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Symbiosis Living together of unlike organisms

Commensalism 2 species live together
One species benefits from the relationship w/o harming or benefiting the other
Ex. Entamoeba coli
Mutualism 2 organisms benefit from each other
Ex. Termites and the flagellates inside their digestive system
Parasitism 1 organism lives in or on another for its survival at the expense of the host
Ex. Entamoeba histolytica
Endoparasite Lives inside the body of the host
Ectoparasite Lives outside the body of the host
Erratic Parasite found in an organ w/c is not its usual habitat
Obligate parasite Need a host to complete their development
Facultative parasite May exist in a free-living state
May become parasitic when the need arises
Accidental/incidental parasite Parasite that established itself in a host where it does not ordinarily live
Ex. Echinococcus granulosus
Permanent parasite Remains on or in the body of the host for its entire life
Temporary parasite Lives on the host only for a short period of time
Spurious parasite Free-living organism
Passes through the digestive tract w/o infecting the host
Definitive/final host Parasite attains sexual maturity
Intermediate host Harbors the asexual/larval stage of the parasite
Paratenic host One in which the parasite does not develop further to later stages
Parasite remains alive and is able to infect another host
Reservoir host Allows the parasite’s life cycle to continue and become additional sources of infection
Biologic vector Transmits the parasite only after the the latter has completed its development within the
Ex. Aedes mosquito
Mechanical/phoretic vector Only transports the parasites
Ex. Flies and cockroach
Epidemiology Study of patterns, distribution and occurrence of disease
Incidence Number of new cases of infection in a given period of time
Prevalence (%) Number of individuals estimated to be infected w/ a particular parasite
Cumulative prevalence % of individuals in a population infected w/ at least 1 parasite
Intensity of infection Number of worms per infected person
(Worm burden)
Morbidity Clinical consequences of infections or diseases that affect an individual’s well-being
Deworming Use of antihelminthic drugs in an individual
Cure rate (%) Number of previously positive subjects found to be egg-negative
Egg reduction rate % fall in egg counts after deworming
Selective treatment Individual-level deworming
Targeted treatment Group-level deworming
Universal treatment Population-level deworming
Coverage Proportion of the target population reached by an intervention
Efficacy Effect of a drug against an infective agent
Effectiveness Measure of the effect of a drug against an infective agent

Information-education- A health education strategy that aims to encourage people to adapt and maintain healthy
communication life practices
Environmental management Planning, organization, performance, and monitoring of activities for the modification
and/or manipulation of environmental factors
Environmental sanitation Interventions to reduce environmental health risks
Sanitation Provision of access to adequate facilities for the safe disposal of human excreta
Eradication Permanent reduction to zero of the incidence of infection caused by a specific agent, as
a result of deliberate efforts
Elimination Reduction to zero of the incidence of a specified disease in a defined geographic area as
a result of deliberate efforts
Protozoan Unicellular organism
Metazoan Multicellular organism
Classification of Protozoan Parasites
Sarcodina Acanthamoeba
Mastigophora Chilomastix
Ciliophora Balantidium
Apicomplexa Babesia
Microspora Enterocytozoon
Classification of Metazoan Parasites
Intestinal Ascaris
Extraintestinal Angiostrongylus
Filarial worms

Cyclophyllidea Dipylidium
Pseudophyllidea Diphyllobothrium
Trematoda Artyfechinostomum
Arachnida Mites
Chilopoda Centipedes
Crustacea Copepods
Diplopoda Millipedes
Insecta Flies

Pentastomida Tongue worms

Common/Other Names
Ascaris lumbricoides Giant intestinal roundworm
Lumbricus teres
Enterobius vermicularis Pinworm
Oxyuris vermicularis
Social or Society worm
Trichuris trichiura Whipworm
Capillaria philippinensis Pudoc worm
Necator americanus American hookworm
American murderer
New world hookworm
Ancylostoma duodenale Old world hookworm
Ancylostoma braziliense Cat hookworm
Ancylostoma caninum Dog hookworm
Strongyloides stercoralis Threadworm

Trichinella spiralis Muscle worm

Garbage worm
Wuchereria bancrofti Bancroft’s filarial worm
Brugia malayi Malayan filarial worm
Loa loa Eye worm
Onchocerca volvulus Blinding worm
Dirofilaria immitis Dog/canine heartworm
Dracunculus medinensis Guinea worm
Fiery serpent of the Israelites
Medina worm
Dragon worm
Anisakis Fish and Marine mammal roundworm
Herring’s worm
Toxocara canis Dog ascarid
Toxocara cati Cat ascarid
Fasciola hepatica Sheep liver fluke
Fasciola gigantica Giant liver fluke
Clonorchis sinensis Oriental liver fluke
Chinese liver fluke
Fasciolopsis buski Giant intestinal fluke
Echinostoma ilocanum Garrison’s fluke
Heterophyes heterophyes Von Siebold’s fluke
Paragonimus westermani Oriental lung fluke
Schistosoma japonicum Oriental blood fluke
Schistosoma mansoni Profile of a man
Schistosoma haematobium Bladder fluke
Taenia saginata Beef tapeworm
Taenia solium Pork tapeworm
Hymenolepis nana Dwarf tapeworm
Hymenolepis diminuta Rat tapeworm (Norway rats)
Dipylidium caninum Dog tapeworm
Double-pored tapeworm
Diphyllobothrium latum Broadfish tapeworm
Echinococcus granulosus Hydatid worm
Infective Stages
Cyst Protozoans (amoebas)
Trophozoite T. vaginalis
Sporozoites Plasmodium
Trypomastigote Trypanosoma
Promastigote Leishmania
Embryonated egg “HATE”
H. nana
A. lumbricoides
T. trichiura
E. vermicularis
Larva T. spiralis
C. philippinensis
Filariform larva Hookworm
S. stercoralis
3rd stage larva (filiform) W. bancrofti
B. malayi
A. cantonensis
L. loa
O. volvulus
Cercaria S. japonicum
S. haematobium
S. mansoni
Metacercaria F. hepatica
F. buski
C. sinensis
O. felineus
P. westermani
E. ilocanum
Cysticercus bovis T. saginata
Cysticercus cellulosae T. solium
Plerocercoid larva D. latum
Hydatid cyst E. granulosus
Cysticercoid larva H. diminuta
D. caninum

Nematodes (Roundworms)
Separate sexes Female = larger, pointed tail
Male = smaller, curved tail
Life cycle Egg stage > Larval stage > Adult stage
Aphasmids Lacks phasmids or caudal chemoreceptors
“TCT”: Trichuris-Capillaria-Trichinella
Phasmids w/ caudal chemoreceptors
S. stercoralis
W. bancrofti
B. malayi
Amphid Cephalic chemoreceptors
Oviparous Lays eggs in unsegmented stage (unembryonated)
Ovoviviparous/oviviparous Lays eggs in segmented stage (embryonated)
Viviparous/larviparous Larva
Frequency “EAT”: Enterobius > Ascaris > Trichuris
Small intestines “CASH”: Capillaria, Ascaris, Strongyloides, Hookworms
Large intestines “ET”: Enterobius, Trichuris
Heart-to-lung migration “ASH”: Ascaris, Strongyloides, Hookworm
Extraintestinal Nematodes Filarial worms = lymphatics and subcutaneous tissues
T. spiralis = muscles
A. cantonensis = meninges
Visceral Larva Migrans T. canis and T. cati
Triad of infection/Unholy 3 “HAT”: Hookworm, Ascaris, Trichuris
Ascaris lumbricoides
Characteristics Resembles common earthworm
Fertilized Egg 3 layers:
-Inner: Vitelline membrane
-Middle: Glycogen layer
-Outer: Mammilation (corticated)

Unfertilized Egg 2 layers:

-Inner: Glycogen
-Outer: Mammilation
Has lecithin granules

Adult Buccal cavity: Triangular, trilobate lips

MOT Ingestion
Symptoms and Pathology Larval migration: Eosinophilia (resembles Loeffler’s syndrome)
Adult: Erratic à Extraintestinal sites
Intestinal perforation
Lab. Diagnosis 1. Stool exam
= Egg: Diagnostic stage
= If (-) stool exam:
a. No infection
b. Early infection
c. All MALE WORM infection
Enterobius vermicularis
Characteristics Autoinfection: Same host (EV, SS)
External autoinfection
Egg Elongated, flattened on 1 side
Adult w/ lateral wings or cephalic alae
MOT Ingestion
Symptoms and Pathology Mother’s complex:
-Pruritus ani
-Lack of sleep
-Extraintestinal enterobiasis
Lab. Diagnosis 1. Perianal swab: Scotch tape swab
= Egg: Diagnostic stage
Trichuris trichiura
Characteristics Causes trichocephaliasis
Egg Barrel-shaped w/ bipolar mucus plug
Resembles Japanese lantern
Adult Slender or attenuated in the anterior
Resembles a whip
MOT Ingestion
Symptoms and Pathology Rectal prolapse (Heavy infection)
Lab. Diagnosis 1. Stool exam
= Egg: Diagnostic stage
Capillaria philippinensis
Characteristics Causes pudoc disease or mystery disease
Egg w/ bipolar mucus plugs that are not as protruded as T. trichiura egg
Guitar, peanut-shaped
Adult Male: w/ chitinized spicule (spicule sheath)
Female: have eggs in utero
MOT Ingestion of freshwater fishes
IH Fresh water fishes:
-Hypselotris bipartite (ipon)
Symptoms and Pathology Malabsorption (CP, GL)
Borborygmi = peculiar abdominal gurgling sound
LBM alternating w/ constipation
Lab. Diagnosis 1. Stool exam
= Egg: Diagnostic stage
Hookworms (Necator, Ancylostoma)
Characteristics Agent of laziness in poor white population and tropical anemia in Puerto Rico
Egg Same for all species
Ovoidal, thin-shelled, colorless
“Morula ball”
Adult N. americanus: S-shaped, w/ semilunar cutting plates
A. duodenale: C-shaped, w/ 2 pairs of teeth
Male copulatory bursa:
-Bipartite (2 digits): Barbed & bristle like
-Tripartite (3 digits): Simple & not barbed
Rhabditiform larva 1st stage larva
Short and stout
Open mouth: feeding stage
Buccal cavity: long
Genital primordium: small or inconspicuous
Filariform larva 2nd stage larva
Long and slender
Closed mouth: nonfeeding stage
Sheath: (+)
Tail: Pointed

MOT Skin penetration

Symptoms and Pathology Mazza Mora/Water sore or ground itch
Severe itching/allergic reaction at the site of skin penetration
Cutaneous larva migrans (Creeping eruption): A. braziliense and A. caninum (animal
Lab. Diagnosis 1. Stool exam
= Egg: Diagnostic stage
2. Harada Mori Culture technique
= Filter paper culture technique
= For hookworm and threadworm larvae
3. Baermann funnel technique (Strongyloides)
Strongyloides stercoralis
Characteristics Causes Cochin-China diarrhea
Facultative nematode:
-Parasitic: small intestine
-Free-living: soil
Adult Female: capable of parthenogenesis (fertilization w/o the benefit of male)
Rhabditiform larva Buccal cavity: short
Genital primordium: prominent or conspicuous
Filariform larva Sheath: (-)
Tail: Notched
MOT Skin penetration
Symptoms and pathology Skin: Allergic reaction
Larval migration: pneumonia
Intestines: abdominal pain, diarrhea, vomiting
Trichinella spiralis
Characteristics Adult: in intestines
Larva: in muscles
Requires 2 host to complete its life cycle
Propagated by black and brown rats
Man: both DH and IH, dead-end host
Freezing destroys the larva
Adult Male: w/ conical papillae
Female: w/ club-shaped uterus (viviparous/larviparous)
MOT Ingestion of meat
Symptoms and pathology Larva: muscle
-Edema, muscle pain, difficulty in breathing and swallowing
Adult: intestines
-Abdominal pain, diarrhea
Lab. Diagnosis 1. Muscle biopsy
= Encysted larva: Diagnostic stage
2. Immuno-tests:
a. Bentonite flocculation (TS, EG)
b. Intradermal test (Bachmann)
3. Xenodiagnostic tests (TS, TC)
= Beck’s albino rats/mice
Filarial Worms
Characteristics Vector-borne nematodes
DH: man (IS: filiform larva/3rd stage larva)
IH: vector (IS: microfilaria)
DS: Microfilaria
Adults In lymphatics and subcutaneous tissue
Microfilaria In blood
Lab. Diagnosis 1. Knott’s technique
= Isolation of microfilaria
= Blood + formalin + Giemsa stain
Wuchereria bancrofti
Habitat Lymphatics
Vector Aedes
Specimen Blood
Microfilaria Sheathed
Nuclei absent in tail
Periodicity Nocturnal (10PM-2AM)

Brugia malayi
Habitat Lymphatics
Vector Mansonia
Specimen Blood
Microfilaria Sheathed
Tail w/ 2 separate nuclei
Periodicity Subperiodic
Loa loa
Habitat Subcutaneous tissue
Vector Chrysops
Tabanid (mango fly)
Specimen Blood
Microfilaria Sheathed
Nuclei continuous up to the tip of the tail
Periodicity Diurnal
Onchocerca volvulus
Habitat Subcutaneous tissue
Vector Simulium (black fly)
Specimen Skin snips/shavings
Microfilaria Unsheathed
Nuclei absent in tail
Periodicity Nonperiodic
Dipetaloma perstans (Acanthoculonema perstans)
Habitat Body cavities
Vector Culicoides
Specimen Blood
Microfilaria Unsheathed
Nuclei up to the tip of the tail
Periodicity Nonperiodic
Mansonella ozzardi
Habitat Body cavities
Vector Culicoides
Specimen Blood
Microfilaria Unsheathed
Tail is free of nuclei
Periodicity Nonperiodic
Dirofilaria immitis
Characteristics Human infection: solitary, peripheral nodules in the lung (coin lesions), or as subcutaneous
Dracunculus medinensis
Characteristics Longest nematode of man
IH Cyclops (copepods): aquatic crustacean
DH Man
MOT Ingestion of crustacean
Angiostrongylus cantonensis
Characteristics Causes human eosinophilic meningoencephalitis
IH Mollusks:
-Achatina fulica
-Japanese snail
-Pila luzonica (kuhol)
-Brotia asperata (suso)
DH Rats
Adult Female: “Barber’s pole appearance”
Looking of whitish uterus to red digestrive tract
Characteristics Causes Herring’s disease
1st IH Various marine crustaceans
2nd IH Smallest fishes
3rd IH Larger fishes
DH Dolphins/whales
MOT Ingestion of raw fish (ex. sashimi)

Phylum Platyhelminthes
Class Trematoda (Flukes)
Characteristics All except blood flukes [Schistosomes] Schistosomes:
1. Flat, leaf like 1. Elongated and cylindrical
2. Hermaphrodite 2. Separate sexes
3. Egg: operculated 3. Egg: Non-operculated
4. MOT: ingestion 4. MOT: skin penetration
5. IS: metacercaria 5. IS: Cercaria (fork-tailed)
6. IH: 2 IH 6. IH: 1 IH (snail)
a. Mature when laid (embryonated): “SHOC”
b. Immature when laid (unembryonated): “PEFF”
Attachment 2 suckers: oral and ventral (acetabulum)
-Heterophyes: 3 suckers (3rd: genital sucker [gonotyle])
Life cycle Egg > Larva (Miracidium>Sporocyst>Redia>Cercaria>Metacercaria) > Adult
1st IH Snail
2nd IH Fish, crab, plant/vegetation, snail
Fish Schistosoma
H. heterophyes
O. felineus
C. sinensis
Crab P. westermani
Plant/vegetation F. hepatica
F. gigantica
F. buski
Snail E. ilocanum
Habitat Liver:
-F. hepatica
-F. gigantica
-C. sinensis
-O. felineus
Small Intestines:
-F. buski
-E. ilocanum
-H. heterophyes
-P. westermani
Fasciola hepatica
Characteristics Causes sheep liver rot
Prevalent in sheep raising countries
Egg Resembles F. gigantica and F. buski
Adult w/ cephalic cone
Leaf-like hermaphrodite
Fasciola gigantica
Characteristics Infects cattle in the Philippines
Egg Resembles F. hepatica and F. buski
Clonorchis sinensis
Characteristics Most important liver fluke of man
Egg Old-fashioned electric light bulb
1st IH Snail
2nd IH Fishes
MOT Ingestion
Opisthorcis felineus
Characteristics Resembles C. sinensis
Fasciolopsis buski
Characteristics Largest fluke parasitizing man
Egg Hen’s egg shaped
Indistinguishable from Fasciola
Echinostoma ilocanum
1st and 2nd IH Snail
Heterophyes heterophyes
Characteristics Smallest but deadliest fluke of man
Adult w/ 3rd sucker (gonotyle)
1 IH Snail
2nd IH Fishes
MOT Ingestion
Paragonimus westermani
Characteristics Causes endemic hemoptysis
Egg w/ thickened abopercular end opposite the operculum
Adult Resembles coffee bean
1st IH Snail
2nd IH Crabs
MOT Ingestion
Lab. Diagnosis 1. Examination: sputum and stool
Characteristics Most romantic parasite of man
Adult Male: w/ gynecophoral canal where the female is held
Lab. Diagnosis 1. Demonstration of egg in feces, rectal or liver biopsies, and urine
2. Faust and Meleney’s egg hatching technique
3. Circumoval precipitin test (COP) of Oliver and Gonzales
Pathology Larval penetration
-Human sp: slight allergic reaction
-Nonhuman sp: Swimmer’s itch
Tissue damage by eggs
Schistosoma japonicum
Characteristics Causes Katayama’s disease
Habitat Superior mesenteric veins in the small intestines
Egg w/ small knob-like or recurved hook on one side
IH Oncomelania quadrasi
Schistosoma mansoni
Characteristics Smallest of the blood flukes
Habitat Superior mesenteric veins of the colon and rectum
Egg w/ lateral spine
IH Biomphalaria
Schistosoma haematobium
Characteristics Vesical blood fluke causing bilharziasis or urinary schistosomiasis (hematuria)
Egg w/ terminal spine
IH Bulinus
Specimen 24-hr unpreserved urine

Phylum Platyhelminthes
Class Trematoda
Characteristics Living worms: creamy white and yellowish
Adult: flat and ribbon-like (masking tape)
1 IH only
Cestode body Scolex = anterior attachment organ
Neck = region of growth
Strobila = chains of segments or proglottids
-Immature, mature, ripe/gravid (filled w/ eggs)
Order Pseudophyllidea False tapeworm (Ex. D. latum)
Scolex: Spoon-shaped w/ bothria (slit-like sucking grooves), no hooklets

Strobila: Anapolytic (not shedding segments)

Egg: operculated w/ aboperculum, immature when laid
Stages: Coracidium > Procercoid > Plerocercoid
IH: 2 IH (Copepods and fresh water fish)
Order Cyclophyllidea True tapeworm
Scolex: Quadrate, w/ 4 cuplike suckers (rostellum w/ or w/o hooklets)
Strobila: Apolytic (shedding segments)
Egg: non-operculated, embryonated (mature when laid), hexacanth embryo
IH: 1 IH
Require vertebrate IH T. solium (IH: pig)
T. saginata (IH: cattle)
Require invertebrate IH D. caninum (MOT: ingestion of “pulgas”)
May or may not require IH H. nana
Diphyllobothrium latum
Characteristics Largest tapeworm of man
Causes Vit. B12 deficiency anemia
Uterus Rosette formation
Lab. Diagnosis 1. Stool examination
= Egg: Diagnostic stage
Taenia saginata Taenia solium
Scolex None, no rostellar hooks w/ rostellum armed w/ 2 rows of large and
small hooklets
Length 25 m 7m
# of proglottids 1000-2000 <1000
Gravid proglottid 15-20 lateral branches 7-13 lateral branches
(dichotomous or tree-like) (dendritic or fingerlike)
Eggs Spherical, striated, inside is an embryo w/ 6 Spherical, striated, inside is an embryo w/ 6
hooklets hooklets
Larva Cysticercus bovis Cysticercus cellulosae
Pathogenesis Taeniasis saginata Taeniasis solium, cysticercosis
Hymenolepis nana Hymenolepis diminuta
Characteristics Smallest tapeworm of man
Scolex w/ rostellum armed w/ a ring of 20-30 spines w/ an unarmed rostellum
Eggs w/ oncosphere enclosed in an inner w/ oncosphere enclosed in an inner
membrane w/ 2 polar thickenings, from each membrane w/ 2 polar thickenings, but w/o
w/c arise 4-8 polar filaments filaments
IS Direct: Eggs Cysticercoid larva
Indirect: Cysticercoid larva
DH Man Rat
Dipylidium caninum
Proglottids w/ double set of reproductive organs and genital pore on each side of the lateral margin
Mature & gravid proglottids: melon seed/pumpkin seed/rice grain-shaped
Eggs Egg packet (8-15 eggs)
IH Ctenocephalides canis (dog flea)
Ctenocephalides felis (cat flea)
Pulex irritans (human flea)
DH Dogs or cats
Man: accidental host
Echinococcus granulosus
Characteristics Shortest tapeworm (only 3 segments: immature, mature, ripe/gravid)
Eggs Resembles Taenia egg
IH Sheep (IS: eggs)
Man: accidental IH
DH Dog
Lab. Diagnosis 1. Exploratory cyst puncture
2. Roentgenogram (x-ray)
3. Immunologic tests:
= Bentonite flocculation test (TS, EG)
= Casoni (intradermal test)

Characteristics Unicellular
Animal-like protists
Division: Fission

No cell wall w/ outer membrane (periplast)

Cytoplasm: ectoplasm (outer) and endoplasm (inner)
Contains at least 1, and some several nuclei
Some contain vacuoles: for storage and transport
Hemotogranules Special organs for locomotion
-Sarcodina/Rhizopoda = Amoeba (pseudopods)
-Sporozoa = no definite locomotory organelle
Class Rhizopoda
Trophozoites Motile
Feeding stage
Diarrheic/liquid stool
Destroyed by iodine
Cyst Non-motile
Nonfeeding stage
Well-formed stool
Infective stage
Characteristics w/ cystic stage except Entamoeba gingivalis
Inhabit the large intestine except Entamoeba gingivalis
Commensals except Entamoeba histolytica
Life cycle Trophozoite > Precystic > Cystic > Metacystic stage
Entamoeba True amoeba
Peripheral chromatin (trophozoite and cyst)
Chromatoidal bars (cyst)
Endolimax/Iodamoeba Other amoeba
No peripheral chromatin
No chromatoid bars
Entamoeba histolytica Entamoeba coli
Trophozoite -Motility: Unidirectional & progressive -Motility: several directions, sluggish
-1 pseudopod (finger-like) -Many pseudopods (blunt & rounded)
-Endoplasm: w/ RBC but no bacteria or cell -Endoplasm: w/ bacteria, yeasts and cell
detritus (clean-looking) detritus (dirty-looking)
-Nucleus: not visible when stained; consists -Nucleus: when stained, consists of thicker
of thin nuclear membrane w/ layer of nuclear membrane w/ layer of variously sized
uniformly sized fine chromatin granules chromatin granules unevenly distributed
distributed along inside the border of nuclear along the inside border of nuclear membrane
memb. -Karyosome: large, eccentrically located
-Karyosome: fine, centrally located (Bull’s
Cyst -Chromatoidal bars: coffin/rod/cigar/ -Chromatoidal bars: splinter-like/ witch-
sausage-shaped broom/whisked broom
-Mature cyst w/ 1-4 nuclei -Mature cyst w/ 1-8 nuclei
Endolimax nana Smallest amoeba
Size = RBC
-Karyosome: large round dot
-Usually oval
-Nuclei: 4 (cross-eyed)
Iodamoeba butschlii [Trophozoite]
Iodamoeba williamsi -Karyosome: w/ cluster of achromatic granules
-Large iodine-staining glycogen vacuole
Entamoeba gingivalis Associated w/ gum infection
Karyosome: small and centrally located
Pseudopodia: similar to E. histolytica but does not exhibit true progressive locomotion
Opportunistic Amoeba
Characteristics Free-living amoeba
Inhabits the CNS
Does not indicate fecal contamination
Cause PAM (fatal)
Includes: Naegleria, Acanthamoeba, Hartmanella

Naegleria fowleri Major causative agent of PAM

Amoeboflagellate (trophozoite)
Acquired while diving & swimming during hot weather in brackish/freshwater
CSF: purulent, w/ motile amoeba
Acanthamoeba Causes keratitis (from contaminated contact lens care solution)
Causes GAE
Culture: BAP flooded w/ E. coli
Class Mastigophora (Flagellata)
Characteristics Possesses whip-like locomotory organelle called flagella
Motor component: flagella and axonemes
Neuromotor apparatus: kinetoplast w/c consists of blepharoplast and parabasal body
(energizing portion)
Digestive tract & Enteromonas hominis
Genital flagellates Embadomonas intestinalis
Chilomastix mesnili
Giardia lamlia
Trichomonas hominis
Trichomonas tenax
Trichomonas vaginalis
Blood and Tissue flagellates Leishmania tropica
Leishmania braziliensis
Leishmania donovani
Trypanosoma rhodesiense
Trypanosoma gambiense
Trypanosoma cruzi
Embadomonas intestinalis [Trophozoite]
-Cleftlike cytostome
Chilomastix mesnili [Trophozoite]
-Spiral groove curving across the body
-Spiral boring, jerky movement
-3 anterior flagella and 1 w/in the cytostome
-Lemon to oval-shaped
-Protrusion at end
-Nipple-like cyst
Giardia lamblia/ Associated w/ Gay bowel syndrome
Lamblia intestinalis [Trophozoite]
-Bilaterally symmetrical
-2 nuclei, each w/ a large karyosome, lying w/in the sucking disk
-Falling leaf motility
-Old man’s face/old man w/ eyeglasses
-2-4 nuclei
Characteristics Trophozoite stage only
4-5 flagella
Jerky motility
Undulating membrane: aids in locomotion
Costa: thickening of membrane
Trichomonas tenax
Habitat Oral cavity
Size Smallest
Nucleus Rounded
Undulating membrane 2/3 of the costa
Inclusion bodies None
Specimen Oral scrapings
Trichomonas hominis
Habitat Intestine
Size Medium
Nucleus Ovoidal
Undulating membrane As long as the costa
Inclusion bodies None
Specimen Stool
Trichomonas vaginalis
Habitat Genitalia
Size Largest
Nucleus Ovoidal

Undulating membrane < ½ of the costa

Inclusion bodies Siderophil granules
Specimen Urine
Vaginal swab/discharge (female)
Prostatic secretion (male)
Characteristics Causes Pingpong’s disease
Male: carrier
-Asymptomatic chronic urethritis
-Epididymis, prostate & urethra
-Burning sensation
-Strawberry cervix
Lab. Diagnosis 1. Modified Diamond medium
2. Feinberg-Whittington medium
Characteristics Include the trypanosomes and leishmanias
May infect the blood, lymph nodes, muscles and RES
Amastigote Leishman-Donovan body
Leishmanial form
Promastigote Leptomonal form
Anterior to nucleus
Epimastigote Crithidial form
Near nucleus
Trypomastigote Trypanosomal form
Posterior to nucleus
Leishmania tropica
Agent of Old world cutaneous leishmaniasis
Oriental sore
Aleppo button
Baghdad or Jericho boil
Dry lesions
Habitat Endothelial cells
Vector Phlebotomus
Pathology Localized cutaneous infection (macule à papule)
Leishmania braziliensis
Agent of American mucocutaneous leishmaniasis
Habitat Mucocutaneous junctions (nasal septum, mouth, pharynx)
Vector Phlebotomus
Pathology Wheeping lesions
Lab. Diagnosis 1. Dr. Montenegro’s (skin test)
Leishmania donovani
Agent of Visceral leishmaniasis
Kala-azar (black fever)
Dum-dum fever
Habitat Endothelial cells of RES
Vector Phlebotomus
Pathology Splenomegaly
Severe anemia
Lab. Diagnosis 1. Culture:
= NNN: Novy-McNeal-Nichole medium (culture for Leishmania & Trypanosoma)
Trypanosoma rhodesiense & Trypanosoma gambiense
Agent of African sleeping sickness
-East Africa: T. rhodesiense
-West Africa: T. gambiense
Vector Glossina (tsetse fly)
Habitat Febrile: blood, lymph node
Sleeping sickness: CSF
Winterbottom sign Inflammation/swelling of lymph nodes
Lab. Diagnosis 1. Febrile stage: blood, lymph node aspirate
2. Sleeping sickness stage: CSF
Trypanosoma cruzi
Agent of American trypanosomiasis
Chagas’ disease
Vectors Triatomid bugs
Kissing bugs
Reduviid bugs
Assasin bugs
Cone nose bugs
Triatoma rubrofasciata = Philippines
Habitat RES, cardiac muscle, CNS
Characteristics C-shaped
Romaña’s sign Unilateral swelling of eye lids
Lab. Diagnosis 1. Chang’s medium
2. Xenodiagnostic test (TS, TC)
Balantidium coli The only significant ciliate
Host: Pigs
Largest parasitic protozoan
MOT: ingestion of cysts (from swine feces)
S/S: Dysentery
-Macronucleus: kidney-shaped, vegetative
-Micronucleus: dot-like, reproductive
-Cilia, oral cytostome (mouth)
-Refractive double wall enclosing cilia
Characteristics Obligate intracellular
No apparent means of locomotion
Life cycle Sexual (sporogony) = DH (arthropod vector)
Asexual (schizogony) = IH (man)
Characteristics Cause of malaria (“bad air”)
IS IH (man): Sporozoites
DH (mosquito): Gametocytes
Asexual Life cycle Female Anopheles ---(sporozoites)---> Man ---> Liver (Exoerythrocytic cycle)----
--->Infected cells (liver) will rupture & release merozoites --> Erythrocytic cycle
Erythrocytic cycle:
1. Merozoites (RBC) ---> Trophozoites ---> Schizont ---> Release merozoites
2. Merozoites ---> Microgametocytes (Male)/Macrogametocytes (Female)
3. Merozoites ---> Destroyed by immune system
Sexual Life cycle Macrogametocytes & Microgametocytes ---> Anopheles mosquito
Anopheles ---> Macro- + Microgametocytes = Zygote (ookinete)
Ookinete ---> Oocysts (contains sporozoites) --->Matured: release sporozoites
Sporozoites ---(Female Anopheles)---> Man
Symptoms and Pathology 1. Recurrent chills and fever
-every 36 hours: malignant tertian malaria = P. falciparum
-every 48 hours: ovale malaria = P. ovale
-every 48 hours: benign tertian malaria = P. vivax
-every 72 hours: quartan malaria = P. malariae
2. Anemia (RBC destruction), splenomegaly, joint pain
3. P. falciparum: fatal
-Cerebral malaria: RBC, organisms and pigment block brain vessels
-Blackwater fever: intravascular hemolysis + hemoglobinuria
Resistant to malaria G-6-PD deficiency
Fy (a-b-)
Sickle cell disease
Hypnozoites Dormant stage
Found in the liver
Once activated, releases merozoites
Responsible for relapse (P. vivax, P. ovale)
Mixed infection P. vivax & P. falciparum
Lab. Diagnosis 1. Examination of blood film
a. Thick blood film = Screening purposes
-Dehemoglobinize RBCs
-Stain w/ Giemsa
b. Thin blood film = Identification of species
-Fix w/ methanol
-Stain w/ Giemsa
2. QBC: Quantitative buffy coat
-Fluorochrome: Acridine orange
3. Immunotests
a. Optimal assay
-Detects pLDH (parasitic LDH) = malarial organism
b. Malaquick test
-Detects HRP-2 or HRP II Ag (P. falciparum)
Plasmodium vivax
Characteristics Prevalent worldwide
Single large ring succeeded by amoeboid form in pale large red cell
Schuffner’s dots (condensed Hgb)
Relapse: Hypnozoites
Infects reticulocytes only
Infected RBCs: enlarged
# of Merozoites Usually 16
Trophozoite Amoeboid
Gametocyte Round
Plasmodium malariae
Characteristics Single large compact ring or band forms
Invades old RBCs
Ziemann’s dots
Schizont arranged around central pigment (rosette/daisy head/fruit pie arrangement)
# of Merozoites 8
Trophozoite Band
Gametocyte Ovoid
Plasmodium falciparum
Characteristics Prevalent in the Philippines
Ring forms: small (1/6 diameter red cell), appliqué forms/marginal/accole
formation/double chromatin dots
Maurer’s dots (Stephen Christopher/Cuneiform dots)
Multiple parasitization of red cells
Infects all age of red cells
# of Merozoites 24-32
Trophozoite Ring
Gametocytes Crescent/sausage/banana-shaped
Plasmodium ovale
Characteristics Single compact ring
Schuffner’s dots/James’ dots
Relapse: Hypnozoites
Infected RBCs: serrated/fimbriated
# of Merozoites 8-9
Babesia microti
Characteristics “Maltese-cross” formation
Resembles P. falciparum rings
-No malarial pigment
-No growing trophozoite
DH Deer
MOT Ixodes tick bite
Blood transfusion
Symptoms and pathology Headache & fever
Hemolytic anemia + hemoglobinuria
Babesia bigemia
Characteristics Causes “red water fever” in cattles
Characteristics Schizogony (asexual) = nucleated cells
Sporogony (sexual) = intestinal mucosa of DH
Infective stage Oocyst (feces)
Isospora belli IH: cattles, pigs
DH: man
MOT: sporulated oocyst in contaminated food and water
-Diarrhea, flatulence
-Acalculous cholecystitis
Cryptosporidium C. parvum: bovines
(C. parvum/C. hominis) C. hominis: man
-Watery, frothy diarrhea among immunosuppressed patients
-Acute and gangrenous cholecystitis
Lab. Diagnosis:
1. Sheather sugar flotation
2. Stool examination
3. Modified acid fast stain (CIC)
Cyclospora cayetanensis Originally called a cyanobacterium-like body (CLB)
Causes chronic and intermittent watery diarrhea
Sarchocystis Zoite: simplest form (banana-shaped)
(S. hominis/S. suihominis) Diseases:
-Gastroenteritis w/ diarrhea
-Eosinophilic enteritis
-Myalgia (mild increase in CK)
Toxoplasma gondii
Characteristics Common cause of congenital infection
DH Cat
-Oocyst in cat feces may infect man
IH Man
-Bradyzoite = inactive form
-Tachyzoite = actively dividing
Lab. Diagnosis 1. Sabin-Feldman dye test
-Methylene blue staining of tachyzoites is inhibited by prior addition of patient serum
containing antibodies to Toxoplasma
Other Intestinal Protozoans
Blastocystis hominis Vacuolated form (most predominant):
-A large central vacuole pushes the cytoplasm and nuclei to the periphery of the cell
Dientamoeba fragilis Former amoeba
Now classified as a flagellate
Trophozoite stage only
-2 nuclei (“Binucleated trophozoite”)
MOT: via transmission of E. vermicularis eggs

Copepods (Cyclops) IH of D. latum, D. medinensis and Gnathostoma spinigerum
Pthirus pubis Crab louse
Agent of “crabs”
Myiasis Invasion of mammalian tissues by dipterous larvae (diptera/flies)
Cantharidin Volatile vessicating substance produced by the blisters of beetles of the family Meloidae
Periplaneta americana American cockroach
Lays about 50 egg capsules (ootheca), each containing about 15 eggs
Blatella germanica German cockroach
Blatta orientalis Oriental cockroach
Aedes aegypti Tiger mosquito
Vector of urban dengue
Aedes albopictus w/ silvery stripe on the mesonotum
Vector of rural dengue
Culex Vectors of Japanese encephalitis
Anopheles flavirostris Primary vector of malaria
Aedes poecilus Mosquito associated w/ Bancroftian filariasis
Mansonia bonneae Vector of the Brugian type of filariasis
Musca domestica Common housefly
Sarcophaga “Chess-board appearance”
Calliphora Bluish fly covered w/ yellow hairs
Lucilia Greenish fly w/ white genae
Phaenicia Bronze-bottle fly
Muscina Slightly larger and more robust than the housefly

Laboratory Methods
Examination of Blood
Detect agents of Malaria
Thick blood films Screening (malaria)
Thin blood films Identification of malarial species
Concentration techniques 1. Preparation of buffy coat smears:
-L. donovani
2. Knott’s concentration membrane filtration
-Detection of microfilaria
3. Fluorochrome acridine orange in microhematocrit centrifuge format
-QBC blood parasite detection method
Examination of Fecal Specimens
Stool fixatives 1. Formalin = all purpose fixative
= 5% conc.: protozoan cysts
= 10% conc.: helminth eggs and larvae
2. Schaudinn’s fluid = w/ HgCl2
3. Polyvinyl alcohol (PVA) = for Trichrome stain (w/ HgCl2)
4. Merthiolate-iodine-formalin (MIF) = a.k.a. Thimerosal
= Merthiolate and Iodine: staining components
= Formalin: preservative
5. Sodium-acetate-formalin (SAF)
= Advantage: does not contain HgCl2
Direct wet mount 1. Saline mount = 0.85% NSS
2. Iodine mount = protozoan cysts (not trophozoites)

Permanent stains 1. Wheatley’s trichrome stain

2. Iron hematoxylin stain
3. Modified acid fast stains (Cryptosporidium, Isospora, Cyclospora)
Concentration Methods for Protozoan Cysts and Helminth Eggs and Larva
Sedimentation Best for eggs of:
-Operculated egg
-T. trichiura
-C. philippinensis
1. Acid-ether concentration
= Ether: dissolves fats and CHO
2. Formalin-ether concentration
= Formalin: preserves the eggs
Flotation 1. Brine Flotation = NaCl
2. Zinc Sulfate centrifugal flotation technique
= SG (ZnSO4): 1.18
= for Protozoan cysts
= for Nematode eggs except T. trichiura and C. philippinensis (sedimentation)
= NOT for Schistosomal and operculated eggs (sedimentation)
Cultural Methods for Protozoa
Culture media for intestinal 1. Boeck and Dorbohlav’s diphasic medium (Modified by Dobell and Laidlaw)
amoeba 2. Cleveland Collier’s medium
NNN Medium for Trypanosoma and Leishmania
Additional Techniques for Examination of Enteric Parasites
Cellulose tape technique For pinworms
Egg studies 1. Direct smear method of Beaver
2. Stoll dilution egg count
3. Kato thick smear = qualitative (Cellophane paper, glycerine, malachite green)
4. Kato Katz smear (Cellophane fecal thick smear) = quantitative
Nematode culture and recovery 1. Harada-Mori paper strip culture
techniques 2. Baermann funnel techniques (Strongyloides)
Examination of Other Specimens
Detection of T. vaginalis Specimens:
-Vaginal and urethral discharge
-Prostatic secretions
Sputum Recovery of protozoal and helminthic parasites
Biopsy 1. Skin biopsy = Onchocerca, Mansonella
2. Muscle biopsy = Trichinella spiralis 04 |Page | 133