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Intestinal flagellates;
Giardia lamblia
Subjects included;
• The flagellates
• Giardia lamblia
• Morphology of Giardia lamblia
• Life cycle
• Pathogenesis&pathology
• Host immunity
• Symptoms
• Diagnosis
The flagellates
•Inhabit the reproductive tract, alimentary
canal, tissuemore than also the blood stream, lymph
 • possess sites and one flagellum.
vessels and cerebrospinal canal.
 • A cytosome may be present(the identification
•There are pathogenic and commensal species of
    of the species).
flagellates.
 • Flagellates can swim invading to a wider range
    of environments unsuitable for other amoebae.
• The flagellates which are encountered in the free-
    They are able to change from a flagellated
intestinal tractenvironment lamblia, Dientamoeba
    swimming are Giardia to a non-flagellated
fragilis, Chilomastix mesnili, Trichomonas
    tissue dwelling stage and vice versa.
hominis, Retortamonas
intestinalis and Enteromonas hominis (the latter 2
being less common).
Giardia lamblia
•   Taxonomical Classification;

    Kingdom    ; Protista
    Subkingdom ; Protozoa
    Phylum      ; Sarcomastigophora
    Subphylum ; Mastigophora
    Class       ; Zoomastigophora
    Order       ; Diplomonadida
Giardia lamblia
•    It is the most common flagellate of the intestinal tract.
•   considered as one of the most common cause of infectious
    diarrhea throughout the world.
•   Geog. Dist: Worldwide (tropical and subtropical region)
•   It is more common in warm climates .
•   Humans are the only important reservoir of the infection.
•   Also known as(Giardia duodenalis )
•   Causes Giardiasis, also called “traveler’s diarrhea” or “beaver
    fever”
•   Morphology: exhibit the trophozoite and cyst .
Trophozoite
• pear or pyriform shaped
• found in diarrheic stool
• rounded anteriorly and pointed posteriorly
• bilaterally symmetrical
• size 9-20um L X 5 - 15um W
• looking like tennis rackets without the handle (they are
  often seen has having a comical face-like appearance
• Divide by binary fission
•    sucking disc occupying 1/2 - 3/4 of the ventral surface (used for
    attachment of jejunal or duodenal mucosa)
•   axoneme (axostyle) at the anterior end terminating posteriorly
•   4 pairs of lateral flagella, 2 ventral and 2 caudal
    (enhance falling leaf movement)
•   2 pairs of blepharoplast: 1 pair at anterior end 1 pair at
      caudal end
•   2 oval-shaped nuclei with large central karyosome on
      each side near the anterior end.
•   2 deeply stained (parabasal bodies) found posterior to
     the sucking disc
Cyst
•     ovoidal/ellipsoidal – shaped
     thick wall .
•   size 8-12um L X 7 - 10um
•   contains 2-4 nuclei located at one end
     axoneme, parabasal bodies and other
    remnant organelles of the trophozoite .
•   Habitat: duodenum and jejunum
•   Mature cyst is the infective stage, at least
    10 cysts are required to cause infection.
Life cycle
• Parasite life cycle;
   The life cycle begins with a non infective cyst being excreted
  with the feces of an infected individual. The cyst is
  hardy, providing protection from various degrees of heat and
  cold, desiccation, and infection from other organisms. A
  distinguishing characteristic of the cyst is four nuclei and a
  retracted cytoplasm. Once ingested by a host, the trophozoite
  emerges to an active state of feeding and motility. After the
  feeding stage, the trophozoite undergoes asexual replication
  through longitudinal binary fission. The resulting trophozoites
  and cysts then pass through the digestive system in the
  faeces. While the trophozoites may be found in the
  faeces, only the cysts are capable of surviving outside of the
  host.
Pathogenesis&pathology
• Infection resulted in crypt hyperplasia
  associated with an increased enterocyte
  migration rate. Villus height was decreased
  in the duodenum, unchanged in the
  jejunum, and increased in the ileum of
  infected animals. Epithelial microvilli were
  markedly shortened, and brush border
  surface area decreased in the jejunum and
  ileum of infected animals. Thymidine
  kinase activity was increased in isolated
  duodenal villus enterocytes but did not
  differ in the jejunum and ileum.
Pathogenesis&pathology
• Giardia lamblia generally does not
  penetrate the intestinal wall, but may
  cause inflammation and shortening of the
  villi in the small intestine. Extremely large
  numbers of trophozoites may be present
  and may lead to a direct, physical
  blockage of nutrient uptake, especially in
  fat soluble substances such as vitamin
  B12. Infection with Giardia lamblia can
  range from asymptomatic to severe
  diarrhea
Pathogenesis&pathology
• In vitro and in vivo experiments showed
  that the infection resulted in decreased
  jejunal glucose-stimulated
  electrolyte, water, and 3-O-methyl-D-
  glucose absorption, whereas in the ileum
  in vitro electrolyte and 3-O-methyl-D-
  glucose absorption was similar in infected
  and control animals. Thus, in the jejunum
  infection causes electrolyte, solute, and
  fluid malabsorption associated with
  decreased brush border surface area. The
  results indicate that the diarrhea
  associated with giardiasis is caused by
  malabsorption rather than active secretion.
Host immunity

• Both cellular &humoral immune
  mechanisms are involved
• Secreted immunoglobulin A and the
  antibody IgM seem to play a role in
  eradicating parasites
• Human milk, but not sow’s milk, kill
  giardia troph in vitro, (infant protection)
Symptoms
• Watery diarrhea that may alternate with
   soft, greasy stools
• Fatigue
• Abdominal cramps and bloating
• flatulence
• Nausea
• Weight loss
• failure to absorb fat, lactose, vitamin A and vitamin
   B12
Signs and symptoms of giardia infection usually
improve in two to six weeks, but in some people they
last longer or recur.
Diagnosis
1.   Stool microscopy
2.   Stool Ag detection
3.   Duodenal content examination
4.   Duodenal biopsy
5.   Serodiagnosis
6.   Molecular diagnosis
Stool examination
 3 stools taken at 2-day intervals, are examined for ova and
 parasites. The cysts are detected 50–70% of the time in the first
 stool specimen examined, and 90% of the time the cysts are
 detected after 3 stool specimen examinations.
 Trophozoites disintegrate rapidly outside of the body but may
 be found in fresh, watery stools.
 Cysts are found in soft and (semi)formed stools. Cyst passage
 is variable and not related to clinical symptoms. If not
 fresh, stool should be preserved in polyvinyl alcohol or
 formalin. Cyst passage may fall behind the onset of symptoms
 by a week
Stool antigen detection
•   Commercially available tests use either an
    immunofluorescent antibody (IFA) assay or a capture
    enzyme-linked immunosorbent assay (ELISA) against
    cyst or trophozoite antigens. a specificity of 90–100%.
These examinations are limited to the detection of
Giardia.
Serum antibody detection
 ELISA assays for serum antibodies against Giardia are
 not readily available.
 It is difficult to make a diagnosis of acute giardiasis
 because immunoglobulin G (IgG) levels remain
 elevated for long periods.
 However, serum anti-Giardia immunoglobulin M
 (IgM) can be helpful in distinguishing between acute
 and past infections.
String test
  String test (entero-test) involves a gelatin capsule connected to a
  weighted nylon string.
  The patient tapes one end of the string to his cheek and then
  swallows the capsule.
  After the gelatin is dissolved in the stomach, the weight carries the
  string into the duodenum.
  The string is left there for 4–6 hours or overnight while the patient
  fasts.
  After removal, the string is examined for bilious staining, which
  identifies successful passage into the duodenum.
  The mucus from the string is examined for trophozoites in iodine
  or saline.
Epidemiology & Risk Factors
• Giardiasis is a global disease. It infects nearly
  2% of adults and 6% to 8% of children in
  developed countries worldwide. Nearly 33%
  of people in developing countries have had
  giardiasis. Giardia infection is the most
  common intestinal parasitic disease affecting
  humans.
TRANSMISSION:
• Only the cyst form is infectious by the oral
  route; trophozoites are destroyed by gastric
  acidity. Most infections are sporadic, resulting
  from cysts transmitted as a result of fecal
  contamination of water or food, by person-to-
  person contact.
RESERVOIR AND
INCIDENCE
• The parasite occurs worldwide and is nearly
  universal in children in developing countries.
  Humans are the reservoir for Giardia, but dogs
  and beavers have been implicated as a
  zoonotic source of infection. Giardiasis is a
  well-recognized problem in special groups
  including travelers, campers, and persons with
  impaired immune states.
Treatment
 •   Metronidazole
 •   Paramomycin
 •   Quinacrine hydrochloride
 •   Furazolidone.
 •   Tinidazole
 •   Albendazole
References:
  http://en.wikipedia.org/wiki/Giardia_lamblia

 http://www.phsource.us/PH/PARA/Chapter_3.
                       htm
      http://en.wikipedia.org/wiki/Flagellate
Intestinal flagellates
Intestinal flagellates

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Intestinal flagellates

  • 2.
  • 3. Subjects included; • The flagellates • Giardia lamblia • Morphology of Giardia lamblia • Life cycle • Pathogenesis&pathology • Host immunity • Symptoms • Diagnosis
  • 4. The flagellates •Inhabit the reproductive tract, alimentary canal, tissuemore than also the blood stream, lymph • possess sites and one flagellum. vessels and cerebrospinal canal. • A cytosome may be present(the identification •There are pathogenic and commensal species of of the species). flagellates. • Flagellates can swim invading to a wider range of environments unsuitable for other amoebae. • The flagellates which are encountered in the free- They are able to change from a flagellated intestinal tractenvironment lamblia, Dientamoeba swimming are Giardia to a non-flagellated fragilis, Chilomastix mesnili, Trichomonas tissue dwelling stage and vice versa. hominis, Retortamonas intestinalis and Enteromonas hominis (the latter 2 being less common).
  • 5. Giardia lamblia • Taxonomical Classification; Kingdom ; Protista Subkingdom ; Protozoa Phylum ; Sarcomastigophora Subphylum ; Mastigophora Class ; Zoomastigophora Order ; Diplomonadida
  • 6. Giardia lamblia • It is the most common flagellate of the intestinal tract. • considered as one of the most common cause of infectious diarrhea throughout the world. • Geog. Dist: Worldwide (tropical and subtropical region) • It is more common in warm climates . • Humans are the only important reservoir of the infection. • Also known as(Giardia duodenalis ) • Causes Giardiasis, also called “traveler’s diarrhea” or “beaver fever” • Morphology: exhibit the trophozoite and cyst .
  • 7. Trophozoite • pear or pyriform shaped • found in diarrheic stool • rounded anteriorly and pointed posteriorly • bilaterally symmetrical • size 9-20um L X 5 - 15um W • looking like tennis rackets without the handle (they are often seen has having a comical face-like appearance • Divide by binary fission
  • 8. sucking disc occupying 1/2 - 3/4 of the ventral surface (used for attachment of jejunal or duodenal mucosa) • axoneme (axostyle) at the anterior end terminating posteriorly • 4 pairs of lateral flagella, 2 ventral and 2 caudal (enhance falling leaf movement) • 2 pairs of blepharoplast: 1 pair at anterior end 1 pair at caudal end • 2 oval-shaped nuclei with large central karyosome on each side near the anterior end. • 2 deeply stained (parabasal bodies) found posterior to the sucking disc
  • 9. Cyst • ovoidal/ellipsoidal – shaped thick wall . • size 8-12um L X 7 - 10um • contains 2-4 nuclei located at one end axoneme, parabasal bodies and other remnant organelles of the trophozoite . • Habitat: duodenum and jejunum • Mature cyst is the infective stage, at least 10 cysts are required to cause infection.
  • 10. Life cycle • Parasite life cycle; The life cycle begins with a non infective cyst being excreted with the feces of an infected individual. The cyst is hardy, providing protection from various degrees of heat and cold, desiccation, and infection from other organisms. A distinguishing characteristic of the cyst is four nuclei and a retracted cytoplasm. Once ingested by a host, the trophozoite emerges to an active state of feeding and motility. After the feeding stage, the trophozoite undergoes asexual replication through longitudinal binary fission. The resulting trophozoites and cysts then pass through the digestive system in the faeces. While the trophozoites may be found in the faeces, only the cysts are capable of surviving outside of the host.
  • 11.
  • 12.
  • 13. Pathogenesis&pathology • Infection resulted in crypt hyperplasia associated with an increased enterocyte migration rate. Villus height was decreased in the duodenum, unchanged in the jejunum, and increased in the ileum of infected animals. Epithelial microvilli were markedly shortened, and brush border surface area decreased in the jejunum and ileum of infected animals. Thymidine kinase activity was increased in isolated duodenal villus enterocytes but did not differ in the jejunum and ileum.
  • 14. Pathogenesis&pathology • Giardia lamblia generally does not penetrate the intestinal wall, but may cause inflammation and shortening of the villi in the small intestine. Extremely large numbers of trophozoites may be present and may lead to a direct, physical blockage of nutrient uptake, especially in fat soluble substances such as vitamin B12. Infection with Giardia lamblia can range from asymptomatic to severe diarrhea
  • 15. Pathogenesis&pathology • In vitro and in vivo experiments showed that the infection resulted in decreased jejunal glucose-stimulated electrolyte, water, and 3-O-methyl-D- glucose absorption, whereas in the ileum in vitro electrolyte and 3-O-methyl-D- glucose absorption was similar in infected and control animals. Thus, in the jejunum infection causes electrolyte, solute, and fluid malabsorption associated with decreased brush border surface area. The results indicate that the diarrhea associated with giardiasis is caused by malabsorption rather than active secretion.
  • 16. Host immunity • Both cellular &humoral immune mechanisms are involved • Secreted immunoglobulin A and the antibody IgM seem to play a role in eradicating parasites • Human milk, but not sow’s milk, kill giardia troph in vitro, (infant protection)
  • 17. Symptoms • Watery diarrhea that may alternate with soft, greasy stools • Fatigue • Abdominal cramps and bloating • flatulence • Nausea • Weight loss • failure to absorb fat, lactose, vitamin A and vitamin B12 Signs and symptoms of giardia infection usually improve in two to six weeks, but in some people they last longer or recur.
  • 18. Diagnosis 1. Stool microscopy 2. Stool Ag detection 3. Duodenal content examination 4. Duodenal biopsy 5. Serodiagnosis 6. Molecular diagnosis
  • 19. Stool examination 3 stools taken at 2-day intervals, are examined for ova and parasites. The cysts are detected 50–70% of the time in the first stool specimen examined, and 90% of the time the cysts are detected after 3 stool specimen examinations. Trophozoites disintegrate rapidly outside of the body but may be found in fresh, watery stools. Cysts are found in soft and (semi)formed stools. Cyst passage is variable and not related to clinical symptoms. If not fresh, stool should be preserved in polyvinyl alcohol or formalin. Cyst passage may fall behind the onset of symptoms by a week
  • 20. Stool antigen detection • Commercially available tests use either an immunofluorescent antibody (IFA) assay or a capture enzyme-linked immunosorbent assay (ELISA) against cyst or trophozoite antigens. a specificity of 90–100%. These examinations are limited to the detection of Giardia.
  • 21. Serum antibody detection ELISA assays for serum antibodies against Giardia are not readily available. It is difficult to make a diagnosis of acute giardiasis because immunoglobulin G (IgG) levels remain elevated for long periods. However, serum anti-Giardia immunoglobulin M (IgM) can be helpful in distinguishing between acute and past infections.
  • 22. String test String test (entero-test) involves a gelatin capsule connected to a weighted nylon string. The patient tapes one end of the string to his cheek and then swallows the capsule. After the gelatin is dissolved in the stomach, the weight carries the string into the duodenum. The string is left there for 4–6 hours or overnight while the patient fasts. After removal, the string is examined for bilious staining, which identifies successful passage into the duodenum. The mucus from the string is examined for trophozoites in iodine or saline.
  • 23. Epidemiology & Risk Factors • Giardiasis is a global disease. It infects nearly 2% of adults and 6% to 8% of children in developed countries worldwide. Nearly 33% of people in developing countries have had giardiasis. Giardia infection is the most common intestinal parasitic disease affecting humans.
  • 24. TRANSMISSION: • Only the cyst form is infectious by the oral route; trophozoites are destroyed by gastric acidity. Most infections are sporadic, resulting from cysts transmitted as a result of fecal contamination of water or food, by person-to- person contact.
  • 25. RESERVOIR AND INCIDENCE • The parasite occurs worldwide and is nearly universal in children in developing countries. Humans are the reservoir for Giardia, but dogs and beavers have been implicated as a zoonotic source of infection. Giardiasis is a well-recognized problem in special groups including travelers, campers, and persons with impaired immune states.
  • 26. Treatment • Metronidazole • Paramomycin • Quinacrine hydrochloride • Furazolidone. • Tinidazole • Albendazole
  • 27. References: http://en.wikipedia.org/wiki/Giardia_lamblia http://www.phsource.us/PH/PARA/Chapter_3. htm http://en.wikipedia.org/wiki/Flagellate