1. Flagellate

2. Flagellates (Matigophora) Mastigophora, the flagellates, have one or more whip-like flagella, the organ for motility.

3. Classification of Flagellates 1.Intestinal, oral and genital flagellates : a)Genus Giardia :  G. Intestinalis ( duodenum) b)Genus Chilomastix :  C. mesnili ( caecum) c)Genus Trichomonas :  T. hominis ( ileo-caecal region)  T. tenax ( teeth & gum)  T. vaginalis ( vagina)

4. 2. Blood & tissue flagellates : a)Genus Trypanosoma b)Genus Leishmania.

5. Most lumen dwelling flagellates are non pathogenic commensals except: - Giardia lamblia -Trichomonas vaginalis

6. Common characteristics All flagellates except Trichomonas, have a trophozoite & cystic stage. The trophozoites possess multiple flagella which arise from blepharoplasts. Axostyle ( central supporting rod) may present. Reproduction occurs by binary fission.

7. Giardia lamblia

8. Synonym : G. intestinalis, Lamblia intestinalis. Habitat : Duodenum & upper part of Jejunum. Morphology : two phases- i.Trophozoite ii.Cyst.

9. Trophozoite Inverse pear shaped Two nuclei Two axostyles 4 pairs of flagella 2 parabasal/ median bodies One sucking disc ventrally.

12. A trophozoite of Giardia lamblia troph. The two nuclei are easy to see in this image.

13. Giardia lamblia trophozoites, as they appear with the scanning electron microscope.

14. Cyst Oval in shape Thick cyst wall The immature Cysts usually Have two nuclei.

15.  A cyst of Giardia lamblia stained with iodine.

16. The mature cysts usually have four nuclei The mature cysts is the infective stage of Giardia lamblia Remnants of flagella and sucking disc may be seen The mature cysts have strong resistance to the environment

18. The cysts are hardy, can survive several months in cold water. Infection occurs by the ingestion of cysts in contaminated water, food, or by the fecal-oral route. Cysts of Giardia lamblia

20. Life cycle

22. Trophozoites Cysts Mature Cysts Duodenum, gall bladder The lower portion Of ileum or colon Contaminate water And food Outside Outside They multiply by Binary fission diarrhea

23. Host: human Two stages: Trophozoite and cyst Infective stage: mature cyst People who ingest the mature cysts in Contaminated water and food get infection They multiply by binary fission Infectivity is high. Only 10 cysts are enough to cause the infection

24. Pathogenesis and symptoms Pathogenesis and symptoms G. lamblia inhabits in the duodenum and upper ileum Trophozoite attaches to the mucosa by sucker Trophozoites multiply by binary fission They damage the mucosa and cause atrophy of the villus

25. Pathogenesis and symptoms Common Symptoms Of Giardiasis Watery diarrhea with foul-smelling Flatulence Anorexia Crampy abdominal pain Fever Nausea

26. Severe giardiasis Fatty diarrhea Fat-soluble Vitamin deficiencies Changes in the structure of intestinal villus Cholecystitis or cholangitis Villus atrophy may interfere with the absorption of food, especially fats and fat-soluble vitamins; The stools may be fatty

27. Diagnosis (1) Feces examination Watery stool: direct fecal smear with normal saline: Trophozoites Formed stool: direct fecal smear with iodine-stain, cysts

28. Trophozoites under microscope

29. Cysts under microscope

30. (2) Duodenal fluid or bile examination a) Enteric - test capsule method b) Duodenal aspiration (3) Biopsy of intestine tissue

31. Capsule withdrawn and mechanically shaken Enteric - test capsule method

32. Epidemiology Distribution Worldwide distribution Prevalence range from 1.5 to 20 percent Prevalence range from 2% to 10%, the average infection rate is 2.52% U.S.A China

33. Epidemiology Source of infection Patients and carriers whose feces contain cysts Mode of infection Drinking contaminated water Eating contaminated food Cattle, pigs, cats, dogs and beavers etc may be infected and sometimes serve as source of infection

34. Trichomonas vaginalis

35. Trichomonas vaginalis inhabits the vagina Of women or urethra and Prostate of men. Trichomonas vaginalis is the causative organism of trichomonas vaginitis, urethritis and prostatitis.

36. Morphology and life cycle Trophozoite  Only trophozoites in life cycle, no cyst stage  Pear or ellipse in shape nucleus Four anterior flagella axostyle A single posterior flagellum attached to an undulating membrane

38. 3 trophozoites stained with Giemsa or Wright

39. A trophozoite of Trichomonas vaginalis from culture. The four flagella and single nucleus are visible. The dark median rod is the axostyle which is characteristic of the trichomonads.

40. Life cycle Only trophozoites in life cycle, no cyst stage trophozoites Women: vagina Men: Men: urethra or prostate The infective stage is trophozoite The trophozoites multiplies by binary fission

41. The infection acquired by sexual intercourse or some indirect ways

42. Pathogenesis Trichomoniasis is one of the most common sexually transmitted diseases. The pathogenic ability has close relationship with Trichomonas vaginalis strains and host’s physical State.

43. Women Under Normal condition The vaginal environment : Ph3.8-4.4 inhibit the growth and reproduction of Pathogenic organisms and parasites Non-pathogenic

44. Women under some conditions (pregnancy, after Menstruation) decrease in acidity of vagina The trophozoites multiplies by binary fission Vaginitis with Foul-smelling discharge

45. Laboratory Diagnosis Finding trophozoites In women: vaginal discharges In men: prostatic fluid or urine Methods: direct smear or culturing methods

46. Epidemiology The infection rate is high, especially among the Women (age from 20 to 40 years old)  Source of infection T. vaginalis vaginitis patients (women) and asymptomatic carriers (including men)

47.  Mode of infection  Direct transmission: it is transmitted during sexual intercourse  Indirect transmission: it is transmitted by using Public plunge bath, bathtub, or public swimsuit, but very rare.

48. Treatment Both the patients and carriers should be treated Husband and wife or sexual partner