Case Study 1

St.
Paul University Philippines

Tuguegarao City, Cagayan 3500
School of Nursing and Allied Health Sciences
Department of Medical Technology
CASE STUDY
REQUIREMENTS IN
MTE 115: CLINICAL
PARASITOLOGY
07.27.2020
SUBMITTED TO: MS. RICHELLE SALES, RMT

INSTRUCTOR
SUBMITTED BY: NICOLAS, SHARMAINE MAE B.

BSMT 2B
St. Paul University Philippines
ACTIVITY NUMBER1
BASED ON YOUR OUTLINES AND READINGS ANSWER BRIEFLY AND CONSISELY THE FOLLOWING
QUESTIONS.
CASE STUDY 1: A patient is suspected of having amoebic dysentery. Upon microscopic

examination of the fresh specimen, the following data were obtained: Atrophozoiteof25um
Progressive unidirectional crawl evenly distributed peripheral chromatin finely granular
cytoplasm.
1. Identify the parasite.

 The patient is infected with Entamoeba histolytica.
2. How can the diagnosis be established?

 The diagnosis of E. histolytica infection may be accomplished by standard and
alternative methods include Microscopic detection, Concentration technique
(FECT and MIFC), Stool culture using Robinson’s and Inoki medium, PCR, ELISA
and isoenzyme Analysis, and Radiographic studies
3. How does infection of this parasite occur?

 Infection by Entamoeba histolytica occurs by ingestion of mature cysts in fecally
contaminated food, water, or hands. Excystation occurs in the small intestine
and trophozoites are released, which migrate to the large intestine. In addition,
E. histolytica may also transferred via unprotected sex. Flies and cockroaches
may also serve as vector of E. histolytica by depositing infective stage on
unprotected food.
4. Discuss the epidemiology of this parasitic infection?

 Entamoeba histolytica infection occurs in as many as 10% of the world’s
population. However, with the recent redescription into three different species:
the pathogenic E.histolytica, and the commensals, E. dispar and E. moshkovskii,
the true prevalence of amebiasis is approximately 1 to 5% worldwide. There are
50 million E. histolytica infection cases, and 40,000 to 100,000 deaths due to

amebiasis in the world per year. Thus, it is considered a leading cause of parasitic
deaths after only malaria and schistosomiasis. In addition to thriving in
subtropical and tropical areas of the world, this parasite exists in colder climates,
such as Alaska, Russia, and Canada. Amebic infection is prevalent in the Indian
subcontinent, Africa, East Asia, and South and Central America. In developing
countries, prevalence depends on the level of sanitation, crowding, socio-
economic status, cultural habits, and age. In developed countries, infection is
usually by the E.dispar, and is prevalent in certain groups: immigrants, travelers
from endemic countries, homosexual males, HIV patients, and institutionalized
people. Human are the major reservoirs of infection with E. histolytica. Ingestion
of food and drink contaminated with E. histolytica cysts from human feces, and
direct fecal-oral contact are the most common means of infection.
CASESTUDY2: A middle aged man was rushed to a hospital due to fever and shortness of
breath. It was seen in his X-ray result that he suffers from cardiomegaly. CBC smear results
revealed rare C-shaped trypomastigote forms. A patient history study revealed that he served
as a military personnel years ago and was destined in the Panama Canal Zone.
1. . What parasitic infection is he likely to have and why?

 The patient is infected by the Trypanosoma cruzi. Trypanosoma cruzi is
commonly referred to as Chagas’ disease. It is can be divided into an acute and
chronic phase. The chronic phase is manifested in fibrotic reactions that cause
injury to the myocardium, cardiac conduction network and enteric nervous
system. The heart is the primary organ affected during this phase, which may
result cardiomegaly, congestive heart failure, thromboembolism, and even
arrhythmias.
2. What is the infective stage and diagnostic stage of the parasite?

 Infective stage- An infected triatomine insect vector (or “kissing” bug) takes a
blood meal and releases trypomastigotes in its feces near the site of the bite
wound. Trypomastigotes enter the host through the bite wound or intact
mucosal membranes, such as the conjunctiva. Inside the host, the
trypomastigotes invade cells near the site of inoculation, where they
differentiate into intracellular amastigotes.
 Diagnostic stage- Trypomastigotes infect cells from a variety of tissues and
transform into intracellular amastigotes in new infection sites. Clinical
manifestations can result from this infective cycle. The bloodstream
trypomastigotes do not replicate (different from the African trypanosomes).
Replication resumes only when the parasites enter another cell or are ingested
by another vector. The “kissing” bug becomes infected by feeding on human or
animal blood that contains circulating parasites.
3. Explain the pathogenesis and clinical manifestation of this infection

 -Chagas disease can be divided into an acute and a chronic phase. The acute
phase is characterized by a focal or diffuse inflammation mainly affecting the
myocardium. Non- specific signs and symptoms, such as fever, malaise, nausea,
vomiting, and generalized lymphadenopathy often accompany the acute phase.
Cutaneous manifestations of the disease can sometimes appear during this
phase, usually associated with a localized inflammatory reaction at or near the
site of inoculation. Chagomas are furuncle-like lesions associated with
induration, central edema, and regional lymphadenopathy. These lesions
represent the site of entry of the parasite. If the parasite penetrates through the
conjunctiva, eyelid swelling called Romaña’s sign may form. This lesion is
characterized by unilateral painless bipalpebral edema and conjunctivitis, and
may involve the lacrimal gland and surrounding lymph nodes. After 1 or 2
months, symptoms resolve, and the patient goes into a latent or indeterminate,
but usually asymptomatic phase. During this phase, patients infected with T.
cruzi are still capable of transmitting it to others through insect vectors, blood
transfusion, or organ transplantation. The pathophysiology of the chronic phase
of the disease was initially thought to be autoimmune in nature; however, this is
controversial. Newer evidence shows that chronic Chagas disease is
multifactorial, and dependent on the interaction between parasite and host.
Nonetheless, the chronic phase is manifested by fibrotic reactions that cause

injury to the myocardium, cardiac conduction network, and enteric nervous
system (decrease in nerve ganglia leading to megasyndromes). The heart is the
primary organ affected during this phase, which may result in cardiomegaly,
congestive heart failure, thromboembolism, and even arrhythmias. Less severe
signs and symptoms associated with the chronic phase of the disease include
chest pain, palpitations, dizziness, syncopal episodes, abnormal
electrocardiogram findings, achalasia associated with megaesophagus, and
chronic constipation associated with megacolon. About one-third of patients in
the latent stage develop some manifestation of chronic Chagas disease after
several years or decades. The majority of symptomatic, chronic patients manifest
with the cardiac form, while the rest develop the gastrointestinal form.
4. What control measures are available to prevent its transmission?
 Vector control and blood transfusion regulations

 Spraying of insecticides, use of insecticide-treated bed nets,
 House improvements to prevent vector infestation have been proven cost-effective.
 Educational programs designed to inform people, especially in endemic areas its
transmission and possible reservoir host.
CASE STUDY 3: A patient who wore contact lenses for an extended period of time complained
to an ophthalmologists about increasing irritation of the eye. The physician sent the patient’s
contact lenses cleaning solution to a laboratory. A wet mount revealed many amoeboid
organisms.
1. Identify the parasite.

 Acanthamoeba species
2. Describe the clinical manifestations of this infection and how will you treat it?
 The patient is infected by the Acanthamoeba species which is an aquatic
organism that is found in a myriad of natural and artificial environments, and can
survive even in contact lens cleaning solution. This parasite have two
pathogenesis, Acanthameoba keratitis and the granulomatous amebic
encephalitis. The situation above the patient had the condition of Acanthmoeba
keratitis, it is associated with the use of improperly disinfected soft contact
lenses, particularly those which are rinsed with tap water or contaminated lens
solution. Symptoms of AK include severe ocular pain and blurring of vision.
Corneal ulceration with progressive corneal infiltration may occur. Progression of
infection may cause scleritis and iritis, and may ultimately lead to vision loss.
 Treatment: AK have successfully been treated with several medications that
include itraconazole, ketoconazole, miconazole, propamidine isethionate,
rifampin, and Neosporin. Other angents that have been used include
polyhexamethylene biguanide, dibromopropamidine isethionate, neomycin,
paromomycin, and polymyxin. The key to successful treatment to eye infection is
to begin treatment immediately once the infection has been diagnosed.

 Acanthamoeba in one of two ways. One route consists of aspiration or nasal
inhalation of the organisms. Trophozoites and cysts enter via the lower
respiratory tract or through ulcers in the mucosa or skin. These organisms often
migrate via hematogenous spread- that is, transported through the
bloodstream- and invade the CNS, causing serious CNS infections. The second
route of infection consists on direct invasion of the parasite in the eye. Two
groups of individual at risk for direct eye invasion, contact lens wearer and to
those who have experienced trauma to the cornea.
4. Discuss the epidemiology of this parasitic infection?
 Over the years, cases of Acanthamoeba have been reported from many
countries worldwide. Both CNS and eye infections of Acanthamoeba spp. Have
been reported in the United States. CNS infections primarily occur in patients
who are immunocompromised or debilitated.
 1991- DeJonckheere first diagnosed Acanthamoeba GAE in a living patient.
 1970s- AK was recognized in US, Europe, South America, and Asia.
 1990s- The first case of AK was recognized in the Philippines from a patient from
the Philippine General Hospital, and samples obtained from the patient was
shown to cause GAE in mice.
Contact lens wearers, particularly those wearing soft contacts, may be at risk of
contracting Acanthamoeba eye infections. Poor hygiene practices, especially the use of
homemade saline rinse solution, is the major risk factor that may lead to these infection.
Animals, including rabbits, beavers, cattle, water buffalo, dogs and turkeys, have been
known to contact Acanthamoeba infections.
CASESTUDY4: A Marine Corps officer returned from Operation desert storm in the Middle
East reported to “sick-bay” with cutaneous lesions on his lips and cheeks. Giemsa’s stain of
the lesions revealed darkly staining kinetoplast and light-staining nuclei within macrophage.
1. The most likely cause of these lesions is?

 It is cause by Leishmania protozoan parasite
2. Explain the life cycle of the parasite?

 Leishmaniasis is transmitted by the bite of infected female phlebotomine sandflies.
The sandflies inject the infective stage (i.e., promastigotes) from their proboscis
during blood meals. Promastigotes that reach the puncture wound are phagocytized
by macrophages and other types of mononuclear phagocytic cells. Promastigotes
transform in these cells into the tissue stage of the parasite (i.e., amastigotes), which
multiply by simple division and proceed to infect other mononuclear phagocytic cell.
Parasite, host, and other factors affect whether the infection becomes symptomatic
and whether cutaneous or visceral leishmaniasis results. Sandflies become infected
by ingesting infected cells during blood meals. In sandflies, amastigotes transform
into promastigotes, develop in the gut (in the hindgut for leishmanial organisms in
the Viannia subgenus; in the midgut for organisms in the Leishmania subgenus), and
migrate to the probosci.
3. What is the epidemiology of the infection?

 Leishmaniasis is found in parts of about 88 countries. Approximately 350 million
people live in these areas. Most of the affected countries are in the tropics and
subtropics. The settings in which leishmaniasis is found range from rain forests in
Central and South America to deserts in West Asia. More than 90 percent of the
world’s cases of visceral leishmaniasis are in India, Bangladesh, Nepal, Sudan, and
Brazil.
4. How does this parasite produce disease?

 The female sandfly lays its eggs in the burrows of certain rodents, in the bark of old
trees, in ruined buildings, in cracks in house walls, in animal shelters and in
household rubbish, as it is in such environments that the larvae will find the organic
matter, heat and humidity which are necessary for their development.
In its search for blood (usually in the evening and at night), the female sandfly covers
a radius of a few to several hundred metres around its habitat.
 In order to avoid destruction by the immune system and thrive,
the Leishmania 'hides' inside its host's cells. This location enables it to avoid the
action of the humoral immune response (because the pathogen is safely inside a cell
and outside the open bloodstream), and furthermore it may prevent the immune
system from destroying its host through nondanger surface signals which
discourage apoptosis. The primary cell types Leishmania infiltrates
are phagocytotic cells such as neutrophils and macrophages. Usually, a phagocytotic
immune cell like a macrophage will ingest a pathogen within an
enclosed endosome and then fill this endosome with enzymes which digest the
pathogen. However, in the case of Leishmania, these enzymes have no effect,
allowing the parasite to multiply rapidly. This uninhibited growth of parasites
eventually overwhelms the host macrophage or other immune cell, causing it to die
5. How would you treat this patient?

 In visceral leishmaniasis, diagnosis is made by combining clinical signs with
parasitological, or serological tests (such as rapid diagnostic tests). In cutaneous and
mucocutaneous leishmaniasis serological tests have limited value and clinical
manifestation with parasitological tests confirms the diagnosis.
 The treatment of leishmaniasis depends on several factors including type of
disease, concomitant pathologies, parasite species and geographic location.
Leishmaniasis is a treatable and curable disease, which requires an
immunocompetent system because medicines will not get rid of the parasite from
the body, thus the risk of relapse if immunosuppression occurs. All patients
diagnosed as with visceral leishmaniasis require prompt and complete treatment
CASESTUDY5: A 45-year old hunter developed fever, myalgia and periorbital edema. He has a
history of bear meat
1. What parasitic infection is he likely to have and why?

 The parasitic infection that the patient have is Trichinella spiralis. Common
associated disease and condition names: Trichinosis, trichinellosis. This parasitic
infection were able to acquire due to raw or insufficiently cooked meat. The
cardinal signs and symptoms of trichinellosis include severe myalgia, periorbital
edema, and eosinophilia.

 Infective stage- Ingestion of undercooked meat
 Diagnostic stage-Encysted larva in strained muscle
3. Explain the pathogenesis and clinical manifestation of this infection.

 Asymptomatic- Patients with light infection, i.e., harboring up to 10 larvae
 Symptomatic- Patients with moderate infection (50-500 larvae)
 100-300 larvae- may lead to symptomatic trichinellosis
 > 1,000 to 3,000 larvae- can result to severe disease.
Clinical manifestation vary depending on the stage of the parasite. The clinical condition
are divided into three phases:
a. Enteric phase- symptoms in the enteric phase may resemble those of an attack
of acute food poisoning, including diarrhea or constipation, vomiting, abdominal
cramps, malaise, and nausea.
a. Invasion phase- during this phase can result in eosinophilia, which results in the
release of histamines. Histamines, serotonins, bradykinins, and prostaglandins
contribute to increase vascular permeability, resulting tin tissue edema. The
cardinal signs and symptoms of trichinellosis include severe myalgia, periorbital
edema, and eosinophilia. Other typical signs and symptoms include high
remittent fever and chills, headache, dyspnea, dysphagia, and difficulty in

chewing.
-Pericardial pain, tachycardia, and electrocardiograph abnormalities can occur
due to larval migration into the heart muscle.
-Pericardial effusion, congestive heart failure, and other heart chronic
abnormalities
-Neurological complication
-Meningitis and meningoencephalitis
-In heavy infections- ocular disturbances, diplegia, deafness, epileptiform
attacks, and coma may occur.
b. Convalescent phase-fever, weakness, pain, and other symptoms start to abate.
These correspond to the stages of (a) incubation and intestinal invasion, (b) larval
migration and muscle invasion, and (c) encystment and encapsulation.

 Health education
 Recommended that meat be cooked at a minimum of 77ºC (170ºF).
 Freezing is another way to kill larvae
 Storage at -15ºC for 20 days or -30ºC for 6 days
 Regular animal monitoring, keeping pigs in rat-free pens, and proper disposal of
suspected carcasses.
 Avoidance of feeding pork scraps to hogs is also necessary to break the T. spiralis
life cycle.
ACTIVITY NUMER 2
QUESTION 1: Differentiate filariform larva and rhabditiform larva.
RHABDITIFORM LARVA FILARIFORM LARVA
 First stage larva  Infective stage; thread-like; often “designed”

 The first “molt” worms after leaving the egg for penetration.
are termed “rhabditiform”  In the feces, they are already in the 4208 celled
 Feeding stage larva- they feed on bacteria and stage
organic matter present in soil and feces short  Non feeding stage
and stout with a long and narrow buccal  Longer and slender with a pointed posterior
chamber, a flask-shaped muscular or bulbous end
esophagus and very small genital primordium  The mouth closes, the esophagus elongates
and cuticle remains as a sheath covering to
larva.
QUESTION NUMBER 2: Differentiate the following nematodes:
Ascaris lumbricoides Trichuris trichiura Enterobius vermicularis

Common name Large intestinal roundworm, Whipworm Seatworm, Pinworm, society
roundworm of man. worm
Final host Human Human Human
Habitat Small intestine large intestine Large Intestines
Diagnostic stage Ova and Adult stool Presence of eggs with Eggs on perianal folds
Recovery and identification of prominent bipolar plug

eggs and/or adults in the Recovery and
feces. identification of eggs in
the feces.
Infective stage Embryonated eggs Embryonated eggs Embryonated eggs ingested
by humans
Mode of Ingestion Ingestion Ingestion and inhalation
transmission
Pathology * Patients infected with a * slight infection are * Asymptomatic
small number of worms (5 to usually asymptomatic * Infections rarely cause
10) will often remain * Major pathology: serious lesion
asymptomatic (slight infection) are * other symptoms may be
* may produce tissue damage usually asymptomatic, associated with the migration
as it migrates through the no treatment is of the female out of the anus
* Pneumonia, obstruction of necessary. to lay her eggs and include:
the intestines, appendix, or (Heavy infections) severe perianal itching, mild
common bile duct. surface of colon is nausea, loss of sleep,
* vomiting and abdominal pain matted with worms irritability, slight irritation of
causes: bloody or mucoid the intestinal mucosa, and
diarrhea, weight loss, vulval irritation in girls from
chronic dysentery in migrating worm.
children, abdominal pain
and tenderness and
increased peristalsis and
rectal prolapse,
especially in children.
QUESTION 3: Differentiate Capillaria philippinensis and Trichuris trichura in terms of

ova.
Capillaria philippinensis Trichuris trichura

Size Male worm: 1.5-3.9 mm Male worm: 30-45 mm
Female worm: 2.3-5.3mm Female worm: 35-50mm
Shell Striated shells and flattened bipolar Yellowish outer and a transparent inner
plugs shell
Shape Female: peanut o barrel shaped Female: bluntly rounded posterior end
Plug-like translucent polar prominences
Male: covered posterior with single spicule
and retractile sheath
Mucus plugs Prominent bipolar mucoid plugs hyaline polar plug at each end
QUESTION 4: Differentiate the following FILARIAL WORMS:
FILARIALWOR HABITAT VECTOR SPECIMEN MICROFILARIA PERIODICITY

M
Wuchereria Lower Aedes Blood Sheathed, nuclei Nocturnal (10pm-
bancrofti lymphatics anopheles Absent in tail 2am)
Brugia malayi Upper Mansonia spp. Blood Sheathed, tail Nocturnal sub
lymphatics With 2 separate periodic
nuclei
Loa loa Subcutaneous Chrysops Blood Sheathed, nuclei Diurnal
tissues Tabanid or Mango continuous up to tip
fly of the tail
Onchocerca Subcutaneous Simullum spp. Skin nips/ Unsheathed, nuclei Non periodic
volvolus tissues shaving absent in tail
Dipetalonema Most Blood-sucking flies Blood or The size range for Unclear, the most
perstans commonly called midges skin-snip sa female worms is 70 recent study
the peritoneal mples to 80 mm in length suggests
cavity or and 120 µm in microfilariae

pleural cavity, diameter, and the indicate a weak
but less males measure but significant
frequently in approximately 45 diurnal periodicity
the mm by 60 µm. Adults
pericardium produce unsheathed,
subperiodic
microfilariae (200 µm
long, 4.5 µm wide)
which enter
peripheral circulation
Mansonella Inside body culicoides Blood Unsheathed, nuclei Non periodic
ozzardi cavities until tip of the tail
QUESTION 5: Differentiate PSEUDOPHYLLIDEAN and CYCLOPHYLLIDEAN
PSEUDOPHYLLIDEAN CYCLOPHYLLIDEAN
Scolex Spatulate/ almond Vary (globular, quadrate)
Strobila Which is a ribbon like chain of Posterior tape made up of segments
independent but connected segments (proglottids)
called proglottids
Ova Ovoidal, operculated, immature Spherical mature
Larval stages Solid (pierocercoid) and (procercus) Cystic
Intermediate hosts 2 1
ACTIVITY NUMBER 3
Ascaris lumbricoides or 1. Loeffler’s syndrome is caused by?

Strongyloides stercolaris
Anclystoma duodenale or 2. Nematode that is capable of pin fashion attachment which

Necator Americanus lacerates large intestines causing Iron Deficiency Anemia?
Pruritis 3. Enterobius vermicularis female adult worm oviposit eggs in

the perianal region at night causing_______that leads to
insomnia and irritation.
Necator americanus 4. Causative agent of wakana disease?

Ancylostoms duodenale
Cutaneous infection 5. Hookworm filariform larva skin penetration will cause?
Strongyloides stercoralis 6. Etiologic agent of cochin china diarrhea wherein the adult
females and rhabditiform larva combine resulting in the
formation of honeycomb appearance in the intestinal
mucosa?
Glash fish, man 7. Enumerate the four intermediate host of pudoc worm.
Stomach rumbling 8. Borborygmus is term also known as?
Strongyloides stercolaris 9. A nematode with no circulatory system which produces
coin lesions in lungs that can be mistaken
asPTB(PulmonaryTuberculosis).
Angiostrongylus cantorensis 10. Causative agent of Eosinophilic Meningoencephalitis?
Anisakis simplex 11. Also known as Herring’s worm and its mode of
transmission is through ingestion of raw fish infected with
larvae for example is consumption of sashimi
FALSE 12. TRUE OR FALSE. Ascaris lumbricoides exhibits
200,000eggs/day
Caudal or phasmids 13. Nematodes with sensory organs known as chemo
receptors are termed as?
Enterobius vermicularis 14. D-shaped ovum?
Strongyloides stercoralis 15. The only parthenogenic nematode?
(adult female)
Guinea worms 16. Also known as fiery serpent of the ancient Israelites
worm?
Angiostongylus 17. Nematode that has white uterine tubules which are
spirally around the blood filled uterus and can be seen
through the transparent cuticles a“barber’spole”pattern.

Chitinous layer 18. Ascaris lumbricoides fertilized egg consists of three layers
Vitelline layer enumerate them.
Albuminoid Layer
Capillaria philippinensis 19. Peanut shape ova?
Helminthic parasite affects 20. Why Enterobius vermicularis considered as the society
all members of the society worm?
regardless of age, gender
and social status
ACTIVITY NUMBER 4
Katayama fever 1. A systemic hypersensitivity reaction caused by the presence

of Schistosoma is called___________
Their presence, along with 2. What is the clinical significance of the presence of Charcot-
eosinophilic infiltrate, is an Leyden crystals in a stool or sputum specimen?
indirect evidence of
parasitic infestation
particularly with Toxocara,
Capilliriasis, Ascariasis, or
Fasciola
Paroxysm 3. it is periodic episode characterized by fever, chills, sweats,
and fatigue
Infected ulcer 4. The specimen of choice for the recovery of Dracunculus
medinensis is?
Sputum 5. When the stool examination is negative, the preferred
specimen for the diagnosis or paragonimiasis is?
Pinworm 6. Oxyuriasis is caused by?
TRUE 7. TRUE OR FALSE. Trichinella spiralis viviparous female lives
for a month and capable of producing more than 15000 larvae
in a lifetime.
Anisakiasis 8. What do you call when herring worm larvae have been
found invading the oropharynx, esophagus and colon
Acinatina fulica, Hemiplecta 9. What are the species of the intermediate host of rat lung
sagittifera, Helicostyla worm found in the Philippines?
macrostoma
Differential interference 10. Angiostongylus cantonensis have white uterine tubules
contrast which are spirally around the blood filled uterus and can be
seen through the transparent cuticle as a_____________.
Placentonema gigantissima 11. Largest nematode?
Trichinella spiralis 12. Smallest nematode?
Brugia malayi 13. It is a filarial worm with two prominent terminal nuclei?
Dermatolymphangioadenitis 14. DLA associated with the blood nematodes stand for?
Chronic proliferation over 15. It is obstruction of the lymphatics of the tunica vaginalis
growth of fibrious tissue and also the chronic manifestation of bancroftian filariasis.
around the dead worm
Onchocerca volvulus 16. Causative agent of river blindness?
Skin snips 17. Specimen of choice for Manzonnella streptocerca?
TRUE 18. TRUE OR FALSE. Trichinollosis is a self-limiting disease

Cyst 19. Infective stage of Trichinella spiralis?
The mosquito-borne filarial 20. Etiologic agent of lower elephantiasis?
nematodes Wuchereria
bancrofti, Brugia malayi, B.

timori
ACTIVITY NUMBER 5
BASED ON YOUR OUTLINES AND READINGS ANSWER BRIEFLY AND CONSISELY THE FOLLOWING
QUESTIONS.
CASE STUDY 1: Given the following characteristics:

Shape: Tear drops
Motility: Falling leaf
Size: 8-20 µm long, 5-16 µm wide
Nucleus: two ovoid shape with a large karyosome
Flagella: Four
5. What is the classification of the parasite according to locomotion?

 The parasite is classified as Flagellates
6. What is the specific organism described?
 Giardia intestinalis also known as Giardia lamblia or Giardia duodenalis

 The infective stage of the Giardia lamblia in the environment is the cyst.
 Both cyst and trophozoites can be found in the feces (diagnostic stage)

 Infection occurs by the ingestion of parasite cysts in contaminated water, food,
or by the fecal-oral route (hands or fomites)
9. It is commonly associated with which of the following condition.

 Common associated disease or condition names; Giardiasis (traveler’s diarrhea).
Characterized by a wide variety of clinical symptoms, ranging from mild diarrhea,
abdominal cramps, anorexia, and flatulence to tenderness of the epigastric
region, steatorrhea, and malabsorption syndrome.
CASE STUDY 2. It possess 4 anterior flagella that arise from a simple stalk and 5 th flagella
embedded in the undulating membrane that extend about ½ of the original length, its
cytosome filled with plenty of siderophil granules.

 The parasite is classified as Flagellates

 the organism described is Trichomonas vaginalis

 The trophozoite form of the Trichomonas vaginalis are both infective and
diagnostic stage.
4. It is commonly associated with which of the following condition.

Common associated disease and condition names:
 Persistent Urethritis. Persistent or recurring urethritis is the condition that
symptomatic men experience as a result of a T. vaginalis infection. Symptoms of
severe infection include an enlarged tender prostate, dysuria, nocturia, and
epididymitis.
 Persistent Vaginitis. Found in infected women, is characterized by a foul-
smelling, greenish-yellow liquid vaginal discharge after an incubation period of 4
to 8 28 days. Urethral involvement, dysuria, and increased frequency of urination
are among the most commonly experienced symptoms.
 Infant infection. Has been recovered from infants suffering from both respiratory
infection and conjunctivitis. These conditions were most likely contracted as a
result T. vaginalis trophozoites migrating from an infected mother to the infant
through the birth canal and/or during vaginal delivery.
 Note: Asymptomatic cases of T. vaginalis most frequently occur in men.

 The primary step necessary to prevent and control. T. vaginalis infections is the
avoidance of unprotected sex.
 Avoid sharing of douche equipment and communal bathing, as well as close
contact with potentially infective underclothing, toilet articles, damp towels, and
wet sponges.
CASE STUDY 3. Roy, a 30 year old man is suspected of having dysentery. The stool
examination was performed and revealed the following:
Formed, Yellow brown
Amoebic Trophozoite, 26 µm
Nucleus: Evenly distributed peripheral chromatin

Cytoplasm: Finely granular
Motility: Progressive

 This parasite belongs to protozoa (amoeba type) based on locomotion

 Entamoeba histolytica

 The cyst of the Entamoeba histolytica is so called infective stage
 Diagnostic stage- trophozoite
4. Explain the pathogenesis and clinical manifestation of this infection.

 It is thought that pathogenesis of infection by Entamoeba histolytica is governed
at several levels, chief among them are (i) adherence of trophozoite to the target
cell, (ii) lysis of target cell, and (iii) phagocytosis of target cell. Several molecules
which may be involved in these processes have been identified. A lectin
inhibitable by galactose and N-acetyl-D-galactosamine is present on the
trophozoite surface. This is implicated in adherence of trophozoite to the target
cell. Various amoebic pore forming proteins are known, of which 5kDa protein
(amoeba pore) has been extensively studied. These can insert into the lipid
bilayers of target cells, forming ion-channels. The phagocytic potential of
trophozoites is directly linked to virulence as measured in animal models. Factors
like association of bacteria with trophozoites also influence virulence. Thus,
pathogenesis is determined by multiple factors and a unifying picture taking into
account the relative contributions of each factor is sought. Recent technical
advances, which includes the development of a transfection system to introduce
genes into trophozoites, should help to understand the mechanism of
pathogenesis in amoebiasis.
 Early symptoms (in about 1-4 weeks) include loose stools and mild abdominal
cramping
 If the disease progresses, frequent, watery, and/or bloody stools with severe
abdominal cramping (termed amoebic dysentery) may occur.
 If the trophozoites reach the intestinal walls and go through them, symptoms of
liver infection such as liver tenderness and fever are the initial signs and
symptoms of liver abscess formation (hepatic amebiasis).
 Other organs (heart, lungs, brain [meningoencephalitis], for example) may
produce symptoms specific to the organ and produce severe illness and/or death.
 Abdominal tenderness and/or stomach pain
 Tenesmus
 Flatulence
 Appetite loss
 Weight loss
 Fatigue
 Anemia
 Occasionally cause skin lesions (cutaneous amebiasis)
5. Discuss the epidemiology of this parasitic infection

 Entamoeba histolytica infection occurs in as many as 10% of the world’s
population and is considered a leading cause of parasitic deaths after only
malaria, the clinical manifestation of infection with Plasmodium spp. parasites. In
addition to thriving in sub-tropical and tropical areas of the world, this parasites
existing colder climates, such as Alaska, Russia, and Canada. Locations at which
human waste is used as fertilizer, areas of poor sanitation, hospitals for the
mentally ill, prisons, and daycare centers tend to harbor E. histolytica. This
organism has historically been prevalent in homosexual communities because it
causes frequent asymptomatic infections in homosexual men, particularly in
Western countries. Several means of transmitting E. histolytica are known.
Ingestion of the infective stage, the cyst, occurs through hand-to-mouth
contamination and food or water contamination. In addition E. histolytica may
also be transferred via unprotected sex. Flies and cockroaches may also serve as
vectors (living carriers responsible for transmitting parasites from infected host’s
uninfected hosts) of E. histolytica by depositing infective cysts on unprotected
food. Improperly treated water supplies are additional sources of possible

infection.
ACTIVITY NUMBER 6
QUESTION 1: Differentiate the following blood flukes.
Schistosoma japonicum Schistosoma mansoni Schistosoma haematobium

HABITAT Superior mesenteric vein, Inferior mesenteric Protatic, uterine, venous
small intestines veins, colon/rectum plexuses
PATHOLOGY Katayama disease, snail Intestinal bilarzhiasis Urinary bilarzhiasis,
fever, oriental Egyptian hematuria, Bloody
schistosomiasis urine
EGG/OVA Has a knob-like or Has lateral spine Has a terminal spine

protuberance on one side
INTERMEDIATE Oncomelania quadrasi Biomphalaria, Bulinus, Physopsis,
HOST Australorbis, Biomphalaria
Tropicorbis
QUESTION 2: Differentiate the following Cestode.
Taenia saginata Taenia solium

COMMON NAME Beef tapeworm Pork tapeworm
INTERMEDIATE Cattle Pig
HOST
SCOLEX -Measures 1-2 mm in diameter With rostellum armed with 2 rows of
-Has 4 prominent acetabula large and small hooklet
-Has no hook or rostellum
LENGTH 25 meters 7 meters
NUMBER OF 1,000-2,000 Less than 1,000
PROGLOTTIDS
GRAVID -15-20 lateral branches (dichotomous or -7 to 13 lateral branches ( dendritic or
PROGLOTTID finger- like) fonger-like)
-longer than wide
- uterus is distended with ova
-the genital pores are irregularly
alternate
EGGS -Measures 30-35 um -Spherical striated inside is an embryo
-Have a thick striated embryophore with 6 hooklet
surrounding hexacanth embryo
-Inside the egg shell is the oncosphere
provided with 3 pairs of hooklets
INFECTIVE STAGE Cysticercus bovis Cysticercus cellulosae, egg
PATHOGENESIS -common chief complaint: passage Cysticercosis
proglottids or segments in stool (a) Neurocysticercosis
-epigastric pain, vague abdominal (b) Cerebral Cysticercosis
discomfort, hunger pangs, weakness, (c) Opthalmic Cysticercosis
weight loss, loss of appetite and
perianal itching.
-may also cause obstruction in the bile,
pancreatic duct as well as in the
appendix
Hymenolepis nana Hymenolepis diminuta

COMMON NAME Dwarf tapeworm Rat tapeworm
INTERMEDIATE Human Insects
HOST
SCOLEX -Subglobular with 4 cup-shaped or It has rudimentary unarmed
cuplike sucker rostellum with 4 cup-like suckers
-it has a retractable rostellum armed
with a single row of 20-30 Y shaed
hooklets
LENGTH 25-45mm 60cm
NUMBER OF Contains 3 ovoid testes, one bi-lobed Three ovoid testes and one ovary in a
PROGLOTTIDS ovary and a single genital pore more or less straight pattern across
the segment
GRAVID When the testes and the ovary -Sac-like uterus filled with eggs
PROGLOTTID disappears while the uterus hallows out -it separate from the main body of
and becomes filled with egg the worm and release eggs into feces
EGGS Spherical or sub-spherical colorless or -greenish yellow when bile stained
clay-colored -the oncosphere are enclosed in the
inner membrane
- it has a bi-polar thickening but lacks
bipolar filaments
LARVA It is a small species, seldom exceeding 20 to 60 cm long
40 mm long and 1 mm wide
INFECTIVE STAGE Eggs (direct) Cystecercoid larva
Cystecercoid larva ( Indirect)
PATHOGENESIS -Heavy infection may result in enteritis Minimal manifestation-mild
due to necrosis and desquamation of abdominal symptoms and headache
the intestinal epithelial cells
Dipyllidium caninum Echinococcus granulosus

COMMON NAME Double pored dog tapeworm Hydatid worm
INTERMEDIATE -Dog flea -Sheep/Ox
HOST -Cat flea -Goat
-Human flea -Horse
-Camel
-Man (Accidental Host)
SCOLEX -small and globular with 4 deeply - typically taeniid, it has 4 acetabula
cupped suckers -armed with 30-36 hooks
-with a prostrusible rostellum which is
armed with one to 7 rows of rose thorn-
shaped hooklets
LENGTH 10 to 70 cm 3 to 6 mm
NUMBER OF Two sets of male and female Average number of eggs per gravid
PROGLOTTIDS reproductive organs (genital pore in proglottid is 823
each lateral margin)
GRAVID It has a size and shape with a pum[kin- -widest and longest proglottid
PROGLOTTID seed and filled with capsules or packers -uterus is midline with lateral
of about 9 to 15 eggs enclosed in an invaginations
embryonic membrane -it is filled with eggs
EGGS -spherical
-thn shelled with a hexacanth embryo
LARVA About 18 inches (46 cm) long Ranges in length from 3 mm to 6 mm
INFECTIVE STAGE Cystecercoid Hydatid Cyst, Embryonated Egg
PATHOGENESIS -asymptomatic Human Cystic Echinoccus
-slight intestinal discomfort, epigastric
pain, diarrhea, anal pruritus, and
allergic reactions have been reported.
---------------------------------------------NOTHING FOLLOWS-------------------------------------------------------

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St.

Paul University Philippines

SUBMITTED TO: MS. RICHELLE SALES, RMT

SUBMITTED BY: NICOLAS, SHARMAINE MAE B.

CASE STUDY 1: A patient is suspected of having amoebic dysentery. Upon microscopic

1. Identify the parasite.

2. How can the diagnosis be established?

3. How does infection of this parasite occur?

4. Discuss the epidemiology of this parasitic infection?

50 million E. histolytica infection cases, and 40,000 to 100,000 deaths due to

1. . What parasitic infection is he likely to have and why?

2. What is the infective stage and diagnostic stage of the parasite?

3. Explain the pathogenesis and clinical manifestation of this infection

Nonetheless, the chronic phase is manifested by fibrotic reactions that cause

4. What control measures are available to prevent its transmission?

 Vector control and blood transfusion regulations

1. Identify the parasite.

3. How does infection of this parasite occur?

1. The most likely cause of these lesions is?

2. Explain the life cycle of the parasite?

3. What is the epidemiology of the infection?

4. How does this parasite produce disease?

5. How would you treat this patient?

1. What parasitic infection is he likely to have and why?

2. What is the infective stage and diagnostic stage of the parasite?

3. Explain the pathogenesis and clinical manifestation of this infection.

remittent fever and chills, headache, dyspnea, dysphagia, and difficulty in

4. What control measures are available to prevent its transmission?

QUESTION 1: Differentiate filariform larva and rhabditiform larva.

RHABDITIFORM LARVA FILARIFORM LARVA

 First stage larva  Infective stage; thread-like; often “designed”

QUESTION NUMBER 2: Differentiate the following nematodes:

Ascaris lumbricoides Trichuris trichiura Enterobius vermicularis

Recovery and identification of prominent bipolar plug

QUESTION 3: Differentiate Capillaria philippinensis and Trichuris trichura in terms of

Capillaria philippinensis Trichuris trichura

QUESTION 4: Differentiate the following FILARIAL WORMS:

FILARIALWOR HABITAT VECTOR SPECIMEN MICROFILARIA PERIODICITY

cavity or and 120 µm in microfilariae

QUESTION 5: Differentiate PSEUDOPHYLLIDEAN and CYCLOPHYLLIDEAN

Ascaris lumbricoides or 1. Loeffler’s syndrome is caused by?

Anclystoma duodenale or 2. Nematode that is capable of pin fashion attachment which

Pruritis 3. Enterobius vermicularis female adult worm oviposit eggs in

Necator americanus 4. Causative agent of wakana disease?

through the transparent cuticles a“barber’spole”pattern.

Katayama fever 1. A systemic hypersensitivity reaction caused by the presence

TRUE 18. TRUE OR FALSE. Trichinollosis is a self-limiting disease

bancrofti, Brugia malayi, B.

CASE STUDY 1: Given the following characteristics:

5. What is the classification of the parasite according to locomotion?

7. What is the infective stage and diagnostic stage of the parasite?

8. How does infection of this parasite occur?

9. It is commonly associated with which of the following condition.

1. What is the classification of the parasite according to locomotion?

2. What is the specific organism described?

3. What is the infective stage and diagnostic stage of the parasite?

4. It is commonly associated with which of the following condition.

5. What control measures are available to prevent its transmission?

Formed, Yellow brown

Nucleus: Evenly distributed peripheral chromatin

Cytoplasm: Finely granular

1. What is the classification of the parasite according to locomotion?

2. What is the specific organism described?

3. What is the infective stage and diagnostic stage of the parasite?