Protozoa Practical Notes

Entamoeba histolytica
Topics Covered In This Sheet

Entamoeba coli

Giardia lamblia

Trichomonas vaginalis

Toxoplasma gondii

Trypanosoma spp.

Leishmania spp.

Plasmodium spp.

By: Hani Bassam -1-

 Entamoeba histolytica
(Obligate, intestinal, extracellular parasite)

Morphology
Trophozoite Cyst
> Uninucleated (Single nucleus)
> Round in shape + Hyaline cyst wall
> Central (nucleolus = karyosome = endosome)
> Quadrinucleated (4 nuclei)
> Dense regular peripheral chromatin
> Central (nucleolus = karyosome = endosome)
> Hyaline pseudopodia
> Dense regular peripheral chromatin
> Food vacuoles containing RBCs

> Definitive host: Humans

> Infective stage: Mature Quadrinucleated Cyst > Pathogenic stage: Trophozoite

> Mode of infection: Fecal oral > Diagnostic stage: Cyst

(Habitat)
> 1st most affected organ: Colon (large intestine) > 2nd most affected organ: Liver

> Disease: either 1ry intestinal amoebiasis (Amoebic colitis)

or 2ry extra-intestinal amoebiasis

> Common presentation: Amoebic dysentery

> Severe complications: Intestinal hemorrhage, Intestinal perforation, liver abscess

> Best method of diagnosis: Stool microscopic examination

> The treatment of choice: Metronidazole (Flagyl)

By: Hani Bassam -2-

 Entamoeba coli

Morphology
Trophozoite Cyst
> Uninucleated (Single nucleus) > Oval in shape + Hyaline cyst wall
> Eccentric (nucleolus = karyosome = endosome) > Has 8 nuclei (sometimes more)
> Irregular peripheral chromatin > Eccentric (nucleolus = karyosome = endosome)
> Hyaline pseudopodia > Irregular peripheral chromatin

> Entamoeba coli is a non-pathogenic intestinal amoeba (commensal), that

has a similar habitat & life cycle to that of Entamoeba histolytica, but it
DOES NOT CAUSE DISEASE !!

> Definitive host: Humans

> Infective stage: Mature Cyst > Active stage: Trophozoite

> Mode of infection: Fecal oral > Diagnostic stage: Cyst

> Most affected organ (Habitat): Colon (large intestine)

> Best method of diagnosis: Stool microscopic examination

> The treatment of choice: Treatment is not usually indicated for Entamoeba coli

By: Hani Bassam -3-

 Giardia lamblia
(Obligate, intestinal, extracellular parasite, has a falling leaf-like motility)

Morphology
Trophozoite Cyst
> Pear shaped > 2 sucking discs
> Oval/ovoid in shape + hyaline cyst wall
> 2 nuclei within the sucking discs
> Has 4 nuclei (2 pairs)
> 4 pairs of flagella
> Parabasal/median bodies
> 2 axonemes/axostyles
> Axostyles/axonemes
> 2 parabasal/median bodies

> Giardia lamblia uses its adhesive/sucking discs for attachment to the intestinal villi,
& to resist the peristaltic movement, as well as being a nourishment point of entry
> Definitive host: Humans

> Pathogenic stage: Trophozoite > Diagnostic stage: Cyst

> Infective stage: Mature Cyst (sensitive to heat & desiccation)

> Mode of infection: Fecal oral

> Most affected organ (Habitat): Small intestine (duodenum & upper jejunum)

> Disease: Giardiasis (traveler's diarrhea)

> Common presentation: Diarrhea/steatorrhea

> Severe complication: Malabsorption syndrome

> Best method of diagnosis: Stool microscopic examination or entero-string test

> The treatment of choice: Metronidazole (Flagyl)

By: Hani Bassam -4-

 Trichomonas vaginalis
(Obligate, urogenital, extracellular parasite, has a rapid jerky movement)

Morphology
Trophozoite

> Colorless & pyriform

> Uninucleated (Single nucleus)
> Undulating membrane covering only half of the trophozoite
> 4 apical/anterior flagella
> Single axostyle/axoneme protruding posteriorly

> Trichomonas vaginalis trophozoite loses its vitality below pH 4.9, thus it cannot live
in the normal acidic vaginal secretions of healthy adults (pH 3.8 – 4.4)

> Definitive host: Humans

> Infective + Pathogenic + Diagnostic stage: Trophozoite

> Mode of infection: (STD) or (contamination of the urogenital area) or (congenital)

> Most affected organ (Habitat): Urogenital tract

> Disease: Trichomoniasis > Complication Urogenital inflammations

> Best method of diagnosis: Microscopic examination of urogenital discharges

> The treatment of choice: Metronidazole (Flagyl)

By: Hani Bassam -5-

 Toxoplasma gondii
(Obligate, intestinal parasite of felines)

Morphology
Tachyzoite Tissue Cyst (Bradyzoites)
> Round cyst containing large number of Bradyzoites
> Crescentic in shape
> Bradyzoites are crescentic in shape
> One broad end & one narrow end
> Bradyzoites has one broad end & one narrow end
> Single central nucleus
> Bradyzoites has a single central nucleus
> Conoid at the narrow end > Bradyzoites has conoid at the narrow end

> Definitive host: Felines (Cats)

> Intermediate host: Humans & other mammals > Pathogenic stage: Tachyzoite

> Infective stage: All stages are infective

> Mode of infection:

• Oral (ingestion of oocyst in contaminated food/water)

• Oral (ingestion of tissue cyst in raw or partially cooked meat)

• Blood/blood transfusion (tachyzoite) (except RBC transfusion)

• Organ transplantation (tachyzoite)

• Transplacental (congenital) (tachyzoite)

By: Hani Bassam -6-

> Most affected organ: Brain, skeletal muscles, & eyes

Note (Habtat): Toxoplasma can inhabit any nucleated cell in the body, thus,
Toxoplasma is not found in RBCs, since RBCs are non-nucleated

> Disease: Toxoplasmosis

> Severe complications: Retinochoroiditis, meningoencephalitis, pneumonitis,

myocarditis, hepatitis

> Best method of diagnosis: IgM & IgG serology

> The treatment of choice: Pyrimethamine & Sulfadiazine

By: Hani Bassam -7-

Trypanosoma brucei (gambiense or rhodesiense)
(Obligate, extracellular, vector borne parasite)

Morphology
Trypomastigote

> Pleomorphic = Polymorphic

> Single central nucleus
> Kinetoplast at the posterior end
> Free anterior flagellum
> Undulating membrane

> Trypomastigotes are highly pleomorphic, & they can escape the immune system
using their variable surface glycoprotein (VSG)

> Definitive host: Humans & other mammals > Vector: Tsetse fly (Glossina fly)

> Pathogenic stage: Trypomastigote

> Infective stage: Metacyclic Trypomastigote > Diagnostic stage: Trypomastigote

> Mode of infection: Bite of Glossina/tsetse fly (vector borne)

> Most affected organ: The CNS

Note (Habitat): Trypanosoma inhabit the (blood, lymph, & CNS)

> Disease: African Trypanosomiasis (sleeping sickness)

> Severe complication: Coma (sleeping sickness)

> Best method of diagnosis: Thick/Thin blood films, or lymph & CSF aspirates

> The treatment of choice: Suramin or Pentamidine // Melarsoprol or Eflornithine

By: Hani Bassam -8-

 Leishmania spp.
(Obligate, vector borne parasite, intracellular within macrophage)

Morphology
Promastigote Amastigote
> Spindle shaped > Oval in shape with no flagellum
> Single central nucleus > A single large nucleus & a kinetoplast
> Anterior kinetoplast > Axoneme/axostyle
> Free anterior flagellum > Could be seen intracellular within a macrophage

> Definitive host: Humans & other mammals > Vector: Female sand fly

> Epidemiology:
Old world Leishmaniasis  Asia, Africa, Europe (transmitted by Phlebotomus sand fly)
New world Leishmaniasis  Central & south America (transmitted by Lutzomyia sand fly)

> Infective stage: Promastigote > Pathogenic stage: Amastigote

> Mode of infection: Bite of female sand fly (vector borne)

> Diagnostic stage: Mainly Amastigote, but also Promastigote

> Affected organs:

Viscera of reticuloendothelial system (liver, spleen, bone marrow) in visceral Leishmaniasis
Skin in cutaneous Leishmaniasis & diffuse cutaneous Leishmaniasis
Skin & mucous membranes in mucocutaneous Leishmaniasis

By: Hani Bassam -9-

> Habitat: Intracellular within macrophage cells

> Disease:
Visceral Leishmaniasis (Kala azar)  caused by Leishmania donovani
Post Kala-azar dermal Leishmaniasis  caused by Leishmania donovani
Cutaneous Leishmaniasis (Dry type)  caused by Leishmania tropica (minor)
Cutaneous Leishmaniasis (Wet type)  caused by Leishmania major
Diffuse cutaneous Leishmaniasis  caused by Leishmania aethiopica
Mucocutaneous Leishmaniasis  caused by Leishmania braziliensis

> Severe complications: 2ry bacterial infections, tendency to bleed, splenic rupture

> Best method of diagnosis: Stained smears or cultures (from the affected area)

> The treatment of choice: Sodium stibogluconate (Pentostam)

By: Hani Bassam - 10 -

 Clinical Cases

(A). Flask-shaped ulcers (Amoebic colitis)

(B). Caused by invasive trophozoites of Entamoeba histolytica

(A). Villus atrophy of duodenum or jejunum

(B). Caused by heavy infection with Giardia lamblia trophozoites

(A). Retinochoroiditis
(B). Caused by Toxoplasma gondii

(A). Hydrocephalus
(B). Caused by congenital Toxoplasmosis (Toxoplasma gondii)

(A). Winterbottom's sign (swelling of the posterior cervical lymph nodes)

(B). Caused by Trypanosoma brucei gambiense

(A). Cutaneous Leishmaniasis (Dry type)

(B). Caused by Leishmania tropica (minor)

(A). Cutaneous Leishmaniasis (Wet type)

(B). Caused by Leishmania major

(A). Diffuse cutaneous Leishmaniasis

(B). Caused by Leishmania aethiopica

(A). Mucocutaneous Leishmaniasis

(B). Caused by Leishmania braziliensis

- Best of luck  -

By: Hani Bassam - 11 -