TISSUE COCCIDIA

Dr. Devika Iddawela Department of Parasitology

10/11

Objectives
To be able to Name the Tissue coccidia that cause human disease and state the habitats of each State the source (s) of infection, entry to and exit of agent from humans Describe the life cycle with stages and events Identify the stages that cause pathogenic effects Outline laboratory methods of identification of organism Identify points in the life cycle where preventive measures are applicable Describe the pathogenicity List the clinical features Describe transmission, prevention and control of toxoplasmosis

COCCIDIA
Intracellular protozoans; alternation of asexual & asexual

Development in epithelial cells (usually gut) of the definitive host TISSUE COCCIDIA INTESTINAL COCCIDIA-

Tissue coccidia Toxoplasma gondii

Sarcocystis spp.

Toxoplasma gondii

Toxoplasma gondii
Coccidian parasite Cats ONLY known DEFINITIVE HOST INTERMEDIATE HOSTS: widespread in birds & mammals

TOXOPLASMOSIS World wide distribution; most prevalent

parasitic infection of humans on serological assays, rates vary in communities 4-90%

Sri Lanka > 50% healthy adults have Ab. Many animals (dogs, cats, rodents are positive; cats 24% )

obligate intracellular parasite of all nucleated cells Latent infection is common It is an important opportunistic parasite

Causes fatal infections in the immunocompromised eg.AIDS

Morphology There are 3 forms:

Characteristic form is crescentic shaped trophozoite

1. Tachyzoites (endozoites) and pseudocysts Crescent shape, 4 8 m with single nucleus found in macrophages (pseudocyst) or any nucleated cell . Multiply rapidly (tachyzoites) . Pseudocysts can cross the placenta

2. Bradyzoites ( cystozoites) and true cysts can be

found in any part of the body Organs commonly affected are brain, eye, heart. Cyst wall is by the parasite and host. Zoites in true cysts multiply slowly (bradyzoites)

3.Oocyst formed in the small intestine of the cat and passed in cat faeces. Each sporulated oocyst contains 02 sporocysts and each sporocyst has 04 sporozoites NOT FOUND IN HUMANS and other intermediate hosts

Life cycle
Only known definitive hosts for Toxoplasma gondii are members of family Felidae (domestic cats and their relatives)

Definitive host

Unsporulated oocysts are shed in the cats faeces

Oocysts take 2-5 days to sporulate in the environment and become infective.

Toxoplasma in Definitive host

Gut epithelial cells of cat

SCHIZOGONY (asexual multiplication)

GAMETOGONY male gametocytes female gametocytes Zygote

SPOROGONY oocyst outside environment- (sporozoites)

Pathogenesis
Tachyzoites actively invade the cells Multiply rapidly Form intracellulaer pseudocyst This leads to cellular disruption, released tachyzoites infect adjacent cells As the host immunity develops,Tissue true cyst form, containing bradyzoites Periodic excystation can occur

clinical disease
majority asymptomatic except in Neonates immunocompromised eg. Transplant surgery, AIDS

Symptomatic toxoplasmosis n normal patients ( immuno-competant)

fever, painless cervical lymphadenopathy + rash

Immunocompromised- organtransplant,AIDS Severe disease- multiple tissue/organ involvement

In Immunodeficient patients- mostly due to reactivation Common _ central nervous system (CNS) disease encephalitis
In patients with AIDS, toxoplasmic encephalitis is the most common cause of intracerebral mass lesions
but may have retinochoroiditis, pneumonitis, or other systemic disease.

Ocular toxoplasmosis Most common cause of infectious posterior Uveitis Due to periodic reactivation of congenital toxoplasmosis or acquired acute infection

Usually unilateral Active lesion is whitish with illdefine margins ( cotton wool appearance) and pigmented when quiescent Involves macular in majority

Clinical features Floaters Blurred vision

CONGENITAL TOXOPLASMOSIS
occurs generally with acute (1ry) infection in Mother (endometrial reactivation reported))

Placental infection

Zoites transmitted to foetus

Risk of infection increases with duration of pregnancy

but foetal damage severe during early pregnancy- abortion, intra uterine death

diagnosis
Indirect

The diagnosis of toxoplasmosis is typically made by serologic testing.

Detection of IgM, IgA or low avidity IgG , rising IgG titreindicate acute infection, IgG Past infection

Serological tests available 1.Sabin-Felman dye test Gold standard 2.IFAT 3. IHA 4. ELISA

Sabin-Felman dye test Use live tachyzoites

live tachyzoites stain blue with alkaline methylene blue dye
If

antibodies to T gondii are present in the patient's serum, they will damage the organisms damaged organisms will not take up the dye and appear as pale "ghosts" compared to undamaged organisms.
The

test needs live tachyzoites and is difficult to perform, so other serological tests are typically used. However, the test is very sensitive and specific and remains the reference method.

Serological test for toxoplasmosis: FAT negative positive

Direct Demonstration of Parasite

1. Observation of parasites in patient specimens, such as bronchoalveolar lavage material from immunocompromised patients, or lymph node biopsy 2. Isolation of parasites from blood or other body fluids, by intraperitoneal inoculation into mice or tissue culture mice should be tested for the presence of Toxoplasma organisms in the peritoneal fluid 6 to 10 days post inoculation;
if no organisms are found serology 4 -6 weeks post innoculation,

Detection of parasite genetic material by PCR,

especially in detecting congenital infections in utero. Amniotic Fluid - parasite DNA by PCR Prenatal diagnosis: Fetal US - calcifications / hydrocephalus

Isolation of parasite placenta, amniotic fluid, foetal blood

Amniocentesis
Done around 16th week of pregnancy A long needle is inserted into the Amniotic sac and amniotic fluid is drawn.

Transmission
Parasitic stages that can be transmitted to humans Oocysts

Tachyzoites or pseudocysts
Bradyzoites or true cysts

Food and water borne a) oocysts via contaminated Vegetables, fruits and water

Transmission

Animal-to-human (zoonotic) transmission

Accidental ingestion of oocysts after cleaning a cat's litter box when the cat has shed Toxoplasma in its faeces Accidental ingestion of oocysts after touching or ingesting anything that has come into contact with a cat's faeces that contain Toxoplasma

Accidental ingestion of oocysts in contaminated soil (e.g. not washing hands after gardening)
Drinking water contaminated with the Toxoplasma oocysts

true cysts (bradyzoites) eating uncooked or undercooked meat of infected animal Accidental ingestion of
undercooked, contaminated meat after handling it and not washing hands thoroughly (Toxoplasma cannot be absorbed through intact skin) Eating food that was contaminated by knives, utensils, cutting boards, or other foods that had contact with raw, contaminated meat

Rarely Organ transplant recipients can become infected by receiving an organ from a Toxoplasma-positive donor.

Tachyzoites or pseudocysts

Mother-to-foetus (congenital) transmission

A woman who is newly infected with Toxoplasma during pregnancy can pass the infection to her unborn child (congenital infection). Laboratory workers who handle infected blood can also acquire infection through accidental inoculation. Entering body through abrasions (butchers, veterinarians),
Blood transfusion

PREVENTION
Reduce Risk of Toxoplasmosis from Food

Avoid eating raw/undercooked meat -15 C for 3 days -65 C 4-5 minutes -4 C persists for months salt/nitrates kills cysts,

To reduce risk from food

Wash cutting boards, dishes, counters, utensils, and hands with hot soapy water after contact with raw meat, poultry, seafood, or unwashed fruits or vegetables.
Avoid eating raw/undercooked meats -

Wash foods such as green salads leaves and fruits, especially if it is to be eaten uncooked.

Reduce Risk of Toxoplasmosis from the Environment

Wear gloves when gardening and during any contact with soil or sand Keep outdoor sandboxes covered.

Wash hands after contact with soil

To reduce environmental contamination

Feed cats only canned or dried commercial food or well-cooked food, not raw or undercooked meats.

Change the litter box daily . The Toxoplasma parasite does not become infectious until 2 to 5 days after it is shed in a cat's faeces

High risk: pregnancy, immunocompromisedAvoid contact with cats/gardening

Avoid changing cat litter

Keep cats indoors.

Do not adopt or handle stray cats, especially kittens.

SARCOSPORIDIOSIS / SARCOCYSTOSIS
Two types - Intestinal sarcocystosis Muscle sarcocystosis Organism - Sarcocystis spp. many species present

coccidian parasite, tissue protozoan Life cycle - requires two hosts ; a definitive host & an intermediate host man can be the definitive host for some species and an intermediate host for some other species In the definitive host - sporogony in intestinal mucosae with the production of sporocysts (infective stage) In the intermediate host-sarcocysts or Meischers tubes in muscle (intermediate stage)

Muscle sarcocystosis
Man act as the intermediate host

Definitive host may be a carnivore; monkey, dog

Sarcocysts are found in muscles andconnective tissues of man Sarcocysts vary in size from few m to 5 mm. These contain cystozoites. Similar to Toxoplasma zoites but larger; banana shaped. Cysts in the muscles can cause myositis and muscle necrosis.

True/ false regarding toxoplasmosis Cats act as definitive hosts Oocysts could be found in human faeces True cysts can be transmitted by blood transfusion Tachyzoites can be transmitted by mosquito bite Risk of congenital infection increase with duration of pregnancy If the mother get infected during the later part of pregnancy, foetal damage is sever Known to cause life- threatening infections in immunocompromized patients

Can cause sever disease in pregnancy

Serology is diagnosis of choice Detection of IgM indicate a past infection Prenatal diagnosis is usually rely on serology Washing hands after going to toilet is good method of preventing infection Oocysts are infective as soon as it pass in the faeces