Flagellates Lecture Notes PDF: Clinical Characteristics & Symptoms

FLAGELLATES JAN ETHAN V. LOVENDINO,RMT,MSPH  Learning Outcomes  At the end of this lecture, you should be able to…. Identify the different parts of a flagellate. Discuss the life cycle and important developmental stages of flagellates Correlate the role of each deve...

FLAGELLATES JAN ETHAN V. LOVENDINO,RMT,MSPH  Learning Outcomes  At the end of this lecture, you should be able to…. Identify the different parts of a flagellate. Discuss the life cycle and important developmental stages of flagellates Correlate the role of each developmental stage to the survival of the parasite inside and outside the host. Enumerate the different clinically important organisms under this classification and the disease they cause, method of diagnosis and possible treatment drugs. General Characteristics  Movement is accomplished by the presence of flagella  All inhabit Large Intestine except:  G.lamblia, T.vaginalis, T. tenax  All undergo encystations except:  T.vaginalis, D.fragilis,  All are commensals except:  G.lamblia, T.vaginalis, D.fragilis,  All undergo asexual reproduction through binary fission. Clinically important species Intestinal Extra-intestinal Giardia intestinalis Trichomonas tenax Chilomastix mesnili Trichomonas Trichomonas hominis vaginalis Enteromonas hominis Retortamonas intestinalis Dientamoeba fragilis Giardia intestinalis Trophozoite Tear drop/pear shape 4 pairs of flagella 2 ventral sucking discs 2 nuclei Axostyle present with the parabasal body Motility: Falling leaf Giardia intestinalis  Cyst  >2 nuclei  Median Bodies  Internal Flagellar structures  Infective stage Life Cycle  Laboratory diagnosis Stool exam Duodenal Aspirate Enterotest Immunochromatography Direct Fluorescent Ab assay Western Immunoblot RT-PCR Epidemiology Found worldwide Cyst are resistant to chlorination Can be transmitted by eating contaminated fruits May be transmitted through fecal oral route HIGH RISK GROUPS Children in day care centers People living in poor sanitary conditions Traveler’s/campers Homosexual males (unprotected sex)  Clinical Symptoms Giardiasis/Traveler’s diarrhea Diarrhea Rotten Egg smelling flatus Abdominal cramps Anorexia Steatorrhea Treatment Metronidazole Tinidazole Nitazoxanide Chilomastix mesnili Trophozoite Pear shape 4 pairs of flagella Curved cytostomal fibril Spiral groove Motility: Stiff rotary movement Chilomastix mesnili Cyst lemon shape with clear anterior hyaline knob  “nipple like cyst” Dientamoeba fragilis Trophozoite Broad hyaline pseudopodia 2 Nuclei with clumps of 4 to 8 chromatin granules Does not possess a cystic stage Symptoms Diarrhea Abdominal pain Flatulence Nausea Vomiting Weakness eosinophilia Treatment Iodoquinol Tetracycline Paromomycin Trichomonas vaginalis Trophozoites 1 nucleus Pear like shape 4 to 6 flagella Short Undulating membrane Axostyle Rapid jerky tumbling motility Life cycle Clinical symptoms MALE FEMALE Persistent urethritis Persistent Seminal vesicle, vaginitis/urethritis prostate involvement Foul smelling greenish- Enlarge prostate yellow discharge Dysuria Red vaginal mucosa Nocturia Itchness burning sensation epididymitis Inflammation of the cervix Trichomonas hominis Trophozoites are pear shape Nervous jerky motility costa Trichomonas tenax Trophozoites pear shape Nucleus is located at the central anterior part 5 flagella Undulating membrane, costa, axostyle and cytostome Enteromonas hominis  Trophozoites: 1 nucleus  4 flagella  jerky motility  Oval Cyst: 4 nuclei Retortamonas intestinalis  Trophozoite 1 nucleus with compact karyosome  2 flagella: jerky motility  Cystic stage 1 nucleus and fused fibrils: Bird’s beak cytostomal fibril