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Home , Balantidium coli, Besnoitia, Isospora

ciliophora • General information • 1 cilia cover all over the body • 2 oval shape • 3 They have 2 nucleus • 4 Different types of vacuoles

• First report: • In 1857 by Malmsten in diarrhea sample • In 1861 Lukart and Ashtin reported from pigs • First balantidiosis report from Iran is from Abadan city by Stewart in 1949 coli – Morphology of 2 stages

1. TROPHOZOITE - large ovoid ; 30 to 150 µm in length and a lot of cili around its body (largest protozoan parasite of humans) • ID characters: 3 angle pristome , , cytopyge , 2 vacoules •Macro nucleous , micro nucleous • Reproduction: B. coli Trophs P C • Oval shape • Large curved macronucleus (M) V • Cytostome (C) • Peristomal cilia (P) • Food vacuoles (V) M 20 mm – Morphology of 2 stages

2. CYST - formed as feces dehydrate in the rectum • round shape; 40 – 60 µm in diameter; cyst wall has 2 transparent layer • transmission: • cyst is the diagnostic stage in a fecal smear 10 W m m Balantidium coli Life cycle The Phylum Ciliophora contains a single of medical importance. Balantidium coli

Hosts and habitat:

Pigs appear to be the source of most human cases

• See case report in lab that describes a fatal infection in a Venezuelan pig farmer.

Cosmopolitan in distribution but more common in the tropics Balantidium coli

• Disease: Balantidiosis • Causal Agent: Balantidium coli • Cysts are the parasite stage responsible for transmission. • The host acquires the cyst through ingestion of contaminated food or water (NOT in undercooked meat). • Common in pigs Epidemiology

• 2 spices is important • 1- balantidium coli • 2- balantidiun suis • Prevalence in pig is 63% -91% • Human infection is prevalent in people who have more occupational correlation with pigs Balantidium coli Pathology

Trophozoites are tissue invaders. They secrete proteolytic enzymes(hyaloronidaz) which digest the epithelium of the large intestine. They are formed in the mucosa of the large intestine and extend into the submucosa. Ulceration results in bleeding and secondary bacterial infection. Perforation of the large intestine has occurred in some fatal cases. Disease is primarily _Secondary infections in other organs such as liver and lungs are rare. Balantidium coli

• Trophozoites

Cytostome Cytostome Diagnosis

• Bloody feces with diahrea • Observing balantidim cyst in the stool exam Balantidium coli Prevention and treatment

Prevention Avoid ingestion of material contaminated with animal feces like water vegtables

Treatment Tetracycline 500 mg x4) daily for 10 days Iodoquinol 650 mg TID for 20 days Metronidazole 750 mg TID for 7days Controll of electrolite and water 6 • Kingdon: • Phylum: • Class: Sporosoea • Subclass: Coccidiasina • Family: • Genus: 1- 2- 3- • Family: Sarcostidae • Subfamily: Sarcocystinae • Genus: 1- 2- • Subfamily: Toxoplasmatinae • Genus: 1-Toxoplasma 2- 3-Hamondia 4- • Family: Cryptosporidiidae • Genus: 1- General information • Non agents

• An opportunistic parasites

• Pathogen parasites Life cycle two host

Sexual cycle  in predator  oocyst or sporocyst

Asesual cycle  in prey  infection Life cycle One host • Sexual and asexual in one host

• Cryptosporidium • Isospora • Eimeria Cryptosporidium

• First report from mouse gut by tizzer in 1907 • The second report from different vertebrata was done in 1976 . • It was reported from CDC as main agent of diarrhea in Aids patients in1982 • The First epidemy was born in America in 1993 Cryptosporidium : general information

• Size =2-6 micron • Living place =brush border of gastrointestinal or respiratory epithelial cell • Intra cellular and extra cytoplasmic Cryptosporidium: hosts

1-cattle 2-immunocomporomized patients 3-aids patients 4-under treatment cancer patients 5-transplanted patients Life cycle of cryptosporidium and human Life cycle of cryptosporidium

• Sign : • fever • vomiting • nausea • Diarrhea • abdominal crump Important species Final host Oocyst size 1- C. homini Human 5.4 x 4.7 2- C. bovis cattle 4.9 x 4.6 3-C. mleagridis turkey 4. 5 x 4.0 4- C. andersoni sheep 7.5 5.5 x 5- C. felis cat 5.0 x 4.5 6- C. baileyi chiken 6.2 x 4.6 7- C. canis dog 4.9 x 4.7 8- C. suis pig 4.6 x 4.2 9- C. parvum mouse 5.2 x 4.6 10- C. muris mouse 7.0 x 5.0 Diagnosis: Modified zeil-nelson staining

• 1-رﻧﮓ ﻓﻮﺷﯿﻦ ﺑﺎزﯾﮏ • 2-ﻣﺘﯿﻠﻦ ﺑﻠﻮ ﯾﺎ ﺳﺎﻓﺮاﻧﯿﻦ • 3-ﻣﺘﺎﻧﻮل ﺧﺎﻟﺺ • 4- ﻓﻨﻞ ﺟﺎﻣﺪ • 5-اﻟﮑﻞ اﺗﯿﻠﯿﮏ 96درﺟﻪ • 6-اﺳﯿﺪ ﺳﻮﻟﻔﻮرﯾﮏ • ﻻم ﺗﻤﯿﺰ ﺷﺪه ﺑﺎ اﻟﮑﻞ • ﭘﺘﺎس 10 درﺻﺪ • ﺳﺮم ﻓﯿﺰﯾﻮﻟﻮژي • ﺑﺎﮔﺖ ﭼﻮﺑﯽ • ﻓﺮﻣﺎﻟﺪﺋﯿﺪ 10درﺻﺪ • اﺗﺮ • ﮔﺎز ، ﭘﻨﺒﻪ ، ﻗﯿﻒ ، دﺳﺘﮕﺎه ﺳﺎﻧﺘﺮﯾﻔﻮژ، ﻟﻮﻟﻪ ﻣﺨﺮوﻃﯽ

23

diagnosis

• IFA test diagnosis

• Elisa test diagnosis

• Molecular technique Electrophoresis gel for Cryptosporidium Epidemiology

• Important agent of diarrhea in human • Australia: 4% of patients in hospital • Central africa:3% of 100 adult patients • And 3% of 193 child • Haeity :17% of 824 children under 2years • South Carolina: most prevelent parasite in children • USA : 65%to 97% of steal water are infected • Milvaki : more than 400,000 cases reported Treatment &prevention

• Nitazoxanide

Immunocompetent Persons(3)

Adult dosage 500 mg BID x 3 days

1-3 years: 100 mg BID x 3 days Pediatric dosage 4-11 years: 200 mg BID x 3 days

Nitazoxanide oral suspension (100 mg/5ml; patients ≥ 1 year of age) and Nitazoxanide tablets (500 mg; patients ≥ 12 years of age) are indicated for the treatment of diarrhea caused by Cryptosporidium. Spiramycin:1g TID x2 weeks • First report by Gilberg and Virashow in 1960 • Eimer reported first human infection • Venion described the oocyst and detected two type Isospora in human I. belli • I.hominis Isospora

• This protozoa is parasite of epithelial cell of cecaum and destroy these cells

• Isospora belli

• Isospora natalensis

• Isospora hominis( sarcocystis) Isospora belli

• Defenit host : human • Most prevalant area: • Chilli • central america • south Africa • south east Asia Morphology :

• Oocyst : 25-30miron length,12-16 micron width ,has two thin layer • 1sporoblast • 2sporocyst • Mature in • 4-5 days 4sporozoite re 5. Wet Mount Staining Techniques for I. belli These stool sample wet mount tests show three wet mount techniques for diagnosing I. belli: bright-field microscopy (A & D); differential interference contrast (DIC) (B & E), and blue UV fluorescence microscopy (C & F). The images on the top row (A,B, & C) show I. belli with a single internal sporoblast and the images on the bottom row (C,D,&E) show two internal sporoblasts. Figure and figure legend reproduced from: Centers for Disease Control and Prevention, Division of Parasitic Diseases. DPDx: Laboratory identification of parasites of public health concern. Isosoporiasis. Available at: Life cycle:

• Direct transfer via mouth with : • food • water • vegetables • Sexual and asexual in epitelial cell of cecaum Isospora life cycle Sign:

• fever • vomiting • nausea • Diarrhea • abdominal crump • weight Loss Diagnosis:

• Observing oocyst in fecal smear

• Flotation :zinc sulfate sugar flotation

• Sedimentation Treatment:

• Premetamin & sulfadiasin 75&45mg • Daily x10 days • Trimetoprim &sulfamethoxazole 160&800 mg • Daily x10 days Cyclospora

• Agent of diarrhea in vertebratas &rodents • Reptilia • The first time in 1977 the agent of the chronic diarrhea named cyanobacterium and some years later it was revealed to be from coccidia • which described • In kaytano university in preau Cyclospora

• Oocyst 8-10 micron • Without spore • With central merola • and 6-9 spherical body Cyclospora

Sources of infection: Drinking water Fruit, vegetables,lettuce Oocyst cyclospora Cyclospora life cycle Life cycle:

• Oocycst without sporelation • Sporelated invitro 5-10 days • Two sporocyst • Each sporocyst has • 2 sporozoite Epidemiology:

• First report from Ginea Papoa • Most prevelant area: • Nepal • Haeite • Preau Diagnosis:

• Observing oocyst in fecal smear

• Sedimentation: ethylen acetate

• Their oocyst has auto fluorescent • Asexual cylce can be followed in jojnum biopsy Comprative slides

Figure 4. Comparative Size of Coccidian Parasites These stool samples stained with modified acid-fast stain show Cryptosporidium sp. (left), Cyclospora cayentanensis (middle), and I. belli (right). Figure and figure legend reproduced from: Centers for Disease Control and Prevention, Division of Parasitic Diseases. DPDx: Laboratory identification of parasites of public health concern. Isosoporiasis. Available at Treatment:

• Trimetoprim &sulfamethoxazole 160&800 mg • Daily x10 days • Cyclosporidiosis cured • Cryptosporidiosis cureless Sarcocystis

• In1868 Lindeman reported in human • Morphology: • Banana shape with more than thousand trophozoite • Size is different from 1 mm to 5 cm Sarcocystis:

• Sarcocystis hominis (bovi hoiminis) • Sarcocysti sui hominis • Sarcocysti lindemani Sarcocyst life cycle

• دارای ﭼرﺧﮫ اﺟﺑﺎری در دو ﻣﯾزﺑﺎن ﻣﮭره دار ﮐﮫ ﯾﮑﯽ ﺷﯾزوﮔوﻧﯽ در ﻣﯾزﺑﺎن واﺳط (ﺷﮑﺎر و دﯾﮕری ﺗوﻟﯾد ﻣﺛل ﺟﻧﺳﯽ در ﻣﯾزﺑﺎن ﻧﮭﺎﺋﯽ (ﺷﮑﺎرﭼﯽ) اﺳت. • ﺑﺎ ﺧورده ﺷدن ﻋﺿﻠﮫ آﻟوده ﺗوﺳط ﻣﯾزﺑﺎن ﺟدﯾد ﺟدار ﮐﯾﺳت ھﺎ ﺗوﺳط اﺳﯾد ﻣﻌده ھﺿم ﺷده و ﭘروﺗوﭘﻼﺳم ھﺎ وارد دﺳﺗﮕﺎه ﮔردش ﺧون ﺷده و ﺑﮫ ﻋﺿﻼت ﻣﺧطط ﻣﯾروﻧد • 4-6 ھﻔﺗﮫ ﺑﻌد اﺟﺳﺎم ﻣدوری ﺗوﻟﯾد ﻣﯾﺷود ﮐﮫ ﺗﺑدﯾل ﺑﮫ ﮐﯾﺳت ﻣوزی ﺷﮑل ﻣﯾﺷوﻧد Sarcocystis:

• Sarcocyst from beef and pork are eaten and burst in small intestine and liberate numerous cystizoites which penetrate the epithelium of the intestinal to the subepithelium space for asexual cycle • The cystozoite in the epithelium tissues develop into further sarcocyst containing numerous merozoites which are released Sexual cycle:

• Merozoites enter the epithelial cell of mucosa to form micro and macrogametocyt and they escape to the gut lumen and to form to oocysts with 2 sporocysts and 4 sporozoite • Infective oocyst are eaten by pigs or cattle. • After schizogony forming numerous merozoites. • Sexual cycle:

• After about 1 month the merozoite inter muscle cell (heart ,oesophagous) where they secrete a cell wall inside which they multiply to form containing numerous cystozoite • The sarcocyst remain dormant in the tissue until eaten by definitive host

Sarcocyst life cycle sarcocystis

• Sporocyst size: 13/1-17x7/7-10/8 micron ﺑﯿﻤﺎرﯾﺰاﺋﯽ

• آﻟودﮔﯽ ﺑﮫ ﺳﺎرﮐوﺳﯾﺳﺗﯾس ﻣﯾﺗواﻧد ﺑﺎ ﻋﻼﺋم ﯾﺎ ﺑدون ﻋﻼﺋم ﺑﺎﺷد • ﻋﻼﺋم ﺷﺎﻣل اﺳﮭﺎل ﻣﻼﯾم ،ﮐراﻣﭘﮭﺎی ﺷﮑﻣﯽ ،ﻧﮑروز اﭘﯾﺗﻠﯾﺎل روده واﺋوزﯾﻧوﻓﯾﻠﮭﺎی ﺳﮕﻣﺎﻧﺗﮫ در ﻧﺎﺣﯾﮫ ژوژﻧوم و اﯾﻠﺋوم ﻣﯾﺑﺎﺷد • ﻣراﺣل ﺗﮑﺛﯾر در ﮔﺎو ﺑﯾﻣﺎری ﺧﻔﯾف اﯾﺟﺎد ﻣﯾﮑﻧد sarcocystis

Sign: usually no sign 3-6 hour, nusea. pain, diarrhea after infected Diagnosis:

• Observing sporocyst with 4 sporozoite in fecal wet mount Thank you for your attention