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GI and Protozoan Infections

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What are the 4 classes of protozoa?
And their distinguishing feature?
Amoeba- pseudopodia
Flagellates- flagella
Sporozoans- gliding
Ciliates- cilia
What are the classes based on?
based on motility
What is the reproduction scheme of most?
binary fission
asexual
What is the reproduction of some?
Some sporozoans can do asexual via Schizogony, and/or asexual via Sporogoy
What is the protective/infectious form of protozoa?
CYST!
protects from env and helps in transmission
Overall, how do cysts get back to environment?
we usually ingest in cyst form, people poop them out
What are the 5 protozoa we are going to talk about here?
Entamoeba histolytica, Giardia lamblia, Cyclospora, Isospora belli, and Cryptosporidium parvum
ENTAMOEBA HISTOLYTICA

What disease does Entamoeba histolytica cause?
Amoebiasis
What is the infectious form?
Cyst
How is it transmitted?
fecal/oral

trophozoites will not survive in the env. or gastric acidity, so they are not infectious
Pathology? Where will it multiply? Is it invasive?
Cysts hatch in GI goes to either colon or circulatory multiplies in colon; INVASIVE
What is the claim to fame?
only ameoba that causes disease

other non-pathogenic species confused for E. histolytica.
E. dispar often responsible for asymptomatic infections
What are the secondary effects**** of the pathogenesis of Entamoeba histolytica?
lysis RBC's and forms brain and liver abcesses
Sx?
GI distress

All symptomatic pts have will present with visible or microscopic blood in their stool (dysntary)

NO fever! this is a way you can distingiush ameobic dysentary from other dysenteries
Symptomatic vs. Asymptomatic? and passing on disease?
Symptomatics have the Tropho-fom but have a harder time passing the disease on

Asymptomatics have cyst form but pass it on easily
Life cycle?
lacks a sexual stage
infectious cyst form and an invasive trophozoite form

cyst can survive in env for weeks, enters humans, motile trophs are released from cysts in the small intestine and go to large: then can invade host tissues (symptomatic) or live in the lumen of LG Intestine without invasion (asymptomatic) or encyst and be shed from host
What is the shape of Entamoeba histolytica penetration lesion into the intestinal wall?
FLASK shaped
When is the only time we see fever with Entamoeba histolytica?
When they get through intestine, into circ., then into liver and make abscesses
get fever and abdominal pain, and WBC increased
Dx?
Stool sample, observational
see cysts or trophozoites
biobsy and serology (extra-intestinal) reacting to antigens of the ameoba
Control Prevention?
sanitation/hygene
When do we see watery stool: with more trophs or more cysts?
more trophs = watery

more cysts = formed
GIARDIA LAMBILA
...
What are the 2 forms of Giardia lamblia?
1: flagellated looks like a sting ray w/ 2 eyes

2: Cyst normal cyst form
Path? Where will they settle? How is this done?
Ingested as cyst excyst in duodenum multiplies by binary fission on mucosa of duodenum--> NO INVASION Adheres to mucosa in intestines using a suction disk on the front of their body --> in feces
Age group of target? Why?
VERY young (b/c kids can be gross); 25-40 y. olds b/c of the recreational sports/being outside a lot
Transmission?
fecal/oral

peaks in summer to late fall
can be animal reservoirs

symptomatic: pass trophozoites
asymptomatic: pass more cysts
What harbors Giardia lamblia a LOT?
water sources
Where can outbreaks (locations)?
Day care centers and workers there; recreation spots
Sx? (asymptomatic vs. symptomatic?)
If symptomatic, then have trophs, so get foul smelling, greasy, floating stool with NO BLOOD (b/c no invasion of mucosa, just attachment), cramping, bloating, gas, NO fever

If asymptomatic, you have cysts and spread Giardia to all your friends
How long does disease last?
Acute: weeks
Chronic: months to years
malnutrition due to malabsorption
Dx?
observe cysts in formed stool
observe trophs in diarrheal stools
Control/Prevention
water treatment/filtration when hiking, etc.
Giardia Troph and cyst: what do they look like?
Troph: teardrop shaped, two nuclei (eyes) four pairs of flagella, claw-shaped median bodies, ventral disk, tumbling swimming motions

Cyst: oval and smooth walled
prominent transvers claw-shaped median bodies and longitudinal axostyle
What is the only other of 5 flagelletes that causes disease?
dientomoeba fragilis and most are asymptomatic
if symps: ab pain, flatulence, diarrhea, and weight loss

no cyst stage
BALANTIDIUM COLI
...
What is the claim to fame for Balantidium Coli?
only ciliated pathogen associated with disease in humans
Transmission?
fecal oral from pigs
Sx generally? Can cause?
Asymptomatic; alternating bouts of diarrhea and constipation CHRONICALLY
The acute path is?
INVASIVE so can have blood and pus in stool
simialar to amebic dystentary
CRYPTOSPORIDIUM PARVUM
a sporozoan
Transmission of Cryptosporidium parvum?
fecal oral
What do you ingest, in particular?
oocytes
Type of disease caused by Cryptosporidium parvum?
cryptosporidiosis
Path?
mature oocyst with sporozites gets ingested, then the sporozoans attach to intestinal epithelium and mature, then sexual forms develop and produce fertilized oocyst, mature oocyst in feces

OR

asexual reproduction in small intestine, merozites are relased into the lumen and can infect new intestinal cells perpetuating asexual cycle
What type of reproduction for Cryptosporidium parvum?
SEXUAL
What is another source for Cryptosporidium parvum?
Animals
Target audience?
very youn and 25-40 yrs
Sx?
Profuse watery diarrhea with cramps, fatigue; NO BLOOD B/C not invasive
Where can we see Cryptosporidium parvum?
Water, public pools contaminated drinking water
Dx?
oocyte in stool
What is the Tx?
mainly self limiting
Prevent?
proper sanitization for drinking water
Who is also at risk here?
immunocompromised, AIDS (15-25% of these pts are infected) can be fatal for AIDS patients, so immunity is important here both Ab and cell mediated
ISOSPORA BELLI
...
Reproduction?
sexual sporozoan
Sx?
fever, diarrhea, weight loss
Path
immature oocyst with sporocyst is injested, mature, sporozoites divide and mature in small intestine of mucosa, sexual forms develop and produce fertilized cyst, becomes oocyst with zygote in feces

NON INVASIVE
Who is most seriously effected?
AIDS PTs: second only to cryptosoridium for causing diarrhea in AIDS pts.

get Watery diarrhea, malabsorption, wt. loss, death
CYCLOSPORA
...
Path?
unsporulated oocyte shed from infected folks oocyst sporulation in env --> fecal to oral transmission oocyte get ingested from contaminated env
Sx?
PROFUSE WATERY DIARRHEA, may have RASPBERRY SEEDS, cramp, fatigue, wt. loss

Disease in AIDS pts more serious
Dx?**
Stool sample with FLOURESCING oocytes under UV!!!!!
MICROSPORIDIA
...
Causes?
intestinal disease or disseminate throughout the body, microsporidiosis
Type of parasite?
obligate intracellular parasite

primitive eukaryotes

worldwide distribution
Infection by?
ingest spores
What we know about disease if from?
increased occurance in AIDS pts
Sx?
Chronic debilitating diarrhea, anorexia, weight loss, 10-20 stools a day
Extra intestinal Sx?
keratoconjunctivitis is an early indicator of dissemination

symps depend on organ infected
DIARRHEA QUIZ
...
Which has diarrhea that is foul smelling, greasy, and floating?
Giardhia
Which has bloody mucus?
Histolytica
Which is profuse and watery?
Crypto
Which is profuse and watery W/ RASPBERRY seeds?
Cyclospora
Which is seen under UV?
Cyclospora
Which can be debilitating to AIDS pts?
Crypto and Isospora