
supporting cytostomal fibrils
o spiral groove
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Epidemiology
transmission occurs when infective
cysts are ingested
o hand-to-mouth contamination
o contaminated food or drink
Dientamoeba fragilis
Common associated disease and
condition names:
o Dientamoeba fragilis infection
(symptomatic)
was initially classified as an ameba
because this organism moves by means
of pseudopodia and does not have
external flagella
differs from the amebic trophozoites
when mounted in water preparations
Hakansson phenomenon: numerous
granules are present in this stage and Morphology: Cysts
exhibit Brownian motion o Does not possess a cystic stage
o feature diagnostic for the
identification Laboratory diagnosis
Morphology: Trophozoites Examination of stool samples for the
o measures 5 to 18um presence of trophozoites is the method
o Has a progressive motility of choice
supported by a broad hyaline has the ability to blend in well with the
pseudopodia background material in the sample
seen in freshly passed DFS and Iodine wet preparation
stool
o irregular and roundish in shape Life Cycle Notes
o has two nuclei, each consisting D. fragilis resides in the mucosal crypts
of four to eight centrally of the large intestine
located massed chromatin rarely been known to ingest red blood
granules that are usually cells
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Clinical Symptoms
Asymptomatic Carrier State
Symptomatic
o diarrhea
o abdominal pain
Treatment
iodoquinol: treatment of choice
Tetracycline
Paromomycin (Humatin)
Trichomonas hominis
Common associated disease and
condition names:
o None (considered as a
nonpathogen)
Morphology: Trophozoites
o measures 7 to 20 um
o pear shaped
o Exhibit characteristic nervous
jerky motility
accomplished with the
assistance of a full
body-length undulating Morphology: Cysts
membrane o Does not possess a cystic stage
o costa: rodlike structure located
at the base of the undulating Laboratory Diagnosis
membrane Stool examination
connects the
undulating membrane Epidemiology
to the trophozoite body frequency of infections is higher in
o Flagella: 3 to five anterior and 1 warm climates
posterior children appear to contract this parasite
more often than adults
Transmission most likely occurs by
ingesting trophozoites
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Laboratory DIagnosis
Examination of stool samples
Epidemiology
Ingestion of infected cysts appears to
be the primary cause of E. hominis
transmission
Retortamonas intestinalis
Common associated disease and
condition names:
o None (considered as a
nonpathogen)
Morphology: Trophozoites
o measures 3 to 7 μm
o ovoid trophozoite exhibits
characteristic jerky motility
Laboratory Diagnosis
stained stool preparation is the best
sample to examine for the presence of
R. intestinalis trophozoites and cysts
Epidemiology
existence has been documented in
warm and temperate climates
throughout the world
Transmission is accomplished by
Morphology: Cysts ingestion of the infected cysts
o lemon- to pear-shaped patients in psychiatric hospitals and
o measure from 3 to 9 μm in others living in crowded conditions,
length have been known to contract infections
o single nucleus, consisting of a
central karyosome, may be Prevention and Control
surrounded by a delicate ring of improved personal and public hygiene
chromatin granules conditions
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Trichomonas vaginalis
Common associated disease and
condition names:
o Persistent urethritis
o persistent vaginitis
o infant Trichomonas vaginalis
infection
Morphology: Trophozoites
o measures up to 30 um
o Has a characteristic ovoid,
round or pearl like shape
o Has a characteristic rapid jerky
motility
o Contains 4 to 6 flagella
o Possess an undulating
membrane, axostyle
o Has single nucleus
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Epidemiology
primary mode of transmission of the T.
vaginalis trophozoites is sexual
intercourse
trophozoites may also migrate through
a mother’s birth canal and infect the
unborn child
known to be transferred via
contaminated toilet articles or
underclothing (rare)
sharing of douche supplies, as well as
communal bathing
Clinical Symptoms
Asymptomatic Carrier State: occur in
men
Persistent Urethritis
o condition that symptomatic
men experience as a result of a
T. vaginalis infection
o patients often release a thin,
white urethral discharge that
contains the T. vaginalis
trophozoites
Persistent Vaginitis
o in women
o characterized by a foulsmelling,
greenish-yellow liquid vaginal
discharge after an incubation
period of 4 to 28 days
Laboratory Diagnosis
Infant Infections
Specimens of choice:
o infants suffering from both
o female patients: urine, urethral
respiratory infection and
secretion, vaginal and cervical
conjunctivitis
secretions
o male patients: semen and
Treatment
prostatic secretions
Metronidazole
unstained wet preparations:
trophozoites
Prevention and Control
can be stained
Personal hygiene
specimen may also be cultured
Avoid unprotected and promiscuous
o Whittington culture media
sexual intercourse
o Diamond’s modified media
o Feinberg medium