PARASITOLOGY HANDOUT

JAN BENDRIC C. BORBE, RMT, MLS(ASCPi)

Definition of Terms:

 Symbiosis: living together of unlike organisms

 Commensalism: symbiotic relationship in which 2 species live together, one species
benefits from the relationship without harming or benefitting the other (e.g. Entamoeba
coli)
 Mutualism: symbiotic relationship in which 2 organisms mutually benefit from each other
 Parasitism: symbiotic relationship in which 1 organism (parasite) lives in or on another
depending on the latter for survival and usually at the expense of the host (e.g. Entamoeba
histolytica)
 Endoparasite: living inside the body of a host (infection)
 Ectoparasite: living outside the body of a host (infestation)
 Obligate parasite: needs a host at a certain stage in its life cycle to complete development
and propagate
 Facultative parasite: exists in a free living state, however, they may become parasitic
when the need arises (e.g. Strongyloides stercoralis or thread worm)
 Accidental parasite: a parasite which establishes itself in a host where it does not
ordinarily live
 Permanent parasite: remains in the body of the host for its entire life span
 Temporary parasite: lives on the host only for a short period of time
 Spurious parasite: a free living organism that passes through the digestive tract without
infecting the host
 Definitive Host: host where parasite attains sexual maturity
 Intermediate Host: harbors the asexual or larval stages e.g. flukes (may have 2
intermediate hosts)
 Paratenic Host: parasite does not develop further to latter stages, they widen the parasite
distribution and bridge the ecological gap (parasite remains alive and is able to infect
another susceptible host)
 Reservoir host: allow the parasite’s life cycle to continue and become additional sources
of infection (e.g. Pig – Balantidium coli)
 Vectors: responsible for transmitting the parasite from one host to another
 Biologic Vector: transmits the parasite only after it has completed its development within
the host
 Mechanical/Phoretic Vector: Only transports the parasite (e.g. flies and cockroaches)

Modes of Transmission:

 Autoinfection: infected individual becomes his own source of infection

Seen in the life cycle of:

> Enterobius vermicularis
> Hymenolepis nana
> Strongyloides stercoralis
> Also possible in Taenia solium and Capillaria philippinensis
  Congenital transmission: Toxoplasma gondii
 Transmammary: Ancylostoma and Strongyloides
 Inhalation: Enterobius
 Sexual Intercourse: Trichomonas vaginalis

Protozoans

1. Entamoeba histolytica
 Most invasive of the parasites in the Entamoeba family
 Humans are the only host
 It is the only member to cause colitis and liver abscess
 No morphologic difference among:
 moshkovskii
 dispar
 histolytica
 Can be differentiated by:
 Isoenzyme analysis
 PCR
 Monoclonal Antibody Typing
 Mode of Transmission:
 Ingestion of cysts
 Venereal
 Direct Inoculation through contaminated enema equipment
 Invasion of mucosa:
 Production of enzymes and cytotoxic substances
 Contact dependent cell killing
 Cytophagocytosis
 Attachment is mediated by amoebal galactose-inhibitable adherence lectins
 Penetration of muscularis muscosa and submucosa to produce flask-shaped
ulcers
 Virulence Factors:
 Cysteine proteinase: histolytic cytolytic enzyme
 Gal/Gal Nac Lectin: mediates adhesion
 Amoeba pores: form pores in the host cell membrane
 Clinical Manifestations:
 Amebic colitis
 Acute Liver Abscess
 Cardinal manifestations: Fever and RUQ pain with hepatomegaly
 MOST COMMON extra intestinal form of amebiasis
 Dreaded complication rupture into the pleura/pericardium
 Anchovy sauce like aspirate, odorless, bacteriologically sterile
 Trophozoites are found at the periphery
 Ameboma
 Mass-like lesion with abdominal pain
 May be mistaken for carcinoma
 Complications
 Perforation
 Secondary Bacterial Peritonitis

2. Entamoeba coli
 Morphological characteristics:
 Larger than E. histolytica
 Consists of 8 nuclei with very diffuse karyosomes
 May also contain needle-like chromatoidal bodies with irregular fragmented
ends

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 STAGE E. histolytica E. coli
CYST # of nuclei Less than 4, More than 4 (6-8),
Quadrinucleated in Octonucleated if
mature mature
Chromatoidal bar Sausage shaped, Witch broom stick
coffin lid with appearance,
rounded ends, cigar splintered or needle
shape like

TROPHOZOITE
Movement Unidirectional Sluggish
Shape of Fingerlike Blunt
pseudopodia
Release of One at a time Several at a time
pseudopodia
Cytoplasm “Clean looking” “Dirty looking”
Nucleus Central karyosome Eccentric
karyosome

 Culture Media:
 Locke’s Egg Medium (Rice, egg, saline based)
 Shaffer Ryden Frye Medium
 Balamuth’s Medium
 Boeck/ Drbohlav’s Diphasic Medium
 Robinson and Inoki
 Staining:
 Quensel’s Methylene Blue-
 Lugol’s Iodine –for cysts, (kills the trophozoite)

Commensal Amoeba

3. Entamoeba polecki (Swine Amoeba)

 Parasite of pigs and monkeys
 Cyst is UNINUCLEATED
 Very prominent nuclear membrane and karyosome on stained smears

4. Entamoeba gingivalis (Kissing Amoeba)

 Found in the mouth, gum pockets and tonsillar crypts
 May cause pyorrhea
 NO CYST STAGE
 Transmission via direct contact, droplet spray, and sharing utensils
 Ingests WBCs

5. Entamoeba dispar
 Morphologically similar to E. histolytica

6. Entamoeba hartmanni
 Similar to E. histolytica
 Smaller
 Does not ingest red blood cells

7. Endolimax nana
 Sluggish movement
 Quadrinucleated cyst when mature
 Comma shaped chromatoidal bar
 Cross eyed Cyst

8. Iodamoeba butschlii
 Identified by its characteristic large vesicular nucleus

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  Large endosome surrounded by achromatic granules (described as “Basket of
Flowers”
 Non peripheral chromatin granules
 Identified by its large glycogen body (“IODINE BODY”)

Free Living Pathogenic Amoeba

 Found in fresh, brackish, salt water, moist soil and decaying vegetation

9. Naegleria (Vhalkampfiidae family)

 Amebo-flagellate
 Causative of Primary Amebic Meningoencephalitis (PAM)
 Infective stage: Trophozoite
 NO CYST STAGE
 2 Forms:
 Amoeboid: Blunt pseudopod, Lobose monopseudopodium
 Flagellate: Pear shaped with 2 anterior flagella

10. Acathamoeba (Acanthamoebidae family)

 Trophozoites
 Single large nucleus
 Large contractile vacuole
 Exhibits small, spiny filaments for locomotion
 Cyst
 Double walled “Wrinkled Cyst”
 Pores of ostioles are found at the point of contact between the two walls
 Clinical Manifestations
 Granulomatous Amebic Encephalitis
 Neurological Manifestations such as ataxia, hemiparesis
 Amebic Keratitis
 Corneal ulceration > Clouding > Scleritis and Iritis > Loss of Vision
 Associated with contact lenses

11. Balamuthia mandrillaris

 Causes Granulomatous Amebic Encephalitis (GAE)

12. Sappinia diploidea

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 CILIATES

13. Balantidium coli

 Largest intestinal protozoa
 The only parasitic ciliate
 Causes balantidial dysentery (although many cases are aymptomatic)
 Capable of invading the intestinal epithelium (produces Hyaluronidase)

 Characteristic ulcer: rounded base with wide neck

 Infective stage: Cyst
 Diagnostic stage: trophozoite
 Definitive host: Pig (Man is only accidental)
 Characteristic Rolling ball motility “thrown ball motility”

Flagellates

1. Giardia lamblia
• Pyriform or teardrop shaped
• Binucleated flagellated trophozoite
• Quadrinucleated infective cyst
• Causes Gay bowel syndrome
• Excessive flatus with the odor of hydrogen sulfide (rotten egg odor)
• Steatorrhea: passage of greasy, frothy stools that float on toilet water

2. Trichomonas vaginalis
 Trophozoite
 5-15 um, Habitat –urogenital tract
 Differs from T. hominis by its shorter undulating membrane
 PATHOGENESIS
 Contact dependent cytopathic effect
 Females
 Vaginal discharge: profuse, watery, mucoid or grayish, occasionally bubbly,
mucosa hyperemic with punctate hemorrhages (described as Strawberry
Cervix)
 Vulvar itchiness; burning sensation, urinary frequency and dysuria
 Males
 Infection frequently asymptomatic
 May involve the prostate, seminal vesicles and urethra
 Diagnosis
 Fresh vaginal smear or prostatic secretions
 Sedimented urine
 Culture:
 Diamond’s medium
 Feinberg Whittington
 Trypticase Liver Serum medium
 Antigen Detection (EIA, DFA, LA, DNA probe)

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Malaria
 “Paludisme”
 Mal –bad
 Aria –air
 Palus (marsh): disease was caused by vapors and mists arising from swamps

Parasite Disease
P. falciparum Malignant Tertian
P. vivax Benign Tertian
P. malariae Quartan Malaria
P. ovale Benign Tertian

 Mode of Transmission
 Through the bite of female anopheles mosquito
 Directly from one person to another by passage of blood containing
erythrocytic parasite through:
 Blood transfusion
 Sharing of contaminated syringes and needles
 Mingling of infected maternal blood with that of
 Infant during birth process (neonatal malaria)
 Transplacental transmission (congenital malaria)
 Vectors
 Principal vector:
 Anopheles minimus var. flavirostris
 Secondary vectors:
 Anopheles litoralis
 Anopheles balabacensis
 Anopheles mangyanus
 Anopheles maculatus
 Pathology
 Anemia: Hemolysis
 Intravascular: rupture of infected and non-infected RBCs
 Extravascular: phagocytosis of infected and non-infected RBC by R.E.
cells (Kupffer cells in the liver, macrophages in spleen, lungs and bone
marrow)
 Changes in blood flow
 Blockage of small blood vessels
 Vasomotor changes
 Blackwater Fever
 Refers to massive intravascular hemolysis and the passage of dark red,
brown, or usually black urine
 More common in G6PD deficient patients receiving sulfa containing
drugs, quinine, or artemisinin
 Diagnosis
 Gold standard
 Thick and thin blood smear
 QBC
 Rapid Slide Test
 Serologic

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  Quantitative Buffy Coat
 Specially prepared capillary tube coated with acridine orange
 Malarial parasites appear bright green and yellow
 Principle involved: Immunofluorescence
 Rapid diagnostic tests
 Principle involved: Immunochromatography
 Antigen targets include:
o HRP II (Histidine Rich Protein II) – for falciparum malaria
o Plasmodium LDH – for falciparum and non falciparum malaria

Intestinal Nematodes

1. Ascaris lumbricoides
 Giant Intestinal Round Worm
 Habitat: small intestine
 Triangular buccal cavity
 Infective Stage: Embryonated Egg
 Diagnostic Stage: Ova
 Unfertilized egg:
 Chitinous layer and albuminous coat are thinner than those of the
fertilized eggs
 Content is made of many refractable granules which vary in size
 Fertilized egg: Thick glycogen layer
 Infective Stage: Embryonated ova
 Clinical Manifestations:
 Pneumonitis (due to larval stages)
 4 days to 2 weeks after infection,
 Increased IgE; asthma like
 Loeffler’s syndrome
 Adults may cause obstruction -> intestinal gangrene
 Unlikely to cause signs and symptoms in light infection
 Erratic migration may be due to increase in body temperature or insufficient
drug dose

2. Enterobius vermicularis “Oxyuriasis”

 Social worm, familial worm
 No lung migration
 Retro infection: young larva migrates back into the cecum
 Main symptom: Pruritus Ani
 Ova:
 Asymmetrical, lopsided, D shaped
 Outer triple albuminous covering: mechanical
protection
 Inner lipoidal membrane: chemical protection
 Adult:
 Cephalic alae or cuticular alar expansion , prominent esophageal bulb
 Males are rarely seen (dies after copulation)
 Diagnosis
 Graham’s scotch tape swab
 Performed for 7 days

3. Trichiuris trichiura
 Whipworm
 Soil transmitted helminth
 Attenuated anterior 3/5
 Posterior 2/5 contains the intestines and reproductive organs
 Esophagus: characteristically embedded in glandular cells called stichocytes

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  Tail end:
 Female: straight and blunt
 Male: usually curved at 360 degrees
 Barrel shaped egg
 Thick, smooth brown egg shell and 2 transparent plugs protruding from both
poles
 Clinical Manifestations:
 Diarrhea, Hypoalbuminemia
 Iron Deficiency Anemia
 Due to ulceration of the intestine resulting from heavy worm burden
 Anemia is less frequent than Hookworm
 Prolapse of the anus and rectum
 Due to frequent loose bowel movement resulting to the loss of muscle
tone of anal sphincter

4. Strongyloides stercoralis
 Threadworm
• Cochin china / “Vietnam diarrhea”
• Facultative parasite characterized by free living and parasitic stages
• Free living female is smaller than the parasitic female
• Parasitic female is capable of self- fertilization
• Disseminated infection occurs among immunosuppressed patients
• Autoinfection occurs when rhabditiform larva pass down the large intestine and
develop into filariform larva
• Clinical Manifestations:
 Pneumonitis
 Diarrhea
 Malabsorption Syndrome
 Secondary bacteremia/ Septicemia (Enteric bacterial flora)
 Diagnosis:
 Harada mori
 Baermann Funnel
 Beale’s String Test
 Small Bowel Biopsy
 Diagnostic Stage: Rhabditiform Larva

5. Hookworm
Necator Americanus
 American killer/ murderer
 New world hookworm

Ancylostoma duodenale
 Old world hookworm
 Larger than Necator

MOT: Skin penetration

 Ova
 Transparent and Ovoid
 2-8 cell stage
 Thin Hyaline Shell
 Pathology
 Larva
 Ground itch
 Water sore
 Dew itch
 Mazza Mora
 Pneumonitis (Wakana’s disease)
 Adult
 Microcytic Hypochromic Anemia

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  Hypoalbuminemia
 Gastrointestinal bleeding
 Cutaneous Larva Migrans
 Will not mature in humans
 Caused by:
 A. caninum
 A. braziliense

6. Trichinella spiralis
 Muscle worm (Biceps, Deltoids), Trichina worm
 Viviparous/ Larviparous
 Not common in the Philippines
 Diagnostic Stage is same as the Infective stage:
 Encysted/ Encapsulated Larva
 Final Host: Rat
 Accidental Host: Man
 Intestinal Phase:
 Inflammation of duodenal and jejunal mucosa:
 Malaise
 Nausea
 Diarrhea
 Abdominal cramps
 Stage of Muscle Invasion:
 Fever
 Facial edema
 Muscle pain, swelling and weakness
 Peripheral eosinophilia
 Clinical Diagnosis
 History of eating raw or inadequately cooked or improperly processed meat
usually pork
 History of intestinal flu or rheumatic pain
 Marked eosinophilia in blood
 Swollen eyelids or severe conjunctivitis
 Diagnosis
 Beck’s Xenodiagnosis
 Bachman Intradermal Test
 Muscle Biopsy

7. Capillaria philippinensis
 “Mystery disease”
 Habitat: small intestines
 Esophagus has rows of secretory cells called stichocytes
 MOT: ingestion of uncooked fish with infective larva
 Diagnosis: eggs in stool
 Eggs:
 Peanut shaped
 Guitar Shaped with striated shells and flattened bipolar plugs
 Eggs embryonate in soil or water, ingested by fish
 IH: Ipon, Birot, Bagsang, Bagtu, Bagsit
 1st generation: produces larva
 2nd generation: produces eggs
 Hyperinfection and autoinfection
 Manifestations:
 Diarrhea
 Abdominal Pain
 Borborygmi

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 8. Dracunculus medinensis
 Dragon worm, Guinea worm, Serpent worm
 Diagnostic stage: Adult worm
 Infective stage: 3rd stage larva
 Intermediate Host: Cyclops/ copepods
 MOT: ingestion of Cyclops in contaminated water

9. Angiostrongylus cantonensis
 CN “Rat Lung Worm”
 First described in 1935, Canton, China
 Habitat: Pulmonary Arteries of Rats
 Causes Eosinophilic Meningoencephalitis
 Acute severe intermittent occipital/ bitemporal headache
 Peripheral eosinophilia
 IH: Achatina fulica or Giant African Snail
 Others:
 Hemiplecta sagittifera
 Helicostyla macrostoma
 Morphology:
 Kidney shaped Barber’s Pole Appearance
 Single lobed
 Well developed caudal bursa
 Female worm has uterine tubules which are wound spirally around the
intestines
 Infective stage: 3rd Stage Larva
 MOT:
 Ingestion of raw mollusk
 Leafy vegetables
 Contaminated water
 Paratenic host

Filaria

1. Loa loa
 “Eye Worm”
 Causes Fugitive Swelling/Calabar Swelling
 MOT: bite of Chrysops Fly/Tabanid Fly
 Periodicity: diurnal
 Diagnosis:
 Identification of the adult worm
 Identification of the microfilaria

2. Onchocerca volvulus
 “Blinding worm”
 Causes Blinding filariasis or “River blindness”
 Habitat: Subcutaneous
 Diagnosis: Skin snips
 MOT: Bite of Simulium

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  Clinical manifestations:
 Onchocercal dermatitis
 Genital Elephantiasis
 Iridocyclitis: fibrosis and retraction of the iris, distortion of the pupils
 Periodicity: Non periodic

3. Wuchereria bancrofti
 Microfilaria appears “Snake like”
 Graceful appearance
 Nuclei does not reach the tail end
 Nuclei regular and spaced
 Vectors: Aedes, Culex, Anopheles
 Periodicity: Nocturnal

4. Brugia malayi
 With secondary kinks
 With 2 nuclei at the tip of the tail
 Nuclei irregular and overlapping
 Vector: Mansonia
 Periodicity: Subperiodic

Clinical Manifestations:
 Tropical Pulmonary Eosinophilia
 Elephantiasis
 Hydrocele/ Chylocele
 DLA- sign of active infection
*Expatriate Syndrome
*Endemic normal
Diagnosis:
 DEC Provocation Test: stimulate the microfilaria to come out to the
peripheral blood
 Detection of CFA
 Nucleopore filter
 Knott’s concentration technique
 Thick smear

Trematodes
 Cercarial Series
 Miracidium- emerges from the egg
 Sporocyst – saclike structure
 Redia
 Cercaria- seeks 2nd host
 Metacercaria – consumed by man
 Habitat:
Liver Lungs Small Intestines Pancreatic
Fasciola hepatica Paragonimus Fasciolospsis buski Eurytrema
westermani pancreaticum

Fasciola gigantica Echinostoma ilocanum

Blood

Clonorchis sinensis Heterophyes heterophyes Schistosoma

Opistrorchis felineus

Opistorchis viverrini

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1. Fasciola hepatica
 Temperate Liver Fluke
 1st IH – snail
 2nd IH – aquatic vegetation
 FH- Sheep
 Distinguished by the presence of a cephalic cone with marked widening at the base
(shoulders)

2. Fasciola gigantica
 Tropical liver fluke
 Less prominent cephalic cone
 Less developed shoulders
 FH: water Buffalo
 1st IH: snail
 2nd IH: Aquatic Vegetation

3. Chlonorchis sinensis
• Smallest egg among the trematodes
• Parasite inhabiting the bile ducts prove intense proliferation of the biliary
epithelium
• Associated with Carcinoma of the gallbladder, liver, cholangiocarcinoma
• 1st IH: snails
• 2nd IH: fish
• Eggs are characterized as:
 Old fashioned electric light bulb

4. Fasciolopsis buski
 Does not have a cephalic cone
 Eggs are unembryonated, indistinguishable from F. hepatica and F. gigantica
 1st IH: snail
 2nd IH: Aquatic vegetation
 Definitive hosts: Pigs and Man
 Clinical manifestations are traumatic, obstructive, and toxic
 Diagnosis: eggs in stool

5. Echinostoma ilocanum
 Characterized by a collar of spines around their oral suckers
 Oral sucker lies in the center of the circumoral disk
 1st IH: Snail
 2nd IH: Snail

6. Heterophyes heterophyes
 Has a 3rd sucker (genital sucker)
 Smallest fluke
 May present with PUD
 1st IH: Snail
 2nd IH: Fish

7. Eurytrema pancreaticum
• FH: Sheep, Goat, Pigs
• Accidental: Man
• 1st IH: Snail
• 2nd IH: Locusts, grasshoppers, praying mantis, ants
• MOT: accidental ingestion of locusts
• Diagnostic Stage: Eggs in stool
• Usually asymptomatic, may cause enlargement of the pancreatic duct

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8. Schistosoma japonicum
 “Swimmer’s Itch”
 “Cercarial Itch”
 Katayama Fever
 IH: Oncomelania hupensis quadrasi
 Main pathology:
 Due to the host granulomatous reaction to eggs deposited in the liver
 Most serious consequence of granuloma formation:
 Obstruction of the intrahepatic portal branches leading to portal
hypertension
 Accompanied by splenomegaly, ascites
 Colonic involvement
 Ulcerations caused by the eggs result in diarreha or dysentery
 Hepatosplenic disease
 Most serious consequence of chronic shistosomiasis
 Pulmonary involvement
 Occurs during larval migration
 Principal manifestation is cor pulmonale due to obstruction of pulmonary
vasculature
 Diagnosis:
 Falcon Assay Method
 Filter Paper Ninhydrin Method
 Faust Meleney Egg Hatching Method
 Rectal or liver biopsy
(Eggs are not demonstrable in the feces unless they are deposited in the
terminal vein or capillaries of the intestinal mucosa)
 COPT: demonstrates formation of bleb or septate precipitates

9. Schistosoma mansoni
 Manson’s blood fluke
 “Almond Shaped Eggs”
 Habitat: Mesenteric veins of colon and rectum
 Intermediate Hosts:
 Biomphalaria
 Tripicorbis

10. Schistosoma haematobium

 “Vesical Blood Fluke”
 Urinary Schistosomiasis
 Terminal hematuria
 Intermediate Hosts:
 Physospsis
 Bulinus
 Diagnosis:
 Eggs in urine (24 hour urine sample)

11. Paragonimus westermani

• Oriental Lung Fluke
• Lung fluke disease, Endemic hemoptysis
• Eggs remaining in the lungs may cause extensive granulomatous reaction
• Diagnosis: eggs in stool, sputum, or tissues
• Operculate, unembryonated
• Moderately thick, yellow brown shell
• Abopercular end is somewhat thickened

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Cestodes

1. Diphyllobothrium latum
 Broad or Fish Tapeworm
 Morphology:
 Scolex is spatulate with 2 bothria or sucking grooves
 Dark rosette like coiled uterus
 Eggs:
 Yellowish brown with an inconspicuous operculum opposite the operculum
is a knob like thickening
 Larval Stages
 Coracidium > Procercoid > Plerocercoid
 1 Intermediate Host: Copepods
st

 2nd Intermediate Host: Fish (perch, trout, salmon, pike)

 Mode of transmission: Ingestion of fish
 Infective stage: Plerocercoid Larva
 Diagnostic Stage: Egg
 Clinical Manifestations:
 B12 Deficiency (Megaloblastic Anemia)
 Obstruction
 Toxemia

2. Taenia saginata
 “Beef Tapeworm
 Cosmopolitan distribution
 Definitive host: Man
 Intermediate host: Cattle
 Habitat: Intestine
 MOT: ingestion of improperly cooked beef
 Eggs:
 Brownish, spherical ova with a thick embryophore (appears striated)
 Inside is an oncosphere with 3 pairs of hooklets
 Scolex: cuboidal (no hooks/rostellum)
 Length: 4-10m (25m)
 Number of Proglottids: 1000-4000
 Uterus: 15-20 lateral branches, “tree-like” dichotomous
 Larva: Cysticercus bovis

3. Taenia solium
 “Pork Tapeworm”
 Cosmopolitan in distribution
 Man may be definitive host and intermediate host
 Habitat: small intestine
 Mode of Transmission:
 Ingestion of Infected Meat
 Ingestion of Eggs
 Autoinfection

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  Clinical Manifestations:
 Intestinal Infection
 Cysticercosis (most commonly located in striated muscles and brain)
 Neurocysticercosis
 Most serious clinical manifestation
 Parenchymal or Extraparenchymal
 Convulsions: Most common manifestation
 Ophthalmic Cysticercosis

4. Dipylidium caninum
 Dog Tapeworm/ Double Pored Tapeworm
 Morphology:
 Rostellum is armed with 1-7 rows of rose thorn shaped hooklets
 2 sets of male and female reproductive organs
 Gravid proglottids resemble pumpkin seed
 Intermediate hosts:
 Ctenocephalides canis
 Ctenocephalides felis
 Pulex irritans
 Eggs:
 In capsules or pockets: 8-15 eggs
 Thin shelled with hexacanth embryo

5. Raillietina garrisoni
• Rostellum is armed with 2 alternating circular rows of 90-140 HAMMER SHAPED
HOOKS
• 200-400 egg capsules with 1-4 spindle shaped eggs
• Segments: appear like grain of salt
• IH: Flour Beetle

6. Hymenolepis nana
 “Dwarf Tapeworm”
 Smallest tapeworm
 Retractable rostellum armed with a single row of 20-30 Y shaped hooklets
 Final Host: Man
 Eggs: Oncosphere has thin outer and thick inner layer with conspicuous bipolar
thickenings
 4-8 hairlike polar filaments
 Lifecycle:
 Direct:
 Host ingests eggs > Cysticercoid Larva > Adult
 Indirect:
 Accidental ingestion (Arthropod Intermediate Host)
 Autoinfection
 Diagnosis: Eggs in stool (Proglottids are not recovered)

7. Hymenolepis diminuta
 “Rat Tapeworm”
 Final Host: Rat (man is accidental)
 Requires an intermediate host
 Unarmed rostellum
 Eggs:
 Oncosphere is more circular than H. nana
 Bipolar thickenings
 No bipolar filaments
 Fan-like arrangement
 Sunny side up
 Diagnosis: Eggs in Stool

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8. Echinococcus
 E. granulosus: Cystic echinococcosis
 Definitive host: Dogs
 Morphology:
 Shortest tapeworm (3-6mm)
 Pyriform scolex
 3 proglottids
 Eggs: Resembles Taenia eggs
 IH: Sheep, Man, Goat, Horses, Camels
 Definitive host: Dogs
 Infective stage: Hydatid Cyst
 Outer: Laminated layer
 Inner: Nucleated germinal layer
 Hydatid sand
 Liver: most common site of involvement (others: lungs, brain orbit)
 Rupture of cyst: Anaphylaxis
 Diagnosis:
 Imaging
 Casoni Intradermal Test
 Bentonite Flocculation Test
 Treatment:
 Surgical Resection (Treatment of choice)
 PAIR
 Scolicidal agents:
 95% ethanol
 Hibitane
 30% hypertonic saline

 E. multilocularis: Alveolar echinococcosis

 Definitive host: Foxes
 Intermediate host: Rodents
 Mode of Transmission:
 Ingestion of raw plants contaminated with feces
 Liver is the most common site of infection

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Coccidians

 Members of the class Sporozoea in the Phylum Apicomplexa

 Characterized by an alternation of generations
 Sexual: Sporogony
 Asexual: Schizogony

1. Toxoplasma gondii
 Definitive host: Cats
 Oocysts (containing 2 sporocysts) are passed in feces
 Extraintestinal stages:
 Tachyzoites: found during the initial and acute stage of infection, fast
multiplying
 Bradyzoites: slow multiplying, forms cysts
 Immunocompetent hosts:
 Asymptomatic
 Immunocompromised hosts:
 Encephalitis is the most common manifestation
 Stillbirth and abortion:
 May result when mothers acquire infection during the first trimester of
pregnancy
 MOT: consumption or handling of infected meat or from contact with cat feces
 Diagnosis: Sabin Feldman methylene blue dye test

2. Isospora belli
 Oocysts are immature when passed
 MOT: ingestion of oocyst containing 2 sporocysts
 Often cause asymptomatic infection
 Diagnosis:
 Direct microscopy
 Zinc sulfate/ sugar flotation,
 Acid fast stain:
 Kinyoun stain
 Auramine rhodamine stain

3. Cryptosporidium hominis
 Causes chronic diarrhea in immunocompromised host
 Bile duct and gall bladder may also be affected leading to acute gangrenous
cholecystitis
 MOT: ingestion of oocyst containing 4 sporozoites
 Water borne transmission is the most common source
 Diagnosis:
 Sheather’s Sugar Floatation
 Kinyoun Acid Fast Method:
 Appears as red pink doughnut shaped circular organisms in a blue
background

4. Cyclospora cayetanensis
 Originally called Cyanobacterium Like Body (CLB)
 Oocysts:
 Unsporulated when passed
 Autofluorescent and appear as blue or green circles under fluorescence
microscopy
 Causes self-limiting chronic and intermittent watery diarrhea
 Diagnosis:
 DFS under high power magnification
 Acid Fast Staining Safranin staining
 Microwave heating

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Hemoflagellates

Trypanosoma

1. Trypanosoma brucei gambiense

 West African Sleeping Sickness
 Transmitted by:
 Glossina (Tsetse flies)
2. Trypanosoma brucei rhodesiense
 East African Sleeping Sickness
3. Trypanosoma cruzi
 American Trypanosomiasis
 Chaga’s disease
 Exhibits all 4 stages of development
 Amastigote stage:
 Observed in cardiac muscle and other tissues
 Intermediate host:
 Reduviid bug (genus Triatoma, Rhodnius, Panstrongylus)
 Chagoma (At the point of inoculation)
 Acute:
 Fever and Generalized Lymphadenopathy
 Romana’s Sign:
 Edema of the eyelid and conjunctiva
 Chronic:
 Cardiomyopathy
 Megaesophagus
 Megacolon

Leishmania
 Transmitted by Phlebotomus spp. (sandfly)
 Amastigote form observed in man
 Promastigote form in the gut of sandflies

1. Leishmania tropica
 Old World Leishmaniasis
 Cutaneous Leishmaniasis
 Oriental sore

2. Leishmania mexicana
 New World Leishmaniasis
 Cutaneous Leishmaniasis

3. Leishmania braziliensis
 Mucocutaneous leishmaniasis
 Espundia
 Uta
 Bubas

4. Leishmania donovani
 Kala Azar or Visceral Leishmaniasis
 Affects the reticuloendothelial system

“ Shoot for the moon because even if you miss, you will land among the stars.”

For corrections or questions, you may contact me at jbborbe.rmt@gmail.com Thanks!

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