INTESTINAL FLAGELLATES Flashcards
Giardia intestinalis
Giardia lamblia
Giardia duodenalis
Giardia lamblia
Cercomonas intestinalis
Giardia lamblia
Megastoma enterica
Giardia lamblia
Lamblia intestinalis
Giardia lamblia
Giardia enterica
Giardia lamblia
Shepherd’s crook
Chilomastix mesnili
Chilomastix hominis
Chilomastix mesnili
Nonpathogenic
Chilomastix mesnili
The only pathogenic intestinal flagellates found only in man
Giardia lamblia
▪ Harmless commensal which is worldwide in distribution
Chilomastix mesnili
▪ More prevalent in warm than cooler climate
Chilomastix mesnili
Duodenal area of small intestine and gall bladder
Giardia lamblia
cecal region of the large intestine
Chilomastix mesnili
➢ Ingestion of cyst usually through contaminated water
Giardia lamblia
➢ Oral-anal route
Giardia lamblia
Ingestion of cyst
Chilomastix mesnili
Giardia lamblia (Invasive stage)
Trophozoite
Giardia lamblia (Infective stage)
Cyst
- Trophozoite ✓ Pear-shaped/Pyriform
Giardia lamblia
- Trophozoite ✓ Rounded anteriorly and pointed posteriorly
Giardia lamblia
- Trophozoite ✓ Resembles “old man in eye glasses” or “tennis racket” appearance
Giardia lamblia
- Trophozoite ✓ Bilaterally symmetrical: two media bodies
Giardia lamblia
- Trophozoite ✓ Measures 9.5 – 21 um by 5 – 10 um
Giardia lamblia
- Trophozoite ✓ With large sucking discs on the ventral, concave side and convex on the dorsal side, occupying about ¾ of the flat ventral surface
Giardia lamblia
- Trophozoite ✓ Presence of 2 nuclei with large, central
Giardia lamblia
- Trophozoite ✓ 2 axostyles, 2 blepharoplast, 2 deeply staining bars
Giardia lamblia
- Trophozoite ✓ 4 pairs of flagella: one pair of laterally crossed flagella, one pair of central flagella, a lateral pair of uncrossed flagella, and one pair of posterior flagella
Giardia lamblia
❖ Motility: jerky falling leaf/kite-like/spinning/flip-flop motility
Giardia lamblia
- Cyst ✓ Ovoid/ellipsoidal; measures 8 – 12 um by 6 – 10 um
Giardia lamblia
- Cyst ✓ 2 – 4 nuclei at anterior end
Giardia lamblia
- Cyst ✓ Thick double wall (“double-walled cyst”); cytoplasm shrinks away from the cell wall
Giardia lamblia
- Cyst ✓ Axostyle and fibrillar remnants of locomotory apparatus present
Giardia lamblia
- Trophozoite ✓ Asymmetrical pearshaped (due to the cytostome) measuring about 6 – 20 um
Chilomastix mesnili
- Trophozoite ✓ Broad anterior, tapering toward the posterior end
Chilomastix mesnili
- Trophozoite ✓ Spiral groove extending through the middle portion of the body
Chilomastix mesnili
- Trophozoite ✓ 3 pairs of flagella and a more delicate one within the prominent cytostome
Chilomastix mesnili
- Trophozoite ✓ Cytoplasm is delicately granular with numerous food vacuoles
Chilomastix mesnili
- Trophozoite ✓ 1 nucleus with central karyosome
Chilomastix mesnili
- Trophozoite ✓ Motility: Boring or spiral forward movement, corkscrew, clockwise, twisting motility
Chilomastix mesnili
- Cyst ✓ 7 – 10 um; thick walled
Chilomastix mesnili
- Cyst ✓ Pear- or lemon-shaped, rounded at one end and conical at the other end with knob-like protuberance projection
Chilomastix mesnili
- Cyst ✓ 1 spherical nucleus with central karyosome
Chilomastix mesnili
Giardiasis or Flagellate diarrhea (also known as Traveller’s diarrhea)
Giardia lamblia
➢ Majority of persons infected are asymptomatic or is manifested as a self-limiting acute onset diarrhea, usually associated with nausea, anorexia, and crampy abdominal pain
Giardia lamblia
➢ Common among pre-school children and immunocompromised patients (AIDS patients)
Giardia lamblia
a. Duodenal Involvement (Duodenitis)
Giardia lamblia
b. Gall bladder involvement (Cholangitis)
Giardia lamblia
✓ Associated with gallbladder colic and jaundice due to obstruction of the bile passages
b. Gall bladder involvement (Cholangitis)
✓ Irritation or edema of the ampulla of Vater
b. Gall bladder involvement (Cholangitis)
✓ Irritation with excess secretion of mucus and dehydration
a. Duodenal Involvement (Duodenitis)
✓ dull epigastric pain
a. Duodenal Involvement (Duodenitis)
✓ chronic diarrhea with steatorrheic stool containing increased amounts of fat and mucus but no blood
a. Duodenal Involvement (Duodenitis)
- DFS: stained or unstained
Giardia lamblia
- ZnSO4 flotation technique – for cyst concentration
Giardia lamblia
- Duodenal aspiration (Entero test)
Giardia lamblia
- Fluoroscopy – may demonstrate hypermotility at the duodenal and jejunal levels
Giardia lamblia
- X-ray to reveal mucosal defects
Giardia lamblia
- Culture method
Giardia lamblia
- Personal and community hygiene
Giardia lamblia
- Sanitation and cleanliness
Giardia lamblia
Metronidazole – drug of choice
Giardia lamblia
Proper hygiene and sanitation
Chilomastix mesnili
- Trophozoite ✓ Pear-shaped or ovoid
Enteromonas hominis
C. mesnilii
- Trophozoite ✓ No cytostome
Enteromonas hominis
- Trophozoite ✓ 4 flagella: 3 anterior and 1 which closely adheres to the flattened surface of one side and trails off posteriorly as a free flagellum
Enteromonas hominis
- Trophozoite ✓ Motility: Jerky motility
Enteromonas hominis
- Cyst ✓ pear-shaped, uninucleated
Enteromonas hominis
- Trophozoite ✓ Measures 4 – 9 um by 3 – 10 um
Embadomonas intestinalis
- Trophozoite ✓ Characteristic cleft – like cytostome may be seen near the nucleus
Embadomonas intestinalis
- Trophozoite ✓ 2 anterior flagella
Embadomonas intestinalis
- Cyst ✓pear-shaped, uninucleated
Embadomonas intestinalis
▪ Optimum pH for survival: 5.2 to 6.4
Trichomonas vaginalis
▪ In the healthy female, the normally acid vaginal secretions of pH 3.8 – 4.4 deter its survival
Trichomonas vaginalis
- Inflammation of the vaginal mucosa occurs several days after inoculation of the trophozoites, after which, polymorphonuclears become numerous and epithelial cells desquamate
Trichomonas vaginalis
➢ Vaginal secretions are liquid in character, greenish yellow in color and very irritating that it causes intense itchiness or burning sensation
Trichomonas vaginalis
➢ Strawberry cervix in appearance
Trichomonas vaginalis
- In most cases, T. vaginalis infection in females present as a symptomatic vaginitis, although chronic infection may be asymptomatic
Trichomonas vaginalis
- In males – trichomoniasis is latent or symptomless during the acute stage and it usually becomes chronic urethritis
Trichomonas vaginalis
- Acid douche (pH of 3.0); Use prophylactic devices
Trichomonas vaginalis
- Oral metronidazole – 250 mg 3x a day for 7 days results in 90-98% cure; for better patient compliance, oral metronidazole 2 grams single dose gas 86% cure rate
Trichomonas vaginalis
(Dobell, 1939)
T. tenax
(Leukart, 1879)
T. hominis
(Donne, 1837)
T. vaginalis
Buccal cavity, tartar of the teeth
T. tenax
Cecum
T. hominis
Vagina, prostate gland
Smallest
T. tenax
Medium
T. hominis
Largest
T. vaginalis
Round
T. tenax
Ovoidal
T. hominis
2/3 of the body length
T. tenax
As long as the body length
T. hominis
Less than ½ of the body length
T. vaginalis
Inclusion bodies NONE
T. tenax
T. hominis
With siderophil bodies in the cytoplasm
T. vaginalis
Flagella 4 anterior and 1 posterior
T. tenax
T. hominis
T. vaginalis
Inconspicuous
T. tenax
Highly conspicuous
T. hominis
Very conspicuous
T. vaginalis
NON-PATHOGENIC
T. tenax
T. hominis
Vaginitis, prostatitis, urethritis, itching and irritation, burning sensation of urine
T. vaginalis
Droplet spray
T. tenax
Kissing; Use of contaminated dishes or drinking glass
T. tenax
Ingestion of contaminated food and drink
T. hominis
Sexual contact and rarely congenital
T. vaginalis
Oral scraping
T. tenax
Stool
T. hominis
Vaginal swab, urine, urethral discharge
T. vaginalis
Oral hygiene
T. tenax
Sanitation and personal hygiene
T. hominis
Avoid promiscuous sexual intercourse
T. vaginalis