CHAPTER FIVE

INTESTINAL
PARASITIC DISEASES
INTRODUCTION TO PARASITE
Definition
 Medical Parasitology (Greece:
Para = beside, Sitos = food).

 Medical parasitology is the science

that deals with organisms living in
the human body (the host)
TYPES OF PARASITES:
 Ectoparasite: a parasitic organism that lives
on the outer surface of its host, e.g. lice,
ticks, mites etc.

 Endoparasites: - parasites that live inside

the body of their host, e.g. Entamoeba
histolytica.

 Obligate Parasite - is completely dependent

on the host during a segment or all of its life
cycle, e.g. Plasmodium spp.
 CONT…
 Facultative parasite – an organism that exhibits
both parasitic and non-parasitic modes of living
and hence does not absolutely depend on the
parasitic way of life, but is capable of adapting
to it if placed on a host. E.g. Naegleria fowleri

 Accidental parasite – it is when a parasite

attacks an unnatural host and survives. E.g.
Hymenolepis diminuta (rat tapeworm).

 Erratic parasite - is one that wanders in to an

organ in which it is not usually found. E.g.
Entamoeba histolytica in the liver or lung of
humans.
CLASSIFICATION OF PARASITES:
1. PROTOZOA:
 Sarcodina (Amoebae):
Entameba histolytica
Endolimax nana
Iodameba butchlii
Dientameba fragilis
 Mastigophora (Flagellates):

G. lamblia
Trichomonas vaginalis

Trypanosoma brucci

 Sporozoa
Plasmodium falciparum
Toxoplasma gondi

 CONT…
2. METAZOA (HELIMINTHS)
 Trematodes:
 Schistosoma
 Fasciola

 Cestodes:
 Diphylobotrium
 Taenia

 Echinococcus

 Hymenolepsis

 Nematodes:
 Intestinal Nematodes E.g. A. lumbricoides
 Somatic Nematodes E.g. W. bancrofti
AMOEBIC DYSENTERY (AMAEBIASIS)
Definition:
 It is an infection due to a protozoa
parasite that causes intestinal or
extra-intestinal disease.

Etiology:
 Entamoeba histolytica
EPIDEMIOLOGY:
 Occurrence is worldwide but most
common in the tropics and
subtropics.

 Prevalent in area with poor

sanitation such as in mental
institutions and homosexuals.
 Invasive amaebiasis is mostly a
disease of young people (adults).
 CONT…
Mode of transmission:
 Fecal-oral transmission by ingestion of food or
water contaminated by feces containing the cyst.
Incubation period:
 Variable from few days to several months or years;
commonly 2-4 weeks.
Period of communicability:
 May continue for years as long as cysts of E.
histolytica passed in feces.
Susceptibility and resistance
 Susceptibility is general.
 Susceptibility to re-infection has been
demonstrated but is apparently rare.
LIFE CYCLE
Transmission
 Cysts ingested in food, water or from hands
contaminated with feces.
Human host
 Cysts excyst forming trophozoites;
 Multiply in intestine;
 Trophozoites encyst.
 Infective cysts passes in feces.

Environment
 Feces containing infective cysts contaminate
the environment.
LIFE CYCLE…
CLINICAL MANIFESTATIONS
1. Intestinal Amebiasis:

Watery diarrhea
Abdominal cramps
Nausea and vomiting.
Dysentery with mucus
Tenesmus
CLINICAL MANIFESTATIONS
2. Extra intestinal
Amebiasis:
Fever
Leukocytosis
Chills and rigors
RUQ pain
Hepatomegaly
Jaundice
Fast growing abscess filled
with “chocolate colored
pus”
DIAGNOSIS
 Demonstration of Entamoeba
histolytica cyst or trophozoite in
stool.

 Serology for extra intestinal

disease.
TREATMENT
 Metronidazole

or

 Tinidazole.
PREVENTION AND CONTROL
1. Adequate treatment of cases.

2. Provision of safe drinking water.

3. Proper
disposal of human excreta and
hand washing following defection.

4. Clearingand cooking of local foods

(e.g. raw vegetables) to avoid eating
food contaminated with feces.
GIARDIASIS
Definition:
 It is a protozoan infection principally of
the upper small intestine.
 It is characterized by chronic diarrhea,
steatorrhea, abdominal cramps,
bloating, frequent loose and pale greasy
stools, and fatigue and weight loss.

Etiology:
 G. lamblia
 CONT…
Epidemiology:
 Occurrence: worldwide distribution.
 Children are more affected than adults.
 The disease is highly prevalent in areas of
poor sanitation.
Reservoir:
 Humans

Mode of transmission:
 Person to person transmission occurs by
hand to mouth transfer of cysts from feces of
an infected individual especially in
institutions and day care centers.
 CONT…
Period of communicability:
 Entire period of infection, often months.

Susceptibility and resistance

 Asymptomatic carrier rate is high.

 Infection is frequently self-limited.

 Persons with AIDS may have more

serious and prolonged infection.
LIFE CYCLE:
 Similar to E. histolytica
CLINICAL MANIFESTATION:
 Ranges from asymptomatic infection to
severe failure to thrive and mal
absorption
 Diarrhea
 Abdominal distension
 Bloating is frequent
 Abdominal cramps
 Anorexia
 Nausea and malaise
 Sulphur testing (belching)
 CONT…

Diagnosis:
 Demonstration of G. lamblia cyst or
trophozoite in feces.

Treatment:
 Metronidazole or Tinidazole.
PREVENTION AND CONTROL:
 Good personal hygiene and hand
washing before food and following
toilet use.
 Sanitary disposal of feces.
 Protection of public water supply from
contamination of feces.
 Case treatment.

 Safe water supply.

ASCARIASIS
Definition:
 It is a helminthic infection of the small
intestine generally associated with few or no
symptoms.
Etiology:
 Ascaris lumbricoids

Epidemiology:
 The most common parasite of humans where
sanitation is poor.
 School children (5-10 years) are most
affected.
 CONT…
Reservoir:
 Humans
 Eggs in soil

Mode of transmission:
 Ingestion of infective eggs from soil contaminated
with human feces or uncooked product contaminated
with soil containing infective eggs.
 But not directly from person to person or from fresh
faces.
 Incubation period:
 4-8 weeks
 CONT…
Period of communicability:
 As long as mature fertilized female
worms live in the intestine.
 Usual life span of adult worm is12
months.

Susceptibility and resistance:

 Susceptibility is general.
LIFE CYCLE:
 Infective eggs ingested in food or from
contaminated hands.
 Larvae hatch.
 Migrate through liver and lungs.
 Pass up trachea and are swallowed.
 Because mature worm in small intestine.
 Eggs produced and passed in feces.
 Eggs become infective (embryonated) in soil
in 30-40 days and contaminate the soil
CLINICAL MANIFESTATION:
 Most infections go unnoticed until large
worms passed in feces and occasionally the
mouth and nose.
 Migrant larvae may cause itching, wheezing
and dyspnea, fever, cough productive of
bloody sputum.
 Abdominal pain may arise from intestinal
obstruction.
 Serious complications include bowel
obstruction due to knotted or intertwined
worms.
 CONT…
Diagnosis:
 Microscopic identification of eggs in stool
sample.
 Adult worms pass from anus, mouth or nose.

Treatment:
 Piperazine
 Albendazole
 Mebendazole
 Levamisole
PREVENTION AND CONTROL
 Rx of cases

 Sanitary disposal of feces

 Prevent soil contamination in areas

where children play

 promote good personal hygiene (hand

washing)
TRICHURIASIS
Definition:
 It is a nematode infection of the large intestine
(caecum and upper colon.

Etiology:
 Trichuris trichuria (whip worm)

Epidemiology:
 It occurs worldwide especially in warm moist
regions common in children 3-11 years of age.

Reservoir:
 Humans
LIFE CYCLE:
Eggs
Ingested
Contaminate Hatch to
the soil Larvae (SI)

Embryonated Migrate
egg in soil to caecum

Eggs produced Become

and passed in
feces. mature worms
 CONT…
Mode of transmission:
 Indirect: through ingestion of contaminated
vegetables.
 Not immediately transmissible from person to
person.
Incubation Period:
 Indefinite

Period of communicability:
 Several years in untreated carriers.

Susceptibility and Resistance:

 Susceptibility is universal
CLINICAL MANIFESTATION:
 Most infected people are asymptomatic.
 Abdominal pain
 Tiredness
 Nausea and vomiting
 Diarrhea or constipation
 Rectal prolapse (heavy infection) young
children
 CONT…

Diagnosis:
 Demonstration of eggs in feces

Treatment:
 Albendazole or

 Mebendazole
PREVENTION AND CONTROL
 Sanitary disposal of feces

 Maintaining good personal hygiene

(i.e. washing hands and vegetables and
other soil contaminated foods).

 Cutting nails esp.-in children

 Rx of cases.
ENTEROBIASIS (OXYURIASIS, PIN WORM)
Definition:
 It is a common intestinal (coecum)
helminthes infection caused by Enterobius
vermicularis.

Epidemiology:
 It occurs worldwide affecting all
socioeconomic classes.
 Prevalence is highest in school-aged (5-10
years) children followed by preschools is
lower in adults.
 Infection usually occurs in more than one
 CONT…
Reservoir:
 Humans

Mode of transmission:
 Direct transfer of infective eggs by hands
from anus to mouth of the same or another
person or
 Indirectly through clothing, bedding, food or
other articles contaminated with eggs of the
parasite.

Incubation period:
LIFE CYCLE:

Eggs Ingested

Eggs become
infective on
Hatch to
perianal skin Larvae (SI)

Migrate to anus
and lay eggs Migrate to
(at Night) caecum
Become
worms
(Caecum)
 CONT…
Period of communicability:
 As long as gravid females are
discharging eggs on perianal skin.
 Eggs remain infective in an indoor
environment for about 2 weeks.

Susceptibility and resistance:

 Susceptibility is universal.
 CONT…
Clinical Manifestation:
 Perianal itching,
 Disturbed sleep
 Irritability and
 Sometimes secondary infection of the scratched skin.

Diagnosis:
 Stool microscopy for eggs or female worms

Treatment:
 Mebbendazole 100mg po stat or
 Albendazole 400mg po stat
PREVENTION AND CONTROL:
1. Educate the public about hygiene (i.e.
hand washing, before eating or preparing
food, keeping nails short and discourage
nail biting)

2. Rx of cases.

3. Reduce
overcrowding in living
accommodations.

4. Provide adequate toilets.

STRONGLOIDIASIS
Definition:
 It is an often asymptomatic helminthic infection of
the duodenum and upper jejunum. (Can be
throughout the small intestine).

Infectious Agent:
 Strongloides stercoralis

Epidemiology:
 It occurs in tropical and temperate areas more
common in warm and wet regions.

Reservoir:
 Humans
 CONT…
Mode of transmission:
 Infective (filariform) larvae penetrate the skin and
enter venous circulation
Incubation Period:
 2-4 weeks (from skin penetration up to when
rhabiditiform larvae appear in the feces.
Period of communicability:
 As long as living worms remain in the intestine:
 Up to 35 yrs in cases of autoinfection.

Susceptibility and resistance:

 Susceptibility is universal.
 Patients with AIDS or immunosuppressive
medications are at risk of dissemination.
LIFE CYCLE:
Infective
filariform larvae
penetrate skin
Become
Larvae migrate,
infective
pass up trachea
filariform larvae
and swallowed.
in the soil

Hatch
Become mature
rhabditiform
worms in small
larvae and
intestine
passes in feces

Eggs laid
LIFE CYCLE:
 Infective filariform larvae penetrate skin e.g.
feet. (Autoinfection also occurs)
 Larvae migrate, pass up trachea and
swallowed.
 Become mature worms in small intestine
 Eggs laid and hatch rhabditiform larvae in
intestine.
 Rhabditiform larvae passed in feces or
become filariform larvae in intestine (causing
autoinfection).
 In soil larvae become free living worms
produce more rhabditiform larvae.
CLINICAL MANIFESTATION:
 Pneumonia occurs during heavy larval
migration.

 Mild peptic ulcer like epigastric

discomfort.

 Severe watery diarrhea.

 Heavy infection may result in mal-

absorption syndrome.
 CONT…
Diagnosis:
 Identification of larvae in stool specimen

Treatment:
 Albendazole (400mg po per day for 03 days
or
 Thiabendazole – 500 mg POBID for 03 days.

Prevention and control:

 Proper disposal of human excreta
 personal hygiene including use of foot wear
 HOOK WORM DISEASE
(ANCYLOSTOMIASIS AND NECATORIASIS)
Definition:
 It is a common chronic parasitic infection with a variety of
symptoms usually anemia.
 It affects small intestine.

Etiologic Agent:
 Ancylostoma duodenale and
 Necator americanus

Epidemiology:
 Widely endemic in tropical and subtropical countries where
sanitary disposal of human feces is not practiced and the soil
moisture and temperature conditions favor development of
infective larvae.
 CONT…
Reservoir:
 Humans

Mode of transmission:
 Through skin penetration by the infective larvae.

Incubation Period
 Few weeks to many months depending on intensity of
infection and iron intake.
Period of communicable:
 Infected people can contaminate the soil for several
years in the absence of treatment.
Susceptibility & Resistance:
 Susceptibility is universal.
 No evidence that immunity develops with infection.
LIFE CYCLE:
 Infective filariform larvae penetrate the skin.
 Larvae migrate, pass up trachea and are
swallowed.
 Become mature worms in small intestine
(attach to wall and suck blood)
 Eggs produced and passed in feces.
 Develop to Rhabditiform larvae (Feed in soil)
 Then develop in to infective filariform larvae
in about 1 week.
 Filariform larvae contaminate soil.
CLINICAL MANIFESTATION
Larval migration to the skin:
 Produces transient (short lasting) localized
maculopapular rash associated with itching
called ground itch.
Larval migration to lungs:
 Produces cough, wheezing and transient
pneumonitis
Blood sucking:
 Light infection does not Produce symptom
 Heavy infection – result in:
PUD like epigastric pain and tenderness.
Blood loss anemia
 CONT…
Diagnosis:
 Demonstration of eggs in stool specimen

Treatment:
 Mebendazole 200 mg POBID for 03 days
 Albendazole – 400mg po stat
 Levamisole

Prevention and control:

 Sanitary disposal of feces
 Wearing of shoes
 Case treatment
TA E N I A S I S
Definition:
 It is an infection of human by tape
worms or cestodes.

Tape worms are of two types:

 [Link] (beef tape worm)
 [Link] (pork tapeworm)
EPIDEMIOLOGY:
 Adult worm live in small intestine of humans.
 Worms containing gravid uterus or eggs
passed in stools.
 Eggs ingested by cows or pigs
 Hatch and penetrate the bowel wall and
carried via blood stream to muscle of animals.
 The larvae grow, invaginate and form
infective cyst called cysticerci ([Link])
 The meat ingested by human.
 Cyst dissolved by GI acid and release
embryos which grow to adult worm.
CLINICAL PICTURES:
 Mostly asymptomatic

 Weight loss

 Abdominal discomfort and pruiritus ani

 No eosinophilia

 Neurologic signs like epilepsy, muscular

pain
 CONT…
Diagnosis:
 Stool: segment or eggs

Treatment:
 Niclosamide 2g chewable tablet stat.
 Albendazole 400mg single dose.
 Praziquantel 600mg stat.
 Mebendazole 100mg po bid for 3 days.

Prevention:
 Proper fecal disposal and meat inspection.
 Health education (cooking of meat, freezing)
 Treating the already existing cases.