This document summarizes information about various protozoal infections including malaria, amebiasis, leishmaniasis, trypanosomiasis, toxoplasmosis, giardia, and trichomoniasis. For each infection, it describes the causative organism, transmission, clinical manifestations, and treatment options. First line drugs for treating different stages and forms of the infections are provided. Common side effects of antiprotozoal medications are also mentioned.

1. SUBJECT: ADVANCED PHARMACOLOGY 2
CLASS: M PHARMACY 2ND SEM
(PHARMACOLOGY)
G H G KHALSA COLLEGE OF PHARMACY

2.  The Protozoal infectionsinclude:
 Malaria,
 Amebiasis,
 Leishmaniasis,
 Trypanosomiasis,
 Trichomoniasisand
 Giardia.
Protozoal infections are common inUnderdeveloped
tropical and subtropicalcountries.
 They spread as a resultof in adequatesanitaryconditions,
unhygienic practices and poor control of the vectors of
transmission.

3.  Malaria is an acute infectiousdiseasecaused by fourspecies of
Plasmodium (P. falciparum, vivax, malariae andovale)
 Plasmodium falciparum is the most dangerous species
causing an acute, rapidly fulminating disease, chatacterizedby
persistent high fever, orthostatic hypotension and massive
erythrocytosis, leading to capillary obstruction, cerebral state
and death.
 Plasmodium Vivax causes benign tertian malaria. Itis
widespread but not fetal.
 Plasmodium Malarae causes quartan malaria . It isgenerally
mild but can lead tonephrosis.
 Plasmodium Ovale causes ovale tertian malariaand is the
leas common.

4.  Plasmodium Life Cycle
 The life cycleof plasmodium iscomposed of:
 Sexual Phase (Sporogony) in the mosquito andthe
Asexual Phase (Schizony) in man ashost.
 Asexual cycle (In the human): twophases
 Exoerythrocytic phase:- occurs “outside” theerythrocyte
and in the liver.
 Erythrocytic phase:- occurs “inside” theerythrocyte
Erythrocytes = Red Blood Cells (RBCs)
 The Antimalarialsattack the parasiteduring theasexual
phase, when it isvulnerable.

5. Sites of action for antimalarialdrugs.
i) DRUG EFFECTIVE AGAINST EXOERYTHROCYTIC FORM:
(TISSUE SCHIZONTOCIDES)
 Thesedrugs act on the primary tissue form of the plasmodium
and are mainly used for casualprophylaxis.
EXAMPLES
 Primaquine
 Proguanil (chloroquine+paludrine)
 Malarone (proguanil+artovaquin)
 Chloroquine
 Fansidar (Pyrimethamine+sulphadoxine)
 Pyrimethamine

6. II) DRUGS EFFECTIVE AGAINST ERYTHROCYTE(ASEXUAL)
FORM(BLOOD SCHIZONTOCIDES)
 Theyproduceclinical & suppressivecureof all the 4 speciesof
malaria parasites.
 Artemisinin- Artemeter+Lumefantrine (Coartem), Atesunatetabs
 Chloroquine tabs, inj.
 Quinine
 Mefloquine(Lariam)
 Pyrimethamine
 Halofantrine hydrochloride (Halfan)
III) DRUG EFFECTIVE AGAINST GAMETOCYTICFORM:
(GAMETOCYTES)
 Theydestroythesexual formof theparasites to interruptthe
transmission of malaria.
 Primaquine
 Quinine
 Chloroquine

7. ADR OF ANTIMALARIALS:
 GIT disorders:- anorexia, nausea,vomiting
 Ocular effects:- difficulty infocusing,
 Headache, dizziness, emotional change,tachycardia,
Bradycardia, etc..
 INTERACTION:
 Oral antacids- inhibit the absorption ofantimalarials
 Beta blockers, Calcium channel blockers & Folic acid-also
inhibit the effect ofantimalarials.

8.  Amebiasis is alsocalled amebic dysentery, is an infection
of the intestinal tract caused by Entamoebahistolytica.
 Can be acute orchronic.
 From asymptomatic to mild diarrhea and to fulminant
dysentery.
 Intestinal disease: Invadeand ulcerate the mucosaof the
large intestine orcolon.
 Luminal amebiasis: Non invasivecolonization.
 Systemic amebiasis: Brain, lung and liver.

9. Classification of amebicidal drugs
i) MIXED AMEBICIDES
 (luminal and systemicactivity)
 Metronidazole tabs 200mg, 250mg, 400mg, or 500mgtds
 Metronidazole is the Drug of choice fortreating amebic infections.
 Used in the treatment of Giardia lamblia, Trichomonas vaginalis,
Anaerobiccocci, and Anaerobicgram-negative bacilli (Bacteroidesspecies),
drug of choice in the treatmentof pseudomembranouscolitiscaused by the
anaerobic, gram-positive bacillus (clostridium difficile) and brain abscesses
caused by theseorganisms
ii) SYSTEMIC AMEBICIDES
 (intestinal wall and liver)
 Chloroquine tabs250mg
 Dehydroemetine
 Emetine

10. III) LUMINALAMEBICIDES
 (parasite in the lumen of thebowel)
 Diloxanide furoate
 Paramomycin
 Iodoquinol
ADR OF AMEBIASIS DRUGS: Nausea, vomiting,
epigastric distress, abdominal cramps, metallic taste,oral
moniliasis, dizziness andvertigo.
 They should not be taken with alcohol, adisulfiram-like
effectoccurs.

11. ForAsymptomatic cystcarriers Drugseffectiveare:-
 Iodoquinol or
 Paramomycin or
 Diloxanide furoate.
For those with Diarrhea/DysenteryExtraintestinal:-
 Metronidazol plus
 Iodoquinol or
 Paramomycin or
 Diloxanide furoate
Forthosewith Amoebic liverabscess:-
 Chloroquine plus
 Metronidazoleor
 Emetine.

12. TRYPANOSOMIASIS has many names:-
AMERICAN:
 Chagasdisease
 Caused by Trypanosomacruzi.
 Causescardiomyopathy.
 Transmitted by inset feces contaminating theeye or break in the skin.
 Treated with nifurtimox.
AFRICAN:
 Slepping sickness
 Caused by T. brucei gambiense.
 Treated with suramin and pentamidine only in theearly stagesof the
disease.
 T. brucei rhodesiense.
 Usually fatal if nottreated.
 Treated with melasoprolol when there is CNSinvolvement.

13.  There are three types of leishmaniasis:cutaneous,
mucocutaneous, and visceral (liver andspleen)
 Is transmitted from animals to humans, and between
humans, by the bite of infected sandflies.
 Sodium stibogluconate is the drug of choice forvizceral
Leishmaniasis.
 Amphotericin B is used with oraftersodium
stibogluconate.

14. TOXOPLASMOSIS is caused by Toxoplasmagondii.
 Transmitted to humanswhen theyconsume rawor inadequately
cooked infected meat.
 An infected pregnantwomancan transmit theorganism to the fetus.
 Cat shed oocysts.
 The drug of choice is the antifolate drug:
 pyrimethamine
 sulfadiazine and pyrimethamine
 trimethoprim and sulfamethoxazole.
 Is caused by Toxoplasmagondii.
 Transmitted to humanswhen theyconsume rawor inadequately
cooked infected meat.
 An infected pregnantwomancan transmit theorganism to the fetus.
 Cat shed oocysts.

15. GIARDIA LAMBLIA is an intestinalparasite.
 Infection occur by the ingestion of cysts in contaminated water
or food, or by the fecal-oralroute.
 Can occur severediarrhea.
 The drug of choice: metronidazole.
 Alternative: tinidazole or mepacrine hydrochloride.
TRICHOMONACIDES is a bacterial infection thatcauses:-
 Trichomona vaginalis infection
 Contact tracingis recommended and sexual contact shouldbe
treated simultaneously.
 Drug of choice: metronidazole
 Alternative: tinidazole

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