FLAGELLATES

Jose M. Duallo Jr., RMT

Mary Grace C. Tayong, RMT
 Learning Objective
• To know the morphologic features, laboratory
diagnosis, life cycle, epidemiology clinical
signs & symptoms, treatment, prevention and
control of the of pathogenic flagellates
infection.
 Flagellates are PROTOZOA
Protozoa are unicellular; lowest form of animal
3 Phyla:
1. Sarcomastigophora
• Subphylum Mastigophora (flagella)
• Subphylum Sarcodina (pseudopodia)
2. Ciliophora
3. Apicomplexa
4. Microspora
 Class Zoomastigophora
May be classified into:
1. Intesinal
• Giardia intestinalis
• Chilomastix mesnili
• Dientameoba fragilis
• Tichomonas hominis
• Retortamonas intestinalis
2. Extraintestinal
• Trichomonas tenax
• Trichomonas vaginalis
 Flagellates
• All flagellates have trophozoite stage – considered to
be more resistant to destructive forces (compared to
amoebas)
• Other species do not have cyst form
• Similar life cycle to amoebas
• Stool is examined for presence of trophozoites and/or
cysts (wet prep / iodine wet prep / permanent stain)
• Some flagellates may have finlike structures
(undulating membrane) and rodlike support structure
(axostyle)
• Recovered from patients with diarrhea without an
apparent cause
Intestinal Flagellates
 Giardia intestinalis
• AKA Giardia duodenale, Giardia lamblia; Old name “Cercomonas
intestinalis”
• ONLY known pathogenic intestinal flagellate; Causes Giardiasis,
traveller’s diarrhea
Morphology:
– Trophozoite:
• Pear-shaped, teardrop with falling leaf motility
• “Old man with eyeglasses/cartoon character/monkey’s face”
• Supported by axostyle made up of axonemes
• Median(parabasal) bodies
• Ventral sucking disc (nourishment point of entry)
– Cyst:
• Young : 2 nuclei; Mature: 4 nuclei; retracted flagella(axonemes); football
shaped
• More resistant to chlorination (filtration +chemical treatment)
Giardia intestinalis
 Giardia intestinalis
Epidemiology:
– one of most common causes of parasitic diarrhea among children
(day care centers), Eating contaminated fruit, oral-anal/fecal-oral
sex, contact with domestic animals
Pathogenesis:
– “gay bowel syndrome”, steatorrhea, frothy pale offensive stool, odor
of rotten eggs
– Fat-soluble vitamins deficiency, folic acid defeciency,
hypoproteinemia and hypogammaglobulinemia
Lab Diagnosis
– Seen In stool, duodenal aspirates; multiple samples is recommended
– DFA (gold standard); RT-PCR
– Self limiting; people with IgA deficiency are more susceptible to
recoccuring infections
 Giardia intestinalis
Treatment
– Metronidazole (Flagyl)
Prevention and Control
– Proper water treatment (double strength
iodine), Avoiding reservoir hosts, sanitary
practices, avoiding unprotected sex
 Chilomastix mesnili
• Non-pathogenic
Morphology
– Trophozoite:
• Spiral groove across the body; 3 anterior flagella and 1
within the cytosome“Corkscrew motility”, stiff rotary
movement
– Cysts
• Nipple-shaped /lemon shaped with clear hyaline knob
Chilomastix mesnili
 Dientamoeba fragilis
Morphology
– Trophozoite
• Binucleated
• Iron hematoxylin stain reveal rosette-shaped nuclei (chromatin granules)
• Resembles Trichomonas (NO Cyst form)
Epidemiology
– Unknown transmission
– Theory: transmitted via eggs of E. vermicularis and A. lumbricoides
– Seen in children, homosexual men, persons living semicommunal groups
Lab Diagnosis
– Stool exam, difficult to find; RT-PCR
Treatment
– Indoquinol (TOC) , Tetracycline, Paromomycin
Prevention and control
– Avoid unprotected homosexual sex, sanitary practices
Dientamoeba fragilis
 Trichomonas hominis
• Non-pathogenic
Morphology
– Trophozoite
• Pear-shaped with nervous, jerky motility
– Cyst: NONE
Epidemiology
– Warm and temperate climates; children
– Thru contaminatedmilk ; Achlorhydria
Trichomonas hominis
 Retortamonas intestinalis
• Nonpathogenic found in LI
Morphology
– Trophozoite
• 1 anterior and 1 posterior flagella with jerky movement
– Cyst:
• resembles Chilomastix Cyst
• Two fused fibrils split and extend separately posterior
to the nucleus (“bird’s beak”)
Retortamonas intestinalis
Extraintestinal Flagellates
 Trichomonas tenax
• Non-pathogenic
Morphology
– 5 flagella: 4 facing anterior, 1 facing posterior
– NO Cyst form
Epidemiology
– Contaminated dishes and utensils, droplet
contamination (kissing), patients with poor oral
hygiene
Lab Diagnosis
– Mouth scrapings
Trichomonas tenax
 Trichomonas vaginalis
Morphology
– Trophozoite
• pear-shaped,4-5 flagella which has jerky motility in wet preps
• NO Cyst stage
• Highly resistant (survive in urine, water , towels)
Epidemiology
– MOT: sexual, congenital, contaminated toilets, toiletries and
underwear
Pathogenesis
– Commonly asymptomatic in males
– Persistent Urethritis: thin white urethral discharge
– Persistent Vaginitis: foul-smelling, greenish-yellow liquid
– Infant Infections: respiratory and conjunctivitis
– Studies show connection to Cervical Carcinoma
 Trichomonas vaginalis
Lab Diagnosis
– Wet prep (spun urine, vaginal discharge, urethral
discharge and prostatic secretions)
– Papsmear
– Affirm VPIII (DNA-based test)
– InPouch TV (culture system) – 3days before result
Treatment
– Metronidazole (Flagyl)
Prevention and Control
– Avoid unprotected sex, avoid sharing of bathing
equipment
Trichomonas vaginalis
END…