Acid fast parasites

common opportunistic and acid fast parasites

1. ACID FAST PARASITES Cryptosporidia , Isospora , Cyclospora & Sarcocystis By EKTA MSY Medical College and Hospital

2. OBJECTIVES To define etiology, morphology, life cycle, disease caused, laboratory diagnosis and treatment of Acid fast Intestinal parasitic infections caused by Isospora, Cyclospora, Cryptosporidia and Sarcocystis spp.,

3. Acid fast Intestinal parasites - size Isospora belli 20-30 µm Sarcocystis – 50-60µm Cyclospora – 40-50µm Cryptosporidium – 4-6µm

4. MICROSPORA Microsporidia 7 genera Enterocytozoon ( E.bieneusi, E.intestinalis ), Encephalitozoon, Nosema, Pleistophora, Thelohanea, Trachipleistophora & Vittaforma Causes microsporidiosis especially in AIDS cases causing persistent diarrhoea, abdominal cramps, nausea, malabsorption

5. MICROSPORA Microsporidia – minute unicellular obligate intracellular spore forming protozoa Life cycle: not worked out fully 2 developmental stages inside a host cell i ) Schizogony, ii) sporogony Spore –polar tube – sporoplasm – enterocytes – merogony – several spore formed Size of spore less than 10µm in length Spores- Oval or cylindrical – Acid fast by MZN

6. MICROSPORA Enterocytozoon hellam-peritonitis, myositis, keratoconjunctivitis Encephalitozoon cuniculi Encephalitozoon intestinalis or septatata intestinalis Treatment: Albendazole 400mg BD for 4 weeks

7. MICROSPORA

8. MICROSPORIDIA

9. MICROSPORIDIA

10. MICROSPORIDIA

11. I. Cryptospor idium species Cryptosporidium is an intestinal coccidian parasite affecting various animals and men. It causes self limiting acute diarrhea in immuno -compromised man. Disease of birds, reptiles and fishes and also man Cryptosporidium parvum & Cryptococcus hominis is the pathogenic s pecies.

12. Morphology Oocyst - Thick wall oocyst Thin wall oocyst the oocysts are acid fast in nature but do not stain by iodine It is the infective form to man as well as the diagnostic form excreted in the feces.

13. Life cycle Cryptosporidium completes its life cycle ( both sexual and asexual stages) in single host. Infective stage- sporulated oocyst Mode of transmission- Ingestion By autoinfection

14. Laboratory diagnosis Direct microscopy (stool examination) Sample collection Direct wet mount Acid fast staining Direct fluorescent antibody staining Antigen detection- from stool By ELISA, ICT Antibody detection- from serum By ELISA Molecular diagnosis-PCR Histopathology of intestinal biopsy

15. Treatment ORS Self limited In sever case- Nitazoxanide

16. Cryptosporidium spp., - Acid fast- MZN

17. Cryptosporidium spp

18. CYCLOSPORA CAYETANENSIS Cyclospora cayetanensis is the most recently described coccidian parasites as human intestinal pathogens. LIFE CYCLE Host- human Transmission- Ingestion of food & water Infective form- oocyst

19. Clinical features Diarrhoea Biliary tract infection

20. Laboratory diagnosis Stool examination- variable acid fast Molecular- PCR Serology- not important Treatment- cotrimoxazole

21. Cyclospora cayatenesis

22. Cyclospora life cycle

23. CYSTOISOSPORA BELLI Isospora belli has been recently renamed as Cystoisospora belli. It belongs to the family Sarocystidae

24. Morphology Oocyst is the infective stage. Life Cycle Host- man Transmission- by ingestion of contaminated food and water

25. Cystoisospora belli

26. Clinical feature Fever Abdominal pain Watery non bloody diarrhoea

27. Laboratory diagnosis Stool examination Saline wet mount Acid fast stained smears- the oocyst is uniformly acid fast Fluorescent stained smears Autoflurescence Phase contrast microscope 2. Molecular methods PCR 3. Histopathologic examination

28. Iso s po r a

29. Treatment Cotrimoxazole

30. Iso s po r a

31. Iso s po r a

32. SARCOCYSTIS hominis , S. suihominis Sarcocystosis Intestinal sarcocystosis Cyst in the muscle (Muscular cyst) Acid fast by MZN Man- definitive host Pig – intermediate host

33. Clinical features Intestinal sarcocystosis Nausea, vomiting, abdominal pain and diarrhea 2. Muscular sarcocystosis Depends on size of muscle cystes

34. Laboratory diagnosis Intestinal Sarcocystosis Stool examination 2. Muscular Sarcocystosis Histological examination 3. Serology- western blot technique

35. Sa r c oc y s tis

36. Sa r c oc y s tis

37. Summary A cid fast Intestinal parasites Persistent diarrhoea – HIV/AIDS Cryptosporidium spp., - Oocyst Cyclospora spp., - Oocyst Isospora spp., - Oocyst Sarcocystis spp., - Oocyst Microsporidium spp., - Spores Balantidium coli- Largest intestinal ciliated protozoan

38. THANK YOU