WEEK 1: INTRODUCTION TO PARASITOLOGY

3. Incidental / Accidental parasite

PARASITOLOGY ➢ attack an unusual host
➢ The area of biology concerned with the 4. Spurious parasite
phenomenon of dependence of one living ➢ free-living organisms in nature that are
organism on another. parasitic to others but not in human

MEDICAL PARASITOLOGY TYPES OF PARASITES ACCORDING TO THE

➢ is concerned primarily with the animal MODE OF HABITAT
parasites of humans and their medical 1. Ectoparasite
significance, as well as their importance in ➢ parasite living outside the body of the host
human communities. ➢ will not penetrate into the tissues.
➢ living on the surface of the skin
DEFINITION OF TERMS ➢ the causes of these are called as infestation
Parasite
➢ Organism depending on another living 2. Endoparasite
creatures for existence ➢ parasite living inside the body of the host
Host ➢ living within the body of the host (infection)
➢ Organism that supports or harbors parasite ➢ usually these are responsible to cause
Vector human infections.
➢ are responsible for transmitting the parasite
from one host to another. 3. Saprophytes
Incidence ➢ that which lives in organic substances in
➢ number of new cases of infection in a state of decomposition.
population in a given period of time.
Exposure TYPES OF HOST
➢ the act or process of inoculation.
Pathogen
➢ animal parasites which are harmful, frequently
causing local and systemic damage of one
type or another.
Incubation period
➢ Period between infection and evidence of
symptoms
● Pre-patent period
● Biologic incubation period
Superinfection BIOLOGICAL RELATIONSHIP
➢ when an individual harboring a parasite is
reinfected with the same species of parasites.
Autoinfection
➢ when the infected person is his own direct
source of reexposure.

TYPES OF VECTOR
1. Mechanical / Phoretic Vector
➢ the parasite is only seen on the surface of
this organism and there will be no
development on the parasite
➢ eg. Cockroaches, flies

2. Biological Vector
➢ the parasite is seen inside the body of this
organism and the parasite needs this
organism for its development
➢ eg. Mosquitoes, tsetse flies

TYPES OF PARASITE ACCORDING TO THE

MODE OF DEVELOPMENT
1. Obligate parasite
➢ depend entirely upon their host for
existence.
2. Facultative parasite
➢ exist in a free-living state or may become
parasitic when the need arises.
SOURCES OF INFECTION
Trypanosomes
Sources Examples
Inhalation E. vermicularis
Ingestion of contaminated Cyst of:
food or drink (primarily ● E. histolytica Secretions S.stercoralis
water) ● G. lamblia Ancylostoma spp.

Hand-to-mouth transfer Eggs of: Sexually transmitted T. vaginalis

● A. lumbricoides
● T. trichiura LIFE CYCLE
Insect bite W. bancrofti ● Parasitic life cycle range from simple to
B. malayi complex, they all have three common
components
Entry via drilling through the Schistosoma spp. ➔ Mode of transmission
skin Hookworm ➔ morphologic form that invades humans
Unprotected sexual relations T. vaginalis ➔ forms that can be detected via laboratory
retrieval methods
Mouth-to-mouth contact T. tenax ● Some parasites require only 1 definitive host,
whereas others also require 1 or more
Eating raw or inadequately E. ilocanum (snails) intermediate host
cooked foods C. philippinensis
(fish) ● A parasite life cycle consist of two common
D.latum ( fish ) phases
T.saginata ( beef )
T.solium ( pork )

Domestic animals D.caninum

H.diminuta

PORTALS
1. Portal of entry
➢ particular site of the body where the
parasite prefer to enter.
2. Portal of exit
➢ site of the body where the parasite moves
out

INDIVIDUALS AT RISK
● Individuals in underdeveloped areas and
countries
● Refugees
● Immigrants
● Visitors from foreign countries
● Individuals who are immunocompromised
● Individuals living in close quarters (e.g.,
prisons)
Portal of Entry Example ● Children who attend day care centers

Mouth A.lumbricoides TREATMENT

T. trichiura
E.vermicularis ● Chemotherapy
E.histolytica ● Surgical intervention – if chemotherapy is
G.lamblia unavailable or has proved inadequate.
C.philippinensis ● The following points must be considered:
➔ Severity, duration and intensity of infection
Skin N.americanus and the probability of reinfection.
A.duodenale
S.stercoralis ➔ Efficacy, availability, toxicity and
S.japonicum acceptability of the treatment.

Percutaneous Malarial parasites

Filarial worms
Leishmania
PREVENTION
● Development and implementation of parasite
awareness
● education programs
● Use of insecticides and other chemicals
● Use of protective clothing
● Use of protective netting
● Proper water treatment
● Good personal hygiene
● Proper sanitation practices
● Proper handling, cooking, and protection of
food
● Avoidance of unprotected sexual relations

TAXONOMIC CLASSIFICATION OF PARASITES

PARASITOLOGY LECTURE e. Cutaneous amebiasis
(WEEK 3 – 09062022) f. Genital amebiasis

PROTOZOA VIRULENT FACTORS

1. Gal/Gal NAc lectin: cytoadherence
PARASITIC AMOEBA 2. Amebapores: poreformers
3. Cysteine proteinase: Tissue invasiveness
PATHOGENIC
- Entamoeba histolytica DIAGNOSIS
1. Direct Fecal Smear
NON-PATHOGENIC a. Unstained c. Liquid stool: show trophozoite
- Entamoeba dispar b. Stained d. Formed stool: show cyst
- Entamoeba hartmanii 2. Liver aspiration biopsy
- Entamoeba coli 3. Culture: Robinson’s and Inoki medium
- Entamoeba gingivalis 4. Serologic Test: ELISA, IHAT, CIE, AGD, IFAT
- Entamoeba polecki 5. Concentration test: FECT, MIFC, FECT, ZnSO4
- Entamoeba moshkovskii 6. Radiographic non-invasive techniques: X-ray/MRI/CT scan
- Endolimax nana
- Iodamoeba butschlii EPIDEMIOLOGY
- Blastocystis hominis • A leading cause of parasitic deaths after only malaria.
• Infection occurs is as many as 10% of the worlds population
PATHOGENIC AND FREE-LIVING • Locations at:
- Naegleria fowleri - which human waste is used as fertilizer
- Acanthamoeba sp. - areas of poor sanitation
- hospitals for mentally ill
CILIATA - prisons
- Balantidium coli - day care center
OTHER INT. PROTOZOAN CLINICAL SYMPTOMS
- Diantamoeba fragilis The only known pathogenic intestinal amoeba. The range of
symptoms varies and depends on two major factors:
PATHOGENIC: Entamoeba histolytica
• Asymptomatic Carrier state
“Named by Schaudinn”
• Symptomatic Intestinal Amebiasis
Entamoeba histolytica (Trophozoite) • Symptomatic Extraintestinal Amebiasis
PARAMETERS DESCRIPTION TREATMENT
Size range: 8-65 um
Motility: progressive, finger-like pseudopodia DISEASE DRUG OF CHOICE
No. of nuclei: One Asymptomatic cyst passer Diloxanide furoate
Karyosome: Small and central Metronidazole
Peripheral Chromatin: Fine and evenly distributed Amebic colitis Tinidazole
Cytoplasm: Finely granular Metronidazole
Cytoplasmic Inclusions: Ingested red blood cell Amebic Liver Abscess Tinidazole

PREVENTION AND CONTROL

Entamoeba histolytica (Cyst) • Boiling or treating water with iodine crystal
PARAMETERS DESCRIPTION • Water filtration or chemical treatment
• Proper washing of food products
Size range: 8-22 um • Avoiding the use of human feces as fertilizer
Shape: Spherical to round • Good personal hygiene
No. of nuclei: One to four • Protection of food from flies and cockroaches
Karyosome: Small and central • Avoidance of unprotected sexual practice
Peripheral Chromatin: Fine and evenly distributed
COMMENSAL AMOEBAE
Cytoplasm: Finely granular
NON-PATHOGENIC: Entamoeba coli
Cytoplasmic Inclusions: Chromatoid bars, rounded ends on young cysts
Diffuse glycogen mass in young cysts
Entamoeba coli (Trophozoite)
PARAMETERS DESCRIPTION
Size range: 12-55 um
Motility: Non-progressive, finger-like pseudopodia
No. of nuclei: One
Karyosome: Large, irregular shape eccentric
Peripheral Chromatin: Unevenly distributed
Cytoplasm: Coarse and granulated
Cytoplasmic Inclusions: Vacuoles containing bacteria often visible

Entamoeba coli (Cyst)

PARAMETERS DESCRIPTION
Size range: 8-35 um
Motility: round to spherical
PATHOLOGY No. of nuclei: One to eight
1. Intestinal Amebiasis Karyosome: Large, irregular shape eccentric
• Characteristic ulcer: FLASK SHAPE ULCER Peripheral Chromatin: Unevenly distributed
2. Extraintestinal Amebiasis Cytoplasm: Coarse and granulated
a. Hepatic amebiasis: Cytoplasmic Inclusions: Diffuse glycogen mass present in young
Amebic Liver Abscess: ANCHOVY SAUCE LIKE cyst thin chromatoidal bars w/ pointed to
b. Pulmonary amebiasis splintered ends in young cyst
c. Cerebral amebiasis
d. Amebic pericarditis EPIDEMIOLOGY
• Geographic areas that have poor hygiene and sanitation practice
TREATMENT NON-PATHOGENIC: Iodamoeba butschlii
• No specific drug is needed to treat the infection
Iodomoeba butschlii (Trophozoite)
PREVENTION AND CONTROL PARAMETERS DESCRIPTION
• Proper disposal of human feces Size range: 8-22 um
• Proper personal hygiene practices Motility: sluggish, usually progressive
• Protection of food and drinks from flies and cockroaches No. of nuclei: One
Karyosome: large, eccentric achromatic granules may
NON-PATHOGENIC: Entamoeba hartmanii
or may not be present
Entamoeba hartmanii (Trophozoite) Peripheral Chromatin: Absent
Cytoplasm: coarsely granular and vacuolated
PARAMETERS DESCRIPTION
Cytoplasmic Inclusions: Bacteria, Yeast cell, Other debris
Size range: 5-15 um
Motility: Non-progressive, finger-like pseudopodia
No. of nuclei: One
Karyosome: small and central Iodomoeba butschlii (Cyst)
Peripheral Chromatin: Fine and evenly distributed
PARAMETERS DESCRIPTION
Cytoplasm: Finely granular
Size range: 5-22 um
Cytoplasmic Inclusions: Ingested bacteria may be present
Shape: ovoid, ellipsoid, triangular
No. of nuclei: One
Entamoeba hartmanii (Cyst) Karyosome: large, eccentric achromatic granules on
one side may be present
PARAMETERS DESCRIPTION
Peripheral Chromatin: Absent
Size range: 5-12 um
Cytoplasm: coarsely granular and vacuolated
Motility: spherical
Cytoplasmic Inclusions: well-defined glycogen mass
No. of nuclei: One to four Granules may be present
Karyosome: small and central
Peripheral Chromatin: Fine and evenly distributed
Cytoplasm: Finely granular EPIDEMIOLOGY
Cytoplasmic Inclusions: Chromatoidal bars, rounded ends in • Found worldwide and has a higher prevalence in tropical regions
young cysts. Diffuse glycogen mass in
young cyst CLINICAL SYMPTOMS
• Nonpathogenic intestinal amoeba that usually that not produce
CLINICAL SYMPTOMS clinical symptoms
• Infections with E. hartmanni are typically asymptomatic
TREATMENT
TREATMENT • Treatment is usually not indicated
• Treatment is usually not indicated
PREVENTION AND CONTROL
PREVENTION AND CONTROL • Upgrading the personal hygiene and sanitation practice
• Good sanitation
• Personal hygiene practices NON-PATHOGENIC: Entamoeba gingivalis
• Protection of food from flies and cockroaches
Entamoeba gingivalis (Trophozoite)
Endolimax nana (Trophozoite) PARAMETERS DESCRIPTION
PARAMETERS DESCRIPTION Size range: 8-20 um
Size range: 5-12 um Motility: active, varying pseudopod appearance
Motility: sluggish, nonprogressive blunt No. of nuclei: One
pseudopods Karyosome: centrally located
No. of nuclei: One Peripheral Chromatin: fine and evenly distributed
Karyosome: large, irregular, blotlike Cytoplasm: Finely granular
Peripheral Chromatin: Absent Cytoplasmic Inclusions: Leukocytes, Epithelial cells, Bacteria
Cytoplasm: granular and vacuolated
Cytoplasmic Inclusions: Bacteria DIAGNOSIS
• Mouth scrapings (gingival areas)
• Vaginal and cervical materials
Endolimax nana (Cyst)
PARAMETERS DESCRIPTION EPIDEMIOLOGY
Size range: 4-12 um • Found in all populations that have been studied for its presence
Shape ovoid, ellipsoid
CLINICAL SYMPTOMS
No. of nuclei: One to four
• Occur in the mouth and in genital tract but asymptomatic
Karyosome: large, irregular, blotlike usually central
• Trophozoites are frequently recovered from patients suffering from
Peripheral Chromatin: Absent
pyorrhea alveolaris
Cytoplasm: granular and vacuolated
Cytoplasmic Inclusions: Chromatin granules nondescript small mass TREATMENT
Diffuse glycogen mass in young cyst
• Treatment is typically not indicated
EPIDEMIOLOGY PREVENTION AND CONTROL
• E. nana is found primarily in warm, moist regions of the world. • Improved oral hygiene
• Areas in which poor hygiene and substandard sanitary conditions exist. • Proper care of teeth and gums
• Prompt removal of IUD’s in infected patients spontaneously
CLINICAL SYMPTOMS removes E. gingivalis from the genital tract
• E. nana infections are usually asymptomatic
NON-PATHOGENIC: Entamoeba polecki
TREATMENT
• Treatment is generally not indicated. Entamoeba polecki (Trophozoite)
PREVENTION AND CONTROL PARAMETERS DESCRIPTION
• Protection of food and drinks from flies and cockroaches Size range: 8-25 um
• Good sanitation and personal hygiene Motility: Normal stool sluggish non-progressive
Diarrheal Stool Progressive unidirectional
No. of nuclei: One EPIDEMIOLOGY
Karyosome: Small and central • Found in warm bodies of water, including lakes, streams, ponds,
Peripheral Chromatin: fine and evenly distributed and swimming pools.
Cytoplasm: Granular and vacuolated • Can survive in up to 0.5µg/ml of hyperchlorinated water
Cytoplasmic Inclusions: Ingested bacteria other food particles • Higher in the summer months of the year
• Able to survive in elevated temperatures up to 46˚C
• Can be acquired in contaminated dust
Entamoeba polecki (Cyst)
CLINICAL SYMPTOMS
PARAMETERS DESCRIPTION
• Asymptomatic
Size range: 10-20 um
• Kernig’s sign
Shape: Spherical or oval
• Primary amebic meningoencephalitis (PAM)
No. of nuclei: One • CSF findings: pleocytosis (high percentage of PMN cells)
Karyosome: Small and central hypoglycorrhacia elevated protein levels
Peripheral Chromatin: fine and evenly distributed
Cytoplasm: Granular TREATMENT
Cytoplasmic Inclusions: Chromatoidal bars, angular pointed ends • Amphotericin B – DOC
in young cyst. Glycogen mass in young • Amphotericin B with rifamfin /miconazole
cysts , inclusion mass
PREVENTION AND CONTROL
EPIDEMIOLOGY • Posting of off-limit sign around known sources of contamination
• This amoeba is found only in select areas of the world , with highest • Educating the medical community and public
prevalence occurring in Papua new guinea. • Swimming pools and hot tubs be adequately chlorinated
• Considered to be a parasite of pigs and monkeys • Cracks found in the walls of the pools, hot tubs, and baths should
be repaired immediately
TREATMENT
• Treatment is typically not indicated FREE-LIVING PATHOGENIC: Acanthamoeba

PREVENTION AND CONTROL Acanthamoeba (Trophozoite)

• Protection of food and drinks from flies and cockroaches PARAMETERS DESCRIPTION
• Good sanitation and personal hygiene Size range: 12-45 um
Motility: Sluggish, spinelike pseudopods
FREE-LIVING PATHOGENIC AMEBAE No. of nuclei: One
FREE-LIVING PATHOGENIC: Naegleria fowleri
Karyosome: large
Peripheral Chromatin: Absent
Naegleria fowleri (Trophozoite)
Cytoplasm: Granular and vacuolated
PARAMETERS DESCRIPTION
Size range: 8-22 um
Motility: Sluglike, blunt pseudopods Acanthamoeba (Cyst)
No. of nuclei: One
PARAMETERS DESCRIPTION
Karyosome: Large and usually centrally located Size range: 8-25 um
Peripheral Chromatin: Absent Shape: roundish with ragged edges
Cytoplasm: Granular, usually vacuolated
No. of nuclei: One
Karyosome: Large and central
Naegleria fowleri (Cyst) Peripheral Chromatin: Absent
Cytoplasm: Disorganized, granular, sometimes vacuolated
PARAMETERS DESCRIPTION
Cytoplasmic Inclusions: Double cell wall, smooth, smooth inner
Size range: 5-22 um
cell wall and outer jagged cell wall
shape ovoid, ellipsoid, triangular
No. of nuclei: One
Karyosome: large, eccentric achromatic granules on
one side may be present
Peripheral Chromatin: Absent
Cytoplasm: coarsely granular and vacuolated
Cytoplasmic Inclusions: well-defined glycogen mass. Granules
may be present

DIAGNOSIS
• Microscopic Examination:
• CSF is the specimen of choice
• Brain tissue
• Corneal scrapings
• Culture: Proteose-peptone, yeast extract, glucose and cysteine
(PYGC) containing antibiotics
• Molecular techniques: PCR
DIAGNOSIS
• Microscopic examination: Trophozoite EPIDEMIOLOGY
• CSF • Reported from many countries worldwide both CNS and eye infection
• brain • CNS infection appears in patient who are immunocompromised
• Tissue • Isolated from air, aquaria, bottled mineral water, soil swimming
• nasal discharge pools, deep well water, contact lens solutions.
• Saline and Iodine wet preparation
• Culture: Balamuth medium CLINICAL SYMPTOMS
• Molecular Techniques: ELISA, PCR • Granulomatous amebic encephalitis (GAE)
• First documented by Stamm
 • Incubation period: 10 days • Cyst is resistant to environmental conditions and may survive for
• Acanthamoeba keratitis long period, they are easily inactivated by heat and 1% sodium
hypochlorite
TREATMENT
• Sulfamethazine OTHER INTESTINAL PROTOZOA
• Itraconazole OTHER INTESTINAL PROTOZOA: Blastocystis hominis
• Ketoconazole Four morphological forms
• Miconazole 1. Vacuolated forms
• Propamidine isethianate (DOC) • Most predominant
• Rifampin •Large central vacuole (reproductive organelle) and very thick capsule
2. Ameba-like forms
CILIOPHORA • Active extensions and pseudopodia
CILIATA: Balantidium coli • Nuclear chromatin: peripheral clumping
• Intermediate stage between vacuolar and pre-cystic
Balantidium coli (Trophozoite) 3. Granular forms
PARAMETERS DESCRIPTION • Observed from old cultures
Size range: 28-152 um in length • Granular contents develop into daughter cells of the ameba-form
22-123 um wide when it ruptures
Motility: Rotary, Boring 4. Multiple fission form
No. of nuclei: Two • Arise from vacuolated forms
Kidney shaped (macronucleus) • Produce many vacuolated forms
small spherical (micronucleus) 5. Cystic form
Other features One or two visible contractile vacuoles • Very prominent and thick osmophilic electron dense wall
Cytoplasm may contain food vacuoles or bacteria • Thick walled cyst: responsible for external transmission
small cytostome present • Thin walled cyst: reinfection within a hosts intestinal tract
Layer of cilia around organism
Blastocystis hominis (Vacuolated form)
PARAMETERS DESCRIPTION
Balantidium coli (Cyst) Size range: 5-32 um
PARAMETERS DESCRIPTION Vacuole: Centrally located
Size range: 43-66 um Fluid-filled structure
Motility: Rotary, Boring consumes almost 90% of organism
Number and app. Of Two Cytoplasm: Appears as a ring around periphery of organism
nuclus Kidney shaped (macronucleus) Nuclei: Two or four located in cytoplasm
small spherical (micronucleus)
Other features Other features One or two visible contractile DIAGNOSIS
vacuoles in young cyst • Stool is the specimen of choice for the recovery of blastocystis
Double cyst wall • Concentration technique: increase sensitivity
Row of cilia visible in between • Hematoxylin or Trichrome: to differentiate various stages
cyst wall layers of young cyst • Culture: Boeck and Drbohlav’s media, Nelson and Jones media

EPIDEMIOLOGY
• B. hominis infections indicated that they occurred as epidemic in
subtropical countries.

CLINICAL SYMPTOMS
• mild to moderate diarrhea
• vomiting
• nausea
Balantidium coli • fever
• Infective stage: cyst, viable for several weeks • abdominal pain and cramping
• Human infection results from ingestion of food or water • bloating
contaminated with fecal material containing Balantidium coli cysts • flatulence
• Incubation period: 4-5 days
• Ingested cysts excysts in the small intestine TREATMENT
• Trophozoites inhabit the lumen, mucosa and submucosa of the • Iodoquinol
large intestine, primarily the cecal region • Metronidazole (DOC)
• Trimethroprim-sulfamethoxazole
PATHOGENESIS
• Disease: Balantidiasis, balantidial dysentery PREVENTION AND CONTROL
• Balantidium coli invades the intestinal epithelium through release of • Proper treatment of fecal material
the enzyme hyaluronidase and creates a characteristic ulcer with a • Proper hand washing
rounded base and wide neck • Subsequent proper handling of food and water
• Acute diarrhea with mucus and blood, cramps
• Complications include intestinal perforation and acute appendicitis

• usually non-pathogenic commensal in the large intestine

• Many infected individuals are asymptomatic
• Majority of the symptomatic patients complain of diarrhea and dysentery
• Abdominal discomfort or pain associated with nausea and vomiting

DIAGNOSIS
• Microscopic identification of trophozoites and cysts in the feces
using direct examination
• Repeated stools for increase sensitivity
• Concentration techniques
• Biopsy from sigmoidoscopy: trophozoite

TREATMENT AND PREVENTION

•Treatment: metronidazole, tetracycline or iodoquinol
•Prevention: proper sanitation, safe water supply and protection of
food from contamination
PARASITOLOGY LECTURE DIAGNOSIS
(WEEK 4 – 09/14/2022) ▪ Stool examination
- flatus smell like rotten eggs: hydrogen sulphide
Subphylum Mastigophora - Formed stool: cyst
(Atrial Flagellates) - Liquid, soft stool: trophozoites
▪ Duodenal aspirate
Atrial Flagellates ▪ Biopsy
▪ Generally have one to several long flagella in trophozoite form ▪ EnterotestTM
(except D. fragilis: pseudopodia) ▪Direct Fluorescence
▪ Some species have rudimentary mouth called cytostome ▪ EIA and ELISA
▪ Neuromotor apparatus consists of kinetoplast and axoneme ▪ Western Blot
▪ Reproduction is through binary fission. ▪ R-T PCR
▪ G.lamblia and C.mesnili have cyst and troph forms, the others
exist in trophozoite stage only. EPIDEMIOLOGY
▪ Found world-wide in lakes, streams, and other water sources.
PATHOGENIC NON-PATHOGENIC
- Giardia lamblia - Chilomastix mesnili CLINICAL SYMPTOMS
- Trichomonas vaginalis - Trichomonas hominis ▪ Considered to be a non-pathogen. This organism is now
- Trichomonas tenax considered to be the only known pathogenic intestinal flagellates:
- Asymptomatic Carrier State
PATHOGENIC: - Giardiasis ( Traveler's Diarrhea/Gay bowel syndrome)
A. GIARDIA LAMBLIA ▪ villous flattening and crypt hypertrophy
▪ Also known as: ▪ decreased electrolyte, glucose, fluid absorption.
- Giardia intestinalis ▪ Deficiencies in disaccharidases
- Giardia duodenalis
- Lamblia duodenalis TREATMENT
- Lamblia intestinalis ▪ Metronidazole
▪ Tinidazole
▪ First discovered by Antoine Van Leeuwenhoek ▪ Nitazoxanide
▪ First described by French scientist Dr. F. Lambl and
Czechoslovakian scientist Dr. Giard: Cercomonas intestinalis PREVENTION AND CONTROL
▪ Stiles coined Giardia lamblia ▪ Proper water treatment and control
▪ Exercising good personal hygiene
Giardia lamblia (Trophozoite) ▪ Proper cleaning and cooking of food
PARAMETER DESCRIPTION ▪ Avoidance of unprotected anal and oral sex
Size range: 8-10 um long
5-16 um wide PATHOGENIC:
Shape: Pear-shaped, teardrop B. TRICHOMONAS VAGINALIS
Motility: Falling-leaf
Trichomonas vaginalis (Trophozoite)
Appearance: Bilaterally symmetrical
Nuclei: Two ovoid-shaped, each PARAMETER DESCRIPTION
a large karyosome Size range: 5-14 um long
No peripheral chromatin Shape: ovoid, round or pear-shaped
Flagella: Four pairs,origination of each: Motility: Rapid, jerky
one pair, anterior end Nuclei: One, ovoid, nondescript
one pair, posterior end Flagella: all originating anteriorly
two pair, central, extending laterally 3-5 extending anteriorly
Other structure: Two median bodies one extending posteriorly
Two axonemes Other structure: - undulating membrane extending half of
Sucking disk body length
- prominent axostyle that often curves
around nucleus
Giardia lamblia (Cyst) - granules maybe seen along axostyle
PARAMETER DESCRIPTION
Size range: 8-17 um long
6-10 um wide
Shape: Ovoid
Nuclei: Immature cyst, two
Mature cyst, four
Central karyosomes
No peripheral chromatin
Cytoplasm: Retracted from cell wall
Other structure: Median bodies: two in immature cyst or four
Interior flagellar structures

DIAGNOSIS
▪ Examination of saline wet prep
▪ Papanicolaou smear
▪ Urinalysis
▪ Culture: InPouch TV (3 days)
▪ Molecular techniques: Affirm VPIII (DNA)
▪ Fluorescent stains
▪ monoclonal antibody assays, enzyme immunoassays,
EPIDEMIOLOGY NON-PATHOGENIC:
▪ Infection with T. vaginalis occur worldwide. B. TRICHOMONAS TENAX
▪ Sexual intercourse is the primary mode of transmission
▪ Known to be transferred via contaminated toilet articles Trichomonas tenax (Trophozoite)
orunderclothing. PARAMETER DESCRIPTION
Size range: 5-14 um long
SPECIMENS FOR IDENTIFICATION Shape: oval or pear-shaped
▪ urine (SOC)
Nuclei: One, ovoid nucleus; consist of vesicular
▪ vaginal secretions
region filled with chromatin granules
▪ scrappings
Flagella: 5 total, all originating anteriorly
▪ cervical swabs
4 extended anteriorly
▪ prostatic secretions
1 extends posteriorly
CLINICAL SYMPTOMS Other structure: - undulating membrane extending 2/3 of
▪ Asymptomatic Carrier state – most frequently in men body length with accompanying costa
▪ Persistent Urethritis - thick axostyle curves around
▪ Persistent Vaginitis - strawberry cervix nucleus:
▪ Infant infection: conjunctivitis, respiratory infection - extends beyond body length
- small anterior cytostome
TREATMENT - opposite undulating membrane
▪ Metronidazole: DOC
▪Treatment of sexual partners is recommended DIAGNOSIS
▪ Specimen of choice is mouth scraping
PREVENTION AND CONTROL
▪ Practice safe, monogamous sex and good personal hygiene EPIDEMIOLOGY
▪ Prompt treatment of cases and asymptomatic male patients ▪The exact mode of transmission is unknown
▪ Public education ▪ Some evidence suggesting that the use of contaminated dishes
and utensils
NON-PATHOGENIC: ▪ Introducing droplet contamination through kissing
A. TRICHOMONAS HOMINIS
CLINICAL SYMPTOMS
Trichomonas hominis (Trophozoite) ▪ Has been known to invade the respiratory tract
PARAMETER DESCRIPTION
Size range: 7-20 um long TREATMENT
5-18 um wide ▪ Nonpathogenic
Shape: Pear-shaped PREVENTION
Motility: Nervous, jerky ▪ Proper and good oral hygiene
Nuclei: One, with a small central karyosome
no peripheral chromatin NON-PATHOGENIC:
Flagella: 3-5 anterior C. CHILOMASTIX MESNILI
1 posterior extending from the posterior end
of the undulating membrane Chilomastix mesnili (Trophozoite)
Other structure: - axostyle that extends beyond the posterior PARAMETER DESCRIPTION
end of the body full body length undulating Size range: 5-25 um long
membrane 5-10 um wide
- conical cytostome cleft in anterior region Shape: Pear-shaped
ventrally loc. opposite the undulating Motility: Stiff, rotary, directional
membrane Nuclei: - One, with small central or eccentric
karyosome
- No peripheral chromatin
Flagella: - four
- 3 extending from anterior to end
- 1 extending posteriorly from cytostome
region
Other structure: - prominent cytostome extending 1/3 to 1/2
body length
- spiral groove
DIAGNOSIS
▪ Stool examination: trophozoites
Chilomastix mesnili (Cyst)
EPIDEMIOLOGY
▪ T. hominis is found worldwide PARAMETER DESCRIPTION
▪ Transmission mostly occurs by ingesting trophozoites Size range: 5-10 um long
▪ Contaminated milk is one of the source of infection Shape: lemon-shaped, with clear hyaline knob
extending from the anterior end
CLINICAL SYMPTOMS Nuclei: - One, with large central karyosome
▪ Asymptomatic - no peripheral chromatin
Other structure: well-defined cytostome located on one side
TREATMENT of the nucleus
▪ No need to treat
▪ Commensal or non-pathogenic

PREVENTION
▪ Proper sanitation
▪ Good personal hygiene
 PREVENTION AND CONTROL
▪ Proper personal hygiene
▪ Public sanitation practices

READ
▪ Enteromonas hominis
▪ Retortamonas intestinalis

DIAGNOSIS
▪ Traditional examination of freshly passed liquid stool
▪ Iodine wet preparation

EPIDEMIOLOGY
▪ C. mesnili is cosmopolitan in its distribution and prefers warm climate
▪ This may occur primarily through hand-to-mouth contamination
or via contaminated food or drink

CLINICAL SYMPTOMS
▪ Asymptomatic

TREATMENT
▪ No treatment is necessary

PREVENTION AND CONTROL

▪ Proper personal hygiene
▪ Public sanitation practices

DIENTAMOEBA FRAGILIS
▪ First discovered by Wenyon
▪ described by Pepps and Dobell
▪ originally described as an ameba
▪ no cyst stage identified
▪ co-infection with Enterobius vermicularis
▪ life cycle is unknown
▪ Hakansson phenomenon: D. fragilis
- differs from the amebic trophozoites when mounted in water
preparations. Although both types of organisms swell and
rupture under these conditions, only D. fragilis returns to its
normal size. Numerous granules are present in this stage and
exhibit Brownian motion.

Dientamoeba fragilis (Trophozoite)

PARAMETER DESCRIPTION
Size range: 5-18 μm
Shape: Irregularly round
Motility: Progressive, broad hyaline pseudopodia
Nuclei: - Two, each consisting of massed clumps of
four to eight chromatin granules
- No peripheral chromatin
Cytoplasm: Bacteria-filled vacuoles common

DIAGNOSIS
▪ Traditional examination of freshly passed liquid stool
▪ Fixed stool with polyvinyl alcohol or Schaudinn’s fixative
▪ Molecular techniques: RT-PCR

EPIDEMIOLOGY
▪ D. fragilis is transmitted via the eggs of helminth parasites such
as Enterobius vermicularis and Ascaris lumbricoides
▪ exact mode of D. fragilis transmission remains unknown
▪ risk of contracting D. fragilis: children, homosexual men, those
living in semi communal groups, and persons who are
institutionalized

CLINICAL SYMPTOMS
▪ Asymptomatic

TREATMENT
▪ Iodoquinol
▪ Tetracycline
▪ Metronidazole
 Trypanosoma cruzi
PARASITOLOGY 311 o Disease: Chagas disease or American Trypanosomiasis
BLOOD AND TISSUE FLAGELLATES
o Carlos Chagas: found trypanosome on the intestine of a
HEMOFLAGELLATES triatomid bug were the same parasite found in a child suffering
o This are parasites which inhabits the tissue and the blood of from fever and enlargement of lymph nodes.
human with the aid of vectors. o An intracellular parasite
o Member species: o Exhibits all four stage of development: amastigote,
✓ Leishmania spp. promastigote, epimastigote, trypomastigote
✓ Trypanosoma brucei gambiense
✓ Trypanosoma brucei rhodesiense BIOLOGICAL VECTOR:
Common names: Genera:
✓ Trypanosoma cruzi
Triatomine bugs • Triatoma
DIFFERENT STAGES OF HEMOFLAGELLATES Reduviid bugs • Rhodnius
Assassin bugs • Panstrongylus
Conenose bugs
Kissing bugs
MODE OF TRANSMISSION
VECTOR Natural transmission by triatomine bugs
through blood meal/contamination with
infected feces
TRANSFUSION A prevalent mode of transmission in urban
area. Gentian violet (24hr) eliminates parasite
in blood
STRUCTURAL PARTS CONGENITAL Occurs during any stage of T. cruzi infection.
o Blepharoplast Can result in premature labor, abortion or
neonatal defects
- basal body in certain flagellated protozoans that consists of
ACCIDENTAL Ingestion of food contaminated with
a minute mass of chromatin embedded in the cytoplasm at
metacyclic trypomastigotes
the base of the flagellum.
o Kinetoplast TYPES OF BIOLOGIC VECTOR
- is a disk-shaped mass of circular DNAs inside a large Salivarian Stercoralian
mitochondrion that contains many copies of the Transmission via mouth parts Hind gut station: acquired from
mitochondrial genome feces or eating the vector
o Undulating membrane Very efficient Inefficient
- a locomotory organelle of certain flagellate (trypanosome Infection rate in vector is low Infection rate
and trichomonad) parasites, consisting of a finlike extension
of the limiting membrane with the flagellar sheath;
wavelike rippling of the undulating membrane produces a
characteristic movement
PATHOGENESIS
o Acute Phase
- active infection
- 1-4 months duration most are asymptomatic (children most
likely to be symptomatic)
STAGE OF DEVELOPMENT
o Indeterminate Phase
Amastigote Promastigote Epimastigote Trypomastigote
PARAMETER DESCRIPTION DESCRIPTION DESCRIPTION DESCRIPTION
- 10-30 years of latency
SIZE 5 by 3 μm 9-15 μm long 9-15 μm long 12-35 μm long - relatively asymptomatic with no detectable parasitemia
by 2-4 μm wide
SHAPE
- seropositive
Round to oval Long and Long and slightly C, S or U shape
slender wider often seen in o Chronic Phase
than promastigote stained blood - 10-30% of infected exhibit cardio-myopathy or
form films
NUCLEUS One, usually off One, located in One, located in One, located megasyndromes
center or near center posterior end anterior to the
kinetoplast
OTHER Kinetoplast present, Kinetoplast, Kinetoplast located Kinetoplast located ACUTE PHASE FEATURES
FEATURES consisting of dotlike located in anterior anterior to the nucleus in the posterior end
blepharoplast from end Single free Undulating membrane, Undulating o 1-2 week incubation period
which emerges a
small axoneme
flagellum,
extending from
extending half of body
length Free flagellum,
membrane,
extending entire
o local inflammation
Parabasal body
located adjacent to
anterior end
usually an
extending from
anterior end
body length
Free flagellum,
- Romaña’s sign: edema of the eyelid and
the blepharoplast extracellular phase found in the intestine extending from conjunctiva
nonflagellate, as in the insect of the vectors anterior end when
intracellular also intermediate present only stage - Chagoma: inflammation at the site of
called Leishman- host (or in culture) found in man in the
Donovan (LD) bodies of leishmania latter illness inoculation
in human cells parasites
o symptoms can include: fever, malaise,
lymphadenopathy, hepatosplenomegaly,
nausea, diarrhea
o acute, often fatal, myocarditis develops in a few individuals
- high parasitemias in myofibrils
 CHRONIC CHAGAS’ CARDIOMYOPATHY PREVENTION AND CONTROL
o long latency characterized by seropositivity and no parasitemia o improvement of human dwellings
o higher prevalence of ECG abnormalities in asymptomatic o separation of animal stalls from house
seropositive persons o health education
o progressive development of abnormalities o insecticides
- right bundle branch block ➢ synthetic pyrethroids
- left anterior hemiblock o gentian violet in blood for transfusions
o clinical presentations include:
- arrhythmias and conduction defects TREATMENT
- congestive heart failure o acute stage
- thromboembolic phenomenon - nifurtimox (8-16 mg/kg/day, 60-90 days)
- benzidazole (5-7 mg/kg/day, 30-120 days)
PATHOLOGY - allopurinol (experimental)
o cardiomegaly - azole antifungal agents (experimental)
o apical aneurysm (left ventricle) o chronic stage
o extensive fibrosis* - treat symptoms
o hypertrophy*
o ± cellular infiltration CLINICAL MANIFESTATION
*correlates best with cardiac symptoms o Gambian trypanosomiasis – Winterbottom’s
sign (enlarged, non-tender posterior cervical
Amastigotes of Trypanosoma cruzi lymph nodes with a consistency of ripe plums
o Pseudocyst in a section of heart
muscle Leishmania spp
o Note necrosis in upper right corner. o Leishmania have two morphological forms:
a. Amastigote
b. Promastigote
Causative agent Disease
o Spleen smear
Leishmania tropica Baghdad boils, Oriental sore
o Note the absence of an undulating
Leishmania mexicana Bay sore, Chiclero ulcer,
membrane or emergent flagellum,
the kinetoplast (K) is more darkly Leishmania donovani Dum dum fever, Kala-azar
stained than the nucleus (N), and Leishmania braziliensis Espundia, Uta
the parasite’s cytoplasm is Leishmania guyanensis Forest yaws, Pian bois
unstained
o Amastigotes of T. cruzi would be PROMASTIGOTE -infective to humans
indistinguishable from those of L. -have single free flagellum
arising from kinetoplast at the
donovoni
anterior end
-promastigote in the proboscis
DIAGNOSIS of the insect vector and the one
o history of living in infestedhouse that grow in artificial media.
o bug bite, chagoma, Romaña's sign AMASTIGOTES -Lives intracellularly in
o cardiac or gastro-intestinal symptoms monocytes, polymorphonuclear
o imaging leukocytes and endothelial cells
o detection of parasite (acute stage) of the vertebrate host.
o serology (chronic stage
o parasite detection TRANSMISSION
➢ direct examination o The reservoir hosts are rodents, dogs, foxes and
➢ stained blood smears jackals
➢ inoculation into mice o The infection is usually transmitted by the bite
➢ in vitro culture (blood feed) of the female sandfly, genus
➢ xenodiagnosis - allow triatomine bugs to fed on patient and Phlebotomus and Lutzomyia
look 10-30 days later for flagellates o Human infection has been reported from blood
➢ PCR transfusion, congenital transmission,
o serological tests contamination of bite wounds and by contact.
➢ hemagglutination
➢ immunofluorescence PATHOGENESIS
➢ ELISA o The multiplying amastigotes inside phagocytes cause
➢ complement fixation destruction of the host cells.
o Trypomastigotes; blood smear o Macrophages with amastigote forms in their cytoplasm are set
o Free flagellum, moderately long free in the circulation, i.e from the skin to the viscera.
undulating membrane o Amastigotes are released and are taken-up by the fixed
o Posterior location of larger size of the macrophages in the spleen, liver, bone marrow, and other
kinetoplast (K) centers of reticuloendothelial activity.
o Characteristic “C”-shape of several cells
o The host cellular defense is stimulated resulting to proliferation Leishmania braziliensis
of macrophages in the bone marrow, which comprises the o Causes espundia, uta or mucotaneous/American
leishmaniasis
production of red cells and granulocytes. o Found in Central Mexico and Northern Argentina
o The end-effects are granulocytopenia and anemia. o Find LD bodies in tissues
o The spleen, liver and lymph nodes are enlarged whereby the o Once cured, lifelong immunity; if dormant – may re-
occur
spleen may end up into hypersplenism that causes more Mucocutaneous Leishmaniasis
destruction of the red blood cells. o Has a clinical picture dominated by great destruction
o The host immune reaction is also stimulated resulting to increase of the nasal mucosa, sometimes with respiratory
production of globulin that may result to reversal of the complications
o Mucocutaneous leishmaniasis is the most feared form
albumin-globulin ratio. of leishmaniasis because it produces destructive and
o The infection is therefore, regarded as a form of disfiguring lesions of the face (Tapir nose)
“reticuloendotheliosis”. o Espundia: metastatic spread to the oronasal and
pharyngeal mucosa

TYPES OF LEISHMANIASIS
TYPE PATHOGEN LOCATION Diagnosis: Cutaneous and Mucocutaneous Leishmaniasis
Cutaneous leishmaniasis The most common is the Cutaneous infections are Diagnosis:
(localized and diffuse) Oriental Sore (caused by most common in Afghanistan,
infections appear as obvious species L. major, L. tropica, Brazil, Iran, Peru, Saudi o Smear: Giemsa stain – microscopy for LD bodies (amastigotes)
skin reactions. and L. aethiopica, L. Arabia and Syria. o Biopsy: microscopy for LD bodies or culture in NNN medium for
mexicana.)
Mucocutaneous leishmaniasis L. braziliensis Mucocutaneous infections promastigotes
(espundia) infections will are most common in Bolivia, o Serologic techniques: IFA
start off as a reaction at the Brazil and Peru, in Karamay,
bite, and can go via China Xinjiang Uygur Montenegro intradermal reaction
metastasis into the mucous Autonomous o highly specific and of great use in cutaneous leishmaniasis,
membrane and become fatal. Region.
Visceral leishmaniasis Caused exclusively by species Found in tropical and although the test may be negative in the disseminated form.
infections are often of the L. donovani complex subtropical areas of all o Cellular immunity depends on T-lymphocytes and becomes
recognized by fever, swelling (L. donovani, L. infantum syn. continents except Australia.
of the liver and spleen, and L. chagasi). Visceral infections are most positive 24-48 hours after infection.
anemia. They are known by common in Bangladesh,
many local names, Dum Dum Brazil,
Fever, Death Fever and Kala India, Nepal and Sudan, in Leishmania donovani
azar. part of China, such as o Disease: Visceral leishmaniasis, kala-azar, dum dum fever
Province and Xinjiang Uygur
Autonomous o There are geographical variations.
Region. o Leishmania infantum mainly affect children
o Leishmania donovani mainly affects adults
CLINICAL TYPES OF CUTANEOUS LEISHMANIASIS o Clinical manifestation
o Leishmania major ✓ Fever: twice daily elevations
- found in sparsely inhabited areas ✓ Splenomegaly, hepatomegaly, hepatosplenomegaly
- Zoonotic cutaneous leishmaniasis ✓ Weight loss
- Wet lesions with severe reaction ✓ Anemia
✓ Epistaxis
- rapid ulceration; few amastigotes
✓ Cough
o Leishmania tropica ✓ Diarrhea
- found in more densely populated regions ✓ Loss of weight
- Anthroponotic cutaneous leishmaniasis ✓ Lymphadenopathy
- Dry lesions with minimal ulceration ✓ pancytopenia
- Many amastigotes; persists for months ✓ Hypergammaglobinemia
✓ darkening of the skin
o Untreated disease can be fatal
Leishmania tropica o After recovery it might produce a condition
o Disease: cutaneous leishmaniasis, Old World called post kala- azar dermal leishmaniasis
cutaneous leishmaniasis, oriental sores, Delhi boils,
Baghdad boils, dry or urban cutaneous leishmaniasis.
(PKDL) that resembles histioid type of leprosy
o incubation period: 2 weeks to several months
o skin ulcer: elevated and indurated DIAGNOSIS
o lesions are painless but with subcutaneous nodules
o Microscopy (amastigote) or culture in NNN
Leishmania mexicana
o Disease: New World cutaneous leishmaniasis, chiclero medium of the following specimen:
ulcer, bay sore ➢ Bone marrow aspirate
o North Central America, Mexico, Texas and possibly the ➢ Splenic aspirate
Dominican Republic and Trinidad
➢ Lymph node
o Cutaneous form, increasing in numbers of infected
o 3 clinical manifestastions ➢ Tissue biopsy
- Cutaneous – Chiclero-ulcer o Specific serologic tests: Direct Agglutination Test (DAT), ELISA,
- Nasopharyngeal mucosal – rare manifestation IFAT, Complement fixation test
- Visceral – rare manifestation
o main reservoir are rodents o Skin test (leishmanin test) for survey of populations and follow-
UNCOMMON TYPES up after treatment.
Leishmania aethiopica o Non specific detection of hypergammaglobulin by formaldehyde
o Diffuse cutaneous leishmaniasis (DCL): caused by, (formol-gel) test or by electrophoresis.
diffuse nodular non-ulcerating lesions. Low immunity
to Leishmania antigens (anergic), numerous parasites.
o Antibody titers
Leishmaniasis recidiva ➢ low in cutaneous, high in mucocutaneous and very high in
o lupoid leishmaniasis: severe immunological reaction disseminated cutaneous or visceral leishmaniasis.
to leishmania antigen leading to persistent dry skin
lesions, few parasites.
 PREVENTION AND CONTROL o Thick and thin blood films
o improvement of human dwellings o Buffy coat concentration method
o separation of animal stalls from house
o health education Trypanosoma brucei gambiense Trypanosoma brucei rhodesiense
o insecticides
➢ synthetic pyrethroids
o gentian violet in blood for transfusions

TREATMENT
o Similar medications used for leishmanisis but modes of
administration and dosages may vary.
➢ First-line therapy (Antimonials): SbV, Pentavalent
antimonials include sodium stibogluconate and methyl-
indistinguishable from one another
glucamine antimonite.
➢ Second line theraphy: Amphotericin B, pentamidine (for
TREATMENT
kala-azar), metronidazole, nifurtimox.
o Effective when begun early in the course of the disease (blood-
o Liposomal AMB (L-AMB) is less toxic than AMB. It has been
lymphatic stage)
effective in the primary treatment of VL in both
o Pentamidine and suramin
immunocompetent and immunocompromised patients
o Melarsoprol or tryparsamide (late stage-CSF)
o DL-alpha-diflouoromethylornithine (DFMO, Eflornithine):
Trypanosoma brucei gambiense
ornithine decarboxylase inhibitor
Trypanosoma brucei rhodoseinse
➢ Eflornithine: not very effective against Rhodesian sleeping
Trypanosoma brucei
sickness
o Disease: Human African Trypanosomiasis
o It is caused by two subspecies of Trypanosoma brucei, namely:
PREVENTION AND CONTROL
➢ Trypanosoma brucei rhodesiense: East Africa, wild and
o Reduction of contact with tsetse flies
domestic animal reservoirs, East African/Rhodesian
➢ Traps, screen, insecticides
sleeping sickness
o Diagnosis and treatment of infected individuals
➢ Trypanosoma brucei gambiense: West and Central Africa,
o Tsetse belt: endemic area extending over third of Africa
mainly human infection, West African/Gambian sleeping
sickness
o forms exhibited: epimastigote, trypomastigote

TRANSMISSION
o Through the bite of the tsetse fly
(Glossina spp.), the metacyclic
trypomastigotes will be inoculated
to the blood of the host
➢ Glossina tachinoides
➢ Glossina palpalis

CLINICAL MANIFESTATION
o Earliest sign is the chancre (painful lesion at
the site of inoculation)
o Acute stage – irregular fever, headache,
myalgia, tachycardia, dizziness and rash
(episodic, 1-6 days followed by an
asymptomatic period lasting several weeks)

Gambian trypanosomiasis
o Winterbottom’s sign: enlarged, non-tender
posterior cervical lymph nodes with a
consistency of ripe plums
o Kerandel’s sign: CNS invasion, more severe
headache, increased mental dullness and
apathy, tremors, hyperesthesia

Rhodesian trypanosomiasis
o more rapid and fatal

DIAGNOSIS
o Demonstration of trypomastigotes in the Giemsa stained blood,
lymph node aspirate and CSF
o Serologic techniques: indirect hemagglutination, ELISA,
immunofluorescence
 o Irregular, ameboid trophozoites, has spread-out appearance
PARASITOLOGY 311 o Pigment: Golden brown, inconspicuous
SPOROZOA AND COCCIDIA
o Number of merozoites: 12-24, average is 16
PHYLUM APICOMPLEXA o Stages found in circulating blood: all stages
Plasmodium spp. •enlarged erythrocyte
•Schüffner’s dots
o Stage of Development
•ameboid trophozoite
1. Ring forms •12-24 merozoites
- Early Trophozoites
- as the name implies, refers to a ring like appearance
of the malarial parasite following invasion into a Plasmodium malariae
previously healthy RBC o Disease: malariae or quartan malaria
- space inside the ring is known as a vacuole o Similar range as P. falciparum, but less common and patchy
2. Developing/Growing Trophozoites distribution
- remnants of the cytoplasmic circle and chromatin dot o Common in tropical Africa, Burma, Sri lanka, India, Malaysia and
are still intact until late development Indonesia.
- the parasite is actively growing during this stage, the o It is occasionally seen in the Philippines.
amount of RBC space invaded is significantly more o Size of erythrocytes: normal
than that of the ring form o Ziemann’s dots rarely seen
3. Immature/Presegmenting Schizonts o Rounded, compact trophozoites with dense cytoplasm.
- active chromatin replication is seen o Band form trophozoites occasionally seen
- expands and occupies more space within the RBC o Pigment: dark brown, conspicuous
4. Mature Schizonts o Rosette schizonts occasionally seen
- Merozoites: emergence of the fully developed stage of o No. of merozoites: 6-12, average is 8
the asexual sporozoa trophozoite o Stages found in circulating blood: all stages
5. Microgametocytes •compact trophozoite
- typical microgametocyte is roundish in shape (except • “band” form
•6-12 merozoites in
P. falciparum, which is crescent-shaped) mature schizont
- large diffuse chromatin mass that stains pink to purple • “rosette”
and is surrounded by a colorless to pale halo
- pigment is usually visible Plasmodium ovale
6. Macrogametocytes o Disease: ovale malaria, Benign tertian malaria
- round to oval (except P. falciparum, which is crescent- o It is the least common Plasmodium infecting man.
shaped) o It occurs mostly in tropical Africa, principally on the west coast
- pigment is also present, and its color and distribution and is endemic in Ethiopia.
in this morphologic form vary by individual o Size of erythrocytes: enlarged, maximum size may be 1 ¼ - 1 ½
Plasmodium species times normal, approximately 20% or more infected RBC are oval
and fimbriated (border has irregular projections)
Plasmodium falciparum o Schuffner’s dots present in all stages except early ring forms
o Disease: malignant malaria, aestivo-autumnal, falciparum o Rounded, compact trophozoites, occasionally slightly ameboid
malaria, subtertian malaria, pernicious malaria, Black water o Growing trophozoites have large chromatin mass
fever malaria o Pigment: dark brown, conspicuous
o It is most prevalent in the tropics and subtropics o No. of merozoites: 6-14, average is 8
- It causes the most severe form of malaria o Stages found in circulating blood: all stages
- It still remains almost unchallenged as the greatest •similar to P. vivax
killer of the human race over most parts of Africa and -enlarged erythrocyte
-Schüffner’s dots
elsewhere in the tropics.
•subtle differences
o Size of Erythrocytes: normal, multiple-infected RBC are common -compact trophozoite
o Maurer’s dots occasionally seen -fewer merozoites (8)
Young rings are small, delicate, often with double chromatin -elongated erythrocyte
dots, accole, applique
o > 1 ring form can be found in 1 RBC (multiple infection) Plasmodium knowlesi
o Gametocytes are crescent or elongated o a primate malaria parasite commonly found in Southeast Asia.
o Pigment: black, coarse and conspicuous in parasite o It causes malaria in long-tailed macaques (Macaca
o Number of merozoites: 6-32, average is 20-24 fascicularis), but it may also infect humans, either naturally or
o Schizonts: bad prognosis artificially.
o Stages found in Circulating Blood: Young, growing trophozoites o The fifth major human malaria parasite
(ring forms) and gametocytes o This is an emerging infection that was reported for the first time
in humans in 1965.
o It accounts for up to 70% of malaria cases in South East Asia
where it is mostly found
o In developing trophozoites of P. knowlesi, band forms may
appear that are similar in appearance to P. malariae.
-numerous rings -trophozoites and schizonts -crescent-Shaped o As the vacuole is lost during maturation of the trophozoite stage,
without mature -not normally seen in peripheral gametocytes the parasite becomes smaller and more compact.
forms circulation
-slightly smaller -severe disease o The pigment appears as dark grains and the red nucleus
-marginal forms -compact parasite increases in size.
-6-32 merozoites o Stippling appears, often referred to as 'Sinton and Mulligan's'
stippling
Plasmodium vivas
o Disease: vivax malaria or benign tertian malaria
o Most widespread, found in most endemic areas including some
temperate zones
o It is more common in temperate than in tropical region.
o It is the second common Malaria in the Philippines.
o Size of Erythrocytes: enlarged, maximum size may be 1½- 2
times normal (attained with mature trophozoites and schizonts) o In developing schizonts of P. knowlesi, Sinton and Mulligan's
o Ring forms occupies 1/3 diameter of RBC stippling may be observed.
o Schuffner’s dots present in all stages except early young forms
o The nucleus continues to divide until there are up to 16 (average 10) MALARIA TRANSMISSION
merozoites. o natural (sporozoites/Anopheles)
o As the schizont matures, it fills the host RBC and the pigment collects o blood transfusions
into one or a few masses. - shorter incubation period
o In the mature schizont, the merozoites may appear 'segmented' and - fatality risk (P. falciparum)
the pigment has collected into a single mass. - relapses possible (P. vivax/ovale)
o It may cause severe malaria as indicated by its asexual erythrocytic o syringe sharing
cycle of about 24 hours.
o congenital
o The typical fever becomes quotidian
- relatively rare although placenta is heavily infected

CLINICAL FEATURES
o characterized by acute febrile attacks (malaria paroxysms)
- periodic episodes of fever alternating with symptom-
free periods
o manifestations and severity depend on species and host status
- immunity, general health, nutritional state, genetics
o recrudescences and relapses can occur over months or years
o can develop severe complications (especially P. falciparum)
COLD STAGE HOT STAGE SWEATING STAGE
-feeling of intense cold -intense heat -profuse sweating
-vigorous shivering, -dry burning skin -declining temp.
rigor - throbbing headache -exhausted, weak → sleep
-lasts 15-60 minutes -lasts 2-6 hours -lasts 2-4 hours
Chilly sensations that The body temperature The patient perspires
progress to a teeth- begins to mount rapidly as profusely, temperature
chattering, frankly the blood vessels dilate. falls and the headache
shaking chill. The Temperature peaks at 39- disappears. The patient is
peripheral blood 41 C, skin is hot and the exhausted but
vessels are constricted face flushed. Sign and symptomless. And the next
and the lips and nails symptoms includes day the patient can feel
are cyanotic nausea, vomiting quite well, before the next
headache and rapid pulse. paroxysm occurs.
High fever may produce
convulsion in children.

MALARIAL PAROXYSMS
o Periodicity varies according to species
o Depends on the length of the asexual cycle
o Plasmodium falciparum
- Malignant tertian malaria (36 hours or less)
o Plasmodium vivax and P. ovale
- Benign tertian malaria (48 hours)
o Plasmodium malariae – Quartan malaria (72 hours)

PATHOGENECITY OF MALARIA
o In P. falciparum infections, as the parasite begins to grow, the
red cell membrane becomes sticky and cells adhere to the
INVERTEBRATE PHASE endothelial lining of the capillaries of the internal organs
o 4-15 days after ingestion of gametocyte o thus, only ring forms and gametocytes appear in the peripheral
o Female Anopheles mosquito takes a blood meal containing blood
gametocytes from infected person
➢ Microgametocytes – male ANEMIA
- Nuclear division and exflagellation o More pronounced in P. falciparum
➢ Macrogametocytes – female o Hemolytic, normochromic, normocytic anemia
- Shifting of nucleus to the surface to form a projection o Decrease Oxygen carrying capacity leading to anoxia
- Microgamete penetrates macrogametes producing an
ookinete SPLENOMEGALY
o Caused by an increase in splenic activity
VERTEBRATE PHASE o Parasitized red cells pass through the spleen, loss their
o Mosquito injects sporozoites to man deformability, thus destroyed in the process
o Sporozoites disappear from the blood o Normal RBC’s are destroyed due to increase activity of
- Some are destroyed by the host immune system macrophages
- Enters liver parenchymal cells (hypnozoites in P. vivax
and P. ovale) NEPHROTIC SYNDROME
o Seen in Plasmodium malariae infection
INSECT VECTORS IN THE PHILIPPINES o Deposition of antigen – antibody complexes causes thickening
o Anopheles flavirostris – primary vector in the Philippines, night of the capillary walls of the basement membrane
biter, breeds in slow-flowing clean water mountain streams o Presence of focal hyalinizing lesions of the tuft of the glomerulus
o Anopheles balabacensis - rest either indoors or outdoors, in and segmental endothelial cell proliferation progressing to
puddles, pools, ponds, and in shades. glomerular sclerosis
o Anopheles lesteri - rest either indoors or outdoors, in pools,
ponds, lakes, and in ricefields. BLACKWATER FEVER
o Anopheles philippinensis - rest either indoors or outdoors, in o Syndrome of acute intravascular hemolysis, accompanied by
pools ponds or lakes. hemoglobinemia and hemoglobinuria
o Anopheles umbrosus - rest out of doors, in pools, ponds, lakes, o Abrupt onset, passage of dark red or almost black urine,
running streams and canals in shades. vomiting of bile-stained fluid, jaundice
o Anopheles leucosphyrus – vector of Plasmodium knowlesi, o High mortality
typically found in forest areas in South East Asia but with a o Rapid and severe hemolysis of both parasitized and non –
greater clearing of forest areas for farmland parasitized red cells
o Anopheles litoralis, Anopheles maculates, Anopheles mangyanus
o Presence of the parasite changes the antigenic structure of o 🦇Reduce Vector
individual erythrocytes and stimulates the production of - environmental modification
antibodies - larvacides/insecticides
- biological control
DISSEMINATED INTRAVASCULAR COAGULATION (DIC) o 🦍Reduce Parasite Reservoir
o Most serious hematologic complication - diagnosis and treatment
o Activation of the clotting system resulting to thrombin - chemoprophylaxis
generation and intravascular coagulation
TREATMENT
SEVERE FALCIPARUM MALARIA o Most drugs used in the treatment are active against the
o Prostration: first probable symptom, o Acute renal failure
a condition characterized by o Acute pulmonary edema and parasite forms in the blood
confusion or drowsiness with Adult Respiratory Distress - Chloroquine: drug resistance with P. falciparum
extreme weakness Syndrome (ARDS) - sulfadoxine-pyrimethamine (Fansidar®)
o Unarousable coma (Cerebral malaria) o Circulatory collapse, shock,
o Generalized convulsions septicemia (algid malaria)
- mefloquine (Lariam®)
o Severe normocytic anemia o Abnormal bleeding - atovaquone-proguanil (Malarone®)
o Hypoglycemia o Jaundice - quinine
o Metabolic acidosis with respiratory o Hemoglobinuria - doxycycline
distress o High fever
o Fluid and electrolyte disturbances o Hyperparasitemia - artemisin derivatives
o In addition, primaquine is active against the dormant parasite
RELAPSE liver forms (hypnozoites) and prevents relapses.
o Present in P. ovale and P. vivax
o Activation of hypnozoites (liver stages) resulting to renewal of PHYLUM APICOMPLEXA
malarial infection. Babesia spp.
Babesia Taxonomy
RECRUDESCENCE - Phylum Apicomplexa
o Renewal of parasitemia or clinical features arising from - Class Sporozoea
persistent undetectable asexual parasitemia in the absence of an - Subclass Coccidia
exoerythrocytic cycle - Subclass Piroplasmia – no oocyst
- Order Piroplasmida
o P. falciparum: Due to infected RBC sequestered by the spleen
- Genus Babesia
o Common tick-borne parasite of domestic and wild animals
DIAGNOSIS
o Parasites of red blood cells, causes malaria-like infections
o Prompt and adequate diagnosis is necessary
o Clinical diagnosis: symptoms o No intracellular pigment in developmental stages
o Rare zoonotic human infection,
o History of being in endemic area
natural host are the rodents and deers
Microscopic identification of the malarial parasites
➢ white-footed mouse (Peromyscus
💉Thick and thin blood smear leucops)
- thick film: screening for positivity and parasite count
- thin film: species identification easier GEOGRAPHIC RANGE
o Stained with Giemsa or Wright’s stain o Worldwide, especially in:
o Gold standard for malarial diagnosis ➢ Europe (although, mostly Babesia divergens)
o Taken at the before height of the fever (schizogony) and before ➢ Asia
antibiotic administration, highest number of parasite in the ➢ United States
blood - Particularly in the Northeast: Especially New England,
o repeat smears every 12 hours for 48 hours if negative New York & other coastal regions
🔬Quantitative Buffy Coat (QBC) - Has been spotted in other parts of the U.S., such as the
- Usually, prepared capillary tube coated with acridine mid-west
orange
- Malaria parasites take up the stain and appear bright HUMAN BABESIOSIS
green and yellow under a fluorescent microscope B. microti B. divergens
🖥Rapid Diagnostic Tests (RDT) Location United States Europe
- Detects parasitic antigens: Reservoir Field mice, voles Cattle, ruminents
o Pan malaria: p-LDH (Diamed Optimal IT) Vector Ixodes scapularis (black- Ixodes ricinus
o Falciparum malaria: HRP-II (Paracheck Pf legged tick) Ixodes dammiini
Test, ParaHIT f Test) Cases ~300 ~30
- Makes use of immunochromatographic methods in
Fatality 5% 50%
order to detect Plasmodium-specific antigens in a
finger-prick blood sample
Mode of Transmission
- Advantages: Can be performed in 15-30 mins, 90%
specific o Tick-bite
- Disadvantages: lack of sensitivity at low levels of o Transplacental
parasitemia, inability to quantify, more costly o Blood transfusion
🖥 Serological Tests
- Cannot differentiate current and past infections –
Most helpful in epidemiological studies o Indirect Babesia microti
Hemagglutination (IHA) o Indirect Fluorescent o Common species diagnosed in human.
Antibody Test (IFAT) o Enzyme-linked Immunosorbent o Small rings within the red blood cell, very
Assay (ELISA) much like Plasmodium falciparum with a
🖥 Polymerase chain reaction (PCR) darkly staining nucleus and very little
- To significantly enhance the microscopic diagnosis of cytoplasm.
malaria especially in cases of low parasitemia and in o It do not have associated pigment in the red
cases of mixed infection blood cell.
o Asexual multiplication by binary fission in the
MALARIA CONTROL RBC with production of merozoite that invade other RBC.
o When taken up by the ticks, there is complex cycle of
o 💁Reduce Human-Mosquito Contact
multiplication that includes a sexual stage, resulting ultimately in
- Insecticide treated bed nets (ITN)
the presence of the parasites in the salivary gland of the tick.
- repellants, protective clothing
- screens, house spraying
o Definitive Host infect an intermediate host (the prey) in which asexual
- A tick is the definitive host multiplication of the parasite occur.
- Transmission occurs from an IN HUMANS
animal to a human, normally using -Cryptosporidium
the northern deer tick or black- -Isospora
legged tick (Ixodes scapularis) as -Cyclospora
-Toxoplasma
the vector.
-Sarcocystis

Babesia divergens
o transmitted by the tick Ixodes Ricinus
o main agent of bovine babesiosis, or redwater fever in Europe
LIFE CYCLE
o it can also infect immunocompromised humans, causing medical
Merogony
emergencies characterized by rapid fulmination and -schizogony
parasitemias that may exceed 70%. -produce merozoites
Gametogony
-gamogony or gametocytogenesis
-produce micro- and
macrogametes
Sporogony
-produce sporozoites
-completed on host cell
-thin (autoinfection) or thick walled
oocysts

PHYLUM APICOMPLEXA
Toxoplasma gondii
o cosmopolitan distribution
o seropositive prevalence rates vary
- generally 20-75%
HUMAN BABESIOSIS o generally causes very benign disease in
Clinical disease immunocompetent adults
o asymptomatic to fatal o tissue cyst forming coccidia
o more severe in splenectomized persons, elderly, or - predator-prey life cycle
immunocompromised - felines are definitive host
o characterized by fever, chills, sweating, myalgia, fatigue, - Infects wide range of birds
nausea, loss of appetite and mammals (intermediate hosts)
o moderate to severe hemolytic anemia
o Renal failure, jaundice and hepatosplenomegaly TYPICAL LIFE CYCLE IN FELINES
Diagnosis o fertilization within infected host cells
o parasite in thin or thick blood smear o immature oocysts in feces
o Tetrad-forms or Maltese-cross arrangement of merozoites o sporulation in environment (1-4 days)
o 🗺 no travel history
o 🖥 Serology – IFA
o lack of response to anti-malarials
Treatment
o no generally effective drugs
o Clindamycin (DOC) + quinine is recommended
Merozoites: TACHYZOITES vs. BRADYZOITES
- reduces duration of parasitemia
o Tachyzoites has been coined for the first, actively
- high level of adverse side affects
multiplying merozoites that develop within the
o atovaquone + azithromycin
intermediate host, irrespective of whether
- as effective as clindamycin + quinine
infection is from oocysts or tissue cysts
- fewer adverse affects
o Metrocytes (noninfectious) and bradyzoites
o blood transfusions for severe anemia
(infectious) are merozoites that develop within
Prevention
tissue cysts
o Skin checks for ticks after being in wooded areas Tachyzoite Stage Bradyzoite Stage
o Check animals for ticks -ingestion of oocysts -dormant, slowly replicating
o Wear long clothing -sporozoites penetrate intestinal -due to host immune response
o Find a good tick repellant epithelium -chronic or latent infection
-rapid intracellular replication (any cell) -tissue cysts primarily in brain
-dissemination via macrophages and muscle
PHYLUM APICOMPLEXA
-2 sporocyst
Coccidians -4 sporozoite
o Class Sporozoea. -merogony → 'merozoites'
o Coccidian parasites infect the intestinal tracts of animals -typical apicomplexan
o The largest group of apicomplexan protozoa. → motile invasive stages
o obligate, intracellular parasites, which means that they must live and →intracellular replication
reproduce within an animal cell. -'binary fission' = endodyogony
o with no definite organ of locomotion -repeated rounds of merogony
o It may have body flexion, gliding or undulating of longitudinal ridges. -acute stage infection
-primarily in reticulo-endothelial cells
COCCIDIA
o characterized by thick-walled oocysts excreted in feces
o In Isospora, Cyclospora and Cryptosporidium only a single direct
cycle of transmission occurs, both the asexual and sexual stages
of multiplication occurs in a single host and that is to man.
o In Sarcocystis and Toxoplasma, the sexual stages are usually in
the intestinal mucosa of a carnivorous host (the predator). The
result in an oocyst or sporocyst that passes out in the feces to
 HUMAN TRANSMISSION PHYLUM APICOMPLEXA
o ingestion of sporulated oocysts Isospora belli
(cat feces + incubation) o Though rare, it has a wide geographical distribution (higher
o ingestion of zoites (tachyzoite & prevalence in warmer climates)
bradyzoites (undercooked meat) o The least common of the intestinal coccidia that infect humans
o congenital infection (only o Can cause severe disease with fever, malaise, persistent diarrhea
during acute stage) and even death in AIDS patients
o Monoxenous (required one host) , probably not zoonosis:
o organ transplants
Asexual and sexual multiplication occurs in man
- chronic infection in donor
o Mode of Transmission: Human are probably infected by
- immunosuppression
accidental hand-to-mouth ingestion of mature oocyst in food
o blood transfusions (only during
and water.
acute stage)
o Habitat: Distal duodenum and proximal jejunum

PATHOGENESIS PATHOLOGY
o The organisms can grow in any organs or tissues, developing in o invades intestinal epithelial cells
the brain, eyes and skeletal muscles o often asymptomatic (seldom reported)
o There is localized proliferation of the organisms and o symptoms range from mild gastro-intestinal distress to severe
immunologic hypersensitivity reaction. dysentery
o Multiplication of the organisms within the infected cell leads to o often self-limiting, but can become chronic (wasting, anorexia)
death and rupture of the cell. o symptoms more severe in AIDS patients

CLINICAL MANIFESTATION Isospora belli

o Most of the cases are asymptomatic. o 30 x 12 mm oocyts
o Congenital toxoplasmosis is often severe o 2 sporocysts
and even fatal. o 4 sporozoites each
o Sabin syndrome (tetrad of signs)
- Chorioretinitis PATHOGENESIS
- Cerebral calcification o Infection is confined to intestinal epithelial cells.
- Convulsion or psychomotor disturbances
o Destruction of the surface layer of the intestine.
- Hydrocephalus or microcephalus
o There is malabsorption markedly abnormal intestinal mucosa
with short villi, hypertrophied crypts and infiltration of the
OTHER FORMS OF TOXOPLASMOSIS
lamina propia with eosinophilia, neutrophils and round cells.
o Typhus-like exanthematous form – may produce myocarditis,
meningoencephalitis and atypical pneumonia
CLINICAL MANIFESTATION
o Cerebrospinal form – There is involvement of the CNS and the
o Infections are often asymptomatic and self -limiting.
CSF is xanthochromic
o It may be from mild gastrointestinal distress to severe dysentery.
o Non-congenital retinochoroiditis infection – The ocular lesion
o The loose, pale yellow and foul-smelling stools are suggestive of
originates in the retina and spread to the choroids.
malabsorption process.
o There may be chronic diarrhea, vague or crampy abdominal pain,
OCULAR TOXOPLASMOSIS
weight loss, weakness, malaise and anorexia.
o retinochoroiditis: likely due to both active
o There may be diarrhea over a period of several months to 15
parasite proliferation and immune
years.
hypersensitivity
o generally a recrudescence--rarely from
DIAGNOSIS
primary infection
o Stool examination to demonstrate the immature oocyst from the
o congenital infection
feces – Iodine stain which facilitates identification.
- 20% exhibit ocular symptoms at
o Modified acid fast stain (Kinyoun’s stain/Auraminerhodamine)
birth
wherein oocyst wall does not stain and sporoblast is deep red
- 82% by adolescence
stained.
o most lesions are focal and self-limiting
o Enterotest™
o rapidly destructive in AIDS patients
o Concentration technique
- zinc sulfate flotation method
DIAGNOSIS
- Formalin-ether sedimentation method
o Identification of the organism in smears of lymph nodes, - Sheather’s sugar flotation
bone marrow, spleen or brain or other materials.
o Inoculation into mice or cell culture (only acute stage) TREATMENT AND PREVENTION
o Sabin-Feldman methylene blue dye test: very sensitive o For mild or asymptomatic infection, non-specific measures such
and specific but requires maintenance of live organism as rest and bland diet mat be sufficient.
o 🖥 Serological test: to detect antibodies o AIDS patients: trimethoprim-sulfamethoxazole
- Polymerase chain reaction (PCR) : detection of the o Prevention: same as Entamoeba histolytica
parasites DNA
- ELISA, IFA, EIA, Latex agglutination PHYLUM APICOMPLEXA
TREATMENT Sarcocystis spp.
o Pyrimethamine and sulfadiazine o The name is derived from Greek:
- controls Toxoplasma but do not kill it. ➢ sarx = flesh and cystis = bladder
- Leucovorin (folic acid): pyrimethamine can cause lower blood counts o rare human infection
- Sulfadiazine: causes allergic reaction but can be substituted by o heteroxenous parasite
clindamycin
➢ predator-prey life cycle
o Corticosteroids: prevent occurrence of hypersensitivity ➢ humans support both stages
o Trimethoprim-sulfamethoxazole: prophylaxis for o originally identified as 2 species
immunocompromised ➢ intestine ~ Isospora
PREVENTION AND CONTROL ➢ tissue ~ Sarcocystis
o Proper cooking of meat (66oC, 150oF) o taxonomic confusion
- wear gloves when handling, wash hands after ➢ generally named after host
o Environmental sanitation species
o Careful attention to cat feces - Sarcocystis hominis
- clean litter box promptly, wear gloves, keep cat in house, cover sand - Sarcocystis suihominis
box, no cats in home, control strays
 INTESTINAL DISEASE DIAGNOSIS
o Ingest undercooked meat o Stool examination to identify the oocyst.
o transient mild to severe diarrhea o Enterotest™: to recover oocyst.
o excrete sporulated sporocysts o Kinyoun’s modified acid fast stain: red-pink doughnut shaped circular
organism in a blue background
- 13x10 mm
o Concentration test
- 4 sporozoites
- Sheather’s sugar flotation
o Serological test:
MUSCLE DISEASE - EIA
o ingest sporocysts - DNA probes specific for C. hominis
o develop sarcocysts TREATMENT
- several 100 mm - Spiramycin
- compartments - Pyrimethamine and sulphadiazine
- sometimes thick striated wall - Somatostatin
o muscle tenderness PREVENTIVE MEASURES:
o episodic inflammation - Environmental sanitation
- Personal hygiene
PATHOLOGY AND CLINICAL MANIFESTATION
o Human sarcocystosis/sarcosporidiosis PHYLUM APICOMPLEXA
- gastroenteritis with diarrhea Cyclospora cayetanensis
- eosinophilic enteritis o first human case in 1979
- myalgia and weakness o named in 1993
- mild increase of creatine kinase - initially called ‘cyano-bacteria like
body’ (CLB) or large
o Intermediate host
Cryptosporidium
- gait abnormalities
- no known animal reservoir
- muscle wasting o more common in tropical and sub-tropical
- head tilt areas
- animals observed to move in circles o Infection most common in HIV/AIDS patients
- abortion in pregnant animals o In freshly passed in stools, the oocyst is not
DIAGNOSIS infective (direct fecal-oral transmission cannot
o Fecal floatation methods occur; this differentiates from
Cryptosporidium).
o Brain tissue biopsy in animals: bradyzoites
o In the environment, sporulation occurs after days or weeks at
o Serological methods: temperatures between 22°C to 32°C, resulting in division of the
- IFA sporoblast into two sporocysts, each containing two elongate
- ELISA sporozoites.
- PCR - 8-10 mm oocyts
- Western blot - 2 sporocysts
TREATMENT - 2 sporozoites each
o No effective treatment known o Fresh produce and water can serve as vehicles for transmission
o Corticosteroids: treating muscular inflammation PATHOGENESIS
o Onset of symptoms may occur 12-24 hrs after exposure
PHYLUM APICOMPLEXA o Chronic and intermittent diarrhea alternating with constipation
Cryptosporium spp. o Fatigue, anorexia, weight loss, nausea, vomiting, abdominal pain,
o fecal-oral transmission (monoxenous) flatulence, bloating, dyspnea
- wide range of animal hosts (C. parvum) PATHOLOGY
- several host-adapted species o Cyclospora infects enterocytes of the small bowel where various stages,
- C. hominis for human species sexual and asexual stages have been observed.
o first human case reported in 1976 o Villous blunting, mild crypt hyperplasia and variable increased chronic
o self-limiting diarrhea in immunocompetent persons inflammatory cells in the lamina propria.
o profuse, watery diarrhea associated with AIDS (life threatening) o In the immunocompromised patient, severe diarrhea can last up to 4
months or longer even if treated thus producing a disease syndrome that
C. baileyi (birds) C. muris (mouse) C. wrairi (guinea pigs)
C. felis (cat) C. nasorum (fish) C. parvum (mammals)
is debilitating and life threatening
C. meleagridis (turkeys) C. serpentis (snakes) C. hominis (humans) o Extra-intestinal infection appears to be more common in AIDS patients
TRANSMISSION
Cryptosporidium hominis o associated with food-borne outbreaks
o Disease: Cryptosporidiosis - luncheons, social events, weddings, etc.
o World wide in distribution o possible source always involved foreign country and fresh fruit or
o Common cause of diarrhea among travelers and in vegetables
day care centers. - raspberries from Guatemala
o Can occur as water-borne outbreaks
- leafy vegetables from Peru and Nepal
o Zoonosis from domestic animals.
o More common in children than adult.
- lettuce and basil pesto in US
o presumed source: contaminated water or human waste as fertilizer
o 4-5 mm oocysts
o 4 sporozoites DIAGNOSIS
o no sporocysts o demonstration of oocysts in feces
- acid-fast stain (kinyoun’s stain)
HABITAT: - safranin staining and microwave heating
o Brush border of the mucosal epithelium of the stomach or intestine.
- Autofluorescence: blue or green circles
o May involved the gallbladder and pancreatic duct.
o 🖥 Serologic methods:
- PCR: to differentiate with closely related Eimeria species
PATHOGENESIS:
o Destruction of the host cells TREATMENT
o villi of intestine: infiltration of inflammatory cells into the lamina propia o Self-limiting, immunity may result with repeated infection •
and elongated crypts Trimethoprim-sulfamethoxazole: only effective drug
Comparison: Oocyts of Different Genera
CLINICAL MANIFESTATION Sporocyst Sporozoites
o Self-limiting in person with sound immune function Cryptosporidium 0 4
o Nausea and vomiting, abdominal cramps, weight loss and fever Cyclospora 2 2
o Diarrhea Isospora 2 4
o Severe fluid loss from diarrhea and vomiting can lead to fatal outcome in Toxoplasma 2 4
children Sarcocystis 2 4
 Wuchecheria bancrofti
PARASITOLOGY 311 o Common name: bancroft’s filaria
BLOOD AND TISSUE NEMATODES
o Disease associated: bancroft’s filariasis, filariasis bancrofti,
FILARIAL WORMS elephantiasis
o Blood and tissue inhabiting nematodes
o Female larviparous or viviparous and insect vector are needed Wuchereria bancrofti (Microfilaria)
for the transmission of the infection Size range 240-300 um long
- Oviparous: lays eggs in unsegmented stage Sheath Present
(unembryonated) Arrangement of Nuclei in Tail Tip of tail free of nuclei
- Ovoviviparous/oviviparous: lays eggs in segmented stage
(embryonated) ADULTS
- Viviparous/larviparous: larva →White and assume a
o The time and day whereby blood contains abundant number of threadlike appearance
micrifilariae, as compared to other hours is called periodicity →Females are typically
- nocturnal: occurring at night larger than male measuring
- diurnal: occurring during the day 40-100 mm and 20-40 mm,
- subperiodic: timing of occurrences not clear-cut respectively
- non-periodic
o Presence or absence of a delicate transparent covering known LABORATORY DIAGNOSIS
as a sheath o Nocturnal periodicity: peak hour of specimen collection are
- Sheathed between 9:00 pm to 4:00 am
- Unsheated - Diethylcarbamizine: stimulates microfilariae to come out
even during daytime
MORPHOLOGICAL FORMS o Examination of fresh Giemsa-stained blood
1. Adult Worms o Nuclepore filter: heparinized blood
- appear creamy white and assume a threadlike appearance o Knott Technique
- males may measure from 20 to 500 mm in length, which is - Using 10ml of 2% Formalin and 1ml blood
often half that of typical adult females. o Serologic Test
2. Larvae/Microfilarae - PCR
o First stage larvae (L1) - detection of Circulating Filarial Antigen (CFA)
o Second stage larvae (L2)
o Third stage larvae (L3)
- slender and may range in size from just under 150 μm to
350 μm in length
- distribution of nuclei within the tip of the tail
- presence or absence of a sheath
Two helpful characteristic speciating the microfilariae
1. Distribution of nuclei in tip of tail
2. Presence or absence of sheath TRANSMISSION
o Vector:
✓ Aedes
✓ Culex
✓ Anopheles
o W. bancrofti may be found in the subtropical and tropical areas
of the world including the Philippines

CLINICAL SYMPTOMS
o Asymptomatic: Infection of this type are self-limiting because the adult
worms eventually die and there are no signs of microfilariae being
present. A patient may undergo the entire process and not even know it.
o Symptomatic
- They develop a fever, chills, and eosinophilia
- Adenolymphagitis/Dermatolymphagioadenitis: formation of
granulomatous lesions following microfilarial invasion into
lymphatics, chills, lymphadenopathy, lymphangitis, and
eosinophilia.
- Bacterial infection with streptococcus may occur
- Elephantiasis or swelling of the lower extremities especially the
legs develop due to obstruction of the lymphatics
- Tropical pulmonary eosinophilia (TPE)
- Hydrocoele/Chylocoele: obstruction of lymphatics of the tunica
vaginalis
- Milky urine: rupture of lymphatics
- On the death of the adult worms, calcification or formation of
abscess may occur

TREATMENTS
o Diethylcarbamazine (DEC)
o Ivermectin (Stromectol) when used in combination with albendazole
o Surgical removal of excess tissue may be appropriate for the scrotum.
o Use of special boots or elastic bandage

PREVENTION AND CONTROL

o Use personal protection when entering known endemic areas
o Destroy breeding areas of mosquito
o Using insecticides
o Mosquito netting
o Insect repellants
o Educating the inhabitants of endemic areas
 Brugia malayi Loa loa
o Common name: Malayan Filarias, Malayan Filarial Form o Common name: African Eye Worm, Oculi Humanis
o Disease associated: Malayan Filariasis, Elephantiasis o Disease associated: Loaisis

Brugia malayi (Microfilaria) Brugia malayi (Microfilaria)

Size range 200-280 um long Size range 248-300 um long
Sheath Present Sheath Present
Arrangement of Nuclei in Tail Presence of two distinct nuclei Arrangement of Nuclei in Tail Distinct continuous row of
in the tip of the tail; The nuclei; extend to tip of tail
organism tissue tends to bulge
ADULTS
around each of the two nuclei
→Typically white in color
ADULTS and exhibit a cylindrical
→Adult B. malayi resemble threadlike appearance
those W. bancrofti.
→Typical adult female worm
measures 53 mm in length LABORATORY DIAGNOSIS
→Adult male measures 24 o Diurnal periodicity: collection is done during the midday hours
mm in length between 10:15 am to 2:15 pm
o Specimen of choice for the recovery of Loa loa microfilariae is
LABORATORY DIAGNOSIS Giemsa-stained blood
o Nocturnal/Subperiodic periodicity o The migrating adult worms may be extracted from a variety of
- Diethylcarbamizine: stimulates microfilariae to come out body location including the eye.
even during daytime o Knott technique
o Examination of fresh Giemsa-stained blood
o Nuclepore filter: heparinized blood LIFE CYCLE
o Knott Technique o Similar to the life cycle described in Wuchecheria bancrofti
- Using 10ml of 2% Formalin and 1ml blood o Difference: Vector and the common habitat
o Serologic Test
- PCR TRANSMISSION
- detection of Circulating Filarial Antigen (CFA) o Human infection of Loa loa is initiated by the bite of an infected
Chrysops fly, Tabanid, mango fly.
EPIDEMIOLOGY - Eosinophilia and calabar or transient subcutaneous
o Areas of the world in which the mosquitoes breed are the swelling
primary locations in which B. malayi may be found including o Adult worms multiply throughout the subcutaneous tissues
Philippines o The microfilariae are present in the blood but not until years
o Although humans are considered to be the primary definite host, after the initial infection making the diagnosis more difficult.
it is also known to infect felines and monkeys
o Transmitted by the mosquito EPIDEMIOLOGY
- Mansonia sp. o The endemic regions of infection correlate with the areas where
- Anopheles the vector flourishes
- Aedes - Chrysops fly inhabits africa especially the rainforest belt
region
CLINICAL SYMPTOMS
o Asymptomatic CLINICAL SYMPTOMS
o Fevers may take months to years to develop after initial infection o After initial bite, individuals infected with Loa loa may experience
o Adenolymphagitis/Dermatolymphagioadenitis: formation of pruritis and localized pain.
granulomatous lesions following microfilarial invasion into o Development of calabar swelling at the site of initial discomfort.
lymphatics, chills, lymphadenopathy, lymphangitis, and o Localized subcutaneous edema
eosinophilia. o Adult worms may only be noticeable when seen migrating under
o Elephantiasis of the legs the conjunctiva of the eye or crossing under the skin of the
o Tropical pulmonary eosinophilia (TPE) bridge of nose
o Hydrocoele/Chylocoele: obstruction of lymphatics of the tunica
vaginalis TREATMENT
o Milky urine: rupture of lymphatics o Surgical removal of adult worms
o Diethylcarbamazine (DEC)
TREATMENT
o Treatment for B. malayi is similar to that for W. bancrofti PREVENTION AND CONTROL
o Most useful medication is Diethylcarbamazine (DEC) o Personal protection
o Destroy vector breeding areas
PREVENTION AND CONTROL o Prophylactic DEC
o The prevention and control measures for B. malayi are identical
to those for W. bancrofti
 Onchocerca volvulus Mansonella ozzardi
o Common name: blinding convulated worm o Common name: New world filaria
o Disease associated: River blindness, Onchocerciasis o Disease associated: None

Onchocerca volvulus (Microfilaria) Mansonella ozzardi (Microfilaria)

Size range 150-355 um long Size range 150-355 um long
Sheath Absent Sheath Absent
Arrangement of Nuclei in Tail Do not extend to tip of the tail Arrangement of Nuclei in Tail Do not extend to tip of the tail
ADULTS ADULTS
→Thin and wirelike in →The location of the adults in
appearance humans is currently unknown
→Typically coil up in knots →Adult female may range in legth
inside infected nodules from 65-80 mm average of 70 mm
→Adult females may measure →Male worm measures 32 mm
up to 500 mm in length, adult
males are 25-50 mm long LIFE CYCLE
o Transferred by the injection of infective larvae to the human
LABORATORY DIAGNOSIS definitive host
o Skin snips - The transmission is carried out by the culicoides sucking
- specimen of choice midges and simulium blackfly
- Adult worms may recovered from infected nodules o Microfilaria is found in the blood as well as in the capillaries and
o Organisms residing in the eye are best seen by opthalmologic intravascular spaces of skin
examination using slit lamp o The emerging adults may take up residence in the body cavities,
o Presence of Eosinophilia and ocular discomfort visceral fat and mesenteries
o Serologic examination
- PCR LABORATORY DIAGNOSIS
o Examination of fresh Giemsa-stained blood
TRANSMISSION o nonperiodic: no known optimum time for collecting the blood
o Vector: Simulium or Black fly sample

EPIDEMIOLOGY EPIDEMIOLOGY
o O. volvulus is distributed primarily in equatorial Africa and o Found exclusively in western hemisphere
central america. o Known to exist in North, central, and south america, as well as
part of west indies and carribean.
CLINICAL SYMPTOMS o The parasite may be transmitted by culicoides midges or
o Patient experience localized symptoms caused by the simulium blackfly
development of infected nodules.
o Some patients may also suffer severe allergic reactions to the CLINICAL SYMPTOMS
presence of the microfilariae o Asymptomatic infections are common, symptoms such as
o When eye becomes involved, lesions may lead to blindness. urticaria, lymphadenitis, skin itching, and arthralgias may occur
o Eosinophilia
TREATMENT
o Ivermectin – DOC TREATMENT
o Surgical removal of adult worms o Ivermectin
o Diethycarbamazine (DEC)
PREVENTION AND CONTROL
o Personal protection
o Controlling the vector breeding grounds with the use of
insecticides
 Mansonella Perstans Trichinella spiralis
o Common name: Perstans filaria o Disease: Trichinosis, Trichinellosis
o Disease associated: None
Trichinella spiralis (Larva)
Mansonella perstans (Microfilaria) Average juvenile size 75-120 um long
Size range About 200 um in long 4-7 um wide
Sheath Absent Average mature size Up to 1 mm in length
Arrangement of Nuclei in Tail Numerous; extend to the tip of Appearance Coiled
tail Encysted in Nurse cells of striated muscle
Notable features Inflammatory infiltrate present
ADULTS
around nurse cell
→They reside in peritoneal
and pleural cavities as well as
the mesentery
→Adult female worm
measures 82 mm in length
→Adult male 43 mm in
length
ADULTS
LIFE CYCLE Adult Female Adult male
o The life cycle of M. perstans is similar to that of M. ozzardi Size 4 by 0.5 mm 2 by 0.04 mm
o Culicoides sucking midges is the only known vector Notable Blunt, round posterior Curved posterior end
o Humans are the primary definitive host in the life cycle features end; single ovary with with two round
o The incubation period of this organism once inside the host is vulva in anterior fifth of appendages
unknown body
COMMON TO BOTH MALES AND FEMALES
EPIDEMIOLOGY o Thin anterior end
o Infection rates are high in areas endemic to the culicoides o Small mouth
sucking midges. o Long slender digestive tract
o Primates are thought to harbor M. perstans or a closely related
species as reservoir hosts

CLINICAL SYMPTOMS
o Adult M. perstans worms usually appear singly.
o Minor allergic reactions or no symptoms at all, are experienced
by the infected individuals.
o These individuals may exhibit moderate eosinophilia
o Presence of calabar swelling, headache, edema, and lymphatic
discomfort are also associated with this infection
o Responsible for joint and bone pain, as well as enlargement and
associated pain in the liver
DIAGNOSIS
TREATMENT o Examination of the affected skeletal muscle
o Serologic methods
o Diethycarbamazine (DEC)
- Bentonite flocculation test
o Effective alternative is mebendazole - Latex flocculation test
o Ivermectin has not proven effective - IFAT
- ELISA
PREVENTION AND CONTROL o Eosinophilia
o Insecticides targeted against the vector o Leukocytosis
o Measures of controlling the vector population o Elevated serum muscle enzyme level (CK, LDH, Myokinase)
o Personal protection
EPIDEMIOLOGY
o T. spiralis is found worldwide, particularly in members of the meat-eating
population

CLINICAL SYMPTOMS
o T. spiralis is known as the great imitator
o Light infection
- Diarhrhea
- Slight fever
- Flu
o Heavy infection
- Vomiting - Eosinophilia
- Nausea - Pain in pleural area
- Abdominal pain - Fever
- Headache - Blurred vision
- Fever - Edema
- Migration of larvae - Cough

TREATMENT
o Get plenty of rest
o Adequate fluid intake
o Fever reducer
o Pain relievers
o Prednisone
o Thiabendazole

PREVENTION AND CONTROL

o Thorough cooking of meats
o Proper storage of meat
o Avoidance of feeding pork scraps to hogs
 Dracunculus Medenensis Angiostrongylus cantonensis
o Common name: Guinea worm, Fiery Serpent of the Israelites, o Common name: Angiostrongylosis, Angiostronggyliasis
Medina worm, dragon worm
ADULTS
o Disease: Dracunculosis, Dracunculiasis, Guinea Worm Infection
Adult Female Adult male
Larval stages Size 21 to 25 mm by 0.30 to 0.36 16 to 19 mm by
Dracunculus medenensis (Larva)
→ first stage or rhabditiform mm 0.26mm
Average size 620 by 15 um larvae (L1) Notable Uterine tubules are spirally Kidney shaped
Tail Consumes one third --Diagnostic stage
→ third stage larvae (L3)
features around the intestine caudal bursa and
characteristics of body length;
--which reside in an arrangement is described as single lobed
culminates in a intermediate host, have not “barber’s pole” can lay up to
point been well described
15,000 eggs daily
ADULTS EGGS LARVA
Adult Female Adult male Size 46 to 48 μm by 68 L1: distinct small knob near
Size 840 by 1.5 mm 21 by 0.4 mm to 74 μm the tip of the tail
Other Prominent rounded Anterior end coils itself Notable Thin hyaline shell L3: 2 well developed
features anterior end at least once features Embryonated when chitinous rods (knob like
oviposited tips) below buccal cavity
Larval stages
o L1: found in the rodent host
o L3: found in mollusk
o Adult worms: found in pulmonary arteries of rat, gravid females
lay eggs which are carried into smaller vessels of the lungs

EPIDEMIOLOGY
o Guinea worm is found in parts of Africa, India, Asia, Pakistan, and
the Middle East
o Copepods reside in fresh water, located particularly in areas
called step wells, from which people obtain drinking water and
bathe
o First-stage D. medinensis larvae escape from the ulcers of
infected persons who come into contact with this water.
o Ponds, human-made water holes, and standing water may also EPIDEMIOLOGY
serve as sources of infection. o First reported by Nomura and Lin from Taiwan
o There are a number of known reservoir hosts, including dogs. o Nishimura and Yogore in the Philippines
Like humans, these animals become infected via contaminated o Mechanism:
drinking water. - ingestion of raw mollusk
- ingestion of leafy vegetables containing mollusk secretion
TREATMENT - Ingestion of paratenic host (freshwater prawn and crab)
o specific dracunculiasis medicines available - Drinking contaminated water
o successful treatment typically consists of total worm removal
o five steps: CLINICAL SYMPTOMS
Step 1: Place the affected body part, in the form of a blister, in o stiffness of the neck, weakness of the muscles, abdominal pain,
cool water nausea, vomiting, peripheral eosinophilia, facial paralysis and
Step 2: In this step, the adult worm breaks through the blister low-grade fever
Step 3: It is important at this juncture to clean the resulting o eosinophils, monocyte and foreign body giant cells in the spinal
wound thoroughly. cord and fluid
Step 4: Manual extraction of the entire worm by winding it o CSF contain 100-2000 leukocytes per μl
around a stick o Charcot-Layden crystals in the meninges
Step 5: Once the worm is removed, apply topical antibiotics to
the wound site to prevent emergence of secondary bacterial TREATMENT
infections o No treatment recommended at present
o Successful in animal experiment
PREVENTION AND CONTROL - Mebendazole
o properly treated water for consumption - Thiabendazole
o boiling water suspected of contamination - Albendazole
o prohibiting the practice of drinking and bathing in the same - Ivermectin
water
o copepods may be removed from suspected water is to filter it PREVENTION AND CONTROL
using a finely meshed filter o properly treated water for consumption
o educate the entire population in endemic areas o boiling water suspected of contamination
o prohibiting the practice of drinking and bathing in the same
water
o proper eating habits
o educate the entire population in endemic areas
o elimination and eradication of intermediate host
 PARASITOLOGY 311
INTESTINAL & INTESTINAL-TISSUE NEMATODES
GENERAL CHARACTERISTICS
o Roundworms are elongated, cylindrical in shape with bilaterally
symmetry and unsegmented
o Have complete digestive system, no circulatory system
o With sensory organ known as chemoreceptor Ascaris lumbricoides (ADULTS)
o Provided with separate sexes although some are parthenogenic FEMALE ADULT MALE ADULT
o Female maybe oviparous or viviparous Size 22-35 cm Up to 30 cm
o Developmental stages (5) Color Creamy white pink tint
➢ EGG → 1st larvae → 2nd larvae → 3rd larvae → ADULT Other feature Pencil lead Prominent incurved
o According to the presence of Caudal receptor thickness tail
➢ Phasmids: with caudal chemoreceptors
- Hookworm Adults may lay a number of
- S. stercoralis undeveloped eggs up to
- W. bancrofti 250,000 /day that are
- B. malayi passed in the feces
➢ Aphasmids: Lacks phasmids or caudal chemoreceptors Terminal mouth: trilobate
- “TCT”: Trichuris-Capillaria-Trichinella lips and a sensory papillae
o According to habitat
- Intestinal Nematode
- Extraintestinal Nematode

2 LIFE CYCLE
1. Direct life cycle: no intermediate host
2. Indirect life cycle: intermediate host
o Generally males of most species have curved tail end and
provided with special structure such as copulatory bursa

POINTS TO REMEMBER!!!
Triad of infection/Unholy 3 Habitat: Large intestine
• Hookworm • Enterobius
• Ascaris • Trichuris
• Trichuris DIAGNOSIS
Habitat: Small intestine Heart-to-lung migration o Direct fecal smear (DFS)
• Capillaria • Ascaris o Kato technique or cellophane thick smear method
• Ascaris • Strongyloides o Kato-Katz technique
• Strongyloides • Hookworm o Adult worms may be present in the stool, vomitted up, or
• Hookworms removed from the external nares.
Visceral Larva Migrans Cutaneous Larva Migrans o Serologic techniques: ELISA
• Toxocara canis (Creeping eruption)
• Toxocara cati • Ancylostoma braziliense EPIDEMIOLOGY
• Ancylostoma caninum o Ascariasis is considered as the most common intestinal helminth
infection in the world
o The region s of the world and of the United State most
susceptible to harbor.
o A. lumbricoides infection in children who place their
contaminated hands into their mouths
Ascaris lumbricoides o Sources of contamination range from children’s toys to the soil
o Common name: Giant Roundworm, Giant itself
o Disease: Ascariasis
CLINICAL SYMPTOMS
Ascaris lumbricoides (Unfertilized Egg) o Asymptomatic o Appendix
Size 85-95 um by 38-45 um ➢ Patients infected with a small o Liver
number of worms will often o Bile duct
Shape Varies
remain asymptomatic. o Infected children may develop
Embryo Unembryonated; amorphous mass of protoplasm o Tissue damage protein malnutrition
Shell Thin o Vague abdominal pain o Low grade fever
o Vomiting o Cough
Other feature Usually corticated o Fever o Eosinophilia
o Distention o Pneumonia (resembles
Shell layers
o Obstruct the intestine Loeffler’s syndrome)
1. Outer mammillary coating
2. Middle glycogen layer TREATMENT
3. Inner vitelline membrane o Albendazole (DOC)
o Mebendazole
Ascaris lumbricoides (Fertilized Egg) o Pyrantel pamoate
Size 40-75 um by 30-35 um
Shape Rounder than nonfertilized PREVENTION AND CONTROL
Embryo Undeveloped unicellular embryo o Avoidance of using human feces as fertilizer
Shell Thick chitin o Exercising proper sanitation and personal hygiene practices
Other feature May be corticated or decorticated o Health education
o Mass chemotherapy
 Enterobius Vermicularis Trichuris Trichiura
o Common name: Pinworm, Seatworm o Common name: Whipworm
o Disease: Enterobiasis, Pinworm Infection, Oxyuriasis o Disease: Trichuriasis, Whipworm Infection

Enterobius vermicularis (Egg) Tricuris trichiura (Egg)

Size 48-60 um long Size 50-55 by 25 um
20-35 um wide Shape Barrel, football, Lemon Hyaline polar plug at
Shape Oval, one side flattened each end Japanese latern appearance
Embryo Stage of development varies may be Embryo Unicellular; undeveloped
unembryonated embryonated, mature Shell Smooth; yellow-brown color because of bile
Shell Double-layered, thick colorless contact
Shell: outer triple Compared to Ascaris
albuminous covering eggs, Trichuris eggs in
(mechanical protection) the soil are more
and inner embryonic susceptible to
lipoidal membrane desiccation
(chemical protection)
Tricuris trichiura (ADULT)
Enterobius vermicularis (ADULTS) Size 2.5-5 cm long; males usually smaller than females
FEMALE ADULT MALE ADULT Anterior Colorless; resembles a whip handle; contains a
Length 7-14 mm 2-4 mm end slender esophagus
Width Up to 0.5 mm <0.3 mm Posterior Pinkish-gray; resembles whip itself; contains digestive
Color Yellowish-white end and reproductive systems; males possess prominent
Tail Pointed; resembles Curved tail and a single curled tail; female has a bluntly rounded tail
pinhead spicule A female lays
Single female lays 4,672 approximately 3,000 to
10,00 eggs per day
to 16,888 per day with
Each female worm can
an average of 11,105 produce a total of over 60
eggs and dies after million eggs over an
deposition average life span of 2 years

DIAGNOSIS
TRANSMISSION
o Direct fecal smear
o Eggs can be acquired through air
o Retroinfection o Kato thick smear
- Infective pinworm that migrates back into the host body, o Kato-Katz technique
develop and reproduce o Concentration technique:
o Autoreinfection/Autoinfection - Zinc Sulfate flotation method
- Infective pinworm eggs are ingested via hand-to-mouth - Formalin-ether concentration technique
contamination
o Familial disease: spread within the family EPIDEMIOLOGY
o E. vermicularis may be responsible for the transmission of Dientamoeba o The life span of the adult worms in untreated infections may be from 4
fragilis to 8 years
o The female lays her undeveloped eggs. Passed into the feces, 1 month
CLINICAL SYMPTOMS outside the human body, the egg embryonate and become infective, and
o Asymptomatic o Insomia: due to ready to initiate a new cycle.
o Pruritus ani: Intense itching and pruritus
o Considered the 3rd most common helminth
inflammation of the anal or vaginal areas o Minute ulcer
o Intestinal irritation o Mild intestinal
o Found primarily in warm climates
o Mild nausea inflammation
o Vomiting irritability o Abdominal pain CLINICAL SYMPTOMS
o Asymptomatic: patients who suffer COMMON SYMPTOMS
from slight whipworm infection. o Abdominal tenderness
DIAGNOSIS o Ulcerative colitis
o Fecal Smear o Chronic dysentery o Pain oWeight loss
o Graham’s scotch adhesive tape swab/scotch tape method/perianal o Severe anemia o Weakness
cellulose tape swab: highest percentage of eggs seen o Growth retardation o Mucoid or bloody
o Rectal prolapse
o Peristalsis
diarrhea
TREATMENT o Mimic the inflammatory bowel
o Albendazole disease
o Mebendazole
o Pyrantel pamoate (DOC) TREATMENT
o Cure is considered if: o Mebendazole (DOC)
➢ 7 perianal smears using scotch tape swab are all found negative o Albendazole
o Benzimidazole derivative
PREVENTION AND CONTROL
o Practicing proper personal hygiene PREVENTION AND CONTROL
o Particularly hand washing o Exercising proper sanitation practices
o Fingernails should be cut short o Avoidance of defecating directly into the soil
o Avoid scratching the infected area o Avoid placing potentially infective hands into the mouth
o Cleaning of all potentially infected surface o Educating children in their personal hygiene and sanitation practice
o Chemotherapy of entire family
 Ancylostoma duodenale (Old) DIAGNOSIS
Necator americanus (New) o Direct fecal smear (DFS)
o Common name: Old & New World Hookworm o Kato technique or Kato-Katz method
o Concentration methods:
Hookworm Egg - ZnSO4 floatation method
Size 50-55 by 25 um - Formalin-ether concentration technique
Length Necator: 60-75 um o Culture methods: oHarada-Mori
Width Ancylostoma: 55-60 um 35-40 um - Larvae may mature and hatch from the eggs in stool
Embryonic Cleavage Two, four, or eight-cell stage o Examination of the buccal capsule
Shell Smooth, colorless
EPIDEMIOLOGY
Egg: Morula ball o The frequency of hookworm infection is high in warm areas in
apperance which the inhabitants practice poor sanitation practice.
o Person at risk for contracting hookworm in areas are those who
walk barefoot in feces contaminated soil
o N. americanus – primarily found in North and South America
o A. duodenale – may be found in europe, china, africa, south
Hookworm Rhabditiform larva
america and caribbean.
Size
Newly hatched 270 by 15 um CLINICAL SYMPTOMS
5 days old 540-700 um long o Asymptomatic Hookworm Infection
Other features Long buccal cavity; small - Some person infected with light hookworm burden do
genital primordium not exhibit clinical symptoms
- Hookworm Disease: Ancylostomiasis, Necatoriasis
2 notable characteristics o Ground itch/Dew itch/Water sore/Mazza mora: patients who
Hookworms vs S. stercoralis are repeatedly infected may develop intense allergic itching at
a. Hookworm has slender the site of hookworm penetration.
larva has a shorter esophagus o A number of symptoms experienced by infected persons are
than that of Strongyloides associated with larvae migration into lungs, including sore
stercoralis throat, bloody sputum, wheezing, headache, and mild
b. Hookworm filariform larva pneumonia with cough
has a distinct pointed tail o In chronic infection, patients may experience vague mild,
gastrointestinal symptoms, slight anemia, and weight loss or
Hookworm Filariform Larva weakness.
o In acute infection, may develop a number of symptoms including
Length of esophagus Short
diarrhea, anorexia, edema, pain, enteritis, and epigastric
Tail Pointed
discomfort
o Adult hookworms compete with the human host for nutrients as
they feed, infected patients may develop a microcytic
hypochromic iron deficiency, weakness, and hypoproteinemia.
Hookworm Adults
TREATMENT
Color Grayish-white to pink
o Albendazole (DOC)
Cuticle Somewhat thick
o Mebendazole
Anterior End Conspicuous bend, hook o Pyrantel pamoate
FEMALE MALE o Dietary therapy
Size 9-12 mm long 5-10 mm long o Proteins
0.25-0.50 mm 0.2-0.4 mm wide
o Iron
wide
Other Prominent posterior
copulatory bursa PREVENTION AND CONTROL
Features
o Proper sanitation practices
BUCCAL CAPSULE CHARACTERISTICS o Appropriate fecal disposal
Necator Contains pair of cutting plates o Personal protection of person: avoid walking barefoot
Ancylostoma Contains actual teeth
 Strongyloides stercolaris Capillaria philippinensis
o Common name: Threadworm o Disease: Mystery Disease

Strongyloides stercolaris (Egg) Capillaria philippinensis (Adults)

Size Average, 48 by 35 um ADULT FEMALE ADULT MALE
Typical growth phase Contains well-developed larvae Length 1.5 to 3.9 mm 2.3 to 5.3 mm
Embryonic cleavage Two, four, or eight-cell stage when Notable features Blunt, round Curved posterior
present posterior end; single end with two round
Shell Thin, hyaline ovary with vulva in appendages
anterior fifth of body
Strongyloides stercolaris Rhabditiform Larva COMMON TO BOTH MALES AND FEMALES
Average Size 220 by 15 um o Thin filamentous anterior end
Other features Short buccal cavity; prominent genital o Small mouth
o Long slender digestive tract
primordium
➢ Stichocytes: rows of secretory cells present in the esophagus
➢ Stichosome: entire esophageal structure

Capillaria philippinensis (Egg)

Size Average, 48 by 35 um
Typical growth phase Laid unsegmented
Average length 690 um Shell Pitted shell that is slightly
Length of esophagus Long constricted
Tail Notched Egg: peanut shaped/guitar shaped with striated shells and flattened bipolar plugs
Filariform Larva: S. stercoralis vs Hookworm
a. S. stercoralis has a long esophagus, compared with that of the hookworm DIAGNOSIS
b. The tail of S. stercoralis is notched, unlike that Hookworm which is pointed. o Direct smear or wet mount
Strongyloides stercolaris Adult Female o Stool concentration method
Approximate Size 2 by 0.4 mm o Duodenal aspiration
Other features Colorless, transparent body; finely straited
cuticle Short buccal cavity; Long slender
esophagus
Probably because no adult male S. stercoralis is known to exist, the adult female is
considered as parthenogenic, because there are no obvious morphologic structures
to indicate that a male is not required for fertilization.

CLINICAL SYMPTOMS
o Severe protein losing enteropathy
EPIDEMIOLOGY o Malabsorption of fats and sugars
o Strongyloides is found predominantly in the tropical and o Decrease excretion of xylose
subtropical regions in the world. o Low electrolyte level (especially potassium)
o High levels of immunoglobulin E
LABORATORY DIAGNOSIS
o Direct fecal smear (DFS) EPIDEMIOLOGY
o Stool concentration: o Intestinal capillariasis was first recorded in Northern Luzon in the
- zinc sulfate philippines.
o Enterotest™, Duodenal aspirates, Small bowel biopsy o Migratory fish-eating birds are considered the natural host
o Beale’s string test
o Culture:
- Harada-Mori TREATMENT
- Baermann funnel o Albendazole (DOC)
o Flotation Technique o Mebendazole
o Serological Test: cross reaction with filarial worm antigens
- ELISA PREVENTION AND CONTROL
o Discourage people from eating raw fish oGood sanitary practices
CLINICAL SYMPTOMS oEducational programs oProper excreta disposal
o Asymptomatic
o Strongyloidiasis: Threadworm
Infection
• Cochin China Diarrhea: • Weight loss
series of watery and • Variable anemia
bloody diarrhea • Heavy infection
• Abdominal pain • Malabsorption syndrome
• Urticaria accompanied by • When the larvae migrates
eosinophilia into the lungs patient may
• Vomiting develop pulmonary
• Constipation symptoms

TREATMENT
o Ivermectin
o Albendazole (DOC)
o Thiabendazole

PREVENTION AND CONTROL

o Proper sanitation practices
o Appropriate fecal disposal
o Personal protection of person: avoid walking barefoot
 TYPE OF CERCARIA
PARASITOLOGY 311 1. Leptocercous
TREMATODES
- Simple tailed – F. hepatica, F. buski, E. ilocanum
PLATYHELMINTHES TREMATODES (DIGENEA) - Keeled tailed – C. sinensis, H. heterophyes, O. felineus
o Common name: Flukes 2. Microcercus
o Subdivided into two: - P. westermani
3. Fork-tailed
MONOECIOUS DIECIOUS - bifurcated at its dorsal end Schistosomes
- flattened or leaf-shaped bodies - cylindrical bodies
- hermaphroditi - sexes are separate IMPORTANT DIFFERENCES IN DEVELOPMENTS
- needs 2 intermediate host - need 1 intermediate host 1. Egg embryonated when laid > hatches on contact with water >
- producing egg - produce non-operculum egg miracidium actively enters appropriate mollusk > develops into
1st generation sporocyst > produce 2nd generation sporocyst
COMMON FEATURES OF HUMAN TREMATODES > produce cercaria
o Trematodes (FLUKES) 2. Egg not embryonated when laid but matures in water and then
- The trematodes or flukes are classified under Phylum hatches > miracidium, after entering the mollusk, develops into
Platyhelminthes 1st generation sporocyst > produce redia > which then produce
- Most member species are hermaphrodites and many are cercaria
capable of self-fertilization except Schistosoma spp. 3. Egg not embryonated when laid but mature in water and
- All species have complex life cycle, requiring one or more hatches > miracidium, after actively entering the mollusk,
intermediate hosts develops into redia > produces 2nd generation redias > which
o Attaches themselves to host by means of 2 oral suckers then produce cercarias.
o Life cycle of trematodes: 4. Egg embryonated when laid but hatches only when ingested by
- Egg stage → Larval stage → Adult stage appropriate snail > miracidium develops into 1st generation
o Eggs are operculated sporocyst > produce rediae > which then produce cercariae
o Infective stage to the final host is the metacercaria
o Mode of transmission is fecal oral (except Schistosoma spp.) INTESTINAL CECA
o Requires 2 intermediate host BRANCHED SIMPLE SIMPLE BUT ARRANGED
o Adult covered by a tegument or skin IN ZIGZAG FASHION
o The digestive tract is degenerate F. hepatica F. buski P. westermani
o The end of intestine is a cecum w/o anus E. ilocanum
o Digestion (Extra ellular process) M. yokogawai
o Excretory system includes flame cells, capillaries, collecting H. yokogawai
tubules and an excretory bladder H. heterophyes
o All trematodes lay eggs, which upon embryonation given rise to C. sinensis
a ciliated embryo known as miracidium O. felineus
o Eggs of most species have a lid called operculum
o Trematodes need body of fresh water to complete the life
TESTES
cycle
Branched and arranged in tandem
- F. hepatica, C. sinensis
MODE OF TRANSMISSION
Deeply lobulated testes arranged in tandem
o Ingestion of metacercaria through improperly cooked 2nd I.H
- E. ilocanum
o Skin penetration by fork-tailed cercaria in flukes
Lobulated testes arranged side by side
- P. westermani
LARVAL STAGE
1. Miracidium – free swimming stage; ciliated embryo which Oval testes arranged side by side or slightly oblique
hatches in water to penetrate the 1st intermediate host -
2. Sporocyst – sac-like structure with germ balls which Lobular testes obliquely arranged
proliferative; found in snail host - O. felineus
3. Redia – sac-like structure containing oral sucker, a pharynx, a Single oval, rounded testes
birth pore, cercariae germ balls and another generation of redia - H. yokogawai
also found in the snail host
4. Cercariae – stage in life cycle which emerges from the snail OVARY
host, all possess tail therefore, they are free swimming BRANCHED LABULATED OVAL OR ROUNDED
5. Metacercariae – fond in the 2nd intermediate host F. hepatica C. sinensis E. ilocanum
F. buski O. felineus H. heterophyes
P. westermani M. yokogawai
H. yokogawai

OUTLINE
Liver fluke Fascioloa hepatica & Fasciola gigantica
Clonorchis sinensis
Opistorchis felineus & Opistorchis Viverrini
Intestinal Echinostoma ilocanum
flukes Artyfechinostomum malayanum
Fasciolopsis buski
Heterophyid flukes
Lung fluke Paragonimus westermani
Blood fluke Schistosoma mansoni
Schistosoma haematobium
Schistosoma japonicum
 LIVER FLUKES Clonorchis sinensis
Fascioloa hepatica & Fasciola gigantica o Common name: Chinese liver fluke
o Common name (h): Temperate liver fluke, Sheep liver fluke o Disease: Clonorchiasis
o Common name (g): Tropical liver fluke
Fascioloa hepatica & Fasciola gigantica (Egg) Clonorchis sinensis (Egg)
Size range 128-150 um by 60-90 um Size range 30 by 15 um
Shape Somewhat oblong Egg contents Developed miracidium
Egg contents Undeveloped miracidium
Operculum Present
Other features Presence of a distinct operculum
Other features Presence of distinct shoulder and
ADULTS presence of small knob opposite
→ averaging 30 mm in length and 13 mm in operculum
width
→ Leaf-shaped ADULTS
→ Each possesses ovaries and testes which are → 10-25x3-5 mm
highly branched and allow for individual flukes → Sunflower seed-like
to produce eggs independently → Oral sucker at the top is
Compared to F. hepatica, the F. gigantica adult is
slightly larger than the ventral
longer and its shoulders are less developed.
sucker located in the anterior 1/5
part of the body
LIFE CYCLE → The digestive tract is divided
into two ceca
→ The pouched-liked excretory
bladder opens at the posterior
end

LIFE CYCLE
o Infective stage: Metacercariae
o Site of Inhabitation: Bile ducts
o Reservoir Host: Cat, dog
o The primary difference in the life cycles of F. buski and o Life span: 20-30 years
F. hepatica is where the adult worms reside in the human host.
1st intermediate host: Snails 2nd intermediate host: Fish
1st intermediate host: Snails 2nd intermediate host: Aquatic plants - Parafossarulus - Alocinma - Cyprinidae spp.
Lymnaea philippinensis Ipomea obscura (kangkong) - Bulimus - Thiara
Lymnaea auricularia rubiginosa Nasturtium officinale (water cress) - Semisulcospira - Melanoides
MODE OF TRANSMISSION
MODE OF TRANSMISSION o Eating raw fresh water fish and shrimps with metacercariae
o Ingestion of aquatic plants containing metacercaria
DIAGNOSIS DIAGNOSIS
o Specimen of choice for recovery of the eggs of F. gigantica and o Direct fecal smear
F. hepatica is stool (duodenal aspirate, biliary aspirate) o Phosphoglycerate kinase (PGK): glycolytic enzyme found in many
o History of eating uncooked water plants from infested locale parasite counterparts for vaccine and drug development
o Serological methods: o Recovery of the characteristic eggs from stool specimens or
- ELISA duodenal aspirates
- PCR-restriction fragment length polymorphism (RFLP) o Enterotest
➢ Restriction enzyme Ava II and Dra II differentiate 2 Fasciola o Adult worms are only seen when removed during a surgery or
species autopsy procedure
o Ultrasound and CT scan o Serologic methods:
EPIDEMIOLOGY - ELISA, EIA, PCR
o Fasciola is considered the most important helminth infection of cattle
o F. hepatica – is found worldwide, particularly in areas in which sheep EPIDEMIOLOGY
and cattle are raised. The natural host for the completion of the F. o C. sinensis is endemic in areas of the far east, including China,
hepatica lifecycle is the sheep. Human serves as accidental hosts. especially the northeast portions, Taiwan, Korea, Vietnam, and
CLINICAL SYMPTOMS Japan.
a. Acute stage – Larval migration and hepatic migration
b. Chronic stage – persistence of fasciola worms in the biliary ducts CLINICAL SYMPTOMS
o Develop abdominal discomfort accompanied by inflammation and o Asymptomatic
bleeding of the affected area, jaundice, diarrhea, gastric discomfort, o include fever, abdominal pain, eosinophilia, diarrhea, anorexia,
and edema epigastric discomfort, and occasional jaundice.
o Malabsorption syndrome o Enlargement and tenderness of the liver and leukocytosis may also
o Halzoun: temporary lodgement of the worm in the pharynx occur.
o headache, fever, chills, and pains in the liver area of the body o Liver dysfunction may result in persons severely infected over a
o eosinophilia, jaundice, liver tenderness, anemia, diarrhea, and digestive long period of time
discomfort, biliary obstruction o Cholelithiasis, pancreatitis, and cholangiocarcinoma (carcinoma of
o Intestinal obstruction, and even death
liver and adenocarcinoma of gallbladder)
TREATMENT
o Dichlorophenol (bithionol) PREVENTION AND CONTROL
o Triclabendazole (DOC) o Practicing proper sanitation procedure
PREVENTION AND CONTROL o Proper fecal disposal by the human
o Exercising proper human fecal disposal and sanitation practices o Reservoir host and avoiding the ingestion of raw, undercooked, or
o Controlling snail population freshly pickled freshwater fish and shrimp
o Avoiding the human consumption of raw water plants or contaminated o stool examination and treatment of positive cases
water
o Education TREATMENT
o Molluscicides o Praziquantel
o Chemotheraphy o Albendazole
 Opistorchis felineus & Opistorchis Viverrini LUNG FLUKES
o Common name (f): Cat liver fluke Paragonimus westermani
o Common name (v): Southeast asian liver fluke o Common name: Oriental lung flake
o Disease: Paragonimiasis, Pulmonary Distomiasis, Endemic
ADULTS Hemoptysis, Parasitic Hemoptysis
→ Measure from 7-12 mm in length
→ They have 2 testes lying one behind the other Paragonimus westermani (Egg) ADULTS
in the posterior portion of the body Size 78-120 um long → 16 mm by 4-8
→ The ovary is anterior to the testes and a 40-60 um wide mm
uterus is coiled between the ovary and ventral Shape Somewhat oval → reddish brown
sucker Egg Undeveloped miracidium and ovoid
EGG contents surrounded by a thin, smooth → possess oral
→ 19-29um long by 12-17 um wide shell and ventral sucker
→ Similar to Clonorchis sinensis Other Prominent operculum with → resembles a
→ They have knob at the abopercular end that features shoulders; obvious terminal coffee bean
may be prominent, insconspicuous, or absent shell thickening opposite
→ When stained with potassium permanganate operculum
O. viverrini eggs show distict melon-like ridges

CLINICAL SYMPTOMS
o May affect the liver, pancreas, and gall bladder
o If not treated in the early stages, opisthorchiasis may cause
cirrhosis of the liver and increased risk of liver cancer, but may DIAGNOSIS
be asymptomatic in children o The recovery of eggs in sputum specimens.
o Two weeks after infection, the parasite may enter the bile duct o These eggs are commonly found in bloody samples
o Severe anemia and liver damage may also incapacitate the o Serologic Test
infected person for 1-2 months - Complement fixation
- EIA
DIAGNOSIS - Immunoblot
o History of eating raw, pickled, or poorly cooked fish
- 1st intermediate host: Bithynia LIFE CYCLE NOTES
- 2nd intermediate host: Cypridae, Cobitidae o RESERVOIR HOST: Pigs , dogs, and feline specie
o Detection of eggs in the patient’s stool or duodenal drainage o 1st Intermediate Host: Snail
aspiration - Antemelania asperata
o Non-invasive ultrasonography, Computed tomography - Antemelania dactylus (formerly: Brotia asperata)
o ELISA o 2nd Intermediate Host: Mountain crab
- Sundathelpusa philippina (formerly: Parathelpusa
PREVENTION AND CONTROL grapsoides)
o Practicing proper sanitation procedure
o Proper fecal disposal by the human EPIDEMIOLOGY
o Reservoir host and avoiding the ingestion of raw, undercooked, o Infection caused by P. westermani occur in several areas of the
or freshly pickled freshwater fish and shrimp world, including portions of Asia and Africa, India, and South
o stool examination and treatment of positive cases america.
o Pigs and monkey serves as reservoir hosts, as well as other
TREATMENT animals whose diet includes crayfish and crabs
o Praziquantel
o Albendazole CLINICAL SYMPTOMS
o Typically experience symptoms associated with pulmonary
discomfort: cough, fever, chest pain, and increased production
of blood-tinged sputum.
o Bronchitis
o Eosinophilia
o Production of fibrous tissue
o Mimic the infection of person suffering TB
o Cerebral Paragonimiasis
o Migration of immature P. westermani organisms to the brain
may result in development of a serious neurologic condition.
o Seizures, visual difficulties, and decreased precision of motor
skills
o Jacksonian epilepsy

TREATMENT
o Praziquantel
o Bithionol

PREVENTION AND CONTROL

o Avoid ingestion of undercooked crayfish & crabs
o Exercising proper disposal of human waste products
 INTESTINAL FLUKES Fasciolopsis buski
Echinostoma ilocanum (Echinostomids) o Common name: Giant intestinal fluke
o Common name: Garrison’s Fluke o Disease: Fasciolopiasis
o Disease: Echinostomiasis ADULT: EGG:
o Garrison first discovered this food-borne, intestinal, zoonotic, → 20-75 x 8-20x1-3 mm →130-140um by 80-85 um
snail-mediated parasitosis in 1907 in Manila →the body is long elliptic, flesh-colored →Oval in shape
o Found in intestine of birds and mammals throughout the world looks like a slice of raw meat →Slightly yellow in color
→largest one of human trematodes →Thinner shell with an
Echinostoma ilocanum (Adult) →Ventral sucker is near by the much operculum encloses an
Size range 3-25 mm in length 1-3 mm width smaller oral sucker ovum and 20-40 yolk cells
Testes 2 deeply bilobed →2 coral-liked testes are located in the
Ovary located in front of the anterior testes posterior half of the body
Follicular vitellaria located in the posterior half of the body
Intestinal ceca simple
Sucker Oral and ventral sucker
Other feature Tapered posterior end and has 49-51
collar spines Reddish-gray
EGGS: LIFE CYCLE NOTES
→ Straw-colored o Site of inhabition: Small intestine
→ Operculated o Infective stage: Metacercariae
o Life span: 1-4 years
→ Ovoid
o RESERVOIR: PIG
→ measuring 83 to 116 um by 58 to 69 um
1st intermediate host: Snails 2nd intermediate host: Aquatic plants
Segmentina Trapa bicornis (water caltrop)
Hippeutis Eliocharis tuberosa (water chestnut)
Ipomea obscura (water morning glory)
Nymphaea lotus (lotus)
MODE OF TRANSMISSION DIAGNOSIS
EPIDEMIOLOGY o Eating raw water plants Stool examination:
o Echinostoma ilocanum is endemic in North Luzon, Leyte, Samar, with metacercariae 1. Direct Fecal Smear
Mindanao provinces 2. Water sedimentation method
o First reported in northern luzon and central luzon ( 1987 ) CLINICAL SYMPTOMS
o Reservoir Host: Wild animals and Birds o Enteritis due to the attachment of the adults manifests abdominal
discomfort, nausea, vomiting, and diarrhea
1st intermediate host 2nd intermediate host o Malnutrition results result from the worms sharing food with host and
Gyraulus convexiusculus Pila luzonica (kuhol) diarrhea. Manifest anemia, edema of leg and face even ascites.
Hippeutis umbilicalis Vivipara angularis (susong pampang)
EPIDEMIOLOGY
o The prevalence of fasciolopiasis is related to growing water plants and
feeding pigs on water plants
Artyfechinostomum malayanum o F. buski is prevalent in southeast asia and lives in human’s and pigs
o Echinostomids intestine.
PREVENTION TREATMENT
Clonorchis sinensis (Adult) EGGS
o Health Education o Praziquantel
Size 5-12mm in length and → Larger, o Do not use night soil o Hexachloroparaxylol
2-3mm in width golden brown in o Avoid feeding pigs with raw o Bithionol
Testes Large, each with color water plants
6-9 lobes arranged in tandem → Operculated
Ovary Small, rounded or oval located → Measures Heterophyid flukes
anterior to testes 120-130um by o Major species:
Other Rounded posterior end and 80-90 um ✓ Heterophyes heterophyes ✓ Haplorchis taichui
✓ Metagonimus yokogawai ✓ Haplorchis yokogawai
features has 49-51 collar spines
o lives in the intestine of fish eating host

EPIDEMIOLOGY Heterophyid flukes (Egg)

o 1st intermediate host: not yet known Average size 30 by 15 μm
o 2nd intermediate host: Egg contents Developing miracidium
- Lymnea (Bullastra) Operculum Present
Shoulders Present but discrete
- cumingiana (birabid)
Small knob May be absent
Shell thickness Heterophyes: thick;
CLINICAL SYMPTOMS Metagonimus: thin
o Light infection – anemia, headache, gastric pain, and loose
stools ADULT:
o Heavy infection – abdominal pain, emaciation, weakness, Heterophyes Metagonimus
o measuring 1.0 by 0.5 mm o measuring approximately 1.5 by
anemia, profuse watery diarrhea, hemorrhage, edema, and
o pyriform organism is 0.5 mm.
anorexia. grayish in color and is o pyriform in shape, with tapering
protected by an outer layer at the anterior end and rounding
DIAGNOSIS TREATMENT of fine spines that are scaly at the posterior end
o Stool examination o Albendazole in appearance. o tiny layer of scaly spines heavily
o Serologic methods: ELISA o Mebendazole distributed over the anterior end
o Praziquantel LIFE CYCLE NOTES
o Niclosamide o 1st Intermediate Host: brackish water snail
PREVENTION AND CONTROL - Melania juncea
o Exercising proper human fecal disposal and sanitation practices - Thiara riquetti
o 2nd Intermediate Host: Fishes
o Controlling snail population
o Avoiding the human consumption of raw water plants or DIAGNOSIS
contaminated water o Identification of Heterophyes and Metagonimus is based on the
o Education recovery of the eggs in stool samples.
o Molluscicides o Careful microscopic examination is essential to ensure proper species
identification.
o Chemotheraphy o This is difficult to achieve because the eggs of Heterophyes,
Metagonimus, and Clonorchis are so similar.
 BLOOD FLUKES LIFE CYCLE NOTES
Schistosoma o Human infection of Schistosoma occurs in fresh water following
o Schistosoma mansoni: Manson’s blood fluke the penetration of fork-tailed cercariae into the skin
o Schistosoma haematobium: bilharziasis or urinary schistosomiasis o Schistosomule migrates into the bloodstream, where
o Schistosoma japonicum: Katayama’s disease maturation into adulthood is complete
o S. mansoni and S. japonicum reside in the veins that surround
Schistosoma mansoni (Egg) the intestinal tract, as well as in the blood passages of the liver
Size range 112-182 um by 40-75 um o S. haematobium resides in the veins surrounding surrounding
Shape Oblong the bladder
Egg content Developed miracidium o Females lay 500-2000 eggs per day, which make their way from
Appearance and Large; Large; lateral the bloodstream through the tissue of colon or the urine
o Once an egg reaches fresh water, the miracidium is released
lateral Location of spine
from the egg and must locate a snail, where it develops into the
cercariae
- Intermediate host: Oncomelania hupensis quadrasi

LABORATORY DIAGNOSIS
o S.mansoni and S.japonicum is accomplished by recovery of the
eggs in stool.
Schistosoma japonicum (Egg) o S.haematobium is recovered in a concentrated urine specimen
Size range 50-85 um by 38-60 um
EPIDEMIOLOGY
Shape Somewhat roundish o Cattle, monkey, rodents, dogs, cats, and other livestock
Egg content Developed miracidium o S. mansoni – parts of Africa
Appearance and Large; Small; lateral o S. japonicum – parts of Far east
lateral Location of spine o S. haematobium – almost all of africa and portions of the
middle east

CLINICAL SYMPTOMS
o Asymptomatic
o Brown hematin pigment is present in the macrophages and
neutrophils: hemoglobinase present in the adult worm breaks
down globulin and hemoglobin
Schistosoma haematobium (Egg) o Schistosomiasis, Bilharziasis, and Swamp fever
Size range 110-170 um by 38-70 um o Inflammation at the cercariae penetration site
Shape Somewhat Oblong o Katayama Fever
Egg content Developed miracidium ➢ Systemic hypersensitivity reaction to the
schistosomule migrating to tissue
Appearance and Large; Large; Terminal
➢ Rapid onset of fever, nausea, myalgia, malaise,
lateral Location of spine fatigue, cough, diarrhea, and eosinophilia
o Colonic Schistomiasis
o Hepatosplenic Disease
o Pulmonary Schistomiasis
o Cerebral Schistosomiasis

DIAGNOSIS
LIFE CYCLE o Rectal/Liver biopsy
o Stool examination:
- Merthiolate-iodine-formalin concentration technique
(MIFC)
- Kato-katz technique
o Immunodiagnosis
- Intradermal test
- Indirect hemagglutination
- Circumoval precipitin test (COPT): bleb and septate
precipitate

TREATMENT
o Praziquantel
o Oxamniquine
o Antimalarial artemisinins
- Artemether
- Artesunate

PREVENTION AND CONTROL

o Proper human waste disposal
o Control of snail population
o Avoidance of human contact with potentially contaminated
water
o Antehelminthic chemotherapy with praziquantel
 INTESTINAL CESTODES
PARASITOLOGY 311 Hymenolepis diminuta
CESTODES o Common name: Rat tapeworm
CHARACTERISTICS Hymenolepis diminuta (Egg)
o Adult tapeworm is flat and ribbon-like Average size 55 by 85 um
o Hermaphrodite Hooklets Three pairs; hexacanth embryo
The body consist of the ff: Classifications of segments Polar thickenings Present
1. Scolex 1. Immature
2. Neck 2. Mature Polar filaments Absent
3. Proglottids 3. 3. Gravid Embryophore Present; colorless
4. d) Strobila

LARVAL FORMS
1. SOLID Larvae
a. Procercoid – relatively globular with the scolex invaginated
into a solid body and with cercomere
b. Plerocercoid – elongated with the scolex free or may be
invaginated into the neck Hymenolepis diminuta (Adult)
2. BLADDER type of larvae Scolex
a. Cysticercoid – with small anterior body into which the No. of sucker Four
scolex is invaginated and frequently with a solid and Rostellum Present
elongated caudal portion Hooks Absent
b. Cysticercus – with a head invaginated into a proximal Gravid proglottid
portion of the large bladder. Contains single scolex only Size Twice as wide as long
c. Echinococcus – with germinal epithelium where smaller
Appearance Saclike uterus filled w/ eggs
cyst originate each of which contains small scolices.
d. Coenurus – with germinal epithelium from where the
protoscolices arise

STAGE DEVELOPMENT
PATHOLOGY AND MANIFESTATION MAY BE CAUSED BY THE:
1. ADULT WORM - producing passive obstruction, migration to
unusual sites and competition with the nourishment of the host LIFE CYCLE
2. LARVAL STAGE - more likely serious because larvae may be
lodged in critical foci such as the brain, eyes or elsewhere and
may grow to large masses producing pressure defects on
adjacent structures.

PSEUDOPHYLLIDEAN CYCLOPHILLIDEAN
Diphyllobotrium latum Species which require
vertebrae IH:
• Taenia solium
• Taenia saginata

Species which require

invertebrae IH:
• Dipylidium caninum

Species which may or

may not require IH:
• Hymenolepis nana
Scolex - Spoon shaped with slit- Quadrate, with four cup-
like sucking grooves like suckers
- No hooklets
Strobila anapolytic apolytic DIAGNOSIS
Ova Oval, operculated Spherical, non o Recovery of eggs in the stool
immature operculated embryonated
o Whole worm is expelled and the morphology of the scolex may
Larval stages Coracidium, procercoid, Cysticercoid, cysticercus,
be used as an aid in diagnosis
plerocercoid or sparganum hydatid
Intermediate 2 Intermediate Host Only one, usually lower
host forms of mammal or EPIDEMIOLOGY TREATMENT
arthropod o Asymptomatic o Praziquatel
o Hymenolepiasis o Niclosamide
OUTLINE - Diarrhea
Intestinal Cestodes Taenia saginata & Taenia solium - Nausea
Hymenolepis diminuta - Abdominal pains
Hymenolepis nana - Anorexia
Dipylidium caninum
Diphyllobothrium latum PREVENTION AND CONTROL
Extra Intestinal Cestodes Echinococcus multilocularis & o Administering effective rodent control
Echinococcus granulosus o Protection of foods from rat droppings and from intermediate
host insects
o Inspection of all potentially contaminated food
 Taenia saginata & Taenia solium DIAGNOSIS
o Common name (saginata): Beef Tapeworm o Stool is the specimen of choice for recovery of egg and gravid
o Common name (solium): Pork Tapeworm proglottids
o India ink: counting of lateral branches
Taenia spp. (Egg)
o Cellophane Tape Preparation
Size range 280-40 um by 18-30 um
o Concentration techniques – FECT
Hooklets Three pairs, hexacanth embryo
Other Features Radial striations on yellowbrown embryophore EPIDEMIOLOGY
o T. solium – is found worldwide
o T. saginata – found primarily in cosmopolitan areas

CLINICAL SYMPTOMS
o Asymptomatic
o Taeniasis
Taenia saginata (Adult) - Diarrhea
Scolex 1 – 2 mm - Abdominal pain
No. of sucker Four - Change in appetite
Rostellum Absent - Slight weight loss
Hooks Absent - Dizziness
Gravid proglottid - Vomiting
Appearance; shape Longer than wide Average, 17.5 by 5.5 um - Nausea
Number of lateral 15-20 - Moderate eosinophilia
Branches on each
Side of uterus o Cysticercosis
ADULT: o Neurocysticercosis
→ Measures 4-10m o CSF findings
→ May have 1,000 – 4,000 proglottids ✓ Increased opening pressure
→ Gravid proglottid contain 97,000 – 124,000 ova (594,000,000 annually) ✓ Elevated protein
✓ Decreased glucose
✓ Increase in mononuclear cells
✓ CSF eosinophilia without peripheral blood eosinophilia

TREATMENT
o Praziquantel (DOC)
o Paramomycin
o Quinacrine hydrochloride
Taenia solium (Adult)
Scolex PREVENTION AND CONTROL
No. of sucker Four o Exercising proper sanitation practices
Rostellum Present o Thorough cooking of beef and pork
Hooks Present (double crown) o Promptly treating infected person
Gravid proglottid
Appearance; shape Somewhat square Taenia asiatica
Number of lateral 7-15 o Adult “Taiwan” Taenia resembles adult T. saginata but by the
Branches on each appearance of the cysticercus it is close to T. solium
Side of uterus
ADULT: “Measly pork”:
→ Measures 2-4m meat infected
→ May have 800 – 1,000 proglottids w/ cysticercus
cellulosae
→ Gravid proglottid contain 30,000 – 50,000 ova

LIFE CYCLE
 Hymenolepis nana Dipylidium caninum
o Common name: Dwarf tapeworm o Common name: Double pored tapeworm
Hymenolepis nana (Egg) Dipylidium caninum (Egg)
Average size 45 by 38 um Number of eggs in Enclosed packet 5-30
Hooklets Three pairs; hexacanth embryo Diameter range Per egg 30-60 um
Polar thickenings Present Ind. Egg features six hooked oncosphere
Polar filaments Present
Embryophore Present; colorless

Dipylidium caninum (Adult)

Scolex
No. of sucker Four
Hymenolepis nana (Adult) Rostellum Present; club-shaped, with
Scolex 1 – 2 mm one to seven circlets of spines
No. of sucker Four Hooks Absent
Rostellum Present; short Gravid proglottid
Hooks Present; one row Shape Pumpkin seed
Gravid proglottid Apperance Full eggs in enclosed embryonic membrane
Appearance; shape Twice as wide as long
Number of lateral Saclike uterus filled with eggs
Branches on each
Side of uterus

LIFE CYCLE

LIFE CYCLE

DIAGNOSIS
o Recovery of the characteristic egg packets or gravid proglottids
in stool sample

INTERMEDIATE HOST
o Ctenocephalides canis (dog flea)
o Ctenocephalides felis (cat flea)
DIAGNOSIS o Pulex irritans (human flea)
o Examining stool sample for eggs o Trichodectes canis (dog louse)
o Proglottids are not recovered because they undergo
degeneration prior to passage with stool EPIDEMIOLOGY
o Incidence of D. caninum infection is worldwide
EPIDEMIOLOGY o Children appear to be the most at risk for infection transmission
o Most common tapeworm recovered in the US
o Found worldwide mainly among children CLINICAL SYMPTOMS TREATMENT
o Tropical and subtropical climates worldwide o Asymptomatic o Praziquantel
o Dipylidiasis o Niclosamide
CLINCIAL SYMPTOMS TREATMENT - Appetite loss o Paromomycin
o Asymptomatic o Praziquantel (DOC) - Diarrhea
o Hymenolepiasis o Niclosamide - Abdominal Discomfort
- Abdominal pain - Indigestion
- Anorexia - Anal pruritis
- Diarrhea
- Dizziness PREVENTION AND CONTROL
- Headache o Dogs and cats should be examined by a veterinarian on a regular
basis
PREVENTION AND CONTROL o Dogs and cats should be treated and protected against flea
o Proper personal hygiene and sanitation practice infestation
o Prevention and control measures aimed at halting the spread of o Children should be taught not to let dogs or cats lick them in or
parasite near their mouths
 Diphyllobothrium latum EXTRA INTESTINAL CESTODES
o Common name: Broad fish tapeworm Echinococcus multilocularis & Echinococcus granulosus
o Common name: Dog tapeworm, Hydatid worm
Diphyllobothrium latum (Egg)
Size range 55-75 um long E. granulosus (Hydatid Cyst – larval stage)
40-55 um wide Protective coverings Cyst wall; multiple laminated
Shape Somewhat oblong germinal tissue layer
Embryo Underdeveloped, termed coracidium Basic cyst makeup Fluid-filled bladder
Shell Smooth; yellow-brown in color Structure that arise Daughter cysts
Other features Operculum on one end; From inner germinal layer Brood capsules
Terminal knob on opposite end Other possible structures present Hydatid sand

Diphyllobothrium latum (Adult)

Scolex ADULT: EGGS:
No. of sucking grooves Two →3 – 6 mm in length →eggs of Echinococcus granulosus
Shape of sucking grooves Almond →Pyriform scolex are identical to, and thus
Gravid proglottid →3 proglottids: indistinguishable from those of
Shape Wider than long - 1immature, Taenia spp. Fortunately, the
Location and appearance Central; Central; rosette - 1 mature, diagnostic stage of E. granulosus is
rosette of uterine structure - 1 gravid that of the larval stage.
→Scolex: 4 acetabula, →swallowed by intermediate host:
30 -36 hooks goats, horses, camels and sheep
LIFE CYCLE

LIFE CYCLE

DIAGNOSIS
o Hydatid cyst fluid may be examined on biopsy samples for the
presence of scolices, daughter cyst, brood capsules, or hydatid
sand.
o Serologic test
- IHA, IFA, EIA
LABORATORY DIAGNOSIS o positive cases undergo gel diffusion assay that would
o Examining stool for the presence of egg or proglottids demonstrate the echinococcal “Arc 5” for confirmation
EPIDEMIOLOGY EPIDEMIOLOGY
o Found in variety of temperate regions worldwide o Primarily found in areas in which sheep or other herbivores are
o It is in areas that raw and/or freshwater fish are routinely raised and in close contact with dogs or wild canines.
consumed
CLINICAL SYMPTOMS
CLINICAL SYMPTOMS Echinococcosis E. granulosus lung infection
o Asymptomatic o Anaphylactic shock o Chest pain
o Diphyllobothriasis o Eosinophilia o Coughing
- Overall weakness o Allergic reaction o Shortness of Breath
- Weight loss o Liver involvement
- Abdominal pain o Obstructive jaundice
- Vitamin B12 Deficiency
TREATMENT PREVENTION AND CONTROL
PREVENTION AND CONTROL o Surgical removal of the o Appropriate personal
o Proper human fecal disposal hydatid cyst hygiene practice
o Avoidance of eating raw or undercooked fish o Mebendazole o Discontinuing the practice
o Thorough cooking of all fish before consumption o Albendazole of feeding canines
o Praziquantel o Potentially contaminated
viscera

NOTE: READ
✓ Rallietina garrisoni
✓ Spirometra