Flagellates I Genito-urinary & Intestinal flagellates

Transcription

1 Flagellates I Genito-urinary & Intestinal flagellates Dr. Anuluck Junkum PARA

2 Objective Can describe the morphology, life cycle, pathology, diagnosis and prevention of pathogenic flagellate

3 Classification of Protozoa Based on locomotive organs : Amoeba : Pseudopodia Ciliate : Cilia Sporozoa : Flagellate : Body flexion or Gliding Flagella

4 flagella

5

6

7

8 Flagellates *

9 Medical important flagellates 1. In GI tract : Giardia lamblia Non-pathogen Dientamoeba fragilis Trichomonas hominis Trichomonas tenax Chilomastix mesnili 2. In GU tract : Trichomonas vaginalis 3. In blood & tissue : Leishmania spp. & Trypanosoma spp.

10 Giardia lamblia Name : Giardia lamblia, Giardia intestinalis Disease: Giardiasis Distribution: - Cosmopolitan (most commonly in warm climate) - most common flagellate of human digestive tract

11 Morphology Trophozoite Sucking disc nucleus median bodies axoneme flagellum Size : 5-15 x 9-21 um Pear-shaped (tear drop) dorsal surface : convex ventral surface : concave 2 ventral sucking disc 2 nucleic central karyosome In middle : axoneme & median bodies 4 pairs of flagella

12

13

14 Giardia lamblia (Trophozoite) Sucking disc Cross section of small intestine Microvilli

15 Morphology Mature cyst oval shape with 4 nuclei 4 nuclei median bodies axoneme Size : 8-14 x 7-10 um no flagella and sucking disc presence : median bodies, axoneme smooth, colorless cyst wall after excystation: transforms into 2 binucleated trophozoites

16 Axoneme

17 Giardia lamblia (cyst) Fragments of sucking disc Axoneme Nucleus Cyst wall

18

19

20 2-15% infection rates in various parts of the world Group infection (children > adult) Fecal-oral transmission (with mature cyst) - contaminated food & water Hiker s diarrhea or Picnicker s disease - direct contaction - sexual transmission (also Homosexual) RH : cats and dogs

21 - Most cases : asymptomatic - Symptomatic cases * hypercellularity of the lamina propria (mucosa) irritation of epithelial cell increase mucus production * malabsorbtion, steatorrhea without blood * typical symptoms: - steatorrhea without blood - abdominal cramp, diarrhea, - dehydration, weight loss * obstruction of gall bladder jaundice

22 Stool examinations - falling leaf motility of trophozoites (difficult to see in mucus stool) - non-motile cyst Duodenal drainage or in combination with EnteroTest capsule Immunodiagnosis: ELISA, IFA

23 EnteroTest capsule

24 Metronidazole ( mg., 3 times a day) Ornidazole ( 2 g. single dose)

25 Education of : - personal hygiene - improved sanitary : water treatment (boil or filtrate) control of insects properly treatment of symptomatic and asymptomatic patients

26 Dientamoeba fragilis

27 Dientamoeba fragilis Habitat : large intestine (cecum) Distribution : cosmopolitan Locomotive organ : pseudopodia grouped to Flagellate : based on ultrastructure immunological & genetic evidence

28 Morphology Size 5-12 um - Trophozoite stage only - amoeba-like - Nucleus : no peripheral chromatin 2 nucleus, big karyosome - food vacuole in cytoplasm

29 Life cycle

30 o Transmission between human : unclear o not invade tissue o Irritate intestinal mucosa - increase mucus & intestinal movement - abdominal pain, diarrhea (mucous) - nausea, vomiting, low fever - anal pruritus

31 Stool examination - fresh smear (mucus area) may be confused with E. histolytica - permanent smear

32 iodoquinol 650mg., 3 times a day, 20 D. tetracycline 500mg., 4 times a day, 10 D. paramomycin 500mg., 3 times a day, 7 D.

33 Trichomonad

34 Trichomonad undulating membrane nucleus flagellum karyosome axostyle pyriform shape longitudinal binary fission

35

36 T. tenax (mouth) T. hominis (large intestine) T. vaginalis (urogenetal tract)

37 Morphology T. tenax T. vaginalis T. hominis Length (µm) No. ant. Flag Undulating mem. 3/4 of body 1/2 of body posterior Post. free flag

38 Trichomonas tenax Size : 5x12 µm non-pathogenic flagellate habitat : mouth (tartar from teeth) Transmission : unclear may be cough, sneeze, kissing, co-use utensil undulating membrane : 3/4 of body length feed on bacteria, epithelial cell

39 Trichomonas hominis Size : 5-15x7-10 µm non-pathogenic flagellate habitat : large intestine most common found next to G. lamblia & D. fragilis Transmission : unclear undulating membrane : cover entire body & projects like a free flagellum movement : jerky, non-direction

40 Trichomonas vaginalis*** Disease: Habitat : Trichomoniasis Female: vagina, urethra Male: urethra, prostate gland Distribution : Transmission: cosmopolitan sexual transmission

41 Morphology - Only trophozoite stage* size 7-15x4-7 um - tear drop-shaped - 4 anterior flagella - 1 nucleus at anterior part - undulating membrane = ½ of body length - jerky movement

42

43 Epidemiology high prevalence : years old (Female) feed on : bacteria & wbc (phagocytosis)

44 Symptoms Asymptomatic: 20-50% (male usually asymptomatic) Symptomatic * : Female Male - vaginal discharge (foul smell, creamy) - leukorrhea, dysuria - vaginitis, cystitis, vaginal & vulva pruritis - mild symptom - itching, cystitis, prostatitis

45 T. vaginalis parasite adhering to vaginal epithelial cells

46 Vaginitis due to T. vaginalis foamy vaginal discharge

47 Strawberry cervix of trichomoniasis

48 Diagnosis Microscopic examination * - wet preparation & vaginal swab (vaginal, urethral discharge, prostatic secretion) -jerky movement, tear drop-shaped trophozoite Culture in culture medium (Diamond s medium) Immunodiagnosis : ELISA, IFA

49 Treatment & prevention Metronidazole : 250 mg, 10 days treat both male & female (couple) hygiene education - use of condom - public toilet - co-use utensil e.g. towel

50 Lab talk

51 Giardia lamblia Trophozoite Cyst

52 Dientamoeba fragilis

53 Trichomonad T. hominis T. tenax T. vaginalis

54