PARASITOLOGY

Compiled Notes

Gulle, Sherlyn
 1
Contents Types of Fixative Used ............................................. 6
PARASITOLOGY ...................................................... 4 Advantages of SAF ................................................... 6
Host ......................................................................... 4 Two Types of Stool Examination .............................. 6
Parasite .................................................................... 4 1. Macroscopic Examination ............................ 6
Kinds of Host ............................................................ 4 2. Microscopic Examination ............................. 6
Predator ................................................................... 4 2.1. Direct Wet Mount ......................................... 7
Prey .......................................................................... 4 2.2. Concentration Techniques ............................ 7
Scavenger................................................................. 4 Methods .................................................................. 7
Symbiosis ................................................................. 4 1. Formalin-Ethyl-Acetate Concentration ......... 7
Commensalism ......................................................... 4 2. Zinc Sulfate Flotation Method ...................... 7
Specialized Type of Commensalism ...................... 4 3. Permanent Stains ......................................... 7
Types of Parasite ...................................................... 4 Special Stains Used .................................................. 7
1. According to Host ......................................... 4 1. Wheatley’s Trichrome Stain ......................... 7
2. According to Area Inhabited ......................... 4 2. Iron Hematoxylin Stain ................................. 7
Vectors ..................................................................... 4 3. Modified Acid Fast Stain .............................. 7
Types of Vectors ....................................................... 4 III. Urogenital and Other Specimens ............................ 8
1. Biological Vectors ......................................... 4 Additional Techniques for Examination of Enteric
2. Mechanical Vectors ...................................... 4 Parasites ...................................................................... 8

Portals of Entry ........................................................ 4 1. Cellulose Tape Technique for Pinworms .......... 8

Mode of Transmission or Exposure to Infection ....... 5 2. Egg Studies ...................................................... 8

Ways in Which the Parasite May Injure its Host ....... 5 3. Nematode Culture and Recovery Technique .... 8

Trauma ................................................................. 5 4. Parasite Culture Techniques ............................ 8

Lytic Necrosis ....................................................... 5 5. Immunodiagnostic Methods ............................ 8

Stimulation by H-T Reaction ................................. 5 INTESTINAL AND UROGENTIAL

FLAGELLATES .......................................................... 8
Toxic and Allergic Phenomena ............................. 5
Taxonomal Classification.......................................... 8
Open Pathways for Secondary Invaders ............... 5
General Characteristics ............................................ 9
SPECIMEN COLLECTION AND TESTING ........... 5
Flagellate Protozoa of the Digestive and Urogenital
Most Commonly Used Specimen ............................. 5
Tract (Intestinal Flagellates) ................................... 10
Less Frequently Used Specimen ............................... 5
1. Chilomastix mesnili ........................................ 10
I. Blood Specimens ....................................................... 5
2. Dientamoeba fragilis ...................................... 11
1. Thick and Thin Blood Films ................................... 5
3. Giardia lamblia ............................................... 11
2. Concentration Technique ..................................... 6
Giardiasis ........................................................... 12
II. Fecal Specimen/Stool ............................................... 6
4. Trichomonas hominis..................................... 13
1. Specimen Collection ............................................. 6
5. Trichomonas tenax ........................................ 13
shacklen
 2
6. Trichomonas vaginalis .................................... 14 Life Cycle Overview: ............................................... 28
Trichomoniasis ................................................... 14 Morphology ........................................................... 28

BLOOD AND TISSUE FLAGELLATES ................. 15 1. Trophozoite ............................................... 29

HEMOFLAGELLATE ................................................. 15 2. Schizont ..................................................... 29

General Characteristics .......................................... 15 3. Gametocyte ............................................... 29

Trypanosoma cruzi ............................................. 16 Exoerythrocytic Shizogonic Cycle ........................... 30

Chagas’ Disease, American Trypanosomiasis ...... 16 Erythrocytic Shcizogonic Cycle ............................... 30

Trypanosoma brucei Complex ............................ 17 Making a Thin Smear ............................................. 31

Sleeping Sickness................................................ 17 Factors Which Control the Thickness of the Film ... 31

TISSUE FLAGELLATES .............................................. 18 Making A Thick Film ............................................... 31

General Characteristics .......................................... 18 Determination of Parasitemia ................................ 31

Leishmania species ................................................. 18 Plasmodium vivax .................................................. 32

L. braziliensis ...................................................... 19 Plasmodium malariae ............................................ 32

L. donovani......................................................... 19 Plasmodium ovale.................................................. 32

L. tropica ............................................................ 19 Plasmodium falciparum ......................................... 32

AMOEBA ................................................................. 19 Relapse of Infection ............................................... 33

Parasite Amoeba Infecting Man are Divided: ......... 20 Recrudesence ........................................................ 33

Major Stages in Its Life Cycle .................................. 20 Black Water Fever .................................................. 34

Cyst .................................................................... 20 Subclass Coccidia ....................................................... 34

Trophozoite ........................................................ 20 Suborder Eimeriina .................................................... 34

A. Entamoeba gingivalis ......................................... 20 Family Eimeriidae .................................................. 34

B. Entamoeba coli .................................................. 21 Genus Isospora ...................................................... 34

C. Endolimax nana .................................................. 22 Isospora belli...................................................... 35

D. Iodamoeba buetschlii......................................... 22 Family Sarcosystidae .............................................. 36

E. Entamoeba histolytica ........................................ 23 Genus Toxoplasma................................................. 36

Entamoeba hartmanni ........................................... 24 Toxoplasma gondii ............................................. 36

Entamoeba dispar .................................................. 24 Genus Sarcocystis .................................................. 37

Intestinal Amoebiasis ............................................. 25 Family Cryptosporidae ........................................... 39

Hepatic Amoebiasis and Other Extraintestinal Cryptosporidium species.................................... 39

Lesions ................................................................... 26 Pneumocystis carini ........................................... 40
Free Living Amoeba ................................................ 27 PHYLUM CILIOPHORA ....................................... 41
Blastocystis hominis ............................................... 28 Balantidium coli ..................................................... 41
PHYLUM APICOMPLEXA.................................... 28 INTESTINAL NEMATODES ................................ 42
Malaria ................................................................... 28 Phylum Nematoda ................................................. 42
shacklen
 3
Class Aphasmid ...................................................... 42
Class Phasmidia ...................................................... 42
Ascaris lumbricoides........................................... 42
Trichuris trichiura ............................................... 46

HOOKWORMS ....................................................... 47
Strongyloides stercoralis .................................... 49
Enterobius vermicularis ...................................... 51
Capillaria philppinensis ....................................... 53
Brugia malayi...................................................... 56
Angiostrongylus cantonensis .............................. 57

PHYLUM PLATYHELMINTHES .......................... 59

Cestodes/Tapeworms ............................................ 59
Trematodes/Digenetic Flukes ............................. 59
Class Trematoda (Flukes) ....................................... 60
Schistosoma japonicum...................................... 60
Paragonimus westermani ................................... 63
Fasciola hepatica ................................................ 65
o Fasciola gigantica ....................................... 65
Clonorchis sinensis ............................................. 67
Opisthorchis felineus .......................................... 69
o Opisthorchis viverrini ................................. 69
Fasciolopsis buski ............................................... 71
Echinostoma ilocanum ....................................... 72
Family Heterophyidae ........................................ 73
Cestoidea Tapeworms ............................................ 75
Taenia solium ..................................................... 75
Taenia saginata .................................................. 78
Hymenolepis nana.............................................. 79
Hymenolepis diminuta ....................................... 80
Dipylidium caninum............................................ 82
Echinococcus granulosus.................................... 83
Echinococcus multiocularis ................................ 85
Diphyllobothrium latum ..................................... 86

shacklen
 4

PARASITOLOGY This symbiotic relationship usually injured
the host to some degree through the
 Is the study of parasites, their hosts, and the
activities of the other animal
relationship between them
 It also deals with the parasite that infect humans, the Types of Parasite
diseases it causes and the response generated by the
1. According to Host
humans against them (parasites)
a. Obligate Parasite
 Can’t exist without the host
Host
 Dependent on the host for
 an animal or plant on or in which a parasite or everything
commensal lives  Ex. Virus
b. Facultative Parasite
Parasite  Can exist as a parasite and as free
 an organism that lives in or on another organism living
and benefits by deriving nutrients at the host’s  Ex. Acanthamoeba –
expense protozoa found in hot
springs, warm and fresh
Kinds of Host water and hot tubs,
1. Definite Host contaminants in contact
 Host where the sexual or adult stages of the lenses
parasite are found or seen 2. According to Area Inhabited
2. Intermediate Host a. Ectoparasite
 Host where the sexual (immature) or larval  Parasite that colonize the superficial
stages are seen or found area of the body
 Infestation – damage produced to
Predator external areas
 Is the attacker or the one that attacks other living b. Endoparasite
animal or organism but not necessarily killing them  Parasite that is found within the
body
Prey  Infection – damage produced inside
 Or the victim the body

Scavenger Vectors
 Those that devour the dead of natural causes taking  Are the carriers or transmitters of the parasite
the leavings of the predator  Usually are blood sucking insects
 It inoculates the infective stage of the parasite into
Symbiosis the skin
 Means living together and usually involves
protection Types of Vectors
1. Biological Vectors
Commensalism  Is essential to the life cycle of the parasite
 Is a form of symbiosis  Mosquito for malaria
 Usually it is beneficial to one partner and at least 2. Mechanical Vectors
not disadvantageous to the other  Usually carries the infective stage of the
parasite
Specialized Type of Commensalism  Fly in transmission of amoeba cyst
1. Mutualism
 This type is usually beneficial to both Portals of Entry
2. Parasitism 1. Mouth – most common
shacklen
 5
2. Skin – second most common  Balantidiasis
3. Nose
4. Genitalia
5. Placenta SPECIMEN COLLECTION AND
Mode of Transmission or Exposure to Infection TESTING
1. Contaminated soil and water
2. Food containing the immature infective stage of the Most Commonly Used Specimen
parasite  Blood
3. Blood sucking insect  Feces/Stool
4. Domestic or wild animals harboring the parasite
Less Frequently Used Specimen
5. Another person, his clothing, beddings, or
immediate environment which he/she  Urogenital Specimen
contaminated  Sputum
6. Oneself  Aspirates
 Biopsy Material/Tissues
Ways in Which the Parasite May Injure its Host
 Traumatic damage
 Lytic Necrosis I. Blood Specimens
 Stimulation of host tissue reaction  Specimen of choice for malarial parasites,
 Toxic and allergic phenomena babesiosis, trypanosomiasis, leishmaniasis, and
 Open pathways for secondary invaders filariasis
 Required to make a good thick and thin blood
Trauma smear/film (buffy coat are used for microfilariae)
 Either external or internal
 Categorized as to slight, moderate or severe 1. Thick and Thin Blood Films
 Can be produced by small or large parasite  Blood is spread over the slide in a thin layer,
yielding intact non-overlapping cellular elements
Lytic Necrosis  Integrity of cells is important
 Lytic enzymes are produced by certain parasites to  Blood films are stained permanently
lyze tissues and incorporate them to their  Thick film – during staining erythrocytes are
cytoplasm dehemoglobinized and only white blood cells,
 Used by parasite as a means of penetrating other platelets, and parasite (if present) are visible
tissues  Thin film – examination for species identification
since the morphology is more defined
Stimulation by H-T Reaction
 Preparation is done by fingerstick, earlobe puncture
 Consist of cellular proliferation and infiltration of or venipuncture
the site of parasitic infestation
 Fingerstick should be freeflow to prevent tissue
 All with few exceptions will stimulate H-T reaction fluid contamination and should be alcohol free
 May also involve systematic increase in certain  In venipuncture, the anticoagulant of choice is
types of cell especially those circulating in the blood EDTA and should be done within an hour after
 Increase production of RBC’s due to infections collection
 Host will wall off parasite by fibrous encapsulation  In staining, the choice is Giemsa stain. The host cell
and parasite’s chromatin stains vividly but the
Toxic and Allergic Phenomena
hemoglobin in erythrocytes will appear as pale red
 May be due to arthropods that produces venom
and it’s the only stain that allows visualization of
Open Pathways for Secondary Invaders the RBC stippling that occurs with infection by
certain malarial parasite
 Ground itch
 Amoebic colitis
shacklen
 6
 Wright’s stain may be used but it stains less and it  Specimen may be passed directly into a clean, dry
stains erythrocyte producing a busier background paper carton or wax paper
 Examination is done at the feathered edge of the  Diarrheic specimen may also be collected in clean
film as erythrocyte are pushed through the edge bed pans
during the smear preparation  Contamination with urine or toilet water may
destroy protozoal trophozoites
2. Concentration Technique  Commercially available containers are available for
 Done by using the buffy coat from a centrifuged use
anticoagulated blood
 Used for microfilariae detection, Knott’s Types of Fixative Used
concentration or membrane filtration, both are 1. 3 parts 5-10% buffered formalin
helpful especially if the concentration of 2. 3 parts of polyvinyl alcohol (PVA)
microfilariae in peripheral blood is very low 3. Merthiolate-iodine-formalin (MIF)
 Knott’s Technique – anticoagulated blood is lyzed 4. Sodium-acetate-formalin (SAF)
with 2% formalin and centrifuged to concentrate
the microfilariae in the sediment and is examined Advantages of SAF
as wet preparation or stained with Giemsa stain or 1. Can be used for permanent stain procedure
hematoxylin 2. Can be used for wet mounts
 Membrane Filtration – blood is lyzed and passed 3. Can be used in concentration method
through a slim membrane filter and is stained with 4. It does not contain mercury (Hg)
hematoxylin to reveal any microfilariae  However, there is a new PVA fixative available with
 The use of fluorochrome acridine orange in a a zinc-sulfate based PVA
microhematocrit centrifueged format allows  Three specimen collected every other day is
detection of blood parasites and appears to be considered the minimum necessary to perform an
more sensitive than traditional thick/thin smears. adequate O & P procedure

Two Types of Stool Examination

II. Fecal Specimen/Stool 1. Macroscopic Examination
 Intestinal parasite are primarily examined through  Examine grossly for consistency, presence of
1. Wet mounts mucus, blood, larvae or adult worms and
2. Concentration technique proglottids
3. Permanent stained smears  Watery/Loose stools – protozoan trophozoites
4. Culture – less frequently  Formed/Soft stools – for cysts or ovum
 Stages of helminths commonly recovered are eggs  Most parasites are uniformly distributed in the
(ovum), larvae, sometimes intact worms or portions stool as a result of the mixing action of the
are occasionally seen cecum
 Intestinal infection are diagnosed by the detection 2. Microscopic Examination
of trophozoites, cysts or oocysts  Can be examined by direct wet mounts of fresh
material, wet mounts of concentrate or
1. Specimen Collection permanent stains
 Proper collection and handling is required  Direct saline wet mounts of fresh feces allows
 Fresh specimen should be examined within 1 hour detection and observation of motile protozoan
of passage, liquid specimen should be examined trophozoites and helminth larvae
within 30 minutes or placed in a fixative to maintain  Direct wet mounts of preserved feces may
the best yield allow detection of parasite that do not
 If not processed immediately, it should be left at concentrate well
room temperature or at the refrigerator and should  Concentration procedures increase the
not be placed in the incubator for this will speed up examiners ability to detect protozoan cysts and
the disintegration of the parasites present
shacklen
 7
helminthes ovum and larvae but unsatisfactory  Efficient in recovering cysts and helminth
for detecting protozoan trophozoites eggs and larvae including operculate egg and
 Permanent stains are useful for detection and moderately efficient for schistosome eggs
morphologic examination of protozoan  Less distortion or protozoal cysts
trophozoites and cysts  Simple and suitable for most laboratory
 Fresh, soft, loose, watery –3 procedures should situations
be done 2. Zinc Sulfate Flotation Method
 Watery – concentration by centrifugation  Fresh stool is processed using zinc sulfate
rather than by flotation formalin ethyl acetate with a specific gravity of 1.18 and
concentration formanilized stool is processed with a
 Formed – examined by concentration method solution of specific gravity of 1.20
 Parasitic elements are seen in the surface
2.1. Direct Wet Mount film of the solution following centrifugation
 Most easy to perform although proper  Yields a clearer preparation than formalin-
interpretation requires careful examination ethyl-acetate concentration method
and experience in using the microscope to full  Unreliable for the recovery of nematode
advantage larvae, infertile eggs of ascaris, eggs of most
 Useful with fresh specimen, especially liquid trematodes and large tapeworms
stool or duodenal aspirates for motile  Use of formanilized stool specimen helps
trophozoites or helminth larvae clear the specimen and prevents popping of
 Done by small amount of stool mixed with a opercula and distortion of the parasite
drop of 0.85% NaCl and covered with coverslip 3. Permanent Stains
and examined  Allows review by consulants if any difficulty
 Use of Lugol’s iodine (1:5 dilution) – iodine is arises
helpful in enhancing the visibility of nuclear  The only method that used the OIO
structures in protozoal cysts and in detection  Useful in detection of protozoal trophozoites
glycogen inclusions and cysts
 Disadvantages are loss of trophozoites motility  Not useful in detection helminthes eggs or
and cyst refractility, difficulty in recognizing larvae
chromatid bodies
Special Stains Used
2.2. Concentration Techniques
1. Wheatley’s Trichrome Stain
 Can be performed on fresh or preserved
 Simple, reliable, and cost effective
specimens
 Specimens are those that have been fixed in
 More sensitive than direct wet mount
Schaudinn’s fixative or PVA fixative, SAF or
 Eliminates the amount of background material
MIF preserved
and concentrate on the organism
 Used for detection of amoeba and flagellates
 Is based on sedimentation or flotation
principles
2. Iron Hematoxylin Stain
 Sedimentation – heavier parasites settle to the  Difficult to perform
bottom as a results of gravity or centrifugation  Results are superior owing to enhanced
 Flotation – lighter parasite cysts and eggs rises definition of key nuclear and cytoplasmic
to the surface of solution of high specific characteristics
gravity  Specimen fixed in Schaudinn’s PVA or SAF
may be used
Methods 3. Modified Acid Fast Stain
1. Formalin-Ethyl-Acetate Concentration  Detection of oocysts of cryptosporidium,
 A biphasic sedimentation technique cyclospora and cryptospora

shacklen
 8
 Acid fast stain are sensitive and cost o Indirect Immunofluorescence Assay
effective for the detection of protozoa but (DFA)
lack specificity o Western Blot
 Use of positive control is mandatory o Radial Immunoassay (RIA)
o Immunodiffusion
6. Antigen Detection
III. Urogenital and Other Specimens  In stool samples usually performed using
 Vaginal and urethral discharges or urine may be fecal immunoassay
submitted as specimen  Sensitive compared to routine O & P
examination
 Most rapid test is the wet mount with saline
 Immunoassays are available in three
 Giemsa staining is the most appropriate stain for
formats:
protozoa especially hemoflagellates
o EIA
 Muscle biopsies/skin biopsies are also considered
o DFA
for parasites that invade muscle tissues and stained
o Lateral Flow
with appropriate stain after compressing it
(Immunochromatography)
between two slides

Additional Techniques for Examination of INTESTINAL AND UROGENTIAL

Enteric Parasites FLAGELLATES
Kingdom Protista
1. Cellulose Tape Technique for Pinworms
 The female pinworm (E. vermicularis), Subkingdom Protozoa
migrates from the cecum to the peri-anal
Phylum Phylum Phylum Phylum
skin where she deposits her eggs that are
Sarcomastigophora Apicomplexa Ciliophora Microsporida
fully embryonated Amoebae Coccidia Balantidium Nosema
 Uses clear adhesive cellophane tape or Flagellates Plasmodium Ichthyopthirius Encephalitozoon
Babesia Rumen and
commercial collection kits Theileria Cecal Ciliates
 Collection is late night, where the worms are Cyatauxzoon
more active or first thing in the morning
before bathing or defecation
2. Egg Studies
Taxonomal Classification
Kingdom:
 Consider the infecting stage of the parasite,
Protista
the age of the host, nutritional status of the
Phylum:
parasite
Sarcomastigophora
3. Nematode Culture and Recovery Technique
Subphylum:
 Harada-Mori filter paper strip culture
Mastigophora
 Filter paper/slant culture
Class:
 Charcoal culture
Phytomastigophora – have
4. Parasite Culture Techniques
chromatophores/plastids
 Less frequently used because of the lack of
Zoomastigophora – does not have plastids
familiarity of the method
Order:
5. Immunodiagnostic Methods
Bodonida – 2 flagella
 Used to identify the parasitic antigen or the
Tetramida – 3 flagella
antibody that is produced in response to the
Hexamitida – 6 or 8 flagella
parasitic infection
Trichomonadida – 3 to 5 flagella
 Methods used in immunodiagnostic:
Trypanosomatida – single flagellum
o Enzyme Immunoassay (EIA)
Family:
Bodonidae
shacklen
 9
 2 flagella: 1 is directed anteriorly, the Hexamitidae
other posteriorly and trailing both arising  Have two nuclei lying side by side in the
from a blepharoplasty in front of the same transverse plane 6 to 8 (3 to 4 pairs)
nucleus flagella in bilateral symmetry
 Member: Retortamonas intestinalis  Member: Giardia lamblia

Tetramitidae Trichomonadidae
 3 anterior flagella with 4
th
trailing  Have cytosome with 3 to 4 have free
flagellum; lack and axostyle or other axial flagella
organelles  Additional flagellum on the margin of an
 Member: Enteromonas hominis undulating membrane
 Axostyle protrudes through the posterior
end of the body
 Member:
o Trichomonas vaginalis
o Dientamoeba fragilis

Chilomastigidae
 3 anteriorly directed free flagella, 4th
delicate flagellum flying within a cytosomal
cleft
 Pear-shaped cysts with clear visible
Trypanosomatidae
cytosome
 Single flagellum which arises from a
 Member: Chilomastix mesnili
nucleus and kinetoplast (composedof
Blepharoplast and parabasal body)
 Members: Trypanosomes and Leishmania

General Characteristics
1. Motions is by flagella. The flagellum arises from
kinetoplast. The kinetoplast is composed of the
blepharoplast and the parabasal body.
2. Vesicular nucleus with central karyosome.
3. Reproduction is by longitudinal binary fission.
4. Complex life cycle include alternation of hosts.

shacklen
 10
5. Intermediate hosts commonly serve as vectors,  Flagella:
which transport developing parasites from one  External: three; anterior
definitive host to another.  Internal: one, cytostomal
6. Their transmission requires a biological vector.  Kinetosomes: anterior; connected by
Parasitical species parasites of tissues and blood: microfibrils
a) Trypanosoma  Cytostomal Groove: prominent; near the
b) Leishmania anterior end; hour-glass shape
7. Their transmission does not require a biological  Cytostomal Fibril: support along each side of
vector. the cytosomal groove
8. Species living in the digestive tract and genitals. o Mobility: Stiff and rotary
a) Giardia lamblia
b) Trichomonas vaginalis Cyst
c) Trichomonas hominis
o Size: 6 to 10 u
Flagellate Protozoa of the Digestive and o Shape: lemon-shaped, ovoid
o Nucleus: one
Urogenital Tract (Intestinal Flagellates) o Cytoplasm: remnants of flagella, kinetosomes and
Groups of parasite with medical and public health cytosomal groove (hour-glass shape); hyaline
importance: anterior nipple
 Chilomastix mesnili (non-pathogenic) o Fairly active with progressive movement in
 Dientamoeba fragilis (non-pathogenic) freshly evacuated stools and sluggish in
 Giardia lamblia (pathogenic) older stools
 Trichomonas hominis (non-pathogenic)
 Trichomonaas tenax (non-pathogenic)
 Trichomonas vaginalis (pathogenic)
 Retortamonas intestinalis (non-pathogenic)
 Enteromonas hominis (non-pathogenic)

1. Chilomastix mesnili
o Common Name: none
o Geographical Distribution: cosmopolitan
o Pathogenesis: non-pathogenic
o Habitat: colon
o Intermediate Host: none
o Reservoir Host: none
o Infected Form: mature cyst
o Mode of Infection: ingestion
o Laboratory Identification: direct fecal smear (wet
and stained)
o Specimen Source: feces

Trophozoite

o Size: 6 to 24 u Notes:
o Shape: pyriform; asymmetrical with longitudinal
 Synonyms:
spiral torsion
 Cercomonas hominis var. A – by Davane
o Nucleus: one relatively big large nucleus to
(1854)
cytoplasm ration; usually found at the anterior
 Chylomastix hominis by Von Prowazek &
portion of the organism by the cytoplasmic
Werner (1914)
membrane
 Discovered by Davaine (1854)
o Cytoplasm:
shacklen
 11
 Accurately described by Wenyon (1910) Notes:
 Named by Alexeieff into C. mesnili (1912)
o Discovered by Wenyon (1909)
 Prevalent in warm climates
o Discovered by Pepps & Dobell (1918)
 Stain used: Iodine, Giemsa, Mayer’s hematoxylin
o Characterized by its minute size
2. Dientamoeba fragilis o Formerly regarded as amoeba
o Common Name: none o Now classified as an amoeba-like flagellates
o Geographical Distribution: Cosmopolitan o Resembles Trichomonas without a flagellum
o Pathogenesis: non-pathogenic o Stain used: Giemsa, Trichrome, Iron hematoxylin
o Habitat: lumen of the caecum & upper colon o Can be seen in the eggs of E. vermicularis
o Intermediate Host: none
3. Giardia lamblia
o Reservoir Host: none
o Common Name: none
o Infected Form: mature trophozoites
o Geographical Distribution: Cosmopolitan, pocket of
o Mode of Infection: ingestion
Colorado
o Laboratory Identification: direct fecal smear (wet
o Pathogenesis: Giardiasis
and stained)
o Serological Diagnosis: Agglutination Test,
o Specimen Source: Feces
Fluorescent Antibody, Elisa
Trophozoites o Habitat: small intestine
o Intermediate Host: none
o Similar to active amoeba trophozoite o Infected Form: mature, quadrinucleated cyst
o Size: small; 3 – 22 um; narrower size: 5 – 12 um o Mode of Infection: Ingestion, sexual contact
o Shape: rounded but also elongated, sometimes o Laboratory Identification: Fecalysis (wet and
pointed at one end or racket shaped stained smear)
o Nucleus: can be mononucleated or binucleated, o Specimen Source: Feces, Duodenal Aspirates
rosette-shaped; has large central chromatin
karyosome with 4 (tetrad-like) discrete granules Trophozoite
o Cytoplasm: may contain food vacuoles with
o Size: 9 to 20 u
bacteria, flagella extends from the cell wall and
o Shape: pear-shaped; sucking disc; “Wry little face”
resembles like pseudopods
 Dorsal Surface: Convex
o Mobility: actively motile with progressive
 Ventral Surface: Concave
movement
o Nucleus: two
Cyst o Cytoplasm:
 Flagella: 8
o No cyst stage has been identified  Anterior: 4
 Ventral: 2
 Caudal: 2
 Kinetosomes: give rise to the flagella; located
between the anterior portion of the nuclei
 Axonemes: interior portion of the flagella;
transverse the cytoplasm before emerging:
the two causal axonemes divide the body
longitudinally into halves
 Medium Bodies:
 large curved; dark-stained
 function: unknown; support or energy
production
 previous ideology: parabasal bodies:,
kinetoplasts or chromatoid bodies

shacklen
 12
 axostyles: there are none; what was  Resistant to proteases
believed to be axostyles are structures  May have a function in parasite survival
formed by the axonemes of the  They change during excystation and encystation
ventral flagella and the associated (antigenic variation)
groups of microtubules  Manifestations:
o Mobility: like a falling leaf  50% asymptomatic
 Acute Cases:
Cyst  Cramping abdominal pain with diarrhea
o Size: 8 to 14 u  Excessive flatus with hydrogen sulfide odor
o Shape: ovoid to ellipsoidal (rotten eggs)
o Nucleus: 2 to 4 u  Abdominal bloating, nausea, anorexia
o Cytoplasm: Remnants of flagella; kinetosomes,  Chronic Infection:
axonemes, and median bodies; cytoplasm is  Steatorrhea, greasy, frothy stools that
float
 Epidemiology:
 Infective dose: as few as 10 cysts
 Prevalence associated with poor environmental
sanitation
 Worldwide distribution
 High among the institutionalized
 Higher prevalence attributed to homosexual oro-
anal practices (Gay bowel syndrome)
 Possibly zoonotic: Cysts also in animals
 Outbreaks almost exclusively water-borne
 Can also be transmitted through fecally
contaminated food
 Diagnosis:
 Demo of trophozoites and/or cysts in stool
 Falling leaf motility in DFS
 3 exams on alternate days
 Duodenojejunal aspiration or biopsy
 Enterotest for trophozoites
 Antigen detection tests and IF tests
 Immunochromatographic assays for antigen
detached from the cyst wall  Direct FAT
o Pathogenesis: Giardiasis  Treatment:
 Oral metronidazole 250 mg TID for 5 – 10 days
(15 mg/kg in 3 divided doses)
Giardiasis  Tinidazole
 The symptoms probably result from  Furazolidone
 Inflammation of the mucosal cells of the small  Others: quinacrine and paromomycin
intestine  Prevention and Control:
 Cause alterations such as:  Proper or sanitary disposal of excreta
 Villous flattening  No to night soil
 Crypt hypertrophy  Consider zoonotic potential in control plans
 Inflammation results in an increased turnover rate of
Notes:
the intestinal mucosal epithelium
 Additional mechanisms:
 Variant-specific surface proteins (VSPs)
shacklen
 13
o Discovered by Leeuwenhoek (1681)
o Recognized by Lambl & named it Cercomonas
intestinales (1859)
o Named by Stiles into G. lamblia (1915)
o Causes “Beaver Fever”
o Known to cause epidemic and endemic diarrhea
o Main protozoal pathogen in Traveler’s diarrhea

4. Trichomonas hominis
o Common Name: none
o Geographical Distribution: cosmopolitan
o Pathogenesis: non-pathogenic
o Habitat: cecal area of large intestines
o Intermediate Host: none
o Reservoir Host: none
o Infected Form: mature trophozoites
o Laboratory Identification: direct fecal smear (wet
and stained), serological tests
o Specimen Source: feces

Trophozoites

o Size: 5 – 14 um, average size: 7 – 8 length by 7 – 10 5. Trichomonas tenax

breadth um o Common Name: none
o Shape: pyriform o Geographical Distribution: cosmopolitan
o Nucleus: mononucleated (ovoidal in shape) with o Pathogenesis: non-pathogenic
scattered fine chromatin granules with conspicuous o Habitat: mouth
central karyosome o Intermediate Host: none
o Cytoplasm: 3 – 5 anterior free flagella with 1 o Reservoir Host: none
additional margin of the undulation membrane o Infected Form: mature trophozoites
with free falling posterior end, twinned o Mode of Infection: droplet spray from the mouth,
blepharoplasty, no parabasal body ingestion, & kissing
o Mobility: rapid forward movement with remarkable o Laboratory Identification: smears from tartar
pseudopodal extension of the cytoplasm between teeth (wet and stained)
o Specimen Source: tartar between teeth, gingival
Cysts scrapings

o No cyst stage has been identified. Trophozoites

Prevention: o Size: 5 – 12 um, average size: 6.5 – 7.5 length by

width
o Improvement in community situation
o Shape: pyriform in shape and slender than T.
o Personal hygiene
vaginalis
Notes: o Nucleus: mononucleated (ovoidal and vesicular)
with few chromatin granules with cytosome near
o First observed and described by Davaine (1854) the anterior end
o 2nd most common intestinal flagellates next to o Cytoplasm: 4 anterior free flagella of equal length
Giardia with 1 additional margin of the undulating
o Infection is more frequently found in warm climates membrane, lacks free trailing posterior end; has
o a.k.a. Pentatrichomonas hominis Costa of the same length of undulating membrane

shacklen
 14
with parabasal apparatus with cholesterol granules o Specimen Source: urine, vaginal, urethral, cervical
throughout the cytoplasm secretions and scrapings
o Mobility: slow forward progression
Trophozoites
Cyst
o Size: 7 – 23 um, average size: 5 – 12 length by width
o no cyst stage has been identified o Shape: pyriform in shape
o Nucleus: mononucleated (ovoidal and evenly
Prevention: distributed chromatin granules and located
anteriorly)
o Improvement of personal oral hygiene
o Cytoplasm: 4 anterior free flagella from simple stalk
Notes: with fifth flagellum embedded in a short undulation
membrane opposite the less conspicuous
o Observed by Muller in a culture of tartar from teeth cytosome, median axostyle extending posteriorly,
& named in Cercaria tenax (1773) with dark-stained siderophil granules
o Named by Dobell as T. tenax o Mobility: cork screw motility
o Quite resistant to temperature changes
o Can survive in drinking water for several hours Cyst

6. Trichomonas vaginalis o No cyst stage has been identified

o Common Name: none
Trichomoniasis
o Geographical Distribution: Cosmopolitan
 Higher prevalence among persons with multiple sexual
o Pathogenesis: Trichomoniasis
partners
o Habitat: genitals, urogenital tract, prostate
 Estimated to be found in the vaginas of about 25% of all
o Intermediate Host: none
o Reservoir Host: none females
o Infected form: mature trophozoites  In USA, it occurs in all ages, including infant females
o Mode of Infection: sexual intercourse  Highest infection rates in women ages 30 – 40
o Laboratory Identification: direct preparation (wet  Black women have an infection rate of about 30%,
and stained), culture, serological which is three times higher than that of white women
 Could also be possibly contracted from contaminated
towels, toilet seat, and bath water
 Incubation period:
 Typically 5 – 28 days
 May survive in a host for 2+ years
 Characteristic liquid vaginal secretions
 Greenish or yellow covering mucosa down to
urethral orifice, vestibular glands, and clitoris
 Very irritating vaginal secretions
 Purulent appearance initially
 Associated with increased incidence of postpartum
endometritis
 Speculum exam in 2% of cases reveals punctuate
hemorrhages of the cervix (strawberry cervix)
 In males, may be latent and essentially symptomless or
in most cases, irritating persistent and recurring
urethritis
 Diagnosis:
 Demonstration of trophozoites in the urine,
urethral secretions, vaginal and cervical

shacklen
 15
secretions and scrapings (swabs) in saline wet BLOOD FLAGELLATES
mounts
 Prostatic secretions and urine (males)  Trypanosoma brucei complex
 Giemsa, Papanicolau, Romanowsky, Acridine  Trypanosoma cruzi
orange
TISSUE FLAGELLATES
 Culture using Diamond’s Modified Medium,
Feinberg and Whittington Culture Medium  Leishmania braziliensis
 Treatment:  Leishmania donovani
 Metronidazole  Leishmania tropica
 Tinidazole
 Simultaneously given to sexual partners
 During treatment period, discourage sexual
intercourse
 Higher prevalence: multiple partners, greater
frequency of sexual intercourse, prostitutes
 Practice safe sex
 Proper diagnosis and treatment of asymptomatic
males
 Self-control, strict discipline and patience

Notes: Amastigote Promastigote Epimastigote Trypomasti-

(Leishmania) (Leptomonas) (Crithidia) gote
 First observed and named by Donné (1836) (Trypanosoma
)
 Does not survive well in external environment T. cruzi Intracellular Transitional In midgut of In feces of
 It can’t survive at the acidic vaginal pH of 3.5 – 4.0 in stage only triatomid triatomid bug,
macrophage bug transfer stage
of a healthy adult women s esp. in to man
 Organisms are established and multiplies when skin, liver,
smooth
vaginal condition becomes alkaline than usual muscles
 Female: L. Intracellular In midgut, Lacking Lacking
braziliensis in later in
 Vagina (lower genital tract) macrophage proboscis of
 The urethra (in chronic infection) s of skin & sand fly,
may be transfer stage
 Male: carried to to man
 Urethra mucocutane
ous
 Prostate glands junctions

BLOOD AND TISSUE FLAGELLATES HEMOFLAGELLATE

Order:  Trypanosomas
 T. cruzi
Trypanosomatida – single flagellulm  T. brucei gambiense
 T. brucei rhoesiense
Family:
General Characteristics
Trypanosomatidae – single flagellum which arises from
 Minute, actively motile, fusiform protozoa and
a nucleus and kinetoplast (composed of blepharoplasty
flattened from side to side
and parabasal (body)
 Conform various shapes
Genera:  Travel with a wavy spiral motion due to contractile
flagellum & undulating membrane
Trypanosomes and Leishmania  Reproduction is by binary longitudinal fission

shacklen
 16
 Occur in the blood of the majority of the vertebrate Notes:
animals
o A stercorarian trypanosome
 The life cycle involves intermediate host, which
o The metacyclic trypanosomes occupy a posterior
usually is an insect
position in the guy of the insect vector
Trypanosoma cruzi o Are passed out in the feces
o Common Name: none o Infection is therefore contamination
o Geographical Distribution: mostly in poor areas of o The causative agent of American Trypanosomiasis
Mexico, Central America, and South America, o Trypanosoma cruzi can also be transmitted through
Chronic Chagas disease is a major health problem in blood transfusion, organ transplantation,
many Latin American countries transplacently, and in laboratory accidents
o Pathogenesis: American Trypanosomiasis or Chagas o Mostly in poor rural areas of Mexico, Central
disease America, and South America. Chronic Chagas
o Habitat: Reticuloendothelial cells disease is a major health problem in many Latin
o Intermediate Host: triatomine/ reduviid bug/ American countries
kissing bug
Chagas’ Disease, American Trypanosomiasis
o Reservoir Host: man/other vertebrates
o Infected Form to Man: metacyclic trypomastigotes  Manifestations:
o Infected Form to Triatomine Bug: amastigote  Asymptomatic fever, anorexia,
o Mode of Infection: skin penetration lymphadenopathy, mild hepatosplenomegaly,
o Laboratory Identification: blood smears (thick and and myocarditis
thin), tissue biopsy, culture, serology  Romana’s sign (unilateral palpebral and
o Specimen Source: blood, tissue periocular swelling) may appear as a result of
conjunctival contamination with the vector’s
feces
 A nodular lesion or furuncle (chagoma) can
appear at the site of inoculation
 Symptomatic chronic form may not occur for
years or even decades after initial infection
 Include cardiomyopathy (the most serious
manifestation); pathologies of the digestive tract
such as megaesophagus and megacolon
 Weight loss
 Diagnosis:
 Microscopic Examination:
a) Of fresh anticoagulated blood, or its buffy
coat, for motile parasites, and
b) Of thin and thick blood smears stained
with Giemsa, for visualization of parasites
 Only in the first two months – can be seen
by direct exam or thick blood smears
 Isolation of the Agent:
a) Inoculation in culture with specialized
media (e.g. NNN, LIT);
b) Inoculation into mice; and
c) Xenodiagnosis – where uninfected
triatomine bugs are fed on the patient’s
blood, and their gut contents examined for
parasites 4 weeks later
 Treatment:
shacklen
 17
 No suitable drug available for treatment Sleeping Sickness Sickness
 Nifurtimox and Benznidazole are only partially Is found in foci in large areas Is much more limited, with
effective in acute disease of West and Central Africa the species found in East
and Southeast Africa
 Prevention:
Both are salivation trypanosomes
 Control of the vector by application of effective Vector tsetse fly (Glossina Vector tsetse fly (Glossina
insecticides to the walls and thatched roof of the palpalis) morsitans)
dwellings
 Proper information, education, and
communication among communitites Difference Between T. brucei and T. cruzi
 Community sanitation
T. brucei T. cruzi
 Blood screening for transfusion in endemic area
Slender Forms Long and thin, Has a single form
about 29 um long (monomorphic),
Notes:
with free about 20 um in
flagellum length and curved
 Discovered by Carlos Chagas in Brazil (1909)
(C-shaped)
 Most commonly transmitting insects:
 Panstrongylus megistus
 Triatoma infestans
 Rhodnius prolixus
 In stained specimen, Trypomastigotes appear in C,
U, or S-shaped

Trypanosoma brucei Complex

o Comprised of:
 T. brucei gambiense – causes Gambian or
West African Sleeping Sickness (West and
Central Africa), chronic form
 T. brucei rhodesiense – causes Rhodesian
or East African Sleeping Sickness (East &
South Africa), acute form
o Common Name: none
o Geographical Distribution: “Tsetse Belt of Africa”,
2/3 of African Continent
o Pathogenesis: African Trypanosomiasis Sleeping Sickness
o Habitat:  3 Stages of Infection:
 Acute: Reticular tissues of lymph and  A trypanosomal chancre can develop on
spleen the site of inoculation
 Chronic: CNS  Hemolymphatic stage with symptoms that
o Intermediate Host: Tsetse Fly include fever, lymphadenopathy, and
o Reservoir Host: Man/Other vertebrates pruritus
o Infected Form to Man: Metacyclic Trypomastigotes  Meningoencephalitic stage, invasion of the
o Infected Form to Tsetse Fly: Typical central nervous system can cause
Trypomastigotes headaches, somnolence, abnormal
o Laboratory Identification: Blood Smear (thick and behavior, and lead to loss of consciousness
thin), Tissue Biopsy, Culture, Serology and coma
o Specimen Source: blood, tissue  The course of infection is much more acute with T.
o General Characteristics: b. rhodesiense than T. b. gambiense
 Winterbottom’s sign: frequently in T. brucei
T. b. gambiense T. b. rhodesiense
gambiensi, the posterior cervical lymph nodes are
Causes West African Causes East African Sleeping
shacklen
 18
enlarged, non-tender and have the consistency of TISSUE FLAGELLATES
ripe plums  Leishmania species
 Evasion of immune response due to antigenic  L. tropica – causes cutaneous
variation leishmaniasis
 Only the epimastigote and trypomastigote forms  L. braziliensis – causes mucocutaneous
are exhibited by T. brucei complex leishmaniasis
 Diagnosis:  L. donovani – causes visceral leishmaniasis
 Demonstrating trypanosomes by
microscopic examination of chancre fluid, General Characteristics
lymph node aspirates, blood, bone  Size is usually small and oval intracellular organism
marrow, or in the late stages of infection, (2 – 5 u by 1 – 3 u)
cerebrospinal fluid  Amastigotes are found within phagocytic vacuoles
 A wet preparation should be examined for of macrophages and other mononuclear
the motile trypanosomes and in addition a phagocytes
smear should be fixed, stained with  Promastigotes are equipped with a long delicate
Giemsa (or Field), and examined anterior flagellum of pyriform to a longer, slender
 Concentration techniques can be used spindle shape
prior to microscopic examination  Reproduction is by longitudinal binary fission
 For blood samples, these include
Leishmania species
centrifugation followed by examination of
o Common Name: none
the buffy coat;mini-anion
o Geographical Distribution: endemic in many parts
exchange/centrifugation and the
of Asia, South America
quantitative buffy coat (QBC) technique
o Pathogenesis: Leishmaniasis
 Isolation of the parasite by inoculation of
o Habitat:
rats or mice is a sensitive method, but its
 Acute: L. tropica – lymphoid tissue of the
use is limited to T. b. rhodesiense
skin
 Antibody detection has sensitivity and
 L. donovani – visceral organs
specificity that are too variable for clinical
 L. brasiliensis – skin and mucous
decisions
membrane
 Thick and thin blood films are made and
o Intermediate Host: Sand fly
stained with Field’s stain and examined as
o Reservoir Host: man/other vertebrates
for malaria parasites
o Infected Form to Man: Promastigote
 Treatment:
o Infected form to Sand Fly: Amastigote
 Pentamidine and suramin during
o Mode of Infection: Bite of Sand Fly
lymphatic stage
o Laboratory Identification: Tissue Biopsy, Culture,
 Melarsoprol or Tryparsamide for late stage
Serology
with CNS involvement o Specimen Source: Bone marrow, spleen, lymph
 Eflornithine – for early or late stages of node
Gambian sleeping sickness
 Prevention: Notes:
 Control of the vector by application of
effective insecticides to the walls and  Is endemic in many parts of Africa, Asia, and South
thatched roofs of the dwellings America. It is transmitted by Phlebotomus species,
 Proper information, education, and sandfly
communication among communities  Are mainly parasites of man and other animals,
 Community sanitation especially dogs and rodents
 Blood screening for transfusion in endemic  Causing three types of diseases (i.e. visceral
area leishmaniasis, cutaneous leishmaniasis,
mucocutaneous leishmaniasis)
shacklen
 19
 These are all debilitating and disfiguring diseases  Natural reservoir host
which occur throughout the Old and New World  Domesticated and wild animals
 Parasites are unusual in that they live entirely  Habitat of the organism:
within the cells of the reticuloendothelial cells  REC of the viscera esp. liver, spleen, bone
 They have become perfectly adapted as the marrow, intestinal mucosa
proteolytic enzymes which attack other foreign  Maybe found in the endothelial cells of the
bodies in the blood stream but do not destroy kidney, suprarenal capsules, lungs,
them. meninges, and CSF
 Are also seen in macrophages in the
L. braziliensis L. donovani L. tropica intestinal wall and has been found in
Disease Mucocutaneous Human Cutaneous feces, urine, blood, and nasal secretions
Leishmaniasis Visceral Leishmaniasis
(ML) Leishmaniasis (CL)  Diagnostic basis
(VL)  Amastigote
Common Espundia, Uta, Kala-azar, Tropical Sore,
 Spherical in shape
Name of the Chiclero Ulcer Black Disease, Aleppo or
Disease Dumdum Baghdad Boil  Elongated forms are slender and
Fever torpedo like
Distribution Brazil, Eastern India, Mediterranea
Peru, Bolivia Bangladesh, n Basin,  Disease association
Nepal Afghanistan  Kala-azar
Manifestation Lesions in Dum-dum Cutaneous
mucocutaneous fever with lesions that  Visceral
junction of the enlarged appears like  Dumdum fever
pharynx, result spleen and volcano,
to deformity of liver, some raised edge  Death fever
the nose and develop post and central  Tropical splenomegaly
mouth kala-azar crater, have
dermal swollen glands  Prevention
leishmaniasis near the  Protection against sand flies
Coexist with source
HIV  Avoidance of contact with infection
Other Species L. brazilensis L. donovani L. tropica  Health education
complex infantum: major and L.
VL in Old aethiopica:  Vaccination
World Old World CL
L. donovani L. Mexicana:
chagasi: VL in New World CL
New World AMOEBA
Vector Sandfly Sandfly Sandfly
(Phlebotomus (Phlebotomus (Phlebotomus Classification
spp.) spp.) spp.)
Subkingdom: Protozoa
Diagnosis Tissue biopsy Microscopy Slit skin smear,
from the lesion, from tissue PCR,
Phylum: Sarcomastigophora
PCR, biopsy, Quantitative Subphylum: Sarcodina
Quantitative culture using Buffy coat and Superclass: Rhizopoda Pseudopodia, Holozoic
buffy coat and NNN or smear
smear Schneider’s, Order: Amoebidae
Drosophilia, Family: Endamoebidae
Serodiagnosis
, Quantitative  All are strictly parasitic, small organism, lack
Buffy coat the contractile vacuoles, binary fission, most
and smear
Treatment Stibogluconate Miltefosine Meglumine will undergo encystations
and antimonite Genus: Entamoeba, Endolimax, Iodamoeba
Pentamidine and
(Resistant Stibogluconate
 Distinguished by their nuclear structure
Cases) (injectable)
Entamoeba
 Small karyosome near or at the center of the
 Has two stages of development: nucleus
 Amastigote – vertebrate host  Peripheral chromatin granules line the nuclear
 Promastigote – invertebrate host membrane
shacklen
 20
 
th
Delicate achromatic threads connect the 4 category would include E. gingivalis
karyosome to the nuclear membrane  Natural parasites of the alimentary tract of man,
monkeys, many species of vertebrate and
Endolimax invertebrate hosts except E. moshkovskii
 Relatively large karyosome of irregular shape  Inhabit the large intestine of their vertebrate hosts
 Several achromatic thread connecting the except E. gingivalis and E. bovis
karyosome to a delicate nuclear membrane  Exclusive lumen dwellers except E. histolytica and E.
 Thin layer of peripheral chromatin which is invadens
inconspicuous
Entamoeba gingivalis
Iodamoeba o Atrial amoeba
 Large karyosome rich in chromatin o A.k.a. Amoeba gingivalis, Amoeba buccalis,
 Surrounded by a single layer of periendosomal Entamoeba buccalis
granules; attached to the karyosome and o Cosmopolitan distribution
nuclear membrane by radiating achromatic o 1st parasitic amoeba to man to be described
threads o Only the trophozoite stage is known

Species: Trophozoite
 Entamoeba: E. histolytica, E. coli, E. gingivalis,
E. dispar, E. hartmanni o 5 – 35 um (10 – 20 um) in size
 Iodamoeba: Iodamoeva buetschlii o Exhibits a definite zone of demarcation between
the clear ectoplasm and the granular endoplasm
Parasite Amoeba Infecting Man are Divided: o Multiple pseudopodia which may at one time be
A. Non-pathogenic long and lobose; at another time, short and blunt
 Mouth Amoeba (E. gingivalis) o Endoplasm with numerous food vacuoles
 Intestinal Amoeba (E. coli, E. nana, I. containing phagocytosed and partly digested
buetschlii, E. hartmanni, E. dispar) leukocytes and epithelial cells and at times bacteria
B. Pathogenic and spirilla, rarely RBC
 Intestinal Amoeba (E. histolytica) o Nearly spherical nucleus with distinct nuclear
membrane lined with closely packed chromatin
Major Stages in Its Life Cycle granules
o Near the center is a moderately small well-defined
Cyst
karyosome with delicate achromatic threads
 Only cysts contain chromatoidal bars, glycogen
extending to the nuclear membrane
vacuoles
 Most will have smooth and rounded walls
 More than 1 nucleus

Trophozoite
 Only trophozoites contain bacteria and food
particles
 Contain ingested RBC
 Show motility
 Most will be irregular in shape and uninuclear

Entamoeba

 Most species fall into 3 groups according to the

number of nuclei in the mature cyst
 1 – E. polecki
 4 – E. histolytica
 8 – E. coli
shacklen
 21
 Habitat:  Moderately large, eccentrically located
 Mouth; often in pyorrheal pockets karyosome
between teeth and gums and tonsilar
crypts Cyst
 Also thrives in apparently hygienic mouth o Size: 10 – 33 um (20 um)
or dental plates o Spherical in shape with definite cystic wall
 Mode of Transmission: o Mature:
 Via droplet spray from the mouth of an  8 nuclei, rarely 16 or 32
infected individual to another  No cytoplasmic inclusions
 Diagnosis:  Eccentrically located karyosome
 Demo of trophozoite in material or o Young:
scrapings removed from the gingival  1 – 4 nuclei
margin of the gums
 Dense glycogen mass lying within a vacuole
 From between teeth or dentures with diffuse borders
 From the soft tartar of the teeth  Chromatoidal bars are seen as spicules or
 Prevention: irregular masses of hematoxylin material
 Proper care of teeth and gums (broomlike or rods with splintered ends)

Entamoeba coli
o A.k.a. Amoeba coli, Endamoeba hominis, Loschia
coli, Councilmania lafleuri
o Distribution is worldwide
o Prevalent in populations native to warm climates,
likewise commonly found in some groups even in
cold climates
o Life cycle has 5 stages: cyst, metacystic trophozoite,
trophozoite, and precyst

Trophozoite

o Size: 15 – 50 um (20 – 30 um)

o NSS preparation:
 Living trophozoite is colorless
 Cytoplasm is viscous in which the ectoplasm
is usually difficult to distinguish from the
endoplasm
o Normal saline solution (NSS)
 Nucleus is not easily or usually visualized
Life Cycle of Entamoeba Coli
 Movement is typically sluggish, rarely
progressive with broad, short pseudopodia Mature Cyst  Ingested  Stomach  Small Intestine 
o Iron Hematoxylin (IH) EXCYSTATION  8 nucleated mass escapes  METACYST 
 Condensed, thickened, rounded mass with cytoplasmic division  8 metacystic trophozoite  large
relatively nongranular ectoplasmic rim and a intestine  feed and grow  MATURE TROPHOZOITE 
densely granular endoplasm
binary fission  unfavorable condition  ENCYSTATION
 Endoplasm described as having
starts  undigested food extruded out  assume a
“honeycomb” appearance or dirty-looking
spherical shape  PRECYST  secrete a tough cystic wall 
 Spherical nucleus with relatively thick
encystation is accomplished  UNINUCLEATE CYST 
nuclear membrane lined with plaques of
BINUCLEATE CYST QUADRINUCLEATE CYST 
coarse chromatin granules
OCTANUCLEATE CYST  passed out with feces
shacklen
 22
 Habitat: lumen of the large intestine  Ill-defined glycogen mass
 Mode of Transmission:  One to few small, slightly curved
 Ingestion of food and drinks contaminated chromatoidal bodies
with mature cyst o Mature Cyst
 Feces soiled fingers or on other objects  4 nuclei, rarely 8
with mature cyst
 Higher incidence of infection in tropical  Habitat: lumen of the large intestine
countries and in cooler climates with  Mode of Transmission: ingestion of viable mature
primitive hygiene and sanitation cysts in polluted water, food, drinks from
 Diagnosis: contaminated objects
 Stool Exam:  E. nana cysts are more susceptible to dessication
 Diarrheic/Dysenteric/Liquid – and putrefaction than E. coli cysts.
trophozoite  Increased prevalence in warm, moist climates and
 Semi-formed – trophozoites and on other areas where there is low standard of
cyst personal hygiene
 Well-formed – cyst  Decreased prevalence in most temperate climates
 Prevention: and in regions in which hygiene and sanitary
 Better personal hygiene and sanitary of conditions are good
human excreta  Diagnosis:
 Stool Exam:
Endolimax nana 1. Direct/Stained
o Called as Dwarf Intestinal Slug 2. Typical ovoidal cysts of E. nana in
o A.k.a. Entamoeba nana, Endolimax intestinalis stained fecal films are easily
o Cosmopolitan distribution diagnosed
o As prevalent as in most populations as E. coli 3. Round cysts and living
o Same stages and life cycle as E. coli trophozoites may be difficult to
differentiate from the small stains
Trophozoite
of E. histolytica
o 6 – 15 um  Prevention:
o Delicately granular and vacuolated cytoplasm with  Control can be effective through personal
a narrow rim of clear ectoplasm cleanliness and community sanitation
o Projects short, blunt, hyaline pseudopodia
o IH preparation: Iodamoeba buetschlii
 Food vacuoles are seen to contain o Called as Iodine Cyst of Wenyon
o A.k.a. Entamoeba williamsi, Entamoeba buetschlii,
bacteria, vegetable cells and crystals
Endolimax williamsi
 Minute spherical or subspherical nucleus
o Worldwide distribution
with conspicuous irregular karyosome
o Ordinarily much less common than E. coli or E. nana
which may be centrally or eccentrically
o Same stages and life cycle as E. coli
located
 Achromatic strands extend from the Trophozoites
karyosome to the nuclear membrane
 Marginal chromatin is a thin layer o Small to medium size (6 – 25 um)
o Short, blunt, hyaline pseudopodia
Cyst  Fairly active with progressive movement in
freshly evacuated stools and sluggish in
o Oval or round
older stools
o 5 – 14 um
o Ectoplasm is clear, usually not well differentiated
o Immature cyst
from the denser endoplasm that contains coarse
 Contains 1 – 2 nuclei

shacklen
 23
and fine granules and has bacteria, yeast cells and o Pathogenic amoeba of man causing amoebiasis,
debris in food vacuoles amoebic dysentery, amoebic hepatitis or liver
o Nucleus: abscess
 Can be observed in both living and stained o A.k.a. Amoeba coli, Entamoeba dysenteriae,
specimens Entamoeba tetragena, Entamoeba dispar, Amoeba
 Provided with a densely chromatic dysenteriae, Endamoeba histolytica, Endamoeba
karyosome which has a diameter half the dysenteriae
nucleus o Worldwide distribution with high incidence in the
o IH preparation tropics and subtropics
 Karyosome is observed to be a large mass o 5 stages in its life cycle: cyst, metacyst, metacystic
which may be centrally placed or trophozoite/amoebulae, trophozoite, precyst
somewhat eccentric
Trophozoite
 The karyosome may appear to have a thin
unstained “halo” around it and is o Invasive, growing and feeding stage
surrounded by lightly staining o Living trophozoite
periendosomal granules which are  10 – 60 um in size
connected by fine fibrils that extend to the  Exhibits remarkable locomotion in freshly
nuclear membrane prepared passed dysenteric or diarrheic
stools
Cyst
 Cytoplasm has a ground glass appearance
 Most conspicuous feature is a large vacuole that is and is differentiated into a clear outer
densely packed with glycogen and is distinctly ectoplasm and inner finely granular
outlined as an ovoid, polygonal or broadly uniform endoplasm in which food vacuoles
mass that stains golden brown with iodine but is containing RBCs maybe observed
devoid of content in fixed IH preparation  Nucleus can be occasionally seen in the
center of the endoplasm
 Habitat: lumen of the large intestine with principal  IH Preparation
site: probably the cecum  Nucleus is spherical
 Trophozoite feeds on enteric bacteria  Contains a small distinct by an
 Mode of Transmission: unstained halo and anchored by
 Same as other amoebae – ingestion of numerous delicate, radiating
mature cyst achromatic fibrils to the inner
 Infection is much less common than E. coli surface of the nuclear membrane
and E. nana  Gives the nucleus the appearance
 Diagnosis: of a “spoke of a wheel” or “bull’s
 Stool Exam: eye”
 In fresh iodine stained  Lining the nuclear membrane is a
preparation, specific diagnosis rim of chromatin that is regularly
can usually be made on the type arranged in small round granules
of glycogen vacuole but maybe aggregated into large
 In IH, nuclear structure and the plaquelike masses
clean cut empty glycogen vacuole
Cyst
are species diagnostic
 Prevention: o 10 – 20 um (12 – 13 um)
 Better personal hygiene and community o Spherical, maybe subspherical or ovoidal
sanitation o Mature:
 4 nuclei with centrally located karyosome,
Entamoeba histolytica
rarely 8 nuclei
o Tissue invading amoeba
shacklen
 24
 No cytoplasmic inclusions o Relatively difficult to distinguish from E. histolytica
o Young: but can be done through culture and biochemical
 1 – 2 nuclei methods
 Glycogen mass with hazy margins
 Chromatoidal bodies which are long or
short rods with rounded eggs (cigar or
sausage-shaped)
 Recent evidence shows that there are 2
significantly different sizes for strains
1. Large race
 Average cyst diameter is
>10 um
 Generally virulent
2. Small race
 Cyst: 5- 9 um size;
trophozoite: 12 – 15 um
 Commensal
nonpathogenic; do not
normally invade tissue

Entamoeba hartmanni
o Life cycle, general morphology, and overall
appearance are identical to E. histolytica with the
exception of size
o Considered as a separate species

Trophozoite
Life Cycle:
o Do not ingest RBC
o Motility is less vigorous than E. histolytica Cyst  ingested  stomach  duodenum  EXCYSTATION
o Nucleus is E. coli-like in character of its chromatin  4 nucleated METACYST escapes out of cyst wall 
and karyosome cytoplasmic division  4 METACYSTIC TROPHOZOITE or
AMOEBULAE  cecum  colonize, feed and grow 
Cyst
MATURE TROPHOZOITE  binary fission  unfavorable
o Glycogen mass condition  ENCYSTATION starts  undigested food
o Several to numerous chromatoidal bars that are extruded out  rounds up  PRECYST  secrete cystic wall
short with tapered ends (rice grain-shaped) or thin  UNINUCLEATED CYST  BINUCLEATE CYST 
and bar-like QUADRINUCLEATED CYST  passed out with feces
o Various reports indicate that strains of E.
histolytica, differing in pathogenicity, can be  Habitat: cecum; make contact with mucosa or become
distinguished from the nonpathogenic ones by lodged in the glandular crypts
isoenzyme analysis  Mode of Transmission:
o E. histolytica has now been divided into 2 species,  Ingestion of food and drinks contaminated with
the other one is the noninvasive E. dispar feces containing the infective stage
 Contamination may be through
Entamoeba dispar 1. Polluted water supply
o Although considered as nonpathogenic, it is  Cyst may remain viable in damp soil
evidently capable of producing intestinal lesions in for at least 8 days, in other moist
experimental animals cool conditions

shacklen
 25
 For over 12 days, and in water for 9 a. Diarrheic/dysenteric/watery stool –
– 30 days; water at 4 for 3 trophozoite
months  Nonfecal material – blood and
2. Unclean handling of infected individuals mucus
(hands, clothing, fomites)  Should be examined as soon as
3. Dropping of flies, and other insects possible preferably within 30
 Cysts are unchanged in the intestine minutes after voiding
of flies and cockroaches and remain  Wet mounts using NSS
viable in feces and vomitus for 48  Preserve parasites if one cannot
hrs examine directly or immediately
4. Use of human excreta in vegetable  Fix with
gardens i. MIF (Merthiolate Iodine
5. Gross carelessness in personal hygiene in Formaldehyde Fixative) or
children’s asylums, mental hospitals, ii. PVA (Polyvinyl Alcohol) or
prisons and other places Schaudinn’s fixative or
 Sexual transmitted disease Permanent Staining
 Human carriers or cyst passers – important  Permanent mounts may be stained
source of infection with IH or Trichrome Stain
 Pathogenecity: Intestinal Amoebiasis b. Solid/Formed Stool – cyst
 Any part of feces but should include
Intestinal Amoebiasis
a portion or any fleck of mucous
 In the intestines
adherent to feces or blood
 May remain localized in the colon and multiply in
 Wet mounts using NSS or Iodine
the crypts (attachment is mediated by an amoebal
 If cysts are two few to be seen, do
galactose or N-acetyl-d-galactosamine adherence
concentration (ZnSO4 centrifugal
lectins)
flotation method); no trophozoite
 Ingest foodstuffs such as starch granules
will be seen because they cannot
 Probably utilize mucous secretions as food
withstand the chemical
 Metabolize anaerobically with certain enteric 2. Saline-purged specimens
bacteria  Will provide material for (+) diagnosis
 Once they invade the tissue when routine fecal exam has been
 Invasive amoeba erode ulcers into the unrewarding
intestinal wall eventually reaching the  Sodium sulphate (Glauber’s salt) or
submucosa and underlying blood vessels; phosphosoda is preferred
they may travel with the blood to other  Following saline purgation, earlier fecal
sites of the body evaluations are discarded
 Organisms are following a dead end course; they
 Sedimented elements of mucus and
cannot leave the host and infect others and so nd rd
tissue cells from the 2 and 3 bowel
perish with their luckless benefactor
movements are pipetted onto the slide,
 They no longer depend on bacteria but obtain their place the coverslip and examine for
nourishment through absorption of dissolved tissue trophozoite
juices 3. Sigmoidoscopy material
 Diagnosis:  May be expressed from ulcers by means
1. S/E by Direct Smears and Stained Mounts of gentle pressure from long-handled
 3 or more specimens at 3 or 4 day curette or loop
interval gives more (+) because of the  1/3 of lesions are in the sigmoidorectal
random irregularity in the excretion of area
cyst  Look for typical lesions

shacklen
 26
 Scrapings or aspirates from the  Mixture of sloughed liver tissue
suspected sites of amoebic ulceration and blood or degenerated liver
may be obtained or punch biopsies cells, RBC, occasional leukocytes
secured  Trophozoite recovered in about
 Aspirated material should be examined 1/3 of cases; best obtained from
microscopically for motile trophozoites the wall of the abscesses
immediately 4. X-ray
 Punch biopsy: more satisfactory to fix,  Exhibit extent of damage
section and stain specimen before 5. Seroimmunologic Test
attempting to examine it  When direct microscopic
4. Culture examination fails to reveal the
 Used in the study of its metabolism and presence of E. histolytica – Ag or
pathogenicity, and in the production of Abs
antigens for serodiagnosis a. Complement Fixation
 Trophozoite or cyst from feces, material b. FAT (Fluorescent Ab Technique)
aspirated by sigmoidoscopy of Goldman
 Culture medium: c. Indirect Hemagglutination (IHA)
 Dibasic medium of Boeck and  Slightly more sensitive
Drbohlav (egg slant base with compared to GDP
isotonic overlay = Locke egg d. Gel Diffusion Precipitin (GDP)
serum (LES) e. Indirect Fluorescent Ab (IFA)
 Diamond’s medium TYI-S-33  Stool and urine
 May reveal the presence of E. histolytica  Satisfactory as screening
when microscopic examination have test
failed but they should never be used as  Not reliable and
a substitute for microscopic examination convenient conventional
method
Hepatic Amoebiasis and Other Extraintestinal Lesions f. Latex Agglutination (LA)
 Results when trophozoites enter the mesenteric g. Counter-current
venules and travel to the liver through the Immunoelectrophoresis (CIE)
hepatoportal system h. Enzyme-linked Immunosorbent
 The center of the abscess is filled with necrotic Assay (ELISA)
fluid, a median zone consisting of liver stroma and  With monoclonal Abs, it
the outer zone consisting of liver tissue being has been used
attacked by amoebae although it is bacterially experimentally to detect
sterile E. histolytica Ag in fecal
 Abscess may rupture pouring debris and organisms specimens
into the body cavity where they attack other i. DNA Hybridization Probe has also
organs: been used to identify E.
1. Determine or establish the presence of histolytica in stool samples.
intestinal amoebiasis
Basis Amoebic Dysentery Bacillary Dysentery
2. Clinical manifestations – increased WBC
Gross Appearance Gelatinous mixture of Mucopurulent mass
and liver function test blood, mucus, and streaked with blood
3. Aspiration of abscess – punch or needle feces
Amount Relatively copious Small
biopsy Odor Offensive (fishy) Inoffensive
 Characteristic chocolate coloured Color Bright red Dark red
(anchovy sauce) content of Reaction Acidic Alkaline
Ghost Cells None (WBC are intact) 95% degenerated
abscess ghost cells
Macrophages Rarely seen Present
RBC Clumped Never clumped,
shacklen
 27
discrete
Charcot-Leyden Present Absent
Crystals
Bacteria Numerous Nil to none
Pus cells Scanty Numerous

Free Living Amoeba

Order: Schizopyrenida
Family: Valkamphidae
Genus: Naegleria

N. fowleri = N. aerobia
o Cause of primary amoebic meningoencephalitis
(PAM)
o Amoebae proliferate rapidly in water as
temperature rises
o Flagellate (swimming form)
 Bears 2 long flagella at one end
 Elongated
o Amoeboid (trophozoite form)
 Diagnostic stage
 Usually has a single blunt lobopodium
o Nucleus
 Vesicular with large karyosome and has
Order: Shizopyrenida
peripheral granules
Family: Hartmannellidae
o Conspicuous contractile vacuoles
Genus: Acanthamoeba
o Food vacuoles
Several Species, e.g. A. culbertsoni
 Contain bacteria when free living
 Host cell debris when parasite A. culbertsoni
o Uninucleate cyst o Cannot tolerate water as hot as Naegleria can
o Meningoencephalitis
o Cause chronic infection of the skin or CNS in ICH,
agents of keratitis

shacklen
 28
Morphological Differences between C. Coccidia
Naegleria/Acanthamoeba and E. histolytica O. Haemosporida
G. Plasmodium
Naegleria/Acanthamoeba Entamoeba histolytica
Nucleolus large and distinct Nucleolus small and indistinct Malaria
Contractile vacuoles present Contractile vacuoles absent
Overview:
Single nucleus in cyst 4 nuclei in mature cyst
No glycogen and chromatoid Glycogen and chromatoid
bodies in cyst bodies present in cyst  Malaria is one of the most prevalent and
Mitochondria present Mitochondria absent debilitating diseases afflicting human
Cyst wall may have pores or Cyst wall has no pores  Worldwide prevalence is at approximately 489
ostioles
million cases, making malaria the most prevalent
human parasitic disease, with an annual death toll
Morphological Differences between Naegleria and
of 2 million
Acanthamoeba
 There are more than 50 species of Plasmodium, but
Naegleria Acanthamoeba only 4 species commonly cause malaria in humans:
Trophozoite with broad Trophozoite with filamentous P. vivax, P. falciparum, P. malariae, and P. ovale
pseudopods pseudopods (acanthopodia)  Species known to transmit malaria in the
Actively motile Sluggishly motile
Philippines:
Forms flagellate stage Does not form flagellate stage
Single-walled cysts Double-walled cysts o A. minimus var. flavirostris
Does not encyst in tissues May encyst in tissues o A. maculatus
o A. litoralis
o A. balabacensis
Blastocystis hominis
o A. mangyamus
o Amoeba-like protozoan that inhabits the large
 Mixed infections with 2 or more species have been
intestines
encountered in 0.5 – 9% of infected individuals
o May assume one of three forms:
 Multiple infections with 2 or more species may
1. Vacuolated
cause one batch of parasite to mature 24 hours
 Most commonly seen
before another thus resulting in daily febrile attacks
 A.k.a. central vacuolar form
 Areas in the Philippines where malaria is prevalent:
2. Amoeboid
most parts of Mindanao, Mindoro, Palawan, Luzon,
 With bizarre shapes
Samar, Leyte (some parts)
 Predominate in heavy infections
3. Granular Life Cycle Overview:
 Should be reported when  Life cycle of Plasmodium that infect humans
numerous (5 or more/hpf) includes 2 hosts:
1. The human host, and the
2. Insect vector, a female mosquito
belonging to the genus Anopheles
 All have cellular structure known as apical complex
which enable them to invade the host cell
 Life cycle involves “alternation of host”
 Reproduction cycle has both asexual (shizogony)
and sexual (sporogony)
 The infective form in humans is the slender,
elongated sporozoite

Morphology
PHYLUM APICOMPLEXA  Parasites maybe examined in:
Taxonomy  Stained or unstained smear
P. Apicomplexa  Thin Film
shacklen
 29
 Used to study the relationship of parasite  P. vivax = 8 – 24 (16)
to the invading RBC  P. ovale = 6 – 12 (8)
 Morphology is better defined  P. malariae = 6 – 12 (8)
 Thick Film = symmetrically arranged
 RBC is hemolyzed = referred to as rosette or daisy
 Parasites: appear smaller and less regular head formation
in outline  P. falciparum = 8 – 32 (16)
 Provides a better diagnostic tool for 3. Gametocyte
experienced workers especially when a. Microgametocyte
parasites are few  Male gametocyte
 Pale blue cytoplasm with diffuse chromatin
Stage mass lying in unstained oval area near its
center P. falciparum
1. Trophozoite
 Kidney bean-shaped with broadly round
a. Early or Ring Form
ends and diffuse chromatin
 Signet ring appearance is characteristic of
b. Macrogametocyte
this stage for all species
 Female gametocyte
 One red chromatin dot
 Deep blue cytoplasm with a dense mass of
 Thin, blue ring of cytoplasm
chromatin dot usually found in one side
 Has vacuole surrounded by the cytoplasm
(periphery) of gametocyte, P. falciparum
 Falciparum ring forms
 Typically crescent-shaped with sharply
 More delicate rounded or pointed ends: compact
 Usually has 2 chromatin dots, either chromatin near center of gametocyte
side by side
 Applique or accole form
b. Growing
 One red chromatin dot
 Blue cytoplasm become irregular in shape
(amoeboid) partially ___
 Contains malarial pigment
c. Mature
 Rounded in shape
 One chromatin dot
 Small vacuole
 Malarial pigment in cytoplasm
2. Schizont
a. Young
 2 chromatin dot
 Cytoplasm may be amoeboid or compact
b. Growing or Developing
 Has 3 or more chromatin dots
 Cytoplasm is similar to young schizont
 Malarial pigment in the cytoplasm
c. Mature
Life Cycle Detail
 Cytoplasm has divided according to the
number of chromatin dots  During feeding, the mosquito secretes sporozoite-
 Each chromatin dot surrounded by its own bearing saliva beneath the epidermis of human
cytoplasm is called merozoite victim, thus inoculating the sporozoites into blood
 Number of merozoites: stream
shacklen
 30
 About 24 – 48 hours later, the sporozoites appear nuclear segment to become a basal body, providing
in the parenchymal cells in the liver, initiating the the center from which the axoneme subsequently
exoerythrocytic schizogonic cycle or pre- arises
erythrocytic cycle  The nucleus with axoneme with small amount of
cytoplasm form a microgamete which detaches
Exoerythrocytic Shizogonic Cycle from the mass and swims to the microgametocyte
 Inside the liver cell, sporozoite develops into  During this period, the microgametocyte have
trophozoite, feeding on host cytoplasm with its developed into macrogamete which become
functional micropore penetrated by microgametocyte
 After 1 – 2 weeks, the nucleus of the trophozoite  The fusion of male and female pronuclei (syngamy)
undergoes multiple fission, producing thousands of produces a diploid zygote elongates into a motile
merozoites worm like ookinete
 These rupture from the host cell, enter blood  Ookinete penetrateds the gut wall of mosquito to
circulation and invade RBCs initiating the the area between the epithelium and the basal
erythrocytic schizogonic cycle lamina where it develops into a rounded oocyst
 Some sporozoites become dormant hypnozoites  Growth of the oocyst is in part due to the
proliferation of haploid cells called sporoblast,
Erythrocytic Shcizogonic Cycle
within oocyst
 Once in the RBC, merozoites assume early
 Sporoblast nuclei undergo numerous divisions,
trophozoite shape consisting of a ring of cytoplasm
producing thousands of sporozoites enclosed
and a dot-like nucleus in the signet ring stage.
within the sporoblast membranes
 These early trophozoites feed on host hemoglobin,
 As membranes rupture, sporozoites enter cavity of
grow to the mature trophozoite stage, then
oocyst
undergo multiple fission as schizonts, producing a
 Sporozoite-filled oocyst, themselves rupture
characteristic number of merozoites in each
releasing the sporozoites in the hemocoel
infected RBC
 Sporozoites are carried to the salivary ducts of the
 Merozoites eventually ruptures RBCs and each
insect and are ready to be injected into the next
merozoite is capable of infecting a new RBC
victim when another blood meal is taken
*only within red blood cells
 One of the 2 fates await these merozoites: Diagnosis
1. Become signet ring trophozoites and begin
schizogony anew 1. History
2. Differentiate into sexual stages, becoming 2. Laboratory Examination
male, microgametocyte, or female,  Microscopic examination of blood film
microgametocyte forms one of the important diagnostic
 Sexual phase occurs in female Anopheles mosquito procedures in malaria
and begins when the mosquito takes blood meal  Between time to collect the specimen for
that contains microgamtocyte and diagnosis is at the height of fever when
microgametocyte the parasites are most numerous
 Once the surrounding RBC material lyzed, the  If only ring forms are seen, repeat exam a
gametocyte are released into the lumen of the few hours earlier (usually after 6 hours) to
stomach arrive at a specific diagnosis as to the
 The microgametocytes undergo maturation process species
known as exflagellation  Difficulty in detecting malarial parasites
 Exflagellation may be encountered
 Nucleus undergoes three mitotic division,  Film taken after administration of
producing 6 – 8 nuclei that migrate to the antimalarial drugs
periphery of the gametocyte  Blood films are taken during apyrexial
 Accompanying the nuclear divisions are centriolar period of falciparum malaria
division following which one portion joins each
shacklen
 31
 Blood films are taken during 2 – 3 days in Determination of Parasitemia
all cases of primary infection Thick Smears

Making and Staining Blood Films  Two tally counters are required to count parasites
and leukocytes separately
 Preparing blood films is better demonstrated than  If after 200 leukocytes have been counted, 10 or
described more parasites have been identified, record the
 Obtaining blood by skin puncture results showing the number of parasites/200
leukocytes
Making a Thin Smear
 If after 200 leukocytes have been counted, 9 or less
Procedure:
parasites have been counted, continue counting
1. Tiny drop of blood films is secured near the end
until 500 leukocytes and record the number of
2. Get another slide (spreader) and place it at a 45
parasites/500 leukocytes
degrees angle
 In each case, the parasite count in relation to the
3. Bring the spreader slide backwards until it touches
leukocyte count can be converted to parasites/uL
the drop of blood
by the simple mathematical formula:
4. Wait for the blood to spread along the edge of the
spreader No. of Parasites X 8000 = parasites/uL
5. Push the spreader firmly and uniformly forward No. of Leukocytes
6. Let the film dry and stain
Thin Smear
Factors Which Control the Thickness of the Film
 Angle between spreader and the original slide  The % infected RBCs is determined by enumerating
 Speed in spreading the film the no. of infected RBC in relation to the number of
uninfected RBCs. A minimum of 500 RBCs total
 Best place to examine for malarial parasite near the should be counted.
tail where the RBC lie side by side (no overlapping)
No. of infected RBCs X 100 = % RBC Counted
 A negative report should not be given until the slide
Total No. of RBC Counted
has been searched for 30 minutes
Malarial Rapid Diagnostic Tests (RDTs)
Making A Thick Film
 Requires larger quantity of blood than thin film  Though microscopic examination is the established
1. Place a big drop of blood at the center of the slide diagnostic method, technical and personnel
2. Use the corner of the spreader slide to spread the requirements often cannot meet
drop of blood to cover 1 cm diameter
3. To estimate the thickness of the film, put the slide Methods
over a watch; if the figures are just visible, the right
 Immunochromatography – to detect Plasmodium
thickness is attained.
specific antigens in a finger-prick blood sample
4. Let dry and stain.
 Dipstick test (Parasight F-test)
 The hemoglobin of the RBC is removed in the
staining process rendering the film transparent. Antigens Being Targeted
 This destroys the RBC and distorts the parasites
making the species identification more difficult  Histadine-rich Protein II (Paracheck Pf test and Para
 4 – 5 minutes is usually ample time for microscopic HIT Test) – specific for P. falciparum
examination  Plasmodium LDH (pLDH)
 Distinguish between falciparum and non-
Stains for Malarial Smear falciparum
 Not between non-falciparum species
 Romanowsky
 Diamed OptiMal IT
 Wright’s
 Combined detection of HRP II with an
 Giemsa
undetermined “panmalarial” antigen
shacklen
 32
Plasmodium malariae (quartan malaria)
Plasmodium Plasmodium Plasmodium Plasmodium
vivax malariae ovale falciparum
Duration of 48 hours 72 hours 49 – 50 hours 36 – 48 hours  Parasites about 0.2% of older RBCs
Schizogony
Motility Active Trophozoite; Trophozoite; Trophozoite;
 Trophozoites accumulate pink staining Ziemann’s
amoeboid slightly slightly active dots
until about amoeboid amoeboid amoeboid
half grown  Hemozoin granules appear in the center or
Pigment Yellowish- Dark brown Dark brown’ Dark brown;
(hematin) brown; fine to black; coarse coarse
periphery of the schizont
granules and coarse granules granules  Trophozoite often appear as a band across the cell
minute rods granules
Stages found Trophozoites, Trophozoites, Trophozoites, Trophozoites,  Mature trophozoites resemble macrogametocytes
in peripheral schizonts, schizonts, schizonts, gametocytes
blood smear gametocytes gametocytes gametocytes
 Recrudescences as long as 52 years after the initial
Multiple Common Very rare Rare Very common infection
infection in
erythrocytes
Appearance Greatly Not enlarged; Slightly Normal size;
of infected enlarged; normal enlarged; greenish;
erythrocyte pale with red appearance outline oval to basophilic,
Schuffner’s with irregular with Maurer’s
dots Ziemann’s Schuffner’s clefts and dots
dots dots
Trophozoites Amoeboid; Small and Amoeboid; Very small and
(ring forms) small and large rings small and large rings
large rings with vacuole large rings with vacuole,
with vacuole and usually with vacuole commonly
and usually one with two
one chromatin chromatin
chromatin dot; also dots;
dot young band amoeboid
forms Plasmodium ovale
Segmented Fills enlarged Almost fills Fills Not usually
Schizonts RBC; 12 – 24 normal-sized approximately seen in
merozoites RBC; 6 – 12 ¾ of RBC; 6 – peripheral  James dots
irregularly merozoites 12 merozoites blood
arranged regularly around centric
around mass arranged or eccentric
of pigment around pigment mass
central
pigment mass
Gametocytes Round; fills Round; fills Round; fills ¾ Crescentric- or
RBC; RBC; of RBC kidney-shaped
chromatin chromatin undistributed chromatin
undistributed undistributed
in cytoplasm in cytoplasm

Plasmodium vivax (benign tertian malaria)

 Less than 1% of the total RBC population is

parasitized
 Predilection for immature RBCs (reticulocytes)
 Schuffner’s dots usually stain pink to red when
Plasmodium falciparum (malignant tertian malaria)
subjected to stains
 Hemozoin granules, by-products hemoglobin  Only ring trophozoites and gametocytes seen in
degradation by the parasite are prominent peripheral circulation, later stages trapped in
 The cytoplasm of the trophozoite stages is very capillaries of muscle and visceral organs
irregular and displays an active amoeboid  Plasma membranes of infected RBCs undergo
movement alteration causing them to adhere to the walls of
capillaries
 Infects RBCs of any age; about 10% of the total
RBCs
 Multiple infections of single RBCs are common
 Gametocytes are crescent shaped cells
 Hemozoin as well as Maurer’s dots (precipitates in
the cytoplasm of RBCs infected to P. falciparum,
shacklen
 33
tend to aggregate around the nuclear region of the idea that this species produced relapses like
gametocytes those produced by P. vivax and P. ovale
 But, it has been shown that the periodic increase in
numbers of parasites results from a residual
population persisting at very low levels in the blood
after inadequate or incomplete treatment of the
initial infection
 The situation may persist for as long as 53 years
before something triggers a parasite explosion with
accompanying disease manifestations
 This phenomenon is called recrudescence

Symptomalogy and Diagnosis

 Pathology in human malaria (P. falciparum) is

generally manifested in 2 basic forms: host
Relapse of Infection inflammatory reactions and anemia
 Victims of vivax or ovale malaria may suffer a  Host inflammatory reactions are initiated by the
relapse periodic rupture of infected RBCs, which release
 Originally, the relapse was thought only to be due malarial pigment such as hemozoin and parasitic
to populations of cryptozoites (pre-erythrocyte metabolic wastes
schizont) being maintained in the exoerythrocytic  These ruptures are accompanied by fever
cycle paroxysms that are usually synchronous except
 While one population progressed to the usual during the primary attack (correlated with the
erythrocytic phase, underwent schizogony and merozoites rupturing from RBCs)
released merozoites into the circulating blood  During cell rupturing, toxins are released which in
stream causing malaria, the other population turn cause macrophage cells to release tumor
maintained an ongoing exoerythrocyte cycle known necrosis factor (TNF); it’s TNF that actually induces
as para-erythrocytic cycle the fever
 Parasites in the hepatic stages of the cycle were  During the primary attack, synchrony may not be
thought to be protected from the host antibodies evident, since the infection may arise from several
until activated by some physiological change within populations of liver merozoites at different stages
the host that allowed them to erupt from the of development
hepatocytes, precipitating another bout of malaria  Macrophages, particularly those in the liver, bone
 A more recent view also recognizes the existence of marrow, and spleen, phagocytose released pigment
2 different populations of sporozoites  In extreme cases, the amount of pigment is so great
 Short prepatent sporozoites – upon entering the that it imparts a dark green, reddish brown hue to
human host, undergo the usual exoerythrocyte and the visceral organs such as the liver, spleen, and
erythrocytic phases of development and cause brain
malaria  With increased RBC destruction, accompanied by
 Long prepatent sporozoites or hypnozoites – the body’s inability to recycle iron bound in the
remain dormanit in the hepatocytes for an insolvable hemozoin, anemia develops
indefinite period
 TNF toxicity may also induce splenic removal of
 Some kind of physiological fluctuation activates unparasitized RBCs and inhibit bone marrow
them into exoerythrocytic and erythrocytic cycles production of new RBCs
and a relapse occur
 One pathological element unique to P. falciparum is
Recrudesence vascular obstruction
 Recurrence of malaria among victims infected by P.  Plasma membranes of RBCs infected with schizonts
malariae many years after apparent cure fostered develop electron dense “knobs” by which they

shacklen
 34
adhere to the endothelium of capillaries in visceral  Interestingly, the surface coat of the sporozoite
organs acts as a renewable “decoy” to the vertebrate
 As a consequence, the capillaries become host’s immune system, stimulating the production
obstructed, causing the affected organs to become of antibodies
anoxic  When the sporozoite is attacked and its “decoy”
 In terminal cases, blocked capillaries in the brain sloughs off, a replacement coat is synthesized and
(cerebral malaria) cause it to become swollen and its “decoy” effect continues
congested  This system provides the ideal protection for the
sporozoite which only spends a brief amount of
Black Water Fever time in the blood before it penetrates a liver cell as
 A condition known as black water fever often is protected from circulating antibodies
accompanied falciparum malaria infections  In endemic areas, premunition is the basis for
 It is characterized by massive lysis of RBCs and it protective immunity as long as low-level infection
provokes abnormally high levels of hemoglobin in persists; however, with complete cure, the victim
urine and blod regains susceptibility
 Fever, vomiting with blood, and jaundice also  Also, while nursing infants in endemic areas are
occurs protected through antibodies in their mother’s
 There is between 20 – 50% mortality rate, usually milk, they are at risk at the time of weaning
due to renal failure; probably due to renal anoxia  Also, P. falciparum can cross the placenta and cause
 The exact cause of this condition is uncertain infection on the fetus
 It may be a reaction to quinine, or it may result
from an autoimmune phenomenon in which Subclass Coccidia
hemolytic antibodies are produced in response to Suborder Eimeriina
chemotherapy  By the present grouping, Coccidia that cause
disease in man are species of the genera
Chemotherapy Cryptosporidium, Isospora, Sarcocystis and
Toxoplasma
 Malaria control requires effective treatment of the
disease in humans and continuous efforts to Family Eimeriidae
control mosquito populations Classification is based on:
 The first known antimalarial drug was quinine 1. Number of sporoblasts within oocyst
 The drug primarily destroys the schizogonic stages 2. Number of sporozoites in each sporocyst
of malaria
 The synthetic drug Atabrine dihydrochloride (circa Genus Eimeria
1936 – 36) proved useful against erythrocytic
 Mature oocyst contains 4 sporocysts, each has
stages and in suppressing clinical stages
4 sporozoites
 Since WWII, several synthetic drugs have been
used: chloroquine, amodiaquin, and primaquin Genus Isospora
 Chroquine is a weak base and it increases the pH of
the food vacuole which in turn prevents the  Mature oocyst contains 2 sporocysts, each has
digestion of hemoglobin 4 sporozoites
 Pyrimethamine used in combination with  The species of Eimeria in man are incompletely
sulfadoxine have been effective in inhibiting the substantiated. They are species (based on false
folic acid cycle of malarial parasites idea) parasites of man.

Immunity Genus Isospora

 Isospora belli is the only species parasitic to man
 In addition to chemotherapy research,  I. hominis is now classified with the Sarcosystidae
development of a protective vaccine against since it is now known that its life cycle differs
malaria is being pursued markedly from that of I. belli
shacklen
 35
Isospora belli microgamete  maturation of
o Disease produced: microgamete occurs in the nucleus of
 Isosporiasis, Intestinal Coccidiosis macrogamete occurs in the nucleus of
o Geographic Distribution: macrogamete in preparation for
 Although rare, the parasite have a wide fertilization  macrogamete – mature
distribution in warm climate gametocyte after fertilization (from each
o Morphology: microgametocyte, only 4 macrogamete is
 Oocyst measures 20 – 33 um by 10 – 19 developed)  from each
um microgametocyte form microgametes 
 Has elongate ovoid shape with a slightly fertilized macrogamete (zygote) secretes a
moderate constriction from one end giving cyst wall and become an oocyst  nucleus
the appearance of bottle with a short neck of oocyst divides to form 2 sporoblast 
 One end is narrower and the other is each sporoblast secretes a cystic wall and
rounded become sporocyst  nucleus of each
 Micropyle – found at the narrow end and sporocyst divides twice (2x) into 4
is sometimes visible; a minute opening daughter nuclei  cytoplasm divides into
inside the wall 8 sickle cell-shaped bodies (sporozoite) 
 Cyst wall is smooth, thin and colorless with schizogonic and partial sporogonic
2 layers development take place in the epithelial
 Unsegmented oocyst contains a spherical cells of the intestinal mucosa but the main
mass of granules with a nucleus visible as a part of the sporogonic development of I.
clear round area within a granular mass belli occurs outside the body of the host
 Mature oocyst has 2 sporocysts with 4
sporozoite and a residual sporocystic
material
 In freshly evacuated stool, the oocyst
usually contains only 1 sporoblast,
sometimes 2 may be present since full
maturation occurs in the past evacuated
stool in 48 hours
 Habitat: intestinal tract probably ileum and cecum
 Life Cycle:
 Mature oocyst ingested via contaminated
food and drinks  sporozoites released in
the small intestine  penetrate in the
cells of the intestinal villi (schizogony) 
forms a small ovoidal shape (trophozoite)
 trophozoite gradually enlarges until it
nearly fills the cells and become schizont
 multiple division give rise to merozoites
 merozoites* eventually develop into
male and female gametocyte
*merozoites – motile fusiform bodies
which an escape from the destroyed host
cell, invade other mucosal cells o the
intestine in which they become
trophozoites and repeat the cycle  Mode of Transmission:
 microgametocyte nucleus divides and  Ingestion of food and drinks contaminated
each nucleus develops a motile with mature oocsyst
shacklen
 36
 Accidental infection occurs in the  Invade every kind of mammalian cell
laboratory except non-nucleated erythrocyte
 Diagnosis  Found in tissues and body fluids or
 The way to establish diagnosis is by intracellularly
identification of the unsegmented oocyst 2. Tissue Cysts (with contain intracystic
in the freshly evacuated feces by direct organism called as bradyzoites)
examination of unstained and iodine  Single cyst may measure up to 200 um
stained preparation or by concentration diameter and may contain as many as
methods 300 organisms
 Alternative diagnostic methods include:  Develop within any organ but found
 Small intestine mucosal biopsy most often in brain, heart, retina,
 Examination or duodenal aspirate skeletal muslces
treatment 3. Oocyst (where sporozoites are formed)
 Usually chemotherapy is not  Ovoidal and measures 10 – 12 um in
necessary diameter produced only in the
 Supportive measrues intestines of members of the cat family
 Pyrimethamine – sulfadiazine and  Produced by asexual and sexual cycle in
trimethoprim the small intestine
 Sulfamethoxazole combination  Maturation occurs only after oocyst
and nitrofurantoin excreted with the feces
 Mature oocyst has 2 sporocyst with 4
Family Sarcosystidae sporozoites in each
 Remains infective in the soil for at least
Genus Toxoplasma
a year
 Used to be in the subphylum sporozoa in 1964
 Life Cycle
 In 1970, Toxoplasma was studied to be a Coccidian
 Definitive Host (DH) in nature are members
species closely related to the Genus Isospora
of cat family
 1980, protozoa are classified as subkingdom under
 Humans and other mammals and other birds
the Kingdom Protista rather than as Subkingdom
are the intermediate host
Animalia
 Five Phases of Life Cycle:
 Genus Toxoplasma with Isospora, Sarcocystic,
1. Proliferative
Cryptosporidium are classified under Subclass
2. Cystic
Coccidian, Class Sporozoa, Phylum Apicomplexa
3. Schizogonic
Toxoplasma gondii 4. Gametogonic
 Disease caused: Toxoplasmosis 5. Oocystic
 Geographic Distribution: cosmopolitan with high  All these 5 stages occur in cat which is the definitive
prevalence in birds and mammals including man host
 Morphology:  In intermediate host, it has only the proliferative
and cystic stage take place.
 Three Forms of Organism:
1. Tachyzoites (trophozoite counterpart)  3 Infective Stages:
 Delicate ovoidal, pyriform or crescent 1. Tachyzoites
shape with one or both ends pointed 2. Cyst
or rounded 3. Mature Oocysts
 4 – 8 um in length, motile, and stains  Life Cycle:
with Giemsa or Wright’s  Proliferative phase – develops when man
 Cytoplasm is blue, which contains and other intermediate host take raw
rounded, red-stained mass of meat infected with tachyzoites or cyst
chromatin near the posterior end  Ingest food and drinks contaminated with
cats’ feces
shacklen
 37
 Containing mature oocyst 3. Transplacental infection
 There is rapid proliferation of tachyzoites 4. Accidental infection – self-inoculation
intracellularly in many tissues during the mainly by syringe among lab workers
primary infection  Diagnosis:
 This will enlarge the cell, which is packed  Presumptive: clinically demonstration of
with organisms and is referred to as cerebral calcification and chorioretinitis
“pseudocyst”  Specific:
 With development of immunity, the  Isolation of organism from blood
infection passes or body fluids by inoculation to
 chronic stage with formation of mice or tissue cell culture
bradyzoites which multiply slowly. This  Demonstration of tachyzoites in
results to formation of tissue cyst historical section of tissue
 when immunity is gone or suppressed,  Serological Tests:
cysts rupture and the released bradyzoites  Methylene Blue Dye Test or
multiply by another new cells and multiply Sabin-Feldman Dye Test
as tachyzoites  If living tachyzoites are
 each tachyzoites and bradyzoites multiply incubated with serum
by internal budding and endodyogeny containing Toxoplasma
 when cats take the infective forms, the antibody and
proliferative/cystic stages occur in tissue complement, they will
similar to man and another intermediate lyze, fail to stain with
host methylene blue
 additional schizogony, gametogony, and  Indirect fluorescent antibody
oocystic development occur in the test
intestinal epithelium  ELISA test for IgM antibody
 development of oocyst with 8 sporozoites  Hemagglutination test
occur outside the host  Treatment
 Pyrimethamine, sulfadiazine, spiramycin
 Prognosis
 Acute toxoplasmosis in young children is
severely fatal.
 In older children and adults, prognosis
depends to the site and degree of tissue
damage
 In patients with AIDS, it can disseminate
rapidly and within response to treatment
is very poor

Genus Sarcocystis
 Disease Caused: sarcosporidiasis, sarcocystosis
 Geographical Distribution: cosmopolitan but rarely
seen in man
 Morphology:
1. Sarcocyst
 Meischer’s tubes
 Mode of Transmission:  In muscle may be visible grossly as
1. Eating undercooked or raw meat whitish streaks corresponding to the
2. Fecal-oral route – explain infection of direction of muscle fibers
herbivores animals and vegetarian humans  May be spindle-shaped/cylindrical

shacklen
 38
 Diameter varies from less than 70 um animals. Cyst wall is broken down mechanically by
to more than 200 u limited by digestive enzymes releasing bradyzoites which
membranes which is due to thick layer penetrate intestinal cell rapidly (within hours which
of closely set villi differentiate into male and female gametes. These
 Cysts are divided by septae and the gametes move into the lamina propria where
bradyzoites are arranged in fertilization occurs (in about 1 day). Zygote
compartment secretes a wall becomes oocyst. Two (2) sporocysts
 Has been reported in musculatures of develop, each with 4 sporozoites. The mature
the heart, larynx, eye, thigh, biceps oocyst and most often, free sporocyst move out to
muscles and chest wall the intestinal lumen and passed in feces.
2. Oocyst 2. Intermediate Host or Prey Animal become infected
 Measures 13 by 9 um by ingestion of oocyst and sporocysts. Sporozoites
 Has 2 sporocyst with 4 sporozoites in encyst in lumen in the intestine and about 10 day
each later, is found in endothelial living arteries where
 Oocyst wall is stretched tightly around the parasites multiply asexually producing
the sporocyst before they are excreted schizonts. Schizonts rupture releasing merozoites
to feces which may repeat the cycle. About 5 – 7 weeks
 Life Cycle: after ingestion of sporocyts, parasite enters
 Discovered in 1972 muslces of body and become encysted. Mature
 Involve 2 hosts infectious sarcocysts containing bradyzoites are
 Alternating between herbivorous formed by 12 – 14 weeks.
intermediate host and carnivorous
definitive host

Merozoites Bradzyoites

Schizont
Man
(Merozoite)

D. L.
Sporocyst/Thi
Sporocyst
n walled
Oocyst

 Humans infected as definitive host by at least 2

years:
 Sarcocystis hominis of cattle
 Sarcocystis suihominis of pigs
 Definitive host harbors intestinal stages
 Humans can also serve as intermediate host
(harboring intra-muscular cyst) for S. lindermanni
 The life cycle of Sarcocystis is of the predator-prey
type with sexual stages in the intestinal wall of
predator animal and asexual multiplication in the
muscular endothelium and inside cells of a prey
animal
1. Definitive Host is a predator – it becomes infected
by ingesting mature sarcocyst from muscles of prey
 Treatment: no known specific treatment
shacklen
 39
 Prognosis: excellent 2. Excystation in intestine with release of
 Prevention: sanitary preparation through cooking sporozoites into the lumen.
of food 3. Formation of parasite-containing vacuole at
the microbillous surface of the host cell.
Family Cryptosporidae 4. Asexual multiplication with formation of 2
types of merozoites.
Cryptosporidium species
 Type I
 Disease caused: Cryptosporidiosis
 Meront with 6 or 8 merozoites
 Previously, a poorly recognized disease in hhumans
 These merozoites undergo
until recently, when it has become a medical
cyclic development to form
problem devastating populations since its
additional Type I meronts
recognition in AIDS
 Type II
 In immunocompetent persons, it produces short-
 Meront with 4 merozoites
term flulike, gastrointestinal illness, whereas in
 These merozoites develop
immune deficient persons, it may produce severe,
directily into sexual stages
persistent diarrhea with extensive fluid loss
without undergoing cyclic
 Recent reports of respiratory and biliary infections
development
indicate that Cryptosporidium is not confined to GIT
5. A microgamete produces 16 microgametes.
of immune deficient persons
Fertilization of macrogamete forms the
 Since 1980, 44 cases of prolonged cryptosporidiosis
zygote.
in immunodeficient individiuals have been reported
6. Approximately 80% of the zygote develop
to the Center of Disease Control
into thick-walled oocyst and undergo
 Of these, 3 patients undergoing
sporozoite development.
immunosuppressive chemotherapy, 3 were
7. These type of oocyst are excreted intact
children with hypogammaglobulinemia, and the
through the feces and transmit the infection
remaining 38 were classified as having AIDS. About
of susceptible host via fecal-oral
2/3 of the AIDS patients with chronic
contamination.
cryptosporidiosis have died.
8. The remaining 20% of the zygotes do not
 Habitat:
form oocyst wall instead, the developing
 The developmental stages are located sporozoites are surrounded by oocyst
characteristically in a vacuole at the membrane. Sporozoites within these
surface of the microvilli of the enterocytes “autoinfective” thin-walled oocyts, are
or surfaces of ciliated epithelium of released into the intestinal lumen and re-
respiratory tract. initiate the endogenous cycle
 Morphology:  Diagnosis:
 Mature oocyst has 4 naked sporozoites 1. Demonstration of oocyst in feces, which
 It has no sporocyst are acid-fast by modified cold kinyoun
 It has one of the smallest coccidial oocyst technique
known, measuring 4 – 6 u 2. Tissue biopsy
 Mode of Transmission: 3. Immunofluorescent antibody test applied
 Integration of mature oocyst through directly on stool examination
contaminated foods or drinks.  Treatment
 Like other coccidiosis, direct transmission  Cryptosporidiosis in healthy individuals do
may occur during sexual practices not require treatment.
involving oral-anal contact.  Therapy in patients with impaired host
 Life Cycle: defenses have been unsuccessful.
1. Starts with ingestion of mature oocyst
containing 4 sporozoites.

shacklen
 40
type I pneumocytes (squamous epitheial
cells)
 Knowledge concerning the life cycle of the
organism…
 2 forms are present on light microscopy:
1. Trophozoite
 Small (1 – 4 u), pleomorphic,
somewhat amoeboid, much
more numerous than cyst
and best identified by
Giemsa Stain
2. Cyst
 5 – 7 u and contains up to 8
small bodies termed as
sporozoites. This is the form
most commonly found in
histopathological sections
and is best identified by
methenamine silver or other
stains which selectively stain
the prominent cell wall
 The life cycle and mode of reproduction of
P. carinii are poorly understood
Pneumocystis carini  Presumably, sporozoites excyst to develop
o Disease Caused: Interstitial plasma cell pneumonia, into trophozoites. Some of these forms
Pneumocystosis will ultimately form cysts.
o Geographic Distribution: worldwide
o Host Factors:
 P. carinii almost exclusively affects the
compromised host:
1. It is commonly seen in premature or
debilitated or malnourished infants.
2. In children with primary immunodeficiency
diseases – defects in both B and T cells
lead to pneumocystosis but probably the
most important factor is impaired cellular
immunity.
3. In patients of all ages receiving
corticosteroids or other
immunosuppressive drugs for the
treatment of cancer, organ transplantation
and other disorders. o Mode of Transmission:
4. In patients with AIDS, P. carinii pneumonia  Animal model studies indicate that
has been documented in early 75% of all infections most likely acquired via the
AIDs (Acquired Immunodeficiency respiratory route
Syndrome) cases  Cases of apparent intrauterine
o Morphology and Life Cycle: transmission have been rarely reported
 P. carinii resides in the alveolus in close o Diagnosis:
relationship with specific lining cell, the  Dependent on the demonstration of the
organism in lung tissue by either open or
shacklen
 41
closed lung biopsy or transbronchial  The posterior end is broadly rounded
biopsy. with small opening, the cytopyge, where
 Transthoracic needle aspirates are useful the contractile vacuole empties
only in children  The cytoplasm contains numerous food
 Serology does not appear to be reliable vacuoles and 1 or 2 contractile vacuoles
tests in these patients due to low  2 nuclei: a bean-shaped macronucleus
sensitivity and specificity and a smaller micronucleus, which lies in
o Treatment: the center of the inner curvature of the
 Trimethoprim-sulfamethoxazole – macronucleus
treatment of choice
o Prognosis:
 Untreated pneumocystosis has a mortality
rate of 50% in malnourished infants and
almost 100% in immunosuppressed
patients
PHYLUM CILIOPHORA
Characteristics:
2. Cyst
1. They are one-celled organisms provided with  Round in shape covered with a tough
threadlike extensions of their cytoplasmic cystic wall; inside, the completely
membrane (cilia) duiring some stage of their cycle. refracted cilia are seen
 Cilia may cover the entire body or confined  There is no increase in the number of
to a limited area as cytostome. nuclei
2. There is a characteristic large macronucleus and  Found in formed or semi-formed stool
one or more micronucleus.
 Their genetic traits are transferred by the
micronucleus by conjugation.
3. They possess distinct cytostome (cell mouth),
leading to cytopharynx usually near anterior end.
4. A cytopyge (anal pore) is found in the posterior
end.

Balantidium coli
o Disease Caused: Balantidiasis
o Geographic Distribution: common in warm climates o Habitat:
o Morphology: it is the largest protozoa parasitizing  large intestine
man, at times visible to the naked eye o Reproduction:
 2 Stages:  usually by binary fission or uncommonly by
1. Trophozoite conjugation
 Large, 50 – 200 u by 40 – 70 u o Life Cycle:
 Found in diarrheic stool  cystic stage – infective stage
 Ovoidal and covered with short cilia of o Mode of Transmission:
uniform length  Through ingestion of contaminated food and
 Anterior end is pointed and on one side drinks
of the longitudinal axis is a deep curved  Excystation occurs in the small intestine
inverted conical depressions, the  From the small intestine, it goes down to the
cytostome large bowels and set up colonies

shacklen
 42
 As the fecal material in which the 2. larval
trophozoite is transported down the bowel 3. adult
becomes dehydrated, encystation occur o Female adult may be classified into:
o Epidemiology: 1. Oviparous
 They are common in hogs. Thus, man gets  which eggs are oviposited and
infected from these animals especially embryo develops outside
piggery workers or slaughterhouse workers maternal body
o Diagnosis:  ex. Ascaris lumbricoides
 Demonstration of the parasites in feces: 2. Viviparous
 Diarrheic stool – trophozoite  Which female give birth to larvae
 Formed stool – cyst  ex. Trichinella spiralis
o Treatment: 3. Parthenogenetic
 Tetracycline – drug of choice  Where females by can produce
o Prognosis: viable eggs without being
 May disappear spontaneously in healthy fertilized by male worms
individuals but may be fatal in debilitated (ovoviviparous)
persons  ex. Strongyloides stercoralis
o Prevention
Class Aphasmid
 environment and personal hygiene
 lack phasmids or caudal chemoreceptors
A. Species which parasitize small intestine
1. Trichinella spiralis
INTESTINAL NEMATODES 2. Capillaria philippinensis
B. Species which parasitize large intestine
Phylum Nematoda
1. Trichuris trichiura
o nematodes or roundworms belong to Phylum
Nematoda Class Phasmidia
o there are free living and parasitic species  With phasmids
o free living – widely distributed to water and soil A. Species which parasitize small intestine
o parasitic species lives in plants, arthropods, 1. Ascaris lumbricoides
mollusks, vertebrates 2. Necator americanus
o many parasitic species have free living phase and 3. Ancylostoma duodenale
some live either parasitic or free living existence 4. Ancylostoma ceylanicum
o nematodes – unsegmented, elongated, cylindrical 5. Strongyloides stercoralis
in shape, vary in size, forms barely visible with the B. Species which parasitize large intestine
naked eye 1. Enterobius vermicularis
o sexes separate, females are larger than males C. Species which parasitize tissues
o posterior end – usually curve in male 1. Wuchereria bancrofti
o movement is sinuous changes of their bodies 2. Brugia malayi
ranging from slow to rapid or gyration D. Species that cause larva migrants in man
o body covered by cuticle, muscle fibers line body 1. Ancylostoma braziliense – dogs and cats
cavity 2. Ancylostoma caninum – dogs and cats
o body cavity – pseudocoele 3. Angiostrongylus cantonensis
1. which contains viscera, digestive,
excretory, nervous, reproductive system Ascaris lumbricoides
o located anteriorly – mouth, which is equipped with o Giant roundworm
spines, hook, cutting plates, stylets, structures for o Soil transmitted helminthes, geohelminths, utilize
attachment and for penetrating tissues soil as common medium for development of eggs
o all cases – life cycle and reservoir of eggs infective for man and as a
1. egg vehicle for facilitating the invasion of human host

shacklen
 43
o Parasite specific for man and life span about 12 months
o Adult worm o Two types of egg recovered from stool:
 white, creamy and pinkish yellow when 1. Fertilized Egg
freshly expelled  Develop in the soil
 Elongated, cylindrical, faint longitiudinal  Broadly oval and nearly spherical and
white “lateral lines” is seen on each side golden brown color
 Head provided three lips with small  Measures from 45 – 75 by 35 – 45 um
triangular buccal cavity located at center  Freshly expelled eggs consist of a
of lips single cell inside
o Males  Egg shell has 3 layers:
 Distinguished from females by having a i. Inner nonpermeable lipoidal
curve posterior end, shorter and slender vitelline membrane (absent if
 When freshly passed, spicules protrude infertile eggs)
when pressure is applied on curve ii. Thick transparent middle layer
posterior end glycogen membrane
 15 – 30 cm by 3 mm iii. Outermost coarsely mamillated
o Female albuminoid layer
 With straight posterior end and at the  Mamillated coat was absent
junction of anterior end middle third part, or removed in eggs and
a depression is present where vagina is referred to as decorticated
located  Decorticated eggs may be
 20 – 45 cm by 5 mm mistaken as hookworm
2. Unfertilized egg
 Larger, narrower, elongated
 Measures 88 – 94 u
 Shell is irregular with an irregular
coating albumin
 Also decorticated which makes it
difficult with an inexperienced
microscopist and mistake it as
hookworm
o Reproductive is high: 240,000 eggs/day which  Inside the shell are highly refractile
counterbalances heavy losses in viability granules of various sizes
o One female produce 65 million fertilized egg during
her active reproductive period of life is 9 months

Figure 1 Fertilized Figure 2 Fertilized Figure 3 Fertilized

egg of A. egg of A. egg of A.
lumbricoides in lumbricoides in lumbricoides in an
unstained wet unstained wet unstained wet
mounts of stool, mounts of stool, mount of stool,
with embryos in with embryos in undergoing early
the early stage of the early stage of stages of cleavage.
development. development.

shacklen
 44

Figure 4 Fertilized Figure 5 Fertilized Figure 6 Fertilized

egg of A. egg of A. egg of A.
lumbricoides in an lumbricoides in an lumbricoides in an
unstained wet unstained wet unstained wet
mount of stool. mount of stool, mount of stool.
200x magnification.
A larva is visible in
the egg.

Figure 7 A. Figure 8 A. Figure 9 A.

lumbricoides lumbricoides lumbricoides o Life Cycle:
decorticated, fertile decorticated, fertile decorticated, fertile
egg in wet mounts, egg in wet mounts,  Small intestine (lumen)  male and female
egg in a wet mount,
200x magnification. 200x magnification. 200x magnification. adult utilize this area as their habitat
The embryo has  fertilized egg passed out in feces  voided
advanced cleavage. directly into the soil, rapid development of
eggs take place (1 – 2 weeks) until embryo is
formed inside egg
 eggs will never hatch in soil, when these
infective stages are swallowed, larvae will
hatch in upper small intestine – it will
penetrate the intestinal wall and they will
Figure 11
Figure 10 enter blood circulation, to liver through the
Unfertilized egg of Figure 12
Unfertilized egg of portal circulation and to the right heart into
A. lumbricoides in Unfertilized egg of
A. lumbricoides.
an unstained wet A. lumbricoides in the pulmonary vessels and into the
Note the
mount, 200x an unstained wet interalveolar tissues of lungs
prominent
magnification. mount of stool.
mammillations on  after its growth, essential development in
the outer layer. lungs, larvae migrate or carried in mucus
flow through respiratory passages to throat
and are swallowed
 on its arrival small intestines, they develop
into adult male and female worn
 long journey requires 7 – 9 days
 incubation period (from time of exposure to
time that mature female lay eggs): 2 – 2 ½
months
o Pathology:
Figure 13 Figure 14 Infertile, Figure 15 Larva of  Grouped into two caused by larval or adult
Unfertilized egg of decorticated egg of A. lumbricoides stages of worm
A. lumbricoides in a Ascaris hatching from an 1. Due to larval migration
wet mount of stool. lumbricoides. egg.
 Causes trauma and minute or
Note this specimen
lacks the petechial hemorrhages in lungs as
mammillated layer shacklen
(decorticated).
 45
larvae breaks out lung capillaries 3. Liver – in the parenchymal area
into air sac causes multiple abscesses
 Massive infection, considerable 4. Pancreatic duct – acute pancreatitis
damages – pulmonary tissues and 5. Bowel – peritonitis
sometimes gives rise to Ascaris  Among Filipinos, female wanderer worms
pneumonitis may lay eggs that will become nucleus of gall
 Symptoms include asthmatic type stones, 27% of gall stones removed from
of respiration, cough, bronchial Filipinos.
rales, urticarial rash, angioneurotic o Diagnosis:
edema eosinophilia blood  Ascariasis – stool examination either by
 Some larvae may lodge in the brain, direct fecal smear or cellophane thick smear
spinal cord, eyeball, kidneys, initiate method (Kato technique)
granulomatous reaction which may  Technician should identify, should be familiar
confused with neoplastic growth as to how the EGGS look spirally
2. Due to adult worms  Stool examination result is negative:
 Nutrition of worms come from 1. Patient free of Ascaris infection
lumen of small intestine  liquid 2. Early stage of infection of immature
nutrient worm
 Ascaris 3. Larval immigration into the blood
i. Decrease fat and nitrogen stream
absorption 4. Male worms are present in intestine
ii. Increase nitrogen loss in o Epidemiology:
feces  Infection is common to children than in
iii. Malabsorption or intolerance adults
of lactose  Endemic in third world countries or
iv. Decrease growth rate in developing countries, where sanitation is
children poor or not developed
 Most recognizable physical effect  Distribution pattern suggest a common
of ascaris: source of infection such as soil contaminated
 Diarrhea, vague abdominal hands or food
pain, nausea, loss of  In the Philippines, prevalence ranges from 80
apetite – 90% in rural areas and in poor and slum
 Fever caused by other sections of towns and cities
factors may stimulate  Global prevalence is 1 million cases
worms to migrate upwards  Soil-contaminated food, especially raw
and sometimes can be vegetables and fruits – most common source
vomited and sometimes of infection
through the nose  Use of untreated or inadequately treated
 Some Ascaris vomited: human feces  fertilizers  epidemic or
 Pass larynx  causes hyperendemic Ascariasis
suffocation  Ascaris in soil may survive for a year or two
 Pass lungs  pulmonary in temperate climates and probably only a
gangrene few weeks or months in tropical countries
 Pass Eustachian tube  o Treatment, Prevention and Control
otitis media  Broad spectrum of Antihelminthics as
 Ascaris is considered as wanderer, erratic Albendazole, Levamisole, Mobendazole,
behavior resulting to ff: Piperazine salts, Pyrantel Pamxatel
1. Intestinal obstruction  Neuromuscular blocking effect or paralysis of
2. Appendix – acute appendicitis parasite
shacklen
 46
 Two methods in controlling Ascaris:  Eggs measures 50 – 54 by 22 – 23 u,
1. Mass Treatment discharged on stools
 Not practical because of high cost  Unsegmented, average of 2000 – 7000
2. Selective Treatment eggs per day by female
 Treat only one group – targeted
group – treatment of children
alone without treating adult is
periodic or at interval
 In the prevention aspect, proper disposal of
human excreta, personal hygiene like
handwashing before eating and avoiding the
use of human feces as fertilizer.

Trichuris trichiura
o Life Cycle:
o Whipworm
 Adult worm – attached to the wall of
o “Japanese Lantern”
caecum, and in heavy infection is found in
o Fresh colored, pinkish slender worm
the appendix, colon, posterior level of
o Anterior 2/3 of worm is attenuated, thin in contrast
ileum
to the remaining posterior one-third which is fleshly
 Eggs – passed out feces – unsegmented
and stouter giving a whiplike appearance
stage upon reaching the soil, about 2 – 3
o Female:
weeks may be required before
 Slightly larger than male
embryonation
 3.5 – 4.5 cm with straight posterior end
 Embryonated egg – infective upon
o Male:
reaching GIT, larva pushes softened mucus
 3 – 4.5 cm in length and posterior end is
plug and leave the egg through the
coiled through 360 degrees or more
opening
 Young larva – lives in the crypts of
intestinal mucosa for 7 – 10 days then
passes down to caecum transform to adult
worm for 2 – 3 months
 Life span of an adult worm: 5 years

o Utilizes caecum as its natural habitat of man with

entire anterior slender portion inserted into
mucosa of the caecum
o Eggs
 barrel shaped with bipolar mucus plugs at
both ends
 One of the plugs is the section where
young larva comes out
 Shell (egg) is thick compared …, bile
stained, brownish yellow

shacklen
 47
4. Ancylostoma braziliense
5. Ancylostoma caninum
o Pathology: 
 Trichuriasis: o N. americanus and A. duodenale – 2 most common
 Unique mode of attachment to the o A. ceylanicum, A. braziliense, and A. caninum –
wall of large intestine where it feeds incidental parasite of man
on its intestinal tissue o A. ceylanicum – accidentally infect man and develop as
 Degree of clinical symptoms depends an intestinal parasite
to the intensity of infection o A. braziliense and A. caninum – hookworms found in
 Host nutritional status should be cats and dogs which may cause skin lesion in man
suspected: diarrhea, o N. americanus
hypoalbuminemia, iron deficiency  stout with a cervical curvature
anemia  due to this curvature that looks like a hook that it
 Trichuris will less likely cause anemia derived its name as hookworm
than the hookworm  Female: larger, 9 – 13 mm with a blunt posterior
 Ulceration of intestine resulting from end
the heavy/huge worm burden which  Male: shorter, 7 – 11 mm; posterior end is
lead to prolapse of rectum as expanded to form fan-like “bursa copulatrix” –
infection extends up to that organ used for copulation
*rectal prolapse – life-threatening  Both male and female adult worm has well
o Diagnosis: developed buccal capsules characterized by the
 Stool: direct fecal smear, Kato technique, presence of semilunar cutting plates
or concentration method, demonstration o Ancylostoma duodenale
of barrel shaped EGGS  Adults buccal capsules
o Epidemiology:  2 pairs of ventral teeth similar in size
 Most infection has light to moderate o Ancylostoma ceylanicum
symptoms and seldom produces syrup  2 pairs of ventral teeth
 Its infection in the Philippines 80 – 90 %  Outer pair larger than inner pair
and usually parallels ascaris o Ancylostoma braziliense
 Eggs are less resistant to adverse  2 pairs of ventral teeth
conditions than ascaris in soil  A pair of small inconspicuous median teeth pair
 Infection rate of children is slightly lower of larger outer teeth
than adult, some areas with a tendency to o Ancylostoma caninum
increase as age increases  3 pairs of ventral teeth – diagnostic character of
 Might be due to long life span of adult species
worms so that infection accumulate in 
host through constant exposure in o Ancylostoma duodenale – body contour tends to follow
endemic areas the general curvature of the body, looks like letter “C”
o Treatment, Prevention, and Control o Necator americanus – tendency to grow against the
 Same as ascaris: albendazole general body curvature at the anterior end and will look
like a hook
o Hookworm eggs
HOOKWORMS  Ovoidal, thin-shelled and colorless
1. Necator americanus  56 – 60 by 34 – 40 um
 CN: American hookworm, American murderer,  When passed in the stool  4 – 8 celled stage
New World Hookworm producing Necatoriasis  Constipated stool, embro develop inside the cell
2. Ancylostoma duodenale  Differentiation of Necator americanus from
 CN: Old World Hookworm Ancylostoma eggs is difficult and impractical.
3. Ancylostoma ceylanicum
shacklen
 48
 Adult stage is attached to the mucosa of the
small intestine in the jejunum area by their
toothlike processes in the buccal capsule
 Worms feed on lymphs, RBCs, and plasma
 Egg is passed in the feces containing the
segmented ovum
 When deposited as worm, moist soil, larva
rapidly develops in the egg and hatches after 1 –
2 days
 Newly formed rhabditiform larvae passes
o Rhabditiform Larvae (First Larval Stage)
through a 7 – 10 days free-living cycle in the soil,
 First stage that hatches in 24 – 48 hours
molting twice and becoming a sheated filariform
 Short and stout with a long narrow buccal
larva which is infective to man
chamber and a flask-shaped muscular or bulbous
 Humans are infected by skin penetration of larva
esophagus
like Necator americanus or passed by oral and
 Feed on bacteria and organic matter present in
percutaneous routes like Ancylostoma duodenale
feces or soil
 Then migrate by way of venous system to the
 Feeding stages of the parasite
heart and the lungs into the alveoli
 The second larval stage or transitional stage
 From the alveoli, larvae are carried towards the
develops from rhabditiform larva and in a few
trachea and larynx, through the esophagus of the
more days, 5 – 8 days, the third larval stage,
stomach and small intestine when they reach 3 –
filariform larva develops
5 days after skin penetration
 After another month, the worms become
sexually mature and may live from 2 – 13 years
 Migrating larvae of Necator grow and develop in
the lungs, those of Ancylostoma do not
 One female Ancylostoma duodenale – 30,000
eggs per day
 One female Necator americanus – 9,000 eggs per
day
o Pathology:
o Filariform Larvae 1. Due to larval stages
 Larger and slender with a pointed posterior end a. Ground Itch or Coolie Itch
 Mouth is closed, esophagus elongates and the  site of cutaneous or filariform
old cuticle remains as a sheath around the larva larvae through the skin be often
 Non-feeding stage characterized by dermatitis, intense
 Infective stage to man itching, edema, and erythema and
later papulovesicular eruption 
lasts up to 2 weeks ending in
vesicles
b. Creeping Eruption or Cutaneous Larva
Migrans
 due to exposure of the skinto
filariform larvae of Ancylostoma
braziliense, Ancylostoma caninum
and occasionally of Necator
o Life Cycle: americanus and Ancylostoma
duodenale;

shacklen
 49
 larvae cannot pass below the  Its prevalence of infection in the Philippines is 5 –
stratum germinativum producing 45 % depend on its geographical location and
instead of serpignous tunnel in the type of rainfall
stratum germinativum of the skin  Candy foam type of soil with plenty of rain
c. Pulmonary Lesions throughout the year appears to be favourable for
 Produced by the migrating larvae in the infection
the form of petechial hemorrhages  Factors affecting the epidemiology of hookworm:
until eosinophilic and leukocytic 1. Suitability of the environment for the eggs
infiltration, … in the tropics or larvae
2. Due to adult worms 2. Mode and extent of fecal pollution of soil
a. Hookworm anemia 3. Mode and extent of contact between
 Caused by continuous suction of infected soil and skin or mouth
blood from the intestinal mucosa  Larvae move very little horizontally but can
 This will depend on the iron content migrate upwards as much as 1 meter
of the host diet, state of iron  Its tendency to become dormant like the
returns and the intensity and Ancylostoma duodenale makes the parasite and
duration of the infection other nematodes to be resistant to most
 Other factors should be considered antihelmintic and resume development at a later
like the presence of bleeding in the death
areas left by the adult worm when  And this complicates the estimation of the life
they transfer to another site span of adult worms
 Loss of blood or red blood cell in o Treatment, Prevention, and Control
the gut per day will be between  In endemic areas where reinfection is likely to
0.03 – 0.05 mL for adult Necator occur, only heavy or moderate infections are
americanus and between 0.16 – worth treating
0.34 mL of Ancylostoma duodenale  In endemic areas, therefore, the man aim of the
 Blood picture will be a microcytic treatment should be to reduce the level of
hypochromic anemia infection below the level of clinical significance
b. Hypoalbuminaemia  Control and Preventive Measures:
 Referring to loss of protein; when this 1. Proper disposal of feces so that they
happens, it is due to a combined loss become harmless
of blood and lymph and the protein 2. If human excreta has to be used for
loss is well in excess loss of RBC fertilizer, it should be treated properly
o Diagnosis: before use
 Ground itch and creeping eruption may be 3. Personal hygiene such as the use of shoes
diagnosed by the character of the lesion and an and slipper while walking and avoiding the
entry of skin contact with the soil ingestion of raw vegetables that are not
 Hookworm infection is diagnosed by recovery of washed properly.
the EGGS on stool examination either by DFS,
Kato, brine flotation, formalin ether Strongyloides stercoralis
concentration techniques o CN: Threadworm producing strongyloidiasis,
 If stool sample is allowed to stand for 12 – 24 strongyloidosis, or cohcinchina diarrhea
hours in the laboratory before examination, o Two species infectious to man:
some eggs may hatch and the rhabditiform larvae 1. Strongyloides stercoralis – specific to man
should be differentiated from those of 2. Strongyloides fuelleborni – parasite of African
Strongyloides primates
o Epidemiology: o In contrast to Ascaris, Trichuris and Hookworm
(TRIUMVIRATE) where the diagnosis is made by the
presence of egg in the stool excretion of Strongyloides

shacklen
 50
stercoralis larvae is intermittent making it impossible to o Rhabditiform Larvae
detect even with the use of special procedures  Excreted in the stool rather than the eggs
o For this reason it makes now difficult to figure out the  Muscular elongated esophagus with a pyriform
reason for its prevalence posterior bulb, a short buccal cavity and a
o This parasite is a fecally transmitted and a soil relatively conspicuous genital primordium
transmitted helminth halfway down the midgut
o Larvaes are infective the moment it goes out with the o Filariform Larvae
feces and this remains as the focus of contamination in  Long and delicate
a humid environment for natural life of the filariform  It has long esophagus occupying half the length
larvae of the larva
o All free living stage of this parasite live in the soil hence  Forked or notched tail
a soil transmitted helminthes  This is used in differentiating Strongyloides
o It is capable of producing new generation of infectious filariform from hookworm filariform larvae
larvae from parthenogenetic females embedded in the
upper small intestinal mucosa and infection may last for
20 – 30 years
o A good example of facultative parasite at certain
conditions, it is able to exist as a free living organism but
when environment condition becomes unfavourable, it
can revert to its parasitic generation
o Parasitic Females
 Delicate filariform worms
 2.2 mm in length
 Esophagus occupy 1/3 of the anterior part of the
o Life Cycle:
worm
 Free-living rhabditiform female lays embryonated
 A parthenogenetic parasite and it does not
eggs in stool which hatch into rhabditiform larvae
require any male to fertilize and fully embryonate
in a few hours
the eggs
 Larvae feed on organic matter and transform into
o Free Living Female
a free living adults and the cycle in the soil goes
 Shorter than parasitic female
on
 Stouter and differs from the parasitic female by
 Unfavorable conditions happen, the rhabditiform
having double bulb muscular esophageal pharynx
larvae changes into filariform larvae changes into
filariform which are now infective to man
 Filariform larvae infect man by way of skin
penetration going to the blood stream to the
heart then the lungs
 From lungs they break out of pulmonary
capillaries into the alveoli, goes to trachea then
swallowed, goes to the stomach, duodenum
where they develop into adults in a month time
 Larvae migrate into the lumen and pass out in
o No parasitic male probably because they are not
the feces which starts the free living cycle
involved in the parasitic cycle in man
 In autoinfection, rhabditiform larvae in the
o Males develop from filariform larvae passed out with
intestinal lumen changes into filariform larvae as
feces
they pass down the large intestine
o Free Living Male
 Infective stage, some filariform larvae may invade
 Broadly fusiform
the bowel mucosa into the blood circulation and
 Smaller than free living females
starts another parasitic cycle without leaving the
 With pointed tail that is curved ventrad
body of the host at the filariform larvae as they
shacklen
 51
pass out with the feces and upon contact with  Age group: 7 – 14 years
the perianal skin, penetrate it and give rise to  Out of the 6 provinces under study, Laguna has
reinfection. been found to be highest prevalence of
*autoinfection – you yourself is the source of Strongyloides
infection and you can also infect others o Treatment, Prevention, and Culture
 Albendazole and Thiabendazole
o Pathology:
 Prevention and control are the same as those of
 Strongyloidiasis may occur in three clinical forms:
hookworms
1. Chronic and Asymptomatic with occasional
excarvations
2. Acute with urticarial, abdominal pains and
diarrhea leading to complications by
malabsorption and hypoalbuminemia
3. Disseminated which occurs in
immunocompromised host (under
immunosuppressive therapy) and is usually fatal,
involves not only the small intestine but the lymph
nodes too, lungs and brain with gram negative
sepsis

Enterobius vermicularis
o CN: pinworm or sitworm (Enterobiasis/Oxyuriasis)
o Synonymous to Oxyuris vermicularis
o Adult Worms:
 Small, whitish or brownish in color
 Anterior end is a pair of lateral articular
expansion  “lateral wings” or “cephalic alae”
 This structure differentiates adult enterobius
from other adults of nematodes of medical
importance

o Diagnosis:
 Made by demonstration of rhabditiform larvae or
stool exam either by DFS or a stool culture
(Harada-Mori)
 Distinguished larvae form hookworm rhabditoid
or filariform
 Harada-Mori culture for Strongyloides, one
should examine the cultured materials after 5
days in hookworm it needs 10 days
o Epidemiology: o Adult male:
 Prevalence of Strongyloides stercoralis in a  2 – 5 mm in length, tail is curved strongly ventrad
tropical country like Philippines o Adult female:
 Out of 4,208 stool cultures (from 6 provinces)  8 – 13 mm in length, long pointed tail
examination, less than 3% were found positive o Eggs/Ovum
 More common in towns and barrios along the  50 – 60 by 20 – 30 um elongated, ovoidal,
coastal areas surrounding lakes or bodies of fresh flattened on the ventral side giving an
water appearance similar to letter “D”
shacklen
 52
 Egg shell is composed of two layers, an outer  In heavy infection, the worm may enter the
thick hyaline albuminous shell and an inner appendix causing appendicitis and may penetrate
embryonic lipoidal membrane the intestinal wall into the submucosa
 Eggs become fully embryonated and mature  Female patients – migrating worms may oviposit
within a few hours after oviposition (6 hours at in the genital organs causing vulvovaginitis with
body temperature), these are already infective mucoidal vaginal discharge
 Single female can deposit eggs that varies from  It into the reproductive tract up to the fallopian
4,672 – 16,888 with a mean of 11,105/day tubes and either become encysted or produce
symptoms of salpingitis
 Once worms may wander from the fallopian tube
into the peritoneal cavity and become
encapsulated
o Diagnosis:
 Pinworm infection may be suspected in persons
that exhibit manifestations like pruritus FO the
perianal cellulose tape swab recovering the eggs
demonstrating the letter D eggs which are fully
embryonated
 Oviposition takes place at night so it is best to
collect in the morning and before he/she has
taken a bath
o Life Cycle:  In children – the worms may sometimes be seen
 Adult worms inhabit the cecum with the heads migrating and of the child’s arms at night
attached to the intestinal wall  Place the worms in alcohol or any fixative and
 Gravid female, the uteri become packed with submit to the lab for identification
eggs and the body becomes distended making o Epidemiology:
the female release its hold on the intestinal wall  Common in the Philippines with a prevalence
and migrate out the anus to lay eggs (die after rate that varies from 10% in rural areas to 75% in
oviposition) crowded urban centers
 The eggs laid on the perianal area becomes fully  Women are more infected than men
mature or embryonated within 6 hours  Children are more infected than adults
 If ingested, larvae hatched in the duodenum  The eggs – immediate infective stage when
passing down the small intestine to the cecum oviposited, transmitted from one person to
and developing adult worms in 2 weeks – 2 another is especially easy especially among
months household members, orphanages and asylums
 At favorable conditions, the eggs are viable up to  Most common means of transmission is by direct
13 days hand to mouth by finger contamination, soiled
o Pathology: night clothes, sleeping in bed with carriers,
 Minute ulcerations or abscesses will develop in contaminated table tops, doorknobs, inhalation
the site of attachment of the cecal mucosa area of airborne eggs, dislodged from bed linens and
 More significant pathology is produced by the clothes
gravid migrating females  Life span is short, autoinfection is responsible for
 During oviposition, there will be intense itching continued existence of infection in infected
or pruritus in the perianal region which results to individuals
scratching until the area will be scarified o Treatment, Prevention and Control
 Pruritus ani more often give rise to hemorrhage,  Piperazine salts, pyrinium pamoate, pyrantel
eczema, and pyogenic infection of the anal and pamoate, and mebendazole
perianal regions and perineum  Prevention is difficult if it only exist in the
household
shacklen
 53
 Personal hygiene is very important  Characterized by the presence of a chitinized
 Bed linens and clothing with infected persons spicule and a long sheath extending beyond the
should be sterilized by boiling length of the worm
 Fingernails should be cut short
 General household cleanliness should be
observed
 In one institution or families where one member
has enterobiasis, all members should be treated
irregardless of whether each one has been
examined by perianal swab or …
 At least 7 consecutive post-treatment
examination should be negative before one is
pronounced free of infection

Capillaria philppinensis
o Intestinal capillariasis was first recognized in the o Eggs by typical capillaria
Philippines in 1963 when the first human case died of  Pale, yellow in color, moderately thick, striated
the disease in the Philippine General Hospital
shell with flattened bipolar plugs
o First case came from Ilocos Norte
 Peanut-shaped measures 42 by 20 u and usually
o A few year later, 1967, the incident in PGH, an epidemic
in the single or two segmented stage of
of capillariasis took place in a town in Ilocos Sur killing
development
90 persons and infected around 1300 persons
o Eggs by atypical capillaria
o Causative agent for the epidemic was identified and
 Thin shelled without polar plugs and
assigned the name Capillaria philippinensis
multisegmented or embryonated
o They are very delicate tiny worm
 Those eggs hatch while still in utero or first stage
o Females:
larvae
 2.3 – 5.3 mm in length
 Two types:
1. Typical Female
 Eggs in utero number from 8 – 10
eggs arranged in a single row
2. Atypical Female
 Eggs in utero are 40 – 45 arranged
in 2 – 3 rows

o Life Cycle:
 Life cycle has been established experimentally
using animals in the laboratory
 Eggs and larvae – by typical and atypical female,
respectively
 Eggs that passed out in the feces embryonate in
o Males fresh water fish, hatch and develop into infective
 1.5 – 3.9 mm in length larvae within 3 week

shacklen
 54
 Upon ingestion of raw fish, larvae will grow into o Diagnosis:
adults within 2 weeks and the first generation  Acute infective eggs can be readily seen in simple
female produce larvae fecal smear
 The larvae will grow into adults in two or more  Better method: concentration technique using
weeks and the females of this generation acid-ether or formalin-ether method
produce the typical capillaria eggs  Washing and sedimentation of stool specimen
 The presence of atypical female producing larvae will often times reveal the presence of adults and
accounts for the intestinal multiplication of the larvae
parasite inside the intestines  Should be aware that capillaria eggs is somewhat
similar to trichuris eggs
 Technicians should be able to differentiate these
to two ovum to avoid…
o Epidemiology:
 Since the first recorded disease in 1967, there
has been 1,800 confirmed cases and 108 deaths
 Twice as many males as females become
infected, ration is 2:1
 Various age group are infected but the peak is in
males between 20 – 40 years of age
 Youngest patient was 2 years old and eldest was
85 years
 Province: Ilocos Norte, Ilocos Sur, Cagayan, La
Union, Pangasinan, Zambales, Agusan del Norte,
and Leyte
 Many acquire the disease by ingestion of raw fish
harboring the larval stage of the parasite
 Present evidence indicate that it is a parasite of fish-
eating birds and that in nature it is a fish-bird life cycle
 The ability to infect fish-eating migratory birds
suggest that this parasite maybe widely
distributed throughout Asia and possibly
anywhere
o Treatment, Prevention, and Control
o Pathology:  Change in eating habits especially of uncooked
 Characterized by borborygmi or gurgling fresh water fish could prevent the disease in man
stomach, abdominal pain and diarrhea  Mebendazole
 Without treatment, patients will experience
weight loss, dehydration, malaise, anorexia, Wuchereria bancrofti
vomiting, anasarca, muscle wasting and cachexia o CN: Bancrofi’s Filarial Worm causing Bancroftian
 Malabsorption of fats and sugar, protein losing Filariasis or Filariasis Bancrofti
enteropathy and low plasma levels of K, Ca, o Causative agent of bancroftian filariasis require a
carotene and total protein mosquito as intermediate host for transmission
 Death is caused by irreversible effects of o Tissue nematode because the adult parasite are found
electrolyte loss resulting in heart failure or in the lymph vessels and lymph glands
septicemia due to secondary bacterial infection o Adult worms:
 Pathologic changes include atrophy of the crypts  Long, creamy white, filariform in shape
of lieberkuhn flattened villi and the lamina o Male
propria infiltrated with plasma cells, lymphocytes  2 – 4 cm in length
and macrophages o Female
shacklen
 55
 8 – 10 cm in length
o Larvae or Microfilariae
 In fresh specimen appears as minute snake like
organism constantly moving about the RBCs
 270 – 290 u by 6 – 7 u enclosed in a hyaline
sheath which is much longer than the larva itself
 When stained the central axis is seen as
compared of dark staining nuclei which serve as
landmark for ID
 The column at the nuclei are in 2 – 3 rows and
distinctly conspicuous
 Microfilariae – several curvatures and has a
graceful appearance

o Pathology:
 Microfilariae does not contribute to any
pathology secondary to Bancroftian filariasis
 Pathology of parasite is centered in the lymph
vessels and glands where the adults are found
 Inflammation, edema, and fibrosis give rise to
o Life Cycle: obstruction of the lymph flow which may give
 Habitat of adult male and female worms in man rise to lymphaginitis, lymph edema, and chyluria
are the lymph vessels and lymph glands  Prolonged obstruction of the lymph glands will
 If both sexes are in the same lymph gland, adult eventually local to marked fibroses, giving rise to
female produces a larvae called microfilariae elephantiasis
 From the lymph vessels, microfilariae will gain  Commonly encountered clinical manifestations
entrance to the peripheral blood circulation are hydrocele, chylocoele, and lymph scrotum
where they may be sucked in the appropriate with accompanying enlargement of the inguinal
mosquito vector during a blood meal and epitochlear lymph nodes and elephantiasis of
 In the mosquito, the microfilariae will develop the scrotum and vulva
into 1st, 2nd, and 3rd larval stage  Genital and pedal enlargements are common
 The 3rd larval stage which are infective will o Diagnosis:
migrate from the thoracid muscles towards the  Infection is diagnosed by blood smear evaluation
mosquito head and proboscis  Microfilariae appear in the peripheral blood
 When it bites, the 3rd larval stage are deposited during the night from 8:00 – 4:00 AM, nocturnal
at the variety of the puncture wound, penetrate  Peak hour to collect is between 10:00 – 2:00 AM
entirely the broken skin as pores to reach the  Simplest method of diagnosis is by making a thick
lymphatic vessel and are filtered into the lymph smear the size of 25 centavo coin (2 thick smear
glands per slide) and use Giemsa stain
 Maturation: 12 – 18 months  In light infection, the Knott’s concentration
 Worm will derive its nourishment from the lymph method may be used
and the adult worm live for about 5 years in the o Epidemiology:
host  Filariasis
shacklen
 56
1. Urban Type – most prevalent in abaca
raising areas
2. Rural Type – away from houses towards
the mountains and hills
 Urban Type
 Mosquito vector is Aedes poecilus breed in
the water, accumulated in the axis of
abaca and banana plants, the mosquito
although a night biter could also bite
during the day
 Rural Type
 Mosquito vector is Anopheles minimus
flavirostris which also the prominent
o Life Cycle:
vector for malaria in the Philippines,
 Same as W. bancrofti
mosquito is a night biter and breeds in
 Maturation: 3 – 9 months before microfilariae
clear running mountain streams
are produced
 In the Philippines, provinces endemic for W.
o Pathology:
bancrofti: Camarines Norte, Camarines Sur,
 Resembles W. bancrofti except that a deformity
Albay, Sorsogon, Quezon, Mindoro, Masbate,
produce in infection is not as severe as
Romblon, Bohol, Samar, Leyte, All provinces in
Bancroftian filariasis
Mindanao, Mt. Province (Bontoc), Sulu, and
 Enlargement of epitochlear, inguinal, and axillary
Palawan
lymph nodes
 Anopheles minimus flavirostris – vector in Mt.
 Non-advanced cases may be asymptomatic or
Province, Sulu and Palawan
have elephantiasis of one or more limbs usually
 Aedes poecilus – vector in the rest of the
below the knee occationally the groin and rarely
province
the scrotum
 Prevalene rate in the areas varies from 4 – 10%
o Diagnosis:
o Treatment, Prevention and Control
 Blood smear examination
 Use of long sleeve shirts and use of mosquito
 Microfilariae has subperiodicity
repellant in exposed skin
 Best time to take blood smear for diagnosis is at
 Diethylcarbamazine (DEC) – a.k.a. Hetrazan – kills
night
the microfilaria, some studies show that the adult
 2 thick smears, the size of a 25 centavo coin,
female are eventually sterilized
prepared on slide and stained the Giemsa
Brugia malayi o Epidemiology:
o CN: Mayan filarial  Only one type of Malayan filariasis in the
o Causing: Malayan filariasis Philippines with subperiodic periodicity
o Causative agent of Malayan filariasis which is similar to  Mosquito vectors: Mansonia bonneae that
bancroftian filariasis breeds in freshwater swamps and Mansonia
o Male: 13 – 22 mm in length uniformis which breeds in ricefields
o Female: 43 – 55 mm in length  These mosquitos are night biters and starts biting
o Adults of Brugia malayi and W. bancrofti is as early as 5:00 PM up to 11:00 pm
indistinguishable  Provinces: Palawan, Quezon, Sulu (Municipality
o Microfilariae – 177 – 230 u of Bongao in Tawi-Tawi), Agusan, and Eastern
o In stained blood smears, they can be seen as being Samar
enclosed in a sheath and having angular curvatures with  In these provinces, W. bancrofti and B. malayi co-
secondary kinks, large excretory cell and with 2 nuclei at exist
the tip of the tail  Common in places with freshwater swamps with
o Location of landmarks are same with W. bancrofti a prevalence rate of more than 3%

shacklen
 57
 The cat is an important reservoir host and may o Male
transmit the infection to man by means of cat-  Well-developed caudal bursa which is kidney
mosquito-man cycle shaped and single lobed
o Treatment, Prevention and Control
 Same as Wuchereria bancrofti

Angiostrongylus cantonensis
o CN: Rat Lungworm
o Causes: Eosinophilic meningoencephalitis
o Nematode parasites of rats
o Discovered by Chen in 1933 in Canton, China
o 1st case – Taiwan, 1944 – Angiostrongylosis
o Adult Worm – Filiform with a length of 17 – 25 u

o Eggs
 Elongated, ovoidal with delicate hyaline shell
 46 – 48 by 68 – 74 u
 Unsegmented or unembryonated when laid by
the female worm into the blood stream

o Female
 Milky white uterine tubules are spirally wound
around the blood-filled intestine and can be seen
through the transparent cuticle as a “barber’s o 1st stage larvae which hatch in the lungs of the rodent
pole” pattern host has a different dorsal minute notch near the tip of
 Posterior end of the tip of the tail has no minute the tail
rejection o 3rd stage larvae – infective stage – presence below the
buccal cavity of two well-developed chitinous rods with
expanded knob like tips of the anterior end
o Life Cycle:
 Adult male and female are in two main
bronchioles of the pulmonary arteries of rat
 Gravid female lays unembryonated eggs into the
blood stream of pulmonary artery
 Eggs are carried by the blood into the smaller
vessels of the lungs
 Eggs become embryonated in 6 days and the 1st
stage larva hatch from the eggs

shacklen
 58
 These larva break through the respiratory tract  In cerebrum and cerebellum, nematodes will be
and migrate up and eventually eliminated with seen in the vascular and perivascular tissues
the feces of the rat  Aggregates of eosinophils monocytes and foreign
 Two intermediate hosts: human and mollusks body giant cells infiltrate around the worm
 1st stage larvae will enter the mollusks that will  Marked tissue necrosis may be seen around the
serve as intermediate host either in the digestive worm
tract (ingestion) or the cuticle (active  Large numbers of charcot-leyden crystals are
penetration) present in the meninges indicating massive
 Mollusks – larvae undergo two molting and response to the parasite
become third stage larvae o Diagnosis:
 This is how the infective stage to rat and man  Difficult to diagnose such infection because the
 These are taken by rats twice and mature in 4 parasite stay primarily in the brain
weeks, enter the wall of cranial venule and travel  In countries where lungworm is endemic in
to the pulmonary artery through the right rodents population, anyone exhibiting brain
ventricle of the heart dyscrasia with moderate eosinophilia counts in
 After 2 weeks, adult female starts laying eggs the CSF are considered as potentially infected
with this parasite
 History of ingestion of the patient with snails,
crabs or leafy vegetables such as lettuce should
be taken into consideration
 No immunologic test available specific for the
parasitic infection
 Upon death of patient suspected with this
infection, it is important to autopsy to make
through gross and microscopic examination of
the brain and spinal cord and to search for the
worms
o Epidemiology:
 This worm was originally described by Chen in
1935 from Rattus norvegicus and R. rattus rattus
in China
 It was reported in 1960 by Nishimurs and Yogori
in the Philippines in domestic rat
 Low prevalence rate of less than 7% in rats
 Intermediate host are Achatina fulica snails and
Garden slugs
 Human cases are reported in Thailand, Taiwan,
Tahiti, etc.
o Pathology:  Man gets parasite by:
 Human angiostrongylosis – characterized by 1. Ingestion of mollusks containing the third
eosinophiic meningoencephalitis stage larvae
 At time of infection/illness, patient may exhibit 2. Ingestion of raw leafy vegetables and
increasing confusion, incoherence, disorientation contaminated with mucus secretions of
and impairment of memory or profound coma the mollusks containing the third stage
 Gross postmortem examination of brain: larva
leptomeningitis, encephalomalacia of the frontal 3. Drinking water contaminated with
and temporal lobes and moderate ventricular infective larvae
dilation

shacklen
 59
4. Ingestion of paratenic hosts such as o Each segment or proglottid is a complete reproductive
freshwater prawn and crabs containing the unit with male and female sex organs
infective larvae o Life cycle of cestodes include:
o Treatment, Prevention, and Control 1. The egg with a hexacanth embryo of
 Thiabendazole – highly effective in controlling oncosphere;
early invasisve stages of parasite 2. The larval stage (cysticercus, cysticercoid larva
 Preventive measures include thorough cooking of or coracidium, procercoid and plerocercoid
prawns and crabs, thorough washing of leafy larva), and;
vegetables and avoidance of ingestion of raw 3. Adult stage
Achatina fulica snails and slugs o All cestodes require an intermediate host although in
 Elimination of snails and slugs intermediate host some species, the DH can serve as IH
and rodent eradication may help present human
Trematodes/Digenetic Flukes
infection
o Have complicated life cycle involving alternation of
generations and hosts
o Usually primary hosts are snails
PHYLUM PLATYHELMINTHES o Most flukes which parasitizes man are also animal
o Flatworms does not only include the parasitic flukes parasites and their non-human vertebrate hosts serve
(trematodes) and tapeworms (cestodes) but also other as reservoirs for human infections
free-living flatworms o Affect various areas of the body
o They are bilaterally symmetrical, compressed dorso-  Circulatory system (blood flukes)
ventrally and has a definite anteroposterior axis
 Intestines (Echinostoma ilocanum)
o All classes of flatworms possess a bilaterally similar
 Liver (Fasciola hepatica)
excretory system, collecting tubules and capillaries
 Lungs (Paragonimus westermani)
which terminate in flame cells
o They vary in size from 1 mm to several centimeter in
o They lack circulatory system
length
o Sexual organs are highly elaborated and complicated
o Organs of attachment are called suckers (oral or ventral
o In most species, the sexes are combined in a single
suckers)
organism (hermaphrodite or monoecious), while in
o Alimentary canal is present but incomplete, anus is
some group, sexes are found in separate orgasnism
absent
(diecious)
o Esophagus bifurcates in front of the ventral sucker into
o The life cycle may involve a single obligatory host (some
a pair of blind intestinal caeca which maybe simple or
tapeworms like Hymenolepis nana) or may require two
branched or may reunite to form a single caecum
or more consecutive hosts (some trematodes like
o Reproductive system is highly developed and complete
Paragonimus westermani)
in each individual
o Two classes of utmost importance under Phylum
o They are oviparous and the eggs are operculated except
Platyhelminthes are (1) Class Cestoidea and (2) Class
for schistosomes and can develop in water
Trematoda
o Life cycle of trematodes includes:
Cestodes/Tapeworms 1. The egg stage
o Inhabit the intestinal tract of vertebrates while the larva 2. The larval stage (miracidium, sporocyst, redia,
parasitizes the tissues of vertebrates and invertebrates cercaria, metacercaria)
o Adult cestodes are usually ribbon or tapelike segmented 3. The adult
parasites varying in sizes from a few millimeter to o DH is generally human which harbors the adult worm
several meters o IH is usually a freshwater snail or mollusk that harbors
o Body consists of 3 distinct regions: the larval stage and sometimes a secondary IH (fish,
1. Head or scolex as holdfast organs crab or another snail) is required for encystment.
2. Neck, which is the region of growth o Definitions:
3. Strobili or body, consist of series of segments  Definitive Host:
or proglottids  One in which a parasite reaches the adult
or sexually mature stage
shacklen
 60
The host in which the infectious agent in 2. Schistiosoma mansoni – coexist with (1) in parts
question undergoes the adult and asexual of Africa, and endemic in some countries of
stage of its reproduction South America, the West Indies, and Puerto Rico
 Called also final host 3. Schistosoma japonicum – endemic in the
 Intermediate Host Philippines as well as China, Sulawesi in
 A host in which a parasite passes one or Indonesia, Japan and Taiwan
more of its asexual stages o Morphology:
 Usually designated first and second, if o Adult flukes
there is more than one  of the trematodes, only schistosomes have
 One in which larval or developmental separate sexes
stages occur o Male
 Male is shorter and more sturdy individual with
Class Trematoda (Flukes) length from 1.2 cm – 1.75 cm by 0.05 mm in
A. Species which inhabit the portal blood stream of
breadth
vertebrates
 It has both an oral and ventral suckers
1. Schistosoma japonicum
 Behind the ventral sucker and extending to the
2. Schistosoma mansoni
posterior end is a groove called gynecophoral
3. Schistosoma haematobium
canal, this is where the female is held by the male
B. Species which inhabit the liver of vertebrates
during most of their life
1. Fasciola hepatica
2. Clonorchis sinensis
3. Opistorchis felineus
C. Species which inhabit the small intestine of vertebrates
1. Fasciolopsis buski
2. Echinostoma ilocanum
3. Heterophyid group
D. Species which inhabit the lungs of vertebrates
1. Paragonimus westermani

Schistosoma japonicum
o CN: Oriental Blood Fluke
o Causing: Schistosomiasis japonica or Oriental
Schistosomiasis
o Female
o They are digenetic trematodes inhabiting the veins of
 Female is longer and more slender than the male
their vertebrate host
measuring 2 – 3 cm by 0.3 mm, oral and ventral
o IH of this trematodes are snails
suckers are also seen
o There are 10 species reported to parasitize man but
only 3 are of major medical importance in relation to
their distribution
1. Schistosoma japonicum
2. Schistosoma mansoni – this parasitizes the
branches of portal vein causing primary hepato-
intestinal schistosomiasis
3. Schistosoma haematobium – inhabits the veins of
the urinary bladder causing schistosomiasis
o The three species have different geographic distribution
depending on their IH, the snail:
1. Schistosoma haematobium – endemic in the
Middle East, Africa, and Southern tip of Europe

shacklen
 61
o Ovum  Oral and ventral suckers are developed
 ova of Schistosoma japonicum measures from 70
– 90 u by 50 – 65 u and have a small knoblike
projection or spine on one side
 Depending on the stage of development at the
time they passed out with the feces, one may
find them from multicellular stage to full
embryonation with a developed miracidium
within the shell *spine – used to diff. ovum

o Life Cycle
 Females deposit eggs in the terminal brances or
venules in the walls of intesines
 The females empties its uterus 10 – 20 times a
day to deposit egg in the tissues
 Maturation of the eggs with formation of a
miracidium require 10 – 12 days
o Miracidium
 Eggs reach the intestinal lumen through
 ciliated, pyriform in shape with a primitive gut, a
ulcerations in the intestinal wall
pair of penetration glands, two pairs of flame
 Mature eggs that pass out with the feces may
cells and germ balls as its posterior end
reach waters where Oncomelania quadrasi are
 Intramolluscan stages – the miracidian becomes
present
the first generation or mother sporocyst soon
 Eggs hatches with escape of the miracidium from
after penetration to its snail host
the egg shell and eventually enters the snail host
 Essentially a sac-like organism with germ balls
 Miracidium develop into the mother sporocyst
 Daughter sporocyst contain cercariae
which give rise to daughter or second generation
sporocyst where cercaria develop
 Cercaria will leave the snail to live in the water
until a mammalian host is exposed
 Usual mode of infection is by skin penetration
 Cercaria becomes transformed into
schistosomule after skin penetration
 Migrates through the circulation to eventually
reach the portal circulation where it matures
 Schistosoma japonicum becomes sexually mature
as early as 24 days after penetration
o Cercariae
 when discharged from the snail is typically
forked, with body and tail of approximately equal
length from 100 – 150 u breadth of tail is 1/3 of
that body
 Fork of the tail situated at the posterior third of
the tail

shacklen
 62
 Some of the eggs are retained where they are
deposited while others are carried possibly with
the portal circulation to be filtered in the
intrahepatic branches
 In both situations, granuloma are formed around
the eggs and this is both protective and harmful
 Enlargement of granuloma will cause tissue
damage and its resolution with sequestration of
the area will lead to fibrosis
 Fibrosis in the intrahepatic portal vessels
eventually lead to portal hypertension that
includes congestion and enlargement of spleen,
ascites, and abdominal enlargement
 Significant number of cases die of hemorrhage
due to ruptured esophageal varices
 In many infections, eggs maybe deposited in
areas not drained by the portaly system including
the lungs and not in frequently the brain
 Essential pathology is also granuloma formation
o Pathology: in the brain, granuloma may give rise to a
 Its pathology is primarily dependent on host number of sensory and motor disturbances while
reaction to the deposition of eggs in the tissues in the lungs, obstruction to the pulmonary …
although lesions and clinical manifestations due  Many infections however are asymptomatic
to skin penetration of the cercariae and due to o Diagnosis:
migrating schistosomules has been described.  Demonstration of ova from stools by DFS or by
 Some forms of dermatitis and hypersensitivity concentration technique
reactions at the site of cercarial penetration and  Demonstration of ova from rectal or liver
other portions of the skin biopsies
 But this reactions are very rarely seen among  Immunodiagnostic test to demonstrate Ab more
natives of endemic areas commonly the circumoval-precipitin test
 Some form of pneumonitis has been reported o Treatment
associated with the migration of schistosomules  Praziquantel in dose of 40 – 50 mg/kilo as a single
through the pulmonary circulations dose or 25 mg/kilo in two doses or 3 doses of 20
 As the eggs are deposited, it will accumulate in mg/kilo given every 4 hours
the mucosa and submucosa of the intestine  Regression of manifestation at hepatosplenic
 Endothelial irritation, some lytic and irritant disease follows after treatment
secretions of the eggs, occlusion of the terminal o Epidemiology, Prevention, and Control
venules and hypermotility of the parasitized  Distribution of Schistosoma japonicum in the
segment of the intestines lead to the escape of Philippines follow that of the snail intermediate
the eggs from blood vessels and production of host, Oncomelania quadrasi
ulcers and in the mucosa  It is found in Sorsogon, Oriental Mindoro, Samar,
 Production of ulcers is responsible for the Leyte, Bohol, and all the provinces of Mindanaa
diarrhea or dysentery seen in early except Oriental Misamis
schistosomiasis  This areas have rainfall throughout the year
 Majority of the eggs are deposited in the which favors breeding of the snail host
intestine and in branches of portal vein where it  Prevalence ranges from 10% as high as 60%
is not possible to cause ulcerations and to reach  Transmission require contact of man and other
the lumen of the intestines mammalian host, with waste water at breeding
sites from the snail host
shacklen
 63
 In endemic areas, the water which support the  Flattened prominent operculum
snail population are also utilized for occupational,  Opposite the operculum is a thickened
domestic and recreational needs therefore the abopercular portion
ruling is that amount of water contact dictated by  80 – 188 by 48 – 60 u
activities of a particular population group now  Immature when released from the adult worm
determines prevalence
o Prevention:
 Avoiding contact of direct skin to snail infected
water which is somewhat impractical for farmers
 Control measures include proper disposal of
human feces including control of domestic
animals since they may be infected animals and
serve as reservoirs of infection
 Snail control by use of molluscicides and
ecological methods to radically change the
environment care effective but expensive and
require prolonged application o Microcercous cercaria
 Round
Paragonimus westermani
 Measures average of 381 – 457 u in diameter
o CN: Oriental lung fluke
o Life Cycle:
o Causing: Paragonimiasis, Pulmonary Distomiasis or
Endemic Hemoptysis  Adult worms in lungs provokes a granulomatous
o Adult worms: reaction around it, which gradually develops into
a fibrotic capsulation or cyst
 Reddish brown in color
 Adult worm are found in pairs of threes (3) in
 7 – 12 mm in length, 4 – 6 mm in width, 3.5 – 5
these capsule which have openings to allow eggs
mm in thickness
to escape with lung exudates into the respiratory
 Rounded anteriorly and somewhat tapering
tract where they are moved up and down by the
posteriorly
ciliary epithelium
 Tegument is covered with single spaced spines
 Arriving at the pharynx, they are either coughed
 Testes are deeply lobed and situated opposite
up or swallowed back into the alimentary canal
each other almost midway between the ventral
to be voided later with the host feces
sucker and the posterior border of the body
 Immature eggs then embryonates in the water, in
 Ovary is located posterior to the ventral sucker
moist soil or leached feces
has six (6) long unbrached lobes
 Miracidium will later develop within 2 – 7 weeks
 Vitellaria are extensively branched
which subsequently pushes the operculum and
sums freely in search for the appropriate snail
host
 In the Philippines, the first intermediate host will
be Brotia asperata, one of the many snail species
for P. westermani
 Inside the snail, miracidium passes through one
sporocyst and two redial stages of development:
 First IH:
 Antemelania asperata
 Antemelania dactylus
o Egg (former name: Brotia asperata)
 Golden brown in color
 Second IH:
 Oval in shape
 Mountain crab
shacklen
 64
 Sundathelphusa philippina
(former name: Parathelphusa
grapsoides)

 Cercaria will emerge from the snail to seek out

and infect the second IH which is the mountain
crab, Sundathelphusa philippina
 The cercaria will penetrate through the soil parts
of the crustacean and encyst as a metacercaria in
the gills, legs, body muscles of the viscera
 The crab may also become infected by eating
infected snails, the definitive host become
infected by ingestion of raw or insufficiently
cooked infected crab
 The metacercaria excysts in the duodenum and
the juvenile parasite traverse through the
intestinal wall into peritoneal cavity where it
wanders about and embeds itself in the
abdominal wall for several days
 The parasite then returns to the colon, migrates o Dx:
through the diaphragm to the pleural cavity  Based on the detection of characteristic eggs in
where it penetrates the lungs and develops into the stool or sputum
adulthood  Sputum, treatment with 10 – 30 % HCl followed
 The parasite are known to persist in humans for by sedimentation and washing is the method of
as long as 20 years or more choice
 Reservoir host of this parasite include dogs, cats,  Repetition maybe necessary to finally detect P.
field rats, and other rodents westermani eggs in the tuberculosis X-ray
 Hemoptysis results from destruction of blood examination
vessels running through the lung capsules that o Epidemiology:
enclose the worm  P. westermani is found in countries of East and
 Other than hemoptysis, patient will also Southeast Asia and due to its spotty distribution
experience fever, sweating, chest and back pains and low prevalence rate in this endemic foci; this
 Cough which are also symptoms of tuberculosis is not considered a public health in the
making the clinicians to misdiagnose it as Philippines
tuberculosis  The known endemic foci: Camarines, Sorsogon,
 During migration to the lungs, young parasite Mindoro, Samar, Leyte, and some provinces in
may settle down or settle other organs and Mindanao
tissues  Prevalence rate in this endemic areas is less than
 Abscess surrounding the mature or immature 5%
worm may be found in extrapulmonary site like  Transmission is by consumption of infected crabs
the abdominal wall, muscular tissues, liver, and also by eating meat of paratenic hosts that
mesenteric lymph nodes, under the skin, spinal harbor immature parasites
cord or brain o Treatment, Prevention, Control
 Emetine hydrochloride, bithionol and
praziquantel are the drug of choice for
paragonimiasis
 Can be prevented by eating sufficiently cooked
crabs and meat

shacklen
 65
 In preparing the crabs for cooking, take care not o Miracidium
to contaminate the kitchen utensils for there  130 by 28 u
might be metacercariae that can attach to it  Eventually forms within the egg shell
 Health education to change the food habits of
the population can also help control the parasite
infection

Fasciola hepatica
o CN: Sheep Liver Fluke
o Sheep liver rot and Fasciolasis hepatica
o Infects herbivorous mammals specially ruminants and is
of economic importance in livestock-raising countries,
human fasciolosis is occasional
o Adult worm:
 Larger, broad, and flat body o Gymnocephalus Cercaria
 20 – 50 mm in length, 6 – 12 mm in width (near  Has a body that measures 280 – 350 u in length
the midbody)  A simple tail that could be as long as 700 u
 Cephalic cone is located anteriorly forming a  This possesses a large cystogenous glands, the
conical projection which together with the secretion of which allow the cercaria to encyst
shoulders, the marked widening at the base at eh and to develop into metacercaria which is
cone serves as the distinguishing feature of this infective stage to DH
parasite
 Posterior end of the parasite is broadly pointed, it
has two relatively small suckers that are located
at the oral sucker and the ventral sucker
 Reproductive organs and intestinal ceca are
highly branched

o Fasciola gigantica
 A related species that infects the same host, but
larger but more lanceolate than F. hepatica
 It has a shorter cephalic cone, less developed
shoulders, a larger ventral sucker and the
intestinal ceca are more branched specially
o Eggs toward the midline of the body
 Large, ovoid, operculated and brownish yellowish  Eggs are also larger than the former species
in color o Life Cycle
 140 – 180 by 80 -100 u in size  Hermaphroditic adult worm inhabits the biliary
 Released from the adult worm still immature that passages in the liver
contains large unsegmented mass of yolk cells  Immature eggs produced are carried by the bile
into the intestine to be mixed and voided with
the feces
 Eggs mature in water
 Miracidium will develop within 9 – 15 days,
colder environment retards its development
 Miracidium escapes through the operculum of
the shell and seek and infect suitable pulmonate

shacklen
 66
snails belonging to Family Lymnaeidae, this will 1. Acute – patient experiences dyspepsia and
serve as the first IH (Lymnaea philippinensis and occasionally symptoms such as
Lymnaea swinhoei) prostration, anorexia, sweating, myalgias,
 Inside the snail, parasite develops into generation joint and bone pains, violent headaches,
of sporocysts and one or two generations of nausea, vomiting, and urticarial
rediae and then cercariae are finally formed 2. Invasive – this corresponds to the period
 Cercariae leave the snail and attach by way of during which the parasite migrated from
this and sucker on surfaces of aquatic vegetation the intestine to the liver and the latent or
(watercress), where they encyst into chronic phase which corresponds to the
metacercaria period when the parasite has settled in the
 These plants serve as the secondary IH bile duct
 Ipomea obscura or kangkong has been suggested  Sudden onset of high fever, enlargement of the
to play such a role for this parasite liver and marked eosinophilia form a triad of
 Cercaria can also encyst freely in the water symptoms of diagnostic importance
 The DH can become infected either by ingesting  The damage caused by the larvae can the
raw or inadequately cooked plants or drinking intestinal wall during its migration from the
water containing metacercariae duodenum to the liver is not significant, however,
 Upon ingestion, metacercarians excyst in serious traumatic and necrotic lesions are caused
duodenum, liberating the juvenile flukes which by the juvenile parasites as it burrows through
penetrates through the intestinal wall into the the liver parenchyma
peritoneal cavity  Severity of the injury depends on the number of
 In the peritoneal cavity, it will wander over the metacercariae that were initially ingested by the
viscera until it reaches the liver capsule host
 Then it burrows through the liver parenchyma,  Healing and possibly regeneration occur after the
feeding and growing until it becomes sexually parasite has reached the bile duct
mature in 3 – 4 months  The symptoms are seen during the chronic phase
 Adult worm can survive for as long as 11 years in of the infection and usually obstructive or
DH inflammatory in nature
 Adult worm causes obstruction and provokes
inflammation on the epithelium of the bile duct,
which develop into fibrosis
 Thickened fibrosis duct causes less bile passed
and leads to build up of back pressure
 In heavy infection, atrophy of liver parenchyma
and concomitant periductal cirrhosis may arise
 Walls of bile duct may become eroded allowing
more worms to reenter the liver parenchyma and
large abscess formation
 During migration, from the intestine to the liver,
parasite may wander or carried by blood (after
penetrating a blood vessel) to ectopic sites as
lungs, subcutaneous tissues, brain and the orbit
and leads to abscesses fibrotic lesion
 Pharyngeal fascioliasis or halzuon (suffocation)
has been reported in Mediterranean countries
from ingestion of raw liver containing parasites
o Pathology attached to the pharyngeal mucosa causing
 Fascioliasis in human can be classified into two asphyxiation
phases:
shacklen
 67
 Halzuon, has been attributed to another liver (one behind the other) in the posterior third of
fluke, Dicrocoelium dendriticum, pentastomid the body
larvae and leeches  The pretesticular ovary is relatively small and has
o Diagnosis three lobes
 Demo of OVUM from stool  Uterus ascends in tightly packed loops
 Eggs are indistinguishable from that of  Intestinal ceca are simple, extending blindly to
Fasciolopsis buski the endemicity of the parasite the posterior end
in the vicinity where the patient comes from
should be known
 Fasciola eggs could also be present in stools of
individuals who have earlier consumed infected
animal liver (false fascioliasis)
 This could be ruled out by keeping the patient on
a liver-free diet for 3 or more days before
another stool examination is done
 Immunodiagnostic test involving techniques as
complement fixation, precipitin reaction,
immunoelectrophoresis,
counterimmunoelectrophoresis, and none of this
however has been adapted for routinary use yet
o Egg
o Epidemiology
 Yellowish brown and measures 26 – 30 by 15 -17
 Fasciola hepatica is a worldwide distributed
u
parasite
 Operculum which is distinctively convex, fits into
 Infections to local cattle, carabaos, sheep, and
the broad rims of the eggshell
goats occur although F. gigantica is probably the
 At the abopercular end, there is a small
more prevalent species infecting cattle and
protuberance
carabaos
 Inside the egg is a well-developed miracidium
 Human infection is very low
that has asymmetrical features
o Treatment, Prevention, and Control
 Emetine hydrochloride, bithionol,
hexachloroparaxylene, and chloroquine
 Prevention include washing and proper cooking
at vegetables and boiling drinking water in areas
where infection is endemic
 Elimination of the snail as IH and also the
reservoir host by chemotherapy

Clonorchis sinensis
o CN: Chinese Liver Fluke, Oriental Liver Fluke
o Clonorchiasis
o Adult Worm
 Inhabits the bile ducts of fish-eating mammals o Lophocercous Cercaria
 It is flat, transparent, rounded posteriorly and  Brownish in color
attenuated anteriorly  Body that measres 250 -275 u long and
 Measure 8 – 25 mm in length, 1.5 – 5 mm in dorsoventrally keeled tail that measures 650 –
width and its oral sucker is larger than ventral 750 u in length
sucker o Metacercaria
 It is hermaphroditic and has two (2) deeply  Measures 125 – 150 u
branched testes that are arranged in tandem

shacklen
 68
 Young fluke moves toward the ampulla of vater
and passes through it on its way to the liver
 Young flukes can also actively migrate from
duodenum up through the common bile duct
into the liver
 After reaching the bile passages, the worm
matures and begins to produce eggs in about a
month
 Entire life cycle can be accomplished in 3 months
and will have a life span of 15 – 20 year
 Aside from man, animal reservoir hosts include
dogs and cats

o Life Cycle
 Adult worm attaches itself to the mucosa of the
bile duct by its suckers and embed themselves in
sticky mucus without causing permanent
ulceration to the epithelial lining
 Can be found in the pancreatic duct or gall
bladder
 Ingests tissue fluids, red cells and mucus
 Eggs are released from the worm in its mature
state (containing viable miracidium), it has been
reported that the adult worm releases egg to as
many as 4,000 eggs per day
 Eggs are released to the environment by way of
feces
 Miracidium are released only after having been
ingested by the first IH which is a snail
o Pathology
 Common species is Parafossarulus manchouricus,
 With parasites that inhabit the bile ducts
snails that live in fish culture ponds, lakes,
provokes intense proliferation of the biliary
swamps, sluggish part of river or small streams
epithelium
also play this role
 Walls of the ducts becomes thickened and the
 Inside the snail, miracidium transform into a
lumen dilated 2 – 3 times their normal diameter,
sporocyst within 4 hours
cause of this hyperplasia is still unknown
 Sporocyst produces rediae in about 17 days and
 Periductal fibrosis subsequently ensues as
each redia in turn produces 5 – 50 cercariae that
epithelial proliferation subsides
are released into the surrounding water
 Neoplasia leading to cholangiocarcinoma of the
 Upon contact with the second IH, a fish, cercariae
liver has been attached to clonorchiasis
attaches itself to the epithelium with its suckers,
 The worms can also be found in the pancreatic
casts off its tail, bores through the skin and
ducts and in the gall bladder
encyst becoming a metacercariae under a scale
 Clonorchis eggs have been associated with the
or in a muscle, majority of fish species belonging
formation of gall stones
to Family Cyprinidae
 The patient will experience symptoms as fatigue,
 When infected fish is eaten by the mammalian
weakness, weight loss, abdominal distress, and
definitive host, metacercariae excyst in the
altered appetitie
duodenum
 Also, there will be fever, enlargement and
tenderness of the liver, and eosinophilia
shacklen
 69
o Diagnosis
 Demonstration of Clonorchis EGG by fecalysis is a
specific diagnosis for this parasitic infection
 Close similarities among eggs of Clonorchis,
Opistorchis, and Heterophyid flukes resulting to
misdiagnosis of either species
o Epidemiology
 Parasitic infection is prevalent in Mainland China,
Taiwan, Hongkong, Korea, Japan, and Vietnam
 Cases in the Philippines have only been reported
in Chinese immigrants and at present no
evidence exists as to its endemicity in the country
 Immunodiagnostic tests are also developed
 Liver scan is also useful
 Transmission is by consumption of infected raw
fish, one main reason and prevalence among
higher and older age group (30 – 50) o Eggs
 Also possible by ingestion of infected fish that  Yellowish-brown, ovoid and smaller than C.
have already been either frozen, salted, pickled, sinensis
dried or smoked  Measures 30 by 11 u
 The metacercaria can apparently withstand the  It has an operculum that sits on the thickened
different food processing techniques rim of the eggshell
o Treatmen, Prevention, and Control  A minute tubercular thickening is likewise found
 Praziquantel is the drug of choice in the abopercular end
 Infection can be prevented by through cooking of  When released from an adult worm, a fully
fish, change the eating habits of the population developed miracidium is present within the
 Also with stopping the seeding the fish culture eggshell
ponds with human feces

Opisthorchis felineus
o CN: Cat Liver fluke
o Opisthorchiasis felineus
o Parasite infects several species of fish-eating mammals
and lives in the biliary and pancreatic pancreas
o Adult Worm
 Reddish yellow in color
 7 – 12 mm in length, 1.5 – 3 mm in width
 Arrangement of internal organs resembles that of
Clonorchis sinensis
 Testes are lobate and are arranged obliquely in
tandem o Lophocercous Cercaria
 It has two suckers, the oval and ventral suckers  Has a body that is 132 – 172 u long and a tail that
 It has a blind digestive system, the only opening measures 440 – 500 u in length
is the mouth; it has no anus  Flame cell pattern in the cercaria differentiates
this species from C. sinensis
o Opisthorchis viverrini
 Another species closely related that is infective to
man
 This differs from Opisthorchis felineus in that:
shacklen
 70
 The ovary and testes are nearer to each that will result in the dilation of the bile ducts,
other thickening of the duct walls and eventually
 Both of which are more deeply lobulated fibrosis
 Vitellaria are aggregated into clusters and  Its clinical involvement will depend largely on
the esophagus is elongated burden by the worm and duration of the
 Differentiating the eggs of two is quite difficult infection
o Life Cycle  Moderate infection s harboring several hundreds
 Its life cycle parallels that of Clonorchis sinensis to a thousand worms will cause enlargement of
 Eggs that contains the viable miracidium is the liver and passive congestion of the spleen
ingested by the only known first IH which is a with icterus and local eosinophilia in the wall of
hydrobiid snail Bithynia leachi the bile duct
 Inside the snail, the parasite will undergo through  Heavy infections, worms can be found in the
the sporocyst and redial stages of development pancreas and the gall bladder, and the patient
 Cercaria will emerge from the two (2) redia in will suffer digestive disturbances
two (2) months after infection  Those who harbors the O. viverrini infection have
 The cercaria will attach itself to and penetrate high incidence of diarrhea, flatulence after a
the skin of cyprinoid fishes that will serve as the meal, and pain over the liver area, bile stones
second IH may formed surrounding the parasite eggs
 Metacercaria excysts in the duodenum then the  Opisthorchiasis has been linked to carcinoma of
young fluke will migrate through the ampulla of the bile duct and the liver
vater to the distal bile passages where they o Diagnosis
mature in 3 – 4 weeks, entire life cycle is  Detection of typical EGGS in stool
completed in a minimum of 4 months o Epidemiology
 Opisthorchis viverrini, its life cycle is similar with  O. felineus is found in many countries in Europe,
Opisthorchis felineus, snails that belong to Genus Turkey, USSR, Korea, Japan, Vietnam, and India
Bithynia will serve as the first IH and cyprinoid  In the Philippines, only one (1) case of O. felineus
fishes as the second IH has been reported in a Filipino, whereas
Opisthorchis eggs have been detected in stools of
many patients
 Cat infections have also been confirmed
 Geographical distribution of this parasite in the
Philippines has yet to be confirmed
 O. viverrini is found in Thailand, Laos, and
Malaysia
 Its transmission is mainly by consumption of
infected raw fish however the possibility that
viable metacercaria may exist in decomposing
fish could be ingested by drinking water
containing them
 Also by ingestion of infected processed fish
 Reservoir host would include dogs, cats, rats,
foxes, beavers, rabbits, seal, and lion
o Treatment, Prevention, and Control
 Praziquantel is a safe and effective drug against
these two parasites
 Its prevention and control is the same as those
o Pathology with chlonorchis
 The parasite present in the bile duct will initiate
proliferative changes of the biliary epithelium
shacklen
 71
Fasciolopsis buski  adult worm lives in the duodenum attached to
o Common name: Giant Intestinal Fluke producing the intestinal mucosa with its suckers, each adult
Fasciolopsiasis produces and average of 16,000 eggs per day
o Large hermaphroditic digenetic fluke is an intestinal  immature eggs is voided together with the feces
parasite of humans and pigs into water where it undergoes further
o Adult worm development that give rise to a miracidium 3-7
 Elongated, oval in shape and its size varies from weeks after
20-75 mm in length , 8-20 mm in width and from  miracidium released from the egg must infect
0.5-3 mm in thickness small planorbid snail that belongs to either Genus
 Does not have a cephalic cone and its Segmentina or Hippeutis, this will serve as the
unbranched intestinal ceca reach close to the first intermediate host of the parasite
posterior end  inside the snail, miracidium transforms into a
 Testes are highly branched, arranged in tandem sporocyst that give rise to two generations of
in the posterior half of the body rediae
 cercaria will leave the daughter rediae and
continue its development in the tissue of the
snail, 7 weeks after infection, cercaria emerge
from the snail
 cercaria swim actively in water and finally attach
themselves and encyst as metacercaria on
surfaces of fruits, bulbs and stems of various
aquatic plants such as caltrop (Trapa bircornis),
water chestnut (Eliocharis tuberosa), water
morning glory (Ipomoea aquatica) and lotus
(Nymphaea lotus)
 these plants will serve as secondary intermediate
o Eggs host of the parasite
 Ellipsoidal, rounded at both ends and measures  metacercaria are ingested when these plants are
130-140 by 80-85u eaten or when the hull or skin of the fruits of
 It has a thin shell and a delicate operculum these infected plants are peeled off between the
 The eggs resembles that of Fasciola hepatica teeth
 aside from humans , pigs are the only effective
definitive host
 metacercaia excyst in the duodenum and attach
themselves to the intestinal wall where they
become sexyally mature in about 3 months

o Cercaria
 has a body that measures on the average 195u in
length and a tail that is about 500u long
o Metacercaria Cyst
 cyst found on the surface of plants is large and
measures on average 3.9 by 3.1 mm
o Life Cycle

shacklen
 72
harbor fewer worms and the worms produce
fewer eggs
o Treatment, Prevention and Control
 hexylresorcinol, tetrachloroethylene and
praziquantel are successful drugs
 in controlling the infection, pollution of swamps
or ponds where the aquatic plants are cultivated
with untreated human or pig feces should be
stopped
 metacercaria are very sensitive to dryness,
avoiding soaking the fruits of these plants in
water and prolonging the time between harvest
and consumption can prevent infection
 boiling the fruit of these plants or washing them
in running water to get rid of free metacercaria
can also help in preventing infection

o Pathology Echinostoma ilocanum

 pathological changes caused by this parasites are o Common name: Garrisons Fluke causing
traumatic, obstructive and toxic Echinostomiasis
 inflammation and ulceration occur at the site of o there are 11 species of flukes belonging to Family
attachment Echinostomatidae that infects human and of these only
 traumatic effect may produce increase in mucus one species confirmed endemic in the Philippines
secretion and minimal bleeding o Adult Worm
 gland abscesses are occasionally formed in the  inhabits the small intestine
mucosa  reddish gray in color and measures 2.5-6.5mm in
 in heavy infections, the worms may cause partial length, 1.-1.35mm in width
intestinal obstruction  tegument is covered with plaquelike scales
 intoxication results from the absorption of the  anterior end is provided with a circumoral disk,
metabolites of the worms and the patient surrounded with a crown of 49-51 spines
experiences generalized toxic and allergic  oral sucker lies in the center of the disk
symptoms such as edema in the face, the  ventral sucker is located in the anterior fifth of
abdominal wall and lower limbs the body
 profound intoxication can result to death  testes are deeply lobed and are arranged in
o Diagnosis tandem, ovary is located in front of the testes
 demonstration of eggs in stool but do not forget
to that the eggs of F. buski morphologically
resembles that of F. hepatica
o Epidemiology
 Fasciolopsiasis is prevalent in countries of
Southeast Asia, including Vietnam, Laos, Thailand
and Indonesia, India, Bangladesh, Mainland
China, Taiwan, and Korea
 at present there is no evidence of endemicity of
this parasite in the Philippines
 pigs were also not reported to have been
infected with F. buski o Eggs
 in many endemic areas, pigs are the only  straw colored, operculated, ovoid and measures
significant reservoir host of this parasite, they 83-116 by 58-69u

shacklen
 73
 immature when passed out with the feces
 it is morphologically similar to eggs of Fasciola
and Fasciolopsis except that it is slightly smaller

o Cercaria
 has a simple tail and a body that resembles in
miniature form that of the adult worm
o Pathology
 spination in the cirumoral disk or head collar is
 inflammation will occur at the site of attachment
similar to that in the adult worm
of the worm, on the intestinal wall
 other common Echinostome species found in
 in heavy infections, diarrhea sometimes bloody
other countries are E. malayum, E. hortense, E.
and abdominal pain may also develop
lindoense and E. malayanum was recently found
 the absorption of the metabolites of the worms
to be in the Philippines
may result in general intoxication
o Life Cycle
o Diagnosis
 adult worm lives in the small intestine and
 demonstration of the egg in the stool by fecalysis
produces immature eggs that is voided together
o Epidemiology
with the feces
 infection of this parasite is prevalent in Northern
 within the eggshell,.the larva develops into
Luzon, Leyte, Samar and Mindanao
miracidium in 6-15 days
 survey shows that it is present also in rats and
 miracidium that hatches from this eggs infects
this serves as an important reservoir host of the
two known species of Planorbid snails, Gyraulus
parasite
convexiusculus and Hippeutis umbilicalis, in
 it is also found in Indonesia, India, China and
which they develop into mother and daughter
Thailand
rediae
 acquiring infection of this parasite is attributed to
 cercaria emerge from the snails 42-50 days after
the habit of eating raw snails that serves as the
to infect the second intermediated host which is
second intermediate host of the parasite
also a snail, Pila luzonica or “kuhol”
o Treatment, Prevention and Control
 cercaria will then transform into metacercariae,
 hexylresorcinol, tetrachloroethylene and
and when the infected snail is ingested, the
praziquantel are the drugs of choice
metacercariae excyst in the duodenum
 infection can be prevented by thorough cooking
 the juvenile flukes attaches itself to the intestinal
of snails that serve as the second intermediate
wall and develop into adult worm
host of this parasite

Family Heterophyidae
o Under this family includes about 14 flukes that infect
humans
o More common species are the following:
 Heterophyes heterophyes
 Metagonimus yokogawai
 Haplorchis taichui
shacklen
 74
 Haplorchis yokogawai o Life Cycle
o Flukes  Adult worm will inhabit the small intestine of the
 Are elongated, oval or pyriform in shape and DH
small in size  Large number of eggs are produced and passed
 Measures less than 2 mm in length out into the environment by the with the feces
 Tegument is covered with fine scale-like spines  Eggs will be ingested by snails as the first IH
 In some species, genital sucker is present near  In the Philippines, snail IH of H. taichui and
the ventral sucker and one or two testes are Procerovum calderoni are the operculate
located at the posterior end brackish water snails Melania juncea and Thiara
riquetti, respectively
 The other snail IH species for other heterophyid
parasite have not yet been identified
 Inside the snail, parasite transforms into a
sporocyst which eventually will develop into one
or two generations of rediae that will give rise to
a cercariae
 Cercariae will emerge from the snail and upon
contact with the suitable fish species that serve
as the second IH, encyst as metacercaria on or
under scales, in muscle, fins, tails or gills
 Metacercaria are more frequently found in the
muscles at the base of the fins
 The definitive host become infected after
ingesting viable metacercaria present in raw or
undercooked fish
 Metacercaria in raw or undercooked fish
 Metacercaria excyst in the duodenum liberating a
young larva that attaches itself to the intestinal
o Eggs wall
 Light brown in color, ovoid in shape, operculated  Larva subsequently matures into adult fluke
and minute which has a short lifespan of less than a year
 Measures 20 – 30 by 15 – 17 u
 A fully developed miracidium is already present
within the egg when it is deposited by the adult
worm
 Internal organs of miracidium are arranged in
bilateral symmetry

shacklen
 75
o Pathology  Infection can be prevented by avoiding ingestion
 Adult worm will provoke local inflammation at of raw or inadequately cooked fish
the site of attachment that cause damage to the  Domestic animals should be prevented from
intestinal mucosa eating
 Patient may experience colicky pains and mucus
diarrhea Cestoidea Tapeworms
 Heterophyid worms have the tendency to burrow Class Cestoidea (Tapeworms)
deep into the intestinal wall where they become Subclass: Cestoda
trapped and die Order: Pseudophyllidea – Scolex spatulate with bothria
1. Diphyllobothrium latum
 The eggs of the degenerating flukes are spilled
Order: Cyclophyllidea – Scolex globular with 4 cuplike
into the blood sttrea and lymphatics by which
suckers
they are carried into the different parts of the
A. Species Which Require Vertebrate Intermediate
body
Hosts
 Eggs will be filtered in the heart muscle
1. Taenia solium
provoking reactions that leads to cardiac failure
2. Taenia saginata
resembling that of cardiac beri-beri
B. Species Which Require Invertebrate Intermediate
 If eggs are deposited in the brain may result to
Hosts
fatal cerebral hemorrhage and when in the spinal
1. Dipylidium caninum
cord may result in loss of motor and sensory
2. Hymenolepis diminuta
functions at the levels where the lesions are
C. Species Which May Or May Not Require Intermediate
located
Host
o Diagnosis
1. Hymenolepis nana
 Laboratory diagnosis is by recovery of EGGS in
D. Species Which Infect Man In Their Larval Stage
the stool
1. Echinococcus granulosus
 However it is difficult to differentiate
2. Echninococcus multiocularis
heterophyid eggs from Clonorchis and
3. Taenia solium
Opisthorchis
 As well as the differentiation of each heterophyid Taenia solium
egg is very difficult to compare o Common name: Pork Tapeworm producing Taeniasis
 In autopsy investigation, cardiac heterophydiasis solium or Pork Tapeworm Infection
may be mistaken for cardiac beri-beri because it o Causative agent for taeniasis solium (infection with the
will resemble MI such as thickening of the heart adult pork tapeworm) in man and fro human
muscles especially at the right side cysticercosis (infection with the larval stage of the
 However under tissue examination will reveal the parasite known as the larval taeniasis)
presence of Heterophyid parasite eggs o Man becomes the intermediate host of the parasite (t.
o Epidemiology Solium)
 Widely distributed o Infection is brought by ingestion of raw or insufficiently
 It is found together with the snails found in fresh cooked pork containing cysticerus cellulosae while the
water, brackish and salty waters, in temperate, other is caused by ingestion of eggs of t. Solium or
tropical and subtropical countries through regurgitation of eggs and gravid segments of
 Heterophyid do not seem to exhibit specificity the parasite into the stomach
with regards to their fish IH o Adult worm
 Fish eating animals as dogs, cats and birds may  measures about 2-3m (exceptional 8m) in length
serve as reservoir host  head or scolex – globular in shape with 4 cup-
o Treatment, Prevention, and Control shaped suckers, scolex is provided with a
 Tetrachloroethylene and praziquantel are the rostellum armed with a double row of hooklets
successful drugs to treat heterophyidiasis  neck – is short, from 5-10 mm in length
 Bithionol and niclosamide have been shown to
decrease egg production
shacklen
 76

o Eggs
 spherical, brown and measures 31-56u in
diameter
 it has two radically-striated shells, outer shell is
thin and rarely seen while the inner shell is
brown, thick and striated
 inside is an embryo or oncosphere with 6
hooklets

o Proglottids
 number is about 800-1000
 genital pore – is marginal
 gravid uterus – consists of a median stem with 5-
13 lateral uterine branches on each side and each
gravid segment contains 30,000-50,000 eggs o Larva
 larval stage or bladder worm is called cysticercus
cellulosae
 cyst measures 5-20mm in length and 5mm in
diameter
 there will be a dense milky white spot at one side
where the invaginated scolex with hooks and
suckers are located

shacklen
 77
o Life Cycle  presence of larva provokes cellular reactions with
 adult worm is attached to the mucosa of the blood cells infiltration, fibrosis, necrosis of
small intestine by its scolex capsule and finally ceasation of calcification of
 gravid segments detached by apolysis and crawl the larva
out of the anus or segments and eggs are  cysticercosis in the brain may cause epilepsy or
discharged with the feces may be responsible for the disordered behavior,
 pigs may ingest gravid segments or eggs while intermittent obstructive hyrdorcephalus,
feeding on human feces or may accidentally disequilibrium, meningoencephalitis, and failing
ingest eggs giving rise to cysticercosis vision
 cysticercosis develops in pigs tissue and the the  heavy cysticercosis may be explained by
meat is termed measly pork regurgitation of gravid segment into the stomach
 man may ingest raw or insufficiently cooked pork of a patient suffering from taeniasis solium
containing cysticerci o Diagnosis
 scolex invaginates and attaches itself to the  infection produced by the presence of adult T.
intestinal mucosa as the bladder portion solium in the lumen of the intestine is called
disintegrates taeniasis solium and in the presence of larval
 worm may start to produce segments and reach stages in the tissues is called cysticercosis
maturity in about 2 months cellulosae
 therefore two methods should be used in
diagnosing this parasite
 demonstration of T. solium eggs may be seen in
ordinary stool examination or in scotch tape
swab
 both techniques will only reveal the presence of
taenia eggs and since T. solium cannot be
distinguished from T. saginata eggs, differential
diagnosis would be examination of gravid
segments pressed between two glass slides
 T. solium less than 13 lateral uterine branches
while T. saginata will have more than 13 lateral
uterine branches
 if the whole worm is expelled, scolex of T. solium
has a rostellum armed with spines whereas T.
saginata has neither rostellum nor spines
 in cysticercosis, the most helpful sign is the
development of sub-cuticular nodules which
o Pathology provide material for biopsy
 presence of this parasite may result to mild  radiologic evidence may not appear for some
transitory intestinal obstruction and may give rise years as calcification does not usually take place
to vague abdominal pain similar to hunger pains for four to five years after infection
 the pathology caused by larval stage (cysticercus o Epidemiology
cellulosae) is quite serious because it may lodge  T. solium has a cosmopolitan distribution, the
in vital organs like the brain, spinal cord, heart, presence of existence of the parasite in a certain
liver, eyes, etc. and give rise to pressure area has direct relationship with the eating habits
symptoms of the people
 symptoms produce vary according to the number  in area where eating raw or insufficiently cooked
of bladder worms and the organs which they food is practiced, there will be higher prevalence
invaded rate

shacklen
 78
 man – is the only known definitive host and the
pig appears to be the only intermediate host for
T. solium
 human cysticercosis is caused by the ingestion of
eggs in contaminated food or water from dirty
fingers or by internal autoinfection when the
eggs are carried by reverse peristalsis back to the
duodenum or stomach
o Treatment, Prevention and Control
 Bithionol, Praziquantel and Paromomycin are the
drug of choice that will expel the ovum
 most effective way of controlling is by avoiding
eating raw or insufficiently cooked pork
o Segments
 proper disposal of excreta would prevent the
 more than T. solium numbering from 1000 –
eggs from reaching to the appropriate
2000 segments
intermediate host
 uterus – lateral uterine branches are 15 or more
 for cysticercosis prevention can only be achieved
in number
by practicing good personal hygiene and
 each proglottid may contain about 80,000 eggs
avoidance of drugs which cause disintergration of
the gravid segments

Taenia saginata
o Common name: Beef Tapeworm producing Taeniasis
Saginata or Beef Tapeworm Infection
o Adult worm
 whitish opaque in color and measures on the
average from 5-10m in length but under
favorable conditions can attain length of 25 m or
more
 scolex – is the structure for attachment of the
parasite and is similar to [Link] except that it
has no rostellum and spines and hooklets
o Eggs
 eggs of T. saginata is indistinguishable from T.
solium
o Cysticercus Bovis or Larval Stage
 is similar to cysticercus cellulosae except that the
scolex is unarmed
 cysticercus larva may remain viable in the tissues
of cattles for about 8 months
o Life Cycle
 similar to that of T. solium except that the
intermediate hosts of this parasite are cattle,
carabao, goat instead of pig
 cattles are infected when T. saginata eggs on
blades of grass are ingested in the grazing field
 cysticercosis develops in the muscles of the cattle
 man gets infected when beef is eaten raw or
insufficiently cooked

shacklen
 79
 it takes about 3 months for the cysticerci or  scolex – is minute, rhomboidal with 4 cup-shaped
bladder worm to grow into adult (T. solium) suckers and a short retractile rostellum armed
 the worm has the same habitat as the T. solium with a ring of 20-30 spines
which is the small intestine  strobila – starts short, narrow proglottids
followed by mature ones
o Segment
 main characteristic of the mature segment is the
three ovoidal testes, one on the left and two on
the right side of the ovary, arranged in a more or
less straight transverse line at the posterior
portion of the proglottids
 gravid segment – becomes completely filled with
eggs, the testes disappear while the uterus
hollows out, becomes saclike and filled with eggs

o Pathology
 it more dangerous to be infected with T. solium o Eggs
compared to T. saginata because there seems to  spherical or sub-spherical, hyaline and measures
be no cysticercosis from T. saginata. The reason is 30 – 47u in diameter
still not clear.  each egg contains an oncosphere enclosed in an
 pathology is caused by the large size of the inner membrane with two polar thickenings from
parasite which is frequently responsible for the each side of which arise 4-8 polar filaments
disturbance in the normal function of the  within the oncosphere are 3 pairs of hooklets
digestive tract  space between the two membrane is filled with
 the absorbed by-products of the worm may also transparent semi-solid material
cause systemic intoxication
o Diagnosis
 same with T. solium by stool examination either
by concentration technique or scotch tape swab
method
 eggs are indistinguishable from that of T. solium
 gravid segments that pass out will be used for
species identification
 gravid segments are pressed between two slides
and the lateral uterine branches are counted
o Life Cycle
o Treatment, Prevention, and Control
 Life cycle could be direct or indirect:
 same with Taenia solium
1. DIRECT
Hymenolepis nana  adults are found in the upper small intestine
o Common name: Dwarf Tapeworm producing of man, rats and mice
Hymenolepiasis nana  the distal most proglottid disintegrate, the
o Adult Tapeworm eggs are set free and passed out in the feces
 A small tapeworm measuring 0.5-9cm in length  eggs are fully embryonated and infective to
and width about 96 to 840 segments the next host

shacklen
 80
 upon ingestion by the new host, eggs  in some cases, metabolic wastes produced by the
liberate the oncoshere which penetrate into parasite can by absorbed by the body and results
the villi of the anterior part of the small to generalized toxemia
intestione  symptoms include headache, dizziness, anorexia,
 in about 4 days, they metamorphose into inanition, pruritus of nose and anus, periodic
young cercocysts or cystercercoid larva diarrhea and abdominal distress
 these larva breaks out of the villi and migrate  Patients are restless and irritable, some have
out into the lumen of the small intestine epileptiform convulsion and eosinophilia
 immature tapeworms attach themselves to  pathology is dependent on the intensity of
the outer villi farther down in the small infection and resistance of the host
intestines by their scolices and the  previous infection confers resistance to
development to mature worms takes about superinfection eliciting immunological response
2 weeks or more to subsequent exposure
 internal autoinfection may explain continued o Diagnosis
heavy infections in man since the eggs are  demonstration of the characteristic eggs in the
already infective when released from the patients stool
segments, this sums up the direct life cycle o Epidemiology
2. INDIRECT  the parasite is a common parasite of rats and
 indirect life cycle, this requires insects as mice and of human beings in different parts of
intermediate hosts the world especially in tropical and subtropical
 eggs passed out in the feces are ingested by countries
fleas (Ctenocephal canis, Xenopsylla cheopis,  human infection has been reported in the
Pulex irritans) or flour beetles (Tenebrio Philippines, India, Europe, USSR, USA, South
molitor, T. obscures, Tribolium confusum) America and Hawaii
and develop to cycticercoid larva  the infection is more common in children than
 accidental ingestion by man of fleas or flour adults
beetles containing cysticercoids larva results
 in the Philippines, infection in children is quite
in infection
rare
 in rats, only less than 2% harbor the parasite
 mice are the most suitable host for this parasite
o Treatment, Prevention and Control
 niclosamide and praziquantel are the drug of
choice
 human infection can be prevented by proper
personal hygiene since infection is caused by
ingestion of eggs from soiled linen, toilet seats or
directly anus to mouth
 protect food from being contaminated with rat
and mice feces, fleas and flour beetles

Hymenolepis diminuta
o Common name: Rat Tapeworm produncing
Hymenolepiasis diminuta
o H. diminuta is primarily a rat tapeworm but man is
occasionally infected
o Pathology
o Adult worm
 in general the parasite is well tolerated by the
 measures 10-60cm in length containing about
body even in heavy infection
800-1,300 proglottids

shacklen
 81
 scolex is small, club shaped with 4 cup-shaped o Life Cycle
suckers and a rudimentary unarmed rostellum  mature worm inhabits the small intestines of the
o Mature segment definitive hosty
 each has three ovoidal testes  gravid proglottids become detached from
 three testes are arranged in a straight line across strobila, disinteghrate and discharge their egg
the segment and separated by the ovary with the feces
 mature segments of H. diminuta and H. nana are  eggs are ingested by the various species of larval
hard to distinguish from each other and adult insects
o Gravid segment  intermediate hosts include male moths, earwigs,
 has appearance of a sac incompletely divided by beetles, cockroaches and rat fleas (These are all
partitions into egg capsules filled with eggs and coprozoic or scavenger in their habits during
occupying nearly the entire segment their larval or adult stages)
 eggs hatch in the gut of the insects and the
oncosphere aided by the hooklets penetrate into
the hemul cavity where they develop to
cercocysts or cysticercoids larvae
 when the infected insect is ingested by man or
rat, the larva are liberated into the intestine of
the DH
 young tapeworm attach themselves to the
intestinal wall and grow to adult in 18-20 days

o Mature eggs
 are spherical or slightly oval and the oncosphere
is surrounded by two membranes
 a thicker yellowish very faintly radially striated
outer membrane
 a thinner envelope immediately surrounding the
oncoshpere
 often with two polar projections but without
filaments
 between the two membranes is a granular,
gelatinous matrix o Pathology
 symptoms are similar to other tapeworm
infection
 there is no autoinfection, infections are usually
light and multiple infections are exceptional
o Diagnosis
 based on the recovery of the characteristic eggs
in the patients stool
 adult worm may sometimes be expelled
spontaneously
o Epidemiology

shacklen
 82
 human is occasionally infected through o Eggs
accidental ingestion of invertebrated hosts  are spherical, have thick transparent albuminous
 this tapeworm is common parasite of the rat, covering with 2 membranes
mouse, and occasionally dog  each egg contains an oncosphere with 6 hooklets
 human cases have been reported in the
Philippines, Europe, USSR, Japan, China, India,
South America and USA
 in the Philippines, human infection is rare and in
rats, the prevalence ranges from 10-13%
o Treatment, Prevention and Control
 Quinacrine and niclosamide are the drug of
choice
 prevention includes eliminating rats and mice in
houses, destruction of beetles, cockroaches and
other insects that act as IH
o Life Cycle
 young children are usually infected from
 Adult worm will inhabit the small intestines of
ingesting insects infesting pre-cooked cereals
man and other animals
Dipylidium caninum  gravid proglottids separate singly or in groups
o Common name: Dog Tapeworm or Double Pored from the strobila and frequently wander down
Tapeworm the bowel and out the anus
o this is primarily a parasite of dogs and man is infected  gravid proglottids disintegrate and release the
by accidental ingestion of dog fleas that contains the egg capsules
larva  eggs in capsule which are deposited on the
o Adult Worm ground are ingested by the larval stage of dog
 inhabits the small intestine of dogs, cat or man flea (Ctenocephalides canis), cat flea (C. felis) or
will measure 10-70cm in length the human flea (Pulex irritans)
 scolex – small with 4 deeply cupped suckers and  eggs hatch in the intestine of these insects where
a median conical rostellum armed with 1-7 circles they develop to procercoid then into
of spines cysticercoids larva in the hemocoele of fleas
 the number of circles of spines depends on the  cysticercoids larva is the infective stage of this
age of the worm and the amount of trauma parasite
suffered by the rostellum  man acquires the infection upon accidental
o Proglottids ingestion of infected fleas
 proglottids – double set of reproductive organs
and a genital pore on each lateral margin
 deriving its name double pored tapeworm
 gravid proglottids – filled with polygonal uterine
blocks, each block or pocket contains 8-15 eggs
enclosed in an embryonic membrane

shacklen
 83
o Pathology  Scolex – bears a prominent rostellum with a
 degree of pathogenicity depends upon the double row of 28 – 40 large and small hooklets
intensity of infection and 4 cup-like suckers
 the most children, usually only a single worm  Three segments consists of one immature
infection without or with mild to severe proglottid, one elongated mature proglottid and
manifestation one long gravid proglottid
 symptoms include slight intestinal disturbances,
indigestion and loss of appetite due to the
absorbed metabolic wastes of the worm
o Diagnosis
 this is based on the recovery of a single or chain
groups of proglottids passed in the feces or
wandering out of the anus
 diagnostic features of the segment are the
double set of reproductive organs which open on
both sides and the division inside the segment
and(?) egg capsules
 eggs in egg capsule are seldom seen in fecal
smears
o Epidemiology
 this is a common tapeworm of the dog and cat
but man is occasionally infected by accidental
ingestion of dog fleas containing the larva
 although it is of rare infection it is found in
countries like Europe, Philippines, China, Japan, o Egg
Rhodesia, Argentina and USA  Subspherical egg has a brown radially striated
 infection is common among children than adults embryophore which cannot be differentiated
suggesting greater exposure or age tolerance from those of Taenia eggs
 prevalence in dogs ranges from 6% to 36% to as
high as 81% in some places
o Treatment, Prevention and Control
 quinacrine, niclosamide and bithionol are the
recommended drugs
 dogs and cats should be dewormed periodically
to removed periodically to remove the infection
 children should be taught as to the dangers of
fonding pets
 insecticide dusting of dogs and cats to kill fleas
may be effective o Larva or Hydatid Cyst
 Develops from the egg and may grow as big as 20
Echinococcus granulosus cm in diameter depending on the stage of
o Common Name: Hydatid worm producing Unilocular infection
Echinococcosis Disease or Hydatid Disease  Enveloping membrane is composed of two layers:
o Smallest tapeworm parasitizing man consisting only of a 1. Outer laminated, milky opaque non-
scolex, neck and three segments nucleated layer, and;
o Adult Worm 2. Inner nucleated germinal layer
 Ranges from 0.25 – 0.9 cm  From the inner layer arises buds or brood
capsules which may remain attached to the inner

shacklen
 84
membrane by stalks or may be set free into the
fluid of the cystic cavity
 The capsules contains scolices
 The free brood capsules and free scolices are
referred to as “hydatid sand”

o Pathology
 The effect of the hydatid cyst in the human body
is both mechanical and toxic
 Growing cyst lodged in vital organs like liver,
lungs, brain, and heart will interfere with the
functions of the organ
 Infection may end fatally or the cyst may grow to
a tremendous size which is physical burden to
o Life Cycle the patient
 Definitive hosts are the dogs and other canines  Unilocular cyst if located in the bone will be
 Adult tapeworms inhabits the intestines attached called “Osseous Hydatid Cyst”
to the villi  With the limited space available in the bone, the
 Gravid proglottids rupture discharging the few cyst migrates along the bony canal and erode the
eggs which are passed in the feces of the dogs body structure
 The embryonated eggs are infective when  The bone gives way without warning resulting in
ingested by a suitable intermediate host such as permanent injury to the patient
sheep, dog, of or man  Symptoms may produced from 5 – 20 years after
 Eggs hatch in the duodenum and the oncosphere infection only after the cyst has reached
penetrates the intestinal wall carried by the sufficient size to press on the organs
lymphatics and blood circulation to various  Rupture of the cyst may produce serious allergic
organs and tissues to become hydatid cyst or anaphylactic reactions, the freed hydatid
 Organs frequently infected are the liver and lungs sands will start new foci of infection
o Diagnosis
 Hydatid cyst is infective, when DH consumes the
viscera of infected IH the scolices freed from the  Unilocular cyst are diagnose later in life after they
hydatid cyst attach to the intestines and develop have grown into a tremendous size
to adult tapeworms  Early diagnosis is made when the cysts are lodged
in foci where serious damage or dysfunction
results
 Hydatid cyst can be diagnosed by: (1)
Roentgenogram, (2) Exploratory cyst puncture,
(3) Immunologic test (intradermal, precipitin,
complement fixation, hemagglutination, and
bentonite flocculation latex slide agglutination
and fluorescent antibody tests)
o Epidemiology
shacklen
 85
 A very rare case of infection in the Philippines,
echinococcus infection
 Only two cases have been reported, first was
from a Spanish priest who had renal
echinococcosis and hydatid cyst removed form
the kidney measuring 7.5 cm in diameter, full of
hydatid sand and another case from a 34 year old
woman who had echinococcus cyst in the lung
 This tapeworm is a common parasite of dogs,
wolves, jackals, coyotes, and other canines
 Most extensive and intensive zoonotic endemic
regions are those of the sheep and cattle raising
countries like Australia, Tasmania, New Zealand, o Hydatid Cyst or Larval Growth
Africa, and South America  Occurs through exogenous budding with
o Treatment, Prevention, and Control progressive invasion of the organ usually the liver
 Surgical removal of the hydatid cyst is helpful o Cyst
only if operable sites  Is called alveolar cyst
 Treatment of multiple and inoperable hydatid by  It has many minute irregular cavities containing
biological methods (desentization of the host and crumpled or discolored hyaline membrane all
death of the cyst, with gradual absorption) has enclosed in a vascular fibrous adventitia
been tried but not always successful  The cavities contain or little or no fluid, scolices
 If surgery is employed precautionary measures are rarely seen
should be employed to prevent spillage of the o Life Cycle
cyst fluid or hydatid sand into the operative  It is the same as that of E. granulosus except for
cavity the larval intermediate host which are the field
 In 50% of cases, there is recurrence of the mouse, vole, squirrel, and shrew
disease after surgery due primarily to the o Pathology
development of secondary cysts from scolices  Common site of development for the alveolar
spilled from the primary cyst at the time of cyst is the liver, next the lungs and then other
operation organs
 Human infection results from fondling infected  Hepatic disease clinically resembles a slowly
dogs, ingesting eggs in dirt or vegetables, utensils developing mucoid carcinoma, with
or contaminated clothing hepatomegaly, splenomegaly, jaundice and
 Strict personal hygiene is recommended ascites in the later stages
 Dogs should be prevented from eating carcasses  In some cases the cyst will metastasizes to other
of sheep, cattle and hogs in endemic areas organs and when found in the brain, it is always
 Deworming of dogs is recommended periodically fatal
o Diagnosis
Echinococcus multiocularis  Is made later in postmortem examination
o Common Name: Hydatid Worm producing Alveolar
 Likely to be missed even at necropsy
Hydatid Disease
 Immunologic test are useful for this parasite
o Adult Worm
o Epidemiology
 Morphologically similar to E. granulosus except
 Alveolar hydatid cyst in man has been reported
for some minor details
from Europe, USSR, South America, Australia,
New Zealand, Canada, Alaska and Japan
 No case reported in the Philippines
 DH are also dogs and other canines

shacklen
 86
 Man acquire the infection from eating raw fruits
and vegetables contaminated with the feces of
the foxes and other canines
o Treatment, Prevention, and Control
 Surgical removal of the cyst is not feasible since
there is no circumscribed capsule
 Biotherapy of the cyst allowing its gradual
absorption into the system may be helpful
 Slow growth of the cyst; it is probable that
exposure takes place during childhood
 Explain to children to avoid wooded area in
playing where canines might also play
o Eggs
Diphyllobothrium latum
 are broadly ovoidal, operculate, moderately thick
o CN: Broad Tapeworm
shelled, light golden yellow in color containing
o Diphyllobothriasis or Fish Tapeworm Infection
immature embryos when oviposited and
o Adult Worm
discharged with the feces
 When freshly expelled from human intestine, the
 measures 56-76u by 40-51u
worm is ivory colored
 released as many as 1m eggs/day
 Measures from 3 meters (young mature
 quite resistant to chemicals but rapidly become
specimen from man) to 10 meters or more in
nonviable when subjected to dessication or
length
putrefaction
 It may contain as many as 3,000 or more
proglottids
 Scolex – is small, spatulate with pair of deep sulci
 Neck region – located immediately behind the
scolex which is attenuate, unsegmented neck
region, several times the length of the head

o Life Cycle
 adult worm will inhabit the small intestine and
will discharge the eggs together with the feces
o Proglottid  embryo will escape the shell through the
 Distally are newly formed proglottids which opercular opening, cast off its embryonal
become mature and finally gravid envelope and as ciliatted embryo swims in water
 Multiple proglottid formation occurs  Within about 12 hours it must be ingested by an
simultaneously along the entire anterior portion appropriate copepod in order to continue its
of the strobila development
 The typical mature proglottid is somewhat  If copepods are ingested by freshwater fish, the
braoder than longer and is practically filled with precercoid larva develops into plerocercoid larva
male and female genitalia or spargum and lies free between the muscle
fibers

shacklen
 87
 Spargum are transferred to larger edible fishes b. when man ingests raw infected flesh of
and when these fishes devour the infected amphibia, reptiles or birds or mammals
smaller ones or their young that contains sparganum
 Different types of freshwater fish serves as the c. use of poultice or local application of the
second intermediate host flesh of infected vertebrates to the skin
 Consuming raw or insufficiently cooked flesh of and other parts of the body, resulting in
infected fishes, man becomes infected and in 5 – the migration of the spargana out of the
6 weeks eggs begin to appear in his/her feces flesh into the human tissue
d. ingestion of raw pork, since spargana
develop also in pigs
 Sparganum – has been recovered in
different parts of the body such as, eye,
nose, neck, brain and abdominal viscera
 tissues infected with spargana will
become edematous and very painful to
touch
 when these lesions are opened it will
reveal either live or degenerated ovum
 Death of the worms will produce intense
local inflammation, eosinophilia and
charcot-leyden crystals
 Ocular sparganosis will result to intense
pain, irritation and edematous swelling
o Pathology of the eyelids with excessive lacrimation
 Pathology of this parasite is grouped into two (2):  Spargana in lymph channels may result
1. PATHOLOGY DUE TO THE ADULT TAPEWORM in elephantiasis; in subcutaneous tissue
 By-products produced by the parasite results to acniform pustules; pulmonary
maybe absorbed into the hosts tissue and artery may become infarcted
creates a systemic toxemia and at times o Diagnosis
anemia  Recovery of EGGS in the stool
 Large number or worms may cause  For sparganosis, dx is not made not after surgical
mechanical obstruction of the intestines removal of the worms and drainage of the site
when they become tangled together involved
 Some infected individuals may suffer from o Epidemiology
“bothriocephalus anemia” or tapeworm  The parasite is common in countries like northern
pernicious anemia Europe, Russia, North America, Manchuria and
 The parasite will compete with man for Japan
the available supply of vit. B12 thus  One case was reported in the Philippines of
causing pernicious anemia when this related genus, spirometra species, common
vitamin is depeleted or denied the host’s tapeworm infection in dogs and cats(capable to
metabolic demands parasitize man)
2. PATHOLOGY DUE TO THE LARVAL STAGES OF THE  Also cases in the phils are reported related to the
PARASITE AND OTHER RELATED SPECIES same genus( d. Mansoni) seen in dogs,
 Human sparganosis may result from sparganum were recovered from the abdomen
a. ingestion of infected cyclops containing below the nipple, inner thigh and base of neck
the procercoid stage that penetrates the and this were attributed to drinking water
intestinal wall and migrates to the infected with cyclops containing procercoid larva
subcutaneous tissues and muscle fascia o Treatment, Prevention, and Control
and develops into sparganum

shacklen
 88
 Quinacrine hydrochloride and niclosamide
(yomesan) are the effective drugs against d.
Latum
 Prevention includes thorough cooking of all
suspected freshwater fish, freezing of fish at 14
for 24-48 hours
 In endemic areas, feces should not be discharged
into river and lakes
 Reservoir hosts especially dogs should be de-
wormed
 Sparganosis in subcutaneous tissue maybe
removed by surgery
 Ocular sparganosis, 40% ethyl alcohol with
procaine is injected into the lesion to kill the
worm in site and after the worm are allowed to
be absorbed
 In endemic areas, sparganosis can be prevented
by boiling or filtering drinking water
 Avoid ingestion of raw tadpoles, frog, snakes,
fowl or mammalian flesh

shacklen