Protozoa

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Kinetoplast

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accessory body found in protozoa -lq mitochondrion next basal granule of anterior or undulating membrane flagellum

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Protozoa

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-eukaryotic unicellular animals
- have organelles
-2 Maj methods of transmission:
-ingestion of infective stage
-arthropod vector
-some sexually
-mode of transportation:
-psuedo podia
- one or many flagella
- cilia
- no Obv mode of mobility but glide

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Class Lobosea
amoebida family

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Trophozoite= motile, reproducing, feeding stage; live in lower GI
Cyst= nonmotile, nonfeeding stage --> INFECTIVE STAGE
-contact with fecally contaminated food and water

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What's so special about entamoeba gingivalis?

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-only spp known to injest WBS, in the tartar of gingiva

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Which of the Lobosea is the pathogenic one?

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Entamoedba HISTOLYTICA

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What are the distinguishing characteristics of E. histolytica?

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ID in feces, 3 fresh stools, invades submucosa
SEXUAL
diarrhea with constipation and blood
CYST = up to 4 nuclei
nuclear appearance = smal central karyosome wtih even chromatin around the edge
cytoplasmic inclu: cigar shapped chromatoid body

TROPH= 1 nucleil
RBCs in cytoplasm

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entamoeba coli

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-often confused with histolytica
CYST= up to 8 nuclei
eccentric karyosome with irreg chromatin surrounding it
splinter shaped inclusion

TROPH= 1 nuclei with eccentric karyo and irreg chromatin
ingested bacteria= inclusion
very lg
when mature= immune to fixatives

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FYI

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endolimax nana

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CYST= 1-4 nuclei with irreg, clumped karosom, no peripheral chromatin
ovoid in shape

TROPH= 1 nuclei, same nuclei as above no inclusions

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Iodamoeba butschlii

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CYST= 1 nuclei with large irreg karyosome w/no periph chromatin
LG glycogen vacuole inclusion (stains brown with iodine)

TROPH= same nuclei as above, no inclusions

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Acanthamoeba spp

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1nuclei with distinct nucleus with smooth staining cytoplasm when viewed in tissue, no chromatin

cyst- has double walled, wrinkled appearance in tissue

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Naegleria fowleri

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NO CYST FORM
Troph= 1 nuclei, large centrally located karyosome
numerous WBCs and no bac present when motile troph seen in CSF

can stand water up to 113 (45C)
spa, unchlorinated water, rivers, warm, non moving brackish water, can tolerate chorinated water

WORLDWIDE

goes up the nose, and invades brain
rapid, severe symptoms, encephalitis, headache, fever, nausea, rarely past 6d
20000 WBC + no bac and see motile amoeba = differential dx

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ballamuthia mandrillaris

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-free living ameoba
-dis 1986 in brain of baboon in SF zoo
-WORLDWIDE
-granulamatis ameboid enchephatilic
-FATAL

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Superclass mastigophora

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-inhabit GI, atria, bloodstream or tissues of humans
-use flagella
-some path, some non path

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Giardia lamblia

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TROPH-bilaterally symmetric, 2 anterior nuclei, 8 flagella
-sucking disk concavity on ventral side= means of attachment to intestinal mucosa

CYSTS- oval, 2-4 nuclei at one end,
-clustered nuclei and central axoneme give the "OLD LADY" appearance

TRAVELLERS DIARRHEA
-results in malabsorption = covers the lingin of intestine --> can't absorb fat (stool floats)
-realy foul smelling stool
-transmission = ingestion of cyst in fecally contam food/water

-reservoir = BEAVER

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Dientamoeba gragilis (intestinal flagellate)

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NO CYST
TROPH - id in feces
-lives in CECUM
-2 nuclei connected by divisional spinal filament
-NO flagella - psuedopoda
-usually asymp, but can have abdom pain, diarrhea, anorexia
-permanent stain - trichrom

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Trichomonas vaginalis (atrial flagellate)

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aka TRICH
WORLDWIDE, men = asymp, fem= vag inflam, burning urination, itch, yellowish, frothy discharge

SEXUAL transmition
fresh bag smear (PAP) or urine sediment; POC avail
NO CYST
undulating membrane ripples, jerky motion, posterior AXOSTYLE, 4 anterior flagella

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NON pathogenic intestinal flagellates

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Cliomastix mesnilii -- looks like histolytica (right)

trichomonas hominis (left)

***indicator of water source contamination --> look for other parasites

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Kinetoplastida

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Trypanosoma and leishmanina
-found multiplying in bood or tissue
-req ARTHROPOD intermediate host
-very pathogenic
-kill a lot of people worldwide
-vector - beetle, kissing bug, mosquito
-maj distinguishing feature = kinetoplast, DNA containing granuale in mitochon assoc w/flagella

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Trypanosoma brucei
-rhodesiense = east african sleeping sickness (LT)
-gambiense = west african sleeping sickness (RT)

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-TSETSE fly = intermediate host, transmits dz
-dx stage= trypomastigote, found extracellularly in blood smear or in tissue (lymph node biopsy) or in CSF late in dz
-lesions at bite site, enlg lymph nodes, jt and muscle pain, fever

gamb= CNS impair 6mo-1yr
rhod= CNS impair 1mo, death from cardiac failure may precede CNS sympt in rhod
Coma, death

**IgM in CSF = dx
high lvls IgM and spinal fluid proteins characteristic
**RBC autoagglut common in vitro

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Trypanosoma cruzi (chagas' dz)

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-can transmit thru TRANSFUSIONS
-central Am and brazil
-reduviid bug = kissing beetle
-can cross placenta and cause dz prenatally
-find in tissue scraping or blood smear (c shaped trypomastigote)
-dx by letting uninfected bugs feed on pxt, later examine bug feces for parasite = xenodiagnosis
-LD bodies (amastigotes) - appear in heart muscle post mort

chronic case = death due to enlarged, weakened heart
Acute = chagoma rxn at bite site
if bite near eye = ROMANA's SIGN
RAPID DEATH

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Leishmnaiasis

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transmit by SAND FLY = intermediate host
scrapings and stains - gimsa or wright
FNA- fine needle aspirate into lesion for biopsy
dx stage = amastigotes (LD bodies) form in macrophages
-trop, mex, brazi = only skin-lesion macrophages
-dono = also invades BM, liver, spleen macrophages

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Leishmania tropica (old world leishmaniasis) -lt
leishmania mexicana - rt

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-ID amastigotes in macrophages of skin lesion
-self healing pus filled lesion
mex = sim to tropica - has 2 subspp, once can disfigure

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leishmania braziliensis (new world leismanisasis)

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-red, itchy indurated ulcers that metastasize along lymphatics
-disfigurement may occur yrs later

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leishmania donovani (visceral leishmaniasis, kala-azar)

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-id amastigotes in early skin lesion
-LD bodies later in RES, liver, splee, lymph nodes and BM
-LD bodies in urine, feces, nasal discharges
-incubation LONG
-small papules at bite site in initial lesion
-malaria like spking chills and fever (double fever spikes)
-sweating, diarrhea, dysentery, anemia, wt loss
-heptosplenomegaly after dissemination
-DEATH w/in 2yrs if untreated = pentostam

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Class kinetofragminophorea

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-ectoplasmic cilia on surface
-2 diff nuclei
-lg, kidney shaped macronucleus
-sm, micronucleus
-cytosome

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Balantidium coli (ciliate)

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**ONLY ciliate pathogenic to humans
-largest protozoa
-tissue invader
-dysentary, vaginal contamination
-found in feces or intestinal mucosa as troph = capsule swollowed w/string
-stains well with iodine
-direct ingestion of cyst
-fecal contam of food/water, poor hygiene
-WORLD WIDE but rare in US
-O&P
txt: tetracycline or metronidazole

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Class sporozoa

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-both asex and sexual life cycles
-most have 2 host life cycle (mosquito, human)
-most widespread parasite

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Plasmodium spp (malaria)

falciparum
vivax
ovale
malariae

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-lots of eos (CBC) and ring forms on smear
-gametocytes - sexual **** know this
-picked up by mosquitos
-gametocytes - schiz - troph - ring forms
-look for ring forms****
***-vivax (more this) and ovale = schuffner dots (stippling prod by body in RBC)
-falciparum = deadly, banana troph, **assoc with severe hemolysis =black water fever**
-anemic, prod orgs that prod toxins, shakes, cycle of fevers/chills (paroxisms), die from exhaustion
-spread by mosquito
dx: troph and schizonts but usually RING FORMS
draw edta, thick (3 dots, spread in circle) and thin smear
-reportable to state and CBC
****dz names
falci: malignant malaria (36-48hrs parox, relapse)
viv: tertian malaria (48hrs parox, can relapse later years)
mal: quartan malaria (72 hrs no relaspe)
ovale: ovale malaria (48hrs relapse)***

***malaria knowlesi - SE asia, transmit by macaques monkey, zoonoses, prod high parasitemia, fatal pulmonary and hepto-renal sympt--accidental host

*tonic water --quinine

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Babesia spp

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WORLD WIDE
-similar to malaria
-2-3wks after bite: resembles malaria, muscle aches (malagia), mild hemolytic anemia, fever, sweats, heptoplenomegaly, DIC, renal failure
-TICK = definitive host - ixodies*
-human = intermed host
-multiply in RBC
-think and thin smears EDTA
-dx stage - troph = ring or**tetrad (maltese cross) forms
-txt: clinomicin, quinade
cloroquin - doesn't treat, just suppress sympt (this is malaria drug)

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toxoplasma gondii

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-mimics kissing dz (mono)
-cats shed in feces- tachyzoites (cresent shapes)
-clean litter box - bad for preggo
-sheds oocysts - these remain viable for up to 1yr
-when ingest - become tach, migrate to head, get encysted, gets walled off, push against brain - contain braidizoites*** - stays viable a long time
-crosses placenta - cause death, retardation, blindness, later in life

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sarcocytis spp

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life cycle sim to toxoplasma
eat undercooked beef or pork
oocysts - 2 sporocysts (top)
body walls off (bottom)

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Isospora belli

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-oocysts
-human ONLY definitive host*****
-zinc flotation not PVA (polyvinyl alcohol)
-anorexia, nausea, diarrhea

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**cryptosporidium spp

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**when water system is contaminated****
-macro and micro gametocytes to form gametes
-invades GI wall
-self limiting 1-2 wks
-acute diarrhea
-Important for immunocompromised**********
-unpasteurized apple cider, contaminates drinking and recreational water

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cyclospora cayetanensis

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oocycts
self limiting diarrhea

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microporidia class

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tissue parasite in immunocompromised pxt!!********

AIDS/HIV
transplant

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E hellum, e cuniculi

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**rabbit eye, tilts head bc can't see out
microsporidium

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pneumocystis carinii

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**reclassified as fungi
-deadly opportunist in AIDS****
-assoc with pneumonia