Flagellates Dr. Anuluck Junkum PARA 317242
Objective Can describe the morphology, life cycle, pathology, diagnosis and prevention of pathogenic flagellates
Classification of Protozoa Based on locomotive organs : Amoeba Flagellate*** Ciliate Sporozoa Microsporidia...
flagella
Flagellates *
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)
Giardia lamblia Name : Giardia lamblia, Giardia intestinalis Disease: Giardiasis Distribution: - Cosmopolitan (most commonly in warm climate) - Most common flagellate of human digestive tract
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
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
Axoneme
Giardia lamblia (cyst) Fragments of sucking disc Larcuna Axoneme Nucleus Cyst wall
Excystation = duodenum Encystation = colon
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
- 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
Giardia lamblia (Trophozoite) Sucking disc Cross section of small intestine Microvilli
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
Metronidazole (200-400 mg., 3 times a day) Ornidazole ( 2 g. single dose)
Education of : - personal hygiene - improved sanitary : water treatment (boil or filtrate) control of insects properly treatment of symptomatic and asymptomatic patients
Trichomonad
Trichomonad undulating membrane nucleus flagellum karyosome axostyle Pyriform shape Longitudinal binary fission
ภาคต ดขวางของ Axostyle แสดงการ เร ยงต วของไมโครท วบ ล
T. tenax (mouth) T. hominis (large intestine) T. vaginalis (urogenetal tract)
Trichomonas vaginalis*** Disease: Habitat : Trichomoniasis Female: vagina, urethra Male: urethra, prostate gland Distribution : Transmission: cosmopolitan sexual transmission
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
Epidemiology High prevalence: 16-35 years old (Female) Feed on: bacteria & white blood cell (phagocytosis)
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
T. vaginalis parasite adhering to vaginal epithelial cells
Vaginitis due to T. vaginalis foamy vaginal discharge
Strawberry cervix of trichomoniasis
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
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
Hemoflagellates FAMILY: TRYPANOSOMATIDAE Leishmania spp. and Trypanosoma spp. 2 or more morphologically different stages in life cycle Blood-sucking insects as intermediate hosts
Leishmania spp.
Life cycle Sandfly Promastigote Human Amastigote
Sandfly (Phlebotomus & Lutzomyia)
Leishmaniasis Cutaneous leishmaniasis Oriental sore Leishmania tropica, L. orientalis Mucocutaneous leishmaniasis Espundia L. braziliensis Visceral leishmaniasis Kala-azar L. donovani, L. infantum, L. orientalis
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
Cutaneous leishmaniasis
Cutaneous leishmaniasis Skin biopsy macrophage Amastigote
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
Mucocutaneous leishmaniasis
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)
Visceral leishmaniasis Thin smear Culture
Cases in Thailand, 1996-2016 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
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)