Page 10 of 11: DEADLY PARASITES!!!

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Isospora belli
I. belli is a rare infection of normal humans, although it is being seen in increasing numbers in AIDS patients. The infection occurs via the oro-fecal route. The infective stage of the organism is an oval oocyst (Figure 11) which, upon ingestion, follows the same course as C. parvum. The disease produces symptoms similar to those of giardiasis. In normal individuals, mild infections resolve themselves with rest and mild diet and heavier infections can be treated with sulpha drugs. The treatment may have to be carried on for a prolonged period in AIDS patients.

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LUMINAL PROTOZOA :
TRICHOMONIASIS
Etiology
Trichomonas vaginalis (a flagellate)
Life cycle
T. vaginalis colonizes the vagina of women and the urethra (sometimes prostate) of men. Infection occurs primarily via sexual contact, although non-venereal infections are possible. The organism does not encyst and divides by binary fission which is favored by low acidity (pH > 5.9; the normal pH is 3.5 to 4.5). There is no non-human reservoir.
Symptoms
T. vaginalis infection is rarely symptomatic in men, although it may cause mild urethritis or occasionally prostatitis. In women, it is often asymptomatic, but heavy infections in a high pH environment may cause mild to severe vaginitis with copious foul-smelling yellowish, sometimes frothy discharge
Diagnosis
Clinical suspicion may be confirmed by finding the organism in Giemsa-stained smears (Figure 12) of vaginal discharge or, in difficult cases, by cultivation of a swab sample in Diamond's medium. Trophozoites must be distinguished from the non-pathogenic flagellate Trichomona hominis.
Treatment
Metronidazole (although teratogenic) is effective in both males and females. Vinegar douche may be useful. Personal hygiene and the use of condoms are helpful.

VAGINAL DISCHARGE IN TRICHOMONIAL INFECTION

TRICHOMONIAS VAGINALIS

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Entameba histolytica
MOT: Oro-fecal
SYMPTOMS: Dysentery with blood and necrotic tissue.
Chronic: abscesses
DIAGNOSIS:Stool: cysts with 1-4 nuclei and/or trophs.
Trophs in aspirate.
TREATMENT: GI: Iodoquinol or
Metronidazole
Abscess: Metronidazole

Giardia lamblia
MOT: Oro-fecal
SYMPTOMS: Fowl-smelling, bulky diarrhea; blood or necrotic tissue rare. DIAGNOSIS: Stool: typical old man giardia troph and/or cyst. TREATMENT:Iodoquinol or Metronidazole.

Balantidium coli
MOT:Oro-fecal; zoonotic
SYMPTOMS: Dysentery with blood and necrotic tissue but no abscesses. DIAGNOSIS:Stool: ciliated trophs and/or cysts. TREATMENT:Iodoquinol or Metronidazole.

Cryptosporidium parvum
MOT: Oro-fecal
SYMPTOMS: Diarrhea
DIAGNOSIS: Ooocysts in stool T
REATMENT: Paromycin (investigational)

Isospora belli
MOT:Oro-fecal
SYMPTOMS:Giardiasis-like
DIAGNOSIS:Ooocysts in stool
TREATMENT:Sulpha drugs

Trichomonas
vaginalis
MOT:Sexual
SYMPTOMS:Vaginitis; occasional urethritis/prostatitis.
DIAGNOSIS: Flagellate in vaginal (or urethral) smear.
TREATMENT:Mebendazole; vingar douche; steroids

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Trypanosoma brucei
MOT: Tsetse fly.
DISEASE/SYMPTOMS: Sleeping sickness; cardiac failure. DIAGNOSIS:Hemoflagellate in blood or lymph node.
TREATMENT: Blood stage: Suramin or petamidine isethionate;

Trypanosoma cruzi
MOT:Reduvid (kissing) bug.
DISEASE/SYMPTOMS: Chagas disease: megacolon, cardiac failure.
DIAGNOSIS:Hemoflagellate in blood or tissue.
CNS: melarsoperol
TREATMENT: Nifurtimox and Benzonidazole.

Leishmania donovani
MOT:Sand fly
DISEASE/SYMPTOMS: Visceral leish-maniasis, granulo-matous skin lesions.
DIAGNOSIS: Intracellular (macrophages) leishmanial bodies.
TREATMENT: Pentosam; Pentamidine isethionate.

Leishmania tropica
Sand fly.
Cutaneous lesions.
DIAGNOSIS: As for L. donovani.
TREATMENT: As for L. donovani.

Leishmania braziliensis
Sand fly
Mucocutaneous lesions.
DIAGNOSIS: As for L. donovani.
TREATMENT: As for L. donovani.

Plasmodium falciparum, P. ovale, P. malariae and P. vivax
MOT: Female anopheline mosquito.
DISEASE/SYMPTOMS: Malarial paroxysm: chills, fever, headache, nausea cycles.
DIAGNOSIS:Plasmodia in rbc, typical of the species involved.
TREATMENT: Quinine derivatives
Proguanil
Lariam

Babesia microti
MOT: Tick
DISEASE/SYMPTOMS: Hemolytic anemia, Jaundice and fever
DIAGNOSIS: Typical organism (Maltese cross) in rbc.
TREATMENT: None; self resolving.

Toxoplasma gondii
MOT:Oral from cat fecal material;or meat
DISEASE/SYMPTOMS: Adult: flu like;
congenital: abortion, neonatal blindness and neuropathies.
DIAGNOSIS:Intracellular (in macrophages) tachyzoites.
TREATMENT: Sulphonamides, pyemethamine, possibly spiramycin (non-FDA).

Pneumocystis jiroveci
MOT: Cough droplets
DISEASE/SYMPTOMS: Pneumonia
DIAGNOSIS: Pneumocystis in sputum.
TREATMENT: Trimethoprim and sulphamethoxazole.

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PLASMODIUM FALCIPARUM: MAURER'S DOT

PLASMODIUM VIVAX: SCHUFFNER'S

PLASMODIUM MALARIAE: ZIEMANN'S DOT

PLASMODIUM OVALE: JAME'S DOT

THESE DOTS ARE STIPPLING FOUND IN HOST CELL BY RESPECTIVE PLASMODIUM!

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PLASMODIUM FALCIPARUM : IN THE RING STAGE WE FIND MULTIPLE RINGS , ACCOLE, WING AND MARGINAL FORMS.
IN REST WE HAVE JUST THICKER CHROMATIN.

IN TROPHOZOITE FORM: WE SEE IN PLASMODIUM MALARIAE CHARACERISTIC BAND FORM, AND FOR FALCIPARUM IT IS SELDOM SEEN IN SMEAR IN THIS FORM.

WHEREAS , IN MICRO GAMAETOCYTE STAGE WE SEE IN FALCIPARUM KIDNEY SHAPED WITH BLUNT ROUND END FORM, CAN BE CALLED BANANA SHAPED.

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WHICH RBC IS AFFECTED BY EACH PLASMODIUM:

FALCIPARUM: ANY AGE
VIVAX: YOUNG RBC
MALARIAE: OLD
OVALE: YOUNG!

AND CHANGE IN HOST CELL SIZE:
FALCIPARUM: NOT ENLARGED
VIVAX: ENLARGED
MALARIAE: NOT ENLARGED
OVALE: ENLARGED!

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IN SMEAR WE FIND TROPHOZOITES , SCHIZONTS AND GAMETOCYTE FOR ALL EXCEPT FALCIPARUM WHERE WE CAN SE ONLY RINGS AND GAMETOCYTES!

AND IN IN FALCIPARUM ONLY WE FIND MULTIPLE INFECTION ON SINGLE RBC.....

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NOW THE COMPLICATIONS:

FALCIPARUM IS KNOWN FOR ITS CNS INVOLVEMENT.(REST OF THEM ALSO DO BUT NOT AS FALCIPARUM AND LEAST BY OVALE)

WHEREAS WE SEE NEPHROTIC SYNDROME::: MOSTLY BY PLASMODIUM MALARIAE AND LEAST BY VIVAX

ANEMIA IS MAXIMALLY CAUSED BY FALCIPARUM > VIVAX= MALARIAE> OVALE.

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HEY NEHRA IF POSSIBLE PLEASE WRITE THE TREATMENT OF MALARIA:

ESPECIALLY OF CHLOROQUINE RESISTANT ONE WITH THE PROPHYLAXIS!

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