Unit 12. Ciliate

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Unit 12.

Ciliate
Topics:
12.1. Balantidium coli
Ciliate
12.1. Balantidium coli
• Balantidium coli belongs to the Phylum Ciliophora and Family Balantididae.
• It is the only ciliate protozoan parasite of humans
• It is the largest protozoan parasite of humans.
History and Distribution
• It was first described by Malmsten in 1857, in the feces of dysenteric
patients.
• It is present worldwide, but the prevalence of the infection is very low.
• The most endemic area is New Guinea, where there is a close association
between man and pigs.
 Habitat
-B. coli resides in the large intestine of man, pigs, and monkeys.
Ciliate

 Morphology
-B. Coli occurs in 2 stages – trophozoite and cyst.
 Trophozoite
• The trophozoite lives in the large intestine, feeding on cell debris, bacteria, starch
grains, and other particles.
• The trophozoite is actively motile and is invasive stage of the parasite found in
dysenteric stool.
• It is a large ovoid cell, about 60–70 µm in length and 40–50 µm in breadth. Very large
cells, measuring upto 200 µm are sometimes seen.

• The motility of trophozoite is due to the presence of short delicate cilia over the entire
surface of the body.
• At the anterior end, there is a groove (peristome) leading to the mouth (cytostome),
and a short funnel shaped gullet (cytopharynx).
Ciliate

• Posteriorly, there is a small anal pore (cytopyge).

• The cell has 2 nuclei—a large kidney-shaped macronucleus and


lying in its concavity a small micro nucleus.

Cyst
• The cyst is spherical in shape and measures 40–60 µm in diameter.
• It is surrounded by a thick and transparent double layered wall.

• Macronucleus, micronucleus, and vacuoles are also present in the


cyst.
• The cyst is the infective stage of B. coli.
• It is found in chronic cases and carriers.
Ciliate

 Life Cycle
• B. coli passes its life cycle in one host only (monoxenous).
• Natural host: Pig.
• Accidental host: Man.
• Reservoirs: Pig, monkey, and rat.
• Infective form: Cyst.

 Mode of transmission:
• Balantidiasis is a zoonosis.
• Human beings acquire infection by ingestion of food and water contaminated with
feces containing the cysts of B. coli.
• Infection is acquired from pigs and other animal reservoirs or from human carriers.
• Once the cyst is ingested, excystation occurs in the small intestine.
• From each cyst, a single trophozoite is produced which migrates to large intestine
Ciliate

• Liberated trophozoites multiply in the large intestine by transverse binary fission.


• Sexual union by conjugation also occurs infrequently, during which reciprocal
exchange of nuclear material takes place between 2 trophozoites enclosed within
a single cyst wall.
• Encystation occurs as the trophozoite passes down the colon or in the evacuated
stool. In this process, the cell rounds up and secretes a tough cyst wall around it.
• The cysts remain viable in feces for a day or 2 and may contaminate food and
water, thus it is transmitted to other human or animals.
Ciliate
Pathogenesis
• In a healthy individual, B. coli lives as lumen commensal and is asymptomatic.
• Clinical disease occurs only when the resistance of host is lowered by
predisposing factors like malnourishment, alcoholism, achlorhydria(lack of HCL
acid in digestive juice), concurrent infection by Trichuris trichiura, or any
bacterial infection.
• Clinical disease results when the trophozoites burrow into the intestinal
mucosa, set up colonies, and intitiate inflammatory reaction.
• This leads to mucosal ulcers and submucosal abcesses, resembling lesions in
amoebiasis
• Unlike E. histolytica, B. coli does not invade liver or any other extraintestinal
sites.
Ciliate

Clinical Features
• Most infections are asymptomatic.
• Symptomatic disease or balantidiasis resembles amoebiasis causing diarrhea
or frank dysentery with abdominal colic, tenesmus, nausea, and vomiting.
• Balantidium ulcers may be secondarily infected by bacteria.
• Occassionaly, intestinal perforation peritonitis and even death may occur.
• Rarely, there may be involvement of genital and urinary tracts.
• In chronic balantidiasis, patients have diarrhea alternating with constipation.
Ciliate

Treatment
• Tetracycline is the drug of choice and is given 500 mg, 4 times daily for 10
days. Alternatively Doxycycline can be give.
• Metronidazole and nitroimidazote have also been reported to be useful in
some cases.
Prophylaxis
- Avoidance of contamination of food and water with human or animal feces.
- Prevention of human-pig contact.
- Treatment of infected pigs.
- Treatment of individuals shedding B. coli cysts.
Ciliate

Laboratory Diagnosis
 Stool Examination
• Diagnosis of B. coli infection is established by demonstration of trophozoites and
cysts in feces.
- Motile trophozoites occur in diarrheic feces and cysts are found in formed stools.
- The trophozoites can be easily recognized by their large size, macronucleus, and
rapid-revolving motility.
- The cysts can also be recognized in the formed stools by their round shape and
presence of large macronucleus.
 Biopsy
- When stool examination is negative, biopsy specimens and scrapings from
intestinal ulcers can be examined for presence of trophozoites and cysts.
 Culture
• B. coli can also be cultured in vitro in Locke’s egg albumin medium or NIH
polyxenic medium like Entamoeba histolytica, but it is rarely necessary

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