SPOROZOA Flashcards
(205 cards)
1
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Phylum: Apicomplexa → Class: Sporozoa → Blood species: Plasmodium
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A. Plasmodium species
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▪ Pathogenic to man
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A. Plasmodium species
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▪ Causative agent of malaria
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A. Plasmodium species
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Principal vector Anopheles minismus var. flavirostris
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A. Plasmodium species
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➢ Obligate intracellular parasites of blood and tissues
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A. Plasmodium species
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➢ Alternation of generations (sexual and asexual development)
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A. Plasmodium species
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➢ Alternation of host:
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A. Plasmodium species
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Sexual cycle – female mosquito (Anopheles minimus flavirostris)
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A. Plasmodium species
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Asexual cycle – man
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A. Plasmodium species
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✓ sporozoites liberated into the bloodstream via bite of an infected female mosquito
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A. Plasmodium species
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✓ through blood transfusion
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A. Plasmodium species
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✓ vertical transmission
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A. Plasmodium species
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➢ Anemia (due to massive red cell destruction), splenomegaly, joint pain
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A. Plasmodium species
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➢ Recurrent/Intermittent chills and fever (synchronized rupture of red blood cells)
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A. Plasmodium species
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Q
Every 36 hours:
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Malignant Tertian Malaria (P. falciparum)
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Every 48 hours:
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Ovale Malaria (P. ovale)
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Every 48 hours:
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Benign Tertian Malaria (P. vivax)
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Every 72 hours:
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Quartan Malaria (P. malariae)
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➢ Quotidian fever – is caused by the asynchronous release of merozoites in the circulation
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20
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is most widely distributed and most prevalent worldwide
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✓ Plasmodium vivax infection
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is most likely fatal
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✓ Plasmodium falciparum infection
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: red cells, organisms and pigment can block the brain vessels
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Cerebral malaria
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: sudden massive intravascular hemolysis resulting to hemoglobinuria
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Blackwater fever
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- Microscopic identification of the malarial parasites in thick and thin blood smears stained with Giemsa or Wright’s stain is still important in making the definitive diagnosis and remains the gold standard method.
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A. Plasmodium species
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2. Collection of specimen must be prior to fever spike
A. Plasmodium species
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3. Bone marrow (through sternal puncture)
A. Plasmodium species
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4. Serological tests (to detect the presence of malarial antibodies)
A. Plasmodium species
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5. Malaria RDTs (Rapid Diagnostic Tests):
Plasmodium LDH
Immunochromatography
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– produced by both sexual and asexual stages and can distinguish between P. falciparum and non-P. falciparum species
Plasmodium LDH
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Plasmodium LDH o Examples:
1. Diamed Optimal IT
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– detects Plasmodium-specific antigens; these target antigens are called HRP II (Histidine-rich protein)
Immunochromatography
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Immunochromatography o Examples:
1. Paracheck Pf test
2. ParaHIT f test
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A. Pre-erythrocytic/Exo-erythrocytic schizogony
I. Asexual phase in man (SCHIZOGONY/MEROGONY)
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B. Erythrocytic schizogony
I. Asexual phase in man (SCHIZOGONY/MEROGONY)
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C. Gametogony
I. Asexual phase in man (SCHIZOGONY/MEROGONY)
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1. Begins with the inoculation of the infective sporozoites to man during a mosquito blood meal
A. Pre-erythrocytic/Exo-erythrocytic schizogony
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2. Within ½ hour, they are carried through blood circulation into the liver parenchymal cells where they undergo nuclear and cytoplasmic division and develop into pre/exo-erythrocytic schizonts
A. Pre-erythrocytic/Exo-erythrocytic schizogony
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3. Schizonts rupture producing exoerythrocytic merozoites that reinvade liver cells, while other invade the RBCs
A. Pre-erythrocytic/Exo-erythrocytic schizogony
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4. In the RBC, merozoite develops into trophozoite
A. Pre-erythrocytic/Exo-erythrocytic schizogony
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5. In P. vivax and P. ovale, sporozoites develop into hypnozoites which remain dormant for years in the hepatocytes. At a predetermined time, the hypnozoites begin to grow and undergo exoerythrocytic schizogony releasing merozoites that invade RBCs causing a recurrence of the malaria attack
A. Pre-erythrocytic/Exo-erythrocytic schizogony
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1. The trophozoite further matures into schizont, then divide into erythrocytic merozoites
B. Erythrocytic schizogony
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2. RBC ruptures releasing merozoites into the bloodstream
B. Erythrocytic schizogony
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1. After 2 – 3 eryhtrocytic generations, Gametocytogenesis begins
C. Gametogony
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2. Some of the merozoites do not form schizont, but rather micro- and macrogametocytes which are infective to the mosquito
C. Gametogony
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1. The male and female gametocytes sucked in by the mosquito undergo maturation and differentiate into micro- and macrogametes
II. Sexual phase in mosquito (SPOROGONY)
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2. The microgamete exflagellates and fertilizes the macrogamete producing a zygote as a result of fertilization
II. Sexual phase in mosquito (SPOROGONY)
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3. Ookinete penetrates the stomach wall and forms an oocyst
II. Sexual phase in mosquito (SPOROGONY)
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4. Within the oocyst, numerous sporozoites are formed
II. Sexual phase in mosquito (SPOROGONY)
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5. Oocysts grows and ruptures releasing sporozoites
II. Sexual phase in mosquito (SPOROGONY)
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6. Sporozoites migrate through tissues to the salivary glands
II. Sexual phase in mosquito (SPOROGONY)
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➢ Small ring forms (1/6 diameter red cell), applique forms, double nuclear dots
a. Plasmodium falciparum
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➢ Organisms invades all ages of red blood cells (most severe)
a. Plasmodium falciparum
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➢ Crescent/banana-shaped gametocytes
a. Plasmodium falciparum
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➢ Single large compact ring or band forms
b. Plasmodium malariae
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➢ Invades old RBCs
b. Plasmodium malariae
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➢ Schizont with merozoites arranges around central pigment (resembles fruit pie)
b. Plasmodium malariae
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➢ Ovoid gametocytes
b. Plasmodium malariae
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➢ Single compact ring
c. Plasmodium ovale
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➢ Large pale red cells with Schuffner’s dots which may be oval and fimbriated
c. Plasmodium ovale
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➢ Single large ring succeeded by amoeboid form in pale large red cell
d. Plasmodium vivax
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➢ Schuffner’s dot (condensed hemoglobin) in red cells
d. Plasmodium vivax
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➢ Only reticulocytes are invaded
d. Plasmodium vivax
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➢ Round gametocyte
d. Plasmodium vivax
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Malignant malaria
a. Plasmodium falciparum
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Quartan malaria
b. Plasmodium malariae
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Ovale malaria
c. Plasmodium ovale
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Tertian malaria
d. Plasmodium vivax
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36- 48 hours
a. Plasmodium falciparum
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72 hours
b. Plasmodium malariae
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48 hours
c. Plasmodium ovale
d. Plasmodium vivax
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Not enlarged
a. Plasmodium falciparum
b. Plasmodium malariae
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Sometimes enlarged; frequently oval with ragged margins
c. Plasmodium ovale
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Enlarged
d. Plasmodium vivax
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Normal; multiply infected red blood cells are common
a. Plasmodium falciparum
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Normal
b. Plasmodium malariae
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Enlarged; approximately 20% or more of infected RBCs are oval and/or fimbriated (border has irregular projections)
c. Plasmodium ovale
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Enrlaged; maximum size may be 1 – 2 times normal RBC diameter
d. Plasmodium vivax
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6 – 32 (average is 20 – 24)
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6 – 12 (average is 8); “rosette” schizonts
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6 – 14; average is 8
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12 – 24; average is 16
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- (Maurer’s dots occasionally seen)
a. Plasmodium falciparum
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- (Ziemann’s dots rarely seen)
b. Plasmodium malariae
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+ (James’ dots; present in all stages except early ring forms)
c. Plasmodium ovale
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+ (Schuffner’s dots; present with all stages except in early ring forms)
d. Plasmodium vivax
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Young rings are small, delicate, often with double chromatin dots
a. Plasmodium falciparum
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gametocytes are crescentshaped or elongated
a. Plasmodium falciparum
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Rounded, compact trophozoites with dense cytoplasm
b. Plasmodium malariae
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band-form trophozoites
b. Plasmodium malariae
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Rounded, compact trophozoites
c. Plasmodium ovale
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occasionally slightly amoeboid
c. Plasmodium ovale
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growing trophozoites have large chromatin mass
c. Plasmodium ovale
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Irregular, ameboid trophozoites
d. Plasmodium vivax
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has “spread out” appearance
d. Plasmodium vivax
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Accole or Applique forms
a. Plasmodium falciparum
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May have multiple rings
a. Plasmodium falciparum
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Band
b. Plasmodium malariae
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Red cell containing trophozoite may have fimbriated edges
c. Plasmodium ovale
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Amoeboid
d. Plasmodium vivax
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Black; coarse and conspicuous in gametocytes
a. Plasmodium falciparum
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Dark brown, coarse, conspicuous
b. Plasmodium malariae
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Dark brown, conspicuous
c. Plasmodium ovale
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Golden brown, inconspicuous
d. Plasmodium vivax
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Sausage or crescentshaped
a. Plasmodium falciparum
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Round
b. Plasmodium malariae
c. Plasmodium ovale
d. Plasmodium vivax
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Rings and/or gametocytes
a. Plasmodium falciparum
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other stages develop in blood vessels of internal organs but are not seen in peripheral blood EXCEPT in severe infection
a. Plasmodium falciparum
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All stages
b. Plasmodium malariae
c. Plasmodium ovale
d. Plasmodium vivax
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wide variety of stages usually not seen
b. Plasmodium malariae
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relatively few rings or gametocytes generally present
b. Plasmodium malariae
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wide range of stages may be seen on any given film
d. Plasmodium vivax
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Multiple infections YES
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Multiple infections NO
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Multiple infections RARE
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Highy mortality
a. Plasmodium falciparum
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Rarely fatal
b. Plasmodium malariae
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Least common ; ; Rarely fatal May cause relapses
c. Plasmodium ovale
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Most common ; Rarely fatal ; May cause relapses
d. Plasmodium vivax
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Phylum: Apicomplexa → Class: Sporozoa → Blood species: Babesia
B. Babesia species
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▪ Pathogenic: Babesia microti
B. Babesia species
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Definitive host: Animals (Deer)
B. Babesia species
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Infective stage: trophozoites liberated via the bite of deer tick
B. Babesia species
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Diagnostic stage: demonstration of characteristic ring forms in Giemsastained blood smears (thick and thin smear)
B. Babesia species
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Man infected by bite of a tick that belong to genus Ixodes (intermediate host); can be transmitted through blood transfusion
B. Babesia species
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An obligate intracellular parasite (seen inside of an RBC measuring about 2 – 4 um)
B. Babesia species
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Pear-shaped
B. Babesia species
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Usually in pair or tetrads (resembling “maltese cross” appearance)
B. Babesia species
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symptoms resemble Malaria (Headache and fever ; Hemolytic anemia with hemoglobinuria in immunocompetent host)
B. Babesia species
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The subclass Coccidia includes species of
Toxoplasma, Isospora, Sarcocystis, Cryptosporidium, and Cyclospora
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Schizogony (Asexual) in variety of nucleated cells
C. Coccidians
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Sporogony (Sexual) in intestinal mucosa of definitive host: infective oocyst are excreted in the feces
C. Coccidians
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C. Coccidians Classification
✓ Intestinal Coccidian
✓ Tissue Coccidian
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− Prevalent in AIDS patient/immunocompromised persons
✓ Intestinal Coccidian
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− Infective stage: oocysts
✓ Intestinal Coccidian
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− Diagnostic stage: oocysts demonstrated in feces
✓ Intestinal Coccidian
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I. Intestinal Coccidian
a. Cryptosporidium parvum
b. Cyclospora cayetanensis
c. Isospora belli
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II. Tissue Coccidian
Toxoplasma gondii
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Important opportunistic infection in AIDS patients
a. Cryptosporidium parvum
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▪ Definitive host: Humans
c. Isospora belli
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▪ Habitat: small intestines of man
c. Isospora belli
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➢ Ingestion of oocysts from food or water contaminated with animal feces
a. Cryptosporidium parvum
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➢ Oral-anal route
a. Cryptosporidium parvum
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➢ Direct contact with infected individual or animal
a. Cryptosporidium parvum
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Ingestion of sporulated oocysts in fecally contaminated food or water
c. Isospora belli
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Immature oocyst ➢ 20 – 33 um by 10 – 19 um
c. Isospora belli
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Immature oocyst ➢ Elongately ovoidal in shape with one end narrower than the other
c. Isospora belli
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Mature oocyst ➢ 29 um by 14 um
c. Isospora belli
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Mature oocyst ➢ Contains 2 sporocyst, each containing 4 sporozoites
c. Isospora belli
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− infective oocysts ingested in contaminated food and water
b. Cyclospora cayetanensis
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− outbreaks have been associated with contaminated berries
b. Cyclospora cayetanensis
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➢ Upon ingestion, sporozoites released from oocyst x
a. Cryptosporidium parvum
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➢ Develop in brush border of intestinal epithelial cells
a. Cryptosporidium parvum
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➢ Sporulated oocysts, containing 4 sporozoites each (no sporocysts), are passed in feces
a. Cryptosporidium parvum
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➢ Infective oocysts are transmitted via fecal-oral route
a. Cryptosporidium parvum
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Cryptosporidiosis
a. Cryptosporidium parvum
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➢ Causes intestinal infection: associated with watery, frothy diarrhea with oocysts shed in feces
Cryptosporidiosis
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➢ Causes chronic diarrhea in immunocompromised person
Cryptosporidiosis
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➢ Acute self-limiting diarrhea
Cryptosporidiosis
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Indistinguishable from cryptosporidiosis
b. Cyclospora cayetanensis
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Human Coccidiosis
c. Isospora belli
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➢ Often asymptomatic and self-limiting
Human Coccidiosis
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➢ Symptoms range from mild gastrointestinal distress to severe dysentery
Human Coccidiosis
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In mild cases: mild abdominal pain and mucoid diarrhea
Human Coccidiosis
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In severe cases: severe abdominal cramps with milky, watery diarrhea
Human Coccidiosis
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Prevalent in AIDS patients/immunocompromised persons
Toxoplasma gondii
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DH cat
Toxoplasma gondii
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IH humans
Toxoplasma gondii
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intracellular obligate parasite of endothelial cells, mononuclear leukocytes, body fluids, and tissue of the host
Toxoplasma gondii
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➢ Accidental ingestion/inhalation of oocysts from cat feces
Toxoplasma gondii
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➢ Ingestion of undercooked meat or oocysts from cat feces
Toxoplasma gondii
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➢ Transplacental
Toxoplasma gondii
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➢ Organ transplants
Toxoplasma gondii
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: Major cause of encephalitis in AIDS px
Toxoplasmosis
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: ➢ Appears after the infection and regional lymph node invasion
Acquired toxoplasmosis
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➢ Parasite is blood borne to many organs where intracellular multiplication takes place
Acquired toxoplasmosis
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Major cause of congenital toxoplasmosis among the newborns:
Congenital infection causes birth defects and mental retardation
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Serological diagnosis: EIA and IFA – for detecting neonatal toxoplasmosis
Toxoplasma gondii
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Sabin-Feldman Dye test: ➢ Methylene blue staining of tachyzoites inhibited by prior addition of patient serum containing antibodies of [?]
Toxoplasma gondii
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➢ Sugar floatation technique
a. Cryptosporidium parvum
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➢ Modified acid fast stain in feces:
a. Cryptosporidium parvum
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Red spherical bodies, four sphorozoites
a. Cryptosporidium parvum
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Oocysts are stained red against blue background
a. Cryptosporidium parvum
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Average size: 4 – 6 um
a. Cryptosporidium parvum
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Modified AFS
b. Cyclospora cayetanensis
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➢ Oocysts stain from light pink to deep red (acid-fast variable)
b. Cyclospora cayetanensis
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➢ Average size: 8 – 10 um (larger than C. Parvum)
b. Cyclospora cayetanensis
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1. Demonstration of oocysts in feces (transparent containing 1-2 sporoblast)
c. Isospora belli
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2. Modified AFS
c. Isospora belli
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➢ Sporoblasts and/or sporocysts stain deep red
c. Isospora belli
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➢ Oocysts are ellipsoid with blunt ends
c. Isospora belli
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➢ Average size: 30 by 12 um
c. Isospora belli
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Newest group of obligate intracellular parasite
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➢ Not certain; most likely by ingestion of spores
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➢ Inhalation of spores, ocular exposure, and sexual intercourse may also be route of transmission
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➢ Similar with Cryptosporidiosis
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➢ Spores are very resistant
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Electron Microscopy – necessary to speciate
D. Microsporidia
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Serological testing
D. Microsporidia
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Modified Trichrome stain:
D. Microsporidia
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➢ Concentration must be 10x higher that traditional trichrome stain
D. Microsporidia
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➢ Performed on unconcentrated specimen
D. Microsporidia
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➢ Spore walls stains bright pink; background stains green or blue (depending on the couterstain)
D. Microsporidia
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▪ The most common microsporidia causing enteritis among patients with AIDS
Enterocytozoon bieneusi (Encephalitozoon intestinalis)
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▪ The organism is very small measuring about 1.5 – 4 um
Enterocytozoon bieneusi (Encephalitozoon intestinalis)
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▪ Characteristic feature: spores containing a polar tubule, used to inject infective spore content into the host cells
Enterocytozoon bieneusi (Encephalitozoon intestinalis)
