Penyakit Mikrobial Parasiter I

PKH-UB 2013

Luminal Protozoa

Parasitology terms..
A parasite is an organism that obtains food and shelter from

another organism and derives all benefits from this association.

obligate parasite, when it can live only in a host;
facultative parasite, when it can live both in a host as well as in
free form.
endoparasites , Parasites that live inside the body
whereas those that exist on the body surface are called ectoparasites.
Parasites that cause harm to the host are pathogenic parasites
while those that benefit from the host without causing it any harm
are known as commensals.

Parasitology terms..
The organism that harbors the parasite and suffers a loss caused by

the parasite is a host.

The host in which the parasite lives its adult and sexual stage is the
definitive host
The host in which a parasite lives as the larval and asexual stage is
the intermediate host.
Other hosts that harbor the parasite and thus ensure continuity of
the parasite's life cycle and act as additional sources of human
infection are known as reservoir hosts.
An organism (usually an insect) that is responsible for transmitting
the parasitic infection is known as the vector.

Sarcomastigophora
(pseudopodia/flagella)

Sarcodina
(amoeboid)

Mastigophora
(flagella)

Protozoa

Apicomplexa
(gliding, intracellular)

Ciliophora

Microspora

Eucoccidiorida
(epithel cells)

Piroplasmorida
(blodd cells)
Haemosporida
(blood cells)

Kinetoplastorida
(hemoflagellata)
Diplomonarida
Trichomonadorida
(intestine
flagellates)

INTESTINAL PROTOZOA
Pathogenic
Entamoeba histolytica
Balantidium coli
Giardia lamblia
Dientamoeba fragilis
Cryptosporidium parvum
Enterocytozoon bieneusi
Septata intestinalis
Cyclospora cayetanensis
Isospora belli

Commensal
Entamoeba hartmani
Entamoeba dispar
Entamoeba coli
Endolimax nana
Iodamoeba btschlii
Chilomastix mesnili
Trichomonas hominis
Blastocystis hominis

INTESTINAL AND UROGENITAL

PROTOZOA
Intestinal and luminal protozoa pada manusia dan hewan
Entamoeba histolytica (Amoebae)
Balantidium coli (Ciliates)
Giardia lamblia and Trichomonas vaginalis (Flagellates)
Cryptosporidium parvum and Isospora belli (Sporozoa)
Protozoan infections in animals may be caused by organisms
in the sub-class Coccidia (disease: Coccidiosis)

amoebiasis (amebic dysentery,

amebic hepatitis)
Causal agent : Entamoeba hystolitica
Phylum: Sarcomastigophora
Subphylum: Sarcodina
Family: Entamoebidae

amoebiasis
Penyakit: disentri pada manusia, kera, anjing, kucing, tikus, babi
Distribusi : seluruh dunia
Morfologi :
- Bentuk tropozoit (tubuh hospes), ukuran 15-30 mikron
- Tropozoit aktif punya vakuola makanan terisi sel darah merah
dalam proses digesti
- amuboid, memiliki pseudopodia, inti 1
- Pembelahan biner (binary fission)

nukleus

The fine granular

endoplasm may
contain ingested
erythrocytes

amoebiasis
- Bentuk kista : bulat dgn dinding tebal, inti lebih dari 1 (1-4

nuklei), badan kromatin padat, di luar hospes

- Encyst:To take the form of or become enclosed in a cyst
- Excystation: escape from a cyst or envelope, as in that stage in the life
cycle of parasites occurring after the cystic form has been swallowed by
the host.

Fecal-oral life cycle

Excystation

Trophozoite

Cyst

Encystment
1. Passed in feces
2. Non motile
3. Resistant to hostile
environment
4. Does not multiply
1
1

1. Metabolically active
2. Motile
3. Multiplies by replication

16

life cycle
1. Ingestion of cyst in
the contaminated water
and food
2. Excystation occurs in
the small intestine. Eight
trophozoites produced
from one cyst.

3. Trophozoites migrate
to large intestine where
they multiply or may
encyst for excretion
1
2

4. Cysts exit hosts

in the stool

amoebiasis
Predileksi :
saluran pencernaan, otak, hepar, paru-paru
Hospes :
manusia, vertebrata

amoebiasis
Patogenesa :
- Abses pada organ predileksi (otakencephalitis, paruparupneumonia, liver hepatitis)
- Jaringan nekrotik
- Sekresi mukus berlebihan pada usus diare mukus khas
amoebiasis sal. Cerna
- Haemorraghi pembuluh darah pada jaringan pecah/rusak

amoebiasis
Gejala klinis
Acute: Frequent dysentery with necrotic mucosa and
abdominal pain.
Chronic: Recurrent episodes of dysentery with blood and
mucus in the feces. There are intervening gastrointestinal
disturbances and constipation. Cysts are found in the stool.
The organism may invade the liver, lung and brain where it
produces abscesses that result in liver dysfunction,
pneumonitis, and encephalitis.

Amoebiasis pada hewan

E. invadens of reptiles is morphologically identical to E. histolytica,

but it is not transmissible to mammals.

E. dispar is a noninvasive, nonpathogenic amoeba morphologically
indistinguishable from the pathogenic species E histolytica

 Pathology

Intestinal ulcers (craters/flasks )are due to enzymatic

degradation of tissue. The infection may result in
appendicitis, perforation, stricture granuloma, pseudopolyps, liver abscess sometimes brain, lung and spleen
abscesses can also occur. Strictures and pseudo-polyps result
from the host inflammatory response.
Hepar dengan abses
karena amoebiasis

Intestinal amoebiasis
flask shaped ulcer

amoebiasis
Diagnosa :
- Pemeriksaan sampel feses (fresh atau swab) langsung /
pewarnaan
Differential Diagnose :
- Giardiasis
- Bacterial diarrhea demam tinggi dan leukocytosis

GIARDIASIS (lambliasis)
Etiology
Giardia lamblia (a flagellate)
Phylum: Sarcomastigophora
Subphylum: Mastigophora

Giardiasis
Causa : Giardia lambia
Predileksi : usus halus
Hospes : manusia, kucing, anjing, unggas, kuda, primata dan

hewan liar lainnya, beaver (reservoir)

Giardia is the most common flagellate of mammals and birds.
Its trophozoites are binucleate and have four pairs of flagella.
Trophozoites adhere to microvilli of epithelial cells of the
small intestine.

 Morfologi umum :
Flagellata, 8 flagella dan 2 axostyles

Stadium trophozoit : pipih, half-pearshape,

tidak memiliki mitokondria, 12 to 15

micrometer, 2 nukleus dan 2 parabasal bodies
Stadium kista : bulat dgn dinding tebal, inti 4

Giardiasis
Infection occurs by ingestion of

cysts, usually in contaminated

water.
Decystation occurs in the
duodenum and trophozoites
(trophs) colonize the upper small
intestine where they may swim
freely or attach to the sub-mucosal
epithelium via the ventral suction
disc.
The free trophozoites encyst as
they move down stream and
mitosis takes place during the
encystment.
The cysts are passed in the stool.
Man is the primary host although
beavers, pigs and monkeys are also
infected and serve as reservoirs.

Giardiasis
Patogenesa :
Tropozoit menutupi epitel mengganggu absorpsi nutrisi

malabsorbsi kekurusan
Kerusakan epitel abdominal pain dalam jumlah banyak kolik
Diare tidak berdarah atau bermukus, karena parasit tidak masuk ke dalam
mukosa usus, hanya menempel berbau busuk dan mengapung di air

Giardiasis
Gejala klinis :
Flatulence
Lactose intolerrance

Abdominal pain
Diare berwarna terang, tanpa darah dan mukus

Tidak ada demam

Differential Diagnose :
- amoebiasis
- Bacterial diarrhea

Trichomoniasis
Phylum: Sarcomastigophora
Subphylum : Mastigophora
Family : Trichomonadidae

TRICHOMONIASIS
Etiology

Trichomonas vaginalis (a flagellate)

Morphology
The trophozoite form is 15 to 18 micrometers in diameter
and is half pear shaped with a single nucleus, four anterior
flagella and a lateral flagellum attached by an undulating
membrane. Two axostyles are arranged asymmetrically
(Figure 12). The organism does not encyst.

 Two trophozoites of Trichomonas vaginalis from culture. The four

flagella and single nucleus are visible. The dark median rod is the
axostyle which is characteristic of the trichomonads

 Life cycle

T. vaginalis colonizes the vagina

of women and the urethra
(sometimes prostate) of men.
Infection occurs primarily via
sexual contact, although nonvenereal infections are possible.
The organism does not encyst
and divides by binary fission
which is favored by low acidity
(pH > 5.9; the normal pH is
3.5 to 4.5). There is no nonhuman reservoir.

 Symptoms

T. vaginalis infection is rarely symptomatic in men, although it

may cause mild urethritis or occasionally prostatitis. In
women, it is often asymptomatic, but heavy infections in a
high pH environment may cause mild to severe vaginitis with
copious foul-smelling yellowish, sometimes frothy discharge
(Figure 12).
Pathology
The organism causes contact-dependent damage to the
epithelium of the infected organ.

Trichomoniasis in cattle
Tritrichomonas foetus
Synonym: Trichomonas foetus
Predilection site: Prepuce, uterus
Hosts: Cattle
Life cycle: The trichomonads reproduce by longitudinal
binary fission. No sexual stages are known and there are no
cysts. Transmission occurs during coitus.
Clinical signs : irregular oestrous cycles, uterine discharge,
pyometra and early abortion

Trichomonas in poultry
Trichomonas gallinae
Synonym: Cercomonas gallinae, Trichomonas columbae
Predilection site: Oesophagus, crop, proventriculus

Hosts: Pigeon, turkey, chicken, raptors (hawks, falcons,

eagles)

Trichomoniasis
Trichomonas caviae occurs in the intestines of guinea pigs. Its

flagella are readily seen in stained fecal smears

Balantidiasis
Balantidium coli
Phylum: Ciliophora
Family: Balantiidae

Balantidiasis

Balantidiasis
Causa : Balantidium coli
Predileksi : ileum, sekum
Hospes : babi, tikus, sapi, kuda, manusia, serigala,

kera
Morfologi :
Bentuk tropozoit : lonjong seperti kantung, silia di

permukaan tubuh, memiliki makronukleus dan

mikronukleus
Bentuk kista : bulat/lonjong, tidak tahan kering, memiliki
makronukleus

Balantidiasis
Hospes definitive adalah manusia
Reservoar adalah babi, tikus dan
hewan lain.
Cysts (bentuk infektif)
menginfeksi melalui makanan
tercemar parasit
Excystasi terjadi di usus halus,
tropozoit membentuk koloni di
usus besar
Di usus besar tropozoit
mengalami pembelahan biner dan
masuk ke dinding colon dan
multiplikasi
Tropozoit membentuk cysta yang
keluar bersama feses

Balantidiasis
Patogenesa :
Mampu menembus mukosa perdarahan & abdominal pain
Merusak mukosa ulcer

Gejala klinis :
Diare ( darah dan berlendir )

Nyeri perut
Nafsu makan berkurang BB turun
Dehidrasi

Lebih sering asimptomatis

 Balantidium coli trophozoites in section of intestine (H&E)

Cryptosporidiosis
Phylum : Apicomplexa
Family : Cryptosporidiidae
Subclass: Coccidia

Cryptosporidiasis
Causa : Cryptosporidium parvum
Predileksi : usus
Hospes : mamalia, burung, reptil

Morfologi :
Termasuk dalam koksidia
Bentuk pada hospes ookista pada mukosa usus

mengandung sporozoit
Bentuk bulat dgn 4 sporozoit, dinding tebal

Cryptosporidiasis

Infeksi melalu ingesti/inhalasi exystation sporozoit masuk ke sel

epitel sal cerna pembelahan asexual (schozogoni) merogoni
gametogony
Microgamon dan makrogamon fertilisasi oocyst

Cryptosporidiasis
Patogenesa :
Penembusan mukosa enteritis
Pada pasien immunocompromised (HIV) infeksi saluran

pernafasan dan cholecystitis

Gejala klinis :
Asimptomatis
Diare cair dan sering
Dehidrasi

Pada hewan muda lemah, nafsu makan turun-hilang,

subklinis, fatal

Isospora belii
Phylum: Apicomplexa
Family : Eimeriidae

 Isospora belli is believed to be a

valid species which ONLY infects

humans causing coccidiosis.

 Oocysts of Isospora belli. The oocysts are large (25 to 30

m) and have a typical ellipsoidal shape. When excreted, they

are immature and contain one sporoblast (A, B). The oocyst
matures after excretion: the single sporoblast divides in two
sporoblasts (C), which develop cyst walls, becoming
sporocysts, which eventually contain four sporozoites each.

Gejala klinis
diarrhea, steatorrhea, headache, fever, crampy
abdominal pain, nausea, dehydration and weight loss.
eosiniphilia

Coccidiosis
Phylum: Apicomplexa
Subordo: Eimeriina

Coccidiosis
Penyebab: Eimeria sp
Ciri:
Cysta yang masak mengandung 4 sporokista (1 sporokista

mengandung 2 sporozoit)
Siklus hidup monoksenosa (1 hospes)
Dalam hospes: intranuklear(obligat), pada umumnya pada sel saluran
pencernaan atau hepar
Predileksi

Hepar : pada kelinci, Eimeria stidae

Urogenital : pada angsa, Eimeria truncata
Proventrikulus, uterus: Eimeria neitzi
Sekum : Eimeria tenella

Coccidiosis in Animals
Coccidiosis is an economically important disease of cattle,

sheep, goats, pigs, poultry, and also rabbits, in which the liver
as well as the intestine can be affected. In dogs, cats, and
horses, coccidiosis is less often diagnosed but can result in
clinical illness.

Stadium infektif : ookista

Masuk ke saluran cerna
ookista pecah di ventrikulus
sporokista keluar
Sporokista masuk duodenum,
terpengaruh trypsin dan cairan
empedu ujung sporokista
menjadi lunak dan aktif
Sporozoit keluar
Sporozoit masuk ke epitel usus

Membulat (tropozoit) inti

membelah banyak schizont
yang berisi merozoit
Merozoit pecah
mikrogamon zygot ookista
keluar bersama feses

 Periode prepaten : waktu yang diperlukan saat hospes

menelan sporozoit sampai dengan ditemukannya di feses

With ingested oocysts moving to the intestinal lining, the life

cycle of coccidia begins. Intestinal cells are damaged and in 4

8 days, depending on the species, oocysts are shed in the faeces
Reproduksi Eimeria bukan tidak terbatas suatu saat
akan berhenti karena:
Jumlah sel hospes terbatas
Adanya faktor imunitas hospes

Coccidiosis di Unggas

Coccidiosis pada kelinci

2 anatomic forms:
hepatic, caused by Eimeria stiedae
intestinal, caused by E magna, E irresidua, E

media, E perforans, E flavescens, E intestinalis, or

other Eimeria spp.
Transmission of both the hepatic and intestinal
forms is by ingestion of the sporulated oocysts,
usually in contaminated feed or water.

Healthy rabbit liver (left) with rare congenital anomaly with a double
biliary vesicle (arrow) and one liver affected by coccidiosis (right).

Portion of rabbit
intestine affected by
coccidia infestation

Faktor yang mempengaruhi patogenesis Eimeria

Faktor hospes-parasit
Hospes: Umur, pada ayam umur 2-4 minggu. (Ayam umur

<2mg masih mempunyai imunitas induk, kekuatan lambung

lemah belum bisa memecah ookista). Pada domba/kambing
umur 4-6 bulan, sapi 3-6 bulan
Jenis parasit tergantung jenis eimeria yang patogen
Jumlah ookista yang tertelan

Gejala klinis
Diare, diare berdarah
Lemah, nafsu makan berkurang, berat badan turun
Kematian karena perdarahan hebat

Toxoplasma
Phylum: Apicomplexa
Subordo: Sarcocystidae

Toxoplasmosis
Bersifat zoonosis
Heteroksenosa, bisa menginfeksi semua jenis hewan

Siklus hidup
Siklus enteroepithelial pada hospes intermediate
Hospes definitive terinfeksi melalui ::
Makan oocyte Toxoplasma (yg telah sporulasi)

Makan cysta Toxoplasma yang terdapat pada hospes

intermediate (daging domba, sapi, tikus, anjing, burung)

Tugas
Jelaskan siklus hidup Toxoplasma gondii
Patogenesa
Penularan

Gejala klinis
Diagnosa

??