Luminal Protozoa

Penyakit Mikrobial Parasiter I
PKH-UB 2013
Luminal Protozoa
Parasitology terms..
 A parasite is an organism that obtains food and shelter from
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another organism and derives all benefits from this association.
obligate parasite, when it can live only in a host;
facultative parasite, when it can live both in a host as well as in
free form.
endoparasites , Parasites that live inside the body
whereas those that exist on the body surface are called ectoparasites.
Parasites that cause harm to the host are pathogenic parasites
while those that benefit from the host without causing it any harm
are known as commensals.
Parasitology terms..
 The organism that harbors the parasite and suffers a loss caused by
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the parasite is a host.
The host in which the parasite lives its adult and sexual stage is the
definitive host
The host in which a parasite lives as the larval and asexual stage is
the intermediate host.
Other hosts that harbor the parasite and thus ensure continuity of
the parasite's life cycle and act as additional sources of human
infection are known as reservoir hosts.
An organism (usually an insect) that is responsible for transmitting
the parasitic infection is known as the vector.
Sarcomastigophora
(pseudopodia/flagella)
Sarcodina
(amoeboid)
Mastigophora
(flagella)
Protozoa
Apicomplexa
(gliding, intracellular)
Ciliophora
Microspora
Eucoccidiorida
(epithel cells)
Piroplasmorida
(blodd cells)
Haemosporida
(blood cells)
Kinetoplastorida
(hemoflagellata)
Diplomonarida
Trichomonadorida
(intestine
flagellates)
INTESTINAL PROTOZOA
Pathogenic
 Entamoeba histolytica
 Balantidium coli
 Giardia lamblia
 Dientamoeba fragilis
 Cryptosporidium parvum
 Enterocytozoon bieneusi
 Septata intestinalis
 Cyclospora cayetanensis
 Isospora belli
Commensal
 Entamoeba hartmani
 Entamoeba dispar
 Entamoeba coli
 Endolimax nana
 Iodamoeba bütschlii
 Chilomastix mesnili
 Trichomonas hominis
 Blastocystis hominis
INTESTINAL AND UROGENITAL
PROTOZOA
Intestinal and luminal protozoa pada manusia dan hewan
 Entamoeba histolytica (Amoebae)
 Balantidium coli (Ciliates)
 Giardia lamblia and Trichomonas vaginalis (Flagellates)
 Cryptosporidium parvum and Isospora belli (Sporozoa)
 Protozoan infections in animals may be caused by organisms
in the sub-class Coccidia (disease: Coccidiosis)
amoebiasis (amebic dysentery,
amebic hepatitis)
Causal agent : Entamoeba hystolitica
Phylum: Sarcomastigophora
Subphylum: Sarcodina
Family: Entamoebidae
amoebiasis
Penyakit: disentri pada manusia, kera, anjing, kucing, tikus, babi
Distribusi : seluruh dunia
Morfologi :
- Bentuk tropozoit (tubuh hospes), ukuran 15-30 mikron
- Tropozoit aktif punya vakuola makanan terisi sel darah merah
dalam proses digesti
- amuboid, memiliki pseudopodia, inti 1
- Pembelahan biner (binary fission)
nukleus
The fine granular
endoplasm may
contain ingested
erythrocytes
amoebiasis
- Bentuk kista : bulat dgn dinding tebal, inti lebih dari 1 (1-4
nuklei), badan kromatin padat, di luar hospes
- Encyst:To take the form of or become enclosed in a cyst
- Excystation: escape from a cyst or envelope, as in that stage in the life
cycle of parasites occurring after the cystic form has been swallowed by
the host.
Fecal-oral life cycle
Excystation
Trophozoite
Cyst
Encystment
1. Passed in feces
2. Non motile
3. Resistant to hostile
environment
4. Does not multiply
1
1
1. Metabolically active
2. Motile
3. Multiplies by replication
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life cycle
1. Ingestion of cyst in
the contaminated water
and food
2. Excystation occurs in
the small intestine. Eight
trophozoites produced
from one cyst.
3. Trophozoites migrate
to large intestine where
they multiply or may
encyst for excretion
1
2
4. Cysts exit hosts
in the stool
amoebiasis
Predileksi :
saluran pencernaan, otak, hepar, paru-paru
Hospes :
manusia, vertebrata
amoebiasis
Patogenesa :
- Abses pada organ predileksi (otakencephalitis, paruparupneumonia, liver  hepatitis)
- Jaringan nekrotik
- Sekresi mukus berlebihan pada usus  diare mukus  khas
amoebiasis sal. Cerna
- Haemorraghi  pembuluh darah pada jaringan pecah/rusak
amoebiasis
Gejala klinis
 Acute: Frequent dysentery with necrotic mucosa and
abdominal pain.
 Chronic: Recurrent episodes of dysentery with blood and
mucus in the feces. There are intervening gastrointestinal
disturbances and constipation. Cysts are found in the stool.
The organism may invade the liver, lung and brain where it
produces abscesses that result in liver dysfunction,
pneumonitis, and encephalitis.
Amoebiasis pada hewan
 E. invadens of reptiles is morphologically identical to E. histolytica,
but it is not transmissible to mammals.
 E. dispar is a noninvasive, nonpathogenic amoeba morphologically
indistinguishable from the pathogenic species E histolytica
 Pathology
Intestinal ulcers (craters/flasks )are due to enzymatic
degradation of tissue. The infection may result in
appendicitis, perforation, stricture granuloma, pseudopolyps, liver abscess sometimes brain, lung and spleen
abscesses can also occur. Strictures and pseudo-polyps result
from the host inflammatory response.
Hepar dengan abses
karena amoebiasis
Intestinal amoebiasis
‘flask shaped’ ulcer
amoebiasis
Diagnosa :
- Pemeriksaan sampel feses (fresh atau swab)  langsung /
pewarnaan
Differential Diagnose :
- Giardiasis
- Bacterial diarrhea  demam tinggi dan leukocytosis
GIARDIASIS (lambliasis)
Etiology
Giardia lamblia (a flagellate)
Phylum: Sarcomastigophora
Subphylum: Mastigophora
Giardiasis
 Causa : Giardia lambia
 Predileksi : usus halus
 Hospes : manusia, kucing, anjing, unggas, kuda, primata dan
hewan liar lainnya, beaver (reservoir)
 Giardia is the most common flagellate of mammals and birds.
Its trophozoites are binucleate and have four pairs of flagella.
Trophozoites adhere to microvilli of epithelial cells of the
small intestine.
 Morfologi umum :
 Flagellata, 8 flagella dan 2 axostyles
 Stadium trophozoit : pipih, ‘half-pear’shape,
tidak memiliki mitokondria, 12 to 15
micrometer, 2 nukleus dan 2 parabasal bodies
 Stadium kista : bulat dgn dinding tebal, inti 4
Giardiasis
 Infection occurs by ingestion of
cysts, usually in contaminated
water.
 Decystation occurs in the
duodenum and trophozoites
(trophs) colonize the upper small
intestine where they may swim
freely or attach to the sub-mucosal
epithelium via the ventral suction
disc.
 The free trophozoites encyst as
they move down stream and
mitosis takes place during the
encystment.
 The cysts are passed in the stool.
Man is the primary host although
beavers, pigs and monkeys are also
infected and serve as reservoirs.
Giardiasis
 Patogenesa :
 Tropozoit  menutupi epitel  mengganggu absorpsi nutrisi 
malabsorbsi  kekurusan
 Kerusakan epitel  abdominal pain  dalam jumlah banyak  kolik
 Diare  tidak berdarah atau bermukus, karena parasit tidak masuk ke dalam
mukosa usus, hanya menempel  berbau busuk dan mengapung di air
Giardiasis
 Gejala klinis :
 Flatulence
 Lactose intolerrance
 Abdominal pain
 Diare berwarna terang, tanpa darah dan mukus
 Tidak ada demam
Differential Diagnose :
- amoebiasis
- Bacterial diarrhea
Trichomoniasis
Phylum: Sarcomastigophora
Subphylum : Mastigophora
Family : Trichomonadidae
TRICHOMONIASIS
 Etiology
Trichomonas vaginalis (a flagellate)
 Morphology
The trophozoite form is 15 to 18 micrometers in diameter
and is half pear shaped with a single nucleus, four anterior
flagella and a lateral flagellum attached by an undulating
membrane. Two axostyles are arranged asymmetrically
(Figure 12). The organism does not encyst.
 Two trophozoites 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
 Life cycle
T. vaginalis colonizes the vagina
of women and the urethra
(sometimes prostate) of men.
Infection occurs primarily via
sexual contact, although nonvenereal 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 nonhuman 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
(Figure 12).
 Pathology
The organism causes contact-dependent damage to the
epithelium of the infected organ.
Trichomoniasis in cattle
Tritrichomonas foetus
 Synonym: Trichomonas foetus
 Predilection site: Prepuce, uterus
 Hosts: Cattle
 Life cycle: The trichomonads reproduce by longitudinal
binary fission. No sexual stages are known and there are no
cysts. Transmission occurs during coitus.
 Clinical signs : irregular oestrous cycles, uterine discharge,
pyometra and early abortion
Trichomonas in poultry
 Trichomonas gallinae
 Synonym: Cercomonas gallinae, Trichomonas columbae
 Predilection site: Oesophagus, crop, proventriculus
 Hosts: Pigeon, turkey, chicken, raptors (hawks, falcons,
eagles)
Trichomoniasis
 Trichomonas caviae occurs in the intestines of guinea pigs. Its
flagella are readily seen in stained fecal smears
Balantidiasis
Balantidium coli
Phylum: Ciliophora
Family: Balantiidae
Balantidiasis
Balantidiasis
 Causa : Balantidium coli
 Predileksi : ileum, sekum
 Hospes : babi, tikus, sapi, kuda, manusia, serigala,
kera
 Morfologi :
 Bentuk tropozoit : lonjong seperti kantung, silia di
permukaan tubuh, memiliki makronukleus dan
mikronukleus
 Bentuk kista : bulat/lonjong, tidak tahan kering, memiliki
makronukleus
Balantidiasis
Hospes definitive adalah manusia
Reservoar adalah babi, tikus dan
hewan lain.
Cysts (bentuk infektif)
menginfeksi melalui makanan
tercemar parasit
Excystasi terjadi di usus halus,
tropozoit membentuk koloni di
usus besar
Di usus besar tropozoit
mengalami pembelahan biner dan
masuk ke dinding colon dan
multiplikasi
Tropozoit membentuk cysta yang
keluar bersama feses
Balantidiasis
 Patogenesa :
 Mampu menembus mukosa  perdarahan & abdominal pain
 Merusak mukosa  ulcer
 Gejala klinis :
 Diare ( darah dan berlendir )
 Nyeri perut
 Nafsu makan berkurang  BB turun
 Dehidrasi
 Lebih sering asimptomatis
 Balantidium coli trophozoites in section of intestine (H&E)
Cryptosporidiosis
Phylum : Apicomplexa
Family : Cryptosporidiidae
Subclass: Coccidia
Cryptosporidiasis
 Causa : Cryptosporidium parvum
 Predileksi : usus
 Hospes : mamalia, burung, reptil
 Morfologi :
 Termasuk dalam koksidia
 Bentuk pada hospes  ookista  pada mukosa usus 
mengandung sporozoit
 Bentuk bulat dgn 4 sporozoit, dinding tebal
Cryptosporidiasis
Infeksi melalu ingesti/inhalasi  exystation  sporozoit masuk ke sel
epitel sal cerna  pembelahan asexual (schozogoni)  merogoni 
gametogony
Microgamon dan makrogamon  fertilisasi  oocyst
Cryptosporidiasis
 Patogenesa :
 Penembusan mukosa  enteritis
 Pada pasien immunocompromised (HIV)  infeksi saluran
pernafasan dan cholecystitis
 Gejala klinis :
 Asimptomatis
 Diare cair dan sering
 Dehidrasi
 Pada hewan muda  lemah, nafsu makan turun-hilang,
subklinis, fatal
Isospora belii
Phylum: Apicomplexa
Family : Eimeriidae
 Isospora belli is believed to be a
valid species which ONLY infects
humans causing coccidiosis.
 Oocysts of Isospora belli. The oocysts are large (25 to 30
µm) and have a typical ellipsoidal shape. When excreted, they
are immature and contain one sporoblast (A, B). The oocyst
matures after excretion: the single sporoblast divides in two
sporoblasts (C), which develop cyst walls, becoming
sporocysts, which eventually contain four sporozoites each.
Gejala klinis
 diarrhea, steatorrhea, headache, fever, crampy
 abdominal pain, nausea, dehydration and weight loss.
 eosiniphilia
Coccidiosis
Phylum: Apicomplexa
Subordo: Eimeriina
Coccidiosis
 Penyebab: Eimeria sp
 Ciri:
 Cysta yang masak mengandung 4 sporokista (1 sporokista
mengandung 2 sporozoit)
 Siklus hidup monoksenosa (1 hospes)
 Dalam hospes: intranuklear(obligat), pada umumnya pada sel saluran
pencernaan atau hepar
 Predileksi
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Hepar : pada kelinci, Eimeria stidae
Urogenital : pada angsa, Eimeria truncata
Proventrikulus, uterus: Eimeria neitzi
Sekum : Eimeria tenella
Coccidiosis in Animals
 Coccidiosis is an economically important disease of cattle,
sheep, goats, pigs, poultry, and also rabbits, in which the liver
as well as the intestine can be affected. In dogs, cats, and
horses, coccidiosis is less often diagnosed but can result in
clinical illness.
Stadium infektif : ookista
Masuk ke saluran cerna 
ookista pecah di ventrikulus 
sporokista keluar
Sporokista masuk duodenum,
terpengaruh trypsin dan cairan
empedu  ujung sporokista
menjadi lunak dan aktif
Sporozoit keluar
Sporozoit masuk ke epitel usus
Membulat (tropozoit)  inti
membelah banyak  schizont
yang berisi merozoit
Merozoit pecah 
mikrogamon  zygot  ookista
 keluar bersama feses
 Periode prepaten : waktu yang diperlukan saat hospes
menelan sporozoit sampai dengan ditemukannya di feses
 With ingested oocysts moving to the intestinal lining, the life
cycle of coccidia begins. Intestinal cells are damaged and in 4 –
8 days, depending on the species, oocysts are shed in the faeces
 Reproduksi Eimeria bukan tidak terbatas  suatu saat
akan berhenti karena:
 Jumlah sel hospes terbatas
 Adanya faktor imunitas hospes
Coccidiosis di Unggas
Coccidiosis pada kelinci
 2 anatomic forms:
 hepatic, caused by Eimeria stiedae
 intestinal, caused by E magna, E irresidua, E
media, E perforans, E flavescens, E intestinalis, or
other Eimeria spp.
 Transmission of both the hepatic and intestinal
forms is by ingestion of the sporulated oocysts,
usually in contaminated feed or water.
Healthy rabbit liver (left) with rare congenital anomaly with a double
biliary vesicle (arrow) and one liver affected by coccidiosis (right).
Portion of rabbit
intestine affected by
coccidia infestation
Faktor yang mempengaruhi patogenesis Eimeria
 Faktor hospes-parasit
 Hospes: Umur, pada ayam umur 2-4 minggu. (Ayam umur
<2mg masih mempunyai imunitas induk, kekuatan lambung
lemah belum bisa memecah ookista). Pada domba/kambing
umur 4-6 bulan, sapi 3-6 bulan
 Jenis parasit tergantung jenis eimeria yang patogen
 Jumlah ookista yang tertelan
Gejala klinis
 Diare, diare berdarah
 Lemah, nafsu makan berkurang, berat badan turun
 Kematian karena perdarahan hebat
Toxoplasma
Phylum: Apicomplexa
Subordo: Sarcocystidae
Toxoplasmosis
 Bersifat zoonosis
 Heteroksenosa, bisa menginfeksi semua jenis hewan
Siklus hidup
Siklus enteroepithelial pada hospes intermediate
Hospes definitive terinfeksi melalui ::
 Makan oocyte Toxoplasma (yg telah sporulasi)
 Makan cysta Toxoplasma yang terdapat pada hospes
intermediate (daging domba, sapi, tikus, anjing, burung)
Tugas
 Jelaskan siklus hidup Toxoplasma gondii
 Patogenesa
 Penularan
 Gejala klinis
 Diagnosa
??