Parasitology

Intestinal Nematodes
Ascaris Anclyostoma Strongyloides Enterebous Trichuris
Nematode
lumbricoides duodenale stercoralis vermicularis trichiura
Ancylostomiasis Enterobiasis or
Disease Ascariasis. Strongyloidiasis Trichurasis
and hookworm oxuyarisi (children)

DH Man
It is common in Tropical and
Europe, India, Cosmopolitan (vermicularis is the
GD Egypt (specially subtropical region
China and Egypt most cosmopolitan)
children) including Egypt

Habitat Small intestine Large intestine

Embryonated egg
Infected stage containing larva Filariform larvae Egg containing larva

Ingestion of foods and

drinks.
Contaminated hands
Ingestion of (autoinfection)
embryonated egg Filariform larvae penetrate the skin Inhalation of air-borne
Mode of eggs
Ingestion of food
with vegetables or usually the toes cause of walking on containing larvae
infection contaminated infected soil Eggs may hatch in
hands with soil preanal region and
migrate back to LI
forming adult worm
(retro infection)
Ground itch Ground itch Prutitis causes
Larva: fever, Loeffler’s syndrome
epigastric pain insomnia, nocturnal Asymptomatic
(lung)
eosinophilia and nausea and vomiting enuresis. Abdominal colic
Clinical Intestinal Mucosal
bronchial asthma. malabsorption Worms may reach Dysentery and
ulcers
Adult worms: intestinal hyper- urethra and cause rectal prolapse
picture Anaemia
infection opportunistic vagianal itching Appendicitis
asymptomatic Nausea, vomiting,
parasite Appendicitis Anaemia
abdominal colic
diarrhoea
Intestinal obstruction
Complications Appendicitis and --------------------------------------------------------------------------------------
peritonitis
Clinically: Pruritis
Stool for the egg
Clinically bronchitis Preanal swapping of
CBC (complete
Stool for egg and +diarrhoea stool egg at morning
blood count)
Diagnosis Stool for egg clinically anaemia Stool for rhabditiform Adult worm can be
count number of
test larvae seen crawling from
blood cells in a
Serological ELISA IF AT anus at night
given volume

Mebendazole and
Albendazole and iron
Treatment Flubendazole
supplements Ivermectin white mercury Mebendazole
ointment for itching
Proper washing of Avoid usage of disposable human Washing hands and Purified water
raw vegetables and faeces as fertilizers patient’s clothes must Proper washing
Prevention washing hands Personal prophylaxis be boiled daily of vegetables and
before meals Proper hygiene. hands
 Parasitology

Intestinal Nematodes

Nematode Trichinella spiralis

Disease Trichinelliasis or trichinosis

DH Pigs. Rodents and man

GD Cosmopolitan widely spread amongst pork eaters

Habitat Small intestine

Infected
Trichina capsule contain larva and found in muscles
stage

Mode of
Ingestion of improper cooked pork meat
infection

Gastroenteritis: diarrhoea, nausea, vomiting and colic

Clinical
Myalgia with difficulty in mastication and swallowing and eosinophilia
picture
Although symptoms vanish still myocarditis may continue

Clinically symptoms
Diagnosis Laboratory: serological (IHAT, IFAT, ELISA) muscle biopsy and x-ray
(calcified cyst)

Treatment Mebendazole and thiabendazole

Avoid feeding raw garbage to pigs

Prevention
Proper cook of pigs
 Parasitology

Filariae (tissue nematodes)

Dracunculus’s
Nematode Wuchereria bancrofti Loa loa
Medinensis
Disease Brocroncroftian filariasis Eye worm (loasis) Dracunculiasis

DH Man Man, and animal

Day time biting big fly

IH Culex mosquito
chrysops-vector
cyclops

Tropical and subtropical

GD Egypt: Cairo, Giza, Dakahlia-Sharqiyah - West and central Africa West Africa Arabia India and Yemen
Assiut

Lymphatic vessels and glands

Habitat Microfoliarie found in lung day and in blood by night (wichuraiana)
Subcutaneous tissue

Infective larvae found on cyclops

Infected stage Filariform larva body

Mode of Filariform larva enter skin during Filariform larva enter skin during Drinking water containing infected
mosquito bite chrysops bite cyclops
infection
Calabar swelling
Asymptomatic: daily discharge of Generalized pruritus
microfilaria
Clinical Acute inflammatory: lymphangitis and Local erythema and tenderness
lymphadenitis with fever and lesion in Formation of ulcers
picture lower limbs and genitalia
Chyluria and elephantiasis

PCR
Detection of microfilariae at night
Serology
Diagnosis Serological test: (IFAT - ELISA)
Eosinophilia
x-ray to detect calcified worm
DEC provocative test
Detection of microfilaria in blood

Antiseptic and antibiotics

Daily rolling up the medinenses
worm for few cm gently to avoid
rupture causing anaphylactic shock
Diethyl carbamizine (DEC) and Hetrazan Thiabendazole
Chemotherapy Surgical removal
and Ivermectin
Treatment For elephantiasis: surgical removal of
Surgical removal of adult loa loa
if seen under conjunctiva
elephantoidal tissue

Boil or filter water

Control of mosquito Control of chrysops
Prevention Mass treatment Treatment of patient
Infected people should be isolated
from water supply
 Parasitology

Larva migrans

Larva Cutaneous (Creeping eruption) Visceral larva

Invasion of skin by non-human Invasion of human viscera

Definition nematode larvae. nematode larvae of cats and dogs

Infected stage Filariform larvae Embryonated egg

Direct contact with moist sand soil

Mode of infection containing dog or cat faeces
Ingestion

Clinical picture Itching -------------------

Diagnosis ------------------- Hepatomegaly

Treatment Thiabendazole Hetrazan

Prevention Personal prophylaxis Wash hands

 Parasitology

Protozoa
General characteristics of protozoa:
• Unicellular
• Eukaryotic
• Ectoplasm: used for phagocytosis (ingestion)/ Excretion/ secretion

• Endoplasm: storage of food vacuoles (glycogen) and protein

Reproduction of protozoa:
• Sexually (sprozoa):
- Syngamy (fusion of male and female gamete nuclei)
- Conjugation: Transfer of DNA

• Asexually:
- Amitosis or mitosis
- Binary fission (most common)
- Multiple fission: one cell split into many cells at once.
 Parasitology

Intestinal protozoa
Cryptosporidium
Balantidium
Entamoeba histolytica Giardia lamblia parvum (zoonotic)
Protozoa coli (pigs)
(Pathogenic Amoeba) (flagellate) (oppurtinisic)
(Ciliates)
(sprozoa)

Balantidium
Disease Amoebiasis
dysentery
Giardiasis Cryptosporidiosis

Habitat Large intestine Small intestine

Ciliated
Thick wall Oocyst
IS Mature- 4 nucleated cyst Balantidium cyst Mature cyst-4 nuclei
(2 nuclei) with 4 sporozoites

Mode of
Ingestion of food containing cyst Ingestion and drinking contaminated water
infection

1-Asymtomatic (cyst)
Travel diarrhoea
2-symtomatic: Duodenitis
Same as Watery-diarrhoea
Intestinal Cholecystitis
entamoeba
Clinical  Acute: dysentery histolytica but Epigastric pain
Loss of weight
 Chronic: diarrhoea and with no extra Malabsorption:
Dehydration
picture Malabsorption
constipation intestinal clinical  Steatorrhea
Extra intestinal: picture.  Hypoproteinaemia
 Amoebic liver and lung  Jaundice
abscess
Intestinal:
 stool examination of
trophozoite and cyst  Stain with modified
Stool examination for (ziehl-nelson)
Diagnosis Extraintestinal: trophozoite and cyst  Intestinal biopsy
 Serological: IHAT & ELISA
 Aspiration of abscess
 X-ray

Luminal amebicides: Nitazoxanide

 Diloxanide furoate+iodoquinol Paromomycin
Treatment Tissue amebicides: Metronidazole (flagyl) Spiramycin
 Tinidazole + Metronidazole Fluid and electrolytes
For treatment: Luminal+Tissue

Personal prophylaxis Proper care of

Prevention Washing hands pigs
Proper wash of hands & drink pure water
 Parasitology

Potentially pathogenic opportunistic free-living amoeba

Amoeba Naegleria fowleri Acanthamoeba

PAM (Primary amoebic GAE (granulomatous amoebic

Disease meningoencephalitis) encephalitis)

Stagnant fresh water and human Stagnant fresh water +human

Habitat brain skin, brain, eye and lung

IS Amoeboid trophozoite

Inhalation or snuffing
While swimming penetrates into
Mode of infection nasal mucosa through snuffing
Open ulcer
Cornea

FAHM
Increase intracranial tension ICT
FAHM (Fever- Anorexia- Skin ulcers
Clinical picture headache-Malaise) Focal granuloma
Coma and death in few days Stiff neck
Convulsion
History
History
CT to find granuloma
Diagnosis CSF to differentiate PAM from bacteria
or viral encephalitis CSF
Culture on NNA (non-nutrient agar)

Surgery removal of granuloma

Treatment Amphotericin B IV
+ Ketoconazole

Avoid swimming in contaminated water and instead sanitize water

Prevention with chlorine
 Parasitology

(flagellates)

Flagellate Trichomonas vaginalis

Habitat Male and female genitalia

IS Trophozoite and trichomonas vaginalis has no cyst

Mode of Sexual intercourse & Contact with toilet seats

infection

In female: Leucorrhoea (bad odour discharge from vagina)

Clinical picture & strawberry cervix.
In male mainly asymptomatic

Vaginal swap and implant on diamonds medium

Diagnosis Immunological: ELISA
PCR

Metronidazole (flagyl) for both partners

Treatment Female lactic acid douche

Use physical barriers while sexual intercourse

Prevention Use disposable toilet seat bags
 Parasitology

Haemoflagellates
 Parasitology

Haemoflagellets Trypanosoma Leishmaniasis

Gambiense
Cruzi Visceral Cutaneous &
Type &
Kala azar mucocutaneous
Rhodesiense
RES (retico-
Muscle fibres endothelial system): RES &
Blood, lymphatic
Habitat system and CNS
Neurons & Blood Liver, spleen, Bone subcutaneous
Heart marrow and lymph mucosa
nodes

IS Metacyclic trypomastigote Promastigote

Contamination of
Mode of Bite from glossina
the bite wound by Bite from female sand fly containing
faeces of winged promastigote
infection bug

Chagoma
Chancre at site of bite FAHM
FAHM Hepatosplenomegaly
Lymphadenopathy
In late-stage Dysentery
CNS damage: Roman’s sign
Leishmanioma
Clinical  Coma Pancytopenia=
(anaemia+leucopenia Face ulcer
picture  Paralysis
+thrombocytopenia)
 Sleepiness Dark granuloma
 Meningitis
Generalized
 Convulsion Lymphadenopathy,
splenomegaly and
hepatomegaly

Trypomastigote in
Biopsy or aspirate of amastigote in RES
blood
Aspirate from RES PCR
Diagnosis Serological: IHAT-ELISA
Amastigote in
lymph node Serological: ELISA & IHAT
Serology Leishman test to check the progress in therapy

Pentamidine Liposomal Amphotericin B

Treatment Tryparsamide
Primaquine orally
Pentamidine

Treatment of patient
Prevention Control of vector
 Parasitology

Blood sprozoa *Malaria* Complication of malaria

Plasmodium species causing malaria:
 P. Vivax causes benign tertian malaria
 P. Falciparum causes malignant tertian malaria
 P. Ovale causes ovale tertian malaria
 P. Malarie causes Quartan malaria

DH Female anopheles’ mosquito

IH Man

IS sporozoite
Bite from FAM
Mode of Blood transfusion
infection Congenital
Contaminated syringe
FAHM
Fever malaria (paroxysm) there is time for fever
Every 48hr for p. vivax and p. ovale
Every 72hr for p. malarie
Irregular duration for p. falciparum
Clinical picture Haemolytic anaemia & Hepatosplenomegaly and Jaundice
Clinical attack stages:
 Cold: (15-30) min
 Hot: (2-6) hrs
 Sweating: (2-3) hrs

Diagnosis Clinical picture & serological (IFAT and IHAT)

Treatment of clinical attack: chloroquine- mefloquine

Treatment Primaquine

Prevention Control of female anapoles mosquito

 Parasitology

Toxoplasma Gondi

Habitat RES (retico-endothelial system)

Cyst
IS Pseudocyst
Tachyzoite

Cyst: through contaminated vegetables and water

Mode of Pseudocyst: through improper cooked meat
infection Tachyzoite: Blood transfusion & organ transplantation and congenital

Asymptomatic
Abortion or stillbirth for pregnant woman
Clinical Acquired: Lymphadenopathy + FAHM
picture Opportunistic due to immunocompromised:
Encephalitis- Myocarditis-Pneumonia

Clinically symptoms and signs

Serological
Diagnosis X-ray
U.S.

Spiramycin
Treatment Daraprim + sulphadiazine

Self-prophylaxis
Prevention Health education for pregnant women
Avoid eating improperly cooked meat