Malaria life cycle, difference among types (vivax, falciparum)

Ascaris
1. Small intestine
2. Hand to mouth, contaminated food, hands, water, toys, embryonated eggs
3. Pathogenesis: Life cycle (intestines, venous system, lungs, mature, aspirated and
swallowed?)
4. Clinical: asymptomatic, abdominal, pulmonary, intestinal obstruction, biliary
obstruction, eosinophilia
5. Dx: Stool microscopy, Modified kato thick smear, Hx of passing adult worms
6. Tx: Mebendazole, Alben, pyrantel, piperazine citrate, surgery
7. Px: hygiene, sanitation, MDA

Trichuriasis (whipworm)
1. Cecum and ascending colon
2. 5000-20000 eggs per day
3. high infection rate children
4. Fecal oral route, ingestion of embryonated eggs
5. Eggs larvae penetrate villi cecum eggs from female excretion in feces
embryonated egg
6. Barrel shaped egg
7. Clinical: Asx, vague RLQ pain, anorexia, weight loss, rectal prolapse
8. Dx: Fecal smear barrel shaped ova
9. Tx: Albendazole (DOC), Mebendazole
10. Px: MDA, hygiene, sanitation

Hookworms (necator 96%, ancylostoma 2% in phils)

1. adults>children
2. Zoonotic
a. Eosinophilic enteritis syndrome (dog hookworm)
b. Cutaneous larva migrans
i. Ancylostoma caninum, brasiliense
3. Transmission
a. Skin penetration of filariform larva (N, A)
b. Ingestion (A)
c. Mature female A: 30,000 per day
d. N: <10,000 per day
4. Causes: barefoot, indiscriminate fecal disposal
5. Filariform larva skin venous circulation lungs swallowed intestine
2 molts adults attach using buccal plates and teeth (N) eggs soil molt
2x infective stage
6. Pathogensis:
a. A: 0.2mL of blood loss per day per worm
b. Blood loss at site of attachment
7. Clinical: dermatitis (ground itch), pneumonitis, chronic: anemia (Fe def),
Malnutrition protein, impaired mental development
 8. During preg: low BW infants, infantile ancylostomiasis, increased fetal mortality,
reduced milk production
9. Dx: stool microscopy identify eggs
10. Tx: Albendazole, mebendazole, pyrantel, address malnutrition and anemia
11. Px: sanitation, health education, MDA
12. Larva migrans: a few hookworms, raised erythematous serpiginous tracts, bullae,
bacterial superinfection

Enterobiasis (pinworm, E. vermicularis)

1. Cecum, appendix, ileum, ascending colon
2. Migrate at night of females (perianal itch)
3. 15000 eggs per day deposited viable for 20 days outside the host
4. Fecal oral route, eggs on fingernails, beddings
5. Autoinoculation common
6. Usually other members affected
7. Clinical: pruritus ani, nocturnal itching, insomnia, excessive scratching, acute
appendicitis
8. Dx: ID of eggs or worm, cellulose tape
9. Embryonated egg
10. Tx: Albendazole (DOC), Mebendazole, Pyrantel, treat all household members at the
same time
11. Px: hand hygiene, thorough house cleaning

Strongyloidiasis (S. stercoralis) human threadworm

1. small intestines
2. reproduction in the host
3. Rhabditiform larva passed in feces
4. Filariform larva, skin, venous circ, lungs, swallowed, small int, eggs, larvae, passed
out
5. Tropical, subtropical, dogs and cats are reservoir
6. M>F
7. Clinical
a. Larva currens: skin reaction, pulmonary, abdominal, eosinophilia chornic,
hyperinfection syndrome (autoinfection)
8. Dx: rhabditiform larvae in stool, enteric string test
9. Tx: Ivermectin (DOC), Albendazole (Alternative)
10. Px: sanitation, wear shoes

Capillariasis
1. C. philippinensis: Ilocos region, Pangasinan, Zambales, Zamboanga coastal areas
eating of raw fish
2. Worm attach to intestinal mucosa blunting of mucosa malabsorption
3. Clinical: diarrhea, emaciation, edema from protein loss
4. Egg, larvae, fish, humans
5. Dx: stool eggs, larvae, adult
6. Tx: prolonged albendazole or mebendazole
7. Death can occur in 4 weeks or more without treatment

Filariasis threadlike nematodes

 1. W. bancrofti, B. malayi
2. 40 M worldwide are disfigured
3. Bicol, Mindoro, Visayas area
4. Mosquito is vector third larva man infective larvae accumulate in
lymphatics blood stream ingested by mosquito
5. Anopheles (clear running streams), Aedes (abaca growing areas)
6. Clinical: fever, lymphangitis, elephantiasis, male genitalia, chyluria, tropical
pulmonary eosinophilia
7. Dx: thick blood smears microfilaria (8pm to 4am)
8. Tx: DEC, surgery for scrotal elephantiasis
9. MDA: DEC with albendazole

Angiostrongylus (a. cantonensis)

1. adult worm rates (pulmonary artery) eggs laid larvae trachea
swallowed 1st larv mollusks 3rd larva infected ingested rats or
humans brain
2. crabs, prawns
3. Manifestsions: self limiting, fatal, eosinophilic meningoencephalitis
4. Dx: CT with ELISA, blood dyscrasia and eosinophilia is suggestive
5. Treatment: supportive, steroids, periodic CSF removal
6. Px: eliminate mollusks, rats

Taeniasis solium, cysticercosis

1. T. solium
2. Taeniasis adults, cyst ingestion
3. Cysticercosis larvae ingestion
4. Undercooked pork scolices
5. Clinical: asx usually, vague abdominal pain, eosinophilia
6. Cysticercosis
7. Dx: stool exam eggs
a. Cysticercosis biopsy, MRI of brain
8. Tx: niclosamide, praziquantel DOC
9. Criteria for cure: (-) exam 3 months after Tx
10. Px: cook the pork

Taeniasis saginata
1. beef tapeworm
2. no human cysticercosis
3. raw beef
4. Tx: niclosamide + praziquantel

Hymenolepiasis dwarf tapeworm

1. Common parasite of house mouse
2. Children > adults
3. Most common tapeworm infection
4. Eggs ingested by humans oncospheres penetrate villi cercocysts or larvae
scolices to mucosa mature embryonated eggs feces
5. Clinical: Asx, abdominal pain, vertigo, seizures, eosinophilia
6. Niclosamide, praziquantel
Schistosomiasis (bloodfluke)
1. S. mansoni, haematobium, japonicum
2. S. hematobium: urinary system
3. S. mansoni: GI tract
4. S. japonicum: oriental blood fluke east asia, phil
a. Humans cercaria skin migrate to preferred sites eggs trigger
inflammatory response urine and feces miracidia freshwater snails
5. Oncomelania
6. Clinical: Vasculitis, Katayama fever (organomegaly, fever, eosinophilia, CNS)
7. Dx: eggs in stool, biopsy of liver, rectal, liver USG
8. Tx: Praziquantel (DOC)
9. Px: MDA of Praziquantel

Paragonimiasis (P. westermani) lung fluke

1. 1st host: antemelania asperata snails
2. Sundathelpusa philippina crab 2nd intermediate host
3. Transmission: raw crabs
4. Clinical: pulmonary, can mimic TB, liver, spleen, brain
5. Tx: Praziquantel (DOC) Triclabendazole (alternative)

Amebiasis (E. histolytica)

1. Protozoan, fecal oral
2. cyst ingestion germinate in small intestine trophozoite may invade mucosa
trophozoite rapidly degenerate outside
3. Flask shaped ulcer
4. 2nd leading cause of protozoal parasitic death second to malaria
5. risk factor: HIV infection
6. Troph invasion of liver liver abscess
7. Clinical: asx, diarrhea, RUQ tenderness, tenesmus, ameboma, disseminate to liver,
lungs, brain, skin
8. Diagnosis: Stool exam
9. Tx: Metronidazole, Tinidazole, Luminal amebicides - paromomycin

Giardiasis G. lamblia
1. Intestinal flagellate
2. Ingestion of cysts duodenal trophozoites colonize lumen of duodenum and
proximal ileum attach to brush border binary fission detach encyst
passed out (viable for 2 months)
3. Risk factor: HIV
4. Major reservoir: contaminated water
5. Manifestions: diarrhea, anorexia, malabsorption, weight loss, constipation
6. Dx: 3 stool exams
7. Tx: Metronidazole, Tinidazole

Trichomoniasis
1. T. hominis, T. vaginalis
2. Anaerobic, flagellated
3. STD
4. F>M
5. Clinical: strawberry cervix, copious malorodous frothy discharge
 6. Males: epididymitis, penile ulceration, asx mostly
7. Dx: wet mount, culture is gold standard
8. Tx: Metronidazole

Toxoplasmosis
1. T. gondii
2. Obligate intracellular coccidian protozoa
3. Cats definitive
4. Oocyst is infective stage sporulate ingested ileal epithelium
5. Generalized or local LAD, most common
6. Encephalitis
7. Intrauterine: blindness and mental retardiation, part of TORCH
8. Tx: Pyrimethamine + trisulfapyrimidine (synergistic)
a. Spiramycin (prevents intrauterine transmission)