MICROBIOLOGY `M̀ICROBIOLOGY—PARASITOLOGY SEC TION II 155

MICROBIOLOGY—PARASITOLOGY
``

Protozoa—gastrointestinal infections
ORGANISM DISEASE TRANSMISSION DIAGNOSIS TREATMENT
Giardia lamblia Giardiasis—bloating, flatulence, Cysts in water Multinucleated Metronidazole
foul-smelling, fatty diarrhea trophozoites A or
(often seen in campers/hikers)— cysts B in stool,
think fat-rich Ghirardelli antigen detection
chocolates for fatty stools of
Giardia
Entamoeba Amebiasis—bloody diarrhea Cysts in water Serology, antigen Metronidazole;
histolytica (dysentery), liver abscess testing, and/or paromomycin or
(“anchovy paste” exudate), RUQ trophozoites (with iodoquinol for
pain; histology of colon biopsy engulfed RBCs C asymptomatic cyst
shows flask-shaped ulcers in the cytoplasm) passers
or cysts with up to
4 nuclei in stool D ;
Entamoeba Eats
Erythrocytes
Cryptosporidium Severe diarrhea in AIDS Oocysts in water Oocysts on acid-fast Prevention (by
Mild disease (watery diarrhea) in stain E , antigen filtering city
immunocompetent hosts detection water supplies);
nitazoxanide in
immunocompetent
hosts
A B C D E

FAS1_2019_03-Microbiology.indd 155 11/14/19 12:21 PM

 156 SEC TION II MICROBIOLOGY `M̀ICROBIOLOGY—PARASITOLOGY

Protozoa—CNS infections
ORGANISM DISEASE TRANSMISSION DIAGNOSIS TREATMENT
Toxoplasma Immunocompetent: Cysts in meat (most Serology, biopsy Sulfadiazine +
gondii mononucleosis-like symptoms, common); oocysts (tachyzoite) B pyrimethamine
⊝ heterophile antibody test in cat feces; crosses
Reactivation in AIDS  brain placenta (pregnant
abscesses usually seen as women should
multiple ring-enhancing lesions avoid cats)
on MRI A
Congenital toxoplasmosis:
classic triad of chorioretinitis,
hydrocephalus, and intracranial
calcifications
Naegleria fowleri Rapidly fatal meningoencephalitis Swimming in warm Amoebas in CSF C Amphotericin B has
freshwater; enters been effective for a
via cribriform plate few survivors

Trypanosoma African sleeping sickness— Tsetse fly, a painful Trypomastigote in Suramin for blood-
brucei enlarged lymph nodes, recurring bite blood smear D borne disease or
fever (due to antigenic variation), melarsoprol for
somnolence, coma CNS penetration
(“I sure am
mellow when I’m
sleeping”)
A B C D

FAS1_2019_03-Microbiology.indd 156 11/14/19 12:21 PM

 MICROBIOLOGY `M̀ICROBIOLOGY—PARASITOLOGY SEC TION II 157

Protozoa—hematologic infections
ORGANISM DISEASE TRANSMISSION DIAGNOSIS TREATMENT
Plasmodium Malaria—fever, headache, anemia, Anopheles mosquito Blood smear: Chloroquine (for
P vivax/ovale splenomegaly trophozoite ring sensitive species);
P falciparum P vivax/ovale—48-hr cycle (tertian; form within if resistant, use
P malariae includes fever on first day and RBC A , schizont mefloquine or
A third day, thus fevers are actually containing atovaquone/
48 hr apart); dormant form merozoites; red proguanil
(hypnozoite) in liver granules (Schüffner If life-threatening,
P falciparum—severe; irregular stippling) B use intravenous
fever patterns; parasitized RBCs throughout RBC quinidine or
occlude capillaries in brain cytoplasm seen artesunate (test for
(cerebral malaria), kidneys, lungs with P vivax/ovale G6PD deficiency)
B
P malariae—72-hr cycle (quartan) For P vivax/ovale,
add primaquine for
hypnozoite (test for
G6PD deficiency)

Babesia Babesiosis—fever and hemolytic Ixodes tick (also Blood smear: ring Atovaquone
C anemia; predominantly in vector for Borrelia form C1 , “Maltese + azithromycin
northeastern United States; burgdorferi and cross” C2 ; PCR
asplenia risk of severe disease Anaplasma spp)

FAS1_2019_03-Microbiology.indd 157 11/14/19 12:21 PM

 158 SEC TION II MICROBIOLOGY `M̀ICROBIOLOGY—PARASITOLOGY

Protozoa—others
ORGANISM DISEASE TRANSMISSION DIAGNOSIS TREATMENT
Visceral infections
Trypanosoma Chagas disease—dilated Triatomine insect Trypomastigote in Benznidazole
cruzi cardiomyopathy with (kissing bug) bites blood smear A or nifurtimox;
apical atrophy, megacolon, and defecates cruzing in my
megaesophagus; predominantly around the mouth Benz, with a fur
in South America or eyes; fecal coat on
Unilateral periorbital swelling transmission into
(Romaña sign) characteristic of bite site or mucosa
acute stage
Leishmania spp Visceral leishmaniasis Sandfly Macrophages Amphotericin B,
(kala-azar)—spiking fevers, containing sodium
hepatosplenomegaly, amastigotes C stibogluconate
pancytopenia
Cutaneous leishmaniasis—skin
ulcers B
Sexually transmitted infections
Trichomonas Vaginitis—foul-smelling, greenish Sexual (cannot exist Trophozoites (motile) Metronidazole for
vaginalis discharge; itching and burning; outside human D on wet mount; patient and partner
do not confuse with Gardnerella because it cannot punctate cervical (prophylaxis; check
vaginalis, a gram-variable form cysts) hemorrhages for STI)
bacterium associated with (“strawberry
bacterial vaginosis cervix”)
A B C D

Nematode routes of Ingested—Enterobius, Ascaris, Toxocara, You’ll get sick if you EATTT these!
infection Trichinella, Trichuris
Cutaneous—Strongyloides, Ancylostoma, These get into your feet from the SANd
Necator
Bites—Loa loa, Onchocerca volvulus, Lay LOW to avoid getting bitten
Wuchereria bancrofti

FAS1_2019_03-Microbiology.indd 158 11/14/19 12:21 PM

 MICROBIOLOGY `M̀ICROBIOLOGY—PARASITOLOGY SEC TION II 159

Nematodes (roundworms)
ORGANISM DISEASE TRANSMISSION TREATMENT
Intestinal
Enterobius vermicularis Causes anal pruritus (diagnosed by seeing Fecal-oral. Bendazoles (bendy
(pinworm) egg A via the tape test). worms), pyrantel
pamoate.
Ascaris lumbricoides May cause obstruction at ileocecal Fecal-oral; knobby-coated, Bendazoles.
(giant roundworm) valve, biliary obstruction, intestinal oval eggs seen in feces
perforation, migrates from nose/mouth. under microscope B .
Strongyloides GI (eg, duodenitis), pulmonary (eg, dry Larvae in soil penetrate skin; Ivermectin or
stercoralis cough, hemoptysis), and cutaneous (eg, rhabditiform larvae seen in bendazoles.
(threadworm) pruritus) symptoms. Hyperinfection feces under microscope.
syndrome caused by autoinfection
(larvae enter bloodstream).
Ancylostoma spp, Cause microcytic anemia by sucking Larvae penetrate skin. Bendazoles or pyrantel
Necator americanus blood from intestinal wall. pamoate.
(hookworms) Cutaneous larva migrans—pruritic,
serpiginous rash C from walking
barefoot on contaminated beach.
Trichinella spiralis Larvae enter bloodstream, encyst in Undercooked meat (especially Bendazoles.
striated muscle D  myositis. pork); fecal-oral (less likely).
Trichinosis—fever, vomiting, nausea,
periorbital edema, myalgia.
Trichuris trichiura Often asymptomatic; loose stools, Fecal-oral. Bendazoles.
(whipworm) anemia, rectal prolapse in children.
Tissue
Toxocara canis Visceral larva migrans—nematodes Fecal-oral. Bendazoles.
migrate to blood through intestinal wall
 inflammation affecting liver, eyes
(visual impairment, blindness), CNS
(seizures, coma), heart (myocarditis).
Onchocerca volvulus Skin changes, loss of elastic fibers, river Female black fly. Ivermectin (ivermectin
blindness (black skin nodules, “black for river blindness).
sight”); allergic reaction possible.
Loa loa Swelling in skin, worm in conjunctiva. Deer fly, horse fly, mango fly. Diethylcarbamazine.
Wuchereria bancrofti Lymphatic filariasis (elephantiasis)— Female mosquito. Diethylcarbamazine.
worms invade lymph nodes.
 inflammation  lymphedema E ;
symptom onset after 9 mo–1 yr.
A B C D E

FAS1_2019_03-Microbiology.indd 159 11/14/19 12:21 PM

 160 SEC TION II MICROBIOLOGY `M̀ICROBIOLOGY—PARASITOLOGY

Cestodes (tapeworms)
ORGANISM DISEASE TRANSMISSION TREATMENT
Taenia solium A Intestinal tapeworm Ingestion of larvae encysted in Praziquantel
undercooked pork
Cysticercosis, Ingestion of eggs in food Praziquantel; albendazole for
neurocysticercosis (cystic contaminated with human neurocysticercosis
CNS lesions, seizures) B feces
Diphyllobothrium Vitamin B12 deficiency Ingestion of larvae in raw Praziquantel
latum (tapeworm competes for B12 freshwater fish
in intestine) megaloblastic
anemia
Echinococcus Hydatid cysts D (“eggshell Ingestion of eggs in food Albendazole
granulosus C calcification”) in liver E ; cyst contaminated with dog feces
rupture can cause anaphylaxis Sheep are an intermediate host

A B C D E
Liver

St

Trematodes (flukes)
ORGANISM DISEASE TRANSMISSION TREATMENT
Schistosoma Liver and spleen enlargement Snails are intermediate host; Praziquantel
A
(S mansoni, egg with cercariae penetrate skin of
lateral spine A ), fibrosis, humans in contact with
inflammation, portal contaminated fresh water (eg,
hypertension swimming or bathing)
Chronic infection with
B
S haematobium (egg with
terminal spine B ) can lead
to squamous cell carcinoma
of the bladder (painless
hematuria) and pulmonary
hypertension
Clonorchis sinensis Biliary tract inflammation Undercooked fish Praziquantel
 pigmented gallstones
Associated with
cholangiocarcinoma

FAS1_2019_03-Microbiology.indd 160 11/14/19 12:21 PM

 MICROBIOLOGY `M̀ICROBIOLOGY—PARASITOLOGY SEC TION II 161

Ectoparasites
Sarcoptes scabiei Mites burrow into stratum corneum and Common in children, crowded populations
A cause scabies—pruritus (worse at night) and (jails, nursing homes); transmission through
serpiginous burrows (lines) often between skin-to-skin contact (most common) or via
fingers and toes A . fomites.
Treatment: permethrin cream, washing/drying
all clothing/bedding, treat close contacts.

Pediculus humanus/ Blood-sucking lice that cause intense pruritus
Phthirus pubis with associated excoriations, commonly on
B
scalp and neck (head lice), waistband and
axilla (body lice), or pubic and perianal
regions (pubic lice).
Body lice can transmit Rickettsia prowazekii
(epidemic typhus), Borrelia recurrentis (relapsing
fever), Bartonella quintana (trench fever).
Treatment: pyrethroids, malathion, or ivermectin
lotion, and nit B combing. Children with head
lice can be treated at home without interrupting
school attendance.

Parasite hints ASSOCIATIONS ORGANISM

Biliary tract disease, cholangiocarcinoma Clonorchis sinensis
Brain cysts, seizures Taenia solium (neurocysticercosis)
Hematuria, squamous cell bladder cancer Schistosoma haematobium
Liver (hydatid) cysts Echinococcus granulosus
Microcytic anemia Ancylostoma, Necator
Myalgias, periorbital edema Trichinella spiralis
Perianal pruritus Enterobius
Portal hypertension Schistosoma mansoni, Schistosoma japonicum
Vitamin B12 deficiency Diphyllobothrium latum

FAS1_2019_03-Microbiology.indd 161 11/14/19 12:21 PM