Intestinal and Urogenital

Flagellates, Balantidium coli &

Blastocystis Species

1
Dr. Rafiei
​PhD of medical parasitology
 Parasitic protozoa are classified under 4 phylums:
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1) Sarcomastigophora: (two sub phylums) Sarcodina+ Mastigophora
2) Ciliophora
3) Apicomplexa
4) Microspora
 FLAGELLATES
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 flagella as the organ of locomotion.
 Flagella are slender, long and thread-like extension of cytoplasm.
 the flagella are external
 except in Dientamoeba fragilis which bears internal flagellum.
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 Giardia lamblia
(syn. G. duodenalis, G. intestinalis)

6 This species is named after two scientists: Giardi (1846–1908) and Lambl
(1841–1895).
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 usually measures 10–20 μm in length and 5–15 μm in width.

 Shape: In front view, it is pear shaped (or tear drop or tennis racket shaped) with rounded anterior end
and pointed posterior end
 Laterally, it appears as a curved portion of a spoon (sickle shaped)
 the ventral surface has a concavity bearing a bilobed adhesive disc.
9 Trophozoite of Giardia lamblia
 The trophozoite has a falling leaf-like motility,
 Trophozoite is bilaterally symmetrical; on each side
from the midline it bears
1. One pair of nuclei
2. Pair of median bodies
3. Four pairs of flagella—two lateral, one ventral
and one caudal pair of flagella
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Giardia cyst is oval shaped, measures 11–14 μm in length and 7–10 μm in width.
It contains four nuclei and remnants of axonemes, basal bodies and parabasal bodies
11 Cyst

 It is the infective form as well as the diagnostic form of the parasite.

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13 Life Cycle

 Host: Giaridia completes its life cycle in one host.

 Infective form: Mature cyst.
 Mode of transmission: Man acquires infection by ingestion of food and water
contaminated with mature cysts or rarely by sexual route (mainly in homosexuals).
14 Pathogenicity

 Infective dose: As few as 10–25 cysts can initiate the infection

 Risk factors:
 Children are commonly affected.
 Other high-risk groups are elderly debilitated persons and patients with cystic fibrosis,
poor hygiene, and immunodeficiency syndromes such as common variable
hypoglobulinemia.
15 Pathogenicity
 Trophozoites adhere to the duodena mucosa and cause disruption of the intestinal epithelial
brush border that leads to increase permeability and malabsorption
 Very rarely, elaboration of enterotoxin such as cystein rich surface protein 136 (CRP-136)

 Malabsorption: There could be various types which include:

 Malabsorption of fat (steatorrhea)— leads to foul smelling profuse frothy diarrhea
 Disaccharidase deficiencies (lactate, xylose)—leading to lactose intolerance
 Malabsorption of vitamin B12 and folic acid
 Protein loosing enteropathy
16 Pathogenicity

 Antigenic variation:
 Giardia undergoes frequent antigenic variation due to a cysteine rich protein on its
surface called variant surface protein (VSP)

 This helps the parasite in evasion of the host immune system

 and resistant to intestinal proteases
 which in turn leads to persistence of infection resulting into chronic and recurrent
illness.
17 Clinical features

 1. Asymptomatic carriers:
 Most infected persons are asymptomatic, harboring the cysts and spreading the infection
 2. Acute giardiasis:
 Incubation period varies from 1 week to 3 weeks (average 12–20 days). Symptoms may develop
suddenly or gradually
 Common symptoms include diarrhea, abdominal pain, bloating, belching, flatus and vomiting
 Diarrhea is often foul smelling with fat and mucus but no blood
 The acute stage lasts for 1 week but usually resolves spontaneously. Very rarely, in some children
may last for months
18 Clinical features
 Chronic giardiasis:
 It may present with or without a previous acute symptomatic episode
 Symptoms are intermittent and recurring
 Common symptoms include recurrent episodes of foul smelling diarrhea, foul flatus,
sulfurous belching with rotten egg taste, and profound weight loss leading to growth
retardation
 Uncommon symptoms such as—fever, presence of blood and/or mucus in the stools, and
other signs and symptoms of colitis
 Extraintestinal manifestations have been described, such as urticaria, anterior uveitis, salt
and pepper retinal changes and arthritis.
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22 Prevention

1. Improved food and personal hygiene

2. Boiling or filtering of potentially contaminated water
3. Treatment of asymptomatic carriers

No vaccine is currently available.

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Chilomastix mesnili
Chilomastix mesnili is a harmless commensal of cecum and colon in man.
 Chilomastix mesnili
24 Organism:
This organism belongs to the flagellates, is a nonpathogen, and causes no disease. Both the
trophozoite (usual size, 6-24 µm long and 4-8 µm wide) and cyst forms (usual size, 6-10 µm
long and 4-6 µm wide) can be found in clinical specimens.

Flagelates

nucleous
cytostome
Spiral groove
Nipplelike protuberance
Cell wall
Cytostome

nucleous
Trophozoit Cyst
 Life Cycle:
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large Intestine, organisms passed in feces
Acquired:
Fecal-oral transmission via cyst form; contaminated food and
water
Epidemiology:
Worldwide, primarily human-to-human transmission
Clinical Features:
None.
Clinical Specimen:
Intestinal: Stool
Laboratory Diagnosis:
Intestinal: Ova and Parasite examination (concentration,
permanent stained smear)
 Organism Description:
26 Trophozoite: Pear shaped, 1 nucleus and distinct oral groove (cytostome);
flagella are rarely seen without special stains.
Cyst: Pear or lemon shaped, will contain 1 nucleus; the cytostomal fibril is
curved and is called the “shepherd’s Crook”.
Laboratory Report:
Chilomastix mesnili (indicate trophozoites and/or cysts)
Treatment:
None
Control:
Improved hygiene, adequate disposal of fecal waste, adequate washing of
contaminated fruits and vegetables
Comments:
Small organisms can mimic other small protozoa.
It must, however, be differentiated from Giardia and from other flagellates
occasionally seen in stool specimens.
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Dientamoeba fragilis
Greek – di: double, entos: inner, amoibos: changing the shape; fragilis: fragile.
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 Dientamoeba fragilis is a common commensal
 lives in the lumen of the cecum and upper colon of humans.

 It was initially thought to be an amoeba as it bears no external flagella but

recently, by electron microscopic studies; it is reclassified as an amoeboflagellate
as the flagellum is internal.
 It closely resembles Histomonas, a parasite infecting turkeys.
 It is cosmopolitan in distribution with incidence rate varies from 1.4% to 19%.
 Higher incidence is reported in children.
30 Trophozoite is the only stage.
Cyst stage is not been confirmed till date.
 Nucleus:
 commonly two nuclei in so named as Dientamoeba
 The nuclear chromatin is usually fragmented into three to five granules (hence named as
fragilis), no peripheral chromatin on the nuclear membrane
 The cytoplasm is usually vacuolated and may contain ingested debris as well as some large
uniform granules
 The life cycle is not fully understood.
 Trophozoites are the infective forms; transmitted by feco-oral route. They
multiply in the large intestine and excreted in feces.
31 It is irregular in shape (amoeboid), relatively
small,
varying from 9 μm to 12 μm
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33 Pathogenesis

 This is controversial; the pathogenic status in not well defined.

 Some authors believe that there may be two distinct genotypes one
of which may be pathogenic
 The organism has been reported in association with mucous
diarrhea, abdominal pain and tenderness, nausea, vomiting, and
low-grade fever.
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 Trichomonas vaginalis
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(Trichomoniasis)
trichos: tini hair, monas: simple creature;
Vagina: vagina.
 Trichomonas vaginalis
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 Trichomonas vaginalis lives in the vagina in women,

and urethral duct and prostate gland in men.

 sexually transmitted.

 The incidence of Trichomonas vaginalis is seen in

women between the ages of 20 to 35 years old.
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Trichomonas

flagelates
Undulating membrane
nucleous
costa cytostome
Food vacoule
axostyle

Size:15-25 µm
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1. T.tenax (mouth)
2. T.hominis (caecum) Trichomonas vaginalis
3. T.vaginalis (vagina, urethra)

Trichomonas hominis Trichomonas tenax

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41 Pathogenesis

 The protozoa cause of vaginitis in women and urethritis

and prostatitis in men.
 Clinical signs usually appear in adult women before
menopause.
 Mostly men are asymptomatic.
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 Contact depended cytopathic effect

 Cell detachment factor in chronic phase is more important
43 Clinical signs
 Clinical signs are divided to two steps acute and chronic.
 In acute phase vaginal discharge is frequently profuse, EP cells, WBC
and number of parasites increased. If the patient are not treat, the
disease become chronic.
 In chronic phase, in this condition vaginal discharge, WBC and parasites
loads are decreased, but the number of EP cells are increased.
44 Diagnosis
 Diagnosis is by demonstration of parasite in wet film preparations.

 In the male, the diagnosis made by examination of urethral discharge, prostatic

secretions, or centrifuged urine.

 Direct + Culture (standard procedure)

 Culture methods may be employed and sometimes increase the percentage of
positive identifications.
45 Treatment

 Metronidazole (Flagyl)

 As the infection can be transmitted by sexual intercourse, treatment

of sexual partner should be considered.

 Due to the similarity of vaginal bacterial (chlamydia and

gonorrhea ) and fungal infections (candidiasis) with this infection
differential diagnosis should be considered.
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 Balantidium coli
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(Balantidiasis)
Balantion: little sack,
colon: terminal portion of the intestine.
48 Ciliata-Balantidium Coli

 Common parasite of pigs , Two stages trophozoite and cyst

 Only ciliate known to infect humans, Body surface is covered with

rows of cilia and responsible for active motility

 Largest Protozoan

 Habitant in large intestines of humans, Pigs and Monkeys

 Trophozoit
 Anterior end shows V shaped mouth ,Cytostom is funnel shaped
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 Posterior end– less prominent pore as named cytopyge (food molecules
evacuated)
 Cytoplasm consists of macronucleus and a micronucleus
 Micronucleus is present in the concavity of macronucleus
 The role of macronucleus is in the parasite metabolism and micronucleus is in
the reproduction of parasite.
 Cytoplasm consists of contractile vacuoles and numerous food vacuoles
 Trophozoite capable of ingesting
bacteria, RBC and fat droplets
50 Cyst
 Round and smaller than the trophozoite
 Size: 40 to 60 µm
 A thick and transparent wall surround the cyst. Cytoplasm
granular and contains macro and micronucleus
 Cilia are absent in mature cysts
 Cyst are resistant forms
 and responsible for transmission of disease
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Transversal binary fission

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53 Pathogenesis
 Hyaluronidase produces by parasite
 Balantidium ulcer similar to amoebic ulcers found in
caecum, sigmoid colon and rectum.
 Parasite do not invade to the muscular layer of intestine
(unlike amoebic ulcers)
 Perforation is the main complication
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Culture is used in Robinson’s medium and other media as used

for culture of E. histolytica
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Treatment
 Tetracycline is drug of choice
 Metronidazole and Iodoquinol are also effective

Prevention and control:

 Sanitary disposal of human and pig feces
 Treatment of infected pigs
 Prevention of fecal contamination of food and water by not using
night soil as fertilizers
 Improved personal hygiene
 Blastocystis Species
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(Blastocystosis)
Blastos: germ, vesicle;
homo: human.
57 Blastocystis
 Disease name: Blastocystosis
 Host: Human, rat, pork and birds
 Multiplication of Blastocystis is by binary fission and budding.
 Transmitted by fecal-oral route
 This protozoa has pleomorphism shapes: Vacuolar, ameba-like,
granular and cyst
 Vacuolated form and cyst are most predominant form in fecal specimen
 Size: 5-40 um
 Life cycle of Blastocystis
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the fecal -oral route.

In the large intestine, the cyst hatches

parasite multiply by binary fission and colonize in

the cecum.
The parasites pass down the colon develop into
cysts.
59 Pathogenesis and Clinical Manifestation

 large numbers of Blastocystis are produce a wide variety

of intestinal disorders:
 abdominal cramps, bloating, flatulence, mild to moderate
diarrhea without fecal leucocytes or blood, nausea,
vomiting, low grade fever, and malaise.
60 Diagnosis
 Microscopic examination using direct fecal smear is useful
but sensitivity is increased when concentration techniques
are used.

 Hematoxylin or trichome staining offers a very convenient

and easy method to differentiate the various stages of
parasites.

 Choice drug is metronidazole.

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.Blastocystis sp
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!Thanks for your attention

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