To understand the basic principles of imaging techniques used in medical parasitology, including X-ray imaging, CT scanning, MRI, ultrasound, endoscopy, and radionuclide imaging. To identify the common imaging findings in protozoal diseases, such as malaria, leishmaniasis, amoebiasis, trypanosomiasis, toxoplasmosis, cryptosporidiosis, giardiasis, pneumocystis pneumonia, and babesiosis.

1. Imaging
Techniques for
Protozoal
Diseases
D. Ibrahim Abouelasaad
MD Lecture
Main Parasitology
https://www.slideshare.net/IbrahimAboAlasaa
d/imaging-radioklogy-and-us-for-protozoal-
diseasespptx

2. objectives
• To understand the basic principles of imaging techniques
used in medical parasitology, including X-ray imaging, CT
scanning, MRI, ultrasound, endoscopy, and radionuclide
imaging.
• To identify the common imaging findings in protozoal
diseases, such as malaria, leishmaniasis, amoebiasis,
trypanosomiasis, toxoplasmosis, cryptosporidiosis, giardiasis,
pneumocystis pneumonia, and babesiosis.
• To discuss the strengths and limitations of each imaging
technique in the diagnosis and management of protozoal
diseases.
• To learn how imaging techniques can aid in the diagnosis
and management of protozoal diseases by providing valuable
information about the location, severity, and extent of the
infection, as well as related complications.
• To highlight the importance of accurate and timely diagnosis
of protozoal diseases using imaging techniques for better
patient outcomes.
• To encourage students to engage in critical thinking and
discussion about the role of imaging techniques in the diagnosis
and management of protozoal diseases.
• Exploring Advanced Imaging Techniques for the Diagnosis
and Management of Protozoal Diseases

3. Introduction
• Imaging techniques are important tools in the diagnosis and management of protozoal
diseases. Protozoal diseases can have diverse clinical manifestations and affect various organs
and tissues in the body, making diagnosis challenging.
• Imaging techniques especially X rays and Ultrasound, have been recommended in the Clinical
Practice Guidelines submitted by WHO for any curative program. Recently, the advanced
equipment as Multislice CT & MRI and multidimensional US can provide parasite imaging
elsewhere in human body.
• Each imaging technique has its own strengths and limitations, and the choice of imaging
technique depends on the suspected infection, clinical presentation, the body site affected, the
severity of the infection, the availability and cost of imaging techniques, and the potential risks
associated with the imaging technique. The use of imaging techniques, in conjunction with
other diagnostic methods, can aid in the accurate diagnosis and management of protozoal
diseases.
• Traditional diagnostic methods, such as microscopy and serological assays, may not always
provide conclusive results. Imaging techniques can help to overcome these limitations by
providing a non-invasive and safe means to visualize the parasites and their effects on the body.
By identifying the location and extent of the parasite infection, imaging techniques can assist in
the diagnosis of protozoal diseases, aid in monitoring the response to treatment, and guide the
selection of appropriate therapeutic interventions.

4. • In this lecture, we will discuss the various imaging techniques used in medical parasitology for
the diagnosis and management of protozoal diseases. We will explore the imaging findings of
common protozoal diseases. We will also discuss the strengths and limitations of each imaging
technique and how they can aid in the diagnosis and management of protozoal diseases.
• By the end of this lecture, you will have a better understanding of the role of imaging
techniques in the diagnosis and management of protozoal diseases and how they can
contribute to better patient outcomes.
• Let's dive into the world of medical parasitology and explore the fascinating world of imaging
Protozoal Diseases."
Traditional Imaging Techniques includes:
1) Radiography
a) X-rays.
b) Computed tomography (CT).
2) Magnetic resonance imaging (MRI).
3) Ultrasound imaging (US).

5. X-rays
Computed Tomography (CT)
 The two-dimensional (2D) imaging provides more clear images,
but some exams require a special dye (contrast) to helps the
radiologist see certain areas more clearly.
 Intravenous contrast agents are used to enhance organs and
visualize blood vessels. Oral contrast agents are used to
visualize the digestive tract.
 Computed tomography (CT) uses special x-ray equipment to make cross-sectional pictures.
 This technique provides tomographic images or slices of specific areas of the body from a large
series of two-dimensional X-ray images taken in different directions.
Advantages
1) X-ray can be carried out quickly and easily.
2) It provides benefit images in presence of suitable contrast media as:
Lung field, Bone, Intestinal gases, Calcified parasite in soft tissues, and
Induced contrast media as barium.
Disadvantages
1) the hazard of radiation exposure limits its use in some cases as pregnancy.
2) it is not useful for most abdominal parasitic diseases because of:
a) The one-dimensional imaging.
b) The unclear contrast media.

6. Disadvantages of Computed tomography:
 CT is highly technical, needs especial equipment and spend longer time in comparison with
plain x ray.
 CT scans deliver a relatively high dose of radiation to the patient. While this is not usually a
problem for a single scan, patients who need to undergo repeated tests can be subjected to
a significant level of radiation, increasing their cancer risk.
 Patients who undergo a CT scan often receive a dose of what’s known as a “contrast
material,” containing iodine. This allows specific areas of the body to be highlighted on the
scan. Some people can have an allergic reaction to this.
※Magnetic resonance imaging (MRI) is a medical imaging technique
using signals produced by resonance of nucleus in magnetic fi elds
to reconstruct images of human body. In recent years, MRI has
been developing rapidly and improving greatly, with capabilities of
examining all body systems and worldwide application.
※MRI is in general more safe technique in comparison CT, since MRI
does not use any ionizing radiation.
※MRI is highly technical, needs especial equipment and spend
longer time in comparison CT.
Magnetic resonance imaging (MRI)

7. Ultrasonography
Ultrasound-based diagnostic imaging technique used for visualizing internal
body structures including tendons, muscles, joints, vessels and internal
organs
Advantages:
• It allows easy and proper adjustment of the view, consequently, can provides proper
imaging.
• It is portable and can be brought to a sick patient's bedside.
• It is substantially lower in cost.
• It is safe as it does not use harmful ionizing radiation.
Disadvantages:
o Difficult imaging structures behind bone.
o its relative dependence on a skilled operator.
Ultrasound images are available today, with higher resolutions, allowing physicians to see much
clearer definition. During the last 20 years, newer technologies are set to improve the practical
uses of ultrasound as,
o Color Doppler US for imaging blood vessels and blood flow.
o Echocardiogram used to examine the heart.
o Endoscopic US for imaging through intestinal lumen.
o Ultrasound Elastography (FibroScan): measures the stiffness of the liver to quantify
liver fibrosis.

8. Factors influencing the choice of imaging technique
• Type of Protozoal Infection: Different imaging techniques may be more suitable for certain
protozoal infections than others, depending on the location and severity of the infection. For
example, imaging techniques such as ultrasound, CT, and MRI are commonly used to diagnose
liver and spleen involvement in leishmaniasis, while blood smears and cerebrospinal fluid
analysis are used to diagnose trypanosomiasis.
• Body Site Affected: Imaging techniques can be used to diagnose protozoal diseases affecting
different body sites, including the brain, liver, spleen, bone, intestines, skin, and eyes. The
choice of imaging technique will depend on the location of the infection and the structures
that need to be imaged.
• Severity of Infection: The severity of the protozoal infection can also influence the choice of
imaging technique. For example, in cases of cerebral malaria or African trypanosomiasis,
imaging techniques such as CT, MRI, and PET may be necessary to detect brain inflammation
and swelling. In less severe cases, blood smears or other less invasive techniques may be
sufficient.
• Availability and Cost: The availability and cost of imaging techniques can also be a factor in
the choice of imaging technique. In resource-poor settings, imaging techniques such as
ultrasound and X-ray may be more readily available and affordable than more advanced
techniques such as MRI or PET.
• Radiation Exposure: Imaging techniques that involve ionizing radiation, such as X-ray and CT,
can pose a risk to patients, particularly if multiple scans are required. In these cases, non-
ionizing techniques such as ultrasound or MRI may be preferred.

9. Imaging Techniques
for Diagnosis of
Protozoal Diseases
• Amoebiasis
• Malaria
• Leishmaniasis
• Toxoplasmosis
• Chagas Disease
• African
Trypanosomiasis
• Free Living amoebae

10. Amoebiasis
Amoebic infections can affect different body sites, including:
o Intestinal Amoebiasis: This is the most common form of amoebic infection,
caused by the parasite Entamoeba histolytica. It can lead to symptoms such as
diarrhea, abdominal pain, and bloody stools.
o Extraintestinal Amoebiasis: This type of infection occurs when the parasite travels
from the intestine to other parts of the body, such as the liver, lungs, brain, and
skin. Symptoms can include fever, abdominal pain, weight loss, and abscesses.
• Hepatic Amoebiasis: This occurs when the parasite infects the liver, leading to
symptoms such as abdominal pain, fever, and jaundice. In severe cases, it can
lead to liver abscesses.
• Pulmonary Amoebiasis: This occurs when the parasite infects the lungs, leading
to symptoms such as cough, chest pain, and shortness of breath.
• Cutaneous Amoebiasis: This occurs when the parasite infects the skin, leading
to the formation of ulcers or lesions.
• Cerebral amoebiasis: also known as amoebic meningoencephalitis, is a rare but
serious form of amoebic infection

11. Case studies for intestinal Amoebiasis
A 32-year-old man presented to the
hospital with fever, abdominal pain,
and diarrhea. Imaging tests,
including Barium enema
demonstrates multiple amebic
ulcers and thumb-printing edema in
the transverse colon.. Blood and
stool tests confirmed the presence
of Entamoeba histolytica, and the
patient was treated with
antiparasitic drugs.
Barium enema showing irregular haustral
pattern and multiple superficial and slightly
deeper mucosal ulcers in the transverse colon
and hepatic flexure

12. • A 49-year-old male patient
presented with history of per
rectal bleeding and vague
abdominal pain since one
month. The abdominal
examination revealed
moderate left lower-quadrant
tenderness. The per rectal
examination revealed a hard
mass which necessitated
radiological examinations.Later
endoscopy was performed,
followed by a biopsy, which
confirmed the presence of
Entamoeba histolytica, and the
patient was treated with
antiparasitic drugs.
Case studies for intestinal Amoebiasis
Contrast CT images showed asymmetrical, abnormal
hyperintense wall-thickening of upper and mid rectum and
an intraluminal hypointense lesion

13. Pleuropulmonary Amoebiasis:
• Pleuropulmonary involvement is a common extraintestinal amebiasis.
• Routes of infection:
• Direct extension from a liver abscess to the thorax is the most common route of
infection.
• Hematogenous route: Invasion of the inferior vena cava occurs infrequently and may
result in pulmonary thromboembolism. In this case, Consolidations are not
continuous with the diaphragm and may exist in any lobe of both lungs.
• Aspiration is rare but have also been reported.
• Pericardial involvement is present in less than 2% of all thoracic complications related to
amebic hepatic abscess and is more common when the left hepatic lobe is affected.
Thoracic amoebiasis may be presented as:
1) Pleuro-pulmonary amoebiasis, (Pneumonia and Pleural effusion).
2) Lung abscess with or without cavitation.
3) Hepatobronchial fistula can form if the abscess drains through a bronchus.
4) pericardial amoebiasis, (Pericarditis, Pericardial effusion and Pneumopericardium).

14. Pulmonary
Amoebiasis
• A 27-year-old man presented
with a persistent cough and chest
pain. Imaging tests, including
chest Plain X ray chest
showing amebic lung abscess
appears as a well- circumscribed
mass in the lateral aspect of the
right lower lobe immediately
above the diaphragm. There is
slight pleural effusion obliterating
the costophrenic angle.
• sputum cytology or fine-needle
puncture aspiration have proved
the diagnosis of pulmonary
amoebiasis

15. • A 55-year-old woman developed a
persistent cough with brown-colored
sputum like anchovy sauce and
difficulty breathing. Imaging tests,
including chest X-ray showed right
lung abscess. The abscess has
ruptured into a bronchus with
partial expectoration of its contents.
• There is now a large air-filled
cavity with a fluid level. A biopsy of
the lung tissue revealed the
presence of Entamoeba histolytica,
and the patient was treated with
antiparasitic drugs.
Pulmonary
Amoebiasis

16. Hepatic
Amoebiasis
• A 50-year-old man developed severe abdominal pain and
fever. Imaging tests, including CT and ultrasound, showed
signs of inflammation and fluid accumulation in the liver,
with the presence of a large abscess. Blood and stool tests
confirmed the presence of Entamoeba histolytica, and the
patient was treated with antiparasitic drugs.
Axial (A) and coronal (C) enhanced CT scan showing a large cystic mass in the right hepatic lobe
corresponding to an amoebic abscess.
Note the enhanced thickened wall of the lesion (red arrow).

17. Hepatic
Amoebiasis
• Middle-aged male with unremarkable past
medical history, recently (1 year earlier)
immigrated to Western Europe from his native
country (Bangladesh). Suffering since a month
from recurrent fever, abdominal discomfort
and cough, unresponsive to empiric
antibiotics. Laboratory evidence of infection
including leukocytosis (18.000 cells/mmc), C-
reactive protein >300 mg/L, plus elevated
gamma-glutamyl-transpeptidase. Initial
ultrasound revealed a larg, well-demarcated
hypoechoic and avascular mass located in the
dorsal aspect of right liver lobe, with pleural
effusion just above the right lobe abscess.
Blood and stool cultures tested negative.
Serology revealed positive Entamoeba
histolytica IgG antibodies, and fecal parasitic
trophozoites were found.

18. Cerebral amoebiasis
• Cerebral amoebiasis is a rare but generally fatal complication. Progression can be very rapid,
sometimes leading to death within 12-72 hours. The amoebic infection of the central nervous
system occurs by hematogenous and it is very often preceded from a lung or liver
abscesses. Patients commonly present with the abrupt onset of nausea, vomiting, headache,
and mental status changes. Computed tomography (CT) reveals irregular lesions without a
surrounding capsule or enhancement. A tissue biopsy sample reveals the trophozoites.
MR imaging is more sensitive than CT. MRI can usually detect infection in the early stage and
can demonstrating small brain lesions. These findings are nonspecific for amebic encephalitis
and cannot be differentiated from brain abscesses of any other etiology.
Diagnosis is based on serology, culture, immunofluorescence or PCR on CSF or biopsy
specimens.
5.A 35-year-old woman presented with a fever, headache, and confusion. Imaging tests,
including MRI, showed signs of brain inflammation and the presence of multiple brain
abscesses. A biopsy of the brain tissue revealed the presence of Entamoeba histolytica, and
the patient was treated with antiparasitic drugs.

19. Cerebral
Amoebiasis
• A 43-year-old woman presented to the emergency
department after a generalized tonic seizure. The
patient was fully conscious on arrival and complete
neurological examination was unremarkable. Vital
signs were normal except for fever (38.5 °C).
CT examination of the brain image reveals (A) left frontal mass lesion having a thick rim-like
contrast enhancement with relatively preserved gyral pattern. (B) Axial T2-weighted image
shows a left frontal hyperinten se lesion containing scattered small hypointense foci indicating
haemorrhage. (C)

20. Amebic Brain
Abscesses
• MRI of multiple amebic brain abscesses. (a) shows
multiple hypointense lesions in the right frontoparietal
area (red arrows). (b) Enhanced MRI shows
pronounced ring enhancement of all lesions, with
demonstration of additional small lesions in the head
of the left caudate nucleus and in the left occipital
area (blue arrows).

21. Pericardial
Amoebiasis
• A seven-year-old male child presented
to The Indus Hospital, Karachi, with the
chief complaints of fever and abdominal
pain for 15 days and diarrhea for three
days. Ultrasound (US) of the abdomen
was performed, which revealed a large
heterogeneous lesion, consistent with
liver abscess, located predominantly in
the left lobe of the liver A few days later,
the child developed chest pain and
respiratory distress. Chest X-ray (CXR)
showed enlargement of the cardiac
silhouette with clear lung fields.
Metronidazole was given for 14 days,
followed by diloxanide furoate for the
next seven days. The effusion gradually
resolved following

22. Malaria
Adult respiratory distress syndrome (ARDS) is the primary manifestation of malaria in the
lung as a criterion for the definition of both severe and complicated malaria. ARDS occurs as
a result to vascular injury related to red blood cell sequestration and destruction, and the
subsequent release of parasite and erythrocyte material into the circulation, and the host
response to these events resulting in pulmonary oedema. Any species of plasmodia can
cause ARDS, but P falciparum infection is the most common.
Case report:
A 42-year-old man presented to the hospital with fever, cough, and shortness of breath. He
had a history of recent travel to an endemic area for malaria. A physical examination
revealed signs of respiratory distress and low oxygen levels in the blood. Blood tests
confirmed the presence of Plasmodium falciparum, and the patient was started on
antimalarial treatment. Imaging tests, including chest X-ray and CT scans, were performed
to evaluate the extent of the lung involvement and rule out other possible causes of the
patient's symptoms. The scans showed signs of severe lung inflammation and edema, with
widespread damage to the lung tissue and signs of increased fluid accumulation.

23. Acute Pulmonary Edema in Falciparum Malaria
Chest radiograph (CXR) showed bilateral basal and perihilar patchy consolidation with
bilateral diffuse alveolar infiltration. A computerised tomography scan (CT scan) of the
chest showed bilateral ground-glass opacities consistent with acute ARDS.

24. Cerebral Malaria
Cerebral malaria is the most severe neurological complication of infection with
Plasmodium falciparum. Imaging Features (CT & MRI) may be:
• Diffuse brain edema.
• Focal infarct and possible secondary hemorrhage.
• Petechial hemorrhages that appear as small foci of hyposignal intensity.
These findings are nonspecific for cerebral malaria. Diagnosis is made by the identification
of trophozoites in thick or thin Giemsa-stained blood films, or by Immunodiagnostic tests.
Case report:
A 30-year-old woman presented to the hospital with fever, headache, and confusion. She had
a history of recent travel to an endemic area for malaria. Blood tests confirmed the presence
of Plasmodium falciparum, Imaging tests, including CT and MRI, were performed to evaluate
the extent of the cerebral involvement and rule out other possible causes of the patient's
symptoms. The scans showed signs of cerebral edema and inflammation, with swelling of the
brain tissue and signs of increased intracranial pressure.

25. Cerebral Malaria
CT scanning in cerebral
malaria during the acute
stage: The brain is swollen
and diffusely hypodense,
except for the basal ganglia.
Sattered areas of hypodensity
throughout the diffusely
swollen brain and basal
ganglia.

26. • MR images (A and B) T2 and SWI: Diffuse petechial hemorrhages present
throughout the brain (particularly the gray-white junction, corpus callosum,
and internal capsule) are seen only on the SWI sequence.

27. Trypanosoma cruzi
Chagas disease
Trypanosomiasis cruzi is acquired through the bite of an insect (Triatoma). The infective stages
(Trypomastigotes) multiply within the macrophages, which ultimately rupture, releasing
amastigotes that invade diverse organs via the bloodstream, including the heart and the
gastrointestinal tract (esophagus and colon).
• Acute Chagas disease:
Occurs shortly after an initial infection and lasts for the first few weeks or months of infection. This
stage is usually symptom-free or exhibits only mild symptoms that are not unique to Chagas
disease. In some cases, acute myocarditis occurs causing cardiomegaly and acute heart failure.
• Chronic Chagas' Disease:
After a period of many years or decades, and probably after repeated infections with the
trypanosomes, the systemic changes of the chronic stage may develop. These occur commonly in
the esophagus, recto-sigmoid colon and heart.
o Late cardiac manifestations include chronic myocarditis with focal and diffuse fibrosis, as well
as involvement of the conduction system with a bundle branch block, which can progress to a
complete atrioventricular block.
o Late gastrointestinal manifestations is related to damage to neurons of the myenteric plexus
(motor innervation), with development of mega-esophagus with achalasia and mega-colon

28. Acute Chagas
disease
• A 25-year-old woman presented to the
hospital with fever, fatigue, and chest pain.
She had a history of recent travel to an
endemic area for Chagas disease and
reported being bitten by triatomine bugs.
Blood tests confirmed the presence of
Trypanosoma cruzi,
• The chest X-ray : Plain X-ray of the chest
shows Acute Chagas' myocarditis: marked
generalized cardiac enlargement with
dilatation of all chambers . The hilar areas
are not prominent, and the lungs show no
evidence of vascular congestion.
• The echocardiography showed signs of
ventricular dysfunction, or impaired heart
function.

29. Chronic Chagas' myocardiopathy
X ray chest shows marked cardiac
enlargement, predominantly left ventricular,
with pulmonary vascular congestion and a
large right pleural effusion.
Case report: A 55-year-old man presented to
the hospital with shortness of breath, chest
pain, and fatigue. He had a history of living in
an endemic area for Chagas disease and
reported being bitten by triatomine bugs.
Blood tests confirmed the presence of
Trypanosoma cruzi, and imaging tests,
including electrocardiography (ECG) and
echocardiography, were performed to
evaluate the extent of the cardiac
involvement and rule out other possible
causes of the patient's symptoms.
The ECG showed signs of abnormal heart
rhythms, and the echocardiography showed
signs of left ventricular dysfunction, or
impaired heart function.

30. Chronic Chagas’
Myocardiopathy
• Two-dimensional echocardiogram apical four-chamber
views of Chagas cardiomyopathy patients. Both patients
have dilated and a diffusely hypokinetic left ventricle but
with different degree of right ventricular involvement.
The right ventricle is normal (on the left) and severely
impaired (on the right). LA: Left atrium; LV: Left ventricle;
RA: Right atrium; RV: Right ventricle.

31. Chronic Chagas'
Disease:
Gastrointestinal
Involvement
• Case report: A 50-year-old man presented to the hospital with
abdominal pain, constipation, and difficulty swallowing. He had a
history of living in an endemic area for Chagas disease and reported
being bitten by triatomine bugs. Blood tests confirmed the presence of
Trypanosoma cruzi, and imaging tests, including barium swallow study,
CT scan and esophageal manometry, were performed The barium
swallow study and CT scan showed signs of esophageal dilation and
dysmotility, and the esophageal manometry confirmed the presence of
achalasia, a condition in which the muscles of the esophagus do not
function properly.

32. Chronic Chagas' Disease: CNS Involvement
• T. cruzi most frequently affects the heart and gastrointestinal system. In AIDS
patients, cerebral infection is the most common form of reactivation. It causes
perivascular inflammation with secondary fatal meningoencephalitis. Chagas’
disease should be included in the differential diagnosis with lymphoma and
toxoplasmosis in patients with AIDS presenting with brain lesions. The diagnosis is
made by identifying the parasite and/or the antibodies to the parasite in the
host’s blood or tissue biopsies.
Imaging Findings
• Computed tomography scanning demonstrates single or multiple ring-
enhancing lesions, hypodense tumor-like lesions that enhance after contrast
administration.
• Hemorrhage within the lesions may be seen.
• Similar inflammatory lesions may occur in the spinal cord with the
appearance of multiple enhancing intramedullary lesions.

33. American
Trypanosomiasis
a)Axial MR image shows a mass lesion in the right
cerebral hemisphere, with peripheral edema.
b)Coronal enhanced MR image demonstrates the
necrotic center with irregular enhancing border
of this lesion.
CSF study disclosed trypomastigote forms of T.
cruzi.
Case study: A 50-year-old man presented to the hospital with seizures, confusion, and weakness
on one side of the body. A physical examination revealed signs of neurological impairment,
including slurred speech and difficulty walking. Blood tests confirmed the presence of
Trypanosoma cruzi, and imaging tests, including CT and MRI scans, were performed to evaluate the
extent of the brain involvement. The CT scans is showed in the figure .

34. Pulmonary toxoplasmosis is a serious complication of toxoplasmosis that can cause severe
respiratory distress. Most cases occur in the presence of cell-mediated immune
deficiency as in patients infected with HIV, and in transplant recipients. The radiological
features of pulmonary toxoplasmosis are nodular infiltrates or reticulonodular infiltrates.
These features are non-specific, and the diagnosis is most frequently made microscopy of
the bronchoalveolar lavage
Pulmonary Toxoplasmosis
Toxoplasma gondii
Case study:
A 35-year-old man presented to the hospital with fever, cough, and shortness of breath.
He had a history of HIV infection and was not receiving antiretroviral therapy. A physical
examination revealed signs of respiratory distress and low oxygen levels in the blood.
Blood tests confirmed the presence of Toxoplasma gondii, and Bronchoalveolar lavage
shows many Toxoplasma gondii tachyzoites. Chest X-ray and CT scans, were performed to
evaluate the extent of the lung involvement. The chest X-ray showed signs of bilateral
pulmonary infiltrates, or abnormal fluid accumulation in the lungs, and the CT scans
showed signs of widespread lung inflammation and edema.

35. Pulmonary
Toxoplasmosis
Radiological findings of pulmonary toxoplasmosis:
A- supine chest x-ray showing diffuse bilateral pulmonary
opacities and obliteration of left inferior hemithorax. Also
note the tracheal tube and venous catheters;
B- Axial CT showing bilateral centrilobular ground-glass
opacities, consolidation of posterior portions of the lungs,
and small bilateral pleural effusions.

36. imaging findings
In congenital toxoplasmosis, the CNS manifests in the newborn as;
• Hydrocephalus,
• Microcephaly,
• Scattered cerebral calcifications,
In the adult immunosuppressed patients form;
o CT & MRI show multiple hypodense regions predominantly in the basal ganglia and at the
corticomedullary junction. its size is variable, from less than 1 cm to more than 3 cm.
o Enhanced CT & MRI show nodular or ring enhancement which is typically thin and smooth
(asymmetric target sign).
o Calcification - seen in treated cases; may be dot-like or thick.
Cerebral Toxoplasmosis
Cerebral toxoplasmosis usually occurs in people with weakened immune systems, such as
those with HIV/AIDS, cancer, or who are taking immunosuppressive drugs. The symptoms
of cerebral toxoplasmosis include fever, headache, confusion, seizures, and behavioral
changes. These symptoms can worsen over time and can lead to a coma or even death if
left untreated. Diagnosis of cerebral toxoplasmosis is usually made by brain imaging tests,
such as CT or MRI scans, and by analyzing cerebrospinal fluid. The infection can also be
detected using serologic tests.

37. Acquired Toxoplasmosis
Enhanced MRI at the level of the fourth ventricle in a
32-year-old AID patient. The image shows a
peripheral, right fronto-parietal ring-enhancing
lesion (arrow). The patient presented with a solitary
space-occupying lesion, which was confirmed to be
secondary to toxoplasmosis.

38. Acquired
Toxoplasmosis
• Cerebral toxoplasmosis in an AIDS patients.
(a): Contrast enhanced CT brain showed a ring enhancing
lesion (red arrow) and marked surrounding brain oedema
(blue arrows).
(b): Contrast enhanced CT brain showed a resolution of
cerebral lesion after 4 weeks of anti-Toxoplasma therapy (red
arrow).

39. Acquired Toxoplasmosis

40. Congenital
Toxoplasmosis
Plain X ray in congenital toxoplasmosis with intracranial
hydrocephalus.
(a) AP and (b) lateral pneumoencephalography:
The grossly dilated lateral ventricles (blue arrows).
The sparing of the cranial sutures (red arrows).
The extensive calcification lining the walls of the dilated lateral
ventricles (green arrows).

41. Case study:
• A newborn baby presented with fever,
jaundice, and an enlarged liver and spleen. A
physical examination revealed signs of
respiratory distress and low oxygen levels in
the blood.
• Blood tests confirmed the presence of
Toxoplasma gondii, and imaging tests,
including ultrasound and MRI scans, were
performed to evaluate the extent of the
organ involvement and rule out other
possible causes of the baby's symptoms. The
ultrasound showed signs of
hepatosplenomegaly, or enlargement of the
liver and spleen, and the MRI scans showed
signs of brain calcifications, or abnormal
deposits of calcium in the brain.
Congenital
Toxoplasmosis

42. • A 3-day-old boy presented with a seizure.
• His computed tomography scan demonstrated
hydrocephalus (red arrows) and periventricular calcification
(green arrows).
• Toxoplasma serology was positive.
Congenital
Toxoplasmosis

43. Congenital Toxoplasmosis
Ultrasound is used to monitor fetal development and to identify manifestations
of congenital infection. Sonographic findings associated with toxoplasmosis
may affect multiple organ systems. However, the sonographic sings are not
specific to toxoplasmosis alone.

44. Congenital
Toxoplasmosis
Ultrasound-guided amniocentesis.
Needle (arrowheads) in amniotic fluid
Placentomegaly

45. Visceral leishmaniasis
Ultrasonography shows that the
enlarged spleen of leishmaniasis is
huge & homogeneous. The left kidney
is displaced.
The splenic enlargement is nonspecific and similar to that of malaria or any other cause of
hypersplenism. The enlarged spleen of kala-azar is homogeneous and grow about 1 inch every
month until it fills the abdomen and reaches the pelvis. Portal and splenic veins dilatations were
less common.

46. • Case study:
• A 30-year-old man presented to the
hospital with fever, fatigue, and weight
loss. A physical examination revealed
signs of enlarged liver and spleen, as well
as anemia and low platelet counts. Blood
tests confirmed the presence of
Leishmania donovani, and imaging tests,
including ultrasound and CT scans, The
ultrasound showed signs of
hepatosplenomegaly, or enlargement of
the liver and spleen, and the CT scans
showed shows prominent hypointense
nodules throughout the spleen (white
arrows).

47. Case study:
Top row: before treatment. a Clinical photograph of a case of cutaneous leishmaniasis with a
lesion in the upper cheek. b Grayscale ultrasound: a hypoechoic oval lesion in the dermis with
intralesional hyperechoic areas and a lobular hyperechoic involvement of the
hypodermis. c Color Doppler: increased intralesional vascularity.
Bottom row: after treatment. d Clinical image after 4 weeks of treatment. e Grayscale
ultrasound: a decrease in the diameter of the lesion with little involvement of the
hypodermis. f Color Doppler: decreased intralesional vascularity
Usefulness of ultrasound for cutaneous leishmaniasis

48. African
Trypanosomiasis
• MRI axial sections ((a) and (b)) showing a
diffuse edema of the white matter of the semi-
oval centers and the basal ganglia (star)

49. African Trypanosomiasis
• Case study:
• A 25-year-old man presented to the
hospital with fever, headache, and fatigue. A
physical examination revealed signs of
neurological impairment, including confusion
and lethargy.
• Blood tests confirmed the presence of
Trypanosoma brucei, and imaging tests,
including CT and MRI scans, were performed
to evaluate the extent of the brain
involvement. The CT scans showed Extended
edema on the basal ganglia and the white
matter predominantly on the right side (star
(a)). Moderate mass effect on the right lateral
ventricle (arrow in (a)) despite the extended
edema. Very slight contrast enhancement in
the posterior arm of the internal capsula
(arrow( b)).

50. Free Living amoebae
Naegleria fowleri,
Acanthamoeba astronyxis,
Balamuthia mandrillaris.
The clinical symptoms depend on the type of amebic infection:
o Naegleria fowleri  primary amebic meningoencephalitis (PAM, or PAME), there
is rapid progression to coma and death.
o Acanthamoeba astronyxis & Balamuthia mandrillaris  Granulomatous amebic
encephalitis (GAE) is a slow, progressive. In case of Acanthamoeba, patients
present with typical skin lesions for a long period before the neurological
symptoms appear.
Case study: A 12-year-old boy presented to the hospital with fever, headache, and nausea.
A physical examination revealed signs of neurological impairment, including confusion and
seizures. Blood tests and cerebrospinal fluid analysis confirmed the presence of Naegleria
fowleri, and imaging tests, including CT and MRI scans, were performed to evaluate the
extent of the brain involvement and rule out other possible causes of the patient's
symptoms. The CT scans showed signs of brain edema, or swelling of the brain tissue, and
the MRI scans showed signs of diffuse brain lesions, which were consistent with PAM.

51. Primary Amebic
Meningoenceph
alitis (PAM):
CT scan brain showed;
(a) diffuse oedema in bilatral cerebral hemispheres
with partial effacement of cortical sulci. There
was also moderate hydrocephalus.
(b) Post-contrast images showed abnormal
meningeal enhancement throughout brain
parenchyma. There was no definite focal
enhancing lesion.

52. Granulomatous Amebic Encephalitis (GAE):
• Case study: A 45-year-old man with
a history of HIV/AIDS presented to the
emergency department with a 2-week
history of fever, headache, and altered
mental status. On examination, the
patient was lethargic and disoriented.
Imaging studies showed multiple areas
of brain inflammation and necrosis.
Cerebrospinal fluid (CSF) analysis was
performed, and microscopy revealed
the presence of free-living amoebae
consistent with Acanthamoeba. The
diagnosis of granulomatous amoebic
encephalitis (GAE) was made, and the
patient was started on a combination
of intravenous pentamidine and oral
fluconazole. Despite, he ultimately died
3 weeks after admission.
Axial (a) and coronal (b) post contrast MRI images reveal
multifocal involvement of bilateral cerebral hemisphere
, the largest lesion in the left frontoparietal lobe
resembling a mass lesion with interspersed
hemorrhages and linear gyriform pattern of
enhancement

53. D. Ibrahim Abouelasaad
https://www.slideshare.net/IbrahimAboAlasaad/imaging-
radioklogy-and-us-for-protozoal-diseasespptx