protozoa Portal of entry Habitat Final site in the host MOT

Toxoplasma gondii mouth

Naegleria fowleri (free living amoeba) Warm water ponds, Lakes, Swimming pool, CNS in human

Acanthamoeba spp (free living amoeba) Moist soil brackish waters. Isolated from nasopharynx of healthy people

Risk groups

All organs, esp brain and lymph node Food and water borne (cyst and oocyst) Organ transplant (zoite and cyst) Cats feces (oocyst) Blood transfusion (zoite) Laboratory accidents (zoite) Pregnant woman (zoite) Immunosuppressed patient (cyst, zoite, oocyst)

Immunocompromised patients -Lymphoproliferative disorders - Long term immunosuppressive chemotherapy -Glucocorticoid therapy - Lupus erythematous -AIDS Trophozoite 2 forms: a)Amoeba-flagellate Trophozoite

Characteristics

Oocyst

Oval shape More resistant but destroyed in boil water, burning and contact with strong NH3 for 3 hours Tachyzoite

-small pear shaped -2 long flagella at one end -no pseudopodium b)Amoeboid shape

-posses 1 large vesicular Nu with large central karyosome -no flagella stage -moves by fine spiky tapering acanthopodia Cysts

Cresent/oval shape Pseudocyst : tachyzoite + its wall Destroyed : freezing/thawing Bradyzoite Slowing dividing form Destroyed : freezong/irradiation

-a single blunt pseudopodium -single vesicular nucleus with large karyosome at the centre with a halo around it. -present of contractile vacuole Cyst

Have wrinkled double walled cyst

-various no of small plugged pores in the cyst wall -single Nu.

Life cycle

Definitive host : cat Accidental host : human Release of oocysts in the cats feces Shedding of oocysts (infected host) Sporozoites (in intestine) Trophozoites (pseudocystendodyogeny) Invade macrophages (lymphatic vessels) Enter blood stream and other intestinal organs True tissue cysts Intracellularly in tissues The immunity is established in healthy host Tissue cysts (dormant bradyzoites) *when host resistant is lowered, cyst is reactivated and bradyzoites are released

- Usually infects a person when they go swimming -Organism gains access to body via nose and hence to CNS through the cribiform plate - Inhalation of contaminated dust leading to invasion of olfactory neuroepithelium -Infective stage: Cysts

-Transmission may occur through inhalation of dust containing cysts that passes via upper respiratory tract & eyes. - Amoeba reaches brain by way of the bloodstream most likely from lower respiratory tract or through ulcers in the skin or mucosa. -Usually reported in patients with reduced immune status. Parasite spreads hematogenously to brain producing chronic infection -Usually fatal cause Granulomatous amoebic encephalitis. -Condition May persist for a week or months

disease Clinical symptoms

toxoplasmosis Congenital toxoplasmosis 1st trimester : abortion 3rd trimester : congenital abnormalities infected newborn : ocular involvement, intracerebral calcification, hydrocephalus, psychomotor disturbances and mental retardation ocular toxoplasmosis : acute retinochoroiditis, pain, photophobia, blurred vision, healed scar pale, prominent black spots of choroidal pigment, blindness acute disease fever, malaise, lymphadenopathy, sore throuat myalgia, popular rash chronic reactivated disease encephalitis myocarditis pneumonitis Isolation : animal inoculation, tissue culture Parasite detection : histological examination PCR Radiology serology

Primary Amoebic Meningoencephalitis (PAM) Incubation Period: usually 2-3 days Clinical manifestations: -A day or so of prodromal symptoms with headache and fever is followed by rapid onset of nausea and vomiting & stiff neck. - Followed by signs and symptoms of meningitis -Progress rapidly with lethargy, confusion, drowsiness convulsions, photophobia. -Coma & death within 57days

Granulomatous amoebic encephalitis (GAE) Incubation period: may be days or even weeks -Onset is insidious -Mimics space occupying lesions consistent with brain abscess -Steady deterioration & death within 2-3 weeks -Cause of death due to bronchopneumonia , hepatic or renal failure -Cutaneous infection: Acanthamoeba keratitis

Diagnosis

Detection of motile trophozoite in wet mounts of fresh spinal fluid Neuroimaging shows infection Serology : F.A.T. (No value as patient dies within 5-7 days Biopsy shows trophozoites in tissue section Amphotericin B given intravenously for 6 days

Examine CSF for trophozoites Culture Biopsy (trophozoites and cysts in tissues) Neuroimaging (Computed tomography & MRI)

treatment

Pyrimethamine + sulfadiazine Pregnant woman Spiramycin + Folate acid

No satisfactory treatment Ketoconazole Penicillin + chloramphenicol