1. MEDICAL PARASITOLOGY & ENTOMOLOGY LECTURER: SR. NORAZSIDA RAMLI

2. Intestinal Sporozoa Cryptosporidium parvum Isospora belli Cyclospora cayetanensis Sarcocytis species

3. General characteristics Nonmotile Nonmotile Obligate intracellular parasites Obligate intracellular parasites Having complex life cycle Having complex life cycle With alternating sexual and asexual phases With alternating sexual and asexual phases Oocyst containing mature sporozoites Oocyst containing mature sporozoites Sporocyst- a sac within certain oocysts containing sporozoites. Sporocyst- a sac within certain oocysts containing sporozoites.

4. Cryptosporidium parvum Oocyst: - round to slightly oval, 4-6µm, Oocyst: - round to slightly oval, 4-6µm, mature oocyst: - contains 4 sporozoites surrounded by a thick double layered wall; no sporocyst are visible; dark staining granul are usually apoparent. mature oocyst: - contains 4 sporozoites surrounded by a thick double layered wall; no sporocyst are visible; dark staining granul are usually apoparent. Schizont and gametocytes: small, 2-4µm, are produced during the life cycle, but rarely seen in human specimens. Schizont and gametocytes: small, 2-4µm, are produced during the life cycle, but rarely seen in human specimens. Cause cryptosporidiosis, zoonotic transmission does occur. Cause cryptosporidiosis, zoonotic transmission does occur.

6. Life cycle

7. Transmission Occurs by ingestion of food or water contaminated with infective oocysts Occurs by ingestion of food or water contaminated with infective oocysts Person to person contact Person to person contact Distributed worldwide, in most untreated water supplies Distributed worldwide, in most untreated water supplies Difficult to remove physically Difficult to remove physically Resistant to many chemicals including chlorine. Resistant to many chemicals including chlorine. Reservoir host: cattle Reservoir host: cattle

8. Pathogenesis Causes self-limited diarrhea in immunocompetent individuals Causes self-limited diarrhea in immunocompetent individuals Incubation period: one to several weeks. Incubation period: one to several weeks. Symptoms: nausea, fever, vomiting, anorexia, abdominal cramps, watery diarrhea, constipation Symptoms: nausea, fever, vomiting, anorexia, abdominal cramps, watery diarrhea, constipation Recovery- dependent on the immune status of the host. Recovery- dependent on the immune status of the host. Serious in infant- cause of morbidity and mortality Serious in infant- cause of morbidity and mortality Immunocompromised individuals- often suffer severe, intractable diarrhea. Immunocompromised individuals- often suffer severe, intractable diarrhea. Patient with AIDS- becomes progressively worse, does not respond to treatment  may cause death, respiratory tract may also be infected. Patient with AIDS- becomes progressively worse, does not respond to treatment  may cause death, respiratory tract may also be infected.

9. Laboratory diagnosis Biopsy Biopsy Microscopic examination Microscopic examination - Modified acid fast stain - Sheather’s sugar flotation method - Formalin fixed - Giemsa stained smears Immunodiagnostic assay Immunodiagnostic assay Enzyme linked immunosorbent assay (ELISA) Enzyme linked immunosorbent assay (ELISA) Fluorescent antibody detection methods Fluorescent antibody detection methods

10. Treatment Highly active antiretroviral treatment (HAART) of HIV– for AIDS patient. Highly active antiretroviral treatment (HAART) of HIV– for AIDS patient. Nitazoxanide- non-immunocompromised individuals. Nitazoxanide- non-immunocompromised individuals.

11. Prevention Proper water treatment Proper water treatment Good sanitary practice Good sanitary practice Treat water supplies with filtration technique, as well as chemicals Treat water supplies with filtration technique, as well as chemicals Zoonotic transmission may be prevented by reducing or eliminating contact especially of immunocompromised individuals, with animals. Zoonotic transmission may be prevented by reducing or eliminating contact especially of immunocompromised individuals, with animals.

12. Isospora belli Oocyst: elliptical or oval, 25-30µm by 10-17µm Oocyst: elliptical or oval, 25-30µm by 10-17µm Immature oocyst: containing a single central mass. Immature oocyst: containing a single central mass. Mature oocyst: develops 2 sporoblasts, which develop into 2 sporocysts, each containing 4 cigar-shaped sporozoites, surrounded by double layered wall. Mature oocyst: develops 2 sporoblasts, which develop into 2 sporocysts, each containing 4 cigar-shaped sporozoites, surrounded by double layered wall.

15. Life cycle

16. Transmission Occurs by ingestion of water or food containing infective oocysts. Occurs by ingestion of water or food containing infective oocysts. Zoonotic transmission does not occur. Zoonotic transmission does not occur. Unprotected sexual activities: – anal-oral sexual. Unprotected sexual activities: – anal-oral sexual.

17. Pathogenesis Infection is often asymptomatic and self-limited. Infection is often asymptomatic and self-limited. When present, symptoms include: When present, symptoms include:-diarrhea -abdominal pain -Weight loss -anorexia An increase of infection in AIDS patients has been reported in recent year. An increase of infection in AIDS patients has been reported in recent year.

18. Laboratory diagnosis Similar to C. parvum. Similar to C. parvum.

19. Treatment Asymptomatic individuals may not require treatment Asymptomatic individuals may not require treatment Trimethoprim-sulfamethoxazole Trimethoprim-sulfamethoxazole Metronidazole Metronidazole Tetracycline Tetracycline Pyrimethamine-sulfadiazine Pyrimethamine-sulfadiazine

20. Prevention Good personal hygiene Good personal hygiene Good sanitary conditions Good sanitary conditions Protected homosexual contact Protected homosexual contact

21. Cyclospora cayetanenis Oocyst: spherical –similar like C. parvum but larger than – 8-10µm, contains 2 sporocysts, each containing 2 sporozoites. Oocyst: spherical –similar like C. parvum but larger than – 8-10µm, contains 2 sporocysts, each containing 2 sporozoites.

24. Life cycle

25. Transmission Occurs by ingestion of contaminated food or water. Occurs by ingestion of contaminated food or water.

26. Pathogenesis Incubation period: 2 to 7 days Incubation period: 2 to 7 days Clinical manifestation: Clinical manifestation: - Diarrhea - Myalgia - Anorexia - Weight loss - Fatigue - Vomiting - “flu-like” symptoms

27. Laboratory diagnosis Flotation Flotation Microscopy examination – using phase contrast microscopy and electron microscope. Microscopy examination – using phase contrast microscopy and electron microscope.

28. Treatment Trimethoprim-sulfamethoxazole Trimethoprim-sulfamethoxazole

29. Prevention Good hygiene Good hygiene Good sanitation practices Good sanitation practices Adequate water treatment methods Adequate water treatment methods Thorough washing of fruits and vegetables Thorough washing of fruits and vegetables

30. Sarcocytis species S. bovihominis- in cattle S. bovihominis- in cattle S. suihominis- in pigs S. suihominis- in pigs Oocyst: oval, contains 2 sporocysts with 4 cigar- shaped sporozoites, 25-33µm, sporocyst is similar to C.parvum but larger, bout 9-16µm, surrounded by double-layered wall Oocyst: oval, contains 2 sporocysts with 4 cigar- shaped sporozoites, 25-33µm, sporocyst is similar to C.parvum but larger, bout 9-16µm, surrounded by double-layered wall Sarcocystis “lindemanni” is the term gien to those organisms that may potentially parasitize humans. Sarcocystis “lindemanni” is the term gien to those organisms that may potentially parasitize humans.

31. Life cycle

32. Transmisson Occur by ingestion of improperly cooked meat (containing the sarcocyst form in muscle). Occur by ingestion of improperly cooked meat (containing the sarcocyst form in muscle). By ingestion of animal feces-contaminated food or water ( oocyst stage in stool). By ingestion of animal feces-contaminated food or water ( oocyst stage in stool).

33. Pathogenesis Symptoms: Symptoms:-diarrhea -abdominal pain -weight loss -muscle pain  may be associated with the presence of sarcocysts in human striated muscle Most cases r asymptomatic Most cases r asymptomatic

34. Laboratory diagnosis Microscopy examination Microscopy examination Muscle biopsies  histological method Muscle biopsies  histological method

35. Treatment No treatment for the muscle form of sarcocytis infection. No treatment for the muscle form of sarcocytis infection. Trimethoprim – sulfamethoxazole Trimethoprim – sulfamethoxazole Pyrimethamine - sulfadiazine Pyrimethamine - sulfadiazine

36. Prevention Adequate cooking of meat Adequate cooking of meat Avoidance of contact with animal feces Avoidance of contact with animal feces - Prevents infection of humans as intermediate hosts.