Flagellates 鞭毛蟲

1. Flagellates 鞭毛蟲 • Intestinal flagellates • Genital flagellates • Haemoflagellates

2. Intestinal and genital flagellates • Intestinal flagellates 腸道鞭毛蟲 • Enteromonas hominis; (non pathogenic) (人內滴蟲) • 恩特若姆那斯鞭毛蟲 • Retortamonas intestinalis; 腸旋滴蟲 (non pathogenic) • Chilomastix mesnili脣形鞭毛蟲 • Giardia lamlbia梨形鞭毛蟲 • Trichomonas hominis (large intestine) 腸道鞭毛滴蟲 • Trichomonas tenax 口腔毛滴蟲(mouth) • Pentatrichomonas hominis人毛滴蟲

3. Intestinal and genital flagellates Genital flagellates生殖道鞭毛蟲 * Trichomonas vaginalis 陰道鞭毛蟲

4. Chilomastix mesnili 麥氏唇形鞭毛蟲 Non-pathogenic Large intestine Life cycle Trophozoite: long cytostome 3 anterior flagella 1 cytostomal flagellum Cyst: single nucleus lemon-shape p.30 fig.21

5. Giarida lamblis梨形鞭毛蟲 (Syn. G. duodenalis) Common infection in both tropic and sub-tropic area Small intestine infection Cystic infection, 10 cysts may produce infection Infection via contaminated food and water Excystation occurs in upper small intestine

6. 活動體 腹面觀 活動體 背面觀

7. Ventral disc Ventro lateral flange

8. Giarida lamblis Life cycle Trophozoite: symmetrical in shape (badminton racket) 2 oval nuclei; 4 pairs of flagella; moving as “falling leaf” binding to tissue by striated disc (ventral surface) mechanical binding byhost proteases activate the lectin of Giardia to promote attachment to enterocytes (腸細胞) multiple by binary fission

9. Giarida lamblis Life cycle Cyst: oval to ellipsoid in shape (11-14 μm) 4 small oval nuclei distinct wall; shrunk cytoplasm produce a space under cyst wall

12. Giarida lamblis Clinical aspects Wide range of gastrointestinal symptoms (especial in children) Vomiting 嘔吐 Flatulence 腸胃脹氣; Diarrhoea 痢疾,下痢 Malabsorption syndrome 吸收障礙 Cholecystitis 膽囊炎

13. Giarida lamblis Clinical aspects Histological aspects : mechanical & biochemical Shortening of villi Cellular infiltration of lamnia propria黏膜固有層of mucous membrane functional impairment of enterocytes Abdominal cramps腹部絞痛 痙攣 Induce motility disturbance

14. Giarida lamblis Diagnosis Stool examination for trophozoites or cysts diagnosis may concentrated by zinc sulphate flotation硫酸鋅浮漂法 Duodenal aspiration “Enterotest” capsule腸內測試膠囊 a gelatin capsule containing a coiled thread for duodenal contents diagnosis

15. Giarida lamblis Treatment Mepacrine (quinacrine) hydrochloride(鹽酸奎那克林) 5 mg/kg/day in divided doses thrice daily for 1 week Nitroimidazoles Tinidazole 2 g single dose Albendazole

16. Giarida lamblis Prevention and control Food hygiene Fly control Sewage disposal Proper water supply Identification and treatment of carriers Chlorination of water can not kill the cysts Iodination of water can kill the cysts (13 ml saturated solution of iodine per liter of water

17. Trichomonas spp 滴蟲 Life cycle Trophozoite: ovoid or pyriform gliding motion 1 or 2 oval nuclei 4 flagella on anterior end 1 flagellum turns back and attach on undulating membrane axostyle軸柱projects out of body for attach to host tissues and cause irritation divide by binary fission No cystic stage

18. Trichomonas hominis人毛滴蟲 Parasite in large intestine No medical significance

19. Trichomonas tenax口腔毛滴蟲 Parasite in the mouth No medical significance

20. Trichomonas vaginalis 陰道滴蟲 Urogenital infection No cystic stage Infected male acting as carrier

21. Trichomonas vaginalis Life cycle Trophozoite: ovoid or pyriform gliding motion single oval nuclei 4 flagella on anterior end 1 flagellum turns back and attach on undulating membrane axostyle projects out of body for attach to host tissues and cause irritation ingests food particles by cytostome Divide by binary fission

22. Trichomonas vaginalis Clinical aspects Vaginitis (陰道炎) resulting in a frothy and creamy white discharge Inflame of vulva and cervix Asymptomatic in males but some urethritis(尿道炎) or (prostatitis)前列腺炎

23. Trichomonas vaginalis Diagnosis Vaginal secretion (woman) trophozoites Semen or prostatic fluid examination (man) Artificial culture

24. Trichomonas vaginalis Treatment infected female and her male consort Drug treatment Nitroimidazoles Metronidazole; 200 mg thrice daily orally for 1 week 2 g for single doses Tinidazole ; 2 g thrice daily orally Ornidazole;

25. Trichomonas vaginalis Prevention and control Normal sexual behavior Fixed sexual partner Safety sexual behavior

26. Haemoflagellates 血液性鞭毛蟲 Leishmania spp利什曼原蟲 L. donovani complex; L. major L. tropica; L. aethiopica L. mexicana complex L. braziliensis complex; L. peruviana Trypanosoma spp 錐蟲 T. rhodesiense; T. gambiense T. cruzi; T. rangeli

27. Leishmania spp infecting man Geographical distribution Visceral leishmaniasis (VL)內臟利什曼原蟲症 India, Bangladesh, scattered areas in the Middle East Mediterranean region, parts of East Africa, South and Central America Cutaneous leishmaniasis (CL)皮下利什曼原蟲症 N. India, Pakistan, Middle East, Southern Europe Northern Africa all Mediterranean Coast, parts of East and West Africa, South and Central America Muco-cutaneous leishmaniasis (MCL)黏膜利什曼原蟲症 South and Central America

28. Leishmania spp infecting man Taxonomic position is often confusing monoclonal antibody typing DNA probe hybidization RFLP karyotyping L. donovani complex; L. major L. tropica; 熱帶利什曼原蟲 L. aethiopica L. mexicana complex L. braziliensis complex; L. peruviana

29. General Classification of Important Leishmaniasis in Relation to Clinical Manifestation

30. Leishmania spp Morphology 4 types fig. 30 Trypomastigote 錐鞭毛體 kinetoplast is at posterior end, locomotory flagellum, long undulating membrane(supported by microtubules), Epimastigote側鞭毛體 kinetoplast is anterior to the nucleus, short U membrane Promastigote前鞭毛體 kinetoplast is at anterior end, no U membrane Amastigote無鞭毛體(“Leishman-Donovan” body) ovoid, 2-3 μm, no flagellum binary fission, starts by division of the kinetoplast, following nucleus division, ending the outer membrane splits

31. Leishmania spp Kinetoplast(動基體) Single mitochondrian Extends along the whole length of the parasite Reveals many cristae in the midgut of vector high degree of activity Relatively less cristae in blood stream activity is suppressed

32. Distribution of morphological types in haemoflagellates

33. Life cycle Vectors: Sandflies白蛉 Phlebotomus Lutzomyia Psychodopygus Western hemisphere : Lutzomyia ; Psychodopygus World wild: Phlebotomus Female sandfly pool feeder ; biting by proboscis or mouth part

35. Host cell infection by promastigotes flagellar attachment or aflagellar poles phagocytosis by host cells Macrophages Phagocytic cells Become amastigotes inside a parasitophorou vacuole Binary fission for multiplication 1.eliciting a small phagocytic oxidative response 2.possessing membrane-associated acid phosphotase 3. Possessing more catalase & glutathione peroxidase than promastigotes Toxoplasma gondii : preventing phagosome-lysosome fusion

39. Leishmania spp infecting man Clinical aspects Difference in virulence of various parasite species Difference in susceptible of various host Muco-cutaneous leishmaniasis (MCL)黏膜利什曼原蟲症 Starts as a pustular swelling in mouth or on nostrils Lesion become ulcerative after many months Then extend into the naso-pharyngeal mucous membrane 2nd infection is very common with destruction of the nasal cartilage and the facial bone

40. Leishmaniasis利什曼原蟲症

41. Leishmania spp Visceral leishmaniasis (VL)內臟利什曼原蟲症: Kala-azar黑熱病 Incubation period is 4 to 10 months Early symptoms: low grade fever with malaise and sweating Later stages: fever become intermittent hyperplasia of lymphoid-macrophage system liver and spleen become grossly enlarged no inflammatory changes lymphadenitis is common in Chinese form but not Indian form post Kala-azar dermal lieshmaniasis (PKDL) after 1 –2 years hypopigmented areas; nodular as lepromatous leprosy skin biopsy shows many parasites PKDL is of epidemiological significance vector transmission easily

42. Leishmania spp Cutaneous leishmaniasis (CL)皮下利什曼原蟲症 Starts as a painless papule(丘疹) on exposed parts of body generally on the face Circular or oval ulcer produce Lesion ulcerates after few months dry type lesion: ulcer remains dry and heals readily wet type lesion: ulcer may spread with inflammatory zone around it, and heal slowly Diffuse cutaneous leishmaniasis (DCL) occur in parts of Africa Nodules and thickening of the skin without any ulceration Leishmaniasis recidivans (LR): chronic infection with very few parasites, not heal spontaneously

43. Leishmania spp Diagnosis Low WBC count Anaemia Chronic symptom gama-globulin coagulation: formaldehyde Immuno-assay Biopsy tissues: bone marrow, spleen; lymph gland Culture

44. Leishmania spp Treatment Visceral & Muco-cutaneous leishmaniasis Pentavalent antimony compounds sodium stibogluconate Diamidines pentamidine isethionate; hydroxystilbamidine Cutaneous leishmaniasis sodium stibogluconate or mepacrine

45. Leishmania spp Prevention and control Vector control Residual insecticides spread for control sandflies High susceptible to insecticide of sandflies Reservoir animal control Vaccination with promastigotes in cutaneous leishmaniasis U.S.S.R and Israel Personal protection long sleeves and trousers; insect repellents; fine mesh nets impregnated with insecticides

46. Trypanosoma spp infecting man Sleeping sickness非洲睡眠病：Africa Trypanosoma rhodesiense羅德西亞錐蟲 Trypanosoma gambiense甘比亞錐蟲 Chagas’ disease：America Trypanosoma cruzi枯西式錐蟲 Non pathogenic：Central and South Africa Trypanosoma rangeli

47. African trypanosomes (sleeping sickness) Pathogens：Trypanosoma rhodesiense 羅德西亞錐蟲 Trypanosoma gambiense 甘比亞錐蟲 (morphologically indistinguishable) Vector：biting flies; tsetse fly 采采蠅; Glossina parasite undergoes a complex development in fly Host：host in human blood with binary fission movement in the direction of flagellum pleomorphic; slender; intermediate; stumpy nucleus, kinetoplast, undulating membrane, flagellum can be recognised with stain