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Chapter 3 : Intestinal Protozoa: Flagellates and Ciliates
Editor:
Lynne S. Garcia1
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Affiliations:
1: LSG & Associates, Santa Monica, California
Content Type: Reference
Publication Year:
2007
Category: Clinical Microbiology
Book DOI:
10.1128/9781555816018
Chapter DOI:
10.1128/9781555816018.ch3
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Abstract:
This chapter begins with a discussion on Giardia lamblia. Recent studies document antigenic variation with surface antigen changes during human infections with G. lamblia; although the biological importance of this work is not clear, it suggests that this variation may provide a mechanism for the organism to escape the host immune response. Routine stool examinations are normally recommended for the recovery and identification of intestinal protozoa. A new and simple colorimetric method has been determined for determining in vitro activity against G. lamblia. Most experts agree that the single most effective practice that prevents the spread of infection in the child care setting is thorough handwashing by the children, staff, and visitors. Currently, the most commonly used method for examining purified material for protozoa is an antibody-based immunofluorescence assay. Isolates from asymptomatic individuals were found in the same zymodemes (isoenzyme groups) as were isolates from symptomatic hosts. The chapter next focuses on Dientamoeba fragilis. Since there is no known cyst stage, this organism will not be seen on a wet preparation. Consequently, it is mandatory that a permanent stained smear be included in the ova and parasite examination. Current recommendations include iodoquinol, paromomycin, or tetracycline. Since symptomatic relief has been observed to follow appropriate therapy, Dientamoeba fragilis is probably pathogenic in infected individuals who are symptomatic. Finally, the chapter focuses on Pentatrichomonas hominis, Chilomastix mesnili, Enteromonas hominis, Retortamonas intestinalis, and Balantidium coli.
Citation:
Garcia L.
2007.
Intestinal Protozoa: Flagellates and Ciliates,
p 33-56.
In
Diagnostic Medical Parasitology, Fifth Edition.
ASM Press, Washington, DC.
doi: 10.1128/9781555816018.ch3
Figures
Intestinal Protozoa: Flagellates and Ciliates
Citation:
Garcia L.
2007.
Intestinal Protozoa: Flagellates and Ciliates,
p 33-56.
In
Diagnostic Medical Parasitology, Fifth Edition.
ASM Press, Washington, DC.
doi: 10.1128/9781555816018.ch3
/content/10.1128/9781555816018.ch03.ch03fig01
Figure 3.1
Life cycle of Giardia lamblia.
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10.1128/9781555816018/ch3fig1.gif
Figure 3.1
Life cycle of Giardia lamblia.
Citation:
Garcia L.
2007.
Intestinal Protozoa: Flagellates and Ciliates,
p 33-56.
In
Diagnostic Medical Parasitology, Fifth Edition.
ASM Press, Washington, DC.
doi: 10.1128/9781555816018.ch3
/content/10.1128/9781555816018.ch03.ch03fig02
Figure 3.2
Giardia lamblia trophozoites on the mucosal surface. (Scanning electron micrographs courtesy of Marietta Voge.)
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10.1128/9781555816018/ch3fig2.gif
Figure 3.2
Giardia lamblia trophozoites on the mucosal surface. (Scanning electron micrographs courtesy of Marietta Voge.)
Citation:
Garcia L.
2007.
Intestinal Protozoa: Flagellates and Ciliates,
p 33-56.
In
Diagnostic Medical Parasitology, Fifth Edition.
ASM Press, Washington, DC.
doi: 10.1128/9781555816018.ch3
/content/10.1128/9781555816018.ch03.ch03fig03
Figure 3.3
(1) Trophozoite of Giardia lamblia (front view); (2) trophozoite of G. lamblia (side view); (3) cyst of G. lamblia; (4) trophozoite of Pentatrichomonas hominis; (5) trophozoite of Dientamoeba fragilis (two fragmented nuclei); (6) trophozoite of D. fragilis (one fragmented nucleus); (7) trophozoite of Chilomastix mesnili; (8) cyst of C. mesnili; (9) trophozoite of Enteromonas hominis; (10–12) cysts of E. hominis; (13) trophozoite of Retortamonas intestinalis; (14 and 15) cysts of R. intestinalis. (Illustrations by Sharon Belkin.)
10.1128/9781555816018/ch3fig3_thmb.gif
10.1128/9781555816018/ch3fig3.gif
Figure 3.3
(1) Trophozoite of Giardia lamblia (front view); (2) trophozoite of G. lamblia (side view); (3) cyst of G. lamblia; (4) trophozoite of Pentatrichomonas hominis; (5) trophozoite of Dientamoeba fragilis (two fragmented nuclei); (6) trophozoite of D. fragilis (one fragmented nucleus); (7) trophozoite of Chilomastix mesnili; (8) cyst of C. mesnili; (9) trophozoite of Enteromonas hominis; (10–12) cysts of E. hominis; (13) trophozoite of Retortamonas intestinalis; (14 and 15) cysts of R. intestinalis. (Illustrations by Sharon Belkin.)
Citation:
Garcia L.
2007.
Intestinal Protozoa: Flagellates and Ciliates,
p 33-56.
In
Diagnostic Medical Parasitology, Fifth Edition.
ASM Press, Washington, DC.
doi: 10.1128/9781555816018.ch3
/content/10.1128/9781555816018.ch03.ch03fig04
Figure 3.4
(A to D) Trophozoites of Giardia lamblia; (E and F) cysts of G. lamblia.
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10.1128/9781555816018/ch3fig4.gif
Figure 3.4
(A to D) Trophozoites of Giardia lamblia; (E and F) cysts of G. lamblia.
Citation:
Garcia L.
2007.
Intestinal Protozoa: Flagellates and Ciliates,
p 33-56.
In
Diagnostic Medical Parasitology, Fifth Edition.
ASM Press, Washington, DC.
doi: 10.1128/9781555816018.ch3
/content/10.1128/9781555816018.ch03.ch03alg01
Algorithm 3.1
Giardiasis. Fecal immunoassay kits can be used on human stool specimens to confirm the presence of Giardia spp. Currently available reagents can be used with fresh, frozen, or preserved specimens (not those containing polyvinyl alcohol). If fluorescent testing is performed, the specimen should not be frozen (the actual organisms are disrupted during the freeze-thaw cycle); however, fresh or preserved specimens are acceptable. Check with each manufacturer for compatibility of the fixative with the proposed test; not all fixatives are compatible with all types of fecal immunoassays.
10.1128/9781555816018/ch3alg1_thmb.gif
10.1128/9781555816018/ch3alg1.gif
Algorithm 3.1
Giardiasis. Fecal immunoassay kits can be used on human stool specimens to confirm the presence of Giardia spp. Currently available reagents can be used with fresh, frozen, or preserved specimens (not those containing polyvinyl alcohol). If fluorescent testing is performed, the specimen should not be frozen (the actual organisms are disrupted during the freeze-thaw cycle); however, fresh or preserved specimens are acceptable. Check with each manufacturer for compatibility of the fixative with the proposed test; not all fixatives are compatible with all types of fecal immunoassays.
Citation:
Garcia L.
2007.
Intestinal Protozoa: Flagellates and Ciliates,
p 33-56.
In
Diagnostic Medical Parasitology, Fifth Edition.
ASM Press, Washington, DC.
doi: 10.1128/9781555816018.ch3
/content/10.1128/9781555816018.ch03.ch03fig05
Figure 3.5
Life cycle of Dientamoeba fragilis.
10.1128/9781555816018/ch3fig5_thmb.gif
10.1128/9781555816018/ch3fig5.gif
Figure 3.5
Life cycle of Dientamoeba fragilis.
Citation:
Garcia L.
2007.
Intestinal Protozoa: Flagellates and Ciliates,
p 33-56.
In
Diagnostic Medical Parasitology, Fifth Edition.
ASM Press, Washington, DC.
doi: 10.1128/9781555816018.ch3
/content/10.1128/9781555816018.ch03.ch03fig06
Figure 3.6
Trophozoites of Dientamoeba fragilis. (Illustration by Sharon Belkin.)
10.1128/9781555816018/ch3fig6_thmb.gif
10.1128/9781555816018/ch3fig6.gif
Figure 3.6
Trophozoites of Dientamoeba fragilis. (Illustration by Sharon Belkin.)
Citation:
Garcia L.
2007.
Intestinal Protozoa: Flagellates and Ciliates,
p 33-56.
In
Diagnostic Medical Parasitology, Fifth Edition.
ASM Press, Washington, DC.
doi: 10.1128/9781555816018.ch3
/content/10.1128/9781555816018.ch03.ch03fig07
Figure 3.7
(A, B) Trophozoites of Dientamoeba fragilis. (A) The trophozoite contains a single nucleus fragmented into four parts; (B) the trophozoite contains two nuclei, both of which are also fragmented.
10.1128/9781555816018/ch3fig7_thmb.gif
10.1128/9781555816018/ch3fig7.gif
Figure 3.7
(A, B) Trophozoites of Dientamoeba fragilis. (A) The trophozoite contains a single nucleus fragmented into four parts; (B) the trophozoite contains two nuclei, both of which are also fragmented.
Citation:
Garcia L.
2007.
Intestinal Protozoa: Flagellates and Ciliates,
p 33-56.
In
Diagnostic Medical Parasitology, Fifth Edition.
ASM Press, Washington, DC.
doi: 10.1128/9781555816018.ch3
/content/10.1128/9781555816018.ch03.ch03fig08
Figure 3.8
Life cycle of Pentatrichomonas hominis.
10.1128/9781555816018/ch3fig8_thmb.gif
10.1128/9781555816018/ch3fig8.gif
Figure 3.8
Life cycle of Pentatrichomonas hominis.
Citation:
Garcia L.
2007.
Intestinal Protozoa: Flagellates and Ciliates,
p 33-56.
In
Diagnostic Medical Parasitology, Fifth Edition.
ASM Press, Washington, DC.
doi: 10.1128/9781555816018.ch3
/content/10.1128/9781555816018.ch03.ch03fig09
Figure 3.9
Life cycle of Trichomonas tenax.
10.1128/9781555816018/ch3fig9_thmb.gif
10.1128/9781555816018/ch3fig9.gif
Figure 3.9
Life cycle of Trichomonas tenax.
Citation:
Garcia L.
2007.
Intestinal Protozoa: Flagellates and Ciliates,
p 33-56.
In
Diagnostic Medical Parasitology, Fifth Edition.
ASM Press, Washington, DC.
doi: 10.1128/9781555816018.ch3
/content/10.1128/9781555816018.ch03.ch03fig10
Figure 3.10
Life cycle of Chilomastix mesnili, Enteromonas hominis, and Retortamonas intestinalis.
10.1128/9781555816018/ch3fig10_thmb.gif
10.1128/9781555816018/ch3fig10.gif
Figure 3.10
Life cycle of Chilomastix mesnili, Enteromonas hominis, and Retortamonas intestinalis.
Citation:
Garcia L.
2007.
Intestinal Protozoa: Flagellates and Ciliates,
p 33-56.
In
Diagnostic Medical Parasitology, Fifth Edition.
ASM Press, Washington, DC.
doi: 10.1128/9781555816018.ch3
/content/10.1128/9781555816018.ch03.ch03fig11
Figure 3.11
(A) Trophozoite of Chilomastix mesnili (note the feeding groove; flagella are not visible); (B) cyst of C. mesnili (note the “lemon or pear” shape and the curved fibril, the shepherd’s crook).
10.1128/9781555816018/ch3fig11_thmb.gif
10.1128/9781555816018/ch3fig11.gif
Figure 3.11
(A) Trophozoite of Chilomastix mesnili (note the feeding groove; flagella are not visible); (B) cyst of C. mesnili (note the “lemon or pear” shape and the curved fibril, the shepherd’s crook).
Citation:
Garcia L.
2007.
Intestinal Protozoa: Flagellates and Ciliates,
p 33-56.
In
Diagnostic Medical Parasitology, Fifth Edition.
ASM Press, Washington, DC.
doi: 10.1128/9781555816018.ch3
/content/10.1128/9781555816018.ch03.ch03fig12
Figure 3.12
Life cycle of Balantidium coli.
10.1128/9781555816018/ch3fig12_thmb.gif
10.1128/9781555816018/ch3fig12.gif
Figure 3.12
Life cycle of Balantidium coli.
Citation:
Garcia L.
2007.
Intestinal Protozoa: Flagellates and Ciliates,
p 33-56.
In
Diagnostic Medical Parasitology, Fifth Edition.
ASM Press, Washington, DC.
doi: 10.1128/9781555816018.ch3
/content/10.1128/9781555816018.ch03.ch03fig13
Figure 3.13
(1) Trophozoite of Balantidium coli; (2) cyst of B. coli. (Illustration by Sharon Belkin.)
10.1128/9781555816018/ch3fig13_thmb.gif
10.1128/9781555816018/ch3fig13.gif
Figure 3.13
(1) Trophozoite of Balantidium coli; (2) cyst of B. coli. (Illustration by Sharon Belkin.)
Citation:
Garcia L.
2007.
Intestinal Protozoa: Flagellates and Ciliates,
p 33-56.
In
Diagnostic Medical Parasitology, Fifth Edition.
ASM Press, Washington, DC.
doi: 10.1128/9781555816018.ch3
/content/10.1128/9781555816018.ch03.ch03fig14
Figure 3.14
(A) Trophozoite of Balantidium coli (note the large bean-shaped macronucleus and evidence of cilia around the organism); (B) cyst of B. coli (note the large bean-shaped macronucleus).
10.1128/9781555816018/ch3fig14_thmb.gif
10.1128/9781555816018/ch3fig14.gif
Figure 3.14
(A) Trophozoite of Balantidium coli (note the large bean-shaped macronucleus and evidence of cilia around the organism); (B) cyst of B. coli (note the large bean-shaped macronucleus).
Citation:
Garcia L.
2007.
Intestinal Protozoa: Flagellates and Ciliates,
p 33-56.
In
Diagnostic Medical Parasitology, Fifth Edition.
ASM Press, Washington, DC.
doi: 10.1128/9781555816018.ch3
/content/10.1128/9781555816018.ch03.ch03fig15
Figure 3.15
Trophozoite of Balantidium coli in tissue. Note the cytostome (oral groove) and a portion of the macronucleus. The cilia are not clearly visible.
10.1128/9781555816018/ch3fig15_thmb.gif
10.1128/9781555816018/ch3fig15.gif
Figure 3.15
Trophozoite of Balantidium coli in tissue. Note the cytostome (oral groove) and a portion of the macronucleus. The cilia are not clearly visible.
Citation:
Garcia L.
2007.
Intestinal Protozoa: Flagellates and Ciliates,
p 33-56.
In
Diagnostic Medical Parasitology, Fifth Edition.
ASM Press, Washington, DC.
doi: 10.1128/9781555816018.ch3
References
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Tables
Intestinal Protozoa: Flagellates and Ciliates
Citation:
Garcia L.
2007.
Intestinal Protozoa: Flagellates and Ciliates,
p 33-56.
In
Diagnostic Medical Parasitology, Fifth Edition.
ASM Press, Washington, DC.
doi: 10.1128/9781555816018.ch3
/content/10.1128/9781555816018.ch03.ch03tab01
Table 3.1
Giardia species
a
Table 3.1
Giardia species a
Citation:
Garcia L.
2007.
Intestinal Protozoa: Flagellates and Ciliates,
p 33-56.
In
Diagnostic Medical Parasitology, Fifth Edition.
ASM Press, Washington, DC.
doi: 10.1128/9781555816018.ch3
/content/10.1128/9781555816018.ch03.ch03tab02
Table 3.2
Giardia genotypes
a
Table 3.2
Giardia genotypes a
Citation:
Garcia L.
2007.
Intestinal Protozoa: Flagellates and Ciliates,
p 33-56.
In
Diagnostic Medical Parasitology, Fifth Edition.
ASM Press, Washington, DC.
doi: 10.1128/9781555816018.ch3
/content/10.1128/9781555816018.ch03.ch03tab03
Table 3.3
Intestinal protozoa: trophozoites of flagellates
Table 3.3
Intestinal protozoa: trophozoites of flagellates
Citation:
Garcia L.
2007.
Intestinal Protozoa: Flagellates and Ciliates,
p 33-56.
In
Diagnostic Medical Parasitology, Fifth Edition.
ASM Press, Washington, DC.
doi: 10.1128/9781555816018.ch3
/content/10.1128/9781555816018.ch03.ch03tab04
Table 3.4
Intestinal protozoa: cysts of flagellates
Table 3.4
Intestinal protozoa: cysts of flagellates
Citation:
Garcia L.
2007.
Intestinal Protozoa: Flagellates and Ciliates,
p 33-56.
In
Diagnostic Medical Parasitology, Fifth Edition.
ASM Press, Washington, DC.
doi: 10.1128/9781555816018.ch3
/content/10.1128/9781555816018.ch03.ch03tab05
Table 3.5
Representative commercially available kits for immunodetection of Giardia lamblia
Table 3.5
Representative commercially available kits for immunodetection of Giardia lamblia
Citation:
Garcia L.
2007.
Intestinal Protozoa: Flagellates and Ciliates,
p 33-56.
In
Diagnostic Medical Parasitology, Fifth Edition.
ASM Press, Washington, DC.
doi: 10.1128/9781555816018.ch3
/content/10.1128/9781555816018.ch03.ch03tab06
Table 3.6
Recommendations for therapy for giardiasis
a
Table 3.6
Recommendations for therapy for giardiasis a
Citation:
Garcia L.
2007.
Intestinal Protozoa: Flagellates and Ciliates,
p 33-56.
In
Diagnostic Medical Parasitology, Fifth Edition.
ASM Press, Washington, DC.
doi: 10.1128/9781555816018.ch3
/content/10.1128/9781555816018.ch03.ch03tab07
Table 3.7
Guidelines for hand washing
Table 3.7
Guidelines for hand washing
Citation:
Garcia L.
2007.
Intestinal Protozoa: Flagellates and Ciliates,
p 33-56.
In
Diagnostic Medical Parasitology, Fifth Edition.
ASM Press, Washington, DC.
doi: 10.1128/9781555816018.ch3
/content/10.1128/9781555816018.ch03.ch03tab08
Table 3.8
Questions for consideration when testing well water
Table 3.8
Questions for consideration when testing well water
Citation:
Garcia L.
2007.
Intestinal Protozoa: Flagellates and Ciliates,
p 33-56.
In
Diagnostic Medical Parasitology, Fifth Edition.
ASM Press, Washington, DC.
doi: 10.1128/9781555816018.ch3
/content/10.1128/9781555816018.ch03.ch03tab09
Table 3.9
Intestinal protozoa: ciliate
Table 3.9
Intestinal protozoa: ciliate
Citation:
Garcia L.
2007.
Intestinal Protozoa: Flagellates and Ciliates,
p 33-56.
In
Diagnostic Medical Parasitology, Fifth Edition.
ASM Press, Washington, DC.
doi: 10.1128/9781555816018.ch3
/content/10.1128/9781555816018.ch03.ch03tab10
Table 3.10
Intestinal flagellates and ciliates: recommended diagnostic procedures
Table 3.10
Intestinal flagellates and ciliates: recommended diagnostic procedures
Citation:
Garcia L.
2007.
Intestinal Protozoa: Flagellates and Ciliates,
p 33-56.
In
Diagnostic Medical Parasitology, Fifth Edition.
ASM Press, Washington, DC.
doi: 10.1128/9781555816018.ch3