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Chapter 137 : Intestinal and Urogenital Amebae, Flagellates, and Ciliates

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Abstract:

This chapter talks about the intestinal amebae and urogenital amebae, flagellates, and ciliates. It is noteworthy that , once classified as an ameba, is now grouped with the flagellates. All diagnostic stages of the amebae (trophozoite and cyst) can be detected in fecal specimens, the most common specimen submitted to the laboratory. and the other spp. are classified as belonging to the phylum Amoebozoa, subphylum Conosa, class Archamoebea, order Euamoebida. Some flagellates are commensals that reside in the intestinal tract and are harmless to the individual. For the detection of flagellates and ciliates, laboratories predominantly receive stool specimens for microscopic examination. The flagellates have greater morphologic diversity relative to one another than do the amebae, making determination of the genus easier. Despite the lack of external flagella, this parasite is currently classified as a flagellate but has historically been grouped with the amebae. Two additional nonpathogenic intestinal flagellates are and . Clinical laboratories are now given more choices for testing in diagnostic parasitology, with assays ranging from microscopy, culture, antigen detection, and nucleic acid amplification techniques. Molecular biology has the promise to deliver more sensitive and specific methods but to date, these methods have not been fully adapted to the clinical diagnostic laboratory.

Citation: Leber A, Novak-Weekley S. 2011. Intestinal and Urogenital Amebae, Flagellates, and Ciliates, p 2149-2171. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch137

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Image of FIGURE 1
FIGURE 1

Intestinal amebae of humans. (Top row) Trophozoites. is shown with ingested RBCs. This is the only microscopic finding that allows differentiation of the pathogenic species from the nonpathogenic species . An ameboid form of is rarely seen and is difficult to identify. (Middle row) Cysts. For the central body form is depicted. (Bottom row) Trophozoite nuclei, shown in relative proportion.

Citation: Leber A, Novak-Weekley S. 2011. Intestinal and Urogenital Amebae, Flagellates, and Ciliates, p 2149-2171. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch137
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Image of FIGURE 2
FIGURE 2

(Top row) trophozoites. Note the ingested RBCs in the cytoplasm. (Middle row) trophozoites. Note the absence of RBCs in the cytoplasm. (Bottom row) cysts. These cysts cannot be identified to the species level on the basis of morphology. Organisms are stained with Wheatley's trichrome stain. (Courtesy of L. Garcia.)

Citation: Leber A, Novak-Weekley S. 2011. Intestinal and Urogenital Amebae, Flagellates, and Ciliates, p 2149-2171. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch137
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Image of FIGURE 3
FIGURE 3

on an iodine wet mount preparation. Note the peripheral nuclei and the central body form. (Courtesy of L. Garcia.)

Citation: Leber A, Novak-Weekley S. 2011. Intestinal and Urogenital Amebae, Flagellates, and Ciliates, p 2149-2171. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch137
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Image of FIGURE 4
FIGURE 4

trophozoite (left) and cyst (right). Note the “bull's eye” nucleus in the trophozoite and the numerous chromatoidal bars within the cyst. Organisms are stained with Wheatley's trichrome stain. (Courtesy of L. Garcia.)

Citation: Leber A, Novak-Weekley S. 2011. Intestinal and Urogenital Amebae, Flagellates, and Ciliates, p 2149-2171. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch137
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Image of FIGURE 5
FIGURE 5

(Top row) trophozoite (left) and cyst (right). Note the large eccentric karyosome in the trophozoite and the chromatoidal bars with sharp pointed ends in the cyst. (Middle row) cyst in iodine (left) and in saline (right). The nuclei are visible; the presence of five or more nuclei is confirmatory for . (Bottom row) cyst (left; trichrome) and cyst (right; trichrome). Both cysts are very distorted and shrunken, although the nuclei can be seen in the cyst on the right. This type of shrinkage is typical of cysts on permanent-stained smears. (Courtesy of L. Garcia.)

Citation: Leber A, Novak-Weekley S. 2011. Intestinal and Urogenital Amebae, Flagellates, and Ciliates, p 2149-2171. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch137
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Image of FIGURE 6
FIGURE 6

(Top row) trophozoites. Note the typical nucleus on the left and the nuclear variation on the right. (Middle row) cysts. Note the typical four nuclei, none of which have peripheral chromatin. (Bottom row) trophozoite (left) and cyst (right). Note the “basket nucleus” in the cyst, along with the large glycogen vacuole. Organisms are stained with Wheatley's trichrome stain. (Courtesy of L. Garcia.)

Citation: Leber A, Novak-Weekley S. 2011. Intestinal and Urogenital Amebae, Flagellates, and Ciliates, p 2149-2171. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch137
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Image of FIGURE 7
FIGURE 7

Intestinal and urogenital flagellates of humans. (Top row) Trophozoites. is found in urogenital sites; all other flagellates are intestinal. (Bottom row) Cysts. trophozoite is shown; no cyst stage.

Citation: Leber A, Novak-Weekley S. 2011. Intestinal and Urogenital Amebae, Flagellates, and Ciliates, p 2149-2171. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch137
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Image of FIGURE 8
FIGURE 8

(Top row) trophozoites. Note the typical nuclei, axonemes, and curved median bodies. ( Bottom row) cysts. The cysts on the right are stained with iron-hematoxylin, and those on the left are stained with Wheatley's trichrome stain. (Courtesy of L. Garcia.)

Citation: Leber A, Novak-Weekley S. 2011. Intestinal and Urogenital Amebae, Flagellates, and Ciliates, p 2149-2171. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch137
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Image of FIGURE 9
FIGURE 9

trophozoites. The trophozoites can have one nucleus (left) or two nuclei (right). No cyst stage is known for this organism. Trophozoites are stained with Wheatley's trichrome stain. (Courtesy of L. Garcia.)

Citation: Leber A, Novak-Weekley S. 2011. Intestinal and Urogenital Amebae, Flagellates, and Ciliates, p 2149-2171. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch137
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Image of FIGURE 10
FIGURE 10

trophozoites. Note the undulating membrane, which comes about halfway down the body. Although the membrane appears to come down farther on one of the trophozoites (right), this appearance occurs because of the photographic angle. Also, note the axostyle that penetrates the bottom of the organism. No cyst stage is known for this organism. Trophozoites are stained with Giemsa stain. (Courtesy of L. Garcia.)

Citation: Leber A, Novak-Weekley S. 2011. Intestinal and Urogenital Amebae, Flagellates, and Ciliates, p 2149-2171. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch137
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Image of FIGURE 11
FIGURE 11

trophozoite (left) and cyst (right). Note the oral groove (feeding groove) at the right side of the trophozoite (clear area) and the curved fibril (shepherd's crook) in the cyst. Also note the typical pear or lemon shape of the cyst. Organisms are stained with Wheatley's trichrome stain. (Courtesy of L. Garcia.)

Citation: Leber A, Novak-Weekley S. 2011. Intestinal and Urogenital Amebae, Flagellates, and Ciliates, p 2149-2171. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch137
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Image of FIGURE 12
FIGURE 12

trophozoite (left) and cyst (right). Note the single macronucleus visible in both the trophozoite and the cyst. The much smaller micronucleus is not visible. Organisms are stained with Wheatley's trichrome stain. (Courtesy of L. Garcia.)

Citation: Leber A, Novak-Weekley S. 2011. Intestinal and Urogenital Amebae, Flagellates, and Ciliates, p 2149-2171. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch137
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Tables

Generic image for table
TABLE 1

Intestinal and urogenital amebae, flagellates, and ciliates of humans

A distinction between and cannot be made on the basis of morphology unless ingested RBCs are seen in the cytoplasm of the trophozoite.

In rare instances, may be found in human stool specimens. A free-living ameba, it is nonpathogenic and morphologically identical to ( ).

and are found in the oral cavity and related specimens.

Citation: Leber A, Novak-Weekley S. 2011. Intestinal and Urogenital Amebae, Flagellates, and Ciliates, p 2149-2171. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch137
Generic image for table
TABLE 2

Key features of trophozoites and cysts of common intestinal amebae

Adapted from reference .

Size ranges are based on wet preparations (with permanent stains, organisms usually measure 1 to 2 mm less).

Nuclear and cytoplasmic descriptions are based on permanent-stained smears.

Description of central body form.

Citation: Leber A, Novak-Weekley S. 2011. Intestinal and Urogenital Amebae, Flagellates, and Ciliates, p 2149-2171. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch137
Generic image for table
TABLE 3

Sensitivity and specificity of diagnostic tests for amebiasis

Reprinted from reference with permission.

NA, not available.

ELISA, enzyme-linked immunosorbent assay.

Citation: Leber A, Novak-Weekley S. 2011. Intestinal and Urogenital Amebae, Flagellates, and Ciliates, p 2149-2171. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch137
Generic image for table
TABLE 4

Key features of trophozoites and cysts of common intestinal and urogenital flagellates

Adapted from reference .

Size ranges are based on wet preparations (with permanent stains, organisms usually measure 1 to 2 mm less).

Nuclear and cytoplasmic descriptions are based on permanent-stained smears.

Citation: Leber A, Novak-Weekley S. 2011. Intestinal and Urogenital Amebae, Flagellates, and Ciliates, p 2149-2171. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch137
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TABLE 5

Key features of the ciliate

Citation: Leber A, Novak-Weekley S. 2011. Intestinal and Urogenital Amebae, Flagellates, and Ciliates, p 2149-2171. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch137

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