2. Upper endoscopy has been suggested as a valuable tool in the diagnosis of following
protozoal infections:
o Giardiasis.
o Cryptosporidiosis
o Microsporidiasis
o Isospora bell
Upper Endoscopy
In patients with persistent watery diarrhea in whom no diagnosis can be made by
lower endoscopy, upper endoscopy should be considered, especially for the
diagnosis of tropical sprue.
3. • Histology of duodenal biopsies and microscopy of
duodenal fluids allowed diagnosis of giardiasis.
• Presence of trophozoites in fecal and duodenal
biopsy specimen confirm giardia infection.
On cytopathologists examination, the mucosa is normal shows minimal changes
in majority of cases with mild villous atrophy, crypt hyperplasia , loss of normal
brush border shorting of villous epithelium and increase intraepithelial
lymphocytes.
The parasite found in lumen close to the surface of villous epithelium
Giardiasis
4. A. Duodenal biopsy of a patient with giardiasis showing partial villous atrophy, a dense
lamina propria infiltrate, and numerous trophozoites (arrow; H&E, /200).
B. Higher magnification: Arrows display the typical pear-shape or flattened Giardia
lamblia.
Giardiasis
5. Chronic nonspecific
duodenitis and giardiasis
are associated with a
scattered white spots
appearance in
duodenal mucosa.
through the endoscopic
course.
Giardiasis
6. Endoscopic view of duodenal nodularity. Multiple small nodular
lesions at the duodenal bulb
Giardiasis
7. histopathologic features of duodenal nodularity
G. lamblia trophozoites were demonstrated on the surface of the duodenal mucosa on
histologic examination
Giardiasis
8. this photomicrograph reveals some of the changes in small bowel tissue
biopsy in a case of cryptosporidiosis
Cryptosporidia oocysts
Cryptosporidiosis worldwide ,endemic in developing countries, found in >50%of
AIDS.
9. Microsporidiasis
Widespread obligate intracellular parasite
Opportunistic infection in
immunosuppressed organ transplant
patents and those with AIDS
The infection includes :
o Enterocytozoon bieneusi
• Diarrhea
• Pneumonia
o Encephalitozoon intestinalis
• Encephalitis
• Nephritis
Histological features : In small bowel
biopsy, both causes a partial villous
atrophy ,mild crypt hyperplasia with short
blunt villi and mild increase in lymphocytes
,plasma cells & eosinophil in the lamina
propria
10. Specimen consisting of a plastic-embedded thick section for electron
microscopy shows spores as well as plasmodial forms of
Microsporidia.
Microsporidiasis
11. The species can cause acute self-limiting diarrhea in immunocompetent
individuals, but in severely immunocompromised patients, this parasite can
cause severe chronic diarrhea which may result in a wasting syndrome, or
even the death of AIDS patients.
Isosporiasis
Isospora belli is the only species of the genus Isospora and is frequently
found in HIV-infected people of tropical and subtropical regions,
accounting for up to 20% of diarrhea cases in AIDS patients.
12. • Sections of the upper jejunum biopcy showing various
developmental stages of Isospora belli.
A. Trophozoites (arrows), spherical in shape.
B. An immature schizont undergone nuclear division (arrow).
Many eosinophils are infiltrated in the lamina propria.
Isosporiasis
13. • (C) A mature schizont with about 6 merozoites (left arrow) and a
merozoite which entered an enterocyte (right arrow). Eosinophil infiltrations
are also seen in this figure.
• (D) Two merozoites in an enterocyte (long arrow), 2 macrogamonts (short
arrows), and a developing trophozoite (left lower) are seen in the jejunal
epithelial layer.
Isosporiasis
14. The specimens obtained can be:
1.Swap,
2.Snip or
3. Biopsy.
The following protozoan parasites can be
detected:
1) E. histolytica.
2) Toxoplasmosis
3) Balantidiasis
Lower Endoscopy
15. The diagnosis of amebic colitis can be difficult and confusing.
The gross endoscopic appearance as well as the results of endoscopic biopsy can be
extremely helpful in differentiating amebiasis from other forms of colitis.
Clinical symptoms, laboratory studies, x-ray findings, cultures, and even serological studies
may not be sufficient for making an accurate diagnosis. Also in some patients, diagnosis of
amebiasis was considered but in whom endoscopy was important for arriving at the correct
diagnosis.
Amoebiasis
16. Amoebiasis
• Endoscopic diagnosis of amebic colitis
can be difficult because its appearance
may mimic other forms of colonic
disease.
• This sequence displays multiple ulcers
at the rectum, but at the ascending
colon and others segments it seems to
be a Crohn´s disease. The rectum
nodules are ulcerated and look “flask
shaped” consistently with amebic
colitis.
17. The image displays the rectum with a ulcerated polypoid
like “flask shaped” and several tiny ulcers (aphtas).
Amoebiasis
18. Amoebiasis
• Endoscopic Image of Amebiasis Colitis. “Flask shaped ulcers”
• The image and the video display multiple rectal nodular ulcers (retroflexed image).
19. Amoebiasis
• Invasive amebiasis and ameboma formation
• This 76-year-old female, suffering of Alzheimer's disease underwent a colonoscopy due to
hematochezia (the passage of fresh blood through the anus).
• A colonoscopy was performed, there are multiple ulcers
20. Toxoplasmosis
• Gastrointestinal toxoplasmosis is a
rare manifestation of a relatively
common disease.
• Disseminated Toxoplasma
gondii must be considered in the
differential diagnosis of any
immunocompromised individual
presenting with nonspecific
gastrointestinal symptoms,
particularly if from or traveling from a
region with high T.
gondii seropositivity. A biopsy is
necessary for definitive diagnosis.
22. Toxoplasmosis
Pathologic specimen with confirmation of T.
gondii by immunohistochemistry. Cystic forms are
present alongside dispersed tachyzoites. The
arrows refer to toxoplasmosis cyst highlighted by
immunohistochemistry.
23. • A colonoscopy revealed a single colonic ulcer in the caecal region. Histology
revealed multiple trophozoites of B. coli in specimens obtained from the ulcer. The
patient was successfully treated with terramycin.
Balantidiasis
