SUPER PARASITOLOGY TABLE

Description Morphology & Epidemiology Infective & Diagnostic Transmission, Diagnosis & Treatment Pathogenesis Remarks
Parasite stage ; Host

1. Intestinal Amoeba
Cysts have 4 nuclei that characteristically
have centrally-located karyosomes and
fine, uniformly distributed peripheral
chromatin.
Cytoplasm containing RBC
(pathognomonic)
Trophozoites: single nucleus and tending
to be more elongated in diarrheal stool.
locomotion: pseudopodia
lacks mitochondria, no RER and GA
prevalent in the tropics, placing
second to malaria in terms of
mortality caused by protozoans,
equal prvalence among men and
women but ALA is 3-10x more
commmon in men
Infective: Cyst , Transmission: fecal-oral, via enema equipment
Diagnostic:
Trophozoite ; Diagnosis: trophozoite and cyst in the stool, saline
Intermediate : None ; and methylene blue stain, PCR and ELISA (for
Definitive: human differentiation from other Entamoeba sp., serum
antibodies (DxOC for ALA), UTZ (round or oval
hypoechoic area with wall echoes, usually in the R
lobe), CT Scan, MRI
Treatment: DOC is Metronidazole for invasive
amebiasis, Diloxanide furoate for asymptomatic
cyst carriers, Percutaneous drainage of liver
abscess if not responding to metronidazole or for
prompt relief of pain or for left lobe abscess that
may rupture into the pericardium
majority is Asx ; most invasive among the Entamoeba family and
the only member to cause colitis and liver
Amebic dysenstery: bloody diarrhea, fish odor stool, (+) Charcot- abscess, the cyst is resistant to gastric acidity
Leyden crystals ; and dessication and can survive in a moist
environment for several weeks ; lasts for weeks
amoebic colitis: abdominal pain and diarrhea +/- blood and and may return after remission, infection persist
mucus for years
Amoebic liver abscess (ALA) is the most common extra-intestinal Factors that determine invasion
form of amebiasis (fever, RUQ pain, "Anchovy paste") ; -number of amoeba ingested
-pathogenic capacity of the strain
Amoeboma: inflammatory or granulomatous tumor-like mass -host factors: gut motility & immune
that may obstruct the lumen competence
-+/- of suitable enteric bacteria that enhances
3 virulence factors: Lectin (for adherence to cells) , Amebapore amoebic growth
(form pores on host cell memb) and Cysteine proteinases
(cytopathic for host cell) ;

mechanism of immunity: cell-mediated immunity ; Flask-

shaped ulcer (usually in the cecum, asceding colon and sigmoid)
;

complications: perforation, secondary bacterial peritonitis,

rupture of the pericardium, intraperitoneal
rupturesecondaryamoebic meningoencephalitis
a. Entamoeba Histolytica
2. The Commensal Amoeba: are non-invasive and do not cause disease ; reproduce by binary fission ; cysts pass through the acidic stomach unscathed, protected by their cyst wall, excystation occur in the SI
a. Entamoeba dispar: morpholigacally similar to E. histolytica but their DNA and ribosomal RNA are different

b. Entamoeba hartmanni: similar to E. histolytica but is much smaller and does not ingest RBC, sluggish
c. Entamoeba coli: cosmopolitan in distribution, harmless inhabitant of colon, has a larger cyst and greater number of nuclei than E. histolytica
d. Entamoeba polecki: parasite of pigs and monkey, cyst is uninucleated
e. Entamoeba gingivalis: has no cyst stage and does not inhabit the intestines, found in the mouth, moves quickly and has numerous blunt pseudopodia, transmission is via kissing or droplet spray
f. Endolimax nana: small size, sluggish movement
g. Iodamoeba butschlii: no peripheral chromatin granules on the nuclear membrane

Page 1 of 25
3. Free-living Pathogenic amoeba
Cysts: wrinkled fibrous outer wall (exocyst)
and an inner wall (endocyst) that may be
hexagonal, spherical, star-shaped or
polygonal. Cysts contain only one nucleus
with a large karyosome
Trophozoites: pleomorphic, often produce
many spine-like processes called
acanthapodia. Large nucleus with a large,
centrally-located karyosome but no
peripheral chromatin. There is no
flagellated trophozoite stage in
Acanthamoeba spp.
a. Acanthamoeba
Cysts in the environment and culture are
spherical, and have a smooth, single-
layered wall. Cysts have a single nucleus tip of a pear-shaped cell body
Trophozoites: cytoplasm is granular and
contains many vacuoles. The single nucleus preferred habitat, run-off from heavy
is large and has a large, dense karyosome rains result in introduction of ameba
and lacks peripheral chromatin.
b. Naegleria : N. gruberi (non-
pathogenic), N. fowleri
(pathogenic)
has acanthopodia for locomotion,
sluggish and polydirectional
movement, ubiquitous ; high
incidence among AIDS Px and contact
lens wearers
Naegleria trophozoites readily forms
a pair of flagella originating from the
(transforms from an ameba into a
biflagellated organism) ; soil is the
from soil into lakes and ponds
active trophozoite route of invasion of CNS is via blood ; trophozoite or
stage and dormant cyst cyst in tissues and CSF ; 5-Fluorocytosine,
stage Ketoconazole, Itraconazole, Pentamidine,
Amphotericin B, surgical excision of infected cornea
with corneal transplantation ; Avoid use of topical
corticosteroids ; Boiling water is the best possible
way of killing trophozoites and cysts
I: Cyst Transmission: oral and intranasal routes while
D: trophozoite swimming in contaminated pools, lakes and rivers,
inhalataion of the dust-borne cyst could lead to
N. fowleri is only infection, most often isolated from thermal
pathogenic to humans, effluents, hot springs and water with elevated temp
others are ; tolerate temp higher than 100C and lower than
opportunistic
pathogens. trophozoites in the brain and CSF, PCR, ELISA ;
DOC is Amphotericin B, Clotrimazole,
Azithromycin, Iodine, Chlorine
Page 2 of 25
Granulomatous Amoebic Encephalitis (GAE):
- poorly chlorinated pools
- immunocompromised patients
- manifests as destructive encephalopathy and meningeal
irritation (confusion, somnolence, hallucinations, seizures, cranial
nerve palsies, visual disturbances, increased ICP)
- Amoebic keratitis: contact lens infection corneal ulceration,
infiltration and clouding, iritis, slceritis, loss of vision; found in
nasal cavity, throat and intestines
Primary amebic meningoencephalitis (PAM):
- manifested as fever, headache, signs of meningeal irritation,
vomiting and encephalitis with progression to coma and death,
has degenerative or cytopathic effects in mammalian cell cultures
feeds on G(-) bacteria, blue-green algae or
yeasts ; reproduce by binary fission , most
affeacted areas of the brain are posterior fossa,
diencephalon, thalamus and brainstem
a free-iving amebo-flagellate because it can
exist as an amoeba (trophozoite from) and as a
flagellate (swimming form) ; is able to survive in
elevated temp up to 46C and in
hyperchlorinated water ; N fowleri does not
65C, its growth is inhibited by 0.2% NaCl and
KCl, dehydration is lethal to trophozoites but
cysts remain viable if rehydrated within 23
months.
4. Ciliates and Flagellates
Cysts are seen less frequently
Trophozoites: characterized by their large
size, the presence of cilia on the cell
surface, a cytostome, and a bean shaped
macronucleus which is often visible and a
smaller, less conspicuous micronucleus.
a. Balantidium coli
Cysts
- oval to ellipsoid and measure 8-19 µm
(average 10-14 µm).
- Mature cysts have 4 nuclei, while
immature cysts have two.
- Nuclei and fibrils are visible
Trophozoites:
- pear-/heart-shaped and measure 10-20
micrometers in length.
- 2 large nuclei are usually visible.
- large concave sucking disks on ventral
surface (used for attaching to the host's
mucosal epithelium),
- median bodies, and 4 pairs of flagella
b. Giardia lamblia
has a cytosome through which it I: Cyst, D: both cyst and
acquires food and a cytopyge through trophozoite ; primarily
which it excretes waste, has a macro associated with pigs ;
and micronucleus and two contractile
vacuoles ; common in pigs
throughout the tropics
binucleated flagellated trophozoite I: Cyst
and quadrinucleated cyst, pyriform D: trophozoite and cyst contaminated with fecal material containing cysts
or tear-drop shaped, pointed ; rapidly multiply and attach to the intestinal villi causing
posteriorly with a pair of ovoidal host: Human
nuclei, dorsal side of the organism is
convex while ventral side is concave
with a large adhesive disc used for
attachment, bilaterally symmetrical
with distinct medial line called
axostyle ; with erratic tumbling
motion by four pairs of flagella ; high
prevalence among homosexuals due
to oro-anal practices
Transmission: ingestion of food/water
contaminated with fecal material containing cysts with a rounded base and wide neck which in turn causes
Diagnosis: Trophozoites and cysts in feces ;
Treatment: Tetracycline, Metronidazole, Iodoquinol excyst in the SI and become trophozoites. Trophozoites inhabit
Transmission: ingestion of food/water
Diagnosis: trophozoites and cysts in feces,
aspiration biopsy, Enterotest, antigen detection
tests
- immunofluorescence test, direct fluorescent
antibody is considered to be the Gold standard
in diagnosis ;
Treatment: Metronidazole, Tinidazole,
Furazolidone, Alternatives: Paromomycin &
Quinacrine
Page 3 of 25
capable of attacking the intestinal epithelium resulting in ulcer the largest protozoan parasite and is the only
ciliate known to cause human disease ;
bloody diarrhea, ulceration is caused by hyaluronidase ; bloody unlike ameba, encystation does not result in an
and mucoid stoool around 6-15x a day, complications include increase in number of nuclei ; reproduce by
intestinal perforation and acute appendicitis ; ingested cysts binary fission ; easily inactivated by heat and 1%
bleach, ordinary chlorination of water may not
the lumen, mucosa and submucosa of the large intestines be as effective
primarily the cecal region, also blood vessels and lymphatics
lives in the duodenum, jejunum and upper ileum of humans, also known as G. intestinalis, G. duodenalis,
excyst in the duodenum and develops into trophozoites which Lamblia duodenalis or L. intestinalis, discovered
by Antoine Van Leeuwenhoek in his own stool
pathologic changes (villous flattening & crypt hypertrophy) that but was described by Lambl ; attachment to villi
leads to a decrease in eletrolyte, glucose and fluid absorption, was observed to be maximal at body temp and
causes mechanical irritation in the affected tissues, secretes stable at a pH of 7.8 to 8.2 ; floating leaf-like
motility ; "Old Man's glasses" ; minimal
Lectin which enables attachment to intestinal epithelium, causes infective dose of 1-10 cysts suggests that it
rearrangement of cytoskeleton in human colonic and duodenal could easily be transmitted by fecally
monolayers --> structural disintegration --> enterocyte apoptosis contaminated food ; Important Risk Factors
; also causes increased epithelial permeability leading to loss of include overcrowding, immunodeficiency
epithelial barrier function ; 50% of cases may be asymptomatic, and homosexual practices ; shown to be
abdominal pain described as cramping with diarrhea, excessive related to the "gay bowel syndrome",
normal water chlorination will not affect cyst
flatus with an odor of hydrogen sulfide "rotten egg" odor ;
but usual water treatment modalities should
be adequate
chronic infection is chracterized by steatorrhea (passage of
greasy, frothy stools that float on toilet water) ; spontaneous
recovery occurs within 6weeks
5. Coccidians: characterized by an alternation of generations - 1 sexual & 1 asexual - occuring in the same host. Asexual reproduction is schizogony while the Sexual cycle is sporogony
Oocysts of I. belli are large (25 to 30 µm)
and have a typical ellipsoidal.
a. Isospora belli
Oocysts are rounded and measure 4.2 to
5.4 µm in diameter. Sporozoites are
sometimes visible inside the oocysts,
indicating that sporulation has occurred.
b. Cryptosporidium parvum,
C. hominis
Oocysts are spherical, 7.5-10 µm in
diameter. Sporulation in the environment
is temperature-dependent and may take
one to several weeks for an infective
oocyst to contain two sporocysts, each
containing two sporozoites.
c. Cyclospora cayatensis
oocyst has two sporocysts with each I: oocyt, D: oocyst
containing four sporozoites ; more
common in children and male
homosexuals esp those with AIDS
oocyst will appear as a red-pink
doughnut-shaped circular organisms
in a blue-background in Kinyoun acid
fast stain
has cyanobacteria-like body, oocysts
are autofluorescent and under
fluorescent microscopy, would
appear as blue or green circles
ingestion of food/water contaminated with fecal Often Asymptomatic, diarrhea occurs intermittently for months, dissemination of parasite into other organs
material containing cysts ; oocysts in feces by direct fever, flatulence, malabsorption syndome ; mucosal lesions of happen in AIDS Px, prognosis is good but
microscopy or after formalin-ethyl acetate shortened villi, hypertrophied crypts and infiltration of the infections may last for months ; cases of
concentration, Acid-fast stain, Iodine staining, lamina propria with polymorphonuclear leukocytes esp acalculous cholecystitis has been noted after I.
Entero-test, duodenal aspirate ; bed rest and bland eosinophils belli infection
diet for asymptomatic patients, Co-trimoxazole or
Pyrimethamine-Sulfadiazine for symptomatic Px
I: oocyst, oocyst; C. Transmission: Ingestion of food/water sporozoites which attach to the surface of epithelial cells of the Varying degrees of malabsorption and excessive
parvum is now contaminated with fecal material containing oocysts GIT --> sporozoites develop into trophozoites and become fluid loss
considered a parasite ; intracellular but extracytoplasmic and attach to the brush
of bovines which can borders ; Most epidemics are associated with water
infect humans while C. Diagnosis: Sheather's sugar flotation or formalin- contaminated with calf feces ; chlorination does
hominis will infect only ethyl-acetate concentration technique or acid fast Immunocompetent: manifest as self-limiting diarrhea of 2- not affect the parasite, multiple disinfectants
humans staining (cheapest and quickest), Indirect 3weeks and combined water treatment processes may
fluorescent antibody, enzyme immunoassay and Immunocompromised: diarrhea becomes more severe, reduce C. hominis oocyst in drinking water
DNA probes ; progressively worse and life-threatening
Treatment: Presently no acceptable treatment for Gangrenous cholecystitis due to heavy infection of bile duct and
Cryptosporidiosis, Nitazoxanide however has been gallbladder
reported effective, Bovine colostrum,
paromomycin, claritromycin and azithromycin have Respiratory infections lead to chronic coughing, dyspnea,
shown promise as treatment bronchiolitis and pneumonia ;
Villi of the intestines become blunted and there is infiltration of
inflammatory cells into the lamina propria and elongated crypts
I: oocyst, D: oocyst ; ingestion of food (leafy vegetables) /water chronic and intermittent watery diarrhea (6-7 weeks) with >6 D-xylose malabsorption has been found to
host: human only contaminated with fecal material containing oocysts stools per day, infections are usually self-limiting and immunity develop in some patients ; There is no alternate
; Direct microscopic examination of fecal smears may result with repeated infections treatment if patients are unable to tolerate
under high magnification (400x), acid fast staining, sulfamethoxazole, boiling of water seems to be
safranin staining, microwave heating, PCR ; disease the best method since chlorination is not
is self-limiting and treament is not necessary, if effective
pharmacologic treatment is warranted, Co-
trimoxozole may be given
Page 4 of 25
 Cysts of Toxoplasma gondii usually range in trophozoite is crescent-shaped with a I: tachyzoite, ingestion of food/water contaminated with cat fecal
size from 5-50 µm in diameter. Cysts are pointed anterior and a rounded bradyzoite and oocyst, material containing oocysts, eating of meat of
usually spherical in the brain but more posterior D: tachyzoite / infected animals, blood transfusion, placental
elongated in cardiac and skeletal muscles. ; bradyzoite ; I: human transfer (1st trimester), organ transplantation esp
Tachyzoites (trophozoites) of Toxoplasma and other animals bone marrow ; examination of tissue imprints
gondii are approximately 4-8 µm long by 2- (rodents, pigs), D: cat stained with Giemsa, hematoxylin or eosin, serum
3 µm wide, with a tapered anterior end, a antibodies, Sabin-Feldman methylene blue dye test,
blunt posterior end and a large nucleus. indirect hemmaglutination, indirect fluorescent
antibody test, ELISA, latex agglutination, PCR ;
pyrimethamine-sulfadiazine (rescue agent for
pyrimethamine: Leucovorin), if with sulfa allergy,
use Clindamycin, alternative drugs: spiramycin,
azithromycin, clarithromycin, dapsone, atovaquone
; Prophylaxis for immunocompromised: Co-
trimoxazole
an intracellular parasite which infects different kinds of nucleated
cells including macrophages ; usually asymptomatic as long as the
immune system of the Px is well functioning ; once stimulated the
immune system quickly responds to the parasites which, in turn,
adapt by transforming into bradyzoites that are proctected by a
cyst wall ; Clinical manifestations become apparent when
immune system is suppressed (old age, drug-induced, AIDS etc):
encephalitis, myocarditis, focal pneumonia, retinochorioditis,
lymphoreticular hyperplasia with enlargement of the posterior
cervical lymph node, hepatitis, splenomegaly, failure to gain
weight ; In pediatric Px it may be manifested as stillbirth,
abortion, chorioretinitis, epileptic seizure, jaundice,
hydrocephalus, microcephaly, anemia, pneumonia ;
The complete life cycle only occurs in the
members of the cat family ; Asexual
multiplication is by a variation of binary fission
called endodyogeny (characterized by
formation of plasma membrane by the two new
daughter parasites, even before the division of
the nucleus) ; follows a typical coccidian life
cycle consisting of schizogony, gametogony and
sporogony in the intestinal epithelium , the
extraintestinal stages are the asexual stages:
tachyzoites and bradyzoites ; only the
tachyzoite and bradyzoite stages are present in
humans ; Food should be protected from
combination by cat feces, pregnant women
should avoid contact with cats

d. Toxoplasma gondii
Oocysts of Sarcocystis in human feces simplest form is called a zoite, which I: oocyst D: oocyst ; I: Transmission: ingestion of uncooked or 2 types: Macrocysts (seen by naked eye), Microcysts (seen under causes Sarcosporidiosis or Sarcosystosis,
measure 15-20 µm long by 15-20 µm wide. is banana-shaped, sporocysts are cattle, pig D: Human & undercooked meat of an intermediate host ; the microscope), penetrate intestinal epithelial tissue and spead infectivity is prolonged during the cooler
Oocysts sporulate in the intestinal composed of 4zoites other primates, dogs, hematogenously to various areas of the body, including the brain months of the year
epithelium and contain two sporocysts, cats Diagnosis: Western Blot, IFA, ELISA
each of which contains four sporozoites SSx include diarrhea, eosinophilic enteritis, myalgia, weakness
and a refractile residual body. Treatment: NO EFFECTIVE TREATMENT IS KNOWN, and mild increase of creatine kinase
Corticosteroids for muscular inflammation, Co-
Trimoxazole for intestinal infections

e. Sarcocystis hominis, S.
suihominis

Page 5 of 25
6. Other Intestinal Protozoans
Blastocystis hominis appear as spherical to
oval cyst-like structures. They vary widely
in size (5 to 30 µm; usual range 8 to 10
µm), and typically consist of a central body,
or "vacuole," surrounded by a thin rim of
cytoplasm containing up to six nuclei.
lacks cell wall but has a
mitochondrion with protozoan
morphology, capable of pseudopodial
extension and retraction ; has 4
morphological forms - vacuolated,
amoeba-like, granular and mutliple
fission ; more common in children
and immunocompromised individuals
I: cyst D: cyst Transmission: fecal-oral route
(vacuolated form) ; D:
human, dogs, chicken, Diagnosis: direct fecal smear, hematoxylin,
ostrich, macaques trichrome stain, Boeck and Drbohlay's media,
Nelson and Jones media
Treatment: DOC is metronidazole, iodoquinol, if
metronidazole-resistant, give co-trimoxazole
abdominal cramps, IBS, bloating, flatulence, diarrhea without inhabitant of the lower GIT of humans and
fecal leukocytes or blood, nausea, vomiting, low grade fever, other animals ; reproduction is asexual by
malaise binary fission or sporulation under strict
anaerobic conditions, optimal growth is at 37
Blastocystis is hard to eradicate because it hides in the intestinal celsius in the presence of bacteria does not
mucus, sticks and holds on to intestinal membranes grow on fungal medium ; the vacuolar form is
the main type that causes diarrhea ; is resistant
to chlorine at standard concentrations

a. Blastocystic hominis
Dientamoeba fragilis has no cyst stage, and
its trophozoites measure 5 to 15 µm. The
flagella is not usually evident and the
pseudopodia are angular to broad-lobed
and transparent. While most trophozoites
are typically binucleate, some have only
one nucleus.
rossette-shaped nuclei ; resembles I: trophozoites D: Trasmission: fecal-oral route, transmission of lives in the mucosal crypts of the cecum and upper colon, does flagellate with only the trophozoite stage
Trichomonas except for the absence trophozoites ; D: helminth eggs particularly Enterobius vermicularis not invade tissues but produces irritation of the mucosa with known ; no cyst stage has been identified ; is
of flagellum ; together with human, pigs secretion of excess mucus and hypermotility not detected by stool concetration methods,
Enterobius, has high prevalence Diagnosis: fecal smear prompt fixation with polyvinyl alcohol,
among pre-school children and Infections are usually asymptomatic, if symptomatic: colicky Schaudinn's fixative is helpful
mental institutions Treatment: Iodoquinol, tetracycline, metronidazole abdominal pain, loss of appetite, diarrhea with excess mucus,
abdominal tenderness, bloating and flatulence, anal pruritus (due
to co-infection with Enterobius), may be found in the egg or
lumen of E. vermicularis

b. Dientamoeba fragilis

Page 6 of 25
7. Plasmodium
pigment producers, amoeboid in
shape, gametocyte is banana shaped,
microgamete cytoplasm is light blue
in color while macrogamete is darker
blue, trophozoite is ring-shaped with
a red chromatin dot and a small blue
cytoplams in Giemsa or Wright stain,
; 1.5 to 2.7M deaths annually, 2.3B
are at risk of being infected,
falciparum and vivax are
responsible for 90% of cases of
human malaria ; most important
parasitic disease affecting man,
considered to be one of the three
major infectious disease threats along
with HIV and TB, it kills more people
than any other communicable disease
except TB, kills 1.5-2.7M people each
year ; In the Philippines, 65 out of 78
provinces are endemic to malaria,
70% of malaria in the Philippines is
caused by P. falciparum while <30% is
P. vivax, <1% is due to P. malariae
Plasmodium falciparum,
Plasmodium vivax,
Plasmodium ovale,
Plasmodium malariae
P. falciparum
Pre-patent period 11-14 days
Incubation period 8-15days
Asexual cycle 48hrs
Periodicity Malignant tertian
RBC preference All ages
Parasitemia Highest
Merozoites 0 12-24
Ring trophozoite Thin; 2 chromatin dots
Gametocytes Banana-shaped
I: sporozoites from Transmission: bite of a female Anopheles mosquito Symptoms include paroxysms of fever with asymptomatic Asexual life cycle: human and other vertebrate
mosquito D: intervals, weakness, desire to stretch and yawn, aching bones Sexual life cycle: mosquito
trophozoites ; I: human Diagnosis: Giemsa or Wright stain remains to and limbs, loss of appetite, nausea, vomiting, chills ; Symptoms
D: mosquito be the Gold Standard (obtain smears evry 6- composed of cold stage (shivering, peripheral vasoconstriction) total duration of a typical attack is 8-12hrs ; has
8hrs) and hot stage (fever, headache, palpitations, tachypnea, GPI (Glycosylphosphatidyl Inositol) act like
- Thick smear +/- of organism epigastric discomfort, thirst, nausea vomiting) endotoxin of gram-negative bacteria
- Thin smear: species identification Lipopolysaccharide, they stimulate the
Cerebral malaria is manifested at symmetrical encephalopathy, monocytes to release TNF or cachexin which is
Quantitative Buffy Coat, Malaria rapid diagnostic retina hemorrhages , bruxism, neck stiffness; (+) Durck implicated as the cause of Malarial fever ;
tests such as Histidine-rich protein, Plasmodium granuloma; and (+) pout reflex, the ff SSx happen to severe history of cough and convulsions are very
LDH (can distinguish between falciparum and non- malaria: Acute renal failure, ARDS, hyperkalemia, hyperuricemia common ; Chloroquine has the best safety
falciparum) ; profile among all antimalarials, it is commonly
combined with Sulfadoxine+Pyrimethamine to
reduce resistance, Tetracycline and Doxycycline
are effective but cannot be used alone because
the kill parasites slowly ; Anopheles is night
biter, breeding in slow flowing partly shaded
streams ; prevention include wearing of light-
Drug Prophylactic use colored clothing which cover most of the body,
use of insect repellants and insecticides
Chloroquine Areas without resistant P. falciparum
Malarone Areas with chloroquine-resistant P. falciparum Chemoprophylaxis with Chloroquine,
Mefloquine, Doxycycline or Atovaquone-
Mefloquine Areas with chloroquine-resistant P. falciparum Proguanil (Take during the entire duration of
Doxycycline Areas with multidrug-resistant P. falciparum stay and up to 4weeks after the last possible
exposure to infection - since parasites may still
Primaquine Terminal prophylaxis of P. vivax and P. ovale infections; emerge from the liver),
alternative for primary prevention
P. vivax P. malariae P.ovale
11-15 days 3-4 weeks 14-26 days
12-20 days 18-40 days 11-16 days
48hrs 72hrs 48hrs
Benign tertian Benign quartan Benign tertian
Young RBC Old RBC Young RBC
Low Lowest Low
6-12 8
Thick; 1Page 7 of 25 dot
chromatin Thicker than falciparum; Compact with little
1 chromatin dot vacuolation
Large round Compact Small round
 P. falciparum P. vivax P. malariae P.ovale may induce uterine contractions in pregnant Px

Pre-patent period 11-14 days 11-15 days 3-4 weeks 14-26 days

Incubation period 8-15days 12-20 days 18-40 days 11-16 days

Asexual cycle 48hrs 48hrs 72hrs 48hrs

Periodicity Malignant tertian Benign tertian Benign quartan Benign tertian

RBC preference All ages Young RBC Old RBC Young RBC

Parasitemia Highest Low Lowest Low

Merozoites 0 12-24 6-12 8

Ring trophozoite Thin; 2 chromatin dots Thick; 1 chromatin dot Thicker than falciparum; Compact with little
1 chromatin dot vacuolation
Gametocytes Banana-shaped Large round Compact Small round

Peripheral blood Rings and crescents All forms All forms All forms
(gametocytes)
Cerebral Malaria Yes No No No

P. falciparum Recrudescence Yes No Yes No

pre-patent period: 11-15 days ; Incubation period: 12-20 days ;
Relapse No Yes Noinfect young RBC ; has relapse Yes

Drug resistance Many Few Few Few

Dots Maurer dots Schuffner dots Ziemann dots Schuffner dots

P. vivax
Clinical setting Drug Therapy Alternative drug
Chloroquine-sensitive uncomplicated P. Chloroquine
falciparum
P. vivax and P. ovale infections Chloroquine + Primaquine
Uncomplicated chloroquine-resistant P. Quinine+Doxycycline/Clindamycin Quinine + Sulfadoxine-Pyrimethamine or
falciparum Or Quinine + Tetracycline or Clindamycin OR
Sulfadoxine-Pyrimethamine Malarone (Atovaquone-Proguanil) OR
Mefloquine OR
Ca-artemether+Lumefantrine
Pregnancy Quinine
Severe or complicated P. falciparum infections Artesunate+Doxycycline/Clindamycin or Artemether+Doxycycline/Clindamycin
Mefloquine/Malarone OR
OR Mefloquine/Malarone
Quinidine gluconate Page 8 of 25 OR
Artemotil
MDR malaria Mefloquine, sulfadoxine-pyrimethamine, halofantrine,
artemisinin and family can be given
 Clinical setting Drug Therapy Alternative drug
Chloroquine-sensitive uncomplicated P. Chloroquine
falciparum
P. vivax and P. ovale infections Chloroquine + Primaquine
Uncomplicated chloroquine-resistant P. Quinine+Doxycycline/Clindamycin Quinine + Sulfadoxine-Pyrimethamine or
falciparum Or Quinine + Tetracycline or Clindamycin OR
Sulfadoxine-Pyrimethamine Malarone (Atovaquone-Proguanil) OR
Mefloquine OR
Ca-artemether+Lumefantrine
Pregnancy Quinine
P. ovale Severe or complicated P. falciparum infections Artesunate+Doxycycline/Clindamycin or Artemether+Doxycycline/Clindamycin
Mefloquine/Malarone OR
OR Mefloquine/Malarone
Quinidine gluconate OR
Artemotil
MDR malaria Mefloquine, sulfadoxine-pyrimethamine, halofantrine,
artemisinin and family can be given

Mefloquine + Artesunate is the DOC for SE Asian

countries

P. malariae

Page 9 of 25
8. Babesia
a. B. divergens
Babesia parasites resemble Plasmodium
falciparum, however Babesia has several
distinguishing features: the parasites are
pleomorphic (vary in shape and size), can
be vacuolated, and do not produce
pigment.
b. B. microti
9. Blood and Tissue Flagellates
A typical trypomastigote has a large,
subterminal or terminal kinetoplast, a
centrally located nucleus, an undulating
membrane, and a flagellum running along
the undulating membrane, leaving the
body at the anterior end. Trypanosomes
measure from 12 to 30 µm in length.
a. Trypanosoma cruzi
cause malaria like infection
cattle parasite
single or paired, amoeboid,
oval/spherical/bizaare-shaped bodies
; intraerythrocytic parasites look
"teardrop-shaped"
trophozoites in tetrads: "Maltese
Cross"
trypomastigotes are characteristically
C or U-shaped ; 16-18M are infected,
chronic disease is more common than
acute disease, highest incidence
occurs in the fifth decade of life,
Male>Female
I: sporozoite D: Transmission: bite from and infected black-legged
trophozoite ; I: tick tick, Ixodes scapularis (also known to carry Borrelia
D:dogs, cattles, horses, burgdoferi), vertical transmission from an infected
rats mother to fetus, blood transfusion
Diagnosis: Immunofluorescent assay (IFA), PCR is
the DxOC ;
Treatment: Clindamycin +/- Quinine
I: metacyclic enters human host through scratched skin or
trypomastigote D: through mucous membranes that are rubbed with
trypanosomes ; I: fingers contaminated with the bug's feces
rodents and burrowing (Triatoma/Rhodnius/Panstrongylus better known as
animals D: humans reduviid, kissing or assasin bug), may also enter
through the conjunctiva of the eye and cause
edema of the eyelids and conjunctiva (Romaña's
sign) ;
Diagnsis: Trypanosomes in blood, CSF, fixed tissue
or lymph via thick blood smears (only in the first
2months), blood culture, Xenodiagnosis,
Immunofluorescent antibody test, complement
fixation test, indirect hemagglutination assay, ELISA,
Dot-immunobinding assay, PCR ;
Treatment: NO ENTIRELY SUITABLE DRUG -
Nifurtimox and Benznidazole are only partially
effective in acute disease
Page 10 of 25
The larval form of the tick attaches to the white-footed mouse for
a blood meal and picks up the parasite from the host. After
feeding, the larva molts to an infective nymphal stage which
attaches to grass leaves and other vegetation, waiting to bite a
bigger vertebrate host (usually deer or human). The infected
nymph takes a blood meal in the new vertebrate host then
emerges as an infective adult which will need another blood meal
to lay eggs, now infected with Babesia ; causes an increase in the
release of TNF, SSx include headache, fever, chills, altered mental
status, DIC, anemia with dyserythropoiesis, respiratory distress
and renal insufficiency
trypomastigotes are engulfed by macrophages and multiply
through binary fission as amastigotes ; cells frequently invaded
are the reticuloendothelial cells of the spleen, liver, cardiac,
smooth and skeletal muscles ; at the site of inoculation, a local
inflammation is produced which is called a Chagoma (small
painful reddish nodule), other SSx include fever, generalized
lymphadenopathy ; chronic infection may manifest as
cardiomyopathy, megaesophagus, megacolon
most are asymptomatic
Most human infection occur in summer of
spring (May to July) because of abundance of
grass and bushes ; prevention include wearing
of light-colored pants, avoidance of places
where ticks are found, use of insect repellants
Chaga's disease / American Trypanosomiasis ;
only exists in the American continent ; exhibits
all four stages of development: amastigote,
promastigote, epimastigote and trypomastigote
; is a zoonosis transmitted from rodents and
burrowing animals
 A typical trypomastigote has a small
kinetoplast located at the posterior end, a
centrally located nucleus, an undulating
membrane, and a flagellum running along
the undulating membrane, leaving the
body at the anterior end. Trypomastigotes
are the only stage found in patients.
Trypanosomes range in length from 14 to
33 micrometer.
b. Trypanosomoa brucei
gambiense
c. Trypanosoma brucei
rhodesiense
flattened and fusiform, body tapes
anteriorly and is blunt posteriorly,
pale blue cytoplasm is granular and
may be vacuolated, red-staining
flagellum runs along the edge of the
undulating membrane and becomes
free anteriorly ; Affects over a third of
Africa, 20,000 new cases are reported
each year, prominent in areas near
river banks and streams
I: metacyclic Transmission: a bite of the vector Glossina sp (tsetse
trypomastigote D: fly) where the parasite trypomastigote form
trypanosomes ; I: develop into epimastigotes (in the salivary gland),
rodents and burrowing multiply and transform into the infective stage,
animals D: humans Congenital transmission is possible
Diagnosis: Giemsa stain, buffy coat concentration
method, indirect hemagglutination, ELISA,
Immunofluorescence
TreatmentPentamidine, Suramin (both does not
reach CSF), Melarsoprol or Tryparsamide (if with
CNS involvement), Eflornithine has been found to
be effective in late stages of Gambian
Trypanosomiasis
Page 11 of 25
In humans, the parasite live in the blood, in the reticular tissues West African Sleeping Sickness (West and
of the lymph and spleen and the CSF, multiply by longitudinal Central Africa) which is the chronic form
binary fission, invade the CNS in chronic infection ; earliest SSx is
a chancre (local, hard, painful lesion at the site of inoculation)
Acute stage: irregular fever, headache, joint and muscle pains,
dizziness, debility, rash, posterior cervical lymphadenopathy with
a consistency of ripe plums (Winterbottom's sign)
CNS invasion: headcahes become more and more severe with
increasing mental dullness and apathy, Tremors, hyperesthesia
(Kerandel's sign) and inversion of sleep cycle may be observed
Trypanosomes are able to evade the immuse response of the
host through a process called antigenic variation. This refers to
East African Sleeping Sickness (East and South
the ability of the Trypomastigote to change its surface coat,
Africa) which is the acute form ; Rhodesian is
which is a variant surface glycoprotein, so that the antobodies
more rapid and fatal than Gambian.
previously produced by the host cannot act on it, resulting in
recurrent waves of parasitemia
 Amastigotes of Leishmania are spherical to
ovoid and measure 1-5 µm long by 1-2 µm
wide. They possess a large nucleus, a
prominent kinetoplast, and a short
axoneme, the last of which is rarely visible
by light microscopy.
Promastigotes have a single free I: Promastigotes D: transmitted via bite of sandfly (Phlebotomus spp),
flagellum arising from the Kinetoplast Amastigotes ; D: congenitally, by blood transfusion, by
at the anterior end ; 12M cases are humans contamination of bite wounds and by contact ;
affected worldwide demonstration of Leishmania in tissue biopsies (skin
for cutaneous Leishmaniasis, bone marrow spleen
or lymph nodes for Kala-Azar), aldehyde &
complement-fixation tests, immunofluorescent
antibody test, counter-current electrophoresis
technique ; Sodium stibogluconate, N-methyl-
glucamine antimonite, 2nd line agents include
amphotericin B, pentamidine, metronidazole and
nifurtimox (Pentamidine and Amphotericin B in
resistant cases), Miltefosine is the first line drug for
Kala-azar in India
Amastigotes live intracellularly in monocytes, PMNs or
endothelial cells, multiply by binary fission ; L. tropica is
manifested as skin ulcer with elevated and indurated margins,
painless and do not result in lymphadenopathy, systemic SSx are
absent , diffuse cutaneous Leishmaniasis causes widespread
thickening of the skin with lesions resembling that of
lepromatous leprosy ; In mucocutaneous Leishmaniasis, lesions
resemble that of cutaneous Leishmaniasis , however, there is
metastatic spread to the oronasal and pharyngeal mucosa
(Espundia), which is highly-disfiguring (leprosy-like tissue
destruction and swelling - Tapir Nose), also with chiclero ulcer
(erosion of the pinna) ; In visceral Leishmaniasis, there is twice-
daily fever, splenomegaly, cachexia, hepatomegaly,
lymphadenopathy and anemia. parasites are numerous in the
reticuloendothelial cells of the spleen, liver, lymph nodes, bone
marrow, intestinal mucosa and other organs
L. tropica invade the lymphoid tissue of the skin
(cutaneous Leishmaniasis), L. donovani the
visceral organs (Kala-Azar or Visceral
Leishmaniasis) while L. braziliensis the skin and
mucous membranes (Mucocutaneous
Leishmaniasis) ; Post Kala-Azar Dermal
Leishmaniasis (PKDL) begin as small macule or
hypopigmented areas around the mouth which
spread to the face, arms and trunk ; Delayed
Hypersensitivity reaction to Leishmania develop
in the late stages of the infection

d. Leishmania tropica, L.
braziliensis, L. donovani
10. Microsporidia important parasites of fishes, birds, insects
coiled within the spore is a unique
structure called the polar filament
which functions to insert in the host
cell the spore's nucleus and cytoplam
(sporoplasm) in order to initiate
infection
usual hosts: birds esp. Diagnosis: fecal samples or biopsy specimens under
parrots the light microscope, hematoxylin stain, eosin stain,
Warthin-Starry stain, Giemsa stain, Chromotope 2R
(stains spore and spore wall),
Gold standard: Electron microscope
Immunofluroescence is used to distinguish between
species, PCR
Treatment: Albendazole and other Benzmidazole
derivatives, 5-FU, and sparfloxacin
Microsporidia family is obligatory, intracellular, multiply via
binary fission or multiple fission ; considered to be among the
most primitive of eukaryotic cells as they posses characteristics
similar to prokaryotic organisms - lack mitochondria, has 70s
ribosomes, all have resistant spores and multiply within the host
cell ;
has three common species: E. intestinalis
formerly called Septata intestinalis (causes
chronic diarrhea, nephritis conjunctivitis,
bronchitis, bronchiolitis, disseminated infection,
biliary tract infection, E. cuniculi (causes
keratoconjunctivitis, disseminated infection,
bronchiolitis, hepatitis, adrenalitis, peritonitis,
UTI and Respiratory infections) and E. hellem
(causes Interstitial nephritis,
keratoconjunctivitis, disseminated infection ; all
species mostly affect immunocompromised px

a. Encephalitozoon
E. bineusi causes chronic diarrhea (in
immunocompromised px CD4 <50 cells/L),
wasting syndrome, gallbladder and biliary tract
infection such as cholecystitis ; has prevalence
b. Enterocytozoon of up to 50% in AIDS Px presenting with chronic
c. Pleistophora diarrhea
causes myositis
d. Nosema keratoconjunctivitis
e. Brachiola B. vesicularum causes myositis
V. cornea (formerly known as Nosema corneum)
f. Vittaforma causes keratoconjunctivitis
g. Trachipleistophora T. hominis causes myositis
causes keratoconjunctivitis, corneal stroma
h. Microsporidium infection

Page 12 of 25
NEMATODE INFECTION
1. Intestinal Nematodes
Fertilized eggs: rounded and have a thick has polymyarian type of somatic I: fully embryonated Transmission is by ingestion of food or while When eggs are ingested, the larvae hatch in the lumen of the most common intestinal nematode of man,
shell with an external mammillated layer muscle arrangement, has a terminal eggs D: playing with soil contaminated with small intestines and the penetrate the intestinal wall. They enter "Giant round worm", Soil-transmitted helminth
that is often stained brown by bile. mouth with 3 lips and sensory unembryonated or embryonated eggs ; the venules to go to the liver through the portal vein, on to the (disease of poverty), reinfection is usually
papillae ; affects around 1Billion fertilized egg; D: heart then to pulmonary vessels where they break out of observed 4months post-treatment and full
Decorticated eggs: absent outer layer. people, 70% of whom are from Asia, humans Diagnosis: Direct Fecal smear, Kato technique or capillaries to enter air sacs. In the lungs they undergo motling reinfection appears at 6-7months after
at least 20,000 die annually, mostly cellophane thick smear method, Kato-Katz before migrating to the larynx and oropharynx o be swallowed treatment. This situation may be remedied by
Unfertilized eggs: elongated and larger young children, has a cosmopolitan technique into the GIT. Adult worms reside in but do not attach to the giving treatment at least 2x a year at an interval
than fertile eggs. Thinner shells and their distrubution mucosa of the small intestines of 4-6months among school children ; Loeffler's
mammillated layer is more variable, either Treatment: Albendazole is the DOC, Mebendazole, syndrome (hypersensitivity pneumonitis,
with large protuberances or practically Pyrantel pamoate, Ivermectin May have allergic manifestations such as asthmatic attacks and malabsorpton syndrome)
none. Contain mainly a mass of refractile edema of the lips, most frequent compaint is abdominal pain,
granules may be regurgitated and vomited or escape through the nostrils,
may enter the liver or gallbladder and be lodged in the appendix
Adults of Ascaris lumbricoides are large or pancreas, may cause intestinal obstruction
roundworms. Females measure 20-35 cm
long with a straightened tail; males are
smaller at 15-31 cm and tend to have a
curved tail. Adults of both sexes possess
three 'lips' at the anterior end of the body.

a. Ascaris lumbricoides
Eggs:cannot be differentiated
microscopically.
- thin-shelled, colorless
Infective, third-stage (L3), filariform larvae
have a pointed tail and a striated sheath
Adult hookworms reside in the small
intestine of their hosts.
- Males are bursate, with two spicules that
do not fuse at their distal ends.
- Females measure approximately 10-15
mm long.
- Adults of both sexes have a buccal
capsule containing sharp teeth.
cylindrical, fusiform, grayish-white, I: filariform larva D:
the head is curved opposite to the eggs ; D: human
curvature of the body, which is like a
hook at the anterior end
Ancylostoma is slightly larger than
Necator, eggs have bluntly rounded
ends and a single thin transparent
hyaline shell
usually in tropical or subtropical
countries
Transmission: Infection is by penetration through blood-sucking nematodes: attach to the mucosa of the small Itch is known as "ground itch" or "dew itch" ;
exposed skin, for Ancylostoma, it can also be intestine and copulate; female worms deposit eggs which are patients may suffer from IDA due to continuous
transmitted via oral route (eating raw vegetables then passed out with human feces blood loss ; here in the Philippines, 97% of
contaminated with larvae or by ingestion of raw hookworm infection is Necator while
infected meat, transmammary transmission Eggs hatch in soil--> into a rhabtidiform larva which is then Ancylostoma would account for 1%. The
transformed into filariform larva, penetrates the skin, enter remaining 2% is composed of mixed infections ;
Diagnosis: Direct Fecal Smear, Kato technique or venules and migrate to the heart and into the alveoli of the lungs, Ancylostoma ca also affect other species:
Kato-Katz, Concentration methods like ZnSO4 larva then ascends to the trachea where it is swallowed passing Ancylostoma braziliense (cat hookworm),
centrifugal flotation and formalin-ether down to the small intestine ; penetration through the skin Ancylostoma caninum (dog hookworm)
concentration method, culture methods lie Harada- produces maculopapular lesions and localized erythema, Itching
Mori ; is often severe, there may be pneumonitis, bronchitis, abdominal
pain, steatorrhea, bloody diarrhea,
Treatment: Mebendazole, Albendazole (DOC)

b. Hookworms: Necator
americanus, Ancylostoma
duodenale

Page 13 of 25
 Trichuris trichiura eggs are 50-55
micrometers by 20-25 micrometers. They
are barrel-shaped, thick-shelled and
possess a pair of polar “plugs” at each end.
; Adult males of Trichuris trichiura are 30-
45 millimeters long, with a coiled posterior
end. Adult females are 35-50 millimeters
with a straight posterior end. Both sexes
have a long, whip-like anterior end.
have an attenuated anterior 3/5 I: embryonated eggs D:
traversed by a narrow esophagus unembryonated egg ;
resembling a string of beads, egg is D: human
lemon-shaped with plug-like
translucent polar prominences,
"barrel-shaped" eggs with bipolar
plugs ; occur in both temperate (20-
30%) and tropical countries (60-85%)
Fecal-Oral route ; Direct Fecal Smear, Kato thick
smear, Kato-Katz technique (for egg counting and
egg reduction rate), concentrations methods such
as acid-ether and formalin-ether ; Mebendazole
(DOC), Albendazole, Ivermectin +/- Albendazole
Inhabit the large intestines, deeply embedded in the cecum, the
infective eggs go to the small intestine and undergo four larval
stages to become adult worms ; cause petechial hemorrhages
which may predispose to amebic dysentery because ulcers
provide a site for E. histolytica invasion, there may be rectal
prolapse, severe diarrhea in heavy infection that may be blood-
streaked, abdominal pain, nausea, vomiting, anemia, weight loss
Whipworm, frequently observed to occur
together with Ascaris, distribution and
prevalence are co-extensive with that of A.
lumbricoides, unlike ascaris, there is NO heart-
lung-migration ; mass treatment may be
indicated if infection rates is higher than 50%,
periodic mass treatment may be necessary due
to reinfection

c. Trichuris trichiura
Eggs: measure 50-60 micrometer by 20-30 meromyarian, adult worms hasve I: egg D:adult worm or Transmission: route of infection is through the males are rarely seen because they usually die after copulation, Human Pinworm / Enterobiasis / Oxyuriasis
micrometer , are elongate-oval and slightly cuticular alar expansions at the egg in perianal folds ; mouth, the respiratory system (inhalation of dust adult worms found in the lower ileum and cecum, gravid female ; characterized by perianal itching ; termed
flattened on one side. ; anterior end and a prominent D: human containing Enterobius eggs) and through the anus worms migrate down the intestinal tract and exit through the familial diasease because it easily spreads
posterior esophageal bulb, eggs are (retroinfection when they go back to the large anus to deposit eggs on the perianal skin, after deposition, the within the family ; second dose may be may be
Adult males of Enterobius vermicularis asymmetrical with one side flattened intestines ; female dies ; mild catarrhal inflammation of the intestinal necessary due to high reinfection rates ; the
measure up to 2.5 mm long by 0.1-0.2 mm and the other side convex ; 208.8M mucosa, mechanical irritation and secondary bacterial invasion, only intestinal nematode that cannot be
wide; adult females measure 8-13 mm long infected, female>male Diagnosis: adult worm or egg on microscopic intense itching, insomnia due to pruritus ; complications include controlled through sanitary disposal of human
by 0.3-0.5 mm wide. examinations, may be seen in the feces or perianal appendicitis, vaginitis, endometritis, salpingitis and peritonitis ; feces because eggs are deposited in the perianal
regions, Graham's scotch adhesive tape swab eggs can be collected from the fingertips and under the region
Adult males have a blunt posterior end (greatest number of eggs seen) ; fingernails of schoolchildren, female worms migrate to the
with a single spicule; females possess a perianal area even during daytime but more migration occurs in
long pointed tail. In both sexes, there are Treatment: Pyrantel Pamoate (DOC), the evening hours
cephalic expansions. Albenadazole, Mebendazole, cure may be
considered only after seven perineal smears are
negative

d. Enterobius vermicularis

Page 14 of 25
 First-stage rhabditiform larvae (L1): short short buccal cavity has four indistinct I: filariform larva D:
buccal canal, a rhabditoid esophagus and a lips
prominent genital primordium
Infective, third-stage filariform larvae (L3):
notched tail and the esophagus to intestine
ratio is 1:1.
Transmission: penetration of skin ; free-living forms are found in the soil ; from the skin, it enters the the only species naturally pathogenic to
Rhabtidiform larvae ; circulation, pass through the lungs and migrate to the larynx humans, more of a fecally transmitted worm
D: human Diagnosis: repeated concentration techniques such where they are subsequently swallowed ; greatest numbers are rather than soil-transmitted helminth ;
as Harada-Mori culture and Baermann funnel, found in the duodenal and jejunal regions ; autoinfection occurs disseminated infection occurs among patients
Beale's string test, duodenal aspiration, small bowel when rhabditiform larva pass down the large intestine and with immunocompromised patients ; serology
biopsy, larvae in sputum or urine develop into filariform larva ; erythema and pruritic elevated may not be useful in filaria endemic areas since
hemorrhagic papules, lobar pneumonia with hemorrhage, there are cross-reactions between Strongyloides
Treatment: Albendazole (egg reduction rate cannot intractable painless intermittent diarrhea (Cochin China diarrhea) and filarial worm
be determined because eggs are not passed out in
the feces but are ovideposited in the intestine and
other tissue of the host)

e. Strongyloides stercoralis
Eggs: have two inconspicuous polar
prominences and a striated shell.
Adult males are shorter than adult females stichosome
in length.
Females may contain embryonated or
unembryonated eggs in utero.
the esophagus has rows of secretory
cells called stichocytes and the entire
esophageal stucture is called a
Eggs: peanut-shaped with striated
shells and flattened bipolar plugs
I: larvae D: adult worm Transmission: ingestion of uncooked small
or unembryonated egg freshwater/brackish water fish "Bagsit" ;
; I: migratory fish-
eating birds D: human Diagnosis: Direct Fecal Smear, stool concentrations
methods, duodenal aspiration
Treatment: Mebendazole, Albendazole (DOC)
because it can destroy larval stage more than
mebendazole, electrolyte replacement and high-
protein diet
characterized with abdominal pain, chronic diarrhea, gurgling
stomach (borborygmus), weight loss, anorexia, severe protein-
losing enteropathy, malabsorption of fats and sugars, decreased
excretion of xylose, Hypokalemia and high levels of IgE ; flattened
and denuded villi and dilated muscoal glands, lamina propria is
infiltrated with plama cells, lymphocytes, macrophages and
neutrophils
parasites do not invade intestinal tissue but
they are responsible for micro-ulcers in the
epithelium and the compressive degeneration
and mechanical compression of cells, the
ulcerative and degenerative lesions in the
intestinal mucosa may account for
malabsorption of fluid, protein and electrolytes

f. Capillaria philippinensis

Page 15 of 25
2. Blood and Tissue Nematodes
The microfilaria of Wuchereria bancrofti
are sheathed. They have a gently curved
body, and a tail that is tapered to a point.
The nuclear column (the cells that
constitute the body of the microfilaria) is
loosely packed
Adults of Wuchereria bancrofti are long
and threadlike.
a. Wuchereria bancrofti,
Brugia malayi
third stage (L3), infective larva: terminal
projection on the tip of the tail which is
characteristic of A. cantonensis.
b. Angiostrongylus
cantonensis
creamy, white, long, filiform in shape I: microfilariae D:
, microfilariae appear as minute snake- microfilariae; D:
like organisms constanty moving human, cat is a
around the RBCs, when stained, the reservoir host
central axis shows dark staining nuclei
which serves as an important
identifying feature ; affects 120M
worldwide, adult > children, male >
female
pale and filiform, well-developed I: third larval stage D:
caudal bursa which is kidney-shaped larvae ; I: slugs and
and single-lobed, uterine tubules of snails D: human
female worms wound spirally around
the intestine "Barber's pole" pattern
Transmission: bite of mosquito (Aedes, Culex,
Anopheles sp. for Wuchereria ; Mansonia sp. for
Brugia ; all are night biters) infected with
microfilariae ;
Diagnosis: wet smears, thick blood smears taken
between 8pm-4am (due to nocturnal periodicity),
DEC provocative test to allow blood smear
collection even in daytime, antigen detection
techniques (circulating filarial antigens) such as
simpel card test, PCR, UTZ may demonstrate live
worms in the lymphatics, contrast
lymphangiography, lymphscintigraphy using
radiolabeled albumin or dextran ;
Treatment: Diethylcarbamazine (DOC),
Ivermectin, DEC +/- Ivermectin or Albendazole, for
acute attacks, the initial step is to relieve the pain
(clean cloth soaked in cools water, elevate and rest
legs), surgical drainage of hydrocoele
transmitted via ingestion (eating mollusks, leafy
vegetables contaminated with mucus secretion of
the mollusk, freshwater crabs or prawns,
contaminated water) or active penetration, when
rats or humans ingest infected mollusks ;
Diagnosed by CSF eosinophilia of greater than 10%, enter the circulatory system and migrate to the brain or spinal
CSF protein mildly elevated but CSF glucose is
normal, CT Scan (to exclude neurocysticercosis) ;
NO ANTHELMINTIC TREATMENT IS RECOMMENDED paralysis, low-grade fever ; may cause intraocular hemorrhage,
AT PRESENT but Mebendazole, Albendazole,
Thiabendazole and Ivermectin were successful in
animal studies, analgesics for pain, removal of 10ml
CSF at frequent intervals to relieve headache,
Prednisone 30mg daily, surgical removal of the
worm when it is lodged in the anterior chamber of
the eye
Page 16 of 25
worms are found tightly coiled in nodular dilatations in lymph
vessels and in sinuses of lymph glands (usually in the lower
extremities, inguinal lymph nodes, epididymis of the males, labial
glands of females), female worms produce microfilariae which
gain entrance to the blood where they are picked up by a
mosquito during a blood meal ; selectively induce CD4+
lymphocyte apoptosis, which may contribute to immune
unresponsiveness to filariasis ; SSx include fever, lymphadenitis,
funiculitis, swelling of arms and legs, edema ; there is also a
chronic proliferative overgrowth of fibrous tissue around the
dead worms, ADL / adenolymphangitis or DLA /
dermatolymphangioadenitis (sensitization to the products of
living or dead worms)
causes eosinic meningoencephalitis in man ; adult worms live in
two main branches of the pulmonary arteries of the rat, lay eggs
in the smaller vessels of the lungs, hatch larvae and then enter
the respiratory tract and migrate up to the trachea where they
are swallowed and eventually expelled in the feces of the rat ;
larvae pass through the stomach into the intestine and then
cord, they may also migrate to the eye ; SSx include severe
intermittent occipital or bitemporal headaches, stiffness of the
neck, weakness of the extremities, abdominal pain, facial
retinal detachment
lymphatic filariasis is one of the most
debilitating diseases (lymphedema,
elephantiasis or hydrocoele) plaguing most of
the tropical countries today, causes "Tropical
pulmonary eosinophilia" (characterized with
paroxysmal nocturnal cough, hyoereosinophilia,
high IgE titers, elevated ESR) , may also present
as "Expatriate Syndrome" which is
hyperresponsiveness to the mature or maturing
worms ; affected extremities should be elevated
at night and exercised regularly, and washed
twice daily to prevent secondary infection
rat lungworm ; infection is self-limiting ; Charcot-
Leyden crystals have been found in the
meninges ; snail species include the ff: Achatina
fulica (giant African snail), Hemiplecta
sagittifera, Helicostyla macrostoma, Vaginilus
plebeius, Veronicella altae ; anthelmintics not
usually neccessary because infection is self-
limiting and killing worms in the brain can cause
greater inflammatory reaction ; A. cantonensis
infections are predominantly cerebral, being
one of the most common causes of eosinophilic
meningitis, although developing but immature
adult worms can on occasion migrate to the
lungs. No A. cantonensis eggs or larvae have
been recognized in human tissues.
 larvae can be found encapsulated in
muscle tissue. Diagnosis is usually made
serologically or based on observation of
the larvae in muscle tissue following
biopsies or autopsies.
c. Trichinella spiralis
whitish in color ; occurs wherever
meat is a part of the diet
I: larvae D: larvae ; I: & Transmission: ingestion of undercooked meat ; infective larvae are usually encysted in the muscle fibers of the full recovery is expected since trichinosis is a
D: human, rats, dogs, host ; larvae upon ingestion excyst in the stomach or small self-limiting disease ; is primarily a zoonosis,
cats, pigs, bears, foxes, Diagnosis: larva in muscle biopsy (usually in intestine, then they burrow into the subepithelium of the villi human is the dead end infection for the
other acarnivores and pectoral, gluteus, deltoid, biceps and where they mature, adult worms mate and after fertilization, will parasite, usually maintained in a pig-to-pig or
omnivores gastrocnemius) , elevated creatine phosphokinase, produce eggs that grow into larvae, larvae penetrate the mucosa pig-to-rat-to-pig cycle ; meat should be cooked
lactate dehydrogenase and myokinase levels, blood through the lymphatics into the circulation and finally into at 77C temperature, or frozen to -15C to -30C to
eosinophilia, antibody titers, Bentonite flocculation striated muscles ; SSx include diarrhea/constipation, vomiting, kill the larvae, smoking, salting or drying meat is
test (BFT), Latex flocculation test (LFT), IFAT, ELISA, abdominal cramps, malaise, high remittent fever ; may cause not effective
Beck's xenodiagnosis ; splenomegaly, pericardial effusion, CHF, meningitis and cerebral
lesions
Treatment: SUPPORTIVE TREATMENT (analgesics,
antipyretics, bed rest), prednisone for severe cases,
Thiabendazole during the 1st week of infection
expels adult worm (but no effect on larvae),
Mebendazole is larvicidal
Page 17 of 25
CESTODE INFECTION
1. Intestinal Cestodes
Eggs: radially striated, internal oncosphere mature proglottids are square in
has six refractile hooks;
The scolex of T. saginata has four large
suckers but lacks the rostellum and
rostellar hooks.
The scolex of T. asiatica possesses
rudimentary hooklets in a wart-like
formation. ;
Adults can reach a length of 2-8 meters,
but the scolex is only 1-2 millimeters in
diameter.
shape and contain mature male and
female reproductive organs ;
Cysticercus is ovoid and milky white
I: Cysticercus bovis Transmission: ingestion of encysted larva from raw inhabits the upper jejunum, gravid proglottids undergo apolysis Beef tapeworm, cosmopolitan in distribution,
(larvae) D: eggs in the or improperly cooked beef ; and are either passed out with the feces or actively crawl out of adult worm seems to be irritated by alcohol and
stool ; D: human the bowel to the external environment, eggs are released and passage of proglottids sometimes happen after
Diagnosis: proglottids / eggs in feces, India Ink, remain viable in the soil for weeks, when cattles ingest Taenia a drinking bout
formalin-ether technique, perianal swab ; eggs, the oncosphere is released, oncosphere actively penetrates
the intestinal mucosa and enter venule to get to systmeic
Treatment: Praziquantel (DOC) , criteria for cure: circulation, it then enters a muscle fiber and develops into
recovery of scolex or a (-) stool exam 3months after Cysticercus bovis ; most common CC is passage of proglottids or
treatment segments in the stool, SSx include weight loss, epigastric pain,
pruritus ani, loss of appetite , proglottids are actively motile and
they may cause obstruction in the bile, pancreatic ducts and
appendix

a. Taenia saginata
The scolex of T. solium contains four large shorter than, has less proglottids than I: Cysticercus bovis Transmission: ngestion of improperly cooked eggs are ingested by hogs and oncospheres are released, inhabits Pork tapeworm, cosmopolitan in distribution,
suckers and a rostellum containing two and has smaller and more spherical (larvae) D: eggs in the infected meat, the larva is ingested and the scolex upper small intestines, proglottids are less active than T saginata infected meat is called "measly pork" ; Taenia
rows of large and small hooks. There are acetabula than T. saginata, has 4 stool ; I & D: human, attached to the intestinal mucosa ; , the oncosphere penetrates the intestinal mucosa to typically eggs are very resistant ; autoinfection is
usually 13 hooks of each size. ; acetabula , scolex carries a cushin-like pig, cattle, goat, wild encyst in muscles as Cysticercus cellulosae , commonly infected common ; neurocysticercosis is one of the most
rostellum with a double crown and boar & moonkeys,is Diagnosis: identifying proglottids eggs or scolex in are the muscles, tongue, heart, diaphragm, liver, spleen, serious zoonotic diseases worldwide ; In the
Gravid proglottids are longer than wide large & small hooks which are absent intermediate host the feces, CT scan, ophthalmoscopy, ELISA, Electro- mesentery ; SSx include non-specific abdominal pain but Philippines, T. saginata is more common than T.
and the two species, T. solium and T. in T. saginata , eggs are immuno transfer blot, western blot for antibodies, obstruction is not likely (because proglottids are not that active) ; solium ; freezing at -20oC for 10days kills the
saginata, differ in the number of primary indistinguishable from T. saginata , DOT ELISA ; Cysticerci are multiple and can develop in any organ or tissue, cysticercus
lateral uterine branches: T. solium contains mature cysticercus has scolex with 4 usually in the striated muscles , brain, eye heart, lungs and
7-13 lateral branches and T. saginata 12-30 suckers and a circlet of hooks, Treatment: Praziquantel (DOC), Niclosamide, peritoneum, cysts may survive up to 5yrs, most serious
lateral branches. Proglottids of T. asiatica Albendazole, Predinosolone, mannitol (for increaed manifestation is neurocysticercosis (focal neurologic deficits,
are similar to T. saginata and possess more intracranial pressure due to "tumor") , surgical generalized seizures, obstructive hydrocephalus, nausea,
than 12 primary uterine branches. removal vomiting) , (+) increased opening pressure, elevated protein,
decreased glucose and increase in mononuclear cells ;
ophthalmic SSx include intraorbital pain, photopsia, loss of vision,
may float freely in the vitreous and aqueos humor

b. Taenia solium

Page 18 of 25
 Eggs: oval and smaller than those of H.
diminuta,
- Inner membrane have two poles, from
which 4-8 polar filaments spread out
between the two membranes.
-The oncosphere has six hooks.
the oncosphere has a thin outer
membrane and a thic inner
membrane with conspicuous bipoar
thickenings, from each of which arise
4-8 hair-like polar filaments
embedded in the inner membrane ;
about 20M is infected
I: Cysticercoid larvae D: direct or indirect tranmission ; wet smears,
eggs in the stool ; I : concentration methods, proglottids are not
rice and flour beetles, recovered because they undergo degeneration prior
D: human to passage with stools ;
TreatmentPraziquantel (dose is higher because
cysticercoids are more resistant)
has a dual pathway, direct (host ingests eggs which hatch in the
duodenum) and indirect development (accidental ingestion of
infected arthopod intermediate hosts like the rice and flour
beetles) ; light worm burden is usually asymptomatic , SSx include
headcahe, dizziness, anorexia, pruritus of nose and and anus,
diarrhea, abdominal pain, pallor , heavy infections may cause
enteritis due to necrosis and desquamation of the intestinal
epitheliam cells , in time, immunity may limit or eventually clear
the H. nana population spontaneously
dwarf tapeworm, the only human tapeworm
which can complete its entire life cycle in a
single host (no need for an obligatory
intermediate host) ; a familial and institutional
infection common in orphanages, day care
centers and mental institutions

c. Hymenolepsis nana
These eggs are round or slightly oval, size eggs are bile-stained, NO BIPOLAR I: Cysticercoid larvae D: accidental ingestion of grain beetles infesting dried eggs when ingested by a wide range of adult and larval insects rat tapeworm, cosmopolitan in distribution ; in
70 - 85 µm X 60 - 80 µm, with a striated FILAMENTS, with hooklets with fan- eggs in the stool ; I : grians, dried fruits flour and cereals ; wet smear ; like fleas, beetles, cockroaches, mealworms and earwigs develop the Philippines, prevalence is only about 8%
outer membrane and a thin inner like arrangement insects, D: human Praziquantel into cysticercoid larvae
membrane. The space between the
membranes is smooth or faintly granular.
The oncosphere has six hooks. There are
no polar filaments extending into the
space between the oncosphere and the
outer shell. ; Proglottids of Hymenolepis
spp. Proglottids of Hymenolepis spp. are
craspedote; i.e. they overlap.

d. Hymenolepsis diminuta
Dipylidium caninum eggs are round to oval pale reddish adult worm with I: Cysticercoid D: Transmission: ingestion of infected insects ; larval fleas ingest the ova as they feed on epidermal debris ; common intestinal parasite of dogs and cats ;
and contain an oncosphere that has 6 proglottids are narrow with two sets proglottids in the stool when the insect is ingested by mammalian host (dog, cat, stool examination for the presence of egg
hooklets. of male and female reproductie ; I : flea D: dog & cats Diagnosis: wet smear of stool ; human), the cystocercoid is liberated and becomes an adult ; very capsules is not recommended since the gravid
organs and bilatera genital pores minimal SSx (slight intestinal discomfort, epigastric pain, proglottids do not disintegrate in the intestines
Proglottids: contains egg packets that are "Double-pored worm", egg is Treatment: Praziquantel diarrhea, anal pruritus and allergic reactions) but in the environment ; 5.19-36% of dogs in
round to ovoid and contain 5 to 15 or more spherical, thin-shaped with a Manila is infected but the dissection of fleas
eggs each. hexacanth embryo ; human infection only showed 2.4% prevalence ; intermediate
is rare hosts: Ctenocephalides canis (dog flea),
scolex: conical-shaped and has four Ctenophalides felis (cat flea), Pulex irritans
suckers. Retractable rostellum armed with (human flea), Trichodectes canis (dog louse)
several rings of small spines, used for
anchoring into the host's tissue.

e. Dipylidium caninum

Page 19 of 25
 for self study
f. Raillietina garrisoni
Diphyllobothrium spp. eggs are oval or
ellipsoidal and range in size from 55 to 75
µm by 40 to 50 µm. There is an operculum
at one end that can be inconspicuous, and
at the opposite (abopercular) end is a small
knob that can be barely discernible ; Close-
up of a few of the proglottids showing the
rosette-shaped uterus at the center of
each proglottid.
g. Diphyllobothrium latum
segments are motile, white, appears
like grain of rice ;
has two sucking grooves or bothria
located dorsally and ventrally ; Ova
are yellowish-brown with an
inconspicuous operculum, opposite
the operculum is a small knob-like
thickening
I: Cysticercoid larvae D: accidental ingestion of flour beetles ; wet smear of cysticeroid larva attaches to the intestinal villi to develop into a common tapeworm of rats ; a common
ova or proglottids in stool ; sometimes, the worm may be expelled by adults ; Direct infection does not occur if eggs are ingested by the intestinal cestode of rodents in the Philippines
the stool ; I : Tribolium child sponatenously without treatment ; mammalian host, therefore these is no autoinfection in H.
confusum (flour Praziquantel may be given to expel the worm diminuta infection ; Px are usually asymptomatic
beetle), D: human
I: procercoid larvae D: ingestion of fish infected with plerocercoid larvae The ova complete their development in water and release the one of the 13 species that infect human; "Fish
eggs in the stool ; I : by man, dog, cat or other mammals ; direct fecal free-swimming coracidium, a ciliated embryo, which is ingested tapeworm" or the "Broad tapeworm" ; compete
fish (perch, trout, smears suffice, Kato technique for demonstrating by freshwater copepods, the copepod is in turn ingested by fish, with VitB12 in the diet which may lead to
salmon, pike) D: human eggs ; Praziquantel (DOC) the procercoid larva migrates through fish tissue and develop megaloblastic anemia (vitamiin B12 content is
into a plerocercoid larva or "sparaganum" in themuscle and approximately 50times that of T. saginata ;
viscera ; Infected Px may show no signs of disease, SSx include although other mammalian host exist as
nervous disturbances, digestive disorders, abdominal discomfort, reservoir hosts, human is responsible for the
weight loss, weakness, anemia propagation of the infection in endemic areas
Page 20 of 25
2. Extraintestinal Cestodes
Eggs: radially-striated. The internal
oncosphere contains 6 refractile hooks
Higher magnification of the cyst showing
daughter cyst (brood capsule). Note the
hooklets (purple arrow) inside one of the
protoscoleces and the calcareous
corpuscles (light blue arrows) along the
germinal layer.
a. Echinococcus sp - E.
granulosus, E. multilocularis
for self study
b. Sparganosis - Spirometra
mansoni, S. erinacei, S.
ranarum
adut worm posseses a pyriform
scolex, short neck and three
proglottids, For E. multilocularis,
foxes are the natural definitive host
and small rodenst are the
intermediate hosts, humans may be
infected by eating raw plants
contaminated with feces of infected
dogs or rats
larvae are opaque, glistening white
I: egg D: eggs in the accidental ingestion of eggs, eggs may come from
stool, hydatid cyst ; I : soil or fur of dogs ; UTZ and history is highly
goat, horse camel, suggestive, serologic tests such as indirect
sheep, man D: dog hemagglutination (IHA), indirect fluorescent assay
(IFA), enzyme immunoassay (EIA), Echinococcus
antigens, ELISA ; surgical resection is still the Tx
of choice for echinococcosis, instilling scolicidal
agent such as hibitane, 95% ethanol or 30%
hypertonic saline solution, endoscopic
sphincteretomy is Tx of choice for hydatid cysts that
have ruptured into the biliary tract and causes
obstructive jaundice ; For inoperable cases and post
surgery, Albendazole, PAIR technique (Puncture,
Aspirate, Injection, Reaspiration), Cyclosporin A
I: Plerocercoid larvae drinking water containing Cyclops or copepods
D: eggs in the stool ; I : infected with procercoid larvae, eating infected
frogs, toads, snakes, D: intermediate hosts such as frogs, toads or snakes
dogs, cats and other containing plerocercoid larvae, applying
carnivores plerocercoid infected flesh of frogs and snakes as
poultices in sores of the eyes, vagina or skin leading
to penetration of cutaneous tissue, consumption of
infected flesh of paratenic hosts like wild pigs ; Dx is
by finding white larvae in the lesion ; Tx of choice is
surgica removal of plerocercoid
Page 21 of 25
adult worms inhabit the small intestines of dogs, eggs are E. granulosus (unilocular cystic echinococcus), E.
swallowed by intermediate host and hatch in the duodenum, multilocularis (alveolar echinococcus) , E,
oncosphere penetrate the intestinal wall and migrate into multilocularis is less common ; Hydatid sand
mesenteric venules which lead them to lodge in various organs refers to protoscolices and brood capsules in
and tissues, the larval stage is called Hydatid cyst, once inside the the cyst ;
definitive host the protoscolices evaginate, attach to the
intestinal wall and develop into adults which reside in the small
intestines of the host (where they release eggs) ; organs most
commonly involved are the liver, lungs, brain and orbit ; causes
down regulation of the inflammatory cytokine leading to local
immunosuppression ; hepatic cyst are mostly found in the
Inferior right lobe and may cause obstructive jaundice, cyst may
rupture from coughing, muscle strain etc and may metastasize
and reach other tissues to develop into secondary cysts ; SSx
include intermittent jaundice, fever, eosinophilia, inc ICP and
Jacksonian epilepsy, hematuria, kidney dysfunction ; may lead to
pyogenic abscess formation, intrabiliary rupture of the cyst is the
most common complication
most are found in the eyes, subcutaneous and muscular tissues Infection is prevented by drinking boiled or
of the thorax, abdomen, thigh, inguinal region and in the viscera ; filtered water and by cooking meat thoroughly
SSx may be painful edema due to migrating larvae
TREMATODE INFECTION
1. Blood Flukes
Schistosoma japonicum: eggs can be ovoidal, rounded or pear-
- eggs: large and more rounded shaped, are pale yellow with a curved
- spine: smaller and less conspicuous hook or spine near one of the polar
ends ; unlike other trematodes,
Schistosoma mansoni: schistosomes have separate sexes,
- eggs:characteristic shape, with a with large sucker anteriorly, a ventral
prominent lateral spine near the posterior sucker and a gonophore (suckers aid
end. The anterior end is tapered and in movement and help flukes
slightly curved maintain their position inside the
veins ; has incomplete digestive
Schistosoma haematobium: system ad excretory system made up
- large and bear a conspicuous terminal of flame cells ; In the Philippines, the
spine. total exposed population is
approximately 6.8M, highest
prevalence is among 5-15y.o., mean
prevalence is 4.4%
I: cercariae D: eggs in Transmission: skin penetration by free-swimming adult worms are primarily parasites of the portal vein and its Oriental lung fluke, endemic in China,
the stool ; I : cercariae ; branches, Eggs deposited in mucosal or sub-mucosal terminal Philippines and Indonesia, has a wide range of
Oncomelania snails, veins or capillaries escape through ulcerations into the intestinal definitive host ; there is evidence that
man D: dog, pig, cat, Diagnosis: rectal or liver biopsy, Merthiolate-iodine- lumen and subsequently exported with feces, once schistosomule escape from the lungs into the
carabaos, cows, formalin concentration technique, Kato-Katz embryonated, egg comes in contact with freshwater, hatches and pleural cavity and pass through the diaphragm
rodents, monkey technique, ELISA, intradermal test for immediate liberates a free-swimming ciliated larva called a miracidium, the into the liver to reach the portal vein ; cercariea
hypersensitivity using worm extracts, indirect miracidium infect the snail Oncomelania hupensis quadrasi and are most abundant in the field during the early
hemagglutination using worm antigens, circumoval develop into sporocysts which will later develop into cercariae, part of the night ; organs usually affected are
precipitin test (COPT) - method of choice in the the cercariae leave the snail host and become free-swimming in the liver, lungs and intestines ; eggs are not
Philippines ; the water, cercariae are transformed into schistosomula after demonstrable in the feces
skin penetration and find entry into superficial lymphatic vessels
Treatment: Praziquantel or subcutaneous veins to reach the lungs, from the lungs the
schistosomule migrates intravascularly to reach the portal vein
where they mature ; worms ingest RBCs and possess a protease
(hemoglobinase) that breaks down globulin and hemoglobin ; SSx
include dermatitis, superficial lung petechiae, fulminating
meningoencephalitis with fever, headache, coma, confusion ;
may cause pneumonitis, hepatosplenic disease, cor pulmonale

a. Schistosoma japonicum , S.
Mansoni, S. haematobium
Paragonimus westermani eggs range from
80-120 µm long by 45-70 µm wide. They
are yellow-brown, ovoid or elongate, with
a thick shell, and often asymmetrical with
one end slightly flattened. At the large end,
the operculum is clearly visible. The
opposite (abopercular) end is thickened. ;
Adults of Paragonimus spp. are large,
robust, ovoid flukes. They are
hermaphroditic, with a lobed ovary located
anterior to two branching testes. Like all
members of the Trematoda, they possess
oral and ventral suckers.
Other species include P.
philippinensis and P. siamensis ;
reddish brown worm which
resembles a coffee bean ; egg is oval,
yellowish-brown, thick-shelled ; adult
worms are found in pairs or in threes
in fibrotic capsules or cysts in the
lungs of the host ; 20.7M are infected,
I: metacercariae D: ingestion or raw or insufficiently cooked crabs with
unembryonated eggs in metacercariae ; Solitary nodular lesions may mimic
the sputum or stool; I : CA and fungal diseases on CXR, (+) ring-shadowed
1st- snail, 2nd- crab D: opacity comprising several contiguous cavities that
human give the appearance of a bunch of grapes,
intradermal test with antigen (does not
differentiate between present and past infections),
serology such as complement fixation, enzyme
immunoassay (EIA), immunoblot (IB) ; Praziquantel,
corticosteroids in Px with cerebral involvement,
Bithionol, Triclabendazole
SSx include cough, hemoptysis consistent with PTB, bloodstained
or rust-colored sputum with foul fish odor, low-grade fever,
fatigue, myalgia ; they escape into the respiratory tract where
they are moved out by the ciliary epithelium and move along
with exudates, they are either coughed out or swallowed into the
alimentary canal to be passed out with feces ; traverses the
intestinal wall into the peritoneal cavity, migrates through the
diaphragm to the lungs where it matures, provoke a
granulomatous reaction that gradually proceeds to the
development of fibrotic encapsulation ; cerebral involvement is
the most serious complication (Jacksonian epilepsy, cerebral
hemorrhage, meningitis)
lung fluke disease, pulmonary distiomiasis,
endemic hemoptysis or parasitic hemoptysis,
"oriental lung fluke" ; first intermediate snail
(Antemelania asperata, A. dactylus formerly
known as Brotia asperata), second intermediate
host is the mountain crab (Sundathelphusa
philippina formerly known as Parathelphusa
grapsoides) ; worms may persist for up to 20yrs
; is a zoonotic disease of carnivorous animals

b. Paragonimus westermani

Page 22 of 25
2. Intestinal Flukes
Eggs: broadly ellipsoidal, operculated,
unembryonated when passed in feces.
Fasciola hepatica: abopercular end has a
roughened or irregular area.
a. Fascilopsis buski
for self study
b. Echinostoma ilocanum,
Artyfechinostomum
malayanum
Adults of Heterophyes heterophyes are
minute flukes, measuring 1-2 mm in
length. The tests are large and paired, and
are situated near a small ovary. The
surface of the worm is covered with
minute spines.
c. Heterophyid flukes -
Heterophyes heterophyes
endemic in countries in SE asia, China, I: metacercarie D: eggs Transmission: ingestion of encysted metacercaria
Korea and India
E. ilocanum worm is reddish-gray
while its egg is straw-colored, A.
malayanum egg is larger and is golden
brown in color
egg is light-brown in color ;
worldwide distribution may be due to
the fact that heterophyids have
adapted to snails belonging to various
families and are not specific to their
secondary intermediate host
adult worm lives in the duodenum attached to the intestinal
in the stool ; I : 1st-snail on aquatic plants or when the hull or skin of fruits mucosa by its suckers, eggs are released together with feces into
2nd-aquatic plants D: of these plants is peeled off between the teeth ; the water, it embryonates in water, gives rise to a miracidium ;
pigs and human inside the snail, the miracidium transforms into a sporocyst,
Diagnosis: fecal smear which subsequently produces rediae and then to a cercarie,
cercariae emerge from the snails into water the attaches and
Treatment: Praziquantel encyst a metacercarie on the surfaces of seed pods, bulbs, stems
or roots of various aquatic plants ; inflammation and ulceration
occur at the site worm attachment leading to increased mucus
secretion, bleeding, gland abscesses and intestinal obstruction ;
SSx include generalized toxic and allergic symptoms
I: metacercariae D: ingestion of metacercariae encysted snails ; fecal adult worm lives in the small intestines of the definitive host ;
eggs in the stool ; I : 1st- smear ; Praziquantel ; the rat is an important immature eggs are released by the parasite and transported to
2nd-snails D: dog, reservoir host for echinostomes the environment through the feces, the eggs mature in water and
human, rat, cat, pig a miracidium hatches from the egg to infect the 1st snail
intermediate host,it then develops into a rediae and then into a
cercariae, after escaping the snails, the cercariae swims in water
to infect the second snail intermediate and transforms into a
metacercariae ; causes ulceration and consequently diarrhea
(sometimes bloody) and abdominal pain
I: metacercariea D: Ingestion of metacercariae encysted in fish ; Kato- eggs are produced and passed out into the environment together
eggs in the stool ; I : 1st- katz technique, Praziquantel with feces, miracidium hatches when the egg is ingested by the
snail, 2nd-fish D: first snail intermediate host and transforms into a sporocyst
human which the develops into cercariae, cercariae encyst as
metacercariae on or under the scales, fins, tails, or gills of the fish
; there is inflammation at the site where the worm is attached or
burrowed in the mucosa, excessive mucus production and
sloughing off of the superficial layers may occur, PUD or APD
(upper abdominal discomfort, gurgling abdomen, colicky
abdominal pain, mucoid diarrhea)
Page 23 of 25
first intermediate host is the snail belonging to
the genus Segmentina or Hippeutis, second
intermediate host such as Trapa bicornis (water
caltrop), Eliocharis tuberosa (water chestnut),
Ipomea obscura (water morning glory) and
Nymphaea lotus (lotus)
Intermediate hosts for E. ilocanum: first
intermediate host is the snail (Gyraulus
convexiusculus, Hippeutis umbilicalis), second
intermediate host (Pila luzonica or kuhol and
Vivipara angularis or susong pampang) ;
Intermediate hosts for A. malayanum: first
intermediate is unknown while second snail
host is Lymnaea cumingiana or birabid
snail intermediate host of H. taichui and
Procerovum calderoni are the brackish water
snails, Melania juncea and Thiara riquetti,
second intermediate host atre fishes (30
different species)
2. Liver Flukes
Eggs: broadly ellipsoidal, operculated,
unembryonated when passed in feces
Adult: anterior end is cone-shaped, unlike ("shoulder"), F. giganitica is longer
the rounded anterior end of Fasciolopsis
buski.
Fasciola worm has a characteristic
cephalic cone which has a marked
widening at the base of the cone
and its shoulders less developed F.
gigantica egg is also bigger affects
2.4M individuals
I: metacercariae D: Transmission: ingestion of metacercariae encysted
eggs in the stool ; I : 1st- in edible aquatic plants or by drinking water with
snail 2nd- aquatic floating metacercarie ;
plants D: sheep, human
Diagnosis: fecal smear or demonstration of eggs in
different samples such as duodenal contents and
bile, PCR-restriction fragment length polymorphism
(RFLP) assay ;
Treatment: Bithionol, Triclabendazole
the fluke penetrates the intestinal wall to reach the peritoneal
cavity where it wanders until it reaches the liver capsule, the
parasite then burrows through the liver parenchyma, and enters
the bile ducts where it becomes sexually mature, inside the snail,
the miracidium develops into a sporocyst to produce a cercariea,
it the escapes the snail and swims freely in water to encyst in
surfaces of the aquatic plants forming a metacercariae ; can be
asymptomatic, SSx include RUQ pain, sundden high fever,
hepatomegaly ; the acute phase corresponds to the migration of
the juvenile parasite from intestine to the liver while the chronic
phase is asymptomatic and corresponds to the period when the
parasite has already reached the biled ducts, can cause
obstruction leading to inflammation and subsequently fibrosis ;
complications include atrophy of the liver, periductal cirrhosis,
abscess formation, hemobilia etc
F. hepatica is the temparate liver fluke or sheep
liver fluke while F. gigantica is the tropical liver
fluke ; In tropical countries, fascioliasis is
considered the ost important helminth infection
of cattle with reported prevalence of 30-90% ;
lives for 9-13years ; first intermediate host:
snail (from the Lymnaedia family such as
Lymnaea philippinensis, L. auricularia
rubiginosa), second intermediate host: aquatic
plants (Ipomea obsucra or kangkong and
Nasturtium officinale or water cress

a. Fasciola hepatica ; Fasciola

gigantica
Clonorchis sinensis eggs:
- small, oval shaped with a convex
operculum, that rests on visible
"shoulders" at the smaller end of the egg.
At the opposite (larger, abopercular) end, a
small knob or hooklike protrusion is often
visible.
- miracidium is visible inside the egg. ;
Clonorchi sinensis adults:
- flattened, hermaphroditic, with a single
ovary situated anterior to two branches
testes. ;
adult worms are leaf-like in shape
with transparent tegument ; affects
30M people, male > female, adults
more tha children
I: metacercariae D: ingestion of metacercarie in infected undercooked
eggs in the stool ; I : 1st- or raw fish and in salted dried or pickled fresh water
snail, 2nd-fish D: dog, fish ; fecal smear, Potassium permanganate smear
cat, pig (will show distinct melon-like ridges in the surface
of O. viverrini eggs), Phosphoglycerate kinase (PGK),
ELISA, Enzyme immunoassay (EIA), determination of
IgM antibodies, PCR ; Praziquantel, Albendazole
metacercariae excysts in the duodenum and moves through the
ampulla of vater to the common bile duct and then to distal
biliary capillaries where it matures into adult worms, egg escapes
into the environment via the feces ; upon enrty into the snail
host, miracidium transform into a sporocyst which then produces
cercariae which is released in water to infect freshwater fishes ;
causes wall of the ducts to become thickened and dilate 2-3x its
normal diameter, causes periductal fibrosis, cirrhosis and portal
hypertension, SSx include chills, fever enlargement with
tenderness of the liver
First intermediate host is the snail of C. sinensis
belong to the genera Parafossarulus (P.
manchouricus, P. anomaliospiralis, P. stratulus),
Bulimus (B. striatulus), Semisulcospira, Alocinma
(A. longicornis), Thiara (T, granifera) and
Melanoides (M. tuberculatus) , 1st intermediate
host for Opistotorchis flukes is under the genus
Bithynia snails ; Second intermediate hosts are
Freshwater fishes under Cyprinidae family ;
infection is related to the carcinoma of the liver
and adenoCA of the gallbladder

Eggs of Opisthorchis spp: often

indistinguishable from the eggs of
Clonorchis sinensis.

Adults of Opisthorchis spp:

- similar to, but often smaller than
Clonorchis sinensis
- differ from adults of Clonorchis in the
shape of the testes
- differ in distribution of the vitelline
glands
- ventral sucker (acetabulum) smaller than
b. Clonorchis sinensis,
the oral sucker.
Opistorchis felineus,
Opistorchis viverrini

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* GA: Golgi Apparatus ; RER: Rough Endoplasmic Reticulum ; Asx: Asymptomatic ; Troph: Trophozoite ; ADCC: antibody dependent cell cytotoxicity ; DxOC: Diagnostic of choice ; SI: Small intestine
IFA: Indirect Fluorescence antibody test

** In general, almost all parasitic infections are associated with poor sanitation and crowded areas

FOR BETTER RESOLUTION OF PICTURES PLS REFER TO THIS LINK: https://www.cdc.gov/dpdx/az.html

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