Chapter 2

Parasitic Protozoans And

Human Diseases
Muhammad Asghar Khan, M.Phil.

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 Contents

1. Introduction
2. Parasitic Protozoans And Human Diseases
 Plasmodium
 Trypanosoma
 Leishmania
 Giardia
 Toxoplasmosis
 Cryptosporidium
 Entamoeba
 Trichomoniasis
3. Economic Importance of Protozoans

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 1. Introduction
 Proto-zoa means first animal
 Eukaryotic organism
 Basal members of the animal kingdom
 Have no tissue organization
 Four main groups (Flagellates species, Amoebae species, Ciliate species,
Sporozoan species)
 Have 34000 extinct species and 24000 living species
 Living species includes (Free living species in aquatic or terrestrial or
parasitic in vertebrates / Invertebrates
1. Flagellates Spp (6900)
2. Amoebae Spp (11550)
3. Ciliate Spp (7200)
4. Sporozoan Spp (5600)

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 Parasitic protozoans and human
diseases
1. Plasmodium species 2. Trypanosoma species
 Cause Malaria  It can cause:
 Transmitted by female anopheles I. African trypanosomiasis (Sleeping
mosquitoes sickness)
 Several spp: a. Caused by trypanosoma brucei
1. Plasmodium falciparum b. Transmitted by tsetse flies
2. Plasmodium vivax II. Chagas disease:
3. Plasmodium malariae a. It can cause by Trypanosoma cruzi
4. Plasmodium ovale b. Transmitted by triatomine bugs

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 Parasitic protozoans and human
diseases
4. Giardia intestinalis (Giardia
3. Leishmania species lamblia) species
 Cause leishmaniasis  Cause giardiasis
 It can be  Transmitted by cyst found in:
i. Cutaneous
i. Contaminated food
ii. Mucocutaneous
ii. Contaminated water
iii. Visceral leishmaniasis

iii. Contaminated surfaces
Transmitted by infected sandflies

 Its symptoms consist of:
Have different spp that cause various diseases
i. Leishmania donovani i. Diarrhea
ii. Leishmania tropica ii. Abdominal pain
iii. Leishmania braziliensis iii. Nausea
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 Parasitic protozoans and human
diseases
5. Cryptosporidium species 6. Entamoeba histolytica
 Cause cryptosporidiasis  Cause amoebiasis
 Effect both human and animals  Transmitted by cyst found in:
 Transmitted through ingestion of i. Contaminated food
oocyts found in:
ii. Contaminated water
i. Contaminated water  Its symptoms consist of:
ii. Contaminated food
i. Diarrhea with blood and mucous
iii. Contaminated surfaces
ii. Liver abscesses
 Caused severe infections in individuals
with weakened immune system
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 1. Plasmodium
 Complex life cycle, have both mosquito vector (anopheles mosquitos) and
human host
 Have complex cellular structure:
i. Motile elongated sporozoite (Salivary glands of infected mosquitos)
ii. Small Merozoites (RBC)
iii. Trophozoites (RBC)
iv. Gametocyte (Mosquito)
Several spp:
1. Plasmodium falciparum: Most severe and cause death, cause cerebral
malaria
2. Plasmodium vivax: Most widespread, cause reoccurring malaria, form
hypnozoites in liver,
3. Plasmodium malariae: Mild form, less severe, persisted for many years
4. Plasmodium ovale: Similar to P. vivax, also form hypnozoites in liver

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 Characteristic P. falciparum P. vivax P. ovale P. malariae
Geographi
Less
cal
Africa Global Africa, Asia common
distributio
worldwide
n
Clinical
Severe Less severe Less severe Less severe
severity
Liver stage
hypnozoite Absent Present Present Absent
s
Relapses Rare Common Common Rare
Morpholog Similar to P.
Irregular Ring form,
y in blood vivax, Band form
form enlarged
smear smaller
Prevalence Present
Absent Absent Absent
in malaria sometimes

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 Life cycle:
1. Mosquito Phase:
i. Female anopheles bites infected human and ingest its blood
ii. In the gut of mosquito gametocytes mature into male and female gametes
iii. Fertilization occurs of the gametes and form zygote
iv. Zygote developed into ookinete
v. Ookinete further developed into oocyst
vi. From oocytes thousands of sporozoites are produced
2. Human phase:
i. Another female mosquito bites the healthy person for blood meal take up the oocyst which
later raptured and releasing sporozoites to mosquitos salivary gland
ii. Sporozoites travel to the liver, invade the liver cells, and developed into merozoites
iii. Merozoites release from the liver cells and invade the RBCs
iv. With in the RBCs, merozoites developed asexually and forming a new merozoites that can
effect more RBCs
v. These merozoites differentiate into sexual forms called gametocytes and taken up by the
mosquitoes during blood meal and completing the cycles

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 Pathology of Malaria:
1. Transmission:
 Transmitted by female anopheles mosquito
 Travel to liver where they mature and reproduce
2. Clinical Manifestation
 Symptoms begin after 10 days to 4 weeks after infection
 Symptoms includes chill, fever, headache, muscle aches, fatigue
 P. falciparum malaria can cause severe illness and can cause organ failure and death
 Generation time of P. vivax, and ovale is 48 hours while P. malaria generation time is 72
hours
 Black urine due to lysis of RBCs (Black water fever)
3. Treatment:
 Antimalarial drugs like Chloroquine
 To prevent relapses of P. ovale and P. vivax (hypnozoites) by drugs
4. Control of vector (Mosquito):
 Insecticide-Treated Bed Nets (ITNs), Indoor Residual Spraying, Environment management,
Chemical larvicides

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 2. Trypanosoma
 Genus of several species that can causes many diseases in humans and animals
 Well known diseases are:
 African trypanosomiasis (Sleeping sickness), and its pathogen is called Trypanosoma
brucei, and it is transmitted by the bite of tsetse flies
 Trypanosoma brucei have two subspecies
1. Trypanosoma brucei gambience (Cause a chronic form of the disease)
2. Trypanosoma brucei rhodesiense (Cause an acute form of the disease)
 Chaghas disease / Amarican trypanosomiasis, and its pathogen is called Trypanosoma
cruczi, and it is transmitted by the bite of triatomine bugs (Kissing bugs)
 Chaghas disease can also be transmitted through blood transfusions, organ transplantation,
and congenital transmission
1. Structure:
 Single-celled organism, elongated and has a flagellum that allow for mortality
 Single neuleus, a kinetoplast (DNA containing structure near the base of flagellum)

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2. Life cycle:
 Have both insect and mammalian host
 Insect vector phase:
 Insect vector became infected with trypanosoma by feeding on the blood of an infected
mammalian host
 In the insect gut trypanosoma transform into procyclic trypomastigote form
 Procyclic trypomastigote form multiply and differentiate into epimastigote form , this
epimastigote form replicate in the gut and transform into the slivery gland of the insect host
where it transform into metacyclic trypomastigotes
 Mammalian host phase:
 When infected insect bites mammalian host, metacyclic trypomastigotes form inters into the
host bloodstream
 Here it transform into amastigote form and multiply within various organs and tissues
 Amastigote form again transform into trypomastigote form and are released into the
bloodstream
 Chaghoma a swelling form near the infection site where inflammation occurs by
Trypanosoma cruzi

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 Symptoms includes; Fever, headache, join and muscle pain, enlarged lymphnodes
(Especially in gambience sleeping sickness)
 Late symptoms includes neurological symptoms like sleep disturbance, confusion, and
tremors, progressive mental retardation
 Pentamidines and Suramine are used to treat gambience and rhodesience sleeping sickness
 Control of tsetse fly:
 Vector control either by traps or insecticide-trearted targets
 Habitat modification through vegetation clearance and land use planning
 Sterile-insect technique by mass production of sterile flies
 Community education, screening and treatment, and animal reservoir control

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 Chagas disease (American
trypanosomiasis)
 Caused by Trypanosoma cruzi and transmitted by triatomine bugs (Kissing bugs)
 It can transmitted through blood transfusions, organ transplantation, and infected mother to
her child during birth
 In its acute stages chagoma form occurs and remain asymptomatic or have mild symptoms
 In its chronic stages, many individuals remain asymptomatic for many years and some may
develop serious cardiac or gastrointestinal complications
 Symptoms includes; Fever, fatigue, body aches, hear related complications, and digestive
complications
 For diagnosis purpose microscopic examination of blood and serological tests are used to
detect antibodies
 Benznidazole and nifurtimox are use as antiparasitic medications
 Vector control measures to reduce exposure to triatomine bugs, and screening of blood
donors and organ transplants to prevent transmission through blood and tissues

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 Characteristic Trypanosoma brucei Trypanosoma cruzi

Disease African trypanosomiasis (Sleeping sickness) Chaghas Disease ( American trypanosomiasis

Vector Tsetse flies Triatomine bugs

Geographical distribution Sub-Saharan Africa Americas (South and central)

Host Humans and animals (Mammals) Humans and Animals (mainly mammals)

Infection site in humans Bloodstream Bloodstream and cells of various tissues

Chronic infections Yes, if untreated Yes, if untreated

Acute symptoms Fever, headaches, joint pain Fever, Chagoma

Chronic symptoms Neurological issues, sleep disturbance Heart and digestive system issues

Cardiac involvement Not associated Common, leading to heart complications in

chaghas disease

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 3. Leishmania
 Genus of parasitic protozoa that can causes many diseases
 Well known diseases is leishmaniasis
 It is transmitted by the bite of Sand fly
 Leishmania is single cell organism that have two forms
1. Promastigote form (elongated-flagellated form that found in the gut of the sand fly)
2. Amastigote form (Non flagellated form and found within the cells of infected mammals)

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Characteristic Cutaneous leishmaniasis Mucocutaneous Visceral leishmaniasis

leishmaniasis
Causative species L.major, L.tropica, L. braziliensis, L. guyanesis L. donovani, L. infantum, L.
L.maxicana chaghasi
Vector Sand fly Sand fly Sand fly

Clinical presentation Skin ulcers, usually localized Skin ulcers, spread to Prolonged fever, enlarged
mucous membranes spleen, and liver, weight loss

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Characteristic Cutaneous leishmaniasis Mucocutaneous Visceral leishmaniasis
leishmaniasis
Mucosal involvement Uncommon Common Affecting internal organs,
including spleen, liver, and
bone marrow
Severity Less severe Cane be severe Can be severe

Geographical distribution Worldwide Some parts of South East Africa, Indian

America subcontinent, South America
Reservoir host Various mammals including Various mammals including Dogs, some wild animals
rodents rodents

Prevention strategies Avoiding sand-fly bite Avoiding sand-fly bite Avoiding sand-fly bite

Treatment Antimonial drugs, Antimonial drugs, Antimonial drugs,

amphotericin B amphotericin B amphotericin B

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 Life cycle:
 Within the female sand fly midgut promastigote form of leishmania reside
 When infected sand fly bite the mammalian host its injects the promastigotes into the skin
 Within the mammalian host the promastigote form are taken up by phagocytic cells such as
macrophages where it change into amastigote form
 When Sand fly feeds on mammalian host its ingest it amastigote form, within the midgut of
the sand fly the amastigote form changed into the promastigote form
 Promastigote form migrates to the proboscis of the sand fly and then affects the other host
through blood meal

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 4. Giardia lamblia / intestinalis /
duodenalis
 Genus of parasitic protozoa that can causes gastrointestinal infections giardiasis
 Symptoms of giardiasis includes abdominal cramps, diarrhea, bloating gas, weight loss
 Chronic giardiasis leads to malabsorption of nutrients, nutritional deficiencies
 Common in adults and children's
 Flagellated protozoan with pear shaped structure
 Giardia have two forms
1. Trophozoites form (Active and motile form, found in small intestine, tear drop like structure
with two nuclei, and multiple flagella which enable them to attached to the wall of the small
intestine)
2. Cysts form (Dormant resistant form protect it from harsh environment)

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 Life cycle:
 Trophozoites form present in the small intestine where it attached to intestinal lining and
reproduce
 Trophozoites can cause symptoms and can transmit the infection
 Trophozoites reached to the colon and transformed into cysts
 Cyst excreted through feces of an infected individual
 Transmission occur through the ingestion of water or food contaminated with cysts
 Once ingested the cyst pass through the stomach and reach the small intestine wherte they
transform into trophozoites and continue the life cycle
 Control through better hygiene , elimination of the source of cyst, proper treatment of
portable water

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 5. Toxoplasmosis
 Caused by Toxoplasma gondii
 Have two host:
1. Definitive host (Domestic cats and other felids)
2. Intermediate host (Domesticated rodents, humans, sheep and other herbivores)
 Infective stages includes:
1. Tachyzoites
2. Bradyzoites (In tissue cysts of various hosts)
3. Sporozoites (In feces of infected cats)
 Life cycle contain the following stages:
1. Oocyst formation (Sexual stage)
 This stage occurs in the small intestine of the definitive host (Cats and felids)
 In intestine sexual reproduction occurs and the formation of oocyst occurs which contain
sporozoites
2. Oocyst shedding
 Transmission occurs through the shedding of oocyst in feces from cats
3. Ingestion by intermediate host
 Intermediate hosts like humans and other warm blooded animals became infected through
ingesting oocyst
 This can happen through consumption of contaminated food, water or by handling
contaminated materials
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 Life cycle contain the following stages:
4. Asexual reproduction (Tachyzoit stage):
 Inside the intermediate host the oocyst release sporozoites
 This sporozoites transformed into rapidly dividing tachyzoites, and spread throughout the host
tissues and organs
5. Formation of tissue cysts (Bradyzoite stage):
 In response to the immune system of the host the tachyzoites transform into bradyzoites
 These bradyzoites are encased in tissues cyst (Brain and muscles)
6. Chronic infection:
 Parasite persist in the host for extended period that can caused chronic infection
7. Transmission to definitive host:
 If infected intermediate host is consumed by cat the bradyzoites released from the tissues cyst
and can undergo sexual reproduction in the cats intestine and completing life cycle

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 Infections of Toxoplasma gondii may range from mild to acute and to chronic infections
 It can cause Toxoplasmosis in developing fetuses, Blindness, Mental retardation
 Treated by sulfonamides and pyrimethamine
 Avoiding from oocyst produced from cats
 Avoiding from ingesting bradyzoites in tissues of infected animals
 Avoiding transplacental transfer of infection

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 6. Cryptosporidium
 Genus of parasitic protozoa that can causes gastrointestinal infections cryptosporidiosis
 Symptoms of cryptosporidiosis includes abdominal cramps, diarrhea, nausea, vomiting
 Symptoms can range from mild to severe (In HIV / AIDS patients)
 Symptoms can be more severe in children’s and cause malnutrition\ and dehydration
 Oocyst is the infectious stage of cryptosporidium, it is microscopic and have tough outer
shell that protects from harsh environmental conditions
 Several cryptosporidium spp can effects human but the most common are:
1. Cryptosporidium hominis
2. Cryptosporidium parvum

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 Life cycle contain the following stages:
1. Oocyst stage:
 Infected individuals shed cryptosporidium oocysts in their feces
 Oocyst can survive the harsh environment and remain infectious for long period of time
2. Sporozoite stage:
 Oocyst are ingested and sporozoites are released in the small intestine
 Sporozoite invade the lining of the small intestine and multiply
 New oocyst are formed and shed in the feces, and completing the cycle

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 Transmission of cryptosporidium can occur through various means:
1. Contaminated water
2. Food contamination
3. Person to person contact
4. Animal contact
 Treatment :
 Use of Nitazoxinide (FDA approved drug)
 Wash hands and maintain proper hygiene
 Stay out of pools, splash pads, and lakes while sick
 Prevention:
1. Practice proper hand hygiene
2. Water safety
3. Avoid swimming in contaminated water
4. Maintain hygiene practices

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 7. Entamoeba
 Genus of parasitic protozoa that include several spp, most well known spp is Entamoeba
histolytica
 It can cause Amoebiasis (Gastrointestinal infection)
 Symptoms of Amoebiasis includes abdominal pain, diarrhea (sometime bloody),weight loss,
fatigue, and fever
 Infections can be amoebic dysentery (Bloody diarrhea) and liver abscess
 In more severe cases this parasite damage the intestinal wall and cause ulcers, and spread to
other organs like liver and leading to abscess
 Entamoeba are single cell parasite that exist in two forms
1. Trophozoite:
 Active, feeding form of Entamoeba, pear shape, have nucleus, cytoplasm, and pseudopodia
for moment and ingestion of food
2. Cyst:
 Dormant form of Entamoeba , cyst have tough outer shell that protect them from harsh
environment

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 Life cycle contain the following stages:
1.Trophozoite stage:
 Infected individuals have trophozoites in large intestine
 Trophozoites feed on bacteria, food particles, and host tissues with in the colon
 Reproduced by binary fission and formed new trophozoites
2.Cyst stage:
 Trophozoites transformed into cyst
 Cyst are passed in the feces of infected individuals
 Transmission occur through the ingestion of food or water contaminated with mature cysts
 Once ingested the cyst passed through the stomach and reached the small intestine where they
released trophozoites
 Trophozoites colonize the large intestine completing the life cycle

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 Transmission of Entamoeba can occur through various means:
1. Fecal-oral route
2. Person to person transmission
3. Contaminated food and water
 Treatment :
 Metronidazole
 Tinidazole
 Prevention:
1. Practice proper hygiene
2. Water safety
3. Wash fruits and vegetables before eating
4. Used bottled water and soft drinks from sealed containers

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 8. Trichomoniasis
 It is sexually transmitted disease (STI) cased by protozoan Trichomonas vaginalis
 Primarily transmitted by sexual activity but it can also be transmitted from infected mother
to her baby during childbirth
 In women; the symptoms includes vaginal itching, burning sensation, abnormal discharge of
fluid and discomfort during urination
 In men; the symptoms includes itching inside the penis, burning after urination or
ejaculation, and rarely , discharge
 Increase the risk of complications like preterm birth in pregnant women, increase risk of
acquiring or transmitting HIV
 Diagnosis occur through laboratory testing of samples such as vaginal swabs in women or
urethral swabs in men

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 Treatment :
 Metronidazole
 Tinidazole
 Prevention:
1. Safe sex by using condoms
2. Regular screening for STI
 Public health impact:
 Prevalence varies among different population
 Early detection and treatments are essential to prevent the spread of the infections it potential
complications
 Partner notification

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 Economic Importance Of Protozoans
 Negative economic impact:
1. Human diseases:
 Malaria (plasmodium spp)
 Amoebiasis (Entamoeba histolytica)
 Sleeping sickness (Trypanosoma spp)
2. Livestock diseases:
 Theileriosis and Babesiosis
 Coccidiosis
3. Crop diseases:
 Clubroot disease (Plasmodiophora brassicae)
 Positive economic impact:
1. Biomedical research and drug development
2. Biological control
3. Water treatment
4. Bioindicators
5. Protein source and sustainable agriculture

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