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Chapter 23 the Parasites of Medical Importance Lecture PowerPoint to accompany Foundations in Microbiology Seventh Edition Talaro Chapter 23 The Parasites of Medical Importance Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. 23.1 Parasitology • The study of eukaryotic parasites, protozoa, and helminths • Cause 20% of all infectious diseases • Less prevalent in industrialized countries; increasingly common in AIDS patients 2 23.2 Typical Protozoan Pathogens • Single-celled, animal-like microbes, most having some form of motility • Estimated 100,000 species, approximately 25 are important pathogens • Life cycles vary – Most propagate by simple asexual cell division of the active feeding cell (trophozoite) – Many undergo formation of a cyst – Others have a complex life cycle that includes asexual and sexual phases 3 4 5 Infective Amebas 6 Entamoeba Histolytica and Amebiasis • Alternates between a large trophozoite, motile by means of pseudopods and a smaller nonmotile cyst • Trophozoite has a large nucleus and lacks most other organelles • Humans are the primary hosts • Ingested • Carried by 10% of world population 7 Figure 23.1 Entamoeba histolytica 8 Entamoeba Histolytica • Cysts are swallowed and arrive at the small intestine; alkaline pH and digestive juices stimulate cysts to release 4 trophozoites • Trophozoites attach, multiply, actively move about and feed • Asymptomatic in 90% of patients • Ameba may secrete enzymes that dissolve tissues and penetrate deeper layers of the mucosa • Causing dysentery, abdominal pain, fever, diarrhea, and weight loss 9 Figure 23.2 Intestinal amebiasis 10 Entamoeba Histolytica • Life-threatening manifestations are: hemorrhage, perforation, appendicitis, and tumorlike growths, amoebomas • May invade liver and lung • Severe forms of disease result in 10% fatality rate • Effective drugs are iodoquinol, metronidazole, and chloroquine 11 Figure 23.3 Entamoeba histolytica in specimen 12 Amebic Infections of the Brain • Caused by Naegleria fowleri and Acanthamoeba • Ordinarily inhabit standing water • Primary acute meningoencephalitis is acquired through nasal contact with water or traumatic eye damage • Infiltration of brain is usually fatal 13 An Intestinal Ciliate: Balantidium Coli • An occupant of the intestines of domestic animals such as pigs and cattle • Acquired by ingesting cyst-containing food or water • Trophozoite erodes intestine and elicits intestinal symptoms • Healthy humans are resistant • Rarely penetrates intestine or enters blood • Treatment – tetracycline, iodoquinol, nitrimidazine or metronidazole 14 Figure 23.5 (a) Microscopic views of Balantidium coli 15 The Flagellates 16 Trichomonads: Trichomonas Species • Small, pear-shaped • 4 anterior flagella and an undulating membrane • Exist only in trophozoite form • 3 infect humans: – T. vaginalis – T. tenax – T. hominis 17 Figure 23.6 Trichomonads of humans 18 Trichomonas Vaginalis • Causes an STD called trichomoniasis • Reservoir is human urogenital tract • 50% of infected are asymptomatic • Strict parasite, cannot survive long outside of host • 3 million cases yearly, a top STD • Female symptoms – foul-smelling, green-to-yellow discharge; vulvitis; cervicitis; urinary frequency and pain • Male symptoms – urethritis, thin, milky discharge, occasionally prostate infection • Metronidazole 19 Giardia Lamblia and Giardiasis • Pathogenic flagellate • Unique symmetrical heart shape with concave ventral surface that acts like a suction cup • Cysts are small, compact, and multinucleate • Reservoirs include beavers, cattle, coyotes, cats, and humans • Cysts can survive for 2 months in environment • Usually ingested with water and food • ID 10 to 100 cysts 20 Figure 23.7 (a) Identification of trophozoites 21 • Cysts enter duodenum, germinate, travel to jejunum to feed and multiply • Causes giardiasis – diarrhea, abdominal pain • Diagnosis is difficult because organism is shed in feces intermittently • Treatment: quinacrine or metronidazole • Agent is killed by boiling, ozone, and iodine 22 Hemoflagellates: Vector-Borne Blood Parasites • Obligate parasites that live in blood and tissues of human host • Cause life-threatening and debilitating zoonoses • Spread in specific tropical regions by blood- sucking insects that serve as intermediate hosts • Have complicated life cycles and undergo morphological changes • Categorized according to cellular and infective stages 23 Hemoflagellates • Amastigote: the form lacking a free flagellum • Promastigote: the stage bearing a single, free, anterior flagellum • Epimastigote: the flagellate stage • Trypomastigote: large, fully formed stage 24 25 Trypanosoma Species and Tropanosomiasis • Distinguished by their infective stage; trypomastigote is an elongate, spindle- shaped cell with tapered ends, eel-like motility • 2 types of trypanosomiasis: – T. brucei – African sleeping sickness – T. cruzi – Chagas disease – endemic to Central and South America 26 Trypanosoma Brucei and African Sleeping Sickness • Spread by tsetse flies • Harbored by reservoir mammals • Two variants of disease caused by 2 subspecies: – T.b. gambiense – Gambian strain; West Africa – T.b. rhodesiense – Rhodesian strain; East Africa • Biting of fly inoculates skin with trypomastigotes, which multiplies in blood and damages spleen, lymph nodes, and brain 27 Figure 23.8 Cycle of the tsetse fly vector 28 Trypanosoma Brucei and African Sleeping Sickness • Chronic disease symptoms are sleep disturbances, tremors, paralysis, and coma • Trypanosomes are readily demonstrated in blood, spinal fluid, or lymph nodes • Treatment before neurological involvement melarsoprol, eflornithine • Control involves eliminating tsetse fly 29 Trypanosoma Cruzi • Causes Chagas disease • Reduviid bug (kissing bug) is the vector • Infection occurs when bug feces is inoculated into a cutaneous portal • Local lesion, fever, and swelling of lymph nodes, spleen, and liver • Heart muscle and large intestine harbor masses of amastigotes • Chronic inflammation occurs in the organs (especially heart and brain) • Treatment nifurtimox and benzonidazole 30 Figure 23.9 American trypanosomiasis (Chagas disease) 31 Figure 23.10 Conditions associated with Chagas disease 32 Leishmania Species and Leishmaniasis • Leishmaniasis – zoonosis transmitted among mammalian hosts by female sand flies that require a blood meal to produce eggs • Endemic to equatorial regions • Promastigotes are injected with sand fly bite, convert to amastigote and multiply; if macrophage does not migrate the infection is localized; systemic if macrophage migrates 33 • Cutaneous-oriental sore, Baghdad boil – localized ulcerated sore • Espundia – skin and mucous membrane infection of the head; chronic infection • Systemic (visceral) – high intermittent fever; weight loss, enlarged spleen, liver, and lymph nodes – Kala azar is the most severe and fatal form if untreated 34 Figure 23.11 Life cycle and pathology of Leishmania species 35 23.3 Apicomplexan Parasites • Sporozoans • Lack locomotor organelles in the trophozoite state • Alternate between sexual and asexual phases and between different animal hosts • Most form specialized infective bodies that are transmitted by arthropod vectors, food, water, or other means – Plasmodium – Toxoplasma – Cryptosporidium 36 Plasmodium: The Agent of Malaria • Dominant protozoan disease • Obligate intracellular sporozoan • 4 species: P. malariae, P. vivax, P. falciparum, and P. ovale • Female Anopheles mosquito is the primary vector; blood transfusions, mother to fetus • 300-500 million new cases each year • 2 million deaths each year 37 Figure 23.12 The malaria belt 38 2 distinct phases of malarial parasite development: • Asexual phase – human host – Infected female mosquito injects asexual sporozoite which localizes in liver; it then undergoes schizogony generating numerous merozoites which enter circulation in 5-16 days depending on species – Merozoites attach to and enter red blood cells, convert to trophozoites and multiply; red cell bursts releasing merozoites that differentiate into gametes 39 • Sexual phase – mosquito host – Mosquito draws infected RBCs; gametes fertilize forming diploid cell which forms sporozoites in stomach – Sporozoites lodge in salivary glands; available to infect human host 40 Figure 23.13 Plasmodium 41 Plasmodium • Symptoms include episodes of chills-fever-sweating, anemia, and organ enlargement • Symptoms occur at 48-72 hour intervals as RBCs rupture; interval depends on species • P. falciparum most malignant type; highest death rate in children • Diagnosis by presence of trophozoite in RBCs, symptoms • Increasing drug resistance • Therapy is chloroquine, mefloquine 42 Figure 23.14 Malaria 43 Coccidian Parasites • Zoonotic in domestic animals and birds 44 Toxoplasma Gondii and Toxoplasmosis • Intracellular apicomplexan parasite with extensive distribution • Lives naturally in cats that harbor oocysts in the GI tract • Acquired by ingesting raw meats or substances contaminated by cat feces • Most cases of toxoplasmosis go unnoticed except in fetus and AIDS patients who can suffer brain and heart damage • Treatment: pyrimethamine and sulfadiazine 45 Figure 23.16 The life cycle and morphological forms of Toxoplasma gondii 46 Figure 23.17 Toxoplasmosis in the brain of an AIDS patient 47 Sarcocystis and Sarcocystosis • Sarcocystis – parasites of cattle, swine, and sheep • Domestic animals are intermediate hosts; they pick up infective cysts while grazing on grass contaminated with human feces • Humans are infected when the meat is consumed
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