Professional Documents
Culture Documents
FG - Parasitology & Medical Entomology
FG - Parasitology & Medical Entomology
Parasitology
& Medical
Entomology
Level 6 Facilitator Guide for Diploma in
Nursing
September 2013
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
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.
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
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
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.
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
5 10 minutes Presentation
and the Host
Presentation/
6 30 minutes Effects of Parasites on the Host
Group Discussion
7 5 minutes Presentation Key Points
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.
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
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
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
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
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
Arthropoda
Ac arina
Phthiraptera Diptera Coleoptera Siphonaptera Orthoptera Hemiptera
Tic k s & Mites
Sarc optadae
Demodic idae
Mites
Step 5: The Relationships between the Parasite and the Host (10
minutes)
ALLOW 2 to 3 groups to present and let other groups to provide additional points
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:
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
Prerequisites
None
Learning Tasks
By the end of this session, students are expected to be able to:
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
Flip charts, marker pens, and masking tape
Black/white board and chalk/whiteboard makers
Computer and LCD
Overhead projector
Handout 2.1: Life cycle of Entamoeba histolytica.
Handout 2.2 : Life cycle of Giardia lamblia
Handout 2.3 : Life cycle of Balantidium coli
SESSION CONTENT
Mode of Transmission
Eating uncleaned fruits and undercooked vegetables
Drinking water contaminated with faeces containing cysts of Entamoeba histolytica
ASK students to pair up and buzz on the effects of entamoeba histolitica on the host for 2
minutes
ALLOW 2 to 3 students to provide responses and let others provide additional responses
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
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
Mode of Transmission
o Ingestion of food (fruits and green vegetables or water) contaminated by faeces
containing Giardia lamblia cysts.
ASK the student to brainstorm on effects of Giardia lamblia on the host for 2 minutes
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
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,
ASK the student to pair up and buzz on mode of transmission of Balantidium coli for 2
minutes
ASK students if they have any comments or need clarification on any points.
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.
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.
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.
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
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
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.
Prerequisites
None
Learning Tasks
By the end of this session, students are expected to be able to:
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
Flip charts, marker pens, and masking tape
Black/white board and chalk/whiteboard makers
Computer and LCD
Overhead projector
Handout 3.1: Life cycle of Cryptosporidium parvum
Handout 3.2: Life cycle of Isospora belli
SESSION CONTENTS
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
Definition of Terms
Cryptosporidium parvum
ALLOW 2 to 3 students to provide their responses and let others provide additional
responses
Mode of Transmission
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
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
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.
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.
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.
At time of excretion, the immature oocyst contains usually one sporoblast (more
rarely two) are ecreted with feaces. In further maturation after excretion, the
Prerequisites
None
Learning Tasks
By the end of this session, students are expected to be able to:
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
Flip charts, marker pens, and masking tape
Black/white board and chalk/whiteboard makers
Computer and LCD
Overhead projector
Handout 4.1: Life cycle of Plasmodium specie
SESSION OVERVIEW
Step Time Activity/Method Content
Presentation of Session Title and Student
1 5 minutes Presentation
Learning Tasks
Morphological Characteristics of
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
5 5 minutes Presentation Key Points
ASK students to discuss in groups on the four Plasmodium species and at least two
morphologic characteristics for each for 5 minutes
Plasmodium species
Plasmodium falciparum
Plasmodium vivax
Plasmodium ovale
Plasmodium malariae
ASK the student to brainstorm on effects of plasmodium species on the host for 2 minutes
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
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
ASK students if they have any comments or need clarification on any points.
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
Prerequisites
None
Learning Tasks
By the end of this session, students are expected to be able to:
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
Flip charts, marker pens, and masking tape
Black/white board and chalk/whiteboard makers
Computer and LCD
Overhead projector
Handout 5.1: Life Cycle of Trypanosoma Gambiense and T. Rhodesiense
SESSION CONTENT
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
Mode of Transmission
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
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.
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)
ASK student to pair up and buzz on effects of Leishmania species on the host for 2 minutes
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.
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.
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.
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
Prerequisites
None
Learning Tasks
By the end of this session, students are expected to be able to:
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
Flip charts, marker pens, and masking tape
Black/white board and chalk/whiteboard makers
Computer and LCD
Overhead projector
Handout 6.1: Life cycle of Taenia species
SESSION OVERVIEW
Step Time Activity/Method Content
Presentation of Session Title and Student
1 5 minutes Presentation
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
5 10 minutes Presentation
Solium
6 5 minutes Presentation Mode of Transmission of Taenia Solium
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
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
Epigastric pain
Chronic indigetion
Hunger pain
Weight loss
Obstruction of the appendix, biliary duct, and pancreatic duct.
Egg (ova)
The eggs of T. solium and T. saginata are indistinguishable
Adult
Sucker
Hooks
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
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.
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.
Stanford. (2006). Morphology. Retrieved from http://www.stanford.edu
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 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.
Prerequisites
None
Learning Tasks
By the end of this session, students are expected to be able to:
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
Flip charts, marker pens, and masking tape
Black/white board and chalk/whiteboard makers
Computer and lcd
Overhead projector
Handout 7.1:Life cycle of Echinococcus granulosus
Handout 7.2: Life cycle of Diphyllobothrium latum.
SESSION OVERVIEW
Step Time Activity/Method Content
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.
Adult
The worm is flattened, the longest tape worm of humans ranges from 3-10 meters in
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
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.
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.
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
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
Prerequisites
None
Learning Tasks
By the end of this session, students are expected to be able to:
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
Flip charts, marker pens, and masking tape
Black/white board and chalk/whiteboard makers
Computer and LCD
Overhead projector
Handout 8.1: Life cycle of Schistosoma species
SESSION OVERVIEW
Step Time Activity/Method Content
Presentation of Session Title and Student
1 5 minutes Presentation
Learning Tasks
Presentation/ Common Schistosoma Species of Medical
2 10 minutes
Buzzing Importance
Morphological Characteristics of
3 30 minutes Presentation
Schistosoma Haematobium
Mode of Transmission of Schistosoma
4 10 minutes Presentation
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
SESSION CONTENTS
ASK the student to pair up and buzz on common Schistosoma species for 2 minutes
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)
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
Lateral spine
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)
ALLOW 2 to 3 groups to present and let other groups to provide additional points
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
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.
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
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.
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.
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
Prerequisites
None
Learning Tasks
By the end of this session, students are expected to be able to:
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
Flip charts, marker pens, and masking tape
Black/white board and chalk/whiteboard makers
Computer and LCD
Overhead projector
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
SESSION CONTENTS
ASK students to pair up and buzz on trematodes less commonly affecting humans for 2
minutes
ALLOW 2 to 3 students to provide response and let others provide additional responses
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.
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
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
ALLOW 2 to 3 groups to present and let other groups to provide additional points
Refer to Handout 9.1-3: Life Cycle of Fasciola Hepatica, Clonorchis Sinensis, and
Paragonimus Westermaani
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.
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
ASK students if they have any comments or need clarification on any points.
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
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.
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).
Prerequisites
None
Learning Tasks
By the end of this session, students are expected to be able to:
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
Flip charts, marker pens, and masking tape
Black/white board and chalk/whiteboard makers
Computer and LCD
Overhead projector
Handout 10.1: Life Cycle of Ascaris lumbricoides
Handout 10.2: Life Cycle of Trichuris trichiura
SESSION OVERVIEW
Step Time Activity/Method Content
Presentation of Session Title and Student
1 5 minutes Presentation
Learning Tasks
Morphological Characteristics of
2 30 minutes Presentation
Ascaris Lumbricoides
Mode of Transmission of Ascaris
3 5 minutes Presentation
Lumbricoides
Presentation/
4 25 minutes Effects of Ascaris Lumbricoides on the Host
Group Discussion
Morphological Characteristics of Trichuris
5 20 minutes Presentation
Trichiura
Presentation/
6 10 minutes Mode of Transmission of T.Trichiura
Brainstorming
7 15 minutes Presentation Effects of Trichuris Trichiura on the Host
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
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)
ASK students to discuss on the effects of Ascaris lumbricoides on the host for 5 minutes
ALLOW 2 to 3 groups to present and let other groups to provide additional points
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.
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.
Polar Plug
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.
Male Female
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
Transmission
Trichuris trichiura is transmitted through ingestion of infective (embryonated) eggs in
food/water contaminated by feaces passed by infected person.
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 ?
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.
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.
University of California - Davis. (2006). Trichuris trichiura. Retrieved from
http://www.ucdavis.edu.
Wikipedia. (2013). Ascaris lumbricoides. Retrieved from http://www.wikipedia.org
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 .
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
Prerequisites
None
Learning Tasks
By the end of this session, students are expected to be able to:
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
Flip charts, marker pens, and masking tape
Black/white board and chalk/whiteboard makers
Computer and LCD
Overhead projector
Handout 11.1: Life cycle of Hookworms
Handout 11.2: Life cycle of Strongloides stercoralis
SESSION OVERVIEW
Step Time Activity/Method Content
Presentation of Session Title and Student
1 5 minutes Presentation
Learning Tasks
Morphological Characteristics of
2 25 minutes Presentation
Hookworms
Presentation/
3 15 minutes Mode of Transmission Hookworms
Group Discussion
4 20 minutes Presentation Effects of Hookworm on the Host
Morphological Characteristic Strongyloides
5 20 minutes Presentation
Stercoralis
Presentation
6 10 minutes Mode of Transmission of S.Stercolaris
Buzzing
Effects of Strongylodes Stercolaris on the
7 15 minutes Presentation
Host
8 5 minutes Presentation Key Points
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.
Egg
The degree of hookworm infection depend on the site at which the worm is present and
the burden of worms
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
Filariform larva
o Have a short ( shallow) mouth
o Have Long cylindrical oesophagus
o Measure 630 µm in length and 10 µm in breadth
ASK the student to pair up and buzz on mode of transmission of S.Stercolaris for 2 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
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.
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
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.
Parasites in Humans. (n.d.) Rhabditiform comparison. Retrieved from
http://www.parasitesinhumans.org
Parija, S. (2006). Textbook of medical parasitology: Protozoology and helminthology
(3rd ed.). New Delhi, India: All India Publishers and Distributors.
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
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).
Prerequisites
None
Learning Tasks
By the end of this session, students are expected to be able to:
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
Flip charts, marker pens, and masking tape
Black/white board and chalk/whiteboard makers
Computer and LCD
Overhead projector
Handout 12.1:Life cycle of Enterobius vermicularis
Handout 12.2:Life cycle of Trichinella spiralis
SESSION OVERVIEW
Step Time Activity/Method Content
Presentation of Session Title and Student
1 5 minutes Presentation
Learning Tasks
Morphological Characteristics of Enterobius
2 25 minutes Presentation
Vermicularis
Mode of Transmission of Enterobius
3 15 minutes Presentation
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
8 5 minutes Presentation Key Points
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.
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
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
ALLOW 2 to 3 groups to present and let other groups to provide additional points
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
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.
Intestinal Phase
Nausea
Vomiting
Diarrhoea
Abdominal pain
Convalescence Phase
Malaise and weakness
Myocarditis
Bronchopneumonia
Vascular thrombosis
Step 8: Key Points (5 minutes)
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.).
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.
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
Prerequisites
None
Learning Tasks
By the end of this session, students are expected to be able to:
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
Flip charts, marker pens, and masking tape
Black/white board and chalk/whiteboard makers
Computer and LCD
Overhead projector
Handout 13.1: Life cycle of Wuchereria bancrofti
Handout 13.2: Life cycle of Loa Loa
SESSION OVERVIEW
Activity/Metho
Step Time Content
d
Presentation of Session Title and Student
1 5 minutes Presentation
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
ASK students to pair up and buzz on mode of transmission of wucherelia bancrofti for 2
minutes
ALLOW 2 to 3 students to provide response and let others provide additional responses
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.
Microfilaria
o Measures 250-300 in length and 6-10 µm in breadth.
http//www.google.com-microfilaria
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
ASK students to discuss on effects of loa loa on the host for 5 minutes
ALLOW 2 to 3 groups to present and let other groups to provide additional points
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,
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)
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.
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.
Handout 13.1:Life cycle of Wuchereria
Bancrofti
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.
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.
Prerequisites
None
Learning Tasks
By the end of this session, students are expected to be able to:
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
Flip charts, marker pens, and masking tape
Black/white board and chalk/whiteboard makers
Computer and LCD
Overhead projector
Handout 14.1 Life cycle of Onchocerca volvulus
Handout 14.2 Life cycle of Dracunculus medinensis
SESSION OVERVIEW
Step Time Activity/Method Content
Source:www.google.com/onchocerca volvulus
ALLOW 2 to 3 groups to present and let other groups to provide additional points
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.
ASK students to pair up and buzz on effectss of onchocerca volvulus on the host for 2
minutes
ALLOW 2 to 3 students to provide responses and let others provide additional responses
Skin lesion
o Acute pruritis rashes, hypatrophic, hyperpigmented and thickened skin
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
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.
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.
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
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.
Prerequisites
None
Learning Tasks
By the end of this session, students are expected to be able to:
Explain the quality assurance in dealing with parasitological specimens
Identify parasitological specimens
Explain on collection and transportation of parasitological specimens
Resources Needed
Flip charts, marker pens, and masking tape
Black/white board and chalk/whiteboard makers
Computer and LCD
Overhead projector
Handout 15.1: Collection and Transport of Specimens
Worksheet 15.1-3: Specimen Collection and Rejection Case Studies
SESSION OVERVIEW
Step Time Activity/Method Content
Presentation of Session Title and Student
1 5 minutes Presentation
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
4 30 minutes Presentation
Parasitological Specimens
Presentation/ Specimen Collection and Specimen Rejection
5 40 minutes
Assignment Case Studies
6 5 minutes Presentation Key Points
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.
Table 17.1: List of Specimens and Parasites and Parasitic Forms to be identified
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.
ASK students to do homework on specimen collection and answer the questions provided in
worksheet 15.1-3
ASK students if they have any comments or need clarification on any points.
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.
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.
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.
Instructions
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
Instruction
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.
Instruction
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
Prerequisites
None
Learning Tasks
By the end of this session, students are expected to be able to:
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
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
Presentation/ Preventive Measures Against Intestinal
2 45 minutes
Group Dscussion Protozoa Infections
Preventive Measures against Blood
3 25 minutes Presentation
Protozoa Infections
Presentation/ Preventive Measures Against Tissue
4 35 minutes
Buzzing Protozoa Infections
5 5 minutes Presentation Key Points
ASK students to discuss on preventive measures against intestinal protozoa infections for 5
minutes
ALLOW 2 to 3 groups to present and let other groups to provide additional points
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.
ASK students to pair up and buzz on preventive measures against tissue protozoa
infections for 2 minutes
ALLOW 2 to 3 students to provide responses and let others provide additional responses
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?
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.
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.
Prerequisites
None
Learning Tasks
By the end of this session, students are expected to be able to:
Explain the preventive measures against roundworms infections
Explain the preventive measures against tapeworm infections
Explain the preventive measures against flukes infections
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
Presentations/ Preventive Measures against Round
2 50 Minutes
Group Discussion Worms Infections
Preventive Measures against Tapeworms
3 20 minutes Presentation
Worms Infections
Presentations/ Preventive Measures against Flukes
4 35 minutes
Brainstorming Infections
5 5 minutes Presentation Key Points
ASK students to discuss in group on preventive measures against round worms of medical
importance for 5 minutes
ASK the student to brainstorm on preventive measures against flukes infections for 2 minutes
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.
ASK students if they have any comments or need clarification on any points.
Prerequisites
None
Learning Tasks
By the end of this session, students are expected to be able to:
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
Flip charts, marker pens, and masking tape
Black/white board and chalk/whiteboard makers
Computer and LCD
Overhead projector
Handout 18.1: Life Cycle of Mosquitoes
SESSION OVERVIEW
Step Time Activity/Method Content
Presentation of Session Title and Student
1 5 minutes Presentation
Learning Tasks
Common Arthropods Transmitting
2 10 minutes Presentation
Diseases/Infections
Presentation/
3 20 minutes Mosquitoes Transmitting Diseases to Man
Buzzing
Morphological Characteristics of
4 25 minutes Presentation
Mosquitoes
5 30 minutes Presentation Biology of Mosquitoes
Presentation/
6 20 minutes Control Measures against Mosquitoes
Group Discussion
7 5 minutes Presentation Key Points
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
o Bancroftian filariasis caused by Wuchereria bancrofti
o Arboviruses caused by viruses
Aedes species transmit
o Yellow fever caused by virus
o Dangue caused by virus
o West Nile virus
o Bancroftian filariasis caused by Wuchereria bancrofti
o Brugian filariasis caused by Brugia species
o Arboviruses caused by viruses
Mansonia species transmit
o Bancroftian filariasis caused by Wuchereria bancrofti
o Brugian filariasis caused by Brugia species
o Arboviruses caused by viruses
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
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
ALLOW 2 to 3 groups to present and let other groups to provide additional points
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.
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.
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/
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.
Prerequisites
None
Learning Tasks
By the end of this session, students are expected to be able to:
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
Flip charts, marker pens, and masking tape
Black/white board and chalk/whiteboard makers
Computer and LCD
Overhead projector
SESSION OVERVIEW
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
Scissor-like structure
ALLOW 2 to 3 groups to present and let other groups to provide additional points
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.
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)
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
ALLOW 2 to 3 groups to present and let other groups to provide additional points
Black flies breed by preference in rapidly flowing streams, the females attach their eggs
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
ASK students if they have any comments or need clarification on any points.
References
Canku Ota. (2001). Black flies (Simuliidae) Retrieved from http://www.turtletrack.org
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.
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.
Wikipedia. (2013). Tsetse fly. Retrieved from http://www.wikipedia.org
Prerequisites
None
Learning Tasks
By the end of this session, students are expected to be able to:
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
Flip charts, marker pens, and masking tape
Black/white board and chalk/whiteboard makers
Computer and LCD
Overhead projector
SESSION CONTENTS
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
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)
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
ASK students to pair up and buzz on biology and life cycle of Musca species for 2 minutes
ALLOW 2 to 3 students to provide responses and let others provide additional responses
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.
ALLOW 2 to 3 students to provide responses and let others provide additional responses
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
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.
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.
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
Figure 20.4: Phthirus Pubis Adult Female, Phthirus Pubis Adult Male
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)
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
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.
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
ASK students if they have any comments or need clarification on any points.
Prerequisites
None
Learning Tasks
By the end of this session, students are expected to be able to:
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
Flip charts, marker pens, and masking tape
Black/white board and chalk/whiteboard makers
Computer and LCD
Overhead projector
Handout 21.1: Medical Importance of Ticks
SESSION OVERVIEW
Step Time Activity/Method Content
Presentation of Session Title and Student
1 5 minutes Presentation
Learning Tasks
The morphological Characteristics of Fleas;
2 20 minutes Presentation
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
5 10 minutes Presentation
(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
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
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).
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,
ALLOW 2 to 3 groups to present and let other groups to provide additional points
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
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