Flagellates. Dr. Anuluck Junkum PARA

Transcription

1 Flagellates Dr. Anuluck Junkum PARA

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

3 Classification of Protozoa Based on locomotive organs : Amoeba Flagellate*** Ciliate Sporozoa Microsporidia...

4 flagella

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8 Flagellates *

9 Medical important flagellates In GI tract: In GU tract: Non-pathogenic Giardia lamblia Dientamoeba fragilis Trichomonas hominis Trichomonas tenax Chilomastix mesnili Trichomonas vaginalis In blood & tissue: Leishmania spp. & Trypanosoma spp. (Hemoflagellate)

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

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13 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

14 Axoneme

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

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17 Excystation = duodenum Encystation = colon

18 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

19 - 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

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

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

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

25 Trichomonad

26 Trichomonad undulating membrane nucleus flagellum karyosome axostyle Pyriform shape Longitudinal binary fission

27 ภาคต ดขวางของ Axostyle แสดงการ เร ยงต วของไมโครท วบ ล

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

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

30 Morphology - Only trophozoite stage* size 7-15x4-7 um - Tear drop-shaped - 4 anterior flagella - 1 nucleus at anterior part - Undulating membrane = 1/2 of body length - Jerky movement

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33 Epidemiology High prevalence: years old (Female) Feed on: bacteria & white blood cell (phagocytosis)

34 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

35 T. vaginalis parasite adhering to vaginal epithelial cells

36 Vaginitis due to T. vaginalis foamy vaginal discharge

37 Strawberry cervix of trichomoniasis

38 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

39 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

40 Hemoflagellates FAMILY: TRYPANOSOMATIDAE Leishmania spp. and Trypanosoma spp. 2 or more morphologically different stages in life cycle Blood-sucking insects as intermediate hosts

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42 Leishmania spp.

43 Life cycle Sandfly Promastigote Human Amastigote

44 Sandfly (Phlebotomus & Lutzomyia)

45 Leishmaniasis Cutaneous leishmaniasis Oriental sore Leishmania tropica, L. orientalis Mucocutaneous leishmaniasis Espundia L. braziliensis Visceral leishmaniasis Kala-azar L. donovani, L. infantum, L. orientalis

46 Cutaneous leishmaniasis Leishmania tropica, L. orientalis Portugal, Spain, Italy,Iran, Saudi Arabia,Turkey (Thailand) Papules & nodules ulcerate scar Scraping and biopsy of the sore, stained with Giemsa

47 Cutaneous leishmaniasis

48 Cutaneous leishmaniasis Skin biopsy macrophage Amastigote

49 Mucocutaneous leishmaniasis Leishmania braziliensis South Mexico to Paraguay Northern part of Argentina Mucosal lesion at nose, lips, pharynx, larynx Scraping, biopsy and puncture of the ulcer in mucous membrane, stained with Giemsa

50 Mucocutaneous leishmaniasis

51 Leishmania donovani, L. orientalis America (Agentina, Brazil) Africa (Sudan, Kenya) Asia (China, India) Splenohepatomegaly Visceral leishmaniasis Biopsy and puncture of splenic, bone marrow, stained with Giemsa Serodiagnosis (ELISA)

52 Visceral leishmaniasis Thin smear Culture

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54 Cases in Thailand, Suratthani, 1996 Nan, 2005 Phangnga, 2006 Nakorn Sri Thammarat, 2007 Songkhla, 2007 Bangkok, 2007 Lop Buri, Lamphun, Songkhla & Trang, 2012 Nan, Lamphun & Chiang Mai, 2014 Songkla, 2016

55 Treatment USA: Pentavalent antimony (sodium stibogluconate): expensive selections for initial therapy : miltefosine (oral), paromomycin (topical), amphotericin B (iv) Thailand: Itraconazole: 5 mg/kg/day (oral) for 3 months (CL, ML) Amphotericin B: 50 mg IV for 1 month (VL)

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