CLINICAL PARASITOLOGY

COCCIDIA (WEEK 8 / LEC)

1st SEM, 2021
Coccidian Parasites ● Obligate parasite
● Under class Sporozoea (Phylum Apicomplexa) ● Complete entire life cycle in single host
● In class Sporozoea, the life cycle is ● Within the intestinal epithelial cells of the
characterized by an alternations of host
generation ● Characterized by a thick walled oocyst
○ Sexual: Sporogony excreted in faeces
○ Asexual: Schizogony ● Have both sexual and asexual reproduction
● Isospora belli ● Are transmitted by the fecal-oral route
● Cryptosporidium hominis through contaminated food or water
● Cyclospora cayetanensis ● Laboratory diagnosis is by finding the oocyst
● Toxoplasma gondii in feces
● Sarcocystis hominis and Sarcocystis suihominis ● OOCYST STAGE: Infective and diagnostic stage
Intestinal Coccidian
● Cryptosporidium
● Isospora
● Cyclospora
Blood and Tissue Coccidian
● Plasmodium
● Toxoplasma
● Babesia LIFE CYCLE OF COCCIDIA
● Sarcocystis

ISOSPORA
Isospora belli
EPIDEMIOLOGY
● wide geographical distribution (higher
prevalence in warmer climates)
● the least common of the three intestinal
coccidia that infect humans
● transmitted fecally in contaminated food and
drink with oocyst

PATHOLOGY
● Infection is usually asymptomatic.
● Symptomatic: diarrhea, weight loss,
Intestinal Coccidian eosinophilia, fever, malaise, abdominal pain
Cryptosporidium, Isospora, Cyclospora and flatulence
GENERAL CHARACTERISTICS: ● In AIDS patients, reports on dissemination of
● Considered as opportunistic parasite in parasite to other organs are present
immunocompromised person ● Disease: Isosporosis/Intestinal coccidiosis

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 CLINICAL PARASITOLOGY
COCCIDIA (WEEK 8 / LEC)
1st SEM, 2021
● often asymptomatic (seldom reported)
● symptoms range from mild gastro-intestinal
distress to severe dysentery
● mild self-limiting infection charac. by fever,
colicky abdominal pain, severe diarrhea,
steatorrhea (fatty stool) and weight loss.
● often self-limiting, but can become chronic
(wasting, anorexia)
● symptoms more severe in AIDS patients
● intracellular development occurs in the
intestinal mucosa (lamina propria)® mucosal
atrophy
● charac. chronic diarrhea (months to years)
abdominal discomfort, low grade fever
DIAGNOSIS
● Direct microscopy
● Concentration technique (FECT, ZnSO4 and
sugar floatation)
● Staining techniques (Iodine, Kinyoun,
Auramine-Rhodamine)
● Enterotest and duodenal aspirate
● Molecular testing
TREATMENT
● Asymptomatic: bland diet and bed rest
● Symptomatic: Trimethoprim Sulfamethoxazole
PREVENTION AND CONTROL
● Good sanitary practices
● Thorough washing and cooking of food
● Provision for safe drinking water
OTHERS
● Infective Stage: OOCYST
● MOT: Ingestion of oocyst (contains 2
sporocyst with 4 sporozoites each)
● Disease is common to children and male
homosexuals with AIDS
● ISOSPORIASIS
● No Intermediate Host (pigs and cattles MORPHOLOGY
appeared to be) ● Oocyst elongate ovoidal-shape with moderate
● Definitive Host: MAN (sexual and asexual constriction in one end giving a charac.
reproduction takes place) ● “Bottle with short neck”appearance
● Ingest OOCYST (excyst) → SPOROZOITES ● 20 – 33 u L X10 – 19 u W
● Cyst wall double-layered, smooth, thin &
(small intestines) → asexual repro
colorless
(SCHIZOGONY) → MEROZOITES →MACRO/
● Unsegmented oocyst contains spherical mass
MICROGAMETOCYTE (unite) → oocyst
of granule with visible nucleus
(excreted in the stool) (consists of a ● Mature oocyst has 2 sporocyst and each
sporoblast) → divides into TWO contains 4 cresent-shaped sporozoites
SPOROBLASTS (matures) → SPOROCYST
(consist of 4 sausage shaped sporozoites)
(MATURE OOCYST)

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 CLINICAL PARASITOLOGY
COCCIDIA (WEEK 8 / LEC)
1st SEM, 2021

● Infective Stage: OOCYST

● Mature oocyst consist of 4 small sporozoites
HABITAT surrounded by a Thick cell wall.
● intestinal tract probably in the ileum and ● The OOCYST of cryptosporidium do not
cecum contain SPOROCYST unlike the Isospora beli
● life cycle similar to Cryptosporidium except ● MOT: INGESTION OF MATURE OOCYST
the oocysts mature in environment ● ALL STAGES à COMPLETED IN THE GIT
● OOCYST→ SPOROZOITES (attach to GIT) →
CRYPTOSPORIDIUM SCHIZOGONY→ PROD MEROZOITES→
● 1976 considered as natural parasite of animal MICRO/MACRO → FERTILIZED AND PROD
especially calves causing diarrheal diseases ZYGOTE→ THIN (INFECT OTHER
● Infect wide range of animal hosts ENTEROCYTES- AUTOINFECTION) AND THICK
(fish-humans) CELL WALL (PASSED IN FECES) →
○ C. hominis & C. parvum is species CONTAMINATE FOOD AND WATER
mostly causing disease in humans ● AUTOINFECTION: THIN-SHELLED
○ C. hominis infects only humans but C.
parvum also infects many other PATHOLOGY
mammals ● Cryptosporidiosis
○ C. felis, C. meleagridis, C. canis, and C. ○ human infection usually waterborne
muris infections have also been and acquired by fecal-oral route
reported ○ highest prevalence of disease in areas
with unreliable water and food
Cryptosporidium hominis sanitation
○ extraintestinal infection of the
respiratory tract, biliary tract and
pancreas may occur.
● Diarrhea → self limiting (2weeks)
● Fluid loss because of diarrhea and vomiting
may be fatal in children
● Gallbladder → leading to acute gangrenous
cholecystitis
● Specimen of choice for recovery: stool
● Immunocompetent: self-limiting diarrhea
within 2-3 weeks
● Immunocompromised: severe diarrhea, bile
duct and gallbladder maybe heavily infected,
blunted intestinal villi, varying degrees of
malabsorption land excessive fluid loss
● AIDS patient: severe form of diarrhea,
progressively worse and life-threatening

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 CLINICAL PARASITOLOGY
COCCIDIA (WEEK 8 / LEC)
1st SEM, 2021
OTHERS ○ Reduced host specificity and
● Geological Distribution: Worldwide monoxenous development
distribution ○ Close associations between human
● Morphology: oocyst round or slightly and animal hosts
oval-shaped, 4 – 6um enclosing 4 ○ Large number of oocysts excreted (up
spindle–shaped sporozoites to 100 billion per calf per day)
TRANSMISSION ○ Low infective dose (<30)
● Mainly through the ingestion and possibly ○ Robust oocysts; resistant to chlorine
inhalation of sporulated oocysts
○ mainly through contaminated water
○ Occasionally food sources, such as
chicken salad
● Fecal-oral transmission (monoxenous)
○ anthroponotic transmission
○ autoinfection
○ zoonotic transmission
● 2 major types & sources:
● C. hominis
○ anthroponotic transmission
○ only human sources
○ non-infective for mice or calves
● C. parvum
○ human and bovine sources
○ infective for mice and calve
○ zoonotic & anthroponotic
transmission
○ waterborne s outbreaks is common
○ in Milwaukee (Wisconsin) in 1993,
affected > 400,000 people

Extracytoplasmic Location
● microvilli extend and fuse to enclose zoite
● close association between parasite and host
intestinal epithelial cell
● called adhesive zone, feeder organelle, etc

Waterborne Cryptosporidiosis
● human infection usually waterborne and
acquired by fecal-oral route
● highest prevalence of disease in areas with
unreliable water and food sanitation
● FACTORS FAVORING WATERBORNE
CRYPTOSPORIDIOSIS
○ Small size of oocysts (4-5 mm)
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 CLINICAL PARASITOLOGY
COCCIDIA (WEEK 8 / LEC)
1st SEM, 2021
CLINICAL FEATURES ● Species Name C.Cayetanensis was given in
1993
● Vary from asymptomatic to severe,
● Initially called ‘cyano-bacteria like body’ (CLB)
life-threatening illness;
or large cryptosporidium
● infection usually self-limiting diarrhea of 1-2
weeks duration characterized by copious
watery diarrhea, vomiting, intense abdominal
pain, anorexia and weakness
● among immunocompromised patient (AIDS) ®
develops severe chronic diarrhea which may
last for months → malabsorption
● Incubation period: 7 days ( 2 to 10 days)
● In immunocompetent persons,
○ Symptoms are usually short lived (1 to
2 weeks)
● Persons with AIDS (CD4 counts <200/µl)
○ Chronic and more severe lasting for
months or even years
● Small intestine: most commonly affected
○ the lungs, and possibly conjunctiva
may be affected
PATHOGENESIS
● •Enterocytes damaged or killed
○ Villus atrophy (blunting)
○ Enterocyte malfunction
○ Impaired absorption
○ Enhanced secretion
● Crypt cell hyperplasia
● Inflammation in lamina propria
○ Impaired absorption
○ Promote secretion ● Infective Stage: OOCYST
TREATMENT
● MOT: INGESTION
● No acceptable treatment yet
● Originally called: cyanobacterium-like body
● Nitazoxanide: said to be effective in
(CLB) → but found to be a coccidian parasite
preliminary studies
● Bovine colostrum, paromycin and ● Sporulated oocyst → w/c contains 2
clarithromycin: treatment of severe diarrhea sporocyst → w/ 2 sporozoites → sporozoites
invade the epithelial cells of small intestines
PREVENTION AND CONTROL → merozoites → Micro/macro → fertilize →
● Chlorination is NOT effective oocyst (feces) → complete sporulation within
● Use of multiple disinfectant and combined 7-12 days in warm environment
water treatment EPIDEMIOLOGY
● Proper disposal of human and animal excreta ● More common in tropical and subtropical
areas
CYCLOSPORA ● 1979 first case of cyclospora infection was
Cyclospora cayetanensis reported in papua, new guinea
● was established to cause human diarrhea in ● Subsequent cases has been reported from
1990 most part of the world
● cases of prolonged watery diarrhea among ● Infection caused by cyclospora can be
immunocompromised (AIDS) patient has been acquired by drinking contaminated water
reported worldwide (fecal-oral)

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 CLINICAL PARASITOLOGY
COCCIDIA (WEEK 8 / LEC)
1st SEM, 2021
● More associated with food-borne outbreaks ● Contains membrane bound refractile globules
(social events, weddings, etc) ● Mature oocysts contains 2 sporocyst with 2
● Parasite infect vertebrates including reptiles, cresent-shaped sporozoite which fluoresce
insect & rodents blue-green under UV light (cryptosporidium &
isospora do not fluoresce under UV light)
PATHOLOGY
● Chronic and intermittent watery diarrhea
occurs in early infection
● Fatigue, anorexia, weight loss, nausea,
abdominal pain, flatulence, bloating and
dyspnea may develop.
LEFT: Fresh stool; RIGHT: Acid Fast
● Infections are usually self-limiting
● D-Xylose malabsorption has been found to
develop
● No death is associated
● Disease: Cyclosporiasis
○ disease is clinically indistinguishable
from cryptosporidiosis and
Isosporiasis Cyclospora cayetanensis (oocyst)
○ self-limiting, characterized by
persistent watery diarrhea that ends
to recur in a relapsing pattern and last
for 3-4 wks,
○ associated with abdominal cramps,
nausea, vomiting, low grade fever, TREATMENT
weight loss and anorexia ● No treatment needed
● Pathogenesis: ● If pharmacologic treatment is warranted,
○ Infection typically confined to the Cotrimoxazole is given
jejunum PREVENTION AND CONTROL
○ characterized by inflammatory ● Good sanitary practices
changes, villous atrophy and ● Access to safe and clean drinking water
hyperplasia of the jejunal tissue ● Proper food preparation

DIAGNOSIS Toxoplasma gondii

● DFS ● Obligatory intracellular parasites
● Concentration techniques ● Infect ALL NUCLEATED CELLS
● Kinyoun stain ● Cause toxoplasmosis
● Fluorescent microscopy ● Felidae family (cats) are FINAL HOST
● Safranin staining
● PCR
ADDED NOTES:
● Symptoms are similar with cryptosporidium,
but duration of diarrhea with CAYETANENSIS
IS LONGER ● Infective Stage: TACHYZOITE, BRADYZOITE
● OOCYST sporulate best at ROOM TEMP. AND OOCYST
● Addition of 5% POTASSIUM DICHROMATE ● Definitive Host: CATS (complete life cycle
allows sporocyst to BECOME VISIBLE occurs in cats)
● Clinical manifestation is apparent if immune
MORPHOLOGY system is suppressed → AIDS patient
● Oocyst spherical-shaped 8-10um dia.
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 CLINICAL PARASITOLOGY
COCCIDIA (WEEK 8 / LEC)
1st SEM, 2021

LIFE CYCLE

● Toxoplasmosis, congenital toxoplasmosis,

cerebral toxoplasmosis
● 2 morph forms: tachyzoites, bradyzoites
● Infective stage for humans: oocyst
● Oocyst is similar with I.belli but smaller
● Tachyzoites: crescent shape, actively
multiplying How is Toxoplasmosis transmitted?
● Complete life cycle → occur in cats (definitive ● Oocyst:
host) ○ Contact with cats
● Typical coccidian life cycle → schizogony,
gametogony, sporogony → in the intestinal
epi
● The extraintestinal stages → are the asexual ○ Dirty hands
stages → tachyzoites and bradyzoites ○ Contaminated food
● In intestinal epi of cats → merozoites ○ Water
multiply→ diff into macro/micro → ● Tachyzoites (Tg):
fertilizaton → oocyst (feces) ○ Meat
● Ingestion of oocyst → release of sporozoites ○ Blood and its products
● Cats: merozoites → micro/macro → oocyst ○ Tissue transplants
● Man/other intermediate host: sporozoites → ● Bradyzoite:
invade nucleated cells (macrophage) → ○ Meat
transfrom PATHOLOGY
● into → tachyzoites (fast multiplying) → ● Toxoplasmosis commonly asymptomatic , if
immunity → immune system is good
● Slow multiplying bradyzoites → form cyst ● Encephalitis-most common manifestation
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 CLINICAL PARASITOLOGY
COCCIDIA (WEEK 8 / LEC)
1st SEM, 2021
● CONGENITAL TOXOPLASMOSIS
Chronic Toxoplasmosis
● Mimic infect. Mononucleosis: fatigue, ● Is asymptomatic (most of cases)
lymphadenitis, chills, fever, headache and
● Occurs in immunocompetent people, the
myalgia
● Congenital toxoplasmosis: fetus is infected via infection enters a latent phase, during which
transplacental means à sever eye and brain only bradyzoites are present
damage, retinochoroiditis, microcephaly, Signs and Symptoms
jaundice, hydrocephaly, epileptic seizures ● Infection has 3 stages:
● Death of newborn → due to anemia w/ ○ Acute Toxoplasmosis (Acquired
pneumonia infection form)
● Stillbirths → when mother acquire infection ○ Chronic Toxoplasmosis (Acquired
during the 1st trimester of preg infection form)
○ Congenital Toxoplasmosis
DIAGNOSIS TREATMENT
● Biopsy- stained through hematoxylin and ● Pyrimethamine, sulfadiazine and spiramycine
eosin stain ● Spiramycin was used during infected
● Morphologic pregnancy and it helps to decrease the
○ Tachyzoites in circulating number of tachyzoites transmission to the
○ Histopathologic fetus
● Serodiagnostic methods- positive titer or a
four-fold rise in the titer
● Sabin-Feldman methylene blue dye test –
very specific and sensitive
● IHAT
● ELISA
● PCR (directly by molecular methods)
● Serologic tests PREVENTION AND CONTROL
● Good sanitation and hygiene
● Proper food preparation
● Do not drink untreated drinking water and
avoid contact
● with food or water potentially contaminated
with cat feces.
● Pregnant women should wear gloves when
gardening or when doing outdoor activities,
including handling soil because cats usually
use gardens and sandboxes as litter boxes.
● Cook food to safe temperatures; freeze meat
for few days at (-20C0) temperatures before
cooking to limit the opportunity of infection.
● Wash any kitchen utensils with hot soapy
water after contact with raw meat.
● Peel or wash fruits and vegetables thoroughly
Acute Toxoplasmosis before eating.
● is FATAL and cause damage to the brain SARCOCYSTIS
● S. hominis
(encephalitis) or the eyes (necrotizing
● S. suihominis
retinochoroiditis)
● S. lindemanni
● Symptoms are often influenza-like: swollen
○ parasite of human and domestic
lymph nodes, or muscle aches and pains that animals (cattle, swine and sheep)
last for a month or more ● Geographical Distribution: Cosmopolitan

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 CLINICAL PARASITOLOGY
COCCIDIA (WEEK 8 / LEC)
1st SEM, 2021
Sarcocystis hominis and Sarcocystis suihominis MORPHOLOGY
● S. hominis from pigs ● Oocyst broadly oval lying along infected
● S. suihominis from cattle muscle fibers, hyaline appearance and
● Definitive Hosts: HUMANS enclose in a membrane
● contains 2 large sporocyst inside tubular mass
(Meischer tube) filled up with 4 mature
crescent-shaped sporozoites
● sporocyst/rainy corpuscles/trophozoite are
banana-shape with subspherical nucleus
found in the muscle thread extending from
end to end

PATHOLOGY
● Sarcosporidiosis and sarcocystosis
● Gastroenteritis, diarrhea, myalgia, weakness,
fever
● For intermediate host, brain, muscle and
kidney tissues maybe damaged
● May cause abortion to cows
● Disease: Sarcocystosis
○ disease uncommon and rare in human
● SPOROCYST AND OOCYT IN FECES → ingested ○ considered as zoonotic
by COWS → Ruptures releasing SPOROZOITES ○ domestic animals are intermediate
→ MEROZOITES → Penetrate muscles and host of the parasite that pick up
develop into → SARCOCYSTS W/ infective cyst while grazing on grasses
BRADYZOITES → ingested in undercooked contaminated with human excreta
meat→ BRADYZOITES (become motile after ○ human infection are acquired through
wall digestion) released→ enter intestinal ingestion of uncooked meat (beef,
cells → MICRO/MACRO → OOCYST -feces pork, lamb) or contaminated food and
drink containing the infected
sarcocyst
○ symptoms includes diarrhea, nausea,
vomiting, abdominal pain which
occurs 1 – 2 days after ingestion
and may last for 2 weeks
DIAGNOSIS
● Demonstration of oocyst in feces / duodenal
aspirate
● Biopsy of tissue of small intestine or colon
demonstrate Meischer tube
● Definitive: biopsy of an infected muscle

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 CLINICAL PARASITOLOGY
COCCIDIA (WEEK 8 / LEC)
1st SEM, 2021
● Fecal floatation methodsà sporocysts will be
seen
● Necropsyà schizonts will be seen
● Western blot
● Serologic tests (IFA, ELISA)
● PCR

TREATMENT
● None for tissue infection (Supportive –
self-limiting)
● For intestinal infection:
○ Trimethoprim + Sulfamethoxazole
○ Pyrimethamine + Sulfadiazine
(alternate drug)
● No effective treatment is known
● Corticosteroids were found to be useful in
muscular inflammation
● Trimethoprim-sulfamethoxazole – seen as
potentially effective in treating intestinal
infections

PREVENTION AND CONTROL

● Avoid contact with infected animal host
● Adequate cooking of all meat
● Uncooked animal carcass should not be fed to
other animals

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