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LECTURE NOTES IN PARASITOLOGY



Prepared by:
Jasmen S. Pasia, RMT, MSMT
MLS Department, San Pedro College


Parasitology
is the area of biology concerned with the
__________________ of one living
organism on another.
Medical Parasitology is concerned with the
animal parasites of humans and their
medical significance, as well as their
importance in human communities.
_________ is a branch of medicine which
deals with tropical diseases and other
special medical problems of tropical
regions.
A tropical disease is an illness, which is
indigenous to or endemic in a tropical area.
Many tropical diseases are
______________________.
Biological Relationships
Symbiosis
___________________________________
Commensalism
- is a symbiotic relationship in which two
species live together and one species benefits from
the relationship ____________________________
_______________________________.
Mutualism
- is a symbiosis in which two organisms
_____________ from each other
Parasitism
- is a symbiotic relationship where one
organism, the parasite lives in or on another for its
__________________________ of the host.
Parasitism
Parasite
- organisms which ____________ of
another organism for growth and survival
Host
- ________________ that harbors the
parasite and is usually larger than the parasite




Types of Parasite:
1. According to its habitat
Ectoparasite
- lives on the outside of the host (______________)
Endoparasite
- lives within the body of the host (_____________)
2. According to its relationship with the host
Obligate
- when they take up ______________ in and are
completely dependent upon the host (Ascaris
lumbricoides)
Facultative
- they are capable of leading both a ____________
______________ existence even if they are outside
the body of the host (Strongyloides stercoralis).
Intermittent
- visit the host only during feeding time
(_______________)
Incidental
- establishes itself in a host in which it __________
ordinarily live ( Trichinella spiralis).
Permanent
- remains on or in the body of the host from early
life until maturity, sometimes for its entire life cycle
(______________________)
Pseudoparasite
- __________ mistaken as parasites (pollen, hairs)
Types of Hosts:
Definitive host
- harbors the _____________________________
stages of the parasite (humans).
Intermediate host
- harbors the _____________________________
of the parasite (snails).
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Paratenic Host
- a host which act as a __________________ for
the parasite and in which the parasite does not
_____________________ (prawns).
Reservoir
- a host in which the parasite is
__________________ and act as a source of
___________ for new cases (rodents).
Incidental Host
- refers to a situation in which the
_______________ is not necessary for the parasite
_______________________ (trichinosis).
Nomenclature
Classified according to the International
Code of _______________________
Each parasite belongs to a Phylum, Class,
Order, Family, Genus, and Species
At times the further divisions of Suborder,
Superfamily, Subfamily, and Subspecies are
employed
Family Name - ___________________
Superfamily - ___________________
Subfamily - ___________________

Names are binomial for species and
trinomial for subspecies
Names are in latin or Latinized.
Modes of Transmission
1. Soil-transmitted
= undergo ______________________ to reach the
infective stage
Ex: Ascaris lumbricoides
Trichuris trichiura
2. Snail-transmitted
= undergo further development in the ___________
to reach their infective stage.
Ex: Schistosoma japonicum
3. Arthropod Transmitted
= undergo further development in
_______________ to reach their infective stage
Ex: malaria _______________
filariasis - _______________
leishmaniasis sandfly
trypanosomiasis
A. American reduviid bug
B. African - tse-tse flies

4. Food-Animal Transmitted
= undergo further development in _____________
to reach their infective stage.
Ex: Taenia solium pork
Taenia saginata - beef
5. Contact Transmitted
= parasite is really __________________
= parasite does not have to go further development
Ex: Trichomonas ________________
________________ vermicularis
6. Animal-borne
= animal to human
= zooanthroponosis

7. Airborne
Ex: Enterobius vermicularis
Ascaris lumbricoides

8. Autoinfection
= infecting ones self (_______________________)

Portals of Entry
1. Mouth (Oral Cavity)
A) ingestion of:
embryonated eggs ( __________________)
___________ (Entamoeba histolytica)
B) intimate oral contact
Trichomonas ________________
Entamoeba _________________

2. Skin
A) Active penetration:
filariform larvae (__________________)
cercariae (Schistosomes)

3. Others
A) Sexual Contact
Trichomonas ____________
B) Transplacental
_________________ gondii
C) Transmammary
Strongyloides stercoralis
D) Intranasal
Naegleria ______________
Acanthamoeba __________

Portals of Exit
1. Stool = ________________________

2. Urine = T. vaginalis, S. haematobium

3. Sputum = Paragonimus ________________

4. Blood = microfilaria (_____________)
Gametocytes (_____________)



5. Tissue Biopsy
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a) muscle
Trichinella spiralis (_____________)
Taenia solium (cysticercus cellulosae)
Diphyllobothrium latum (______________)

b) rectal biopsy
amoebiasis
secondary Schistosoma infection

Epidemiologic Measures

Epidemiology
= is the study of patterns, _____________, and
occurrence of disease

1) Incidence
= is the number of _______________ of infection
appearing in a population in a given period of time

2) Prevalence
= is the number (______________________) of
individuals in a population estimated to be infected
with a particular parasite species at a given time

3) Cumulative Prevalence
= is the percentage of individuals in a population
infected with at least one parasite

4) Intensity of Infection
= refers to the ______________ per infected
person
= this may be measured directly or indirectly and is
also called as the _________________

5) Morbidity
= clinical consequences of _________________
that affect an individuals well-being

6) Mortality
= incidence of ____________ in a given population

Parasitic Infection and Disease

The transmission of parasites involved 3 factors:
a) source ____________
b) mode of __________________________
c) _________________ of susceptible host

A human being, when infected by a parasite may
serve as:
a) its only ______________
b) its principal host with ____________ also
infected
c) its ______________ host with 1 or other
animals as principal host


Phylum Nematoda

General Characteristics
Females ________ than males and have a
________ tail.
Males have ___________ tail with spicules
for _________________.
Unsegmented
Round elongated worms measuring from a
few mm to meter in length
Complete digestive tract (mouth to anus)
___________ circulatory system
Found in the intestine, blood, and tissue
Worldwide _______________
There are sensory organs

Aphasmids
Trichinella spiralis
Trichuris trichiura
Capillaria philippinensis
Phasmids
Ascaris lumbricoides
Strongyloides stercoralis
Hookworms
Enterobius vermicularis
Filarial worms
Habitat
Small Intestine
Ascaris lumbricoides
Strongyloides stercoralis
Hookworms
Capillaria philippinensis
Trichinella spiralis

Large Intestine
Trichuris trichiura
Enterobius vermicularis







PARASITOLOGY
HELMITHS
PHYLUM
PLATYHELMINTHES
Class Cestoda Class Trematoda
PHYLUM NEMATODA
PROTOZOA ARTHROPODS
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Tissue Nematodes
Trichinella spiralis
Wuchereria bancrofti
Brugia malayi
Onchocerca volvulus
Loa loa
Dirofilaria immitis
Gnathostoma spinigerum

Larva Migrans in Man
Dracunculus medinensis
Angiostrongylus cantonensis
Ancylostoma caninum
Ancylostoma braziliense

Trichinella spiralis
Also known as the ______________, Pork
Worm
Diseases:
- Trichinosis
- ________________
- Trichinelliasis
Morphology:
Male Worm
Measures _______ in length by 40-60 micra
in transverse diameter.
Cloaca is found at the caudal end which is
evertible during coitus. It is guarded by 2
conspicuous _______ which clasp the
female during copulation.
Spicule is ______________.
Posterior end of the worm is curved ventrad.


Female Worm
About 3-4 mm long and 60-80 micra in
width.
Vulva opens at the __________ of the body.

Has a single uterus which contains
________________.

Encysted Larva
measures __________ micra when
extruded by the female worm
provided with a ___________ burrowing tip
at its tapering anterior end
in the striated muscles, the larva grows to
about 0.8-1mm and becomes encrusted
along the axis of the muscle fibers


Life Cycle
Infective Stage - _____________ larva
Definitive Host - ______________
- man (accidetnal host)
Diagnostic Stage - encysted larva


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Diagnosis
- Muscle Biopsy
- Bentonite _______________ Test

Clinical Disease
1. Destruction of the muscle fiber.
2. Eosinophilia
3. May have ____________ involvement

Prevention and Control
1. Sterilizing garbage containing
____________ scraps.
2. Cook meat properly (77
o
C or 170
o
F).
3. Storage at -15
0
C for 20 days or -30
0
C

for 6
days.
4. Screening of _____________.
5. Public Education.

Treatment:
1. Thiabendazole
2. Mebendazole

Trichuris trichiura
Also known as the _______________
Diseases:
- Trichuriasis
- _____________ Infection

Morphology:
Male Worm:
Measures 3 - 3.5 cm.
A single lanceolate spicule protrudes
through a refractile penial sheath which has
a bulbous termination covered with
___________________________.
Distinguished from the female by its coiled
caudal extremity about 360 degrees or
more.
Female Worm:
Measures 3.5 - 5.5 cm in length.
Vulva opens at the ____________, the
fleshy portion of the body.
Has a single ____________________.
Bluntly rounded at the posterior end.





Ova:
characteristically _________________ with
bipolar unstained intralaminar prominences
which have the appearance of mucoid plugs
measures ________ micra by 22-23 micra
in addition to a vitellaine membrane, it has a
triple shell consisting of chorionic layer,
albuminous layer and the bile-stained layer



Life Cycle
Infective Stage
- _______________ egg
Definitive Host
- humans
Diagnostic Stage
- ________ (unsegmented)
No _________________ phase
Resides in the ____________ intestine
No intermediate host needed



Pathology:
1. mild ulceration
2. Abdominal pain
3. Diarrhea
4. _____________ prolapse

Diagnosis:
1. ________________________________
2. Kato-Katz Technique
3. ___________________ Technique
(Recovery of eggs in the stool specimen)

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Prevention and Control:
1. Proper disposal of feces.
2. Hand ____________________.
3. AVOID using human fecal matter as
fertilizer.
4. Community education.

Treatment:
1. Piperazine citrate
2. ______________________
3. Pyrantel Pamoate

Capillaria philippinensis
Disease:
- Intestinal Capillariasis
- ______________________

History:
- was 1
st
recognized in the Philippines in 1963 at
PGH
- ____________________, Ilocos Norte
- 1967, epidemic in Capillariasis in Pudoc, West
Tagudin, Ilocos Sur (approximately 1,300 persons
became ill and 90 persons died of the infection)

Morphology:
Male Worm:
Small, measuring ____________mm in
length.
Characterized by caudal alae and long, non-
spiny sheaths

2 Types of Female Worm:

Atypical Female ___________________
(responsible for population build-up)

Typical Female- _____________________

NB: Both has an esophagus with secretory
cells called _____________________ and
the esophageal structure is called
_______________________________

Female Worm:
Measures _______________ mm in length.
Body is divided into 2 almost equal parts,
the anterior containing esophagus and
esophageal glands and the posterior
containing intestine and reproductive
system with slightly prominent vulva.






Eggs:
similar to that of the whipworm but are
smaller about ____________________
micra usually in the single or 2-segmented
stage of development
more oval in shape
_________________ plugs that are not
protruberant
shell is thick and pitted which appear as
_______________ hence peanut-shaped


Life Cycle:
Infective Stage
_______________________
Intermediate host
_______________________
Definitive host
- humans
Diagnostic Stage
_______________________






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Pathology:
1. Abdominal pain
2. Gurgling of the stomach
(________________)
3. Loss of ________________
4. Vomiting and edema


Diagnosis:
1. Demonstration of characteristic
______________ in the feces.
2. Larva and adult stages may also be seen.

Prevention and Control:
1. Proper disposal of feces.
2. Proper cooking of fishes.
3. Freezing of ____________________.


Ascaris lumbricoides
Common Name:
- __________Worm
- _______________ Intestinal Roundworm
Diseases:
- Ascariasis
- Ascaris infection
- ____________________ Infection

Male Worm
Measures ____________ cm with smooth
striated cuticles.
They have a terminal mouth with
____________ with a sensory papillae.
They have a ventrally curved posterior end
with two ______________________.



Female Worm
Measures ____________ cm with smooth
striated cuticles.
They have a terminal mouth with
______________ with a _____________
papillae.
They have paired _____________ organs in
the posterior 2/3.
Posterior end is blunt.
Productive capacity of 26 million eggs or
200, 000 eggs per day.



Egg (3 layers)
1. Albuminous covering
- outer ______________ covering
- serves as an auxiliary barrier to
__________________________



2. Hyaline Shell
- ____________________ structure

3. Vitelline Lipoidal Layer
- highly impermeable

Egg (3 Types)

1. Fertilized Egg

measures ____________ micra by
____________ micra, shorter than the
infertile eggs
there is an outer coarsely mammilated
albuminous covering
_____________ yolk granules





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2. Unfertilized Egg
measures ________ micra by 39 to 44
micra, longer and narrower than fertilized
eggs
it is _____________ with an irregular
mammilated coating filled refractile granules
they are difficult to identify and are found
only in the ____________________.



3. Decorticated Egg

___________ of albuminous coating

Life Cycle:
Infective Stage
- _____________ egg
- embryonation in soil
(_______ weeks)

Definitive Host
- _______________________

Diagnostic Stage
- fertilized or unfertilized eggs
in the feces











Clinical Disease:

1. Worm Ball __________________ in the
intestine
2. Ascaris pneumonitis- due _____________
__________________ in the lungs

Diagnosis:
1. Demonstration of characteristic
___________ in feces.
2. Recovery of adult worms from _________,
nasal passage, or even _____________.

Prevention and Control:
1. Proper ______________ of feces.
2. Cooking well of vegetables.
3. Avoid using human feces as
____________.
4. Proper _______________.

Treatment:
1. Pipperazine citrate.
2. Mebendazole or pyrantel pamoate.










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Strongyloides stercoralis

Common Name:
Threadworm
Disease:
Strongyloidiasis
Conchin-China Diarrhea
Morphology:
Parasitic or Filariform Female:
smallest nematodes measuring 2.2 x 0.04
mm
it has a slender tapering anterior end and a
short conical pointed tail
the short buccal cavity has 4 indistinct lips
the vulva is located 1/3 the length of the
body from the posterior end
the uteri contain a single file of eight to
twelve thin-shelled, transparent, segmented
ova
Parthenogenetic/ parthenogenic

Free-Living Female:
measures 1 mm by 0.06 mm and is smaller
than the parasitic female
it has a muscular double-bulbed esophagus
and the intestine is a straight cylindrical tube

Free-Living Male:
measures 0.7 mm by 0.04 mm and is
smaller than the female
it has a ventrally curved tail, two copulatory
spicules, a gubernaculum but no caudal
alae

Rhabditiform Larva:
measures 225 micra by 16 micra
it has an elongated esophagus with a
pyriform posterior bulb
differs from hookworm in being slightly
smaller and less attenuated posteriorly
it also has a shorter buccal capsule and a
larger genital primordium

Filariform Larva:
is the non-feeding stage
slender measuring about 550 micra
it is similar to the hookworm filariform larva
but usually is smaller, with a distinct cleft
(notched) at the tip of the tail

Egg:
rarely seen in the stool specimen
it has a clear, thin shell and are similar to those of
hookworms except that they measure about 50-58
micra by 30 to 34 micra

Life Cycle:
Infective Stage
- Filariform Larva
Definitive Host
- Humans, Monkeys
Diagnostic Stage
- Rhabditiform Larva in
stool sample
NB: Eggs hatch in mucosa of intestines and are
rarely seen in feces.
It has both a free-living and parasitic
cycle.



Clinical Disease:
A) Three stages based on Life Cycle
1. Cutaneous
- initial skin penetration
2. Pulmonary
- larval migration in the lungs
3. Intestinal
- symptoms depend on worm load,
immunocompromised patients may exhibit
leukocytosis and eosinophilia

B) Hyperinfection Syndrome
- may lead to death due to tissue damage
- occurs in immunosuppressed patients
(AIDS, drugs)
- can be transferred through organ
transplantation
- transmammary

C) Autoinfection
- some of the rhabditiform larva develop
into filariform larva in the bowel and reinfect the host



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Diagnosis:
Demonstration of _______________ and/or
filarform larvae in the feces using:
a) DFS
b) concentration technique
c) Baermann technique

Prevention and Control:
1. Proper sewage disposal.
2. Avoid walking barefooted.

Treatment
1. ___________________
2. Thiabendazole

Hookworms
Necator americanus
________________________
Ancylostoma duodenale
________________________
Ancylostoma braziliense
Ancylostoma caninum
Ancylostoma ceylanicum

Disease:
- Ancylostomiasis
- _______________
- Necatoriasis
- _____________________

Morphology:

Male Worm:
8-11 mm long
Posses a bursa (____________) which aids
in the speciation of hookworms
Exhibits dental pattern

Female Worm:
10-13 mm long
_____________ tail
Adults may live 2-14 years
Rarely seen in the stool since firmly
attached to the mucosa

Rhabditiform Larva:
_____________, feeding stage
Bulbuous esophagus
Long buccal cavity (approximately as long
as the width of the body)
_____________ genital primordium

Filariform Larva:
______________, non-feeding stage
700 um long
Straight espohagus (1/4 of the length of the
body)
Pointed tail

Life Cycle:
Infective Stage
- _______________
Definitive Host
- humans
Diagnostic Stage
____________________




Clinical Disease:

1. Pneumonitis
2. Allergic Reactions
3. Anemia (each adult worm consumes
________ of blood/day)
4. Cutaneous Larva Migrans
(due to migration of dog hookworms)
* A. braziliense & A. caninum through the
subcutaneous tissue causing itching and he
formation of _____________________

Diagnosis:
1. Demonstration of characteristic egg in the
feces (________________ cell stages)
Larva is not seen in feces (unless the specimen is
left for 24 hours)

R-E-M-E-M-B-E-R
If a stool specimen is left at room temperature, the
larva may continue to develop and must be
differentiated with _____________________..

Diagnosis:
Should you recover the adult Hookworm,
easier differentiation is done by observing the buccal
capsule.
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N. americanus ____________ cutting
plates
A. duodenale ______ pairs of ventral
teeth
A. caninum ______ pairs of ventral teeth
A. ceylanicum ______pairs of ventral
teeth with outer bigger than the inner pair
A. braziliense _______ of big teeth

Prevention and Control:
1. Proper disposal of feces.
2. Avoid walking barefooted.
3. Health education on personal, family, and
community hygiene.
4. Treatment of infected individuals.
5. Mass chemotherapy when prevalence is
greater than ___________
6. Protection of susceptible individuals.

Treatment:
1. Albendazole
2. Mebandazole
3. _____________

Enterobius vermicularis
Common Name:
1. ________________
2. Sitworm
3. ________________

Disease:
1. Enterobiasis
2. __________________

Male Worm:
Measures 2 to 5 mm by 0.1 to 0.2 mm.
It has a characteristic curved tail with a
single spicule.
Relatively smaller that the female worm.
They are rarely seen because they die after
copulation.

Female Worm:
Measures 8 to 13 mm by 0.4 mm.
It has a long ____________ hence the
common name pinworm.
The uteri of the gravid female are distended
with eggs.
They are capable of laying as much as
4, 672 to 16, 888 eggs/day.

Ova:
are assymetrical, with one side flattened and
the other side _____________
measures 50 to 60 micra by 20 to 30 micra
averaging 55 by 36 micra
the translucent shell consists of an outer, triple
albuminous covering for mechanical protection
and an inner lipoidal membrane for
____________
outside the host , eggs become infective in
________________________

Life Cycle:
Infective Stage
- ___________________
Definitive Host
- Humans
No IH needed
Autoinfection is very possible



Pathology:
1. Perianal itching or _______________
2. Autoinfection
3. Familial disease

Diagnosis:
1. Scotch tape technique (cellulose tape)
- ____________ stick to the tape
- since migration of female occurs at ___________,
the method is performed before the patients bowel
movement or before the patient has taken a bath
- adults may become stuck to the outside of the
stool as it passes the perianal folds where the
female migrates to lay eggs

Prevention and Control:
1. Proper hygiene.
2. Public Education.
3. Familial treatment.







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Blood and Tissue Nematodes

The microfilariae group
1. Wuchereria bancrofti
2. Brugia malayi
3. Loa loa
4. Onchocerca volvulus

Wuchereria bancrofti

Diseases:
- Bancroftian filariasis
- Wucheriasis
- _________________
Microfilaria:
- sheathed
- no nuclei at the tip of the tail
- norturnal periodicity (9pm-2am is its
greatest concentration in the tblood)
Elephantiasis:
- permanent blockage of lymphatic
system can occur in _________________
Diagnosis:
- demonstrate in blood smears (thick and
thin) sheathed microfilariae with
________________ at the tip of the tail

Brugia malayi
Disease:
- Malayan filariasis
Microfilariae:
- sheathed
- nuclei stops then there is a clear space
with __________________ at the tip
of the tail
- exhibits ____________ periodicity
Elephantiasis:
- restricted to the ____________
extremities
Diagnosis:
- demonstrate in blood smears (thick and
thin) sheathed microfilariae with
__________ terminal nuclei in tail
Generally found in the Far East

Loa loa

Also known as the _________________
Microfilariae
- sheathed
- nuclei _________________ of the tail
- exhibits _________l periodicity
(microfilaria is shed in peripheral blood
constantly day or night)

Causes ________________ swellings
- allergic reaction due to worm
migration in tissue and death in capillaries

Diagnosis:
- demonstrate in blood smears (thick
and thin) sheathed microfilariae with continuous
nuclei to the tip of the tail
- found in Africa

Onchocerca volvulus
Also known as the Blinding Worm
Disease:
- Onchocerciasis
- Onchocercosis
- _____________________
Microfilariae
- only pathogenic tissue nematode
which is not sheathed
- ____________ at the tip of the tail
- found in nodules under skin, not in
peripheral blood

Clinical Significance/Disease:
- sever dermatitis
- microfilaria in ocular structures
may result in blindness
- leading cause of blindness
in Africa
Diagnosis:
- demonstrate from skin snips/tissue
scrapings unsheathed microfilariae with no
nuclei in tail

NB:
_______________________
eosinophilia is associated with the microfilariae
of these nematodes




















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Microfilariae Disease Arthropod Vector Diagnostic stage found
in
W. bancrofti Elephantiasis Mosquito (Culex/ Anopheles) Blood
B. Malayi Elephantiasis Mosquito
(Mansonia)
Blood
L. Loa Calabar
swelling
Blindness
Fly
(Chrysops)
Blood
O. volvulus River
blindness
Fly
(Simulian)
Tissue from nodule

LIFE CYCLE

1. Ingestion of the microfilariae from the blood
or tissues by a blood-sucking insect.
2. The metamorphosis of the microfilaria in the
arthropod vector 1
st
into rhabditiform larva
and then into an infectious filariform larva.
3. The transfer of the infective larva to the skin
of a new host by the proboscis of the biting
insect.
4. The development of the larva after entry to
the bite wound into a mature worm at its
selective site.
Treatment/Prevention/Control
1. Control on mosquitoes and human
sources of infection.
2. Spraying of houses with residual
insecticides.
3. Diethylcarbamazime (DEC)
4. Ivermectin

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Dracunculus medinensis

Common Name:
____________________
____________________
Medina Worm
Disease:
Dracunculiasis

parasite is frequently found in the
subcutaneous tissues and mucscles of
humans, dogs and sometimes cattles and
horses
The disease causes cutaneous nodules and
subsequent ulcers.

Morphology
Males are small (1.2-2.9 cm long)
Females measures 60cm in length
The larvae, which measure between 500
and 700 micrometers, can live for 6 days in
clean water and 2 to 3 weeks in muddy
water.

Life Cycle
Infective Stage ______________
Definitive host humans, dogs, horses
Intermediate host - ________________

Treatment:
Removal of Worm
Filtering water sources
Avoid contact with contaminated water



Angiostrongylus cantonensis

Common Name:
____________________
Was described by Chen in 1935 from
domestic rats in Canton, China
The worm normally lives in the lungs of rats
but can cause eosinophilic
meningoencephalitis in man

Disease:
Angiostrongyliasis
Eosinophilic meningoencephalitis

Morphology
Male:
- pale and filifprm
- 16 to 19 mm x 0.26 mm in diameter
- they have a well-developed caudal bursa
(kidney-shaped and single-lobed)

Female:
- pale and filiform
- 21 to 25 mm x 0.30-0.36 mm in
diameter
- has uterine tubules which are round spirally
around the intestine (__________________)
- lays 15,000 eggs/day

Eggs
Have delicate hyaline shells
Measure 46-48 micra x 68 micra
Unembryonated when oviposited



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Life Cycle
Infective stage 3
rd
stage larva
Definitive host rats, humans
Intermediate host snails
(Achantina fulica)

Diagnosis
Relatively difficult
Presumptive diagnosis is made by travel
history and exposure
CSF (10% eosinophilia in proportion to the
WBC)
CT Scan
ELISA

Treatment
No antihelminthic treatment is
recommended
Thiabendazole, Medendazole, Albendazole,
Ivermectin (effective in experimental
animals)
Prevention/Control
______________________
Safe food preparation
Elimination of IH
Washing of leafy vegetables
Eating sufficiently cooked prawns and crabs