FG Parasitology & Medical Entomology

NMT 06226
Parasitology
& Medical
Entomology
Level 6 Facilitator Guide for Diploma in
Nursing
September 2013
United Republic of Tanzania

Ministry of Health and Social Welfare
Ministry of Health and Social Welfare
Department of Human Resources Development
Nursing Training Section
© Ministry of Health and Social Welfare 2013
Table of Contents
Acronyms ……......................................................................................................................................iii
Acknowledgement .................................................................................................................................iv
Goals and Objectives of the Training Manual ......................................................................................vii
Overall Goal for training manual ......................................................................................................vii
Objectives for training manual..........................................................................................................vii
Introduction viii
Module Overview ............................................................................................................................viii
Who is the Module For? ..................................................................................................................viii
How is the Module Organized? .......................................................................................................viii
How Should the Module be Used? ..................................................................................................viii
Module Sessions
Session 1: Basic Concepts of Parasitology and Medical Entomology...................................... 1
Session 2: Intestinal Protozoa of Medical Importance - Entamoeba Histolytica, Giardia
Lamblia and Balantidium Coli................................................................................. 13
Session 3: Intestinal Protozoa of Medical Importance - Cryptosporidium Parvum and Isospora
Belli............................................................................................................................. 27
Session 4: Blood Protozoa of Medical Importance - Plasmodium Species.............................. 37
Session 5: Blood and Tissue Protozoa of Medical Importance - African Trypanosoma and
Leishmania Species..................................................................................................... 46
Session 6: Cestodes of Medical Importance – Tape Worms/Taenia Sagnata and Taenea Solium
.................................................................................................................................... 56
Session 7: Cestodes of Medical Importance - Tape Worms/Echinococcus Granulosus and
Diphyllobothrium latum.............................................................................................. 63
Session 8: Trematodes of Medical Importance - Haematobium and Schistosoma Mansoni... 73
Session 9: Trematodes of Medical Importance - Fasciola Hepatica, Clonorchis Sinensis, and
Paragonimus Westermani ........................................................................................... 81
Session 10: Intestinal Nematode of Medical Importance- Ascaris Lumbricoides and Trichuris
Trichiura ..................................................................................................................... 93
Session 11: Intestinal Nematodes of Medical Importance - Hookworms and Strongyloides
Stercolaris................................................................................................................. 103
Session 12: Intestinal Nematode of Medical Importance - Enterobius Vermicularis and
Trichnella Spiralis ................................................................................................ 114
Session 13: Blood Nematodes/Filarial Worms of Medical Importance.................................... 125
Session 14: Tissue Nematodes of Medical Importance - Onchocerca Volvulus and Drancuculus
Medinensis ................................................................................................................ 134
NMT 06226 Parasitology & Medical Entomology NTA Level 6, Semester 2

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Session 15: Utilization of Knowledge of Parasitology and Entomology in Prevention of
Diseases .................................................................................................................... 143
Session 16: Preventive Measures against Intestinal and Blood/Tissue Protozoa of Medical
Importance ................................................................................................................ 154
Session 17: Preventive Measures against Helminthes - Cestodes, Trematodes and Nematodes of
Medical Importance .................................................................................................. 160
Session 18 : Common Vectors of Medical Importance - Arthropods ........................................... 167
Session 19 : Common Vectors of Medical Importance - Tsetsefly and Blackfly ...................... 176
Session 20 : Common Vectors of Medical Importance - House Flies, Cockroaches and Lice . 183
Session 21: Common Vectors of Medical Importance - Fleas and Ticks .................................... 196

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Acronyms
µm micrometer
AIDS Acquired Immunodeficency Syndrome
BHC Benzene Hexachloride
CNS Central Nervous System
CSF Fluid Spinal Cerebral
ESR Erythrocite Sedimentation Rate
FBP Full Blood Picture
Hb Haemoglobin
mm millimeter
PPE Personal Protective Equipment
RDT Rapid Diagnostic Test
SIT Sterile Insect Technique
SOP Standard Operating Procedure

iii
Acknowledgement
The development of the training manuals for Certificate and Diploma in Nursing (NTA Level
4 to 6) has been possible and accomplished through involvement of different stakeholders.
The Ministry of Health and Social Welfare (MoHSW) through the Director of Human
Resources Development sends sincere gratitude to the stakeholders including the
coordinating team (Department of Nursing and Midwifery Training), TNI, through AIHA and
the WINONA state University for funding the activity.
The MOHSW would like to thank all those involved during the process for their valuable
contribution to the development of these training materials. The ministry of Health would like
to thank the Assistant Director for Nursing Training section Mr. Ndementria Vermand, and
Ms. Vumilia B.E Mmari (Coordinator for Nursing and Midwifery Training) who tirelessly
led this important process.
Sincere gratitude is expressed to main facilitator: Mr. Golden Masika, Tutorial Assistant
University of Dodoma for his tireless efforts and Mr. Nicolaus Ndenzako Programme
consultant of AMCA inter consultant in guiding participants through the process. Special
thanks go to the team of contributors representing the Health Training Institutions, hospitals
and Universities. Their participation in meetings and workshops and their inputs in the
development of the content for each module have been invaluable. It is the commitment of
these participants that has made this product possible.
These participants are listed with our gratitude below:
SN Name Title Institution

1. Mary S. Matembo Nurse Tutor Korogwe NTC
2. Elialilia M. Herman Nurse Tutor MT. Meru Hospital
3. Alice Chifunda Nurse Tutor Mbulu NTC
4. Lilian Wilfreda Nurse Tutor KCMC
5. Aselina Milinga Nurse Tutor KCMC
6. Veronica Mahela Nurse Tutor Kahama
7. Samwel Mwangoka Nurse Tutor Mbeya SOTM
8. Hamza S. Matagira Nurse Tutor Kahama NTC
9. Elikana Wallace Nurse Tutor Kolandoto S/Nursing
10. Anna Sangito Pallangyo Nurse Tutor Kahama NTC
11. David Abincha Nurse Tutor Bukumbi NTC
12. Leon S. Mgohamwende Nurse Tutor Tosamaganga NTC
13. Crescent D. Ombay Nurse Tutor Haydom S/Nursing
14. Kizito B. Tamba Nurse Tutor Ndanda S/N
15. Robert E. Moshi Nurse Tutor IMTU college of Nursing
16. Oresta Ngahi Nurse Tutor Muhimbili S/N
17. Aloyce Ambokile Nurse Tutor Kondoa District Hosp.
18. Helma A. Shimbo Nurse Tutor Mwambani NTC
19. Elizabeth G. Chezue PNO N Tutor MOHSW HIS & QAS
20. Hinju Januarius Obstetrian Dodoma Regional Hosp.
21. Manase Nsunza Principal HLT Singida HLTC
22. Ezekiel Amata IMC Facilitator Mpwapwa Hosp.

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23. Sostenes D. Ntambuto HLT Tutor SMLS MUHIMBILI
24. Anna Sangito Pallanyo N/Tutor Kahama SN
25. Naomi Kagya NT Muhimbili
26. Aloyce Amboikile Nurse Kondoa
27. Golden Masika Lecturer UDOM
28. Vumilia B.E. Mmari CD-NT MOHSW
29. Upendo kilume Nurse PHN
30. Fatuma Iddi Librarian MOHSW
31. Shango Nasania Nurse Newala
32. George Laisser C/Analyst MOHSW
33. Anande Mungure Nurse Tutor Mbulu NTC
34. Robert Masano Nurse Tutor Nkinga NTC
35. Ambokile Dodoma General Hospital
36. Nolasca Mtega Nurse Tutor Tukuyu School of Nursing
37. Asteria Ndomba Senior Lecturer CUHAS
38. Alfreda Ndunguru
39. Elizabeth Chezua MOHSW
40. Magwaza Charles
41. Ellen Mwandemele
42. Robert Mushi IMTU
43. Anna Mangula Nurse Tutor Mirembe NTC
44. Cesilia Mallya Nurse tutor Newala NTC
45. Helma Shimba
46. Kapaya Andrew TNMC
47. Ntambuto Sostenese
48. Joseph Nkungu
49. Anastazia Dinho
50. Eliaremisa Ayo Nurse Tutor MOHSW
51. Grace Mallya Paediatrician RCHS/GBV/VAC-MOHSW
52. Dr. Tecla Kohi Senior Lecturer MUHAS
53. Dr. Lilian Msele Lecturer MUHAS
Supporting staff:
Daniel Muslim Driver, Ministry of Health and Social Welfare
Fatuma Mohamed Health Librarian, Ministry of Health and Social Welfare
Mbaruku A. Luga Driver, Morogoro School of Public Health Nursing
Roselinda RugemaliraAdm. Secretary, Tanzania Nursing & Midwifery Council
Veronica Semhando Secretary Ministry of Health & Social Welfare
George Laizer System Analyst Ministry of Health & Social Welfare
Silvanus Ilomo System Analyst Ministry of Health & Social Welfare
Violet Mrema Adm. Secretary, Ministry of Health and Social Welfare
Walter Ndesanjo System Analyst, Ministry of Health and Social Welfare
Dr. Gozbert Mutahyabarwa

Ag: Director of Human Resource and Development,

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Background
In 2007 the Ministry of Health and Social welfare (MOHSW) started the process of
reviewing the nursing curricula at Certificate and diploma level. In 2008 refined and
developed NTA Level 4 to 6 Nursing Curricula and in the same year 2008 started the
implementation. The intention was to comply with the National Council for Technical award
(NACTE) Qualification framework which offers a climbing ladder for higher skills
opportunity. Advanced Diploma awards are not among the awards of the council and do not
conform to NACTE framework. Therefore, institutions offering Advanced Diploma in
nursing are required to either offer Ordinary Diploma (NTA Level 6) or develop its capacity
to offer Bachelor’s Degree (NTA Level 7&8).
These programs have been developed in line with the above consideration aiming at
providing a room for Nurses to continue to a higher learning and achieve advanced skills
which will enable them to perform duties competently. In addition, WHO advocates for
skilled and motivated health workers in producing good health services and increase
performance of health systems (WHO World Health Report, 2006). Moreover, Primary
Health Care Development Program (PHCDP) (2007-15) needs the nation to strengthen and
expand health services at ALL levels. This can only be achieved when the Nation has
adequate, appropriately trained and competent work force who can be deployed in the health
facilities to facilitate the provisions of quality health care services.
In line with these new curricula, the MOHSW supported tutors by developing quality
standardized training materials to accompany the implementation of the developed curricula.
These training materials will address the foreseen discrepancies in the implementation of the
new curricula. NTA level 8 training materials have been developed after Curricula validation
and verification.
This training material has been developed through writers’ workshop (WW) model. The
model included a series of workshops in which tutors and content experts developed training
materials, guided by facilitators with expertise in instructional design and curriculum
development. The goals of Writer’s Workshop were to develop high-quality, standardized
teaching materials and to build the capacity of tutors to develop these materials. This product
is a result of a lengthy collaborative process, with significant input from key stakeholders
(NACTE, MOHSW, AIHA and WINONA University) and experts of different organizations
and institutions. The new training package for NTA Level 4-6 includes a Facilitator Guide
and Student Manual. There are 28 modules with approximately 520 content sessions

vi
Rationale
The vision and mission of the National Health Policy in Tanzania focuses on establishing a
health system that is responsive to the needs of the people, and leads to improved health
status for all. Skilled and motivated health workers are crucially important for producing
good health through increasing the performance of health systems (WHO, 2006). With
limited resources (human and non-human resources), the MOHSW supported tutors by
developing standardized training materials to accompany the implementation of the
developed CBET curricula. These training manuals address the foreseen discrepancies in the
implementation of the new curricula.
Therefore, this training manual for Certificate and Diploma program in Nursing (NTA Levels
4-6) aims at providing a room for Nurses to continue achieving skills which will enable them
to perform competently. These manuals will establish conducive and sustainable training
environment that will allow students and graduates to perform efficiently at their relevant
levels. Moreover, this will enable them to aspire for attainment of higher knowledge, skills
and attitudes in promoting excellence in nursing practice.
Goals and Objectives of the Training Manual
Overall Goal for training manual

The overall goal of these training manual is to provide high quality, standardized and
competence-based training materials for Diploma in nursing (NTA level 4 to 6) program.
Objectives for training manual

 To provide high quality, standardized and competence-based training materials.
 To provide a guide for tutors to deliver high quality training materials.
 Enable students to learn more effectively.

vii
Introduction
Module Overview
This module content has been prepared as a guide for tutors of NTA Level 6 for training
students. The session contents are based on the sub-enabling outcomes of the curriculum of
NTA Level 6 Certificate in Nursing.
The module sub-enabling outcome as follows:
1.1.4 Explain basic concepts of parasitology
1.1.5 State the relationship between the parasites and hosts
1.1.6 Apply knowledge of parasitology in the provision of quality nursing care
Who is the Module For?

This module is intended for use primarily by tutors of NTA Level 4 to 6 in nursing schools.
The module’ sessions give guidance on the time and activities of the session and provide
information on how to teach the session to students. The sessions include different activities
which focus on increasing students’ knowledge, skills and attitudes.
How is the Module Organized?

The module is divided into 21 sessions; each session is divided into sections. The following
are the sections of each session:
 Session Title: The name of the session.
 Learning Tasks – Statements which indicate what the student is expected to learn at the
end of the session.
 Session Content – All the session contents are divided into steps. Each step has a heading
and an estimated time to teach that step. Also, this section includes instructions for the
tutor and activities with their instructions to be done during teaching of the contents.
 Key Points – Each session has a step which concludes the session contents near the end
of a session. This step summarizes the main points and ideas from the session.
 Evaluation – The last section of the session consists of short questions based on the
learning objectives to check the understanding of students.
 Handouts are additional information which can be used in the classroom while teaching
or later for students’ further learning. Handouts are used to provide extra information
related to the session topic that cannot fit into the session time. Handouts can be used by
the participants to study material on their own and to reference after the session.
Sometimes, a handout will have questions or an exercise for the participants. The answers
to the questions are in the Facilitator Guide Handout, and not in the Student Manual
Handout.
How Should the Module be Used?

Students are expected to use the module in the classroom and clinical settings and during
self-study. The contents of the modules are the basis for learning Parasitology and Medical
Entomology. Students are therefore advised to learn each session and the relevant handouts
and worksheets during class hours, clinical hours and self-study time. Tutors are there to
provide guidance and to respond to all difficulty encountered by students.

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Session 1: Basic Concepts of Parasitology and
Medical Entomology
Total Session Time: 120 minutes
Prerequisites
 None
Learning Tasks
By the end of this session, students are expected to be able to:
 Define terms used in parasitology and medical entomology
 Explain types of parasites and host
 Classify parasites of medical importance
 Explain the relationship between the parasite and the host
 Explain the effects of parasites on the host
Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard makers
 Computer and LCD
 Overhead projector
SESSION OVERVIEW
Step Time Activity/Method Content
Presentation of Session Title and Student
1 5 minutes Presentation
Learning Tasks
Definition of Terms used in Parasitology
2 10 minutes Presention
and Medical Entomology
Presentation/
3 20 minutes Types of Parasites and Hosts
Group Discussion
Presentation/ Classification of Parasites of Medical
4 35 minutes
Buzzing Importance
The Relationship between the Parasite
and the Host
Presentation/
6 30 minutes Effects of Parasites on the Host
Group Discussion
7 5 minutes Presentation Key Points
8 5 minutes Presentation Evaluation
NMT 06226 Parasitology & Medical Entomology

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NTA Level 6, Semester 2 Session 1: Basic Concepts of Parasitology
SESSION CONTENT
Step 1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify.
ASK students if they have any question before proceeding.
Step 2: Definition of Terms used in Parasitology and Medical

Entomology (10 minutes)
Definition of Terms
 Parasitology : Scientific study of parasites , word derived from Latin words, Para means
besides , sito means food, and logy means study
 Parasite: An organism that lives either temporarily or permanently on or in another
organism, for the purpose of procuring food and shelter. The term parasite is applied only
to the organisms belonging to protozoa and helminthes
 Host: Is a large organism which provides food and shelter for the other small organism (a
parasite)
 Infection: Invasion of the body by parasites which grow, multiply and cause harmful
effects in the body of the host
 Disease: Invasion of the body by parasites which grow, multiply and cause harmful
effects which are accompanied by symptoms and signs.
 Carrier: An infected individual not showing symptoms (clinical manifestation),a carrier
serves as a potential source of infection.
 Pathogenic: Causing disease or capable of doing it. Pathogenic parasites are disease-
causing parasites, for example Plasmodium species
 Entomology: The scientific study of arthropods including insects
 Arthropod: An insect which are segmented invertebrate that are supported by rigid
frame work known as exoskeleton. e.g insects and arachinida
 Insect: The invertebrate creature in which is devided into three regions: head, thorax
and abdomen e.g mosquito.
 Vector : Invertebrate host mostly arthropod which is able to transmit diseases from the
infected host/source of infection to the susceptible /health host
o An arthropodic host which can harbour parasites and be able to transmit them
to another susceptible host
o The term vector usually applied only to blood-feeding arthropod intermediate
hosts such as mosquitoes, tsetse flies that carry the pathogenic agent of disease
from an infected host to a susceptible host.
 Biological Vector: Vector which harbours some developmental stages of the
parasite inside its body. For example: Female Anopheles mosquito harbours
zygote, ookineete, oocyst and sporozoite stages of Plasmodium species
 Mechanical vector: Vector which harbours the parasite on its outside body structures.
For example: House fly that transmits intestinal protozoa and helminthes (infective
forms) on its body parts.

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Step 3: Types of Parasite and Host (20 minutes)
Activity: Small Group Discussion (15 minutes)
DIVIDE students into small manageable groups
ASK students to discuss on the levels types of parasite and host for 5 minutes
ALLOW 2 to 3 groups to present and let other groups to provide additional points
WRITE their response on the chalk/white board or flip chart
CLARIFY and summarize their responses using the content below
Types of Parasite:
 Endoparasite: Parasite that lives inside another organism (host) depending on it for
food and shelter. For example, Plasmodium species, Ascaris lumbricoides
 Ectoparasite: Parasite that lives outside (on the body) of another organism (host)
depending on it for food and shelter. For example, Lice, ticks
 Obligate parasite:This parasite is completely dependent on the host during a segment
or all of its life cycle, e.g. Plasmodium spp
 Facultative Parasite: An organism that exhibits both parasitic and non-parasitic modes
of living and hence does not absolutely depend on the parasitic way of life, but is
capable of adapting to it if placed on a host. E.g. Naegleria fowleri
 Accidental parasite: When a parasite attacks an unnatural host and survives. E.g.
Hymenolepis diminuta (rat tapeworm)
 Erratic parasite: Is one that wanders in to an organ in which it is not usually found e.g.
Entamoeba histolytica in the liver or lung of humans.
Types of Host
 Definitive host: A host that harbors a parasite in the adult/mature stage or where the
parasite undergoes a sexual method of reproduction, e.g. a human is a the definitive
host for Schistosoma haematobium whereas Anopheles mosquito is the definitive for
the malaria parasites (Plasmodium spp)
 Intermediate host: A host that harbors the larval/immature stages of the parasite or an
asexual cycle of development takes place. In some cases, larval development is
completed in two different intermediate hosts, referred to as first and second
intermediate host, e.g. the tsetse fly is the intermediate host for the Trypanosoma
species that cause African trypanosomiasis (Sleeping sickness)
 Paratenic host: An animal acting as a substitute intermediate host of a parasite, usually
having acquired the parasite by ingestion of the original host; no development of the
parasite takes place but the phenomenon aids in the transmission of infection.
o Called also transfer or transport host e.g. the successive fish hosts that carry the
plerocercoid of Diphyllobothrium latum, the broad fish tapeworm, to larger food fish
eventually eaten by humans or other final hosts.
 Reservoir host: Is an animal in the absence of human host that maintains and makes
the parasite available for the transmission to another host and is usually not affected
by the infection e.g. Mosquitoes for filariasis and malaria, domestic and wild animals.
 Accidental host: a host that under normal circumstances not infected with the parasite

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Step 4: Classification of Parasites of Medical Importance (35 minutes)
Activity: Buzzing (5 minutes)
ASK students to pair up and buzz on classification of parasites of medical importance for 2
minutes
ALLOW 2 to 3 students to provide responses and let others provide additional responses
WRITE their responses on the board/flipchart
CLARIFY and summarize by using the content below
 Taxonomy
o The science dealing with the description, identification, naming, and classification of
organisms into groups based on similarities of structure, origin.
o The system currently used by taxonomists is called the Linnaeus taxonomic system, in
honor of Swedish biologist Carolus Linnaeus (1707 — 1778).
o The Linnaean system breaks down organisms into seven major divisions, called taxa
(singular: taxon). The divisions are as follows:
 Major Taxonomic Levels
 Kingdom
 Phylum
 Class
 Order
 Family
 Genus
 Species
 Parasites of medical importance come under the kingdom called animalia.
 The names of parasites are Latinized, and some times the parasites are given names of
discoverers
 The parasites with which we deal with belong to three Phyla of animal Kingdom:
 Protozoa
 Platyheleminthes:
o Cestodes
o Trematodes
o Nematodes
 Each phylum is divided into classes, and these in-turn are divided into orders, families,
genera, and species. (Kingdom -Phylum - Class - Order- Family – Genus – Species)
 Medical Protozoology: Deals with the study of medically important protozoa
o Protozoa: Any of a large group of single-celled, usually microscopic, eukaryotic
organisms, such as amoebas, ciliates, flagellates, sporozoans and Coccidia
o Amoebas
 Any of various one-celled aquatic or parasitic protozoan of the genus Amoeba or
related genera, having no definite form and consisting of a mass of protoplasm
containing one or more nuclei surrounded by a flexible outer membrane.
 It moves by means of pseudopods e.g. Entamoeba histolytica.
o Flagellates

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 Are organisms (nonphotosynthetic free-living protozoan) with one or more whip-
like organelles called flagella.
 Flagella are generally used for propulsion and may also be used to create a current
that brings in food.
 They can cause diseases and they can make their own food so some are pathogens
of humans and other animal e.g. Trichomonas vaginalis, Giardia lamblia, and
Trypanosomes.
o Ciliates
 A group of protozoans characterized by the presence of hair-like organelles called
cilia, which are identical in structure to flagella but typically shorter and present in
much larger numbers with a different undulating pattern than flagella.
 Cilia occur in all members of the group and are variously used in swimming,
crawling, attachment, feeding, and sensation e.g. Balantidium Coli
o Sporozoa
 Unlike most other protozoans, sporozoans have no cilia or flagella.
 All species are parasitic and have elaborate life cycles, often requiring more than
one host to complete their life cycle; Asexual and Sexual modes of reproduction
are present.
 Asexual reproduction occurs by multiple fissions while sexual mode of
reproduction occurs by syngamy.
 The best-known sporozoan is Plasmodium falciparum, the causative organism of
malaria.
o Coccidia
 Are single celled organisms that infect the intestine
 They are microscopic parasites detectable on routine fecal tests in the same way
that worms are, but coccidia are not worms and are not susceptible to deworming
medications.
 They are also not visible to the naked eye.
 Coccidia infection causes a watery diarrhea that is sometimes bloody and can be a
life-threatening problem to an especially young or small pet.
o Medical Helminthology
 Deals with the study of helminthes (worms) that affect man
o Helminthes
 The heliminthic parasites are multicellular, bilaterally symmetrical animals having
three germ layers.
 They normally cause disease and illness in humans.
 Infected people excrete helminth eggs in their faeces, which then contaminate the
soil in areas with inadequate sanitation.
 Other people can then be infected by ingesting eggs or larvae in contaminated
food, or through penetration of the skin by infective larvae in the soil (hookworms
o The helminthes of importance to human beings are divided into three main Classes:
 Cestoda (Cestodes): Is the name given to a class of parasitic flatworms (ribbon-
like), commonly called tapeworms, of the phylum Platyhelminthes; that are
parasitic in the intestines of humans and other vertebrates.
 Trematodes or flukes: Are parasitic flattened (flatworms) oval or worm-like
animals having external suckers for attaching to a host , usually no more than a
few centimeters in length, although species as small as 1 millimetre (0.039 in) and
as large as 7 metres (23 ft) are known.
 Nematodes: Are small, usually microscopic, unsegmented roundworms with a

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narrow cylindrical body; they resemble a tube within a tube with a head, mouth,
tail, and anus.
 The outer tube is comprised of the cuticle, hypodermis, and muscle; and the inner
tube contains the pharynx and intestine.
 Nematodes also have several hundred nerve cells and a prolific reproductive
system.
 They vary in size from a fraction of a millimeter to many centimeters for some
animal/human parasitic species.
Fig.1.1: Classification tree of Parasites of Medical Importance
Source: (Erickson, 2009)
 Medical Entomology
o Deals with the study of arthropods which cause or transmit disease to man.
 Classification of arthropods
o There are three medically important classes of Arthropods:
o Class Insecta: The general feature of this class includes:
 Division of body into head, thorax and abdomen.
 Possess one pair of antenna on the head.
 3 pairs of legs, carried by thorax.
 Wings may be present and could be one /two pairs.
o This class is divided into four orders:
 Order Diptera: This order consists of mosquitoes and flies.
 They have one pair of wing and development is by complete metamorphosis.
 Order Siphonaptera: Consists of fleas. Arthropods in this order are wingless but
have strong leg to help them jump. Their development is bycomplete
metamorphosis.
 Order Anoplura: Is order consists of lice, which are wingless and with short legs.
 Their development is by incomplete metamorphosis
 Order Hemiptera- This order consists of bugs. Bugs have rudimentary wings and
develop by incomplete metamorphosis.
o Class Arachnida

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 Body divided into cephalothorax (head and thorax fused) and abdomen.
 Possess 4 pairs of legs.
 They are wingless
 No antennae
 Undergo incomplete metamorphosis.
o There are 3 orders in this class:
 Order Acarina: This consists of Ticks and mites. The adult tick or mite has 4 pairs
of legs and the Nymph 3 pairs of legs.
 Order Araneida: This consists of spiders.
 Order Scorpionida: This order consists of scorpions.
o Class Crustacea: The general feature of this class includes
 Body divided into cephalothorax and abdomen
 4 pairs of legs
 2 pairs of antenna
 Wingless
 Most are aquatic
 This class includes the Cyclopes.

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Figure1.2: Classification tree of Arthropods of Medical Importance
Arthropoda
Ins ec ta Crus tac ea Arac hinida
Ac arina
Phthiraptera Diptera Coleoptera Siphonaptera Orthoptera Hemiptera
Tic k s & Mites
Cimic idae Argas idae

Nematoc era Cy c lorrhapha
Cimex Soft tic k s
Culic idae Ps y c hodidae Muc s idae Glos s inidae Reduv iidae

Ix odidae
(Mos quitoes ) Sandflies Mus c a s pp Ts ets e flies Triatomine
Hard tic k s
Simulidae Seratopogonidae Oes tridae

Calliphoridae Trombic ulidae
Blac k fly Culic oides Oes trus
Trombic ulus
Sarc optadae
Demodic idae
Mites
Figure 1.3: Features of Arthropods
Source: (Science, 2013)
Step 5: The Relationships between the Parasite and the Host (10
minutes)

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 Introduction
o In parasitic relationship, the half of the partnership which benefits from the
relationship is the parasite and that provides the benefit is called the host.
o The degree of dependence of the parasite on the host varies considerably from one
species of organism to another.
o For example, malaria parasites are unable to survive outside of a mosquito and
human body whereas some parasitic worms are capable of surviving for several
generations independently of a host.
o The majority of parasitic species lie between these two extremities
o The relationship between the parasite and host, which live together , can be of the
following types:
 Symbiosis
o Is the close association between the host and parasite
o Both are so dependant upon each that one can not live without the help of the
other.
 Commensalism
o It is an association in which the parasite only drives the benefit without causing
any injury to the host (e.g Entamoeba coli in human intestine)
 Parasitism
o An association in which the parasite derives benefit from the host and always
causes injury to the host, however mild may be (e.g. Plasmodium species causing
malaria)
 Immunity:
o Is a biological term that describes a state of having sufficient biological defenses
to avoid infection, disease, or other unwanted biological invasion
 Immune Reaction
o A bodily defence reaction that recognizes an invading substance (an antigen: such
as a parasite, virus, fungus, bacteria or transplanted organ) and produces
antibodies specific against that antigen
 Allergy
o The term allergy is used to describe a response, within the body, to a substance,
which is not necessarily harmful in itself, but results in an immune response and a
reaction that causes symptoms and disease in a predisposed person, which in turn
can cause inconvenience, or a great deal of misery.

9
Step 6: The Effects of Parasite on the Host (30 minutes)
ASK students to discuss on on effects of parasite on the host for 5 minutes
 Many parasites cause harmful effects to their host, but in most case these effects are
not of such importance that the host is being killed.
 The damage which pathogenic parasites produce in the tissues of the host may be
described in the following two ways:
Direct Effects of the Parasite on the Host

 Mechanical injury
o May be inflicted by a parasite by means of pressure as it grows larger, e.g.
Hydatid cyst causes blockage of ducts such as blood vessels producing infarction
o In the case of malaria the lysis of erythrocytes does lead to haemolysis and
anaemia.
o While in the case of Ascaris lumbricoides infection the presence of the worms in
the small intestine may lead to intestinal occlusions
 Deleterious effect of toxic substances
o In Plasmodium falciparum production of toxic substances may cause a sudden
paroxysmal chill with high temperature, called the cold stage, followed by a sense
of heat and profuse perspiration, called the hot stage (rigors) and other
symptoms.
o Also it is thought that the African trypanosome, when in the central nervous
system produces aromatic amino-acid analogues that may affect brain function.
 Immunodepression
o Deprivation of nutrients, fluids and metabolites -parasite may produce disease by
competing with the host for nutrients.
o Malaria, bilharzias, etc. lead to a certain degree of immune suppression which
renders the infected host more susceptible to other diseases
 Irritation of skin and tissues
o This may be ectoparasites and Endoparasites
 Wasting (cachexia, spoliatrices)
o African trypanosomiasis and leishmaniasis may lead to severe loss of weight in
both animals and man.
o Superinfections
 In the case of (muco) Cutaneous leishmaniasis ulcerations and Dracunculiasis may
lead to superinfections with bacteria.
 Allergic reaction

10
o In the case of onchocerciasis (river blindness) the presence of the filarial worms
under the skin
o May lead to depigmentation due to allergic reactions.
 Ulceration
o A discontinuity of the skin or a break in the skin that stops it from continuing its
normal functions
 Ulcer
o Is a sore, ranging in size from about a quarter of an inch to two inches
o Ulcers can occur on the surface of the body, such as on the foot, but more
commonly that forms in the stomach
Indirect Effects of the Parasite on the Host

 Immunological reaction
o Tissue damage may be caused by immunological response of the host, e.g.
nephritic syndrome following Plasmodium Infections.
o Excessive proliferation of certain tissues due to invasion by some parasites can
also cause tissue damage in man, e.g. fibrosis of liver after deposition of the ova
of Schistosoma.
 Immunosuppression:
o Involves an act that reduces the activation or efficacy of the immune system.
o Some portions of the immune system itself have immuno-suppressive effects on
other parts of the immune system, and immunosuppression may occur as an
adverse reaction to treatment of other conditions
 Anemia
o Is a condition characterized by abnormally low levels of healthy red blood cells or
hemoglobin
Step 7: Key Points (5 minutes)
 Parasite is an organism that lives within ,upon, or at an expense of another organism

known as host
 Host is the organism from which a parasite obtains its nourishment and shelter
 The parasites with which we deal with belong to three Phyla of animal Kingdom; these
are Protozoa, Platyheleminthes (Cestodes and Trematodes) and Nematohelminthes
(nematodes).
 Parasites attack the host internally or externally and cause deleterious effect, hence
are said to infect or infest and can be either Endoparasites or Ectoparasites.
 Effect of parasites to the host can be either direct such as; mechanical injury,
production of toxic substance leading to fevers, Immunodepression, irritation of skin
and tissue and wasting. Also indirect reaction such as an immunological reaction.

11
Step 8: Evaluation (5 minute)
 Mention two major types of parasites and hosts

 With examples, mention three side effects which may occur in the host due to the
invasion of the body by parasites
ASK students if they have any comments or need clarification on any points.
References
Cheesbrough, M. (1987). Medical laboratory manual for tropical countries (Vol. 1, 2nd ed.).
Oxford, United Kingdon: ELBS Butterworth-Heinemann.
Cheesbrough, M. (1998). District laboratory practice in tropical countries: part 1. Noida,
India: Gapson Papers.
Cook, G. (2000). Manson’s tropical diseases (22nd ed.). London: W.B. Saunders.
Erickson, A. (2009) Parasite. Retrieved from htttp://www.stanford.edu
Gupte, S. (2010). The short textbook of medical microbiology including parasitology (10th
ed.). New Delhi, India: Jaypee Brothers Medical Publishers.
Harwood, R. F., & James, M. T. (1979). Entomology in human and animal health (7th ed.).
Pullman, WA: Washington State University-Pulman.
Leventhal, R., & Russell, F. C. (2009). Medical parasitology: A self-instructional text (5th
ed.). New Dehli, India: Jaypee Brothers Medical.
Parija, S. (2006). Textbook of medical parasitology: Protozoology and helminthology
(3rd ed.). New Delhi, India: All India Publishers and Distributors.
Science. (2013). Arthropods. Retrieved from http://www.esccalbe.blogspot.com

12
Session 2: Intestinal Protozoa of Medical Importance -
Entamoeba Histolytica, Giardia Lamblia and
Balantidium Coli
Prerequisites
 None
Learning Tasks
 Identify the parasites of Medical Importance
 Describe Morphological Characteristics of Entamoeba histolytica
 Explain the Mode of transmission of Entamoeba histolytica
 Explain the effects of E.histolytica on the host
 Describe Morphological Characteristics of Giardia lamblia
 Explain the Mode of Transmission of Giardia lamblia.
 Explain the effects of Giardia lamblia on the host
 Describe Morphological Characteristics of Balantidium Coli.
 Explain the Mode of Transmission of Balantidium coli
 Explain the effects of Balantidium coil on the host
Resources Needed
 Handout 2.1: Life cycle of Entamoeba histolytica.
 Handout 2.2 : Life cycle of Giardia lamblia
 Handout 2.3 : Life cycle of Balantidium coli

NTA Level 6, Semester 2 13 Session 2: Intestinal Protoza of Medical
Importance - Entamoeba Histolytica,
Giardia Lamblia and Balantidium Coli
SESSION OVERVIEW
Learning Tasks
Morphological Characteristics of Entamoeba
Histolytica
Presentation/ Mode of Transmission of Entamoeba
3 15 minutes
Group Discussion Histolytica
4 10 minutes Presentation Effects of E. Histolytica on the Host
Morphological Characteristics of Giardia
Lamblia
6 5 minutes Presentation Mode of Transmission of Giardia Lamblia
Presentation/
7 10 minutes Effects of Giardia Lamblia on the Host
Brainstorming
Morphological Characteristics of
Balantidium Coli
Presentation/ Mode of Transmission and Disease Caused
9 10 minutes
Buzzing by Balantidium Coli
10 5 minutes Presentation Effectss of Balantidium Coli on the Host
SESSION CONTENT

Step 2: Morphological Characteristics of Entamoeba Histolytica

(15 minutes)
Trophozoite
 Measures from15-30 µm and the cyst 10 -16 µm in diameter
 Cytoplasm has 2 zones; hyaline outer margin and granular inner margin that may
contain red cells.
 Movement of trophozoites in fresh material is brisk and unidirectional
 The parasite exists in both trophozoite and cystic forms
 Movement is by means of pseudopodia

Cyst
 Oval creature surrounded by a tough cyst wall as a protective means
 Can not move, feed and divide
 Formed in the body of the host
 Infective stage to most intestinal protozoan parasites
 Cystic form posseses four nuclei
Figure 1.1: Morphological Features of Trophozoites and Cysts of Entamoeba histolytica
Source: (Brooks, Carroll, Butel, & Morse, 2007)
 Entamoeba histolitica. A, B: Trophozoite (vegetative form) with ingested red cells in

A; C: Entamoeba hartmanni trophozoite with food vacuoles, not red cells; D: cysts
with 1, 2, and 4 nuclei and chromatoid bodies; E: E. hartmanni binucleate cyst (left),
uninucleate precyst (right).

Step 3: Mode of Transmission of Entamoeba Histolytica (15 minutes)
Refer students to Handout 2.1: Life cycle of Entamoeba Histolytica
ASK students to discuss on Mode of transmission and disease caused by Entamoeba

Histolytica for 5 minutes
ALLOW students to provide their responses in groups
CLARIFY and summarize using the answers in the worksheet
Mode of Transmission
 Eating uncleaned fruits and undercooked vegetables
 Drinking water contaminated with faeces containing cysts of Entamoeba histolytica
Refer students to Handout 2.1: Life cycle of Entamoeba histolytica
Step 4: Effectss of Entamoeba Histolytica on the Host (10 minutes)
ASK students to pair up and buzz on the effects of entamoeba histolitica on the host for 2
minutes
In Acute Phase
 Frequent dysentery with necrotic mucosa
 Abdominal pain.
In Chronic Phase
 Recurrent episodes of dysentery with blood and mucus in the faeces.
 There are intervening gastrointestinal disturbances and constipation.
 Liver dysfunction, pneumonitis, and encephalitis when the parasite invades the liver,
lung and brain respectively

Step 5: Morphological Characteristics of Giardia Lamblia (20 minutes)
 Giaardiaa lamblia exists into two parasitic forms:
Trophozoite
 Bilaterally symmetrical
 Pear-shaped flagellate measuring 12 – 15 mµ in diameter with a broad, rounded
anterior and a tapering posterior extremity
 Dorsal surface is convex
 Bears four pairs of flagella used as a means of movement “ falling leaf movement”
 Has two nuclei, each containing a large central karyosome giving characteristic face-
like-appearance to the parasite
Cysts
 Measure 9 -12 mµ in diameter
 Ellipsoidal cells with a smooth well-defined wall
 The cytoplasm contains four nuclei and many of the structures seen in the trophozoite
Figure 1.2: Giardia lamblia
Source: (Brooks et al., 2007)
 A: Face and B: Profile of vegetative (Trophozoite) forms.

 C and D are Cysts; Binucleated (D) and Quadrinucleate Stages
Step 6: Mode of Transmission of Giardia Lamblia (5 minutes)
 Mode of Transmission
o Ingestion of food (fruits and green vegetables or water) contaminated by faeces
containing Giardia lamblia cysts.
Refer students to Handout 2.2: Life cycle of Giardia lamblia
Step 7: Effects of Giardia Lamblia on the Host (10 minutes)

Activity: Brainstorming (5 minutes)
ASK the student to brainstorm on effects of Giardia lamblia on the host for 2 minutes
ALLOW 2 to 3 students to respond and let other provide additional responses
WRITE their responses on the flip chart/ board
CLARIFY and summarize by using information below
Early Stages
 Flatulence, abdominal distension,
 Nausea, foul-smelling bulky, explosive
 Often watery diarrhoea
 The stool contains excessive lipids but very rarely any blood or necrotic tissue.
Chronic Stage
 Vitamin B12 malabsorption,
 Disaccharides deficiency and lactose intolerance
Step 8: Morphological Characteristics of Balantidium Coli –Intestinal

Ciliates (15 minutes)
Trophozoite
 Is a ciliated oval organism
 Measures 60 x 45 µm or more
 The cell wall is lined with spiral rows of cilia
 Cytoplasm surrounds two contractile vacuoles, food particles and vacuoles and two nuclei
(a large kidney – shaped macronucleus and a much smaller, spherical genetic
macronucleus).
Cyst
 When the organism encysts, it secretes a double-layered wall measuring from 40 µm –
70µm in diameter.
 The macronucleus, contractile vacuoles, and portions of the ciliated wall may be visible
with cyst,

Figure 1.3: Morphological Features of B. Coli (A: Trophozoite and B: Cyst)
Source: (Brooks et al., 2007)
Step 9: Mode of Transmission of Balantidium Coli (10 minutes)
ASK the student to pair up and buzz on mode of transmission of Balantidium coli for 2
minutes

Mode of Transimission
 Infection results from ingestion of fruits, green vegetables or water contaminated with
viable cysts previously passed in the faeces of infected humans and possibly pigs.
Refer Students to Handout 2.3: The Life Cycle of Balantidium Coli
Step 10: Effects of Balantidium Coli on the Host (10 minutes)

Balantidiasis is often accompanied by:
 Diarrhoea or dysentery
 Abdominal pain
 Nausea and vomiting

Entamoeba Histolytica Parasite
 Exists in both trophic and cystic forms
 Moves by means of pseudopodia
 Transmission is through ingestion of viable cysts
 Infection may also involve liver
Giardia Lamblia Parasite

 Is a flagellated parasite moves by the aid of flagella
 Human acquires infection through ingestion of viable cysts
 Infection is very common in children
Balantidium Coli Parasite

 Protozoa that moves by the aid of cillia
 Transmission is through ingestion of viable cysts passed in n feaces of the infected host
Step12: Evaluation (5 minutes)
 Mention two parasitic forms of Entamoeba histolytica

 State the scientific name for pathogenic intestinal amoeba, and intestinal ciliates
respectively.
 Mention two morphological characteristics of Balantidium coli
 What are the specimens to be used for laboratory diagnosis of Amoebiasis, Giardiasis,
and Balantidiasis respectively?
References
Brooks, G. F., Carroll, K. C., Butel, J. S., & Morse, S. A. (2007). Jawetz, Melnick &
Adelberg’s medical microbiology. New York City, NY: McGraw-Hill.

Handout 2.1: The Life Cycle of Entamoeba
Histolytica
Source: (CDC, 2009)
 Cysts and trophozoites are passed in feces. Cysts are typically found in formed stool,
whereas trophozoites are typically found in diarrheal stool.
 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.
 The trophozoites multiply by binary fission and produce cysts, and both stages are passed

in the feces.
 Because of the protection conferred by their walls, the cysts can survive days to weeks in
the external environment and are responsible for transmission.
 Trophozoites passed in the stool are rapidly destroyed once outside the body, and if
ingested would not survive exposure to the gastric environment.
 In many cases, the trophozoites remain confined to the intestinal lumen (: noninvasive
infection) of individuals who are asymptomatic carriers, passing cysts in their stool.
 In some patients the trophozoites invade the intestinal mucosa (intestinal disease), or,
through the bloodstream, extraintestinal sites such as the liver, brain, and lungs
(extraintestinal disease), with resultant pathologic manifestations.
 It has been established that the invasive and noninvasive forms represent two separate
species, respectively E. histolytica and E. dispar.
 These two species are morphologically indistinguishable unless E. histolytica is observed
with ingested red blood cells (erythrophagocystosis).
 Transmission can also occur through exposure to fecal matter during sexual contact (in
which case not only cysts, but also trophozoites could prove infective).

Handout 2.2: The Life Cycle of Giardia
Lamblia
Source: (CDC, 2009)
Life Cycle
 Infection occurs after cysts are ingested. This marks the beginning of the life cycle.
 After ingestion, mature cysts in the small intestine release trophozoites through a process
called excystation. 3 Cysts are able to survive exposure to gastric acid; gastric acid may

actually trigger excystation. 2The trophozoite stage is responsible for producing clinical
disease in humans. Giardia lamblia trophozoites
 Trophozoites have two distinct nuclei and four pairs of flagellae. They resemble teardrops
when viewed from the top and they are spoon shaped from the side.
 They are 12-15 µm in length.Trophozoites colonize the small intestine, attaching to the
mucosa of the bowel using a ventral sucking disks.
 The trophozoites then multiply by longitudinal binary fission.4.
 As the Giardia trophozoites move toward the colon, they retreat into the cyst stage
(known as encystation) and the new cysts are excreted in the feces.
 Bile salts and intestinal mucus boost trophozoite multiplication and encystations.

Handout 2.3 The Life Cycle of Balantidium
Coli
Source: (CDC, 2009)
Life Cycle
 Cysts are the parasite stage responsible for transmission of balantidiasis.
 The host most often acquires the cyst through ingestion of contaminated food or water.
 Following ingestion, excystation occurs in the small intestine, and the trophozoites
colonize the large intestine .
 The trophozoites reside in the lumen of the large intestine of humans and animals, where
they replicate by binary fission, during which conjugation may occur .
 Trophozoites undergo encystation to produce infective cysts.
 Some trophozoites invade the wall of the colon and multiply.

 Some return to the lumen and disintegrate.
 Mature cysts are passed with feces

Session 3: Intestinal Protozoa of Medical Importance -
Cryptosporidium Parvum and Isospora Belli
Prerequisites
 None
Learning Tasks
 Define Cryptosporidium parvum
 Describe morphological characteristics of Cryptosporidium parvum
 Explain the mode of transmission of Cryptosporidium parvum
 Explain the effects of Cryptosporidium on the host
 Describe morphological characteristics of Isospora belli
 Explain the mode of transmission of Isospora belli
 Explain the effects of Isospora belli on the host
Resources Needed
 Handout 3.1: Life cycle of Cryptosporidium parvum
 Handout 3.2: Life cycle of Isospora belli

NTA Level 6, Semester 2 27 Session 3: Intestinal Protozoa of Medical
Importance - Cryptosporidium Parvum
and Isospora Belli
SESSION OVERVIEW
Learning Tasks
Presentation/
2 10 minutes Definition of Terms
Buzzing
Cryptosporidium Parvum
Presentation/ Mode of Transmission of Cryptosporidium
4 10 minutes
Brainstorming Parvum
5 5 minutes Presentation Effects of Cryptosporidium on the Host
Morphological Characteristics of Isospora
Belli
7 5 minutes Presentation Mode of Transmission of Isospora Belli
8 5 minutes Presentation Effects of Isospora Belli on the Host
SESSION CONTENTS
READ or ASK students to read learning tasks and clarify.
Step 2: Definition of Terms (10 minutes)
ASK students to pair up and buzz on the definition of Cryptosporidium Parvum for 2
minutes
ALLOW 2 to 3 students to provide response and let others provide additional responses
WRITE their response in the chalk/white board or flip chart
Definition of Terms
 Cryptosporidium parvum

and Isospora Belli
o Is a protozoa parasite of coccidia group inhabiting mammalian intestinal tract
o Cryptosporidium parvum is a parasite of humans; other species are parasites of other
animals. Cryptosporidium parvum infection is characterized by acute, watery, and
non-bloody diarrhoea.
 Cryptosporidium parvum infection is of particular concern in immunocompromised
patients, where diarrhoea can reach 10–15 litre per day:
o The infection is generally self-limiting in immunocompetent people.
o In immunocompromised patients, such as those with AIDS or those undergoing
immunosuppressive therapy, the infection may not be self-limiting, leading to
dehydration and, in severe cases, death.
Step 3: Morpholgical Characteristics of Cryptosporidium Parvum
(5 minutes)
 Cryptosporidium parvum is a small round coccidian parasite measuring 3 - 5 mµ in
diameter
 Exists into two parasitic forms:
o The oocysts are rounded and measure 4.2 - 5.4 µm in diameter
o Sporozoites are sometimes visible inside the oocysts, indicating that sporulation has
occurred
Figure 2.1: Cryptosporidium Species
Source: (CDC, 2009)
 Oocysts (Pink Arrows) in wet mount

 Budding yeast (brown arrow) is in the same field.

and Isospora Belli
Step 4: Mode of Transmission of Cryptosporidium Parvum (10 minutes)
ASK student to brainstorm on guidelines on mode of transmission for 2 minutes
ALLOW 2 to 3 students to provide their responses and let others provide additional
responses
WRITE their responses on the flip chart/board
CLARIFY and summarizes by using the content below
 Transmission of Cryptosporidium parvum occurs mainly through following ways:
o Ingestion (faecal-oral) of oocysts in contaminated water (e.g., drinking or recreational
water) and occasionally food sources, such as chicken salad which serve as vehicles
for transmission.
o Water-borne transmission can occur when drinking water supplies become
contaminated (Chlorination of water does not kill the oocysts).
o However, boiling of water for ten minutes destroys the organisms)
o Also can be acquired from contamination of water parks, community swimming
pools, and day care centres
o Zoonotic transmission of C. parvum occurs through exposure to infected animals or
exposure to water contaminated by faeces of infected animals.
o Sporulated oocysts, containing 4 sporozoites, are excreted by the infected host
through faeces and possibly other routes such as respiratory secretions and are
infective to the susceptible host when ingested
Refer students to Handout 3.1: Life Cycle of Cryptosporidium Parvum
Step 5: Effects of Cryptosporidium Parvum on the Host (5 minutes)
 Diarrhoea most likely in large number of people in the community

o Copious watery diarrhoea,
o Cramping abdominal pain,
o Flatulence and weight loss.
 In AIDS patients, the organism may cause prolonged, severe diarrhoea
 Severity and duration of symptoms are related to immuno-competence.

and Isospora Belli
Step 6: Morphological Characteristics of Isospora Belli (5 minutes)
 Parasitic forms of Isospora belli

o Oocysts
 Are large; 25 - 30 µmin diameter and have a typical ellipsoidal shape.
 When excreted, they are immature and contain one sporoblast (A, B).
 As the oocyst matures after excretion the single sporoblast divides in two
sporoblasts (C), which develop cyst walls, becoming sporocysts.
o Sporocysts
 Two sporocysts in a mature oocyst each contains four sporozoites
Figure 2.2: Parasitic Forms of Isospora Belli Sporoblast (A, B), Two Sporocysts in a Mature
Oocyst each Contains Four Sporozoites (C)
A B C
Source: (CDC, 2009)

Step 7: Mode of Transmission of Isospora Belli (5 minutes)
 The organism is acquired by fecal-oral transmission of oocysts from either human or
animal sources.
 Oocyst the infective stage ingested in water or food, as with C. parvum.
 Also can be acquired from contamination of water parks, community swimming pools,
and day care centres
Refer students to Handout 3.2: Life Cycle of Isospora belli
Step 8: Effects of Isospora Belli on the Host (5 minutes)
 Acute, non-bloody diarrhea with crampy abdominal pain,

o Last for weeks and result in malabsorption and weight loss
 In immunodepressed patients, and in infants and children, the diarrhea can be severe.
 Is an intestinal protozoan that causes diarrhea, especially in immunocompromized
patients, e.g., those with AIDS
 Its life cycle parallels that of other members of the Coccidia.

and Isospora Belli
 Cryptosporidium parvum
o Exists into two forms oocysts and sporozoites
o Transmission is through ingestion of oocysts containing sporozoites
o Diarrhea is very common
 Isospora belli
o Transmitted through ingestion of oocysts in contaminated food/water
The disease produces symptoms similar to those of giardiasis.
Step 10 : Evaluation (5 minutes)
 Mention two parasitic forms of Cryptosporidium parvum and I. belli

 How humans acquire Cryptosporidiasis
 Mention two factors that influence Cryptosporidiasis in man
References

and Isospora Belli
Handout 3.1: Life cycle of Cryptosporidium Parvum
Source: (CDC, 2009)
 Sporulated oocysts, containing 4 sporozoites, are excreted by the infected host

through feces and possibly other routes such as respiratory secretions .
 Transmission of Cryptosporidium parvum and C. hominis occurs mainly through
contact with contaminated water (e.g., drinking or recreational water).
 Occasionally food sources, such as chicken salad, may serve as vehicles for
transmission.
 Many outbreaks in the United States have occurred in waterparks, community
swimming pools, and day care centers.
 Zoonotic and anthroponotic transmission of C. parvum and anthroponotic
transmission of C. hominis occur through exposure to infected animals or exposure to
water contaminated by feces of infected animals . Following ingestion (and possibly
inhalation) by a suitable host , excystation occurs.
 The sporozoites are released and parasitize epithelial cells ( , ) of the
gastrointestinal tract or other tissues such as the respiratory tract. In these cells, the
parasites undergo asexual multiplication (schizogony or merogony) ( , , ) and
then sexual multiplication (gametogony) producing microgamonts (male) and

and Isospora Belli
macrogamonts (female) .
 Upon fertilization of the macrogamonts by the microgametes ( ), oocysts ( , )
develop that sporulate in the infected host.
 Two different types of oocysts are produced, the thick-walled, which is commonly
excreted from the host , and the thin-walled oocyst , which is primarily involved
in autoinfection. Oocysts are infective upon excretion, thus permitting direct and
immediate fecal-oral transmission.
 Note that oocysts of Cyclospora cayetanensis, another important coccidian
parasite, are unsporulated at the time of excretion and do not become infective until
sporulation is completed. Refer to the life cycle of Cyclospora cayentanensis for
further details

and Isospora Belli
Handout 3.2: Life cycle of Isospora belli
Source: (CDC, 2009)
 At time of excretion, the immature oocyst contains usually one sporoblast (more
rarely two) are ecreted with feaces. In further maturation after excretion, the

and Isospora Belli
sporoblast divides in two (the oocyst now contains two sporoblasts); the sporoblasts
secrete a cyst wall, thus becoming sporocysts; and the sporocysts divide twice to
produce four sporozoites each.
 Infection occurs by ingestion of sporocysts-containing oocysts: the sporocysts excyst
in the small intestine and release their sporozoites, which invade the epithelial cells
and initiate schizogony. Upon rupture of the schizonts, the merozoites are released,
invade new epithelial cells, and continue the cycle of asexual multiplication.
 Trophozoites develop into schizonts which contain multiple merozoites.
 After a minimum of one week, the sexual stage begins with the development of male
and female gametocytes. Fertilization results in the development of oocysts that are
excreted in the stool.

and Isospora Belli
Session 4: Blood Protozoa of Medical Importance -
Plasmodium Species
Prerequisites
 None
Learning Tasks
 Describe Morphological Characteristics of Plasmodium falciparum, P.vivax, P.ovale,
and P. Malariae
 Explain the mode of transmission of Plasmodium species
 Explain the effects of Plasmodium species on the host
Resources Needed
 Handout 4.1: Life cycle of Plasmodium specie
SESSION OVERVIEW
Learning Tasks
Presentation/
2 25 minutes Plasmodium Falciparum, P.Vivax, P.Ovale,
Group Discussion
and P.Malariae
3 5 minutes Presentation Mode of Transmission Plasmodium Species
Presentation/
4 15 minutes Effects of Plasmodium Species on the Host
Brainstorming

37
NTA Level 6, Semester 2 Session 4: Blood Protozoa of Medical
Importance - Plasmodium Species
SESSION CONTENT

Step 2: Morphological Characteristics of Plasmodium Species (25 minutes)
Refer students to Handout 4.1: Life cycle of Plasmodium species
ASK students to discuss in groups on the four Plasmodium species and at least two
morphologic characteristics for each for 5 minutes
ALLOW students to provide their responses in groups
CLARIFY and summarize using the content below
Morphological Characteristics of Plasmodium Species in Stained Blood Smear
Plasmodium species
 Plasmodium falciparum
 Plasmodium vivax
 Plasmodium ovale
 Plasmodium malariae
Diagnostic Features of P. Falciparum

 Red Cells are not enlarged.
 Rings appear fine and delicate and there may be several in one cell.
 Some rings may have two chromatin dots.
 Presence of marginal or appliqué forms.
 It is unusual to see developing forms in peripheral blood films.
 Gametocytes have a characteristic crescent shape appearance.
 However, they do not usually appear in the blood for the first four weeks of infection.
 Maurer's dots may be present.

38
Figure 4.1: Morphological Characteristics of Plasmodium falciparum in Blood Smear
Source: (CDC, 2009)

Diagnostic Features of Plasmodium Vivax
 Red cells containing parasites are usually enlarged.
 Schuffner's dots are frequently present in the red cells as shown.
 The mature ring forms tend to be large and coarse.
 Developing forms are frequently present
Figure 4.2: Morphological Characteristics of Plasmodium Vivax in Blood Smear
Source: (CDC, 2009)
Diagnostic Features of Plasmodium Ovale

 Red cells enlarged.

39
 Comet forms common (top right)
 Rings large and coarse
 Schuffner's dots, when present, may be prominent.
 Mature schizonts similar to those of Plasmodium malariae but larger and coarser.
Figure 4.3: Morphological Characteristics of Plasmodium Ovale in Blood Smear
Source: (CDC, 2009)
Diagnostic Features of Plasmodium Malariae

 Ring forms may have a squarish appearance.
 Band forms are a characteristic of this species.
 Mature schizonts may have a typical daisy head appearance with up to ten merozoites.
 Red cells are not enlarged.
 Chromatin dot may be on the inner surface of the ring.

40
Figure 4.4: Morphological characteristics of Plasmodium malariae in blood smear
Source: (CDC, 2009)
Step 3: Mode of Transmission of Plasmodium Species (5 minutes)

 By the bite of an infective female Anopheles mosquito when taking blood meal injecting
Sporozoites from its salivary glands into the blood circulation of man.
 Transfusion of unscreened blood
 Congenital (Mother to foetus through placenta)
Refer students to Handout 4.1: Life Cycle Plasmodium species
Step 4: Effects of Plasmodium Species on the Host (15 minutes)
ASK the student to brainstorm on effects of plasmodium species on the host for 2 minutes
ALLOW 2 to 3 students to respond and let others provide additional responses
CLARIFY and summarize their responses by using the content below
Cold Stage
 Characterized by rigor and headache
 The patient feels cold and shivers even though his or her temperature is rising
Fever Stage
 Body temperature rises to its maximum and the headache, is severe

41
 Usually patient feels pains in the back and joints, muscle aches, anorexia, nausea and
often vomiting and diarrhoea.
Sweating Stage
 The patient perspires, the temperature falls; headache and other pains are relieved until
the next rigor.
Complications
 Severe anaemia
 Cerebral malaria
 Renal impairment (black water fever)
 Hypoglycaemia with lactic acidosis
 Tropical splenomegaly
 There are four Plasmodium species affecting man

 Diagnostic features of Plasmodium species can be described in stained blood smears
using microscope
 Malaria transmission is between infected Female Anopheles mosquito and susceptible
humans and vice versa
 Malaria Complications include anaemia, spleenomegaly etc.
 Plasmodium falciparum is the commonest cause of malaria incidences in Tropics and Sub
Tropics
Step 6: Evaluation (5 minutes)
 Mention four Plasmodium species

 Which Plasmodium species is the commonest cause of malaria in Tropics and sub
Tropics?
 Mention two modes of transmission of malaria parasites
 What are the commonly used laboratory diagnostic methods for malaria

42
References

43
Handout 4.1: The Life Cycle Plasmodium
Species
Source: (CDC, 2009)
Life Cycle
Life cycle of Plasmodium species takes place in two hosts:
 Female Anopheles mosquito
o Sporozoites are injected with salaiva into humans
o Sporozoites infect liver cells and develop into schizonts
o Schizonts grow and rupture releasing merozoites which invade new cells( RBC and
liver cells)
o Merozoites infect red blood cells, Some parasites differentiate into sexual erythrocytic
stages (gametocytes)
o Blood stage parasites are responsible for the clinical manifestations of the disease
 Female Anopheles mosquito
o The gametocytes, male (microgametocytes) and female (macrogametocytes), are
ingested by an Anopheles mosquito during a blood mea

44
o While in the mosquito's stomach, the microgametes penetrate the macrogametes
generating zygotes
o The zygotes in turn transform into another form called ookinetes which develop into
oocysts
o The oocysts grow, rupture, and release sporozoites which make their way to the
mosquito's salivary glands.
o Inoculation of the sporozoites into a new human takes place when a mosquito next
takes a blood

45
Session 5: Blood and Tissue Protozoa of Medical
Importance - African Trypanosoma and
Leishmania Species
Prerequisites
 None
Learning Tasks
 Describe morphological characteristics of Trypanosoma gambiense and T.
rhodesiense
 Explain the mode of transmission and of Trypanosoma gambiense and T.rhodesiense
 Explain the Effects of African Trypanosomes on the host
 Describe morphological characteristics of Leishmania species
 Explain the mode of transmission Leishmania species
 Explain the Effects of Leishmania species on the host
Resources Needed
 Handout 5.1: Life Cycle of Trypanosoma Gambiense and T. Rhodesiense

NTA Level 6, Semester 2 46 Session 5: Blood and Tissue Protozoa of
Medical Importance - African
Trypanosoma and Leishmania Species
SESSION OVERVIEW
Learning Tasks
2 15 minutes Presentation Trypanosoma Gambiense and Trypanosoma
Rhodesiense
Mode of Transmission of African
Trypanosoma Species
Presentation/ The Effects of African Trypanosomes on the
4 25 minutes
Group Discussion Host
Morphological Characteristics of Leishmania
Species
Mode of Transmission of Leishmania
Species
Presentation/ The Effects of Leishmania Species on the
7 30 minutes
Buzzing Host
SESSION CONTENT

Step 2: Morphological Characteristics of Trypanosoma Gambiense and

T.Rhodesiense (15 minutes)
Introduction
 Trypanosoma brucei gambiense and Trypanosoma brucei rhodesiense cause African
trypanosomiasis in humans. The disease is also known as sleeping sickness.
 The parasites are closely related and belong to the Trypanosoma brucei group, or
complex.
Morphological Characteristics
 Trypanosomes are minute, actively motile, fusiform protozoa, flattened from side to side.
The long sinuous body has a tapering anterior and a blunt posterior end.
 The flagellum, projects from the anterior end after passing along the margin of the
undulating membrane, a wavy fold of the periplast on the convex border of the
trypanosome.
 A large oval nucleus, is situated toward the middle of the body

 Near the posterior end there is a kinetoplast, consisting of a spherical or rod-shaped
parabasal body of variable size and an anterior connecting basal granule, the
blepharoplast.
 Trypanosomes travel with a wavy spiral motion produced by the contractile flagellum and
undulating membrane.
 Both T.gambiense and T.rhodesiense are morphologically indistinguisshable
Figure 5.1: Morphological features of Trypanosoma b.rhodesiense (Stained smear)
Source: (CDC, 2009)
Step 3: Mode of Transmission of African Trypanosoma Species (10 minutes)
 African Trypanosomiasis is transmitted through bite of infective tsetse flies ( Glossina
species)
 Both male and female tsetse flies suck blood and able to transmit the parasites to humans
 Transfusion of unscreened blood to recipient
Refer students to Handout 5.1: Life Cycle of Trypanosoma gambiense and

T. Rhodesiense.
Step 4: Effects of African Trypanosomes on the Host (25 minutes)
 The progression of African Trypanosomiasis can be divided into three stages:
Bite Reaction
 A non-pustular, painful, itchy chancre
 Forms 1-3 weeks after the bite and lasts 1-2 weeks, it leaves no scar.
Parasitemia Stage
 Marked by attacks of fever which starts 2-3 weeks after the bite and is accompanied by
malaise, lassitude, insomnia headache and lymphadenopathy and oedema
 Painful sensitivity of palms and ulnar region to pressure (Kerandel's sign) may develop in
some Caucasians
 Very characteristic of Gambian disease is visible enlargement of the glands of the
posterior cervical region (winter bottom’s sign)
 Febrile episodes may last few months as in Rhodesian disease or several years as in
Gambian disease.

CNS Stage
 The Trypanosome parasites invade the central nervous system giving symptoms of
meningoencephalitis that is marked by changes in character and personality.
 Other symptoms include:
o Lack of interest and disinclination to work,
o Trembling, and inability to speak properly,
o Progressive mental dullness,
o Excessive sleeping and incontinence.
o Males become impotent.
o Death results from coma, intercurrent infection or cardiac failure.
Step 5: Morphological Characteristics of Leishmania Species (15 minutes)

Amastigote
 Are small, oval, intracellular organisms, found within phagocytic vacuoles of
macrophages and other mononuclear phagocytes
 The amastigote measures about 2µ - 4µ x 1µ - 2µ
 In this form the most conspicuous basophilic staining structures are the nucleus and a rod-
shaped kinetoplast
Promastigote
 Elongated body with nucleus, kinetoplast and free flagellum
 The kinetoplast situated at the anterior extremity
 Measures 14µ - 20µ by 1.5µ - 4.0µ
Fig. 5.2 Amastigote and Promastigote Forms of Leishmania
Species
Source: (Opperdoes, 1997)
Step 6: Mode of Transmission of Leishmania Species (10 minutes)
 Cyclic transmission (human vector contact)

 Mechanical transmission
 The presence of the amastigotes in the nasal and intestinal mucosa theoretically enables
transmission by respiratory tract or faecal contamination

Refer students to Handout 5.2: Life Cycle of Leishmania species
Step 7: Effects of Leishmania Species on the Host (30 minutes)
ASK student to pair up and buzz on effects of Leishmania species on the host for 2 minutes
 Leishmania infection is grouped into three (3):

Old World Cutaneous Leishmaniasis (Tropical/Oriental Sore)
 The parasites affect the reticuloendothelium of skin and localized papules, boils, and
ulcers
 The disease leads to ulceration of the invaded parts
 Sandflies feed on the skin lesion
 The L.ethipica causes the diffuse or disseminated ulcers. This parasite prevails in the
areas of Ethiopia ,Kenya, and possibly Yemen
New World Cutaneous and Mucocutaneous Leishmaniasis (Espundia)

 Four sub-species of the species L.braziliensis play a major role in causing the infection.
o L.b.braziliensis
 This parasite causes espundia in Brazil and adjacent tropical forest areas.
 The parasite affects multiple face, larynx and nasal pharynx
o L.b.guyanensis
 The infection leads to multiple ulcers of the body and extremities
o L.b.panamensis
 The infection does not metastasi, the parasite causes shallow ulcers on exposed
parts and
 Secondary Nodules, along lymph channels.
o L.b.peruviana
 Parasite causes cutaneous ulcer without nasopharynx
Visceral Leishmaniasis (Kala-Azar, Dum Dum Fever)

 This disease occurs in both old world and new world, caused by L.donovani
 The parasite affects the reticuloendothelium of spleen, liver, bone marrow, and visceral
lymphnodes.
 The infection leads into spleenomegally, enlargement of the liver, and increased number
of macrophages and decreased erythrocytic function of bone marrow
 African Trypanasomaisis is caused by two species Trypaanasoma gambiense and

T.rhodesiense
 African Trypanasomaisis is also known as Sleeping sickness transmitted by a vector
Glossina species
 When the Trypanosome parasites invade the Central Nervous System it may result into
meningoencephalitis that is marked by changes in character and personality
 Leishmaniasis is a vecctorborne disease caused by Leishmaania species, it is transmitted
by the insect called Saandfly Phlebotomus and Lutzomyia species
 Parasites of Leishmania species are found in tissues of ddifffernt organs of the human
body:
o Reticuloendothelium of skin
o Mucous membranes of larynx and nasal pharynx

 What is Afrcan Tryipanasomiais?
 Mention a vector associated with African Tryipanasomiais
 Mention three clinical manifestations when African Tryipanasomiais is at the critical
stage.
 Mention four Leishmania species of medical importance
References

Handout 5.1: Life Cycle of Trypanosoma
Gambiense and Trypanosoma Rhodesiense
Source: (CDC, 2009)
 During a blood meal on the mammalian host, an infected tsetse fly (genus Glossina)
injects metacyclic trypomastigotes into skin tissue. The parasites enter the lymphatic
system and pass into the bloodstream . Inside the host, they transform into bloodstream
trypomastigotes , are carried to other sites throughout the body, reach other blood fluids
(e.g., lymph, spinal fluid), and continue the replication by binary fission . The entire life
cycle of African Trypanosomes is represented by extracellular stages.
 The tsetse fly becomes infected with bloodstream trypomastigotes when taking a blood
meal on an infected mammalian host ( , ). In the fly’s midgut, the parasites transform
into procyclic trypomastigotes, multiply by binary fission , leave the midgut, and
transform into epimastigotes . The epimastigotes reach the fly’s salivary glands and
continue multiplication by binary fission . The cycle in the fly takes approximately 3
weeks. Humans are the main reservoir for Trypanosoma brucei gambiense, but this
species can also be found in animals. Wild game animals are the main reservoir of T. b.
rhodesiense.

Handout 5.2: Life Cycle of Leisshmania Species
S
ource: (CDC, 2009)
Life Cycle
In a Vertebrate Host
 The sandfly (Phlebotomus or Lutzomyia), while feeding regurgitate promastigotes from
the blocked foregut into the wound; the promastigotes quickly invade local tissue cells
and change to amastigotes, an obligatory intracellular parasite.
 In the phagocytic cells the amastigotes multiply by longitudinal binary fission in the
macrophages of skin, intestinal mucosa, bone marrow, lymphnodes and R.E.S.
 The macrophages full of amastigotes then rupture releasing numerous amastigotes which
are infective to the insect vector
In Invertebrate Host
 The intracellular and free amastigotes are taken by the female sandfly when sucking a
blood meal, after about 72 hours the amastigotes become flagellated (promastigotes) in
the midgut of the sandfly, and multiply.
 As the stationary growth phase is reached, the organisms undergo biochemical surface
changes as well as slight morphologic ones and are now infective for mammal cells.
 After 5-10 days the anterior gut and pharynx are partially blocked by flagellates.
When the sandfly attempts a subsequent blood meal, some of the infective

promastigotes are dislodged and introduced into the skin.

Session 6: Cestodes of Medical Importance – Tape
Worms/Taenia Sagnata and Taenea Solium
Prerequisites
 None
Learning Tasks
 Describe morphological characteristics of Taenia saginata and Taenia solium
 Explain mode of transmission of Taenia saginata and T.solium
 Explain the effects of Taenia species on the host
Resources Needed
 Handout 6.1: Life cycle of Taenia species
SESSION OVERVIEW
Learning Tasks
Presentation/ Morphological Characteristics of Taenia
2 10 minutes
Brainstorming Saginata
3 5 minutes Presentation Mode of Transmission of Taenia Saginata
Presentation/
4 5 minutes Effects of Taenia Saginata on the Host
Buzzing
Morphological Characteristics of Taenia
Solium
6 5 minutes Presentation Mode of Transmission of Taenia Solium
7 10 minutes Presentation Effects of Taenia Solium on the Host

NTA Level 6, Semester 2 56 Session 6: Cestodes of Medical
Importance – Tape Worms/Taenia
Sagnata and Taenea Solium
SESSION CONTENT

Step 2: Morphological Characteristics of Taenia Saginata/Beef Tape Worm

(10 minutes)
ASK the student to brainstorm on morphological characteristics of Taenea Saginata for 2

minutes
Egg (Ova)
 Measures 35 x 45 mµ
 Roundish in shape and yellow-brown
 Has peripheral radial striations and contains an embryo with 3 hooklets
Figure 6.1: Shows Morphological Feature of Taenia Species Egg in Stool Mount
Source: (CDC, 2009)
Adult
 Its size can be up to 4 to 6 meters long and 12 mm broad
 Has a pear-shaped head (scolex) with four suckers but no hooks or neck.
 Has a long flat body with several hundred segments (proglottids) each mature segment is
about 18 x 6 mm with a branched uterus (15-30 branches).
Figure 6.2: Shows Scolex of Taenia saginata with four suckers

Suckers
Source: (Stanford, 2006)
Step 3: Mode of Transmission of Taenia Saginata (5 minutes)

 Taenia saginata is transmitted to humans through ingestion of infected beef containing
infective larva (Cysticercus bovis).
 The beef containing cysticercus in the striated muscle when ingested by humans,
develops into adult tapeworm
Refer students to Handout 6.1: Life Cycle of Taenia species
Step 4: Effects of Taenia Saginata on the Host (5 minutes)
 Epigastric pain
 Chronic indigetion
 Hunger pain
 Weight loss
 Obstruction of the appendix, biliary duct, and pancreatic duct.
Step 5: Morphological Characteristics of Taenia Solium/Pork Tape Worm

(10 minutes)

ASK the student to pair up and buzz on the morphological characteristics of Taenea Solium
for 2 minutes
Egg (ova)
 The eggs of T. solium and T. saginata are indistinguishable
Adult

 Slightly smaller than T. Saginata
 Have a globular scolex with four suckers and a circular row of hooks (rostellum) that
gives it a solar appearance.
 The proglottids are 5 x 10 mm with a 7-12 branch uterus.
Figure 6.3: Scolex of Taenia solium showing suckers and hooks
Sucker
Hooks
Source: (CDC, 2009)
Step 6: Mode of Transmission of Taenia Solium (5 minutes)

 Taenia solium is transmitted to humans through ingestion of infected raw or insufficiently
cooked pork containing infective larva (Cysticercus cellulosae).
 The pork containing cysticercus in the striated muscle when ingested by humans develops
into adult tapeworms.
 Humans also acquire infection through autoinfection ( anal to mouth) wwhen ingests
infective eggs, the infection results into cysticercosis
Refer students to Handout 6.1: Life Cycle of Taenia species
Step 7: Effects of Taenia Solium on the host (10 minutes)
 Infection with the tapeworm T.solium rarely produces serious effects.

 There may be abdominal pain with intestinal disturbances and loss of appetite.
 Infection with the larvae of T.solium (cystercosis) can cause cystic nodules in
subcutaneous tissues and muscles.
 Usually the larvae produces few serious symptoms except when present in the brain
where they cause epilepsy and other central nervous disorders
 Taenia saginata and T.solium infect maan through ingestion of un/undercooked beef or
pork respecxctively
 The morphological characteristics of their body differ except the morphological
characteristics of their eggs which are indistinguishable
 The other hosts involved in transmission of Taeniasis saginata and solium include cattle

and pig respectively
 The infection with T.solium through autoinfection is known as cysticercosis
 Mention two Taenia species of medical importance

 How taeniasis can be diagnosed?
 What are the infective stages of Taenia species to man
References
Stanford. (2006). Morphology. Retrieved from http://www.stanford.edu

Handout 6.1:Life Cycle of Taenia Saginata and
T.Solium
Source: (CDC, 2009)
STEP 1
 Infected humans (definitive host) excrete the eggs or gravid proglottids in their feces,
passing the parasite from the gastrointestinal tract onto nearby vegetation.
 In egg or gravid proglottid form, T. solium is able to remain viable anywhere from days
to months.
 T. solium can be diagnosed at this point in the life cycle.
 Note: Autoinfection can also occur at this point in the life-cycle via fecal-oral
contamination. In this case, eggs or gravid proglottids re-enter the body through the
mouth and often travel to the central nervous system (CNS), the muscles or the eye,
where they develop into cysticerci. The presence of cysticerci in these locations leads to
the pathogenesis of cysticercosis (neurocysticercosis in the CNS). [4,5]

STEP 2
 Pigs (intermediate host) acquire infection by eating and digesting the eggs or gravid
proglottids along with the parasitized vegetation.
STEP 3
 The eggs or gravid proglottids migrate to the pig's intestine and as oncospheres, break
through the intestinal wall.
 Then, via the circulatory system, they embed themselves in the muscles of the pig and
develop into cysticerci (the infective form of T. solium).
 Cysticerci have the ability to persist in the muscle for many years.
STEP 4
 Humans acquire the infection by eating the undercooked or raw flesh of an infected
animal.
STEP 5 - 6
 Cystercerci migrate to the small intestine of the human host and develop into their adult
tapeworm form normally within two months.
 By attaching to the intestinal wall with their scolices (hooked structures), these adult
tapeworms may persist for long periods of time, even years.

Session 7: Cestodes of Medical Importance - Tape
Worms/Echinococcus Granulosus and
Diphyllobothrium latum
Prerequisites
 None
Learning Tasks
 Describe morphological characteristics of Echinococcus granulosus and
Diphyllobothrium latum
 Explain mode of transmission of Echinococcus granulosus and Diphyllobothrium latum
 Explain the effects of Echnococcus granulosus and Diphyllobothrium latum on the host
Resources needed
 Computer and lcd
 Handout 7.1:Life cycle of Echinococcus granulosus
 Handout 7.2: Life cycle of Diphyllobothrium latum.
SESSION OVERVIEW
1 5 minutes Presentation Session Title and Related Tasks

Presentation/ Morphological Characteristics of
2 30 minutes
Buzzing Echinpococcus Granulosus
3 15 minutes Presentation Mode of Transmission of E.Granulosus
Presentation/
4 15 minutes Effects of E. granulosus on the Host
Brainstorming
Diphyllobothrium Latum
6 10 minutes Presentation Mode of Transmission of D.Latum
Presentation/
7 10 minutes Effects of D. latum on the Host
Buzzing

Importance - Tape Worms/Echinococcus
Granulosus and Diphyllobothrium latum
SESSION CONTENT

Step 2: Morphological Characteristics of Echnococcus Granulosus (30

minutes)
 Echinococcus species are tape worms also called extraintestinal larval tape worms of
human bein. They are parasites which normally occur in carnivores, and the larvae of the
species frequently occur in man.
 The adult worms differ from the Taenia species in their:
o Small size
o Limited number of segments
o The absence of lateral branches from the gravid uterus
o Unlike Tanenia species in which a single egg produces or gives rise to one larva
which results into a single adult, in Echinococcus a single hyadatit cyst produces large
numbers of scoleces which then become adult worms in definitive host
 Egg (ova)
o The egg, 30 -38µ, resembles those of the other Taenia species
Figure 7.1: Shows Morphological Feature of Echnococus Species which Resemble that of
Taenis Species.
Source: (CDC, 2009)
 Larva (Hyadatid cyst)

o Grows to a diameter of 1 cm in five months, eventually attain the size of a child’s
head
o It is avascular body full of fluid with sedment(scoleces)
o Enormous number of scoleces are contained in it, each one of which when swallowed
by the dog may become an adult worm in that animal
 Adult
o It is the smallest tapeworm (2.5 -9.0 mm) of medical importance
o The globular scolex bears a prominent rostellum with a double crown of 30-36 hooks
and 4 prominent suckers
o The body consists of head, neck and three proglottides
o The first immature , the more elongate middle proglottid with fully developed

reproductive organs and the last or gravid segment has a medium uterus with 12 to 15
branches distended with some 500 eggs
Fig. 7.1: Shows Adult Echinococcus Granulosus
Source: (CDC, 2009)
Step 3: Mode of Transmission of Echinococcus Granulosus (15 minutes)

 Hosts of Echinococcus granulosus involve herbivores animals (sheep and cattle) and
carnivores animals like domestic dogs and wild carnivores like foxes, wolves and jackals.
 Intermediate hosts acquire the infection by ingestion of the infective eggs during grazing.
 Carnivores acquire the infection by ingestion of infected raw material of the intermediate
hosts (mostly viscera)
 Like the intermediate hosts, man acquires the infection by ingestion of infective eggs.
Refer students to Handout 7.1: Life Cycle of Echnococcus Granulosus

Step 4: Effects of Echnococcus Granulosus on the Host (20 minutes)
 The initial phase of primary infection is always asymptomatic.

 Latent periods of more than 50 years before symptoms arise have been reported.
 The clinical presentation of E. granulosus infection depends upon the site of the cysts and
their size.
 Small and/or calcified cysts may remain asymptomatic indefinitely.
 However, symptoms due to mass effect within organs, obstruction of blood or lymphatic
flow, or complications such as rupture or secondary bacterial infections can result.
 Principal areas infected are liver(60%), lungs and peritoneal cavity, and occasionally the
bone marrow
Step 5: Morphological Characteristics of Diphyllobothrium Latum/Fish

Tape Worm (25 minutes)
Egg (Ova)
 The egg, 55 – 76 µ by 41- 56µ has a single shell with an inconspicuous operculum at one
end and often a small knob-like thickening at the centre
 Daily, one million eggs are discharged into the intestine from the distended uteri of the
gravid segment, which disintegrate when egg laying has been completed
Fig. 7.2: Shows Egg and Adult D. Latum
Source: (CDC, 2009)
Adult
 The worm is flattened, the longest tape worm of humans ranges from 3-10 meters in

length, 1-2 cm breadth and may have more than 3000 proglottides
 The worm is grayish-yellow
 Mature segments are broader than long hence the name latum and contains both male and
female reproductive organs
 The head is elongated with 2-3 mm in length by 1 mm breadth
 The female organ (ovary) is bi-lobed)
Step 6: Mode of Transmission of Diphyllobothrium Latum (10 minutes)

 The definitive hosts of D. latum include humans, dogs and cats. Two intermediate hosts
include a plankton crustacean and a freshwater fish.
 Humans acquire the parasite by eating raw infected fish containing infective larva
plerocercoid
Refer students to Handout 7.2: Life Cycle of Diphyllobothrium Latum
Step 7: Effects of Diphyllobothrium Latum on the Host (20 minutes)
ASK the student to pair up and buzz on effects of diphyllobothrium latum for 2 minutes
 Symptoms of diphyllobothriasis are generally mild, and can include diarrhea, abdominal
pain, vomiting, weight loss, fatigue, constipation and discomfort.
 In a small number of cases, diphyllobothriasis leads to severe vitamin B12 deficiency due
to the parasite absorbing 80% or more of the host’s B12 intake, and a megaloblastic
anemia indistinguishable from pernicious anemia.
 The anemia can also lead to subtle demyelinative neurological
 Worms in large number can cause mechanical obstruction in the intestines

 Diphyllobothrium latum infects man through ingestion of un/undercooked fish containing

infective larva
 Transmission of infection is through human contaminating weter by feaces containing
eggs.
 Why Echnococcus granulosus is called an extraintestinal larval tape

 Mention the intermediate hosts of Diphyllobothrium latum
 Give reason of why D.latum is called fish tape worm
References

Handout 7.1:Life cycle of Echinococcus Granulosus
Source: (CDC, 2009)
 The adult Echinococcus granulosus (3 to 6 mm long) resides in the small bowel of the
definitive hosts, dogs or other canids. Gravid proglottids release eggs that are passed in
the feces.
 After ingestion by a suitable intermediate host (under natural conditions: sheep, goat,
swine, cattle, horses, camel), the egg hatches in the small bowel and releases an
oncosphere that penetrates the intestinal wall and migrates through the circulatory
system into various organs, especially the liver and lungs.
 In these organs, the oncosphere develops into a cyst that enlarges gradually, producing
protoscolices and daughter cysts that fill the cyst interior.
 The definitive host becomes infected by ingesting the cyst-containing organs of the
infected intermediate host.
 After ingestion, the protoscolices evaginate, attach to the intestinal mucosa , and
develop into adult stages in 32 to 80 days.Humans become infected by ingesting eggs

, with resulting release of oncospheres in the intestine and the development of cysts
, , , , , in various organ

Handout 7.2: Life cycle of Diphyllobothrium
Latum
Source: (CDC, 2009)
 Immature eggs are passed in feces . Under appropriate conditions, the eggs mature
(approximately 18 to 20 days) and yield oncospheres which develop into a coracidia
 After ingestion by a suitable freshwater crustacean (the copepod first intermediate host)
the coracidia develop into procercoid larvae .
 Following ingestion of the copepod by a suitable second intermediate host, typically
minnows and other small freshwater fish, the procercoid larvae are released from the
crustacean and migrate into the fish flesh where they develop into plerocercoid larvae
(sparganum) .
 The plerocercoid larvae are the infective stage for humans. Because humans do not
generally eat undercooked minnows and similar small freshwater fish, these do not
represent an important source of infection. Nevertheless, these small second intermediate
hosts can be eaten by larger predator species, e.g., trout, perch, walleyed pike .
 In this case, the sparganum can migrate to the musculature of the larger predator fish and
humans can acquire the disease by eating these later intermediate infected host fish raw or
undercooked .
 After ingestion of the infected fish, the plerocercoid develop into immature adults and

then into mature adult tapeworms which will reside in the small intestine.
 The adults of D. latum attach to the intestinal mucosa by means of the two bilateral
groves (bothria) of their scolex .
 The adults can reach more than 10 m in length, with more than 3,000 proglottids.
 Immature eggs are discharged from the proglottids (up to 1,000,000 eggs per day per
worm) and are passed in the feces .
 Eggs appear in the feces 5 to 6 weeks after infection. In addition to humans, many other
mammals can also serve as definitive hosts for D. latum.

Session 8: Trematodes of Medical Importance -
Haematobium and Schistosoma Mansoni
Prerequisites
 None
Learning Tasks
 Explain Common Schistosoma species of medical importance
 Describe morphological characteristics of Schistosoma haematobium
 Explain the mode of transmission, of Schistosoma haematobium
 Explain effects of Schistosoma haematobium on the host
 Describe morphological characteristics of S. mansoni
 Explain the mode of transmission of Schistosoma mansoni
 Explain effects of Schistosoma mansoni on the host
Resources Needed
 Handout 8.1: Life cycle of Schistosoma species
SESSION OVERVIEW
Learning Tasks
Presentation/ Common Schistosoma Species of Medical
2 10 minutes
Buzzing Importance
Schistosoma Haematobium
Mode of Transmission of Schistosoma
Haematobium
5 10 minutes Presentation Effects of S. Haematobium on the Host
Presentation/ Morphological Characteristics of
6 25 minutes
Group Discussion Schistosoma Haematobium
7 10 minutes Presentation Mode of Transmission of S. Mansoni
8 10 minutes Presentation Effects of Schistosoma Mansoni on the Host

NTA Level 6, Semester 2 73 Session 8: Trematodes of Medical
Importance - Haematobium and
Schistosoma Mansoni
SESSION CONTENTS
Step 2: Common Schistosoma Species of Medical Importance (10 minutes)
ASK the student to pair up and buzz on common Schistosoma species for 2 minutes
Two Common Schistosoma species of Medical Importance

 Schistosoma haematobium
o Mainly affects urinary bladder
 Schistosoma mansoni
o Mainly affects small intestine
Step 3: Morphological Characteristics of Schistosoma Haematobium

(30 minutes)
 Egg of Schistosoma haematobium

o Large and oval in shape measuring about 145 x 55 mµ
o Has a characteristics small spine at one end (terminal spine)
o Contains a fully developed miracidium.
Figure 8.1: Schistosoma Haematobium Egg Showing Terminal Spine

Terminal spine

Schistosoma Mansoni
Source: (CDC, 2009)
 Larva cercaria
o The cercaria has a head portion that contains the penetration glands used to secrete
substances that allow penetration.
o Schistosome cercariae are characterized by its bifurcated tail, which aids it in skin
penetration.
 Adult
o Male and female have Oral and ventral suckers present.
o Oral sucker surrounds the mouth.
o Male body folded to form the gynaecophoric canal that enfolds the female during
copulation
o Male and female are held permanently in copula
Figure 8.2: Adult Male with Female in the Copulatory Groove (Gynaecophoric Canal)
Source: (CDC, 2009)
Step 4: Mode of Transmission of Schistosoma Haematobium (10 minutes)

Transmission
 Human acquire the infection through contact with water when a person bathing, washing
clothes, fishing, or engaged in agricultural work or other activity involving contact of
water that has been faecally or urinary contaminated and contains the snail hosts of the
parasites
 The cercariae released from the infected snail become attached to the skin and are able to
penetrate unbroken skin.
 Drinking unboiled or non- chlorine treated water that contain infective cercariae that
penetrate mucous membrane and enter blood circulation
 Water becomes infective after being contaminated with faeces or urine containingviable
eggs which hatch into larva and then develop into infective form
Refer to Handout 8.1: Life Cycle of Schistosoma Species

Schistosoma Mansoni
Step 5: Effects of Schistosoma Haematobium on the Host (10 minutes)
 Cercarial dermatitis & Katayama syndrome may occur (rarely) due to penetrating
cercariae through the unbroken skin
 Haematuria is the cardinal symptom – it is characteristically terminal haematuria(last
drop of urine with blood)
 Hydronephrosis – may be complicated by bacteriuria leading to pyelonephritis.
 Lower abdominal pain (suprapubic pain)
 Frequency and urgency of micturition
 Bladder symptoms: contraction, calcification, and carcinoma of the bladder may occur.
Step 6: Morphological Characteristics of Schistosoma Mansoni
(25 minutes)
 Egg
o Large and oval, measuring about 150 x 60 mµ
o Has a characteristic lateral spine
o Contains a fully developed miracidium
Figure 8.3: Egg of Scistosoma Mansoni Showing Lateral Spine
Lateral spine
Source: (CDC, 2009)
 Adult
o The elementary canal resembles that of S.haematobium except that in the male, after
primary bifurcation the two caeca re-unite in the anterior ½ of the body
o The male worm measures about 1cm x 1.3 mm, behind the ventral sucker the body is
covered with innumerable coarse tubercles
o Possesses eight spherical testes
o The worm is about 1.1 cm x 170 µm, with smooth skin;
Figure.8.4: Adult male Schistosoma mansoni showing suckers (A) & gynacopholic canal (B)

Schistosoma Mansoni
B
A
Source: www.google.comm/adult schistosoma image
Step 7: Mode of Transmission Schistosoma Mansoni (10 minutes)
ASK students to discuss on mode of transmission of Schistosoma Mansoni for 5 minutes
 Transmission
o Human contact with water when a person bathing, washing clothes, fishing, or
engaged in agricultural work or other activity involving contact of water that has been
faecally or urinary contaminated and contains the snail hosts of the parasites
o The cercariae released from the infected snail become attached to the skin and are
able to penetrate unbroken skin.
o Drinking unboiled or non- chlorine treated water that contain infective cercariae that
penetrate mucous membrane and enter blood circulation
o Water becomes infective after being contaminated with faeces or urine
containingviable eggs which hatch into larva and then develop into infective form
Refer to Handout 8.1: Life Cycle of Schistosoma species

Schistosoma Mansoni
Step 8: Effects of Schistosoma Species on the Host (10 minutes)
 Acute schistosomiasis (Katayama's fever) may occur weeks after the initial infection,
especially by S. Mansoni
 Abdominal pain
 Diarrhoea
 Eosinophilia - extremely high eosinophil granulocyte (white blood cell) count
 Hepatosplenomegaly - the enlargement of both the liver and the spleen.
 Genital sores - lesions that increase vulnerability to HIV infection.
Step 9: Key points (5 minutes)
 Schistosoma species are transmitted by cercariae penetrating the skin when a person is
bathing, washing clothes, fishing, or engaged in agricultural work or other activity
involving contact of water
 Transmission involves two hosts (humans and snails)
 Schistosomiasis can be diagnosed by identifying eggs in urine or stool samples
 Mention the causative agent of urinary and intestinal schistosomiasis

 Mention the snail responsible for transmission of Schistosoma haematobium and
Schistosoma mansoni respectively
 List five activities associated with transmission of schistosomiasis
References

Schistosoma Mansoni
Handout 8.1: Life cycle of Schistosoma species
Source: (CDC, 2009)
Life cycle of Schistosoma Haematobium and Schistosoma Mansoni
In Snail
 Eggs are passed with feces or urine hatch and release miracidia which swim and penetrate
specific snail intermediate hosts (Bulimus species for S.haematobium and Biomphalaria
species for S.mansoni).
 The parasite passes through several stages (miracidium-sporocyst and lastly cercaria
which is the infective stage when penetrates the unbroken skin of the human host.
In Human Host
 When the cercariae penetrate the human unbroken skin they become schistosomulae,
migrate through several tissues and stages to their residence in the veins, Adult worms in
humans reside in the mesenteric venules in various locations, which at times seem to be
specific for each species.
 For instance, S. mansoni occurs more often in the superior mesenteric veins draining the
large intestine, S. haematobium most often occurs in the venous plexus of bladder, but it
can also be found in the rectal venules.
 The females deposit eggs in the small venules of the portal and perivesical systems.
 The eggs are moved progressively toward the lumen of the intestine (S. mansoni) and of

Schistosoma Mansoni
the bladder and ureters (S. haematobium), and are eliminated with feces or urine,
respectively which may contaminate water and initiate another cycle.
 Human contact with water is thus necessary for infection by schistosomes

Schistosoma Mansoni
Session 9: Trematodes of Medical Importance -
Fasciola Hepatica, Clonorchis Sinensis, and
Paragonimus Westermani
Prerequisites
 None
Learning Tasks
 Describe trematodes less commonly affecting humans
 Describe morphological characteristics of Fasciola hepatica, Clonorchis sinensis, and
Paragonimus westermani
 Explain the mode of Transmission of Fasciola hepatica, Clonorchis sinensis, and
Paragonimus westermani
 Explain the effects of Fasciola hepatica, Clonorchis sinensis, and Paragonimus
westermani on the host
Resources Needed
 Handout 9.1: The life Cycle of Fasciola hepatica
 Handout 9.2: Life Cycle of Clonorchis sinensis
 Handout 9.2: Life Cycle of Paragonimus westermani

Importance-Fasciola Hepatica, Clonorchis
Sinensis, and Paragonimus Westermani
SESSION OVERVIEW
Learning Tasks
Presentation/ Trematodes Less Commonly Affecting
2 10 minutess
Buzzing Humans
Morphological Characteristics of Fasciola
3 40 Minutes Presentation Hepatica, Clonorchis Sinensis, and
Paragonimus Westermani
Presentation/ Mode of Transmission of Fasciola Hepatica,
4 25 minutes Group Clonorchis Sinensis, and Paragonimus
Discussion Westermani
Effects of Fasciola hepatica, Clonorchis
5 30 minutes Presentation Sinensis, and Paragonimus Westermani on
the Host
SESSION CONTENTS
Step 2: Trematodes less Commonly Affecting Humans (10 minutes)
ASK students to pair up and buzz on trematodes less commonly affecting humans for 2
minutes
Trematodes less commonly affecting humans include:

 Fasciola hepatica – Liver fluke
 Fasciolepsis buski – Intestinal fluke
 Paragonimus westerman – Lung fluke
 Clonorchis sinensis – Liver fluke

 Metagonimus yokogawai – Intestinaal fluke
Step 3: Morphological Characteristics of Fasciola Hepatica Fasciola

Hepatica, Clonorchis Sinensis, and Paragonimus Westermani (40 minutes)
 Fasciola hepatica
o Adult
 Relatively large, flat and leaf-shaped
 Measures 2.5 – 3.0 cm long and 1.5 cm breadth
 The anterior end shows a distinct conical projection while the posterior end is
rounded
 Possesses oral sucker for attachment
 It is hermaphrodite, contains both male and female sex organs
o Egg
 Large, ovoid and operculated
 Measures 130 – 150 µm by 63 – 9 µm
 Each egg contains a large refractile ubsegmented embryo surrounded by a mass of
yolk cells.
Figure 9.1: Adult Fasciola Hepatica, Dorsal-Ventrally Flattened
Source: (CDC, 2009)
 Clonorchis sinensis
o Adult
 Relatively small fluke measuring 10 – 25 mm in length and 3 – 5 mm in breadth
 The oral sucker slightly larger than the ventral sucker
o Egg
 Small and flask-shaped
 Measures 28-35 µm by 12 – 18 µm
 Operculum is presnt at the smaller anterior end of the egg
Figure 9.2: Adult Clonorchis sinensis showing its internal organs

Source: (CDC, 2009)
 Paragonimus westermani
o Adult
 Egg-shaped fluke
 Measures 7-12 mm by 4 -6 mm in breadth and 3.5 – 5 mm in thickness
 The anterior end is slightly broader than the posterior end
 Posseses two sucker oral sucker and ventral sucker
o Egg
 Oval in shape
 Measures 48-80 µm
 Operculated wwith a clearly visible operculum at the large end
Figure 9.3: Adult Paragonimus westermani showing its morphological features
Source: (CDC, 2009)

Step 4: Mode of Transmission of Fasciola Hepatica Clonorchis Sinensis, and
Paragonimus Westermani (25 minutes)
ASK students to discuss on mode of transmission of fasciola hepatica clonorchis sinensis,

and paragonimus westermani for 5 minutes
 Transmission of Fasciola hepatica

o Fasciola hepatica are transmitted by ingesting metacercariae encysted on wild
watercress or other aquatic plants grown in water contaminated with faeces from
domestic herbivorous animals e.g. sheep goat and cattle.
 Transmission of Clonorchis sinensis
o Infection is acquired by eating raw, insufficiently cooked, smoked or pickled fish
contains infective Clonorchis sinensis larvae ( Metacercariae)
 Transmission of Paragonimus westermani
o Infection is by ingesting the flesh or juice of raw, insuffucienly cooked, or picked crab
or crayfish which contains Paragonimus metacercariae.
Refer to Handout 9.1-3: Life Cycle of Fasciola Hepatica, Clonorchis Sinensis, and
Paragonimus Westermaani
Step 5: Effects of Fasciola Hepatica, Clonorchis Sinensis, and Paragonimus

Westermani on the Host (30 minutes)
 Fasciola hepatica
o Incubation phase:
 From the ingestion of metacercarial to the appearance of the first symptoms(few
days to 3 months
 Depends on number of ingested metacercariae and immune status of host
o Invasive or acute phase
 Fluke migration up to the bile ducts.
 This phase is a result of mechanical destruction of the hepatic tissue and the
peritoneum by migrating juvenile flukes causing localized and or generalized
toxic and allergic reactions( Associated with Hepatomegaly and splenomegaly,
Ascites , Anaemia and Jaundice )
o Latent phase
 This phase can last for months or years.

o Chronic or obstructive phase
 Develops months or years after initial infection.
 Adult flukes in the bile ducts cause inflammation and hyperplasia of the
epithelium.
 The resulting cholangitis and cholecystitis, combined with the large body of the
flukes, are sufficient to cause mechanical obstruction of the biliary duct
 Clonorchis sinensis
o Biliary duct inflammation,
o Intermittent biliary duct obstruction,
o Abdominal pain, Nausea ,Diarrhea ,Eosinophilia,
o Cholangitis - in long-term infections; Cholelithiasis - in long-term infections;
o Pancreatitis - in long-term infections; Cholangiocarcinoma - in long-term infections.
 Paragonimus westermani
o Heavy infection cause pulmonary disease.
o Symptoms of severe pulmonary Paragonimiasis often resemble those of pulmonary
tuberculosis with chest pain, cough, night sweats and hemoptysis (coughing up
blood).
 Both Fasciolaa hepatica and Clonorchis sinensis are liver flukes affecting humans
 Mode of transmission of Fasciola hepatica and Clonorchis sinensis is through ingestion of
uncooked or insufficiently cooked frsh water fish and fresh water plants respectively
 Mention the transamission routes for the infections with :

o Fasciola hepatica
o Clonorchis sinensis
o Paragonimus westermaani

References

Handout 9.1: Life Cycle of Fasciola Hepatica
Source: (CDC, 2009)
 Immature eggs are discharged in the biliary ducts and in the stool. Eggs become
embryonated in water; eggs release miracidia, which invade a suitable snail intermediate
host, including the genera Galba, Fossaria and Pseudosuccinea.
 In the snail the parasites undergo several developmental stages (sporocysts, rediae, and
cercariae).
 The cercariae are released from the snail and encyst as metacercariae on aquatic
vegetation or other surfaces.
 Mammals acquire the infection by eating vegetation containing metacercariae.
 Humans can become infected by ingesting metacercariae-containing freshwater plants,
especially watercress.
 After ingestion, the metacercariae excyst in the duodenum and migrate through the
intestinal wall, the peritoneal cavity, and the liver parenchyma into the biliary ducts,
where they develop into adults.
 In humans, maturation from metacercariae into adult flukes takes approximately 3 to 4
months. The adult flukes (Fasciola hepatica: up to 30 mm by 13 mm; F. gigantica: up to

75 mm) reside in the large biliary ducts of the mammalian host.
 Fasciola hepatica infects various animal species, mostly herbivores.

Handout 9.2: Life Cycle of Clonorchis Sinensis
Source: (CDC, 2009)
Life Cycle
 This parasite requires the involvement of two intermediate hosts (fresh water snails and
fish) to complete the life cycle.
 Embryonated eggs are discharged in the biliary ducts and in the stool . Eggs are
ingested by a suitable snail intermediate host ; there are more than 100 species of snails
that can serve as intermediate hosts.
 Each egg releases a miracidia , which go through several developmental stages
(sporocysts , rediae , and cercariae ).
 The cercariae are released from the snail and after a short period of free-swimming time
in water, they come in contact and penetrate the flesh of freshwater fish, where they
encyst as metacercariae . Infection of humans occurs by ingestion of undercooked,
salted, pickled, or smoked freshwater fish .
 After ingestion, the metacercariae excyst in the duodenum and ascend the biliary tract
through the ampulla of Vater .
 Maturation takes approximately one month. The adult flukes (measuring 10 to 25 µm by
3 to 5 µm) reside in small and medium sized biliary ducts. In addition to humans,
carnivorous animals can serve as reservoir hosts.

Handout 9.3: Life Cycle of Paragonimus
Westermani
Source: (CDC, 2009)
 The eggs are excreted unembryonated in the sputum, or alternately they are swallowed
and passed with stool . In the external environment, the eggs become embryonated ,
and miracidia hatch and seek the first intermediate host, a snail, and penetrate its soft
tissues . Miracidia go through several developmental stages inside the snail :
sporocysts , rediae , with the latter giving rise to many cercariae , which emerge from
the snail.
 The cercariae invade the second intermediate host, a crustacean such as a crab or crayfish,
where they encyst and become metacercariae. This is the infective stage for the
mammalian host . Lungs, where Human infection with P. westermani occurs by eating
inadequately cooked or pickled crab or crayfish that harbor metacercariae of the
parasite . The metacercariae excyst in the duodenum , penetrate through the intestinal
wall into the peritoneal cavity, then through the abdominal wall and diaphragm they
become encapsulated and develop into adults (7.5 to 12 µm by 4 to 6 µm).

 The worms can also reach other organs and tissues, such as the brain and striated muscles,
respectively. However, when this takes place completion of the life cycles is not
achieved, because the eggs laid cannot exit these sites. Time from infection to
oviposition is 65 to 90 days.

Session 10: Intestinal Nematode of Medical Importance-
Ascaris Lumbricoides and Trichuris
Trichiura
Prerequisites
 None
Learning Tasks
 Describe the morphological characteristics of Ascaris lumbricoides
 Explain the mode of transmission of Ascaris lumbricoides
 Explain effects of Ascaris lumbricoides on the host
 Describe the morphological characteristics of Trichuris trichiura
 Explain The mode of transmission of Trichuris trichiura
 Explain the effects of Trichuris trichiura on the host
Resources Needed
 Handout 10.1: Life Cycle of Ascaris lumbricoides
 Handout 10.2: Life Cycle of Trichuris trichiura
SESSION OVERVIEW
Learning Tasks
Ascaris Lumbricoides
Mode of Transmission of Ascaris
Lumbricoides
Presentation/
4 25 minutes Effects of Ascaris Lumbricoides on the Host
Group Discussion
Morphological Characteristics of Trichuris
Trichiura
Presentation/
6 10 minutes Mode of Transmission of T.Trichiura
Brainstorming
7 15 minutes Presentation Effects of Trichuris Trichiura on the Host

NTA Level 6, Semester 2 93 Session 10: Intestinal Nematode of
Medical Importance- Ascaris Lumbricoides
and Trichuris Trichiura
SESSION CONTENTS
Step 2: Morphological Characteristics of Ascaris Lumbricoides

(30 minutes)
Fertilized Egg
 Oval to subspherical in shape
 Measures 45 – 70 µm in length and 35 – 50 µm in breadth
 Are bile stained and golden brown in colour
 The egg is surrounded by a thick shell with a light brown mammaliated albuminous outer
coat
Fig. 10.1: Egg of Ascaris Lumbricoides (Fertilized Egg)
Source: (Wikipedia, 2013)
Unfertilized Egg
 It is darker in colour and has more granular albuminous covering than a fertilized egg
 More elongated than a fertilized egg,
 Measures about 90 x 45 .µm
 Contains a central mass of large refractile granules

Figure 10.2: Egg of Ascaris Lumbricoides (Unfertilized Egg)
Adult Worm
 It is a large intestinal nematode (a diagnostic feature if worm happen to come from a
human host)
 Female worm measures 20-35 cm long by 3-6 mm in diameter and male worms measure
15-30 cm long by 2-4 mm in diameter
 Pink-brown (when freshly expelled) or yellow –white in colour.
 Tail of the male is curved and has two small spicules (rod-like projections)
Figure 10.3: Adult Male and Female Ascaris Lumbricoides
Source: (CDC, 2009)
Step 3: Mode of Transmission of Ascaris Lumbricoides (5 minutes)

Transmission
 Ascaris lumbricoides is transmitted through ingestion of infective eggs from faeces in the
soil. (Faecal oral route)
 Can also be through drinking contaminated water with infective eggs
Refer to Handout 10.1: Life Cycle of Ascaris Lumbricoides

Step 4: Effects of Ascaris Lumbricoides on the Host (25 minutes)
ASK students to discuss on the effects of Ascaris lumbricoides on the host for 5 minutes
 Once inside the body, these worms reproduce and can cause very serious health
problems( cause obstruction and inflammation of the appendix, bile duct, and pancreatic
duct )
 A small amount of worms can cause some abdominal cramping
 Many parasitic worms can cause severe pain and vomiting.
 The worms also cause sleep disturbance and restlessness
 In heavy infections, adult worms can cause obstruction of the intestinal tract
 Any time many larvae enter the lungs; they can cause a pneumonia-like illness.
 Adults feed on the contents of the small intestine and in heavy infections this may
compound problems in malnourished individuals (especially children).
 Migration of larvae may cause localized reactions in various organs.
o Penetration of the larvae from capillaries into the lungs can lead to Loeffler's
pneumonia, in which pools of blood and dead epithelial cells clog air spaces in the
lungs.
o Resulting bacterial infections can be fatal.
Step 5: Morphological Characteristics Trichuris Trichiura (20 minutes)
 Egg
o Measures 50 x22 µm,
o Brown in colour
o Has characteristic barrel shape and single thick egg shell with a plug at each end
(bipolar plug).
o Contains an unsegmented embryo.

Fig.10.4: Morphological Features of Trichuris Trichiura Egg
Polar Plug
Source: www.google .com/Trichuris
 Adult Male
o Is 3-4.5 cm long
o Has a thin anterior portion which is half as long as the thicker posterior portion, thus
named whip worm.
o The caudal end is curved and terminates in a spicule.
 Adult Female
o Larger than male
o Is 3.5-5.5 cm long
o Has a thin anterior portion which is twice as long as the thick posterior half containing
a stout uterus packed with eggs.
Fig. 10.5: Adult Male and Female Trichuris Trichura
Male Female
Source: (University of California – Davis, 2006)

Step 6: Mode of Transmission of Trichuris Trichiura (10 minutes)
ASK student to brainstorm on the mode of transmission of Trichuris trichiura for 2 minutes
ALLOW 2 to 3 students to provide their responses and let others provide additional
responses
CLARIFY and summarizes by using the content below
Transmission
 Trichuris trichiura is transmitted through ingestion of infective (embryonated) eggs in
food/water contaminated by feaces passed by infected person.
Step 7: Effects of Trichuris Trichiura on the Host (15 minutes)
 The clinical manifestations of Trichuris trichiura infection depend up on the intestinal

worm load of the person:
o Abdominal discomfort
o Diarrhoea occasionally with blood and mucus
o Retardation of growth
o In heavy infection there is:
 Anaemia
 Abdominal pains
 Diarrhoea
 Nausea
 Vomiting
 In young children, severe infection can cause chronic diarrhoea, intestinal ulceration, and
anaemia, failure to develop at the normal rate, weight loss and prolapse of the rectum.
 Massive infection can be fatal.
 Ascaris lumbricoides is a largest intestinal round worm infesting man

 The infectiveness of Ascaris lumbricoides eggs takes place on the ground ( in soil)
 Major complications due to Ascaris lumbricoides and Trichuris trichiura infections
include intestinal obstruction and rectal plorapse respectively
 Massive infections can be fatal.

Step 9: Evaluation(5minutes)
 What are the other names of the Ascaaris lumbricoides and Trichuris trichiura
 Which parasite has its egg with bipolar plug appearance
 How do human acquire Trichuriasis ?
References
University of California - Davis. (2006). Trichuris trichiura. Retrieved from
http://www.ucdavis.edu.
Wikipedia. (2013). Ascaris lumbricoides. Retrieved from http://www.wikipedia.org

Handout 10.1:Life Cycle of Ascaris Lumbricoides
Source: (CDC, 2009)
 Adult worms live in the lumen of the small intestine. A female may produce
approximately 200,000 eggs per day, which are passed with the feces .
 Unfertilized eggs may be ingested but are not infective. Fertile eggs embryonate and
become infective after 18 days to several weeks , depending on the environmental
conditions (optimum: moist, warm, shaded soil).
 After infective eggs are swallowed , the larvae hatch , invade the intestinal mucosa,
and are carried via the portal, then systemic circulation to the lungs .
 The larvae mature further in the lungs (10 to 14 days), penetrate the alveolar walls,
ascend the bronchial tree to the throat, and are swallowed .

 Upon reaching the small intestine, they develop into adult worms . Between 2 and 3
months are required from ingestion of the infective eggs to oviposition by the adult
female. Adult worms can live 1 to 2 years.

Handout 10.2:Life Cycle of Trichuris Trichiura
Source: (CDC, 2009)
 The life cycle of Trichuris trichiurais simple, completed in a single host, the man:
 Man acquires infection by ingesting soil containing embryonated eggs.
 The embryonated eggs hatch in the intestine and liberate the larva that penetrate the villi
and continue to develop.
 The larva after 7 days leaves the small intestine and moves to the caecum where they
develop into sexually mature male and female worms.
 The fertilized female begins to lay the eggs which are unembryonated, are excreted out
with faeces.
 Eggs in the faeces (in damp warm soil) develop to embryonated (infective) eggs in 10 -14
days

Session 11: Intestinal Nematodes of Medical Importance
- Hookworms and Strongyloides Stercolaris
Prerequisites
 None
Learning Tasks
 Describe the morphological characteristics of hookworms
 Explain mode of transmission, of Hookworms
 Explain the effects of hookworms on the host (Ancylostomiasis)
 Describe morphological characteristics of Strongyloides stercoralis
 Explain mode of transmission of Strongtloides stercolaris
 Explain Effects of Strongylodes stercolaris on the host
Resources Needed
 Handout 11.1: Life cycle of Hookworms
 Handout 11.2: Life cycle of Strongloides stercoralis
SESSION OVERVIEW
Learning Tasks
Hookworms
Presentation/
3 15 minutes Mode of Transmission Hookworms
Group Discussion
4 20 minutes Presentation Effects of Hookworm on the Host
Morphological Characteristic Strongyloides
Stercoralis
Presentation
6 10 minutes Mode of Transmission of S.Stercolaris
Buzzing
Effects of Strongylodes Stercolaris on the
Host

NTA Level 6, Semester 2 103 Session 11: Intestinal Nematodes of
Medical Importance - Hookworms and
Strongyloides Stercolaris
SESSION CONTENTS
Step 2: Morphological Characteristics of Hookworms (25 minutes)
 Adult
o Human hookworms include the nematodes Ancylostoma duodenale and Necator
americanus whose anterior body end bent slightly dorsally, hence the name
hookworm.
o Adult female hookworms are about 11 mm x 50 µm
o Males are smaller than females
o The anterior end of N. americanus is armed with a pair of curved cutting plates
o The anterior end of A. duodenale is equipped with one or more pairs of teeth.
Fig. 11.1: Mouthparts of Adult Hookworms, Show Three Paris of Teeth
Source: Source: (Elliott, 2011)

Fig. 11.2: Mouthparts of Adult Hookworms, Show Three Pars of Teeth (Left) and Cutting
Plates (Right)
Source: (Elliott, 2011)
Figure 11.3: Rhabditform Larvae of Hookworms and Strongyloides Stercolaaris
Source: (Parasites in Humans, n.d.)
Fig. 11.4: Filariform Larvae of Hookworms and Strongyloides Stercolaaris
 Egg

o Eggs of both Necator americanus and Ancylostoma duodenale are morphologically
similar
o Is colourless with a thin shell which appears as a black line around the ovum.
o Oval in shape, measuring about 65 x 40 micrometer
o Contains an ovum which usually appears segmented
Figure 11.5: Hookworm Egg
Source: (CDC, 2009)
Step 3: Mode of Transmission of Hookworms (15 minutes)
DIVIDE student into small manageable groups
ASK students to discuss in group on mode of transmission hookworms for 5 minutes
ASK students to provide their responses after discussion
 Hookworm infection is spread by faecal pollution of the soil

 Infection occurs when filariform larvae (infective stage) penetrate the skin, especially
when a person walks barefoot on infected ground.
 Ancylostoma duodenale can infect also by oral route the filariform larvae penetrating oral
mucous membrane
Refer to Handout 12.1: Life Cycle of Hookworms
Step 4: Effects of Hookworms on the Host (20 minutes)
 The degree of hookworm infection depend on the site at which the worm is present and
the burden of worms

 Light infection may not be noticed
Table 11.1: Clinical Features of Hookworms Infection
NO Site Symptoms Pathogenesis
1 Dermal Localerythema, macules, Cutaneous invasion and Subcutaneous

papules ( ground itch) Migration of Larva
2 Pulmonary Bronchitis, pneumonitis and, Migration of larvae through lung,
sometimes, eosinophilia bronchi, and trachea
3 Gastro- Anorexia, epigastric pain and Attachment of adult worms and injury
intestinal gastro-intestinal hemorrhage to upper intestinal mucosa
4 Hematologic Iron deficiency, anemia, Intestinal blood loss
hypoproteinemia, edema,
cardiac failure
Step 5: Morphological Characteristic Strongloides Stercoralis (20 minutes)
 Adult: The size and shape of threadworm varies depending on whether it is parasitic or
free-living:
 The parasitic Female measures 2.2 mm in length and 0.4 – 0.5 mm in breadth
 The anterior part of the body consists of a long, cylindrical oesophagus
 The free-living female worm measures 1 mm x 60 µm
 Males are not known to exist
 Egg
o Eggs of Strongyloides stecolaris are not passed in feaces, they are hatched while are
in the worm uterus and passed as rhabditform larvae
 Rhabditform larvae
o Have a short mouth( shallow)
o Have double-bulb oesophagus
o Measure 200-300 µm in length x 16 µm in breadth

Fig. 11.6: Rhabditform larvae of Hookworms and Strongyloides Stercolaaris
 Filariform larva
o Have a short ( shallow) mouth
o Have Long cylindrical oesophagus
o Measure 630 µm in length and 10 µm in breadth
Fig. 11.7: Filariform Larvae of Hookworms and Strongyloides Stercolaaris

Step 6: Mode of Transmission of Strongyloids Stercolaris (10 minutes)
ASK the student to pair up and buzz on mode of transmission of S.Stercolaris for 2 minutes
 Strongylodiasis is transmitted in the following ways:

o By filariform (infective stage) penetrating the skin and occasionally, the buccal
mucosa.
o By autoinfection (self-infection) with rhabditiform larvae (first stage larvae)
developing into filariform larvae (infective stage) in faecal matter on perianal skin
followed by penetration of the skin.
o By autoinfection with rhabditiform developing into filariform larvae in the intestine
followed by penetration of the gut wall.
Refer to Handout 11.1: Life Cycle of Strogyloides Stercolaris
Step 7: Effects of Strongylodes Stercolaris on the Host (15 minutes)
 In immunocompetent host, parasit persists or multiplies within the host for years without
producing any symptoms or producing minimal symptoms
 In immunocompromised hosts, the worm has the potential to produce a life threatening
infections namely hyperinfecction syndrome and disseminated strongyloidiasis
 Skin penetration causes itching and red blotches.
 During migration, the organisms cause bronchial verminous pneumonia
 In the duodenum, they cause a burning mid-epigastric pain and tenderness accompanied
by nausea and vomiting.
 Diarrhea and constipation may alternate.
 Heavy, chronic infections result in:
o Anemia,
o Weight loss and
o Chronic bloody dysentery.
 Secondary bacterial infection of damaged mucosa may produce serious complications.
 Gastrointestinal complications include:
o Malabsorption
o Haemorrhage and intestinal perforartion
o Asthma, pneumonitis

 The Hookworms of medical importance include Ancylostoma duodenale and Necator
americanus
 The parasitic forms of hookworms and stronyloides are called filariform larva
 One of the clinical manifestation of Hookworms infection is anaemia

 Mention the effects of hookworm on the host
 How autoinfection occurs with Strongylodiasis
 Mention two complications of Strongylodiasis
References
Elliott, D. E. (2011). Chapter 110: Intestinal infections by parasitic worms. Retrieved from
http://cfuk22.blogspot.com/2011/08/chapter-110-intestinal-infections-by.html
Parasites in Humans. (n.d.) Rhabditiform comparison. Retrieved from
http://www.parasitesinhumans.org

Handout 11.1: Life cycle of Hookworms
Source: (CDC, 2009)
Life Cycle
 Life cycle completed in a single host man. Man acquires the infection following
penetration of the unbroken skin, usually on the bare foot by the infective filariform
larva.
 By their mechanical and lytic action enter through the epidermis into the dermis
and subcutaneous tissues.
 Then enter into the lymphatic and veins from where they enter the heart-lung
circulation. In the lungs, they break out off the capillaries into the alveolar spaces.
 They then ascend the bronchial tree to the pharynx, and are swallowed back to
reach the small intestine.
 In the small intestine the larva develop into sexually mature worms; the fertilized
female begins to lay eggs which are excreted out in the faeces.
 It takes about 6 weeks for the female worm to start laying eggs after penetration of
the skin by the infective filariform larvae.
 Eggs under favourable conditions (damp, warm, well oxygenated soil) hatch to
rhabditform larvae within 24 – 48 hrs

Handout 11.2:Life cycle of Strongloides Stercoralis
Source: (CDC, 2009)
 The Strongyloides life cycle is more complex than that of most nematodes with its
alternation between free-living and parasitic cycles, and its potential for autoinfection
and multiplication within the host.
 Two types of cycles exist:
Free-Living Cycle
 The rhabditiform larvae passed in the stool (see "Parasitic cycle" below) can
either molt twice and become infective filariform larvae (direct development) or molt
four times and become free living adult males and females that mate and produce
eggs from which rhabditiform larvae hatch .
 The latter in turn can either develop into a new generation of free-living adults (as
represented in), or into infective filariform larvae.
 The filariform larvae penetrate the human host skin to initiate the parasitic cycle
(see below).

Parasitic Cycle
 Filariform larvae in contaminated soil penetrate the human skin, and are
transported to the lungs where they penetrate the alveolar spaces; they are carried
through the bronchial tree to the pharynx, are swallowed and then reach the small
intestine.
 In the small intestine they molt twice and become adult female worms. The
females live threaded in the epithelium of the small intestine and by parthenogenesis
produce eggs , which yield rhabditiform larvae.
 The rhabditiform larvae can either be passed in the stool (see "Free-living cycle"
above), or can cause autoinfection.
 In autoinfection, the rhabditiform larvae become infective filariform larvae, which
can penetrate either the intestinal mucosa (internal autoinfection) or the skin of the
perianal area (external autoinfection); in either case, the filariform larvae may follow
the previously described route, being carried successively to the lungs, the bronchial
tree, the pharynx, and the small intestine where they mature into adults; or they may
disseminate widely in the body.
 To date, occurrence of autoinfection in humans with helminthic infections is
recognized only in Strongyloides stercoralis and Capillaria philippinensis infections.
 In the case of Strongyloides, autoinfection may explain the possibility of
persistent infections for many years in persons who have not been in an endemic area
and of hyperinfections in immunodepressed individuals.

Session 12: Intestinal Nematode of Medical Importance
- Enterobius Vermicularis and Trichnella
Spiralis
Prerequisites
 None
Learning Tasks
 Describe morphological characteristics of Enterobius vermicularis
 Explain mode of transmission of Enterobius vermicularis
 Explain the effects of Enterobius vermiculaaris on the host
 Describe morphological characteristics of Trichinella spiralis
 Explain mode of transmission of T.spiralis
 Explain effects of Trichnella spilaris on the host
Resources Needed
 Handout 12.1:Life cycle of Enterobius vermicularis
 Handout 12.2:Life cycle of Trichinella spiralis
SESSION OVERVIEW
Learning Tasks
Morphological Characteristics of Enterobius
Vermicularis
Mode of Transmission of Enterobius
Vermicularis
4 10 minutes Presentation Effectss of E.Vermicularis on the Host
Presentation/ Morphological Characteristics of Trichinella
5 25 minutes
Group Discussion Spiralis
6 10 minutes Presentation Mode of Transmission of T.Spiralis
Presentation/
7 20 minutes Effects of Trichinella Spilaris on the Host
Brainstorming

Medical Importance - Enterobius
Vermicularis and Trichnella Spiralis
SESSION CONTENTS
Step 2: Morphological Characteristics of Enterobius Vermicularis

(25 minutes)
 Adult
o The adult worms are small, white, and spindle-shaped and thread-like (thus, thread
worm)
o They re visible to the naked eye
o An adult worm characteristically has a pair of cervical alae (wing-like expansion) at
the anterior end surrounding the mouth and conspicuous double bulb oesophagus.
Fig.12.1: Anterior Part of E.Vermicularis (Female) Showing Cephalic Alae
Cephalic alae
Source: (Web Atlas of Medical Parasitology, 2003)
 Female
o The female worm measures 8 - 12 mm in length and 0.3 - 0.5mm in breadth
o They are straight body with tapering end
o The uteri fill up the entire body of the worm
 Male
o The male is smaller, measuring 2- 5 mm in length and 0.1 – 0.2 mm in breadth
o The posterior end is blunt, sharply curved and has a conspicuous terminal copulatory
spicule
 Egg
o Measures 50-54 x 20-27 µm with characteristic shape – flattened on one side
o Almost colourless with bean-shaped double contour shell
Figure 12.2: Eggs of Enterobius Vermicularis (A and B)

A B
Source: (CDC, 2009)
Step 3: Mode of Transmission of Enterobius Vermicularis (15 minutes)
 Ingestion of infective (embryonated) eggs from contaminated anal skin during the night
hours
 Within a few hours ( about 6 hrs) of being laid the egg contains an infective larva
(embryonated egg)
 By autoinfection which is most common in children, because as the female crawl on the
perianal area cause intense irritation and scratching of the infected area leads to
contamination of the fingers.
 By airborne transmission
o Polluted air when inhaled becomes a source of infection usually from bedding
material
Refer to Handout 12.1: Life Cycle of Enterobius Vermicularis
Step 4: Effects of Enterobius Vermicularis on the Host (10 minutes)
 Enterobiasis rarely produces serious lesions.

o The most common is perianal, perineal and vaginal irritation caused by the female
migration.
o The itching results in insomnia and restlessness.
o In some cases gastrointestinal there may be:
 Pains
 Nausea
 Vomiting
Step 5: Morphological Characteristics of Trichnella Spiralis (25 minutes)

ASK students to discuss on morphological characteristics of trichinella spiralis for 5 minutes
 Adult
o The adult worms are very small, white and just visible to the naked eye
o The male measures 1.5 mm in length and 0.04 mm in diameter
o The spicule and copulatory sheath are absent
o The adult female measures 3.5 mm in length and 0.06 mm in breadth
o The uterus is filled with developing eggs in the posterior region but fully developed
and hatched larvae in the anterior region.
o The females are larviparous, they produce only larvae but not eggs
 Larvae
o The larvae in the tissue are coiled in a lemon-shaped capsule.
o They remain coiled inside muscle cysts, which are present only in the striated skeletal
muscles
o They measure 100 µm in length and 6 µm in breadth

Figure 12.3: Encysted Larvae of Trichinella Spiralis in Pressed Tissue (Bottom)
Source: (CDC, 2009)
Step 6: Mode of Transmission of Trichnella Spiralis (10 minutes)
 Ingestion of raw flesh infected with viable cysts or larvae

 Two different hosts are required in the life cycle (Pig as a primary host and
carvorous/omnivorous animal)
o Man acquires infection on ingestion of viable encysted larvae in raw or insufficiently
cooked pork
o Pigs acquire infection by eating infected carcases of other pigs ( Pig-to-pig) or rats
( rat-to-pig)
o Rats also acquire infection from other infected rats ( Rat-to-rat)
Refer to Handout 12.2: Life Cycle of Trichinella Spiralis
Step 7: Effects of Trichinella Spilaris on the Host (20 minutes)
ASK students to brainstorm on effects of trichinella spilaris on the host for 2 minutes
ALLOW 2 to 3 students to provide responses and let other provide additional responses.
CLARRIFY and summarize their responses using the content below

 The severity of the clinical manifestations of Trichinellosis depends up on:
o Number of the larvae ingested
o Immune status of the host
 In heavy infection depending up on the sites of the lesion caused by the parasite three
clinical phases of the disease occur:
Intestinal Phase
 Nausea
 Vomiting
 Diarrhoea
 Abdominal pain
Muscle Invasion Phase

 Conjunctivitis
 Fever
 Splinter haemorrhage
 Fatigue
 Periorbital and facial oedema
Convalescence Phase
 Malaise and weakness
 Myocarditis
 Bronchopneumonia
 Vascular thrombosis
 Enterobius vermicularis is transmitted through

o Ingestion of eggs from contaminated fingers, bedding, and fomites
o Autoinfection
 Enterobiasis is characterized with intense perianal itching that result into insomnia and
restlessness to patients.
 Trichinella spiralis is a tissue nematode of which the larval stage is found encysted in
tissue.
 Trichinellosis occurs by ingestion of larvae, in poorly cooked meat,
 What is the mode of transmission of Enterobius vermicularis

 Mention one prominent clinical presentation of Enterobiasis
 Mention the hosts involved in transmission of Trichinellosis
References

Web Atlas of Medical Parasitology. (2003). Enterobius vermicularis. Retrieved from
http://www.atlas.or.kr

Handout 12.1:Life cycle of Enterobius
vermicularis
Source: (CDC, 2009)
Enterobius Vermicularis - Pinworm

 Human pinworm, Enterobius vermicularis, is the most common parasitic worm infection
in the United States and Western Europe.
 Pinworms are easily transmitted from human to human and are particularly common in

children. Luckily the disease, enterobiasis, causes only anal itching.
 Enterobius vermicularis does not need an intermediate host to complete its life cycle.
Humans get infected by accidentally swallowing or inhaling microscopic pinworm eggs.
 Once inside the first part of the small intestine, duodenum, pinworm larvae hatch from the
eggs. The larvae are only about 0.15 mm long but grow very fast.
 They migrate towards the ending of the small intestine as they mature into adults. Adults
are white, thin worms. Males are 0.2 mm thick and 2–5 mm long whereas females are 0.5
mm thick and 8–13 mm long.
 Life expectancy for males is seven weeks whereas females live 5–13 weeks. The males
usually die after the pinworms have mated in the last part of the small intestine, ileum.
 The gravid (pregnant) female resides at the beginning of the large intestine, colon, eating
what ever food passes through the intestinal tract. Female pinworm reaches fertility
within four weeks. She swims at the rate of 12 cm per hour towards the rectum.
 During sleep when body temperature is low and there is less movement the female pushes
out from the anus and lays eggs on the outside skin.
 The eggs get stuck on skin, underwear or bedding and become infective within a few
hours. Eggs survive up to three weeks on clothing, sheets or other objects. After the
female has laid 11000–16000 eggs it dies.
 Sometimes pinworms lay eggs inside the colon. If the eggs are not taken out in the feces
the larvae might have enough time to hatch.
 This can only happen in the large intestine or rectum and only if enough oxygen is
present. The larvae migrate back up the intestinal tract and develop into adults.
 This is very rare but happens every now and then.

Handout 12.2:Life cycle of Trichinella spiralis
Source: (CDC, 2009)
 The typical life cycle for T. spiralis involves humans, pigs, and rodents.
 Pigs become infected when they eat infectious cysts in raw meat, often pork or rats
(sylvatic cycle).
 Humans become infected when they eat raw or undercooked infected pork (domestic

cycle).
 After humans ingest the cysts from infected undercooked meat, pepsin and hydrochloric
acid help free the larvae in the cysts in the stomach. The larvae then migrate to the small
intestine, where they molt four times before becoming adults.
 Thirty to 34 hours after the cysts were originally ingested; the adults mate, and within five
days produce larvae.
 The worms can only reproduce for a limited time because the immune system will
eventually expel them from the small intestine.
 The larvae then use their piercing mouthpart, called the "stylet", to pass through the
intestinal mucosa and enter the lymphatic vessels, and then enter the bloodstream.
 The larvae travel by capillaries to various organs, such as the retina, myocardium, or
lymph nodes; however, only larvae that migrate to skeletal muscle cells survive and
encyst.
 The larval host cell becomes a nurse cell in which the larvae will be encapsulated.
 The development of a capillary network around the nurse cell completes encystation of
the larvae.

Session 13: Blood Nematodes/Filarial Worms of Medical
Importance
Prerequisites
 None
Learning Tasks
 Describe the morphological characteristics of Wuchereria bancrofti
 Explain the mode of transmission of Wucherelia bancrofti
 Explain the effeccts of Wucherelia bancrofti on the host
 Explain on morphological characteristics of Loa loa
 Explain the mode of transmission of Loa loa
 Explain the effects of Loa loa on the host
Resources Needed
 Handout 13.1: Life cycle of Wuchereria bancrofti
 Handout 13.2: Life cycle of Loa Loa
SESSION OVERVIEW
Activity/Metho
Step Time Content
d
Learning Tasks
Presentation Morphological Characteristics of Wuchereria
2 20 minutes
Bancrofti
Presentation/
3 15 minutes Mode of Transmission of Wucherelia Bancrofti
Buzzing
4 20 minutes Presentation Effects of Wucherelia Bancrofti on the Host
5 20 minutes Presentation Morphological Characteristics of Loa Loa
6 10 minutes Presentation Mode of Transmission of Loa Loa

Presentation/
7 20 minutes Group Effects of Loa Loa on the Host
Discussion

125
NTA Level 6, Semester 2 Session 13: Blood Nematodes/Filarial
Worms of Medical Importance
SESSION CONTENTS

Step 2: Morphological Characteristics of Wuchereria Bancrofti (20 minutes)

 Adult Female
o Cylindrical in shape
o Measures 80- 100 mm in length and 0.24 -0.3 mm in breadth
o Have curved tail
 Adult Male
o Measures 4 cm in length and 0.1 mm in breadth
o The tail end is sharply curved ventrally with two spicules of unequal length
 Microfilaria
o Vary in size: 244 – 296 µm long and 7.5 – 10 µm in diameter
o Is covered by hyaline sheath that projects at both ends of the body
o They are found in the peripheral blood and often in hydrocele fluid and chylous urine
o Nuclei do not extend the end of the tail
Figure13.1: Microfilaria in Stained Blood Smear
Hyaline sheath at the posterior end
Source: CDC. (2009)

126
Step 3: Mode of Transmission of Wuchereria Bancrofti (15 minutes)
ASK students to pair up and buzz on mode of transmission of wucherelia bancrofti for 2
minutes
 Filariasis is spread from infected persons to uninfected persons by bite of female

mosquitoes when taking blood meal by which can acquire or inject the microfilaraiae
 The mosquitoe involved in transmission of Bancroftian filariasis include:
o Culex species
o Anopheles species
o Aedes species and
o Mansonia species
Refer students to Handout 11.1: Life Cycle of Wuchereria bancrofti
Step 4: Effects of Wuchereria Bancrofti on the Host (20 marks)
 Persons infected with W.bancrofti can develop clinical symptoms, the so called lymphatic
filariasis that is characterized by:
o Recurrent attack of fever with painful inflamed lymhatics.
o Lymphoedema caused by presence of adult worms in the lymphatic channels
o Lymphadenitis, the inflammation of the lymph nodes
o Damage to the lymhatics leads to the thickening and eventual blockage of lymphatic
vessels.
o The lymhatics involved are mainly those of the limbs, genital organs (esp. those of the
spermatic cord) and brest.The obstruction to flow lymph causes swelling, fibrosis and
eventually elephantiasis.
o Chronic filariasis, or obstructive phase usually takes 10 – 15 years to develop.
Step 5: Morphological Characteristics of Loa Loa (20 minutes)
 Adult Loa loa

o Thread like worms
o The anterior end tapers to a narrow head
o Male measures 30 – 34 mm in length and 0.35 – 0.43 mm in diameter
o The female worm measures 40 – 70 mm in length and 0.5 mm in diameter
 Microfilaria
o Measures 250-300 in length and 6-10 µm in breadth.

127
o Sheath is present and stains best with haematoxylin. it stains poorly or not at all with
Giemsa.
o Nuclei are present extending right up to the tip of the tail
Figure 13.2: Loa loa Microfilarias in Thin Giemsa-stained Blood Smear
Faint myaline sheath
http//www.google.com-microfilaria
Step 6: Mode of Transmission of Loa Loa (10 minutes)
 Humans acquire Loiasis through the bite of Chrysops spp when takinga blood meal
 The infective larvae ( microfilariae) enter in the large numbers through the punctured
wound on the skin made by the fly, during the blood meal
 Microfilariae are transmitted to female Chrysops when they bite humans and suck the
blood, which contains microfilariae.
Refer students to Handout 13.2: Life cycle of Loa loa
Step 7: Effects of Loa Loa on the Host (20 minutes)
ASK students to discuss on effects of loa loa on the host for 5 minutes
 The infection results in subcutaneous (Calabar) swelling; Swelling that measures about 5-
10 cm in diameter, marked by erythema and angioedema, usually in the extremities.
 The organism migrates under the skin at a rate of up to an inch every two minutes.
Consequently, the swelling appears spontaneously, persists for 4 to 7 days and disappears,

128
and is known as fugitive or Calabar swelling.
 The worm usually causes no serious problems, except when passing through the orbital
conjunctiva or the nose bridge
 Loa loa is often referred to as “eye worm” because the adult worms sometimes migrate
across the conjunctiva or eyelid
 Wuchereria bancrofti causes elephantiasis in both males and females and hydrocele in
males
 Man is the only definitive host and mosquitoes of different genera are vectors
 The adult worms are found in the lymphatics and the microfilaria are in the blood and
lymph
 The vector of Loa loa microfilariae is Chrysops species
 Filariasis in Tanzania mainly occupy the Coastal belts
 The Loa loa infection results in subcutaneous swelling called Calabar)
 Mention four mosquito vectors transmitting microfilariae of Wuchereria Bancrofti

 State the common sites of human body usually invaded by microfilariae of W. Bancrofti
 What is Calabar swelling
References
Handout 13.1:Life cycle of Wuchereria
Bancrofti

129
Source: (CDC, 2009)
Life Cycle
In Man
 During a blood meal, an infected mosquito introduces third-stage filarial larvae onto the
skin of the human host, where they penetrate into the bite wound.
 They develop in adults that commonly reside in the lymphatics.
 The female worms measure 80 to 100 mm in length and 0.24 to 0.30 mm in diameter,
while the males measure about 40 mm by .1 mm.
 Adults produce microfilariae measuring 244 to 296 μm by 7.5 to 10 μm, which are
sheathed and have nocturnal periodicity, except the
 South Pacific microfilariae which have the absence of marked periodicity.
 The microfilariae migrate into lymph and blood channels moving actively through lymph
and blood.
In Mosquito
 A mosquito ingests the microfilariae during a blood meal.

130
 After ingestion, the microfilariae lose their sheaths and some of them work their way
through the wall of the proventriculus and cardiac portion of the mosquito's midgut and
reach the thoracic muscles.
 There the microfilariae develop into first-stage larvae and subsequently into third-stage
infective larvae.
 The third-stage infective larvae migrate through the hemocoel to the mosquito's prosbocis
and can infect another human when the mosquito takes a blood meal.

131
Handout 13.2:Life cycle of Loa Loa
Source: (CDC, 2009)
In the Vector
 When a noninfected deer fly takes a blood meal from an infected human, it ingests
microfilariae.
 The microfilariae lose their sheaths; migrate from the fly's midgut to the hemocoel and
eventually to the thoracic muscles.
 There they develop into first stage and eventually into third stage (infective) filarial
larvae. The development inside the fly takes up to two weeks.
 They migrate to the fly's proboscis (the snout) and invade another human during the next
blood meal.
In Man
 The third stage larvae are transferred from the insect (Chrysops) mouth parts to the skin.
 They burrow into the bite wound and enter the subcutaneous layer where they mature into
adults in one year.
 When a Loa loa female gives birth to living microfilariae (pre-larval eggs) inside the skin
of an infected human.

132
 The microfilariae travel in peripheral blood during daytime, but during the night
(noncirculation phase) they reside in the lungs. Loa loa adults live up to 17 years

133
Session 14: Tissue Nematodes of Medical Importance -
Onchocerca Volvulus and Drancuculus
Medinensis
Prerequisites
 None
Learning Tasks
 Describe the morphological characteristics of Onchocerca volvolus
 Explain the mode of transmission of Onchocerca volvolus
 Explain the effects of Onchocerca volvolus on the host
 Describe the morphological characteristics of Dracunculus medinensis
 Explain the mode of transmission of Dracunculus medinensis
 Explain the effectsof Dracunculus medinensis on the host
Resources Needed
 Handout 14.1 Life cycle of Onchocerca volvulus
 Handout 14.2 Life cycle of Dracunculus medinensis
SESSION OVERVIEW
1 5 minutes Presentation Session Title and Learning Tasks

Morphological Characteristics of Onchocerca
Volvulus
Presentation/ Mode of Transmission of Onchocerca
3 20 minutes
Group Discusion Volvulus
Presentation/
4 15 minutes Effects of Onchocerca Volvulus on the Host
Buzzing
Dracunculus Medinensis
Mode of Transmission of Dracunculus
Medinensis
Presentation/ Effects of Dracunculus Medinensis on the
7 20 minutes
Buzzing Host

NTA Level 6, Semester 2 134 Session 14: Tissue Nematodes of Medical
Importance - Onchocerca Volvulus and
Drancuculus Medinensis
SESSION CONTENTS
Step 2: Morphological Characteristics of Onchocerca Volvolus

(20 minutes)
 Onchocerca volvolus microfilaria

o It measures 240-360µm in length and 5-9µm in breadth
o Has no sheath
o Head end is slightly enlarged
o Both the anterior and posterior ends are nuclei free
o The anterior end is slightly enlarged and tail pointed
Figure 14.1: Onchocerca Volvolus Microfilariae

Anterior end slightly enlarged
Source:www.google.com/onchocerca volvulus

 Adult Onchocerca Volvolus
o The male is much smaller thgan female
o Measures 19- 42 cm in length and 0.13 -0.21 mm in diameter
o The female is relatively larger and measures 34-50 cm in length and 0.3 -0.4 mm inn
breadth
Step 3: Mode of Transmission of Onchocerca volvulus (20 minutes)
ASK students to discuss on mode of transmission of onchocerca volvulus for 5 minutes
 Man acquires infection by the injection of infective microfilariae into the skin by the bite
of vector female Simulium species
 The larvae enter the skin through the punctured wound and migrate to the subcutaneous
tissue
 Transmission of infection to blackfly (Simulium species) takes place by the ingestion of
microfilariae from the skin of the infected man during the blood meal.
 Factors which favour transmission include hydroelectricity, rivers, and irrigation.
o The vector Simulium breeds running water.
Refer students to Handout 12.2: The Life Cycle of Onchocerca volvolus
Step 4: Effects of Onchocerca Volvolus on the Host (15 minutes)
ASK students to pair up and buzz on effectss of onchocerca volvulus on the host for 2
minutes
 Skin lesion
o Acute pruritis rashes, hypatrophic, hyperpigmented and thickened skin

o Atrophic depigmented lesions
o Subcutaneous nodule ( onchocercoma)
o Secondary bacterial infection of the skin
 Ocular lesion
o Visual impairment or blindness
Step 5: Morphological Characteristics of Dracunculus Medinensis

(20 minutes)
 Female
o The adult female worm measures 50-120 cm in length and o.7 – 1.7 mm in diameter
o It has a rounded anterior end and a tapering posterior end in form of hook-like
structure
 Male
o Difficulty to demonstrate as they die immediately after fertilizing the females
 Larva
o With a round anterior end and a long slander filariform tail
o Measures 650-750 mm in length and 17-20 mm in breadth
Figure 14.2: Infected Person with Dracunculus Medinensis (Top) and Dracunculus Emerging
from Foot (Bottom)
Source:www.google.com
Step 6: Mode of Transmission of Dracunculus Medinensis (10 minutes)

 Dracunculiasis/Dracontiasis is transmitted by swallowing water containing infected
Cyclops that is infected with D.medinensis larvae.
 Man acquires infection by drinking unfiltered water containing infected Cyclops species
 The Cyclops is infected by the swimming larvae when ingests them and allowing them to
develop and become infective to humans when next swallow water containing infected
Cyclops.
Refer students to Handout 14.2: The Life cycle of Dracunculus medinensis
Step 7: Effects of Dracunculus Medinensis on the Host (20 minutes)
 D. Medinensis infection is asymptomatic until the female worm reaches surface of the
skin and is ready to discharge the larvae.
 Formation of blisters, which is the primary physical sign
 Blister formation is accompanied by an intense burning pain
 Over next few days the blister vesculates and the blister ruptures producing a painful
 The female worms cause severe pain and allergic reactions including urticaria, fever, and
nausea and vomiting.
 In superficial tissue, it liberates a toxic substance that produces a local inflammatory
reaction
 Secondary bacterial infection (due to contamination) may occur produces abscesses,
cellulitis, extensive ulceration and necrosis.
 Onchocerca Volvulus is a tissue nematode of man invading subcutaneous tissues

 The infective stage of Onchocerca Volvolus is the filarial larvae known as microfilariae
 Onchocerca volvulus is transmitted by a vector black fly
 The D. Medinensis infection is caused by ingestion of water containing infected Cyclops
 Mention three morphological features of O.volvulus larva

 What are the risk factors for transmission of river blindness
 What is the intermediate host of D.medinensis
References


Handout 14.1:Life Cycle of Onchocerca Volvulus
Source: (CDC, 2009)
In Man
 During a blood meal, an infected blackfly (genus Simulium) introduces third-stage filarial
larvae onto the skin of the human host, where they penetrate into the bite wound.
 In subcutaneous tissues the larvae develop into adult filariae, which commonly reside in
nodules in subcutaneous connective tissues. Adults can live in the nodules for
approximately 15 years. Some nodules may contain numerous male and female worms.
 Females measure 33 to 50 cm in length and 270 to 400 μm in diameter, while males
measure 19 to 42 mm by 130 to 210 μm. In the subcutaneous nodules, the female worms
are capable of producing microfilariae for approximately 9 years.
 The microfilariae, measuring 220 to 360 µm by 5 to 9 µm and unsheathed, have a life
span that may reach 2 years.
 They are occasionally found in peripheral blood, urine, and sputum but are typically
found in the skin and in the lymphatics of connective tissues.
In Black Fly
 A blackfly ingests the microfilariae during a blood meal. After ingestion, the
microfilariae migrate from the blackfly's midgut through the hemocoel to the thoracic
muscles.
 There the microfilariae develop into first-stage larvae and subsequently into third-stage
infective larvae. The third-stage infective larvae migrate to the blackfly's proboscis and

can infect another human when the fly takes a blood meal.

Handout 14.2:Life Cycle of Drancuculus
Medinensis
Source: (CDC, 2009)
In man
 Humans become infected by drinking unfiltered water containing copepods (small
crustaceans) which are infected with larvae of D. medinensis.
 Following ingestion, the copepods die and release the larvae, which penetrate the host
stomach and intestinal wall and enter the abdominal cavity and retroperitoneal space.
 After maturation into adults and copulation, the male worms die and the females (length:
70 to 120 cm) migrate in the subcutaneous tissues towards the skin surface.
Approximately one year after infection, the female worm induces a blister on the skin,
generally on the distal lower extremity, which ruptures.
 When this lesion comes into contact with water, a contact that the patient seeks to relieve
the local discomfort, the female worm emerges and releases larvae.
In the Cyclops
 The larvae are ingested by a copepod and after two weeks (and two molts) have
developed into infective larvae.
 Ingestion of the copepods by humans closes the cycle.

Session 15: Utilization of Knowledge of Parasitology
and Entomology in Prevention of Diseases
Prerequisites
 None
Learning Tasks
 Explain the quality assurance in dealing with parasitological specimens
 Identify parasitological specimens
 Explain on collection and transportation of parasitological specimens
Resources Needed
 Handout 15.1: Collection and Transport of Specimens
 Worksheet 15.1-3: Specimen Collection and Rejection Case Studies
SESSION OVERVIEW
Learning Tasks
Presentation/ Quality Assurance in Dealing with
2 15 minutes
Group Discussion Parasitological Specimen
Presentation/
3 20 minutes Identificaation of Parasitological Specimens
Buzzing
Collection and Transportation of
Parasitological Specimens
Presentation/ Specimen Collection and Specimen Rejection
5 40 minutes
Assignment Case Studies

NTA Level 6, Semester 2 143 Session 15: Utilization of Knowledge of
Parasitology and Entomology in
Prevention of Diseases
SESSION CONTENTS
Step 2: Quality Assurance in Dealing with Parasitological Specimens

(20 minutes)
ASK students to discuss in group on on the definition of quality assurance and two
importances of quality assurance for 5 minutes
 Quality assurance
o Is the overall term used to describe the steps and procedures which need to be taken
to ensure the reliability of results
o It includes control of collection and transportation of specimens, and control
measures taken in the laboratory to ensure the reliable performance of tests and
correct reporting of results, thus “garbage in garbage out”
 Importance of Quality assurance
o Is essential if consistently reliable results are to be obtained from parasitological
investigation.
o Facilitates correct laboratory results that lead to true diagnosis and subsequently
accurate treatment of patients
o Prevents unnecessary expenses that may be incurred when tests are not performed
well, drugs and time wasted, and further investigations performed to establish a
diagnosis.
 Note: In order to ensure proper collection and transport of specimens adequate written
instructions (SOP) should be prepared and reviewed at regular intervals.
Step 3: Identification of Parasitological Specimens (20 minutes)
 Parasitological specimens: Any biological specimens collected for identification of

parasites
 Nature of Parasitological specimen
o Blood

o Stool
o Urine
o Skin snips
o Tissue
o Sputum
o Cerebral Spinal Fluid (CSF)
 Aim of collecting parasitological specimens
o To identify different parasitic forms depending on the nature of specimen under
examination for treatment and research purposes
Table 17.1: List of Specimens and Parasites and Parasitic Forms to be identified
Specimen Parasite Form

E.histolytica Cyst, amoeba
G.lamblia Cyst, trophozoites
B.coli Cyst, trophozoite (ciliate)
I.belli Oocyst
Cryptosporidium Oocyst
T.solium Egg, segment
T.saginata Egg, segment
Faeces H.nana Egg
D.latum Egg
O.sinensis Egg
S.mansoni Egg,worm
A.lumbricoides Egg
T.trichiura Egg
Hookworm Egg, larva
S.stercoralis Larva
Paragonimus spp egg
Plasmodium spp Trophozoite, schizont, gametocyte
Blood Trypanosoma spp Trypomastigote
W.bancrofti Microfilaria
Loa loa microfilaria
Muscle Trichnella spiralis Larva
Rectal Scraping E.histolytica Cyst, trophozoites (amoeba)
S.mansoni egg
Duodenal Aspirates G.lamblia Fllagelates (trophozoites)
O.sinensis Egg
F.hepatica Egg
S.stercoralis larva
Sputum Paragonimus spp eggs
Skin snip/Tissue Onchocerca volvulus Microfilaria
Cerebral spinal fluid Trypanasomes Flagellates

gambiense,
T.rhodesiense

Urine S.haematobium, Egg
Trichomonas vaginalis Trophozoites
Step 4: Collection and Transport of Parasitological Specimens (30 minutes)
 The laboratory diagnosis of an infectious disease begins with the collection of a clinical
specimen for examination or processing in the laboratory.
 The right specimen be collected at the right time and in the proper container
 Proper collection of an appropriate clinical specimen is the first step in obtaining an
accurate laboratory diagnosis of an infectious disease
 Guidelines for the collection of specimens should be made available to responsible
personnel in a lucidly written format.
 The guidelines must emphasize two important aspects:
o Collection of the specimen before the administration of antimicrobial agents.
o Prevention of contamination of the specimen with externally present organisms or
normal flora of the body
 Collection procedure
o Specimens will be collected by following the SOPs designed according to the type of
speciemen e.g stool, urine, venous blood, Dried Blood Smear (DBS), B/S and sputum.
o Apply strict aseptic techniques throughout the procedure.
o Wash hands before and after the collection.
o Wear appropriate personal protective equipment (PPE)
o Collect the specimen at the appropriate phase of disease.
o Make certain that the specimen is representative of the infectious process (e.g. sputum
is the specimen for pneumonia and not saliva) and is adequate in quantity for the
desired tests to be performed.
o Collect or place the specimen aseptically in a sterile and/or appropriate container.
o Ensure that the outside of the specimen container is clean and uncontaminated.
o Close the container tightly so that its contents do not leak during transportation.
o Label and date the container appropriately and complete the requisition form.
o Arrange for immediate transportation of the specimen to the laboratory.
 Transportation of parasitological specimens
o The container with specimen is properly closed that its contents do not leak
o The container be labeled (Name of paatien, dated of collection, nature of specimen,
ward) and accompanied with the requisition form.
o The specimen container be arranged for immediate transportation of the specimen to
the laboratory:
o For stool specimens, should reach to the laboratory within 10 minutess fro the time of
collection
o The container with all specimens should be labeled Handle with care Pathological
specimens
 Criteria for rejection of specimens
o Criteria should be developed by a laboratory on the basis of which the processing of a
specimen may not be done by the laboratory.
o The following are some examples:
 Missing or inadequate identification.
 Insufficient quantity.
 Specimen collected in an inappropriate container.

 Contamination suspected.
 Inappropriate transport or storage
 Unknown time delay.
 Haemolysed blood sample
Refer students to Handout 15.1: Collection and Transport of Specimens
 Parasitological specimens are of different nature collected differently

 Proper collection of specimens and transportation leads to accurate laboratory results
 Improper handling of specimens may lead to unreliable results and subsequently
unreliable treatment of patients
 The laboratory diagnosis of an infectious disease begins with the collection of a clinical
specimen for examination or processing in the laboratory.
 The right specimen be collected at the right time and in the proper container
 Mention four types of parasitological specimens

 Why is it important to label specimens?
 What specimen is required for identification of Paragonimus westermani, Fasciola
hepatica, and Giardia lambria?
ASK students to do homework on specimen collection and answer the questions provided in
worksheet 15.1-3
Refer students to Worksheeet 15.1-3: Stool and Blood Smear Collection

References

Handout 15.1: Collection and Transport of
Specimens
Type of Specimens, Time of Collection, Collection Technique and Packaging and
Dispartching
 If parasites are to be identified with lab. Methods successfully, the type of specimens, its
collection, and the time and method of dispartch to the laboratory must be correct.
 Adequate information about the patient’s condition must be indicated on the request form
and must be sent with the specimen.
Type of Specimen
 The correct type of specimen to collect will depend on the pathogen to be identified e.g
sputum not saliva is essential for the detection of Paragonimus westermani; blood stained
with mucus is an ideal sample for Entamoeba histolytica.
Time of Collection
 Specimen such as urine and sputum are best collected soon after a patient wakes when
organisms had the opportunity to multiply over several hours.
 The time for collection for most other specimens will depend on the condition of the
patient, and time agreed between medical, nursing and laboratory staff for the delivery of
the specimen to the laboratory.
Collection Techniques
 Details of the collection of specimens in hospitals and health centres are described the
subsequent subunit of this chapter
 The laboratory should issue written instruction for those responsible for collecting
specimens including the wards, outpatient clinics, and health centre.
Labelling of Specimen and the Sending of a Request Form

 Each specimen must be clearly labeled with the date and time of collection, and the
patient’s name, number, ward or health centre.
 Slides with one end frosted (area of opaque glass on which to write) should be used for
making smears so that lead pencil can be used to label slides clearly
 Each specimen must be accompanied by request form which gives
 The patient’s name, age, number, and ward.
 Type of specimen and the date and time of its collection
 Investigation required
Stool
 Give the patient a clean,dry,disinfectant-free bedpan or suitable wide-necked container in
which to pass a specimen.The container need not to be sterile.Ask yhe patient to avoid
contaminating the faeces with urine
 Transfer a portion (about a spoonful) of the specimen,especially that whih contain
mucus,pus,or blood , into a clean,dry ,leak-proof container
 Note: if thespecimen contains worms or tapeworm segment,transfer these to a separte
contiane, and send them for identification.

 Label the specimen and send it with a request form to reach the laboratory within 2
hours.If the specimen contains blood,or amoebic dysentery is suspected: Deliver to the
laboratory as soon as possible i.e not more than 30 minutuesThe specimen must be fresh
to demonstrate actively motle amoebae.
Urine
 Give a patient dry, wide-necked, leak-proof container. If the same specimen is required
for microbiological examination then a clean catch mid stream urine (msu) is required.
 Female patients should be instructed to cleanse the area around the urethral opening (for
msu) with clean water, dry the area, and collect the urine with the labia held apart.
 Note:
o Whenever possible, the first urine passed by the paient at the beginning, should be
sent to for examination. For urinary schistosomiasis, the last drop of the urine
(terminal Haematuria) should be allowed to enter into the container.
o Avoid water to enter into the container because schistosome eggs will hatch into
miracidium due to change of pH.
o Label the container with the date, the name and number of the patient, and the time of
collection.A soon as possible, deliver the specimen with request to the laboratory.
Sputum
 Sputum for parasitological investication in order to identify Paragonimus westermani is
collected similar to that for microbiolgical investigation.
 Give the patient a clean (need not to be sterile), dry, wide-necked,leak-proof
container,and request him or her to cough deeply to produce a spuum specimen.
 Caution: When a sputum specimen is being collected, adequate safety precautions should
be taken to prevent the spread of infectious organisms.
 Note: The sputum must be sputum, not saliva.Sputum is best collected in the morning
soon after the patient wakes.
Thick Blood Smear for Malaria Parasites

 Place a completely clean(grease-free) and scratch-free slide on the table or bench
 Cleanse the lobe of the finger (or heel if an infant) using a swab moistened with 70% v/v
alcohol.
 Using a sterile lancet, prick the finger or heel. Squeeze gently to obtain a large drop of
blood, and then release it on the slide.
 Spread a large circle by use of an applicator stick or spreader (equal to fifty coin circle).
 Using a black lead pencil if the slide is one end frosted; label the slide with the date and
the patient’s name and number.
 Allow the smear to air-dry in horizontal position and placed in safe place(where there is
no risk of the blood coming into contact with any person or along the top of the film).
 Send to the laboratory
Worksheet 15.1: Stoll Specimen Collection
Instructions

 Choose a person from a group to demonstrate
 Representative will demonstrate to the group members following the appropriate SOP
 Use the appropriate SOP according to the procedure in place.
Stool Specimen Collection Case 1

Mrs Kezy Makongo 30 yrs old, was admitted in peadiatric ward with her child who was
experiencing watery diarrhoea for 3 days. A child was not vomiting but with abdominal
discomfort. On physical examination the clinician ordered stool examination for
intestinal parasites.
Questions
1. What are the requirements for that stool collection procedure?
2. What parasites do you expect to be identified in that stool specimen ordered?
3. What are the characteristics of the specimen container to be used?
4. What last procedure should you do before transporting the specimen to the laboratory for
examination?
5. How many minutes will you take from collection of the specimen to the time the stool
specimen reaches the laboratory?
Answers
1. Requirements for stool collection
 PPE (Gloves)
 Provide to a parent a screw-caped plastic container with an applicator spoon-like in
side with instructions how to collect the specimen
 Instruction to a parent how a stool specimen should be collected :
o Parent informed about the procedure
o Given appropriate container
o Parent told to pick a portion of stool using the spoon-like device present in the
stool container
o Parent, cap the container and bring the specimen to a nurse
2. Parasites expected to be identified in that stool specimen ordered
 Since a patient is child and was experiencing watery diarrhoea, the most probable
parasite associated with that condition is Giardia lambria
3. Characteristics of the stool container to be used
 Plastic-made
 Wide mouth
 Screw-caped
 Contains spoon-like applicator device with label
4. Last procedure before transporting the specimen to the laboratory for examination
 Labelling the specimen (Name of patient, Age, ward, nature of specimen, date of
collection)
 Confirming correlation of the laboratory request form with the specimen having
related information

Worksheet 15.2: Blood Smear Collection
Instruction
1. Choose a person from a group to demonstrate. Representative will demonstrate to the

group members following the appropriate SOP
2. Use the appropriate SOP according a procedure in place.
Blood Smear Collection Case Study
Two blood smears were collected from two different patients in male ward and placed
over the respective laboratory request forms. Eventually there was a wind blow which
displaced the slides from their forms. A nurse tried to return the slides with smears to
their forms, unfortunately because the B/Ss were not labelled a nurse failed to organise
the materials.
Questions
1. In that situation what can you do?
2. What ideal place the specimens should be kept before transportation to the laboratory?
3. When is it the right time to take blood smears to the laboratory?
Answers
1. Things to do:
 Apologize to the patient on what happened
 Seek consent from the two patients to collect another blood smears
 Immediately label the blood smear after collection :
o Name of patient
o Name of ward
2. Ideal place to keep the specimens before transporting to the laboratory
 Dust-free place
 Place with no pests/insects
 Wind-free place
3. The right time to take blood smears from ward to the laboratory:
 With immediate effects once the smear(s ) are dry
Reason
 To meet turn around time that is, the time from when a specimen is corrected to the time
when laboratory results are back to the war/ requester.

Worksheet 15.3: Blood Smear Collection
Instruction
1. Choose a person from a group to demonstrate. Representative will demonstrate to the

group members following the appropriate SOP
2. Use the appropriate SOP according a procedure in place.
Blood Specimen Rejection Case Study
Mr Kamzungu Prati was admitted in TB male ward. After the morning ward round a
doctor requested several laboratory tests: FBP, ESR and Hb estimation. A nurse on
duty drew 1ml of blood in a plain Vacutainer tube for the above mentioned test. The
tube was labelled with: Date of collection, and name of the ward.
After transportation of the specimen to the laboratory, eventually a nurse received a
phone from the laboratory that the specimen has been rejected.
Questions
1. In that situation what can you do?
2. What do you think could be the reasons for rejection of the specimen?
Answers
1. Things to do:
 Go to the laboratory to see what happened to that specimen
 Check what caused rejection of that specimen
 Go back to the ward to collect another specimen appropriately and correctly
2. Reasons for rejection of the specimen:

 Specimen in incorrect container the plain tube with red cap
o Specimen for FBP,ESR amd Hb should be collected in a tube purple caped with
EDTA
 Insufficient blood (1ml).
o The amount of blood for FBP, ESR and Hb should be 2 ml.
 Specimen had no name of the patient

Session 16: Preventive Measures against Intestinal and
Blood/Tissue Protozoa of Medical
Importance
Prerequisites
 None
Learning Tasks
 Explain the preventive measures against intestinal protozoa infections
 Explain the preventive measures against blood protozoa infections
 Explain the preventive measures against tissue protozoa infections
Resources Needed
SESSION OVERVIEW
Learning Tasks
Presentation/ Preventive Measures Against Intestinal
2 45 minutes
Group Dscussion Protozoa Infections
Preventive Measures against Blood
Protozoa Infections
Presentation/ Preventive Measures Against Tissue
4 35 minutes
Buzzing Protozoa Infections

NTA Level 6, Semester 2 154 Session 16: Preventive Measures against
Intestinal and Blood/Tissue Protozoa of
Medical Importance
SESSION CONTENTS
Step 2: Preventive Measures against Intestinal Protozoa (45 minutes)
ASK students to discuss on preventive measures against intestinal protozoa infections for 5
minutes
 Physical measures
o Health education
o Avoid eating uncooked fruit and vegetables
o Boiling drinking water
o Adequate and safe water supply
o Hand washing after defecation and before eating
o Sanitary disposal of human excreta
o Improvement of standard of living
o Early case detection and treatment
 Chemical measures ( killing/eliminating parasites using chemical agents)
o Chemoprophylaxis
o Treatment ( e.g Metronidazole tabs against Giardia lamblia)
o Use of chemical agents aimed at killing the parasites/organisms e.g water
chlorination
 Prevention of E. Histolytica infection
o Preventing faecal contamination of the environment by proper use of latrines and
protecting water supplies from faecal contamination.
o Hand washing after defaecation and before eating.
o Covering water and food to prevent contamination from flies which can act as cyst
carriers.
o Thorough washing of salads with hot water before use.
o Boiling drinking water (E. Histolytica cysts are killed at 55oc)
o Screen and treat all infected cases.

Medical Importance
o Health education, particularly of food handlers, and also in schools and community
health centres.
 Prevention and control of G. Lamblia infection
o Improve environmental sanitation and personal hygiene to prevent food, water, and
hands becoming contaminated with faeces containing cysts.
o NB: The cyst are not killed in food or water stored at 4-6oC. Like the cyst of E.
Histolytica, those of Giardia are resistant to the concentrations of chlorine normally
used for the treatment of domestic water supplies
 Prevention and control of Balantidiasis (Balantidium coli infection)
o Infection with B.coli can be avoided by not eating food which is likely to be
contaminated with pig faeces.
o Protecting water supplies from faecal contamination and improving personal hygiene.
Step 3: Preventive Measures against Blood Protozoa Infections (25

minutes)
 Vector control Methods:

o Physical Measures
 Intervening the life cycle of vectors using approaches other than chemical
substances to disturb their ecology; For example, drying stagnant water against
mosquitoes, clearing bushes, e.tc
o Chemical Measures
 Application of chemical substances like insecticides and larvicides to kill the
insects during adult or larval stages respectively
o Biological Measures
 Approach by which a large organism (Predator) is used to feed on the smaller
organism (prey) of different species in order to reduce them in number. For
example; Fish feeding on mosquito larvae in water
 Prevention and Control Measures against Malaria
o Avoiding mosquito bites by:
 Screening windows and doors with mosquito netting.
 Using effective mosquito bed nets during the biting hours of the local mosquito
vectors.
 The impregnation of nets with insecticides such as permethrin increases
protection.
 Wearing protective clothing such as long trousers, long skirts, sarongs, and
garments with long sleeves.
 Using mosquito repellents such as oil of cintonella, dimethyl phthalate, mosquito
repellent coils, or smoke from fires or from burning pyrethrum pellets or
eucalyptus leaves or bark.
o Controlling breeding of mosquito by:
 Altering the habitat to discourage breeding e.g. preserving or planting vegetation
where the vector needs sunshine or clearing vegetation where the vector needs
shade.
 Flooding or flushing of breeding places.
 Draining to remove surface water and filling in ponds, pot-holes, drainage ditches,
 Regularly spraying breeding sites with oil or chemicals.
o Destroying adult mosquitoes by:

Medical Importance
 Regular spray of houses with residual insecticides such as DDT (used twice
yearly) or Malathion (used every 3 months) as part of control programme and
providing there is no resistance of mosquitoes to the insecticide.
o Measures against the parasites
 Early diagnosis and proper effective treatment
 Prevent infections (prophylaxis), especially in non-immune persons visiting or
going to work in malarious areas or in person with reduced immunity such as
pregnant woman.
o Health education
 Provide health education on how disease is transmitted and control measures in
schools, villages, and community in general.
 Also train primary health care providers how to teach malaria control measures.
 Prevention and control measures of African Trypanosomiasis
o Detecting and treating human infections at an early stage, and increasing public
awareness of the disease.
o Siting human settlements in tsetse fly infested areas only when there is adequate
o Vector control :
 Using and maintaining insecticide impregnated tsetse fly traps.
 Identifying and studying the breeding habits of local vectors.
 Selectively clearing the bush and wooded areas, especially around game reserves,
water –holes, bridges and along river banks.
 Spraying vehicles with insecticide as they enter and leave tsetse fly infested areas.
 Identifying animal reservoir hosts and treats them, in endemic areas.
Step 4: Preventive Measures against Tissue Protozoa Infections (35

minutes)
ASK students to pair up and buzz on preventive measures against tissue protozoa
infections for 2 minutes
 Personal protection from vector bites by:

o Using insect repellants, although in hot and humid condition they are of limited use
due to profuse sweating
o Avoiding endemic areas especially at times when sandfly are more active.
o Use of pyrethroid impregnated bednets and curtains.
 Destroy/ control by the use of Insecticide spraying in their resting sites
 Application of insecticide/larvicide in their breeding sites
 Elimination and control of rodents in areas where these are the sources of Human
infections

Medical Importance
 Measures against Parasites
o Early treatment of infected indivisuals
o Chemoprophylaxis if recommended
Prevention and Control Measures Against Leishmaniasis

 Early detection by serological diagnosis (VL) and treatment of infected persons,
especially in areas where humans are the only important reservoirs of infection.
 Personal protection from sandfly bites by:
o Using insect repellants, although in hot and humid condition they are of limited use
due to profuse sweating
o Avoiding endemic areas especially at times when sandfly are more active.
o Use of pyrethroid impregnated bednets and curtains.
 Destroy/ control by the use of light traps, sticky paper traps, or residual Insecticide
spraying of houses and farm buildings where this is practical.
 Destruction of stray dogs and infected domestic in areas where dogs are the main
reservoir hosts.
 Elimination and control of rodents in areas where these are the sources of Human
infections
About Parasitic Infection Control

 An improved environmental sanitation can be achieved by:
Physical Measures against Parasites

 Use of clean and safe water supply.
 Use of sufficiently cooked food.
 Protection of food from biological contaminants.
 Efficient and safe human and animal waste disposal.
 Adequate housing in clean and safe surrounding (i.e. environmental hygiene).
 Adequate personal hygiene.
Chemical Measures
 Use of insecticide to eliminate vectors
 Treatment of infected individuals to die out spread of disease.
 Eating cooked food, drinking boiled water are effective measures in preventing most of
the intestinal protozoa infections like Amoebiasis, Giardiasis etc.
 Prevention and control measures against parasitic infections may involve both parasite
and vector control depending on the nature of the life cycle
 Vector control measures is divided into Physical, chemical and biological approaches
 Mention two diseases which can be effectively controlled by drying breeding sites
 What are the preventive measures against malaria?

Medical Importance
References

Medical Importance
Session 17: Preventive Measures against Helminthes -
Cestodes, Trematodes and Nematodes of
Medical Importance
Prerequisites
 None
Learning Tasks
 Explain the preventive measures against roundworms infections
 Explain the preventive measures against tapeworm infections
 Explain the preventive measures against flukes infections
Resources Needed
SESSION OVERVIEW
Learning Tasks
Presentations/ Preventive Measures against Round
2 50 Minutes
Group Discussion Worms Infections
Preventive Measures against Tapeworms
Worms Infections
Presentations/ Preventive Measures against Flukes
4 35 minutes
Brainstorming Infections

Helminthes - Cestodes, Trematodes and
Nematodes of Medical Importance
SESSION CONTENTS
Step 2: Preventive Measures against Round Worms Infections (50 minutes)
ASK students to discuss in group on preventive measures against round worms of medical
importance for 5 minutes
 Preventive measures against Ascariasis and Trichuriasis

o Proper use of latrines
o Avoiding the use of untreated human faeces as fertilizer
o Washing hands after visiting toilet and before eating
o Avoiding the eating of uncooked vegetables, salads and fruits which may be
contaminated with faeces containing viable Ascaris lumbricoides eggs from infected
soil.
o Treating infected individuals as part of a control programme
 Preventive measures against Enterobius vermicularis infection
o Treating all members of a family in which infection has occurred; because
E.verimicularis eggs are infective very soon after being laid ( within 6 hrs) hence an
entire family or community (e.g. in a school or institution) often becomes infected
after handling bedding and which have become contaminated other articles
o Washing of the anal skin each morning soon after waking in order to avoid
autoinfection
o Ironing bedding material and all night dresses
o Health education to the community
 Preventive measures against Hookworm infection and Strongylodiasis
o Proper use of latrines.
o Avoiding the use of untreated human faeces as fertilizer
o Preventing the entry of infective larvae by wearing protective footwear (closed shoes).
o Treat infected individuals as part of control measures
o Provide health education
 Preventive measures against Filariasis caused by (W.bancrofti, L.loa, and O.volvulus)
o Parasite control
 Treating infected individuals with diethylcarbazine (DEC) as part of mass control

 programme in endemic areas to prevent mosquitoes becoming infected
o Vector control
 Studying the ecology and behaviour of local vectors to reduce mosquito numbers
and eradicate breeding sites in polluted and stagnant water by improving the
maintenance of pit latrines and septic tanks and covering of surface water by
polystyrene beads.
 The use of selective weed killer to avoid breeding of Mansonia mosquitoes that
transmit B.malayi.
 Using insecticides known to be effective against local vectors
o Wearing suitable clothing e.g. long trousers and long sleeved shirts.
o Using mosquito nets and especially the one impregnated with pyrethroid.
o Using mosquito wires on windows, making houses mosquito proof.
o Clearing trees around houses in brugian filariasis areas where monkeys are important
reservoir hosts.
 Health education
o Informing people living in endemic areas about the cause, early symptoms detection
and control of lymphatic filariasis
o Community participation is essential in the control of filariasis.
 Prevention and control of loiasis
o Avoid the bites of Chrysops flies (day time feeder’s vectors) by:
 Wearing protective clothing, e.g. long trousers, light coloured clothing also gives
some protection.
 Siting settlements, including adequate water supplies, away from forest areas
o Destroying Chrysops flies by:
 Changing the character of breeding places wherever possible, e.g. clearing
vegetation to allow in sunlight to dry out muddy areas which were previously
heavily shaded.
 Using insecticides as part of a control programme where this is feasible.
o Early diagnosis and Treatmen of infected individuals
 Prevention and control of Onchocerciasis
o Identification of infected communities followed by treatment of communities with
Iverm-ecting.
 This drug has been shown to be a safe and effective microfilaricide, particularly in
preventing the development and progression of Onchocerca eye disease.
 Careful monitoring is required in areas where L.loa also occurs.
 Interruption of transmission by the destruction of Simulium including:
o Selective use of insecticides, e.g. aerial spraying to destroy black fly larvae in rivers
and streams.
o Avoiding simulium bites by:
 Covering as far as possible those parts of the body most at risk.
 Sitting human dwellings away from areas where black flies breed. This often leads
to the abandonment of fertile river valleys.
 Prevention and control of Drancotiasis or Dranculosis
o As a community measure, prevent water sources from becoming infected by:
 Installing a piped water supply.
 Filling in step –wells or replacing them with draw-wells.
 Covering community water supplies and chlorinating when possible.
 Construct wells which do not allow the return of water

 Providing health education including demonstrating Cyclops in community
drinking water supplies.
o Avoiding drinking infected water by:
 Filtering drinking water through nylon or muslin cloth (100 meshes to 1 cm) or
other suitable filter to hold back the larvae.
 Boiling all drinking water.
o Destroying the Cyclops intermediate host by using organophosphorous chemicals or
chlorine in pot chlorinators.
o Encourage infected individuals to do not walking in water to avoid contamination of
the water with D.medinensis larvae
Step 3: Preventive Measures against Tapeworms Infections (20 minutes)
 Preventive Measures Against Taenia saginata infection

o Eating sufficiently cooked beef which may contain cysticerci
o Avoiding contamination of cattle grazing area with human feaces suspected to have
infective eggs of Taenia saginata
o Provission and use of latrines
o Inspecting meat and condemning any found to contain cysticerci.
o Treating infected persons
o Treating infected cattle
o Providing health education and adequate sanitary facilities.
 Preventive Measures Against Taenia solium infection
o Eating sufficiently cooked pork which may contain cysticerci (‘measly’ pork).
o Ensuring pigs to do not have access to human faeces.
o Provission and use of latrines
o Inspecting meat and condemning any found to contain cysticerci.
o Treating infected persons
o Treating infected pigs
 Preventive Measures Against Echinococcus infection
o Inspecting meat of sheep and condemn any found to contain hydatid cysts.
o Treating infected dogs
o Proper handling of dogs to avoid contamination of hands with infective eggs from
infected dog
o Proper disposal of dog feaces
o Proper disposal of carcases from infected sheep
Step 4: Preventive Measures against Flukes Infections (35 minutes)

ASK the student to brainstorm on preventive measures against flukes infections for 2 minutes
WRITTE their responses on the flip chart/ board
Prevention and Control of Urinary and Intestinal Schistosomiasis

 Avoiding contact with water known to contain cercariae by:
o Providing safe water supplies in villages to reduce as much as possible contact with
infested water.
o Constructing footbridges across infested rivers and streams.
o Providing safe recreational bathing sites, especially for children
 Preventing water becoming contaminated with eggs by:
o Health education.
o Build and use latrines
o Proper disposal of excreta
o Providing sanitation facilities.
o Treating infected persons.
 Minimizing the risk of infection from new water conservation and irrigation schemes and
hydroelectric developments by:
o Treating workers when proven infected.
o Siting settlements away from canals, drains, and irrigation channels and providing
latrines and sufficient safe water for domestic use.
o Lining canals with cement and keeping free from silt and vegetation in which snails
can breed.
o Filling in formerly used irrigation ditches with clean soil to bury snail hosts.
o Varying the water levels in the system.
o Using molluscides (chemicals to kill snails) at regular intervals.
 Destroying snails intermediate hosts, mainly by:
o Using molluscides where this is affordable and feasible, and will not harm important
animal and plant life.
o Introducing fish or other predators which will feed on the snails, or introducing other
species of snails which will compete with the unwanted snails in a given habitat.
o Removing vegetation from locally used water places, draining swamps, and other
measures to eradicate snail habitats.
o Taking environmental measures to prevent seasonal flooding which results in an
increase in snail numbers and transmission.
 Treating water supplies by:
o Using a chlorine disinfectant.
o Storing water 48 hours after which time any cercariae in the water will be dead.
o Using filter systems at water inputs to prevent cercariae from entering.
Preventive Measures against Fasciola Hepatica Infection (Fasciolopsiasis)

 Treating water plants (vegetation) which may be infected using boiling water or cooking

them before eating or teeth –peeling.
 Construct and proper use of latrines.
 Avoid the use of untreated human as fertilizer in cultivation ponds.
 Identifying and destroying snail hosts and their habitats.
 Treat infected individuals (within a control programme).
 Provide health education.
 Prevention and control of many parasitic infection includes Physical and chemical
measures
 Physical measures do not involve use of any chemical substances to interfere the
biology of the parasite
 Prevention and control of vector-borne diseases will need measures against the
vector by:
o Interfering their ecology
o Applying larvicides and insecticides
 An improved environmental sanitation can be achieved by :
o Use of clean and safe water supply.
o Protection of food from biological contaminants.
o Efficient and safe human and animal waste disposal.
 Adequate housing in clean and safe surrounding (i.e. environmental hygiene).
 Adequate personal hygiene.
o Use of insecticide
o Provision of health education in order to create awareness about the disease and
ways to prevent and control infection.
 Mention two approaches used to control vector-borne diseases

 How Schistosoma infections can be prevented?
 Mention three water –borne diseases very common in Tanzania

References

Session 18 : Common Vectors of Medical Importance -
Arthropods
Prerequisites
 None
Learning Tasks
 Identify common Arthropods transmitting Diseases/Infections to man
 Explain Mosquitoes transmitting diseases to man
 Describe the morphological characteristics of mosquitoes
 Explain the biology (Life cycles) of Anopheles, Aedes, Culex and Mansonia species
 Explain control measures of mosquitoes
Resources Needed
 Handout 18.1: Life Cycle of Mosquitoes
SESSION OVERVIEW
Learning Tasks
Common Arthropods Transmitting
Diseases/Infections
Presentation/
3 20 minutes Mosquitoes Transmitting Diseases to Man
Buzzing
Mosquitoes
5 30 minutes Presentation Biology of Mosquitoes
Presentation/
6 20 minutes Control Measures against Mosquitoes
Group Discussion

167
NTA Level 6, Semester 2 Session 18: Common Vectors of Medical
Importance - Arthropods
SESSION CONTENTS
Step 2: Common Arthropods of Medical Importance (10 minutes)

 Mosquitoes ( Anopheeles, Aedes, Culex and Mansonia sspecies)
 Tsetse fly ( Glossina species)
 Black fly ( Simulium species)
 Housefly ( Muscica species)
 Ticks ( Hard and Soft ticks)
 Fleas ( Xenopsylla, Pulex and Tunga species)
 Lice ( Pediculus and Pthirus species)
 Cockroach ( Periplaneta and Blattella species)
Blood Sucking Insects

 These insects introduce microorganisms into human skin
 They obtain parasite organisms in a blood meal from infected person and later deposit
them a vomit drop in the puncture wound (plague), or in faecal pellets near the puncture
wound (typhus) made in the skin off susceptible person
 Examples;
o Mosquitoes, sandfly, Tsetsefly, Blackfly, flea, lice, bugs, and ticks
Non-Blood Sucking Insects

 May deposit a vomit drop containing pathogens on human food or drink, e.g. Typhoid
infection of man
 Some non-blood sucking flies may ingest filth during their larval (i.e maggot) stage and
their associated pathogens may be retained in their intestine during the period of pupation,
later to be deposited by the adult fly on human food or human tissues
 Examples;
o Housefly and cockroache

168
Step 3: Mosquitoes Transmitting Diseases to Man and the Diseases
Transmitted (20 minutes)
ASK the student to pair up and buzz on mosquitoes transmitting diseases to man for 2
minutes
 Anophilinae (Anophilines)
o Include all Anopheles species
 Culicinae (Culicines)
o Include Culex, Aedes and Mansonia
 Anopheles species transmit
o Malaria – caused by Plasmodium species
o Bancroftian filariasis caused by Wuchereria bancrofti
o Brugian filariasis caused by Brugia species
o Arboviruses caused by viruses
 Culex species transmit
 Aedes species transmit
o Yellow fever caused by virus
o Dangue caused by virus
o West Nile virus
 Mansonia species transmit
Step 4: Morphological Characteristics of Anopheles, Aedes and Culex

Species (25 minutes)
 Anopheles Mosquitoes
o Eggs
 Laid singly on the water surface
 Typically boat-shaped laterally having a pair of air-filled sacs called floats
o Larvae
 Lacks siphon
 Lies parallel to the water surface

169
 Are surface feeders and so spend most of their time at the water surface
o Pupae
 Have respiratory trumpet which is short and broad distally thus appearing conical
 The most reliable character for identifying Anophiline pupae is the presence of
short, peg-like spines situated laterally near the distal margins of abdominal
segments 2-7 or 3-7.
o Adult
 Adult Anopheles usually rest with their body at an angle to the surface, that is
with the proboscis and abdomen in a straight line, or head down bottom up
 The wings have dark and pale( usually white or yellowish) scales arranged in
blocks
 Female mosquitoes have antennae which are pilose whereas males have antennae
which are plumose
 The palps of females are as long as the proboscis and usually lie closely alongside
it
 In male Anopheles the palps are also about as long as the proboscis but are
distinctly swollen at the ends and are said to be clubbed
 The middle lobe of the salivary glands is shorter to the other two
 Culicine mosquitoes ( Aedes and Culex species )
o Eggs
 Never have floats
 Laid either singly (e.g Aedes) or in thee form of egg rafts ( e.g Culex) that float on
the water surface, or aree deposited as sticky masses glued to the underside of
floating vegetation ( e.g Mansonia)
o Larvae
 All culicine larva posses a siphon, which may be long or short
 They hang upside down at an angle from the waater surface when they are getting
air.
 ( are called bottom feeders)
 Lies parallel to the water surface
 Are surface feeders and so spend most of their time at the water surface
o Pupae
 The length of respiratory trumpet in culicines pupae is variable, but they are
generally longer, and more cylindrical
o Adult
 Adult culicines rest with the thorax and abdomen more or less parallel to the
surface
 The scales covering the wing veins are commonly uniformly brown or black
 Female mosquitoes like in Anopheles have antennae which are pilose whereas
males have antennae which are plumose
 The palps of females are shorter than the proboscis and usually lie closely
alongside it
 In males the palps are about as long as the proboscis but are swollen distally and
hence do not appear clubbed
 The middle lobe of the salivary glands is as long as the other two
Figure 18.1: Resting Positions of Anopheline and Culicine Mosquitoes

170
Source:
Figure 18.2: Chart of the Principal Characters of the Stages in the Life Cycle that Distinguish
Anopheline fro Culicine Mosquitoes.
Step 5: Life cycles of mosquitoes (35 minutes)

Source: (Lab Space, n.d.)
Step 5: Life cycle (Biology) of Anopheles, Aedes, Culex and Mansonia

species (30 minutes)
 Most mosquitoes mate shortly after emergence from the pupa. Sperm fro a male enter the
spermotherca of a female ( pocket-like structure which receive and store sperms) and
usually serves to fertilize all eggs formed during her life time, thus only one mating and
insemination per female is required.
 Egg biology
o Depending on the species, female mosquitoes lay eggs. In Anopheles the eggs are laid
singly and float on the water, whereas those of Culex are laid vertically in several
rows held together by surface tension to form an egg raft which floats on the water.
o Mansonia species lay their eggs in a sticky mass that is glued to the underside of
floating plants.
o Aedes species do not lay eggs ion the water surface. Instead they deposit them just

171
above the water linen on damp substrates, such as mudd and leaf litter, or on the
inside walls of tree holes and clay water storage pots.
o Eggs of Aedes can withstand desiccation and remain dry for months or even years but
still remain viable and hatch when soaked in water
 Larval biology
o A larva hatches from the egg after about 1 - 2 days and generally floats parallel or
under the water surface, since it needs to breathe.
o It feeds by taking up foods from the water; the larvae feed on algae, bacteria, and
forms of particulate matter.
o When disturbed, the larva quickly swims towards the bottom but soon needs to return
to the surface to breath
o There are four larval stages (instars)
o The larva remains in the fourth instar stage for 3 or 4 more days before changing to a
pupa
o The total time spent in the larval stage is generally 8-10 days at normal tropical water
temperatures. At lower temperatures, the aquatic stages take longer to develop
 Pupal biology
o The pupa is a stage during which a major transformation takes place, from living in
water to becoming a flying adult mosquito, thee pupa does not feed
o The pupa stage lasts for 2-3 days after which the skin of the pupa splits,then the adult
mosquito emerges and rests temporarily on the water’s surface until is able to fly.
 Adult biology
o Mating takes place soon after the adult emerges from the pupa.
o The females usually mates only once because she receive sufficient sperm from single
mating for all subsequent egg batches
o Normally the female takes her first blood meal only after mating, but sometimes the
first blood meal can be taken by young virgin females
o The first batch of eggs develops after one or two blood meals (depending on the
species), while successful batches usually requires only one blood meal.

172
Figure 18.3: Life Cycle of Anopheles Mosquito
Source: (Lab Space, n.d.)
 Feeding habits
o Some mosquitoes enter houses to bite and are described as being endophagic; others
bite mostly outside and are called exophagic
o Many Anopheles species feed on both humans and animals; they differ, however, in
the degree to which they prefer one over the other.
o Some mosquitoes prefer to take blood from humans rather than animals and are
described as being anthropophagic while others only take animal blood and are known
as zoophagic
o Clearly, those who prefer to take human blood are the most dangerous as they are
more likely to transmit diseases from man to man
 Resting habits
o After a mosquito has taken a blood meal, she usually rest for a short period
o Mosquitoes that enter a house usually rest on a wall, under furniture or on clothes
hanging in the house after they bite and are said to be endophilic.
o Most mosquitoes that bite outside usually rest on plants, in holes, in trees or on the
ground or in other cool dark places and are called exophilic

173
Step 6: Control Measures Against Mosquitoes (20 minutes)
ASK students to discuss on control measures against mosquitoes for 5 minutes
 Chemical measures against Adult mosquitoes

o Organochlorides (OCS) e.g. DDT( used twice yearly)
o Organophosphates (ops) e.g. malathion (used every 3 months)
o Fenitrothion
o Chlopyriphos
o Pyrethroids; carbamates.
 Chemical measures against larvae ( larvicides)
o Organophosphates
o Pyrethroids: Permethrin, Deltamethrin
o Insect Growth Regulators(IGRS) e.g. Methopren,Diflubenzuron
o Biocides: Bacillus thuringiensis, Bacillus Sphaericus.
o Use of herbicides: Diquat or Pentachlorophenol
 Physical Measures against larval stages
o Filling in, drain; remove, destroy, burry or cover containers; ponds, pot-holes
and drainage ditches.
o Flooding or flushing of breeding places
o Improve Sanitation systems
o Removal of aquatic vegetation
 Biological control
o Stocking particular fish species that feed on mosquito larva into the water
body Such as Gambusia, Tilapia and Northobranchius
o Fungi
o Nematodes
 There are two major subfamilies of mosquitoe: Anophiline and Culinae

 Mosquitoes differ in their morphological characteristics as well as bilogy characters
 Mosquitoes can be conveniently ssexed by examination of their antennae and palps
 Mosquitoes have four different stages in their life cycle: the egg, larva, pupa and adult
 The time taken for the various stages to develop depends on temperature and nutritional
factors in their environment, Development is shorter at higher temperatures

174
 Mention three genera found under the subfamily culicinae
 How female Anophiline do differs from female culicine?
 How do larval stage of Anopheles species differs from that of Aedes species
References
Lab Space. (n.d.). Distinguishing Anopheles mosquitoes from other types. Retrieved from
http://labspace.open.ac.uk/
Lab Space. (n.d.). Life cycle of the mosquito vector. Retrieved from
http://labspace.open.ac.uk/

175
Tsetsefly and Blackfly
Prerequisites
 None
Learning Tasks
 Describe the morphological characteristics of Tsetseflies (Glossina species)
 Explain the biology (Life cycle) of Glossina species
 Describe the morphological characteristics Blackfly (Simulium species)
 Explain the biology (Life cycles) of Simulim species
 Explain control measures against Glossina and Simulium species
Resources Needed
SESSION OVERVIEW

Learning Tasks
Tsetseflies (Glossina Species)
Presentation/
3 25 minutes Biology (Life Cycle) of Glossina Species
Group Discussion
Control Measures Against Glossina
Species
Morphological Characteristics Blackfly
(Simulium species)
6 25 minutes Presentation Biology (Life cycles) of Simulim Species
Control Measures against Simulium
Species

176
Importance - Tsetsefly and Blackfly
SESSION CONTENTS
Step 2: Morphological Characteristics of Tsetseflies (Glossina Species)

(15 minutes)
 Adult
o Yellowish or brown-black robust flies
o A rigid forward-projecting proboscis
o A closed cell between wing veins 4 and 5 which, with little imagination, looks like an
upside –down hatchet ( i.e axe, cleaver or chopper) often called Hatchet cell
o At rest the tsetse flies wings lie over the abdomen like the closed blades of a pair of
scissors
o The proboscis is relatively large and has a bulbous base
Figure 19.1 Structures of Larva, Pupa and Adult Tsetse Flies
Figure 19.2: Structures of Adult Tsetse Flies
Scissor-like structure

177
 Larva
o Creamy white composed of 12 visible segments, the last of which bears a pair of
prominent dark protuberances called Polypneustic lobes
o Through which it breathes( respiratory structures)
o By which actively burrows below the surface soil
 Pupa
o Brown or dark brown barrel-shaped
o Measures about 5-8 mm
o Like the larva has the distinct polypneustic lobe
Step 3: Biology: Life Cycle of Glossina Species (25 minutes)
ASK students to discuss on life cycle of Glossina species for 5 minutes
 Egg to Larval development

o Tsetse-flies have a form of reproduction called adenotrophic viviparity where the egg
hatches within the female and the larva develops in the female by feeding on food
from modified accessory glands.
o During her life-span a female can theoretically give birth to only a maximum of 8-10
offspring (in reality much lower), so tsetse-flies are rather like human beings in that
they make a large investment per offspring so that juvenile mortality is low.
o However, this means that they can't produce many offspring.
o Eggs develop sequentially in the female, alternating between the four ovarioles, after
the female is about 9 days old, the first egg passes into the uterus from one of the two
ovarioles in the right ovary.
o After 9-10 days, there is the second ovulation from one of the two ovarioles in the left
ovary, and so on. In the uterus the egg is fertilized by a sperm from the spermatheca
(gained during earlier mating with a male).
o After 3.5 days of development in the egg, the 1st larva breaks out of the egg case.
 Larval-pupal to adult development
o The freshly-laid free-living larva is fully fed, and after expelling the waste-products it
gained while developing in its mother, it burrows into the soil by the aid of
Polypneustic lobes where its skin hardens and blackens into a puparium and within
the puparium, and pupation and metamorphosis take place.
o The puparial period can range from 20 days (at 30ºC) - 47 days (at 20ºC). After
completion of puparial development the fly emerges from the puparium, forces its
way to the surface of the ground and flies away.

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o The entire life cycle from egg to adult usually takes about 30 days.
Step 4: Control Measures against Glossina Species (20 minutes)
 Removal of vegetation.
o In savanna areas, larviposition occurs in shaded places, so one control method is to
remove trees and bushes so one is just left with grass.
o This method is labour intensive and requires that there be reslashing of vegetation on
an annual basis.
o However, removal of vegetation for fire wood and urbanisation has sometimes
achieved the same effect.
 Trapping
o A number of different traps have been developed for capturing tsetse-flies in large
numbers.
o Traps are particularly effective in reducing Glossina populations that are isolated on
islands or which occur in a linear riverine habitat.
o Insecticide-impregnated cloth targets that are attractive to the flies are also used.
o Host odour attractants are used on these traps. The advantage of using traps is that
there is no contamination of the environment with insecticide
 Spraying of insecticides.
o Spraying of residual insecticides that persist in the environment for at least 2-3
months; and
o Spraying of non-residual aerosols that kill adult tsetse at the time of spraying but
which must be repeated at regular intervals in order to kill newly emerged adults.
 Both ground and aerial application methods have been used.
 Aerial methods are expensive.
 However, consider the detrimental environmental effects of using these residual
insecticides.
 Ground spraying of residual insecticides can be a feasible and economical control
strategy if it is applied to selected sites where there are concentrations of tsetse-
flies.
 Sterile insect technique (SIT)
o This method involves breeding up thousands of male Glossina which are sterilised
using radiation and then released at regular intervals, thus swamping the population
with males that are unable to fertilise females successfully.

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Step 5: Morphological Characteristics Simulium species ( 10 minutes)
 Adult
o Quite small, about 2 – 5 mm long, relatively stout bodied
o When viewed from the side, have a rather humped thorax
o As their vernacular name indicates they are usually black in colour
o Blackfliess have compound eyes which are dichoptic (separated) in females whereas
in males are holloptic ( the eyes touch each other )
o Wings are characteristically short and broad and lack both scales and prominent hairs
o The abdomen is short and squat, and covered with inconspicuous closely appressed
fine hairs
o Black-fliess are easily sexed by looking to see whether their eyes are dichoptic
(females) or holoptic ( males)
Figure 19.3 Adult Simulium Species
Source: (Canku Ota, 2001)
 Larva
o The larvae are cylinder-like with hairy mouth parts posteriorly having finger-like anal
gills.
 Pupa
o The pupa is enclosed in a pocket-like cocoon; the posterior part has hooklets and long
respiratory filaments attached
Step 6: Biology and Life Cycles of Simulim Species (25 minutes)
ASK students to discuss on life cycle of Simulim species for 5 minutes
 Black flies breed by preference in rapidly flowing streams, the females attach their eggs

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to rocks at or beneath the water surface, others prefer to breed in quite streams and
ditches attaching the eggs to sub-merged tips of grasses rooted along the margin, and on
rocks by a gelatinous fluid.
 In 3-5 days a yellowish-green, cylindrical larva with hairy mouthparts and finger-like anal
gills emerges and attaches itself in an upright position to rocks, or aquatic vegetation, and
others (S. damnosum) to crabs.
 The larva molts seven times in 13 days before spinning a cocoon with an open pocket.
 The adult emerges in about 3 days, female lives only a few weeks; the adult female black
fly usually remains close to the breeding area except immediately after rain when they
may be found as much as 1000 yards away
Figure 19.4: Life Cycle of Simulium Species
Source: (Canku Ota, 2001)

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Step 7: Control Measures against Simulim species (10 minutes)
 Black flies are difficulty to control, but chemical spray in their bushy areas is helpful:
o Insecticide application (with 20 mg DDT or 4 mg BHC per square meter)
o larvicide application( DDT is also used as Larvicides for steams by drip method)
 Mechanical destruction of breeding places is effective but expensive.
 Adult Tsetse flies are principally characterized by their wings which have hatchet cell
feature between veins 4 and 5
 Glossina species are known to be larviporous (reproduce by giving out grown larva) one
at a time
 Simulium species breed in flowing streams
 What is a unique feature of the immature stage of Glossina species

 How do the body of adult Simulium differs from that of Glossina species
 What are the medical significance of Glossina and Simulium species
References
Canku Ota. (2001). Black flies (Simuliidae) Retrieved from http://www.turtletrack.org
Wikipedia. (2013). Tsetse fly. Retrieved from http://www.wikipedia.org

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House Flies, Cockroaches and Lice
Prerequisites
 None
Learning Tasks
 Describe the morphological characteristics of House flies (Musca species)
 Explain the biology (Life cycle) of Musca domestica
 Explain control measures against Musca domestica
 Describe the morphological characteristics Cockroaches ( Periplaneta species)
 Explain the biology ( Life cycles) of Cockroaches
 Explain control measures against Cockroaches
 Describe the morphological characteristics Lice ( Pediculu and Pthirus species)
 Explain the biology ( Life cycles) of Pediculu and Pthirus species
 Explain control measures against Lice
Resources Needed

NTA Level 6, Semester 2 183 Session 20: Common Vectors of Medical
Importance - House flies, Cockroaches
and Lice
SESSION OVERVIEW
Learning Tasks
Morphological Characteristics of House
Flies (Musca Species)
Presentation/
3 10 minutes Biology (Life Cycle) of Musca Species
Buzzing
Control Measures against Musca
Domestica
Presentation/ Morphological Characteristics
5 10 minutes
Buzzing Cockroaches
6 10 minutes Presentation Biology; Life Cycles of Cockroaches
Presentation/
7 10 minutes Control Measures against Cocroaches
Brainstorming
Morphological Characteristics Lice;
Pediculus and Pthirus Species
Biology; Life Cycles of Pediculus and
Pthirus Species
Presentation/
10 15 minutes Control Measures against Lice
Buzzing
SESSION CONTENTS
Step 2: Morphological Characteristics of Musca Domestica (10 minutes)
 Adult
o Are medium-sized non-metallic flies
o Measures about 6-9 mm long,
o Vary in colour from light to dark grey with some darker markings
o They have four broadish black longitudinal stripes on the dorsal surface of the thorax
o Each antenna consists of three segments, the distal and largest of which is cylindrical
and has a prominent hair, called an arista, which has hair on both sides
o The mouth parts(proboscis) are specially adapted for sucking up fluid or semi-fluid
food

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o The wings have vein 4 bending up sharply to join the costa (thick vein along the front
edge of the wing) close to vein 3; this is an important identification character which
helps distinguish Musca species from other rather similar flies
Figure 20.1: Head and Thorax of Musca Domestica showing 4 Parallel Strip on the Dorsum
of Thorax
Four black longitudinal stripes
Source: (Ebeling, 2002)
 Larva (Maggot)
o Have small head followed by an 11-segmented cylindrical body
o At the pointed head end a pair of blackish small curved mouthhooks can be seen
beneath the integument
o At the posterior end of the body there is a pair of conspicuous spiracles shaped like a
letter D
Figure 20.2: Four Developmental Stages of Musca Species (Egg, Larva, Pupa and Adult)
Egg Larva Adult

Pupa
Source: www.google.com
 Egg
o Creamy-white
o Measures about 1-1.2 mm long
o Distinctly concave dorsally giving them a banana- shaped appearance
Step 3: Biology (Life cycle) of Musca Domestica (10 minutes)

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ASK students to pair up and buzz on biology and life cycle of Musca species for 2 minutes
 Female Musca domestica lays eggs in decomposing material such as animal manure,
Poultry dung, urine-contaminated bedding, carcases, garbage and waste food from
kitchens. The fly may lay eggs 5-10 times in her life times ( 75 -150 eggs/ batch)
 The eggs hatch after only 10-16 hours, but this period is extended in cool weather.Eggs
can not withstand desiccation and die if they dry out. Larvae feed on liquids from
decomposing organic material, there are three larva instars.
 Prior to pupation third-instar larvae often move to drier ground, pupation may also occur
in the dry soil underneath larval habitats
 The puparial stage lasts about 3-5 days in a warm weather but longer during cooler
periods
 The adult stage escapes from its puparial case by pushing off its anterior end and crawling
out, and after a short period flies away.
 Some 36 hours after having emerged from the pupa, the female is receptive for mating;
the male mounts her from behind to inject sperm .
 Normally the female mates only once, storing the sperm to use it repeatedly for several
sets of eggs.
 Males are territorial: they will defend a certain territory against other males and will
attempt to mount any females that enter that territory.
Step 4: Control Measures against Muscaa Domestica (10 minutes)
 Sanitation or cultural control

o Food and materials on which the flies can lay eggs must be removed, destroyed as a
breeding medium, or isolated from the egg-laying adult
o Removal of wet manure at least twice a week is necessary to break the breeding cycle.
o Spilled feed should not be allowed to accumulate but should be cleaned up two times
a week.
 Traps
o House flies are attracted to white surfaces and to bits that give off odors.
o Indoors, ultraviolet light traps collect the flies inside an inverted cone or kill them
with an electrocuting grid
o Openings to buildings should be tightly screened with standard window screen,
thereby denying entrance to flies.
o Traps can be baited with molasses, sugar, fruit or meat, and often are used in
combination with a device that captures the attracted flies.
 Biological control
o Natural biological suppression of the house fly results primarily from the actions of

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certain chalcidoid wasps (Hymenoptera: Pteromalidae), of which many species have
been associated with house fly around the world.
 Chemical control
o Residual wall sprays can be applied where the flies congregate.
o Outdoors, the control of flies includes the use of boric acid in the bottom of
dumpsters, treatment of vertical walls adjacent to dumpsters and other breeding sites
with microencapsulated or wettable powder formulation, and the use of fly baits near
adult feeding sources.
o Manure can also be treated with an insecticide, though this method is highly
discouraged as it interferes with biological control of flies, often resulting in a
rebound of the fly population.
o More commonly, insecticides (especially insect growth regulators) can be fed to
livestock, and residual insecticide in the manure inhibits fly breeding.
Step 5: Morphological Characteristics Cockroaches (10 minutes)
ASK students to pair up and buzz on morphological characteristics of cockroaches for 2

minutes
 Adult
o They are large, swift running, terrestrial insects
o Have long antennae,
o Possess narrow, hardened forewings, membranous hind wings, and three pairs of legs
approximately equal in length.
o Flattened dorso-ventrally with a smooth, shiny and tough integument
o Has a pair of long prominent filiform antennae arise from the front of the head
between the eyes
o The mouth parts are modified for chewing. Gnawing and scraping; they can not suck
blood
o The cockroach fore-wings ( tegmina), are thick and leathery
o The sizes range from 1.0 cm to 9 cm depending on the species.
o Species from North America (Blattella orientalis) a dark-brown insect about 2.5cm in
length, and large reddish-brown (Periplaneta americana, about 3.8 cm
o German Cockroaches (Blattella germanica), about 1.3cm in length
Step 6: Biology (Life Cycles) of Cockroaches (10 minutes)
 Cockroaches deposit eggs in a leathery whitish-capsule when laid, which may be often
seen protruding from the body at the posterior end of the female, the capsule may be
carried for a day.

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 The female cockroach glues the capsule to some objects or drops it; a single capsule may
contain 20 – 30 eggs (Blattela).
 Eggs hatch into tiny nymphs, the developed nymph closely resembles the adult except
that lacks wings, nymph pass through 12 moults before becoming mature.
 Cockroaches reach maturity stage within a period of 10 – 20 months, depending on
species and environmental conditions
 The life span of the adult is slightly more than 40 days.
 Adult cockroaches have scent glands which secrete an oily liquid responsible for the
characteristic “roachy odour”
Step 7: Control Measures Against Cockroaches (10 minutes)
ASK the student to brainstorm on control measures against cocroaches for 2 minutes
 Cleanliness in kitchens and the protection of stored foods are the primary essentials
 Repair of cracks and tight-fitting plumbing installations in the walls are preventive
measures
 Small boxes baited with chlorpyrifos, an organophosphate (RAID), that can be placed in
strategic locations about the house are currently popular.
 Spray of effective insecticides; dusts containing insecticides are usually more effective
than sprays and are spread in cracks and across lines of traffic of the insects.
Step 8: Morphological Characteristics Pediculus and Pthirus Species (10

minutes)
 Pediculus capitis (head louse) and Pediculus humanus /corporis (body louse), and
o Morphologically the body and head lice are virtually indistinguishable
 Adult are small, pale or greyish wingless insects
 Have soft but rather leathery integument
 Dorso-ventrally flattened
 Males measure about 2-3 mm and female about 3-4 mm long
 The head has a pair of small black eyes and a pair of short 5-segmented antennae
 The three thoracic segments are fused together and the legs are stout and well
developed
 Mouthparts of the louse differ from those of most blood-sucking insects in that
they do not form a projecting proboscis , but consist of a sucking snout-like
projection called the haustellum which penetrates the host’s skin when feeding
 Tip of the abdomen in males is rounded whereas in females it is bifurcated and
used to grip fibres off clothing during egg laying

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Figure 20.3: Adult Pediculus Species (Right) and Nit/Egg (Left)
 Crab louse/P. Pubis

o is distinguished by its small size 0.8 to 1.2 mm with 6 segments,
o Has rectangular head
o With short, indistinctly segmented abdomen , and large , heavy claws
Figure 20.4: Phthirus Pubis Adult Female, Phthirus Pubis Adult Male
Source: (CDC, 2009)
 Egg
o Commonly called nit is oval, white , aabout 1 mm long
o Has a distinct operculum ( cap) containing numerous small perforation used for
breathing
 Nymph
o Resembles a small adult
Step 9: Biology (Life Cycles) of Pediculus and Pthirus Species (20 minutes)
Figure 20.5: Life Cycle of the head louse

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 Pubic lice (Phthirus pubis) have three stages: egg, nymph and adult. Eggs (nits) are laid
on a hair shaft.
 Females will lay approximately 30 eggs during their 3-4 week life span.
 Eggs hatch after about a week and become nymphs, which look like smaller versions of
the adults.
 The nymphs undergo three molts (, ,) before becoming adults .
 Adults are 1.5-2.0 mm long and flattened.
 They are much broader in comparison to head and body lice. Adults are found only on
the human host and require human blood to survive.
 If adults are forced off the host, they will die within 24-48 hours without a blood feeding.
 Pubic lice are transmitted from person to person most-commonly via sexual contact,
although fomites (bedding, clothing) may play a minor role in their transmission

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Figure 20.6: Transmission of Pediculosis

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Source: (CDC, 2009)

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Figure 20.7: Life Cycle of Pthirus Species
Source: (CDC, 2009)
Step 10: Control Measures Against Lice (15 minutes)
ASK the student to pair up and buzz on control measures against lice for 2 minutes
 Head louse
o Treat all infested persons
o Check all family members, classmates and playmates.
o Anyone who is infested should receive proper treatment.
o Remove nits from hair
o Mechanical removal of louse eggs helps reduce the number of lice that might hatch on
the scalp.

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o Since children who are declared "nit-free" by a doctor or school nurse can return to
class sooner, removing nits has a positive impact on their morale and lessens
disruption to their school and social activities.
o Special combs are provided with the pediculicides and the instructions for their use
must be followed explicitly.
o Items such as brushes and combs should be washed thoroughly in hot water (at least
130o F) for 5-10 minutes.
o Washable clothing, hats, head bands, bed linen and other personal items should be
washed in hot soapy water, and then dried in a clothes drier for at least 20-30 minutes.
 Body louse
o All bedding and clothing of infested people should be washed and dried at a high
temperature (150°F or higher).
o Pillows or other nonwashable items should be placed in plastic bags and placed in a
freezer for several days.
o It is not necessary to clean other areas of schools or homes.
o Control should concentrate on treating infested individuals.
o Never treat furniture, bedding, floor or walls inside a school or home with insecticide
to control head lice.
o There are several insecticidal products available to control head lice.
o Insecticides containing permethrin and synergized pyrethrins are common in
shampoos and lotions than can be purchased over-the-counter.
 House flies are important mechanical vectors of several pathogens to humans: Helminths,
Protozoa, and Viruses
 Cockroaches are insects which undergo the hemimetabolous type of metamorphosis (their
developmental stages involve egg capsule, nymph and adult)
 Lice are insects which infest the body of man in the clothes, on the head and in pubic
hairs
 They are very sensitive to changes in temperature, they quickly abandon a dead person to
seek new hosts
 How do houseflies differ from Tsetse flies

 Mention the two medical importance of Cockroaches
 How do Pediculus species differ from Pthirus species

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References
Ebeling, W. (2002). Urban entomology. Retrieved from http://www.entomology.ucr.edu

and Lice
Session 21: Common Vectors of Medical Importance -
Fleas and Ticks
Prerequisites
 None
Learning Tasks
 Describe the morphological characteristics of Fleas; Xenopsylla, Pulex and Tunga
species
 Explain the biology (life cycle) of Fleas
 Explan control measures against Fleas
 Describe the morphological characteristics Ticks (Hard and Soft ticks)
 Explain the biology (life cycles) of Ticks
 Explan control measures against Ticks
Resources Needed
 Handout 21.1: Medical Importance of Ticks
SESSION OVERVIEW
Learning Tasks
The morphological Characteristics of Fleas;
Xenopsylla, Pulex and Tunga species
Presentation/ The Biology (Life Cycle) of Fleas;
3 30 minutes
Buzzing Xenopsylla, Pulex and Tunga species
4 10 minutes Presentation Control Measures Against Fleas
The Morphological Characteristics Ticks
(Hard and Soft Ticks)
Presentation/ The Biology (Life Cycles) of Ticks and
6 25 minutes
Group Discussion their Medical Significnce
7 10 minutes Presentation Control Measures Against Ticks
SESSION CONTENTS

196
Importance - Fleas and Ticks
Step 2: Morphological Characteristics of Fleas (20 minutes)
 Adult
o Adult flea bodies are identified by their piercing-sucking mouthparts
o Adults are small (1-4mm) and more or less oval.
o The insects are compressed laterally varying in colour light to dark brown
o They are wingless, consisting of three pairs of powerful and well developed legs, the
hind legs are specialized for jumping
o The legs and a large part of the body are covered with bristles and small spines.
o The head is roughly triangular in shape, bears a pair of conspicuous black eyes, a few
species are eyeless e.g. Leptopsylla species.
o The mouthparts point down words,
o In some species a row of coarse, well developed and tooth-like spines (Genal
comb/ctenidium) is present along the bottom margin of the head capsule.
o Some genera of fleas lack both the Geneal and Pronotal combs thus “comb less flea”
o While in other genera both combs are present, these are also referred to as complex
fleas
o In female fleas the tip of the abdomenis more rounded than in males
Figure 21.1: Anterior Parts of Different Genera of Fleas Showing Presence and Absence of
Combs
Comb
Source: www.google.com
 Larva
o Has a small brownish head with a pair of very small antennae followed by 13 brown,
ddistinct and more or similar segments
o The last segment ends in a pair of finger-like ventral process termed anal struts
o Measures 4-10 mm long
 Eggs

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o Are very small
o They are oval, white or yellowish
o Measure about 0.1-0.5 mm long
Session 3: The Biology (Life Cycle) of Fleas (30 minutes)
Fig. 21.2: General Life Cycle of Fleas
Source: (CDC, 2009)
 Both sexes take blood-meals and are therefore equally important as disease vectors
(Xenopsylla and Pulex species)
 A female flea leaves is host and deposits her eggs in debris which accumulates in the
host’s dwelling place, e.g rodent burrows.
 Fleas that bite humans or their domestic pets, such as cats’ fleas, lay their eggs while they
are still on the host and because they are not sticky they soon fall off the host and are
mainly found in areas where hosts, such as cats or dogs, spend the most time.
 Eggs usually hatch after 2-5 days but this depends on the species of the flea, temperature
and humidity
 A minute legless larva emerges from the egg, Larvae are very active, they avoid light, and
shelter in cracks and crevices and amongst debris on floors of houses, or in nests or
animal burrows.
 Occasionally, however, larvae are found on people who wear dirt-laden clothes, and
sometimes in beds
 Larvae feed on almost any organic debris but to successfully achieve adult hood it seems
that larvae of many species must consume partly digested blood evacuated from the
alimentary canal of adult flea (i.e. adult flea feaces).

198
 At the end of larval period the larva spines a whitish cocoon from silk produced by its
salivary glands
 Being sticky it becomes covered with fine particles of dust, debris and sand picked up
from the floor of the host’s home.
 Adults are ready to emerge from the pupa (cocoon) after about 5-14 days, although this
period depends on the ambient temperature and also a stimulus (i.e. Vibration generated
by the host’s movement within its home, burrow or nest and some times CO2 emitted by
the host and seasonal increase in humidity)
 The life-cycle from egg to adult emergence may be as short as 2-3weeks for certain
species under optimum conditions.
Life Cycle of Tunga Penertans

 Eggs are dropped into the floor of houses or on the ground outside; they hatch within
about 3-4days, and the larvae prefer to inhabit dirty and dusty floors or dry sand soils.
 Under favourable conditions the larvae transform into pupa within about 10-14days and
the pupal stage lasts about 5-14days
 Newly emerged adults are very agile and jump and grow about on the ground until they
locate a suitable host, which is usually a man or pig.In people habitually sitting on the
ground e.g., beggars or infants, the buttocks may be infected, others are leprosy patients.
 Both sexes feed on blood, but the male soon leaves the host after taking the blood meal.
 The female after being fertilized burrows into the skin where it is soft e.g between the
toes or under toe-nails, the sole etc.
 Burrowing into the skin is accomplished by the fleas’ sharp and well developed
mouthparts.
 The entire flea with the exception of the tip of the abdomen bearing the anus, genital
opening and large respiratory spiracles, becomes completely buried in the host’s skin.
 While the blood-meal is being digested, the abdomen distends to a size of about 6 mm
both male and female attain a size of small pea.
 This expansion takes about 8-10days, towards the end of this period of abdominal
enlargement the ovaries are composed of thousands of minute eggs,
 The eggs are then passed out of the female genital opening, most of them fall to the
graced and hatch after 3-4days.
 The area surrounding the embedded flea becomes itchy and inflamed and secondary
bacterial infection may become established, resulting in ulceration and accumulation of
pus.
 When the female dies it remains embedded within the host, this frequently causes
inflammation and lead to secondary bacterial infection.
Step 4: Control Measures Against Fleas (10 minutes)
 Environmental control
o Spraying of rodent runways, harbourage areas, floors, and other areas with one
of the following: (0.5-1% Permethrin, 2-5% Carbaryl (Sevin), 2-5%
Malathion, and 1% HCH or 1-2% Diaznon.
 Chemical Control
o The following are used: 5% DDT, 1% HCH, or 0.5% Dieldrin.
o Also insecticides dust can be blown into rodent burrows.
o However, in areas situations where fleas are resistant to Organochlorides ( DDT,

199
HCH, and Dieldrin) organophosphate and carbamate insecticides such as 2%
Diaznon, 2% Fenthion(Baytex), 5% Malathion, 2% Fentrothion (Sumithion) or 3-5%
Carbaryl (Sevin) can be used.
o Insecticide fogs or aerosols containing 2% Malathion, or 2% Fenchlorphos (Ronnel)
have sometimes been used to fumigate houses containing fleas.
o Rodenticides to kill rodent vectors, e.g. ‘one-dose’ zinc phosphate, sodium
fluoroacetate, or strychnine or the modern fast-acting anticoagulants e.g. bromadilone,
and chlorophacinone.
o Note: Killing of rodents should be done after killing fleas, otherwise the fleas
will leave the dead rodents and jump onto man and result in increased disease
transmission.
Step 5: The Morphological Characteristics Hard and Soft Ticks

(10 minutes)
 Soft Ticks - Ornithodoros Moubata

o Adult ticks are dorso-ventrally flattened and oval in outline
o The integument is tough and leathery, wrinkled, usually with fine tubercles.
o Ornithodoros moubata of Africa, an oval, yellowish-brown measures about 8 to 9
mm,
o There is no scutum or dorsal shield as is found in Ixodid ( hard ticks)
o The mouth parts capitulum is situated ventrally” false head” making it not visible
dorsally; this character serves to separate adult and nymphal soft ticks from hard ticks
which have the capitulum projecting forward and clearly visible dorsally
o Soft ticks posses a pair of four-segmented palps
o The four pairs of well-developed legs terminate in a pair of claws
o The coxial organ(glands) open between the bases of coxae of the 1st and 2nd pair of
legs
o Males and females are similar in external appearance, but as both sexes feed on blood
and can consequently be disease vectors, it is not so important to distinguish between
them
 Hard ticks - Several Genera
o Adult ticks are dorso-ventrally flattened, ovoid, measuring about 3 – 23 mm in length
depending on species or whether they are unfed of fully engorged with blood. (Female
being larger than male)
o The capitulum projects forward beyond the body outlines and is visible from the
above
o All hard ticks have a dorsal plate called a shield or “Scutum”.
o In males the scutum is large and covers almost the entire dorsal surface of the body
where as in female s it is much smaller restricted to the anterior part of the body just
behind the capitulum
o In engorged females the scutum may be difficult to see because it appears small in
relation to the enlarged body and becomes pushed forwards
o Some species have coloured markings on the scutum and body, sometimes there are
o There are no coxal organs in ixodid ticks
Step 6: The Biology (Life Cycles) of Ticks (25 minutes)

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ASK students to discuss on the life cycle of ticks for 5 minutes

201
Fig. 21.3: Life Cycle of Ticks Both Hard Tick (Left) and Soft Tick (Right)
Source: (CDC, 2009)
 A blood meal is essential for maturation of the ovaries and egg laying, after each blood
meal female argasid ticks lay several (often 4-6) small egg batches, each of about 15-100
spherical eggs.
 Adult tick can live for many years, so a female may lay thousands of eggs during her life
time.
 Eggs are deposited in or near the resting place of the adults such as in cracks, and crevices
in the walls, floors, and furniture of houses or in muds.
 Eggs hatch usually within 1- 4 weeks, and they can remain viable for many months under
adverse climatic condition.
 Both argasid and ixodid ticks have a hemimetabolous life cycle, that is, eggs hatch to
produce six-legged larvae which superficially resemble the adults.
 The nymphal stage passes through several stages before transforming into adult stage. In
argasid ticks the nymph is usually very active and searches for a host from which to take
a blood-meal.
 Blood feeding on the host lasts about 20 – 30 minutes after which the engorged larva
drops to the ground and after a few days moults to produce an eight-legged nymph, the
feeding on blood continues.
 Each nymphal stage requires a blood meal before it can proceed to next nymphal instar.
 The duration of the life cycle, from egg hatching to adult, depends on the species of tick,
temperature and the availability of blood meals, but often about 6 months or

202
 Three-host ixodid ticks have a life cycle that usually spans three years, although some
species can complete the cycle in only two years.
 Adult females drop off the third host to lay eggs after feeding, usually in the fall.
 Eggs hatch into six-legged larvae and overwinter in the larval stage. In the spring, the
larvae seek out and attach to the first host, usually a small rodent.
 Later in the summer, engorged larvae leave the first host and molt into nymphs, usually in
the fall.
 The ticks overwinter in this stage. During the following spring, the nymphs seek out and
attach to the second host, usually another rodent or lagomorph.
 The nymphs feed on the second host and drop off later in the summer.
 Nymphs molt into adults - off the host in the late summer or fall, and overwinter in this
stage.
 The next spring, adults seek out and attach to a third host, which is usually a larger
herbivore (including cervids and bovids), carnivore, or human.
 The adults feed and mate on the third host during the summer. Females drop off the host
in the fall to continue the cycle.
 Females may reattach and feed multiple times. The three hosts do not necessarily have to
be different species, or even different individuals.
 Also, humans may serve as first, second or third hosts
Medical Importance of Ticks

 Mechanical Injuries
o The mechanical injury of their bites, local itching, or even the formation of pruritis
nodules, or granulomas;
o Its insertion of capitulum produces an inflammatory reaction of the peri-vascular
tissues of the corium with local edema, hemorrhage e.t.c
o The wound may become necrotic or secondarily infected
o The production of tick paralysis e.g Dermacentor , Haemaphysalis and
Rhipicephalus species
 As Vectors of Disease
o Tick-borne relapsing fever caused by Borrelia duttoni- Transmitted by Ornithodorus
moubata
o Tularemia caused by Francisella tularensis -Amblyomma species and Dermacentor
o Lyme disease caused by Borrelia burgdorferi- Ixodes species
Step 7: Control Measures against of Ticks (10 minutes)
 Soft ticks are best controlled by destroying their nests or lairs.

 Floors and walls of local huts should be plastered to eliminate the crevices and
then sprayed with DDT or benzene hexachloride (BHC).
 More than one application is required, since these insecticides are ineffective
against the eggs.
 Rodent proofing of buildings is desirable.
 Ixodidae ticks may be eliminated by exterminating their rodent hosts and
destroying their habitats, infected grounds, houses, and animals may be sprayed
with DDT, Chlordane, Dieldrin, or BHC.
 Sprays and 5-10 % dusts are equally effective.
 DDT when applied as liquid sprays to floors and walls is effective for several
weeks; more than one application may be required.

203
 Prevention of house infestation can be done by the removal of infested clothing
and the treatment of dogs with DDT or BHC.
 Fleas transmit plague and certain tape worm infection

 Tunga penetrans is not incriminated as vector of disease but can predispose to secondary
bacterial infection
 Ticks infect animals a variety of domesticated animals and humans
 Ticks are of two groups: hard ticks and soft ticks
 What are the control measures against fleas

 What is the scientific name of the causative organism of plague
 Mention the control measures against ticks
References

204

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NMT 06226

United Republic of Tanzania

NMT 06226 Parasitology & Medical Entomology NTA Level 6, Semester 2

NMT 06226 Parasitology & Medical Entomology NTA Level 6, Semester 2

NMT 06226 Parasitology & Medical Entomology NTA Level 6, Semester 2

These participants are listed with our gratitude below:

SN Name Title Institution

NMT 06226 Parasitology & Medical Entomology NTA Level 6, Semester 2

Dr. Gozbert Mutahyabarwa

NMT 06226 Parasitology & Medical Entomology NTA Level 6, Semester 2

NMT 06226 Parasitology & Medical Entomology NTA Level 6, Semester 2

Goals and Objectives of the Training Manual

Overall Goal for training manual

Objectives for training manual

NMT 06226 Parasitology & Medical Entomology NTA Level 6, Semester 2

Who is the Module For?

How is the Module Organized?

How Should the Module be Used?

NMT 06226 Parasitology & Medical Entomology NTA Level 6, Semester 2

8 5 minutes Presentation Evaluation

NMT 06226 Parasitology & Medical Entomology

Step 1: Presentation of Session Title and Learning Tasks (5 minutes)

ASK students if they have any question before proceeding.

Step 2: Definition of Terms used in Parasitology and Medical

NMT 06226 Parasitology & Medical Entomology

Activity: Small Group Discussion (15 minutes)

DIVIDE students into small manageable groups

WRITE their response on the chalk/white board or flip chart

CLARIFY and summarize their responses using the content below

NMT 06226 Parasitology & Medical Entomology

Activity: Buzzing (5 minutes)

WRITE their responses on the board/flipchart

CLARIFY and summarize by using the content below

NMT 06226 Parasitology & Medical Entomology

NMT 06226 Parasitology & Medical Entomology

Fig.1.1: Classification tree of Parasites of Medical Importance

Source: (Erickson, 2009)

NMT 06226 Parasitology & Medical Entomology

NMT 06226 Parasitology & Medical Entomology

Ins ec ta Crus tac ea Arac hinida

Cimic idae Argas idae

Culic idae Ps y c hodidae Muc s idae Glos s inidae Reduv iidae

Simulidae Seratopogonidae Oes tridae

Figure 1.3: Features of Arthropods

Source: (Science, 2013)

NMT 06226 Parasitology & Medical Entomology

NMT 06226 Parasitology & Medical Entomology

Activity: Small Group Discussion (15 minutes)

DIVIDE students into small manageable groups

ASK students to discuss on on effects of parasite on the host for 5 minutes

WRITE their response on the chalk/white board or flip chart

CLARIFY and summarize their responses using the content below

Direct Effects of the Parasite on the Host

NMT 06226 Parasitology & Medical Entomology

Indirect Effects of the Parasite on the Host

Step 7: Key Points (5 minutes)

 Parasite is an organism that lives within ,upon, or at an expense of another organism

NMT 06226 Parasitology & Medical Entomology

 Mention two major types of parasites and hosts

NMT 06226 Parasitology & Medical Entomology

NMT 06226 Parasitology & Medical Entomology

11 5 minutes Presentation Key Points

12 5 minutes Presentation Evaluation