PARASITOLOGY

HELMINTHES
PLATYHELMINTHES
FLAT WORMS
HELMINTHES
Platyhelminthes (platy flat,
helminthes worm)
2 Classes:
Cestoda (tape worms)
Rounded head scolex
(+) suckers, hooks, or sucking grooves
Flat body of multiple segments proglottids
Grows by adding new proglottids next to
the scolex
Distal end of proglottids produce many
eggs excreted in the feces
Acquired by eating undercooked flesh
containing larvae
Trematoda (flukes)

CESTODES
(Flatworms)
Taenia solium (pork tapeworm)

Diseases:
Adult worm Taeniasis;
Larvae Cysticercosis
Important Properties:
Transmission: Eating raw or undercooked pork
containing larvae (cysticerci)
Humans definitive host
Pigs Intermediate host
Cysticercosis:
Person ingests the eggs in food or water
hatches in the small intestine blood vessel
disseminate eyes, brain encyst cysticerci
Taeniasis
Passed out
in Human
feces
Eaten by
pigs
Pigs blood
vessels
Pigs
skeletal
muscle
Eaten by
human
Cysticercosis
Person ingests
the eggs in
food or water
Eggs hatches
in the small
intestine
blood vessel
disseminate eyes, brain encyst
cysticerci
Pathogenesis:
Adult tapeworm little damage
Cysticerci becomes large in the brain space
occupying lesion
Clinical Findings:
Adult tapeworm asymptomatic; anorexia and
diarrhea
Cysticercosis
Brain - Headache, vomiting and seizures
Eyes Uveities or retinitis; larvae can be visualized
floating in the vitreous
Lab. Diagnosis:
Proglottids in stool
(+) Cyst in x-ray or CT scan
Treatment: Praziquantel or Albendazole ,
surgical excision
Prevention:
Cook pork adequately
Dispose waste properly
Proper hygiene
Taenia saginata
Disease: Taeniasis
Characteristics:
Beef tapeworm
Terminal proglottids
detach pass in feces
eaten by cattle blood
vessels skeletal muscles
cysticerci
Transmission: Eating raw or
undercooked beef
Lab. Diagnosis: Proglottids
seen in stool exam
Treatment: Praziquantel
Prevention: Adequate
cooking of beef. Proper
disposal of human
waste.

Terminal
proglottids
detach
pass in
feces
eaten by
cattle
Cattles
blood
vessels
Cattles
skeletal
muscles
cysticerci
Diphyllobothrium latum
Disease: Diphyllobothriasis
Characteristics:
Fish tapeworm
Human ingest undercooked fish containing larvae
attaches to gut wall adults proglottids
eggs passed in feces fresh water eggs hatch
eated by copepods eated by fresh water fish
larvae form in fish muscle
Transmission:
Eating raw or undercooked freshwater fish
Lab. Diagnosis: Eggs visible in stools
Treatment: Praziquantel
Prevention: Adequate cooking of fish. Proper
disposal of human waste

Human ingest
undercooked
fish containing
larvae
attaches to
Human
intestines
Adults
proglottids
eggs passed in
feces
fresh water eggs hatch
Eaten by
copepods
eaten by fresh
water fish
larvae form in
fish muscle
Echinococcus granulosus
Hydatid cyst disease
Characteristics:
Dog tapeworm
Dogs are infected when they ingest the entrails of sheep
containing hydatid cyst
Develop in the gut eggs passed in the feces
ingested by sheep (and humans) hatch in the gut
migrate in the blood to other organs (liver and brain)
forms large cyst containing daughter cyst
Transmission:
Ingestion of eggs in food contaminated with dogs feces
Pathogenesis:
Hydatid cyst in a space occupying lesion ruptures
antigens can cause anaphylaxis
Lab. Diagnosis: Examination of excised cyst
Treatment: Albendazole or surgical removal of cyst
Prevention: Sheep entrails should not be fed to dogs

Dogs ingest the
entrails of sheep
containing
hydatid cyst
Develop in the
dogs gut
eggs passed in
dogs feces
ingested by
sheep (and
humans)
hatch in the gut
migrate in the
blood to other
organs (liver and
brain)
forms large cyst
containing
daughter cyst
Clonorchis sinensis
Disease: Clonorchiasis
Characteristics:
Liver flukes
Humans ingest undercooked fish containing larvae
duodenum enters biliary duct adults
release eggs passed in feces eggs eaten by
snails eggs hatch multiply free swimming
cercariae encyst under scales of fish eaten by
humans
Transmission:
Eating raw or undercooked freshwater fish.
Pathogenesis: Inflammation of biliary tract
Lab. Diagnosis: Eggs visible in feces
Treatment: Praziquantel
Prevention: Adequate cooking of fish. Proper
disposal of human waste.

Humans ingest
undercooked
fish containing
larvae
Human
duodenum
enters biliary
duct adults
release eggs
passed in
Human feces
eggs eaten by
snails
eggs hatch
multiply
free swimming
cercariae
encyst under
scales of fish
eaten by
humans
Paragonimus westermani
Disease: Paragonimiasis
Characteristics:
Lung fluke
Humans ingest undercooked freshwater crab meat
containing larvae peritoneal cavity burrow
through diaphragm lung parenchyma become
adults eggs enter bronchioles Coughed up or
swallowed freshwater enter snails multiply
infects and encyst in crabs
Transmission: Eating raw or undercooked
crab meat
Pathogenesis: Inflammation and secondary
bacterial infection of lungs
Lab. Diagnosis: Eggs visible in sputum or
feces
Treatment: Praziquantel
Prevention: Adequate cooking of crabs.
Proper disposal of human waste.

Humans ingest
undercooked
freshwater crab
meat containing
larvae
peritoneal
cavity
burrow through
diaphragm
lung
parenchyma
become adults
eggs enter
bronchioles
Coughed up or
swallowed
freshwater
enter snails
multiply
infects and
encyst in crabs
Eaten by
Humans
Schistosoma (mansoni,
japonicum, haematobium)
Disease: Schistosomiasis
Characteristics:
Blood fluke
Humans are infected by penetrating the
skin blood vessels liver adults
portal vein mesenteric venules
(mansoni, japonicum) or urinary bladder
(haematobium) excreted hatch in
fresh water penetrate the snails
multiply free swimming cercariae
Transmission: Penetration of skin

Humans are
infected by
penetrating the
skin
blood vessels
liver adults
portal vein
mesenteric
venules
(mansoni,
japonicum)
urinary bladder
(haematobium)
Excreted in
feces or urine
hatch in fresh
water
penetrate the
snails
multiply
free swimming
cercariae
Human skin
Pathogenesis:
Eggs induce inflammation, granulomas, fibrosis
and obstruction (liver and spleen)
S. mansoni damages the colon (inferior
mesenteric venules)
S. japonicum damages small intestines (superior
mesenteric venules)
S. haematobium damages the urinary bladder;
can lead to carcinoma
Lab. Diagnosis: Eggs visible in feces or
urine. Eosinophilia
Treatment: Praziquantel
Prevention: Proper disposal of waste.
Swimming in endemic areas should be
avoided.

NEMATODES
(Roundworms)
Ancylostoma duodenale and
Necator americanus
Disease: Hookworm
Characteristics:
Penetrates skin blood lungs
alveoli trachea swallowed
Adults in SI attach to walls via teeth
(ancylostoma) or cutting plates (necator)
Eggs passed in feces
Transmission:
Penetrate skin of feet

Penetrates skin
blood
lungs alveoli
trachea
swallowed
Adults in SI
attach to walls via
teeth (ancylostoma)
or cutting plates
(necator)
Eggs passed in
feces
Penetrates human
skin
Pathogenesis:
Anemia
Lab. Diagnosis:
Eggs visible in stool exam
Treatment:
Mebendazole or pyrantel pamoate
Prevention:
Use of footwear. Proper disposal of
human waste
Ascaris lumbricoides
Disease: Ascariasis
Characteristics:
Humans ingest eggs larvae in gut
blood lungs alveoli trachea
swallowed adults lay eggs
passed in the feces
Become infective in soil
Transmission:
Food contaminated with soil containing
eggs
Humans
ingest eggs
larvae in gut
blood
lungs
alveoli
trachea
swallowed
adults
lay eggs
passed in
the feces
Become
infective in
soil
Humans
Pathogenesis:
Larvae in lung can cause pneumonia
Heavy worm burden can cause intestinal
obstruction or malnutrition
Lab. Diagnosis:
Eggs visible in feces. Eosinophilia
Treatment:
Mebendazole or pyrantel pamoate
Prevention:
Proper disposal of human waste
Enterobius vermicularis
Disease: Pinworm infection
Characteristics:
Humans ingest eggs adults in gut
at night, females migrate from the anus
lay many eggs on skin and in
environment
Reinfection is common
Transmission: Ingestion of eggs
Pathogenesis: Perianal pruritus
Lab. Diagnosis: Scotch tape
technique
Humans ingest
eggs
adults in gut
at night,
females
migrate to the
anus
lay many eggs
on skin and in
environment
Reinfection is
common
Treatment: Mebendazole or pyrantel
pamoate

Strongyloides stercoralis
Disease: Strongyloidiasis
Characteristics:
Penetrate the skin blood lungs alveoli
trachea swallowed adults females produce
eggs hatch in colon passed in feces
Transmission: Penetration of skin
Pathogenesis: Massive superinfection in
immunocompromised persons
Lab. Diagnosis: Visible in feces. Eosinophilia
Treatment: Thiabendazole
Prevention: Proper disposal of human waste
Trichinella spiralis
Disease: Trichinosis
Characteristics:
Humans ingest undercooked meat containing
larvae adults in SI female worms release
larvae blood skeletal muscle or brain
encyst
Transmission: Ingestion of raw or
undercooked meat, usually pork
Pathogenesis: Inflammation of muscle
Lab. Diagnosis: Visible in muscle biopsy.
Eosinophilia.
Treatment: Thiabendazole
Prevention: Adequate cooking of pork
Trichuris trichiura
Disease: Whip worm infection
Characteristics:
Human ingest eggs adults in gut eggs
passed in feces soil
Transmission: Food or water
contaminated with soil containing eggs
Pathogenesis: Causes little damage
Lab. Diagnosis: Eggs visible in feces
Treatment: Mebendazole
Prevention: Proper disposal of human
waste
Toxocara canis
Disease: Visceral larva migrans
Characteristics:
Eggs passed in dogs feces ingested by
humans hatch in SI blood liver,
brain, eyes trapped and die
Transmission: Ingestion
Pathogenesis: Granulomas form
around dead larvae. Can cause
blindness
Lab. Diagnosis: Larvae visible in tissue
Treatment: Diethycarbamazine
Prevention: Dogs should be dewormed
Wuchereria bancrofti
Disease: Filariasis
Characteristics:
Bite of female mosquito deposit larvae
adults blood (night) ingested by
mosquitoes
Transmission: Female mosquitoes
(anopheles and culex)
Pathogenesis: Causes inflammation
blocks lymphatic vessels (elephantiasis)
Lab. Diagnosis: Visible in blood smear
Treatment: Diethylcarbamazine
Prevention: Mosquito control
INTESTINAL PROTOZOA
Entamoeba histolytica
Disease: Amebic dysentery and liver
abscess
Important Properties:
Life cycle has 2 stages:
Motile ameba trophozoite
Found in diarrheal stools
Nonmotile ameba cyst
Found in non-diarrheal stools
Highly resistant, readily killed by boiling or
freezing but not chlorination
Removed by filtration
4 nuclei
Transmission:
Ingestion of cyst fecal-oral route from
contaminated food and water
Anal-oral transmission
Pathogenesis:
Ingested cyst ileum trophozoites
cecum colon secrete enzymes
localized necrosis muscularis layer
tear drop ulcer submucosa portal
circulation liver abscess
Clinical Findings:
Dysentery acute intestinal amebiasis (bloody,
mucous containing diarrhea)
Lower abdominal discomfort, flatulence and
tenesmus (difficulty in defecation)
Chronic amebiasis occasional diarrhea, weight
loss and fatigue
90% are asymptomatic carriers
Feces containing cyst
Amebic abscess right upper quadrant pain,
weight loss, fever and tender, enlarged liver
Can penetrate lungs
Aspiration of liver abscess yields brownish-
yellow pus with the consistency of anchovy
paste
Laboratory Diagnosis:
Stool exam or fecalysis
(+) Trophozoites in diarrheal stools
(+) Cyst in formed stools
Treatment:
Metronidazole (Flagyl)
Drain hepatic abscess
Prevention:
Avoid fecal contamination of food and water
Good personal hygiene
Purification of water
Use of night soil for fertilization of crops should
be prohibited
Vegetables should be cooked

Giardia lamblia
Disease: Giardiasis
Important Properties:
2 Stages:
Trophozoite pear shaped with 2 nuclei, 4
pairs of flagella and suction disk
Cyst oval, thick walled with 4 nuclei and
several internal fibers
Pathogenesis:
Fecally contaminated food and water ingestion
of cyst encystation in duodenum
trophozoite attaches to the gut but does not
invade inflammation protein and fat
malabsorption
Clinical Findings:
Non-bloody, foul smelling diarrhea
Steatorrhea
Nausea and vomiting, anorexia, flatulence and
abdominal cramps persisting for weeks or months
No fever
Laboratory Diagnosis:
Stool exam
(+) Trophozoites in diarrheal stool
(+) Cyst in formed stools
String test
Treatment: Metronidazole (Flagyl)
Prevention: Drink boiled, filtered or iodine
treated water
UROGENITAL PROTOZOA
Trichomonas vaginalis
Disease: Trichomoniasis
Important Properties:
Pear shaped with a central nucleus and
4 anterior flagella
(+) Undulating membrane
Exists only as a trophozoite; no cyst
form
Pathogenesis:
Transmitted by sexual contact
Primary location are the vagina and the
prostate
Clinical Findings:
Watery, foul smelling,
greenish vaginal discharge
accompanied by itching and
burning
Strawberry cervix
Usually asymptomatic in
men; 10% with urethritis
Laboratory Diagnosis:
Vaginal or prostatic
secretions
Treatment and Prevention:
Metronidazole for both partners
Maintenance of low pH of the
vagina
Condoms
BLOOD AND TISSUE
PROTOZOA
Plasmodium
Disease: Malaria
**P.vivax, P.ovale, P.malariae,
**P. falciparum
Important Properties:
Vector and definitive host: Female
anopheles mosquito
2 Phase in lifecycle:
Sexual cycle: Mosquitoes
Sporogony sporozoites
Asexual cycle: Humans (intermediate host)
Schizogony Schizonts
Lifecycle in Humans:
Sporozoites from mosquito saliva
human blood hepatocytes within 30
mins cell multiplication merozoites
(male) released from liver infect
RBC
Periodic release of merozoites
recurrent chills, fever, and sweat
P.vivax and P. Ovale produce a latent
form (hypnozoite) in the liver Relapse
Lifecycle in Mosquitoes
Human RBC merozoites (males) and
female (gametocytes) Anopheles
mosquito bite ingest gametocyte (egg
cells) gut fertilization burrows in
gut wallsporozoites are released
migrate to salivary gland next blood
meal human blood
Pathogenesis:
Pathologic findings result from destruction of RBC; 2
reasons
Release of merozoites
Action of spleen to sequester the infected RBC and
lyse them
(+) Enlarge spleen (splenomegaly) due to congestion
with erythrocytes
P.falciparum is more severe
Infection of more RBC of all ages
P.vivax reticulocytes; P.malariae mature RBC
Occlusion of capillaries with parasitized RBC
Leads to life threatening hemorrhage and necrosis,
particularly the brain (cerebral malaria)
Extensive hemolysis and kidney damage
hemoglobinuria dark color urine black water
fever
Timing of the Fever Cycle:
P.malariae 72 hrs (Quartan malaria)
Recurs every 4
th
day
Others 48 hrs (Tertian malaria)
Recurs every 3
rd
day
Malignant malaria: P.falciparum
Benign malaria: P.vivax and P.ovale
Transmission:
Mosquito bites
Placental transmission, blood transfusion, IV
drug abuse
Occurs in tropical and subtropical areas
especially in Asia, Africa and Central and South
America

Clinical Findings:
IP: 2 weeks; Abrupt onset of fever and chills with
headache, myalgia and arthralgia
Fever spike up to 41C, with n/v and abdominal pain
Fever is followed by drenching sweats
(+) Splenomegaly and hepatomegaly
(+) Anemia
Untreated malaria
Extensive kidney and brain damage
Other plasmodium (malariae, vivax and ovale)
are self-limited
Relapse: P.ovale and P.vivax
Occurs several years after the initial illness
as a result of hypnozoites latent in liver
Laboratory Diagnosis:
Microscopic examination of blood
Thick smear screen for presence of
organisms
Thin smear for species identification
P.falciparum Crescent shaped (banana
shaped)


Others - spherical
Treatment:
Chloroquine
But does not kill hypnozoites of P.vivax and
P.ovale
Primaquine kills hypnozoites
Prevents relapses
Prevention:
Chemoprophylaxis for travellers
2 weeks before arrival until 6 weeks after departure
Followed by Primaquine is exposure is high
Mosquito netting, window screens, protective clothing and
insect repellants
Mosquitoes feed from dusk to dawn
Protection during the night
Drainage of stagnant water in swamps and ditches
No vaccine
Toxoplasma gondii
Disease: Toxoplasmosis
Important Properties:
Definitive host: Domestic cat and other
felines
Humans and other mammals are
intermediate hosts
Transmission:
Ingestion of cyst in undercooked meat or
from contact with cat feces
Cycle in Cats: ingestion of raw meat ex.
Mice
Humans: eating undercooked meat (lamb,
pork)
Pathogenesis:
Transmission: Ingestion or transplacental
Ingestion intestines brain, lungs, liver and
eyes
Cell mediated immunity plays a major role;
antibodies enhances killing
Congenital infection of fetus
Mother is infected during pregnancy
Clinical Findings:
Asymptomatic in immunocompetent adults
Congenital infection- abortion, stillbirth or neonatal
encephalitis, chorioretinitis and
hepatosplenomegaly
Fever, jaundice and intracranial calcifications
Laboratory Diagnosis:
Immunoflourescence
Microscopic examination of
trophozoites and cyst
Treatment:
Congenital toxoplasmosis sulfadiazine
and pyrimethamine
Prevention:
Cook meat thoroughly
Pregnant women should avoid
undercooked meat and contact with cats
Cats should not be fed raw meat
Pneumocystis carinii
Disease: Pneumonia in
immunocompromised patients
Important Properties:
Lifecycle in unclear
DNA analysis in 1988; should be
classified as fungus related to yeast
Medically; protozoan
Does not grow in fungal media
Antifungal drugs are ineffective
Found in domestic animals such as
horses and sheep and in variety of
rodents
Pathogenesis:
Transmission: Inhalation
Cyst in alveoli inflammation frothy exudate
blocks oxygen exchange
Pneumonia occurs when helper T cells are
reduced (AIDS, premature or debilitated infants)
Clinical Findings:
Sudden onset of fever, cough and dyspnea
and tachypnea
Bilateral rales and rhonchi
CXR: Diffuse interstitial pneumonia
Extrapulmonary pneumocystis: liver, spleen,
LN and bone marrow
50-100% mortality

Laboratory Diagnosis:
Microscopic examination of lung tissue
Treatment:
TMP-SMX + Pentamidine + Atovaquone
Prevention:
TMP-SMX or Pentamidine
chemoprophylaxis in
immunosuppressed patients