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In immunocompromised reactivation leads to severe disease encephalitis, chorioretinitis. Diagnosis: histopathology or serology IgM.
Life cycle Cryptosporidium parvum C. Source of infection may be food and drinking water recreational water pets and direct contact with farm animals Highly resistant to disinfection e.
Oocysts are shed unsporulated and sporulate in the environment; sexual stages are incapable of autoreinfection and person to person spread is highly unlikely. Source of infection is food frequently fruit for Cyclospora or drinking water. Resistance to disinfection is exceptional.
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Existence of animal reservoirs is uncertain. Cyclospora shows summer seasonality. In case of Isospora some sporozoites or merozoites may form extraintestinal hypnozoites.
Cause diarrhoea and maladsorption as Cryptosporidium, but out of extraintestinal manifestations only acalculous cholecystitis has been reported Diagnosis is morphological in stool samples after concentration oocysts show autofluorescence two sporocysts with two sporozoites in each Treatment of choice is co-trimoxazole Kinyoun stain safranin stain Sarcocystis spp. PCR are not routinely used Therapy is not established; co-trimoxazole, furazolidone, albendazole are potentially active drugs Giardia duodenalis G.
Trophozoites and giardia cysts in stool images. Eight genetically distinct genotypes A-H.
Humans are infected mainly by A and B. High frequency in developing countries. Faecal-oral, food-borne or water-borne spread. A proportion of infections is of zoonotic origin.
Morphology Kinetoplast Nuclei Axostyl Life cycle Cysts are ingested, the infectious dose is low cysts. Cysts four nuclei, 16N excyst into excyzoites 16Nexcyzoites divide into four trophozoites one nucleus, 4N. Excyzoites have 8 flagella and adhere through an unknown mechanism α1-giardin?
Echinococcosis- hooklet (hydatid sand) in hydatid fluid
The four resulting trophozoites actively move with their flagella and adhere with an adhesive ventral disk. Trophozoites divide and may cause disease.
In the ileum, trophozoites encyst into cysts, which contain the remains of flagella and ventral disks. Pathogenesis Trophozoites reside in the small intestine and cause apoptosis of intestinal cells, disruption of the intercellular junctions, anion secretion, shortening of microvilli and decrease in brush border enzymes disaccharidases.
As epithelial cells are shed, motility and reattachment are crucial for pathogenesis. No tissue invasion. Mucus layer inhibits attachment. Mast cells are recruited.
Enterocyte-derived NO is inhibitory, Giardia counteracts by producing arginase. IgA is partially protective. Intestinal microbiota influences the efficacy of adaptive immune response.
Diagnosis morphological cysts in faeces or trophozoites in duodenal fluid antigen detection in faecal samples.
Therapy metronidazole tinidazole, ornidazole furazolidone quinacrin, albendazole, paromomycin, nitazoxanide Other body cavity Excavata oral cavity Trichomonas tenax gastrointestinal tract Chilomastix mesnili Dientamoeba fragilis Pentatrichomonas T.
Transmission with Enterobius eggs.
Pathogenic role uncertain. Differential diagnostic challenge, must be differentiated from Entamoeba histolytica Giardia cysts in stool images susceptible. Lobosea 6 7 Entamoeba Entamoeba histolytica, E. Disease, diagnosis and treatment Zoonotic, pigs act as asymptomatic reservoirs Transmission without pig exposure is also possible Source of infection is water, food or direct contact Hyaluronidase plays a role in giardia cysts in stool images formation Disease spectrum include asymptomatic infection acute mucoid or bloody diarrhoea dysenteria, rarely with perforation chronic diarrhoea rarely lung infection Diagnosis: microscopic detection cysts are rare in acute disease Therapy: tetracycline, metronidazole Stramenopiles Blastocystis spp.
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