Urogenital flagilates, & Ciliata Shaheed Beheshti University of Medical Sciences 1 A. Haghighi Sunday, December 17, 2017 Phylum Sarcomastigophora (Traditional cassification) (Flagella, Pseudophora) Subphylum: Mastigophora (flagella) • Class: Zoomastigophora • Order: 1- Kinetoplastida Suborder: Trypanosomatina ( Leishmania, Trypanosoma) 2- Diplomonadida Suborder: Diplomonadina (Giardia) 3- Trichomonadida (Dientamoeba, Trichomonas) 2 Classification of Protozoa ( 2000s cassification) Subkingdom: Archezoa (Archetista) a)Phylum: Sarcomastigophora Subphylum: Mastigophora (Flagella) 1- Phylum: Parabasalia Class: Zoomastigophora Order: Monocercomonadida a - Class: Trichomonadiea Genus: Dientamoeba - Order: Trichomonadida: Species: Dientamoeba fragilis (Jepps and Dobell, 1918) Dientamoeba fragilis; Trichomonas vaginalis; Pentatrichomonas hominis 3 Genus: Dientamoeba • ھﻣﮫ ﺧﺻوﺻﯾﺎت آﻣﯾﺑﮭﺎ را دارد و اﯾﺟﺎد ﭘﺎی ﮐﺎذب ﻣﯽ ﮐﻧد • ﻏﺎﻟﺑﺎً 2 ھﺳﺗﮫ ﺑﺎ ﮐﺎرﯾوزوم ﺑزرگ و ﻣﻌﻣوﻻً 4 ﺗﺎ 8 ﺗﮑﮫ Species: Dientamoeba fragilis • در اﯾن ﺗﮏ ﯾﺎﺧﺗﮫ ﮐﯾﻧﺗوﭘﻼﺳت و ﺗواﻧﺎﯾﯽ اﯾﺟﺎد ﺗﺎژک ﮔزارش ﺷده (Jepps and Dobell, 1918) • ﻧدرﺗﺎً 3 و 4 ھﺳﺗﮫ ای و ﻣﺣل اﺳﺗﻘرار ًروده ﺑزرگ Morphology ﻓﻘط ﺗروﻓوزوﺋﯾت Double Single nucleus nucleus 6-12 m 4 Life cycle 5 Dientamoeba fragilis (Jepps and Dobell, 1918) ﺑﯾﻣﺎرﯾزاﯾﯽ: D. Dragilis is a small cosmopolitan parasite. Only the trophozoite stage * ﻣﻌﺗﻘدﻧد ﮔﺎھﯽ ﺑﯾﻣﺎرﯾزاﺳت has been identified. There have been ﻋﻼﺋم: ﺑﯽ اﺷﺗﮭﻠﯾﯽ، درد ﺷﮑم، ﺗﮭوع و اﺳﺗﻔراغ، اﺳﮭﺎل و ﯾﺑوﺳت، ﮐﺎھش وزن، ﮔﺎھﯽ ﻣدﻓوع ﺧوﻧﯽ و ﺑﻠﻐﻣﯽ reports of infections with D. fragilis associated with gastrointestinal symptoms, but in most cases, the ﺗﺷﺧﯾص: Parasite is non-pathogenic. 1. ﻣﯾﮑروﺳﮑوﭘﯽ ﺷﺎﻣل: - (Wet mount) آزﻣﺎﯾش ﻣﺳﺗﻘﯾم در ﺳﮫ ﻧوﺑت - ﺗﻐﻠﯾظ (ﻓرﻣل اﺗر ﮐﻧﺳﺎﻧﺗراﺳﯾون) درﻣﺎن: - رﻧﮓ آﻣﯾزی داﺋﻣﯽ - ﻣﺗروﻧﯾدازول mg, 3 times / day / 10 days 250 2. ﮐﺷت - ﯾدوﮐﯾﻧول - ﺗﺗراﺳﯾﮑﻠﯾن 6 - ﭘﺎراﻣوﻣﺎﯾﺳﯾن Urogenital and intestinal flagilates Phylum: Sarcomastigophora Subphylum: Mastigophora (Flagella) Class: Zoomastigophora Order: Trichomonadidae ﺑﯿﺶ از 100 ﺗﺮﯾﮑﻮﻣﻮﻧﺎس Genus: Trchomonas ﺷﻨﺎﺳﺎﯾﯽ ﺷﺪه اﺳﺖ :Species - Trichomonas tenax - Trichomonas hominis Humans - Trichomonas vaginalis - Trichomonas foetus 7 Genus Trichomonas 8 Anterior flagellum Undolating Nucleus membran T. hominis Contractile Costa and Food vacuoles Parabasal body Axostyle Trophozoite - T. vaginalis- T. tenax - T. hominis - T. Foetus - 10-30 m- 5-16 m - 5-20 m - 10-20 m - Urogenital - Urogenital - Mouth - Intestine (lumen system system - Non of cecum) - - pathogenpathogen - Non pathogen pathogen از 160 ﺑﯿﻤﺎر ﺑﺎ ﻋﻔﻮﻧﺖ ﻟﺜﻪ در اﯾﺮان 33 ﻧﻔﺮ (6/20%) و از 160 ﺷﺎﻫﺪ ﺳﺎﻟﻢ 3 ﻣﻮرد (9/1%) ﺗﻨﺎﮐﺲ داﺷﺘﻨﺪ Trichomonas vaginalis (Donne, 1837) 15 to 60 % in high risk ladies 10-25% in women Over 200 million infected annually It estimated 3-4 million cases annually in America Only about 15%-40% of infected ladies show symptoms 9 Trichomonas vaginalis (Donne, 1837) راھﮭﺎی اﻧﺗﻘﺎل: ﻋﻠﻞ ﺑﯿﻤﺎرﯾﺰا ﺷﺪن: 1. ﻋﻣدﺗﺎً ﻣﻘﺎرﺑت 2. ﺗواﻟت ﻓرﻧﮕﯽ 1. اﻓﺰاﯾﺶ ﮔﻠﯿﮑﻮژن در واژن 3. ﻣﺎدران آﻟوده 2. ﮐﺎﻫﺶ Lactobacillus doderlin 4. اﺳﺗﺧرھﺎی ﺷﻧﺎ 3. اﻓﺰاﯾﺶ pH واژن ﺑﻪ ﺣﺪود 7-6 5. ﺣﻣﺎم ﺳوﻧﺎ 4. ﻋﺪم رﻋﺎﯾﺖ ﺑﻬﺪاﺷﺖ واژن 6. ﻟﺑﺎﺳﮭﺎی زﯾر ﻣﺷﺗرک 5. ﺧﺼﻮﺻﺎً در زﻧﺎن ﺑﺪﮐﺎره ﻋﻼﺋﻢ: • در ﻣﺮدﻫﺎ ﺑﺪون ﻋﻼﺋﻢ اﺳﺖ و ﺑﻨﺪرت اورﺗﺮﯾﺖ • در ﺧﺎﻧﻤﻬﺎ ﻫﻢ ﻏﺎﻟﺒﺎً (ﺗﺎ 60%) ﺑﺪون ﻋﻼﻣﺖ اﺳﺖ و ﯾﺎ اﯾﺠﺎد واژﯾﻨﯿﺖ ﻣﯽ ﮐﻨﺪ ﺑﺎ ﻧﺸﺎﻧﻪ ﻫﺎي: ﺗﺮﺷﺢ زﯾﺎد و ﺑﺪ ﺑﻮ، ادرار دردﻧﺎك، اﻟﺘﻬﺎب، ﺧﺎرش و ﺳﻮزش 10 Trichomonas vaginalis (Donne, 1837) ﺗﺷﺧﯾص: 1- ﻣﯾﮑروﺳﮑوﭘﯽ ﺷﺎﻣل: - آزﻣﺎﯾش ﻣﺳﺗﻘﯾم ﺗرﺷﺣﺎت واژن در ﺳﮫ ﻧوﺑت - رﻧﮓ آﻣﯾزی داﺋﻣﯽ ﺑﺎ ﮔﯾﻣﺳﺎ درﻣﺎن: 2. ﮐﺷت و ﺗﮑﺛﯾر ﺗﮏ ﯾﺎﺧﺗﮫ • ﻣﺗروﻧﯾدازول 3- ﺑروﻧﮑوﺳﮑوﭘﯽ و ﺳﯾﮕﻣوﺋﯾدوﺳﮑوﭘﯽ - ﺧوراﮐﯽ : mg, 3 times / day / 10days 250 - واژﯾﻧﺎل : mg intravaginal 500 ﭘﯿﺸﮕﯿﺮي: - ﮐﻠﯾﻧداﻣﺎﯾﺳﯾن • ﮐﻠوﺗزﯾﻣﺎزول (ﮐﻣﯽ ﻣؤﺛر) 1. ﻋﺪم ﻣﻘﺎرﺑﺖ ﺗﺎ 5 ﻫﻔﺘﻪ در ﺻﻮرت ﺗﺸﺨﯿﺺ آﻟﻮدﮔﯽ 100 mg intravaginal / 7 days 2. رﻋﺎﯾﺖ ﺑﻬﺪاﺷﺖ در ﻣﻘﺎرﺑﺖ 3. در ﻣﺎن ﻫﻤﺰﻣﺎن زن و ﺷﻮﻫﺮ 11 4. ﻋﺪم اﺳﺘﻔﺎده از ﻟﺒﺎس زﯾﺮ ﺑﻄﻮر ﻣﺸﺘﺮك Classification of Ciliophora Kingdom – Protista Subkingdom: Neozoa 1- Phylum: Ciliophora (Ciliates) - Class: Litostomatea - Order: Vestibuliferida: - Sub-order: Trichostomatida - Genus: Balantidium - Species: Balantidium coli 12 Balantidiom coli Iran in past • First report 1949 stowart in In South America, Philipina, Abadan South Guinea, Center of Asia • 2 cases 1950 Ansary in Tehran 60 to 90% in pigs • 72 cases 1952 Mac cary • 34000 people / 14 cases Rare in human (less than 1%) • 0.009% in Tehran suburbs Camels are also Sporadic in Sistan and Balochestan 13 reservoir hosts Phylum: Ciliophora Morphologu & Life cycle Balantidiom coli Cyst 40-60 X 50 -100 m 40-60 m Cytopharynx Macronucleus Micronucleus Cytopyge • ﻣﺣل اﺳﺗﻘرار روده ﺑزرگ • ﺑﯾﻣﺎرﯾزاﺳت 14 Histological Epidemiology Findings: - World wide distribution - invade the mucosa and sub mucosa - An estimated prevalence of 1% (U.S.A) - Causing ulceration and infiltration - Epidemics (psychiatric hospitals) - Sub mucosal abscesses - most commonly in - Potential to invade tissue • Latin American - Ulcer may be full of pus • Southeast Asia - Extra intestinal disease • Papua (new guinea) - A case of Pulmonary Balantidium • Mortality rate 30% in untreated - A case of pneumonia patients 15 Balantidiom coli << Claparede and Lachmann, 1858 >> ﺗﮑﺛﯾر : ﺗﺷﺧﯾص: 1. دوﺗﺎﯾﯽ ﻋرﺿﯽ : Binary fission آزﻣﺎﯾش روﺗﯾن ﻣدﻓوع، ﮐﻠوﻧﺳﮑوﭘﯽ، ﺳﯾﮕﻣوﺋﯾدوﺳﮑوﭘﯽ، 2. اﻟﺣﺎق : Conjugation رادﯾوﮔراﻓﯽ و CT رﯾﮫ، ﻋﻼﺋم : دﻟدرد، دﻟﭘﯾﭼﮫ، ﻧﻔﺦ ﺷﮑم، ﺗﮭوع و اﺳﺗﻔراغ، اﺳﮭﺎل، ﮐﺎھش وزن ﺑﯽ اﺷﺗﮭﺎﯾﯽ، ﺳردرد، دﯾﺳﺎﻧﺗری ﺑﺎﻻﻧﺗدﯾﺎل و اوﻟﺳرھﺎی ﺑﺎﻻﻧﺗﯾدﯾﺎل درﻣﺎن : 1. ﻣﺗروﻧﯾدﻟزول mg, 3 times / day / 7 days 750 ﭘﯾﺷﮕﯾری : 2. اﮐﺳﯽ ﺗﺗراﺳﯾﮑﻠﯾن mg, 3 times / day / 10 days 500 ﺑﮭﺑود ﺑﮭداﺷت ﻋﻣوﻣﯽ، ﺗﺎﻣﯾن آب ﺳﺎﻟم، ﺳﺎﻟﻣﺳﺎزی ﺗﻐذﯾﮫ 3. ﯾدوﮐﯾﻧول mg, 3 times /day / 20 days 650 ﺧوک، درﻣﺎن اﻓراد ﺑدون ﻋﻼﻣت 16.