CLINICAL PARASITOLOGY
PARASITOLOGY o Fecal suspension – no specimens are intact from the stool –
Parasites are organisms that infect other living beings. They live in
or on the body of another living being (HOST) and obtain nourishment
from it. Medical parasitology deals with parasites which causes human
infections and diseases they produce
DEFINITION OF TERMS
● Parasitology- area of biology concerned w/ the phenomenon of dependence
of one living organism on another.
● Clinical Parasitology - concerned w/ the animal parasites of man & their
medical significance as well as their importance in human communities.
● Parasites - living organisms w/c for the purpose of procuring food & shelter,
take up their abode temporarily or permanently on or w/in another living
organism.
● Parasitosis - the state of infection or infestation w/ an animal parasite.
● Parasitism - any reciprocal association in w/c a species depends upon another
for its existence.
● Infection - the invasion of endoparasites.
● Infestation - the external parasitism of ectoparasites.
MICROSCOPE
• How to use microscope
o Avoid moving the coarse and fine adjustment knob
o The objective lens should not be the HPO or the OIO before
examining the slides, it should be position on the LPO
o The position of the glass slide should show the material or the
specimen on the center
o There is a knob to control the light (electronic microscope)
• Some parts of the microscope
o Eyepiece or ocular – to view
▪ Both eyes should open but the concentration should
be on one eye
▪ Monocular – one eye
▪ Binocular – two eyes
o Body tube – hold the ocular and where the revolving
nosepiece and lenses is attached
o Revolving nosepiece
o Objectives – scanner (4x - shorter) use when focusing on the
larvae of a parasite (view visible larvae like T. trichiura), LPO
(10x) usually the first objective in doing a microscopic exam,
HPO (40x or 60x – long) usually use to focus on like amoeba
because they are small, and OIO (100x - longer) usually don’t
use it in parasitology because it focuses on bacteria with the
use of one drop of cedar oil or immersion oil (clear,
transparent smear under microscope)
▪ When using OIO, don’t contaminate the other lens
because it could destroy them
▪ After using (or even before), wipe the oil out of the
lens (lens paper or cotton)
▪ Start rotating the microscope from scanner, LPO,
HPO, and OIO
▪ Eggs of the parasite from LPO move to HPO (intestinal
parasite)
▪ OIO – malarial parasite
o Stage clip
o Coarse adjustment knob
▪ When the gap is high between the lens and the
objects, move the coarse adjustment knob to lessen
the gap
▪ Give a nearer appearance. Move first before the fine
adjustment knob
o Fine adjustment knob
▪ If the object is blur, adjust this knob slowly to the
object clearly
PREPARATION OF FECAL SMEAR
• Materials: glass slide, applicator stick, cover slip, specimen, NSS
(normal saline solution)
• NSS mixed with the fecal specimen to come up with a fecal
suspension
• One drop if NSS on the center of the glass slide
• Composition of NSS are sodium chloride and water (0.85 or 0.9g NaCl
per 100mm H2O) – to dilute the fecal smear
• Technique: trial and error
• Place NSS on the glass slide then use the applicator stick (wooden) to
poke the stool (several times in different portion)
o Scybalous – hard stool
o If watery stool – use the stick as stirring
o After poking, mixed it with the NSS on the glass slide to come up with
fecal suspension
2nd Year – BS Medical Technology | 2nd Sem – 1st Block
the stool is not intact, whole
o Avoid very thick smear or very thin smear
o Should be cloudy
o After preparation of smear, cover it with cover slip and check on the
microscope
o Move slide (left, right, up, and down -until whole smear is scan on
the microscope). Count several fields for average result (reporting)
o Count each field (depending on type of parasite)
o Lowest to highest number observe
o + sign (other type of parasite – if they don’t want to put
numbers)
• Result form has name of patient, age, name of physician who
requested, fecalysis or stool examination (middle), color of stool
(under), next to color is consistency (watery or diarrhetic stool, soft,
scybalous - formed), and fill out the about the parasite seen (block)
o Amoeba – count per field (number of ova per field)
o MedTech can’t release another result if the patient misplaces their
result
CLASSIFICATION OF PARASITE
● MICRO PARASITE
o Generally, parasites that multiply within their definitive
hosts. Microparasites are characterized by small size, short
generation times, and a tendency to induce immunity to
reinfection in those hosts that survive.
o Viruses, Bacteria, Protozoa
● MACRO PARASITE
o Are bigger, and include things like helminths and arthropods.
o They have relatively long generation times.
o Macroparasite infections tend to be chronic, and they are
accumulated relatively slowly.
o Hosts don’t usually develop immunity to macroparasites, or
else the immunity is short-lived and/or only happens with
high parasite burdens.
TYPES OF PARASITES ACCORDING TO
LOCATION
a. Ectoparasite
• a parasite living outside the body of a host
• It will not penetrate the tissues.
• Its presence is called an infestation
Ex. Head louse, body louse, scabies
b. Endoparasite
● a parasite living inside the body of a host (INFECTION)
● Its presence is called an infection. Usually, these are
responsible for causing human infections.
Ex. Protozoa, helminths
HOST REQUIREMENT
a. Obligate Parasite
• they need a host at some stage of their life cycle
• they need a host to complete their development and to
propagate their species
• It cannot exist without a host.
Ex: tapeworms depend entirely upon their host for
existence
b. Facultative Parasite
• may exist in a free-living state or may become parasitic
when the need arises
Ex: pathogenic free-living amoebas like:
Naegleria fowleri, Acanthamoeba sp.
DURATION
a. Permanent
• remains on or in the body of the host for its entire life
Ex: Wuchereria, Schistosoma, Plasmodium falciparum
b. Temporary
• lives on or in the host for a short period of time
Ex: Mosquitoes, bed bugs – they feed on the host and
then they leave aka: “micro predators”
c. Periodic
• The parasite affects you, but the stage of the parasite is
only in the “larval stage” or “baby stage”
d. Transitory
• It is like a periodic parasite, it is in its “larval stage” in a
host, but when it becomes an “adult,” it will NOT become
a parasite
CLINICAL PARASITOLOGY | 1
 TYPES OF HOSTS ● Cylindrical in shape but no segmentation
● Accidental - Host other than the normal one that is harboring a ● Dioecious - Organism with separate male and female sex
parasite ● Complete digestive system, has mouth and anus
● Definitive- Host in which the adult sexual phase of parasite ● 1 adult female larvae has the capacity to lay 26 million eggs in its
development occurs lifetime and can lay 200,000 eggs per day
● Intermediate- Host in which the larval asexual phase of parasite ● Most males only have a single testis, some species have two.
development occurs ● Most females have two ovaries, some species even have more.
● Reservoir- Host harboring parasites that are parasitic for humans and ● In stool examination, eggs can be seen.
from which humans may become infected ● Outside of the body of the host, the eggs of the parasite will not die
● Paratenic (Vectors)- Host responsible for transferring a parasite from immediately as long as there’s still favorable conditions (moisture
one location to another from the ground or from the fecal material) so it will develop to a
● Carrier- Parasite-harboring host that is not exhibiting any clinical larvae.
symptoms but can infect others ● About 2-3 weeks, the egg becomes embryonated.
● Incidental - an individual that, though infected, is not necessary for ● The soil mixed with fecal material – night soil
the survival or development of the parasite. TYPES OF OVA
VECTORS • Corticated ova have an albuminous coat.
● Biologic Vector- transmits the parasite only after the latter has • Decorticated ova, removal/absence of albuminous coat
completed its development within the host.
• Unfertilized ova, cytoplasm is filled with granules
● Mechanical or Phoretic vector- only transports the parasite.
• Fertilized ova have spaces in the cytoplasm
PARASITE-HOST RELATIONSHIP
● Symbiosis - living together; the association of two living organisms, • Embryonated ova, has small worm embryo inside the cytoplasm of
each of a different species the ova. (In An Infectious stage to human, when it reaches the
● Commensalism - association of two different species of organisms stomach, shells will break and embryos will be released.)
that is beneficial to one and neutral to the another OVA LAYERS
● Commensal - relating to commensalism; the association between ● Albuminous coat – outermost layer of ascaris ova
two different organisms in which one benefits and has neutral effect ● Glycogen layer – next layer after albuminous coat
on the other ● Utellin layer – next to glycogen layer
● Mutualism - association of two different species of organisms that is ● Lecithin granules – inside the cytoplasm
beneficial to both
● Parasitism - association of two different species of organisms that is
beneficial to one at the other’s expense
● Pathogenic - Parasite that has demonstrated the ability to cause
disease
PARASITE-HOST RELATIONSHIP
● Duffy Blood Group
○ Racial Variation (natural selection)
○ Resistance against Plasmodium ovale
● Too Much Carbohydrates
○ Favors development of certain tapeworms
○ Taenia saginata (beef tapeworm)
○ Taenia Solium (pork tapeworm)
○ Increase of Immunoglobulins (IgM and IgME)
● Low Protein Diet
○ Favors amoebiasis
● Sickle Cell Trait
○ Black Americans
○ Increase resistance to Plasmodium falciparum
○ Abnormality
● Eosinophilia
○ Increase eosinophils
○ Immunologic manifestations associated with parasitic
infections
○ Erythrocytosis - increase RBC
○ Erythrocytopenia - decrease RBC

Nematodes
Nematodes
Nematodes
● Ascaris lumbricoides (roundworm)
○ Can be seen in any part of the smear
● Trichuris trichuria (whipworm)
○ Found in the side or edge part of the smear since the ova
likes to hide
○ Tail movement is whip-like
○ Tail is thread-like TRICHURIS TRICHIURA
● Enterobius vermicularis (pinworm) • Whip worm due to its thick and thin sections
○ White, small, outside or surface of the anus • Movement: like that of a whip
ASCARIS LUMBRECOIDES • Mode of Transmission: Ingestion
● Roundworms • Infective Stage: Embryonated ova
● Disease: Ascariasis • Lifespan: 3 to 6 years
● Infective Stage: Embryonated Ova • Thin end tail, thread tail while the head is thick
● Mode of Transmission: Ingestion
• Female larvae lay 3,000 to 10,000 eggs per day
● Phylum: aschelminthes
● Means of reproduction: Copulation
• Female is larger than male
● Ascaris life span inside the host, 12-17 months only • Ascaris will eat what you eat while Trichuris will suck blood (0.05 ml
● Both tails and heads are tapering (patulis). The tail is straight, no per day) that could cause anemia
curving (female), end of tail is curved/coiled (male) • Trichuris and ascaris – mutualism
● More than 1 ft. long (adult). Usually, female larvae are bigger than • Trichuris is smaller than ascaris
males

CLINICAL PARASITOLOGY | 2
 TYPES OF OVA
• Barrel shaped like a Japanese lantern (because of its mucous plugs)
• Ova has distinct 2 mucous plugs on both ends which serves as an
opening or exit for the release of embryo
• Appear as yellow to orange in color on fresh specimen
• If the mucous plug is already open when examined under the
microscope, it means that the ova has already hatched but if the
mucous plug is intact means that the ova is not yet hatched
• Trichuris and Ascaris is like cousins because they can be seen in one
specimen together
• When examining under the microscope – scan up to the edges of the
smear, as they are likely to hide in fecal debris unlike ascaris
EFFECTS
• In heavy infectious stages it can lead to rectal prolapse
• Anemia
• It can also cause blockage in the appendix, which can lead to
appendicitis
• Infection in children (about 800 worms) will also lead to anemia
• Trichuriasis
ENTEROBIUS VERMICULARIS
● Pinworm
● Mode of transmission: Inhalation and ingestion
● Disease: Oxyuriasis
● Common symptoms: anal itchiness, medical term: pruritus ani.
Unconsciously grinding of the teeth (based on observation, no
scientific research)
● Mode of transmission: inhalation and ingestion
● Very contagious type of infection
● Pruritus ani – dermatological condition characterized by itching in
the anal area
● DC – dilation and curettage (D&C), cleaning of uterus (pregnant
woman)
● Female larvae becomes gravid
● The female larvae will travel from the intestine to the surface of the
anus to lay its eggs. Goes back inside again, comes out next day
● Larvae can also be found in the urine as a contaminant, because the
eggs are just at the surface of the anus which is close to urethra
● Larvae can enter wrong passage (vaginal canal instead of the anus),
so the urine can contain the larvae as contaminant
● Has a very unique cycle/characteristic
● The adult larvae will not lay its eggs inside the intestine. It comes out
to lay its eggs on the surface of the anus.
● In the microscope during fecalysis, you won’t see the egg of E.
Vermicularis
● Scotch tape technique, Graham technique, Cellophane tape swab –
tests specialized for collecting enterobius ova from the surface of the
anus
● Night time – best collection time because metabolism slows down
and organs movement is slow which is the time that female larvae
(gravid) pregnant will come out and lay its eggs in the corrugated skin
of the anus
● Crawling while laying eggs – causes the patients to itch (pruritus ani)
● One person with the infection, once they touch things around the
house, the eggs transfer and can infect other family members
● One larvae can lay 11,000 eggs per day, but has fast mode of
transmission
OVA LAYERS
● Hyaline layer, chitin layer – purpose of providing mechanical
protection
● Lipoidal layer – purpose of providing chemical protection
● Because of these layers, Enterobius ova will not be easily damage by
chemicals/chemical agents
● Treatment: Change beddings and clothes every day and night while
undergoing treatment
TRICHINELLA SPIRALIS
● Tissue nematode
● Discovered by: James Paget in the muscle of the humans
● Mode of transmission: Ingestion, raw/uncooked pork
● Specimen collection: muscle tissue surgically extracted from the Life
span: 30 years
● Two muscles of calf: gastrocnemius and soleus – this is where
skeletal muscles can be collected for the examination of T. spiralis
● Not seen on intestines/digestive tract, but in muscles
● Parasite of animal like pigs and bears
● body by a pathologist
● No exit, they stay in muscles
● Usually infects people with deficiency in glycogen
● 1% pepsin and hydrochloric acid for 1 hour (nakababad), will digest
the tissue
● The liquid left will contain the Trichinella Spiralis
● Serologic test, muscle biopsy
● Trichinella Spiralis prove to infect skeletal muscles which are usually
found attached
● Bones – this is where the larvae will stay and coil
● -15C best temperature for preventative measures for meat in the
freezer, low temp. kill parasites
● Encystation - Occurs in the duodenum, male and female larvae will
develop
● The female larvae will lay larvae, not eggs
● The larvae laid will penetrate lymphatic and mesenteric veins after 5
days. From the vein, it will go to the liver and heart.
● From the heart to the lungs, finding their way in the arterial system
and ends in the muscles where they will encyst and coil
HOOKWORMS
● Intestinal nematodes
○ Old-world hookworm – ancylostoma species
○ New-world hookworm – necator species
● Mode of transmission: skin penetration (usual), Ingestion (when
conditions are favorable for the parasite
● Infective Stage: Larvae of the hookworm. Specifically filiform larvae
(very thin/fine structure that can get in the skin pores)
● Soil-loving, “ground itch” is associated with hookworms, loves
moisture in soil
● Ancylostoma duodenale. The only species of hookworm found in
Europe and in south America, india, china.
● Ancylostoma and nector species are also found in Brazil, Southeast
Asia, Southwestern Pacific.
● Different species, different characteristics
● To distinguish between specie, focus on the buccal cavity
● Hookworm larvae may either contain teeth or cutting plate in their
mouth
○ Ancylostoma braziliense – 1 pair (hookworm for human)
CLINICAL PARASITOLOGY | 3
 ○ Ancylostoma duodenale – 2 pairs (hookworm for human)
○ Ancylostoma caninum – 3 pairs (hookworms for dogs)
● Hookworm attached to the mucosa thru biting
● Hirubin – substance injected to maintain that opening continuously
bleeding which makes blood continuously being sucked.
● Hookworm casually causes anemia, because of sucking of blood.
● Hookworm egg- oblong shaped, 4 nuclei in the cytoplasm or more (8
max)
● If stool is freshly collected, under the microscope we can see eggs
(oval-shaped with 4-8 nuclei in cytoplasm)
● If old collected stool, the larvae found in microscope is of hookworm
Filariform larvae
● First stage, infective stage, can penetrate in skin
● Travel via bloodstream until it develops into rhabditiform
larvae.
Rhabditiform larvae
● Develops after 7 days, the feeding stage, sucking blood, has
teeth or cutting plate and can inject hirubin
COMMON SYMPTOMS
● Pica – habitual ingestion of non-food substances
● Geophagy – ingestion of soil
● Creeping eruption – ancylostoma braziliense and caninum can
cause cutaneous larva migrans, they can only penetrate under
the skin. Ancylostoma duodenale can penetrate in the internal
organ.
• Harada-mori technique
CULTURE METHOD
• Filter paper stool culture method which utilizes the water tropism of
strongyloides was to concentrate them.
• Fresh feces are deposited on the filter paper which is soaked with
water and then incubated for 10 days at 30 degrees Celsius.
• Purpose is to allow the hookworm egg to hatch into a larva to be able
to distinguish which species of hookworm.
• In a test tube, there is a 1cc of sterile water, with the filter paper,
drawing a vertical line in the center. Using the applicator stick, poke
the fecal specimen then smear in the vertical line. Fold the filter
paper lengthwise making the fecal material be sandwiched inside.
Then place the filter paper inside the test tube. The edge of the filter
paper should touch the inside bottom of the tube for it to get wet.
The moisture will travel up the filter paper and will cause the
hookworm eggs to hatch. Incubated for 10 days, for the eggs to hatch
becomes a larva. The larvae will travel down the bottom where water
is for the moisture. The water in the test tube will contain the larvae.
Add a few drops of 1% formalin, mixed to immobilize the hookworm
larvae, then place in the glass slides, cover slip and examine under
the microscope.
BENJAMIN CABRERA
• Filipino physician and parasitologist
• Responsible for the introduction of some lab methods in the
Philippines.
• Went to Japan to study RE:the lab methods of culturing hookworms
o Ancylostoma duodenale
o ancylostoma braziliense
o ancylostoma caninum
o necator americanus
• he brought the lab method here in the Philippines of identifying
between the 4 species of hookworm
• conducted a study in one of the islands here in the Philippines
wherein he was able to prove that 96% of those residents are
affected with hookworm
• conducted a mass examination, stool containing hookworms
• mass treatment was conducted for 3 years to eliminate the
hookworm infection in the island
STRONGYLOIDES STERCORALIS
● Threadworm
● The ova, under the microscope, looks the same with ancylostoma
● Time of collection (first question asked when fecal specimen is
submitted to the lab) this is asked because the specimen cant exceed
2 hours after collection, but mostly because of strongyloides
stercoralis, time of collection is important.
● They lay eggs, the eggs stay in the intestinal mucosa and does not go
with defecation s the eggs of the strongyloides cannot be seen
● Freshly collected stool, larvae can be seen.
Blood and
and Tissue
Tissue Nematode
Nematode
Nematodes
Blood
(Filariae)
(Filariae)
Microfilaremia- the appearance of microfilariae in the blood.
Various terms referring to the disease sometimes depend on the names
of the discoverers, place where it was discovered and even the
characteristics of a parasite.
A. SHEATHED FILARIAE
In the sense that they are covered by a lining which is known as a
sheath. The larvae are covered with a sheath.
WUCHERERIA BANCROFTI
● Named after from its discoverer’s last name: Bancroft.
● Disease name: Bancroftian filariasis is a mosquito-borne disease
● Other disease term is Elephantiasis and sometimes because of its
characteristics being found in the blood at night time then it’s a.k.a
Nocturnal filariasis. And because of its habitat which is in the
Lymphatics it is also known as a Lymphatic filariasis.
● Mode of Transmission: No longer by ingestion but a vector which are
the mosquitos. Their breeding place are mostly on moisture area
where water is present.
● Best time of collection usually between 10pm and 4am to visibly see
the microfilaria in the blood under the microscope
● 3 Genuses of mosquitos(vectors) – Anopheles, Aedes, Culex.
o Anopheles minimus flavirostris, aside from bringing
parasite it also serves as a vector for Wuchereria.
o Aedes polynesiensis, the aedes mosquito that brings
Wuchereria.
o Culex fatigans and Culex quinquefasciatus, serves as a
vector for Wuchereria.
CLINICAL PARASITOLOGY | 4

Elephantiasis – is the enlargement of lower extremities. (if Wuchereria
bancrofti)
BRUGIA MALAYA
• Filariasis are commonly found in tropical and sub-tropical
countries: Central Africa, Asia, Sri Lanka, Pakistan, India, Malaysia,
Thailand, Philippines, China, Korea, Japan.
• Anopheles are night time biters.
• Invasion of microfilariae in the peripheral blood is usually between
10pm and 4am. Best time of collection is within those time to visibly
see the microfilaria in the blood under the microscope. (under
Wuchereria). Whereas the Brugia malayi it could be seen during the
day time.
• If the microfilariae died inside a patient’s body it has the tendency to
calcify. If by chance the patience would undergo X-ray it could be
seen there the calcified worm.
• Symptoms: Lymphangitis- Inflammation of the Lymph bloods.
• Chyluria is when there is chyle in the pee. Chyle is a milky fluid made
in the bowels (intestines) during digestion.
• Treatment: Through oral administration of Diethylcarbamazine
(DEC) - a medication used in the treatment of filariasis including
lymphatic filariasis, tropical pulmonary eosinophilia, and loiasis.
• Microscopic examination to detect the presence of microfilariae in
the patient’s blood smear. When the microfilariae die inside the
body, it calcifies (tumitigas), so it becomes visible in the x-ray film.
STAGES
• 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 lymphatic
system.
• The adult worms resemble those of Wuchereria bancrofti but are
smaller.
• Female worms measure 43 to 55 mm in length by 130 to 170 μm in
width, and males measure 13 to 23 mm in length by 70 to 80 μm in
width.
• Adults produce microfilariae, measuring 177 to 230 μm in length and
5 to 7 μm in width, which are sheathed and have nocturnal
periodicity.
• The microfilariae migrate into lymph and enter the blood stream
reaching the peripheral blood.
• A mosquito ingests the microfilariae during a blood meal.
• After ingestion, the microfilariae lose their sheaths and work their
way through the wall of the proventriculus and cardiac portion of the
midgut to reach the thoracic muscles.
• There, the microfilariae develop into first-stage larvae.
• Then, it develops into third-stage infective larvae.
• The third-stage infective larvae migrate through the hemocoel to the
mosquito’s prosbocis and can infect another human when it takes a
blood meal.
LOA LOA
• an eyeworm
• Vector: a type of fly called Mango fly or Deer fly. Belongs to the group
genus Chrysops.
• Symptom: Calabar swelling or fugitive swelling.
• Treatment for Sheathed Filariae: Surgical removal of the worm from
the eye. And oral intake of diethylcarbamazine Phenergan
• Invades the eyes and causes blindness.
• Specimen for Examination: Blood Specimen Microfilariae have been
recovered from spinal fluids, urine, and sputum.
• Mode of Transmission: requires a vector, transmitted through a bite
of an infected deer fly/mango fly.
• Transparent worms visible to the naked eye
• The disease caused by Loa loa can be called African Eye Worm,
Loiasis
• Inhabits/targets the subcutaneous tissue (eye white)
• They invade just below the lining of the eye white or they can travel
and enter the retina which damages the eyesight and causes
blindness.
• The worm can travel from one eye to another and pass through the
nose bridge.
• Symptoms: Calabar, or fugitive, swellings that are localized, non-
tender swellings usually found on the arms and legs and near joints.
Itching can occur around the area of swelling or can occur all over
the body. Eye worm is the visible movement of the adult worm
across the surface of the eye which can cause eye congestion,
itching, pain, and light sensitivity.
STAGES
• During the day they are found in peripheral blood, but during the
non-circulation phase, they are found in the lungs.
• During a blood meal, an infected fly (genus Chrysops, day-biting flies)
introduces third-stage filarial larvae onto the skin of the human host,
where they penetrate into the bite wound.
• The larvae develop into adults that commonly reside in
subcutaneous tissue.
• The female worms measure 40- 70 mm in length and 0.5 mm in
diameter, while the males measure 30- 34 mm in length and 0.35-
0.43 mm in diameter.
• Adults produce microfilariae measuring 250-300 μm by 6-8 μm,
which are sheathed and have diurnal periodicity.
• The fly ingests microfilariae during a blood meal.
• After ingestion, the microfilariae lose their sheaths and migrate from
the fly’s midgut through the hemocoel to the thoracic muscles of the
arthropod.
• There, the microfilariae develop into first-stage larvae.
• Then, it develops into third-stage infective larvae.
• The third-stage infective larvae migrate to the fly’s proboscis and can
infect another human when the fly takes a blood meal.
B. UNSHEATHED FILARIAE
No sheath, no additional covering (naked)
ONCHOCERCA VOLVULUS
● This particular organism is inhabiting both the dermis and the
subcutaneous tissue that will result to disease called river blindness
● The vector is kind of fly called blackfly (Simulium damnosum) - are
breeding along the side of the river
● Not common in the Philippines. The disease is common in Africa,
Guatemala, Mexico, and parts of Venezuela
● The disease can be also called onchocerciasis or River Blindness.
● The larvae (unsheathed) are observed in skin biopsy since the
habitant is in the dermis and subcutaneous tissue
● The difference is that in different location of infection, people also
developed different symptoms
○ Usual appearance of nodules on the site where the vector bites
(after long exposure, minimum is 1 year and above)
○ Nodules - small elevated structures that are developing
outside the skin like boil or cyst like in appearance
○ Mexico and Guatemala – the nodules are developed on the
scalp
○ Africa – nodules appear on the lymph (legs, trunk, hips)
CLINICAL PARASITOLOGY | 5
 ○ Encapsulated worms inside the tumor-like appearance
● Female larvae are bigger than the male
● Surgical procedure: Nodulectomy
○ Surgical removal of palpable nodules
● African onchocerciasis – resulted into hanging groin
● Inhabits/targets the dermis and subcutaneous tissues.
● 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.
● Symptoms:
○ Onchocercomata (subcutaneous nodules) – contains the
encapsulated worms/larvae; starts appearing after long
exposure (1 year and above).
○ Pruritus or itching, Dermatitis
○ Lymphadenopathy is the term for swollen glands or swelling
of the lymph nodes.
○ Hanging groin Ocular lesions that can progress to blindness.
TESTS
● Skin biopsy is done to determine the presence of the parasite and
not by stool exam
○ Method: skin snips
○ Procedure is done by using a needle. Pricking the side of the
skin nodules and raising it up (skin) then slicing it off. Collect
skin snips and bring it to a clinical lab for examination
○ Symptoms: pruritus (itchiness) in parts of the body (any)
○ Other term: onchocercomas– biopsy of onchochercomas
● Presumptive test: Mazzotti test
○ Involves the use of medicine administered orally (DEC)
○ Oral administration is done by 50mg of DEC
○ After the oral administration, the patient will experience
intense pruritus (within a few hours)
○ To control the itchiness, the patient will be given
corticosteroids (the itchiness will subside within 2 to 3 days)
● Another test: Patch test
○ Not orally
○ Need a piece of occlusive dressing (net-like gauze)
○ Apply 10% DEC with Lanolin to the occlusive dressing then
cover the affected area where the nodule is found
MONSONELLA OZARDI
● Mansonella species are less popular than O. volvulus
● Responsible for the disease called Mansonellosis
● Inhabits/targets the body cavities (hollow spaces inside the body).
● Symptoms:
○ Pruritus, arthralgias, headache, rashes, lymphadenopathy,
edema, and eosinophilia. Corneal lesions
● A filarial worm (unsheathed)
● Discovered by Manson (family name) – Filaria Ozzardi Manson
● Mode of transmission: bite of vector
● FH: human
● Vector: a fly with the genus Culicoides
○ Culicoides guttatus
○ Culicoides paraensis
● Habitat: body cavities (hollow spaces)
MANSONELLA PERSTANS
● Considered as nonpathogenic but can cause joint and bone
pain
● MOT: bite of vectors
● Vectors: Culicoides
○ Culicoides grahami
○ Culicoides austeni
● Habitat: peritoneal (stomach) and pleural (lungs) cavity
● All medication for filarial worm is the DEC
● Inhabits/targets the peritoneal and pleural cavities (stomach and
lungs).
● Symptoms:
○ Culicoides paraensis
○ transient subcutaneous swellings
○ pericarditis and pleuritis
○ ocular symptoms (e.g., impaired visual acuity) if microfilariae
enter the eye
○ joint/bone pain, fever, fatigue, pruritus, arthralgias,
○ headache and abdominal pain may occur
○ lymphadenopathy and eosinophilia
MONSONELLA STREPTOCERCA
● Skin biopsy is done to determine the presence of the parasite and
not by stool exam
● Responsible for the disease called Mansonellosis
● M. streptocerca is an Old World species that occurs in
● tropical regions of West and Central Africa.
● Adult worms live in the dermis and subcutaneous tissues.
● Mode of Transmission: requires a vector, transmitted through a bite
of an infected fly/midge.
● Exam for Identification: Microfilariae are found in the skin and can
be diagnosed from skin snips or biopsies.
● Specimen for Examination: Skinsnips
● Treatment: Through oral administration of Diethylcarbamazine
(DEC) -a medication used in the treatment of filariasis including
lymphatic filariasis, tropical pulmonary eosinophilia, and loiasis.
● Symptoms:
○ Method: skin snips
○ pruritus and dermatitis
○ hyperpigmented lesions on the torso
○ eosinophilia
C. SPECIAL NEMATODE
Can be classified as trematodes
DRACUNCULUS MEDINENSIS
● Known as guinea worm, serpent worm; not a true filarial but is
considered a nematode (roundworm) because it appears similar to
other nematodes – cylindrical body.
● Ancient parasite, not true filaria but considered as nematode
(cylindrical body that could reach 1 meter long – longest)
● Small diameter of the body than nematode but longer
● Some of the longest nematodes with recorded lengths up to 100 cm/
1m; an ancient nematode
● Responsible for the disease called Dracunculiasis or Guinea Worm
Disease
● Found in tropical regions of Asia and Africa and in the West Indies
and tropical South America.
● Live in subcutaneous tissues and become clinically evident when the
female worm migrates to the skin surface and produces a blister,
usually on the lower extremities.
● MOT: ingestion (infected drinking water)
● Symptoms:
CLINICAL PARASITOLOGY | 6
 ○ fever, swelling, and pain in the area
○ inflamed skin lesion, which contains an adult worm more
than 90% of worms come out of the legs and feet, but worms
can appear on other body parts, too
○ debilitating arthritis.
● IH: cyclops, copepods (small organisms)
● Exam for Identification: Diagnosis is by inspection. Guinea worm
disease is diagnosed through a simple physical exam. Health care
providers look for the telltale white, stringy worm poking through
the blister once the affected area has been immersed in water.
● Specimen for Examination: adult worm in the lesion
● Treatment: slowly removing the adult worm over days to weeks by
rolling it on a stick or sometimes by surgically removing it.
● Particular in India
○ Get water in the stepwells (people step on the water to get
water for drinking purposes)
● Treatment:
○ Need to remove the worm to lessen the pain that could affect
the walking of the host
○ Submerge the affected area in the water to invite the larvae
out
CAPILLARIA PHILIPPINENSIS
● Discovered in the Philippines (Luzon - Ilocano patient)
● Common name: Pudoc worm
● Symptoms: Gurgling stomach (borborygmus), Diarrhea and
Malabsorption
● Mode of Transmission: Ingestion of freshwater fishes infected with
C. philippinensis; is often found in the tissues of small, freshwater
fish.
● Immediate Host: Freshwater fishes
● Exam for Identification: The specific diagnosis of C. philippinensis is
established by finding eggs, larvae and/or adult worms in the stool
or in intestinal biopsies.
● Can be classified under trematode but still considered as nematode
● Known as mysterious disease before C. philippinensis
● Responsible for the disease called Capillariasis.
● Endemic in the Philippines and epidemics have occurred in the
Northern Luzon region.
● The parasite is also endemic in Thailand, and sporadic cases
● have been reported from other East and Southeast Asian countries.
● Capillaria philippinensis inhabits the small bowel of humans.
● Unembryonated eggs are the typical stage found in the feces. In
severe infections, embryonated eggs, larvae, and even adult worms
can be found in the feces. Note: Examined through stool specimen,
and ova is very similar to Trichuris trichiuria.
● The difference between them is the mucus plugs in C. philippinensis
is CONCAVE-shaped and the ova is shaped like a peanut (with a
―waist line, but not very prominent curve). While in T. trichiuria, the
mucus plugs are CONVEX-shaped and the ova is barrel-shaped.
● Specimen for Examination: Stool Specimen
● Treatment: To treat C. philippinensis, medications that can be used
include mebendazole (200 mg twice a day for 20 days), and
albendazole (400 mg a day for 10 days).
● Can be observe in stool exam or analysis
OVA
• Similar to T. trichiura though the shape has a slight difference
• C. philippinensis has slight waist line shape (peanut shape)
• C. philippinensis – has mucous plugs that are concave while T.
trichiura are convex
Cestodes
Cestodes
Nematodes
Phylum Platyhelminthes
Known to include flatworms. Class cestodes or cestoidia and class
trematoda
TAPEWORM
• Derived from the description of the appearance of the worm like a tape
measure which is flat and long but not wide
• Can be accommodated in the intestines because it can be coiled
• The worm itself is white in color but not having a smooth body or
straight like ascaris
• Clearly has divisions or segments
• Depending on the specie of tapeworm is the number of segments or
division may vary. It may up to reach 1000 to 3000 segments but can
also have 3 segments or proglottids
ORDER
• Pseudophyllidea has one genus which is the genus Diphyllobothrium
o Diphyllobothrium latum – a fish tapeworm that is common in
human host
• Cyclophyllidea has four genuses: genus Hymenolepis, genus Taenia,
genus Echinococcus, and genus Dipylidium
MORPHOLOGICAL CHARACTERISTICS
• Known to be flat-ribbon like organisms
• The body of tapeworms have 3 distinct parts - head (scolex), neck, and
proglottids (strobila)
o In the scolex, some have hooks and other don’t have
o If the tapeworms contain a hook, these are used for attachment
especially on to the intestine
o If the tapeworm doesn’t contain a hook, they use suckers for
attachment to the intestine
o Tapeworms have suckers instead of hooks known as armed
tapeworms while tapeworms with hooks are known as
unarmed tapeworms
• Tapeworm likes to inhabit on the small intestine (digested food)
DIPHYLLOBOTHRIUM LATUM
• Fish Tapeworm
• MOT: Ingestion of infected fishes
• Infective Stage: Plerocercoid larvae
• Common in the Philippines as well as other country but it is not a
problem in the PH because not all people will get infected by this
tapeworm
• Eat infected fish not well cook (raw) – transmission to human host.
Infected fish depends on what place like lakes, rice field, irrigation
canal, pods, and etc.
• Fish can get infected by eating smaller fishes. Freshwater has many
small organisms and crustaceans which will get infected first because
of the polluted water. Small organisms – big fish – humans
• Tapeworm from fish can grow into about 20 to 30 feet long
• Distinct regions are consisting the scolex (head), neck, and strobila
(proglottids)
o Scolex has a structure for attaching like hooks for armed
tapeworms and also have suckers (if no hooks, they will be
attached by the means of sucker)
o Neck is the region of growth and where the proglottids will start
developing
o Proglottids or divisions in the neck are close together near each
other as it is going towards the end of the tail, there is a
distance from the proglottids
CLINICAL PARASITOLOGY | 7
 o Scolex is small and the end of the tail is wider and bigger o Men will be infected with taeniasis or cysticercosis
because of the division • The parasite inside the human host can be also found in the CNS or
o As the tapeworms will elongate, the number of proglottids will central nervous system
increase o Reason why it can be seen on x-ray
o Neck then immature proglottids then mature proglottids and • Similar to pinworm, you can find the ova of Taenia solium using the
those are found at the end of the tail are called gravid scotch tape technique
proglottids o There is a possibility that the Taenia solium egg will pass out by
the anus
• Are armed tapeworm because it has hooks on the suckers that is use
to the intestine
• As the gravid proglottid is going to detach from the body, the term
refers to is known as apolysis
o Apolysis – detachment or the lost of gravid proglottid
INFECTION
• Cysticercosis
o Can be found through x-ray of CNS
o Observed when the larvae become calcified
• If the cysticercosis appear in subcutaneous tissues (muscles), they are
going to produce nodules
WHY GRAVID?
• Because tapeworms have no separate sexes, they are called TAENIA SAGINATA
hermaphrodites • Beef Tapeworm
• Hermaphrodites – one organism contain the both male and female • The eggs of T. solium and T. saginata are indistinguishable
reproductive organ and capable of self-reproduction • Ranging in size from 28 to 40 µm by 18 to 30 µm, the average,
• Mature proglottids has testes and ovaries somewhat roundish Taenia spp. egg measures 33 by 23 µm.
• The longest tapeworm (beef) can grow up to 1000 to 3000 proglottids • The egg consists of a hexacanth embryo, including the standardthree
CHARACTERISTICS pairs of hooklets.
• The gravid proglottid usually detach from the body. When it will • The embryo is surrounded by a yellow-brown shell present on select
detach, it will grow into another tapeworm having also its own scolex, tapeworm eggs known as an embryophore on which distinct radial
neck, and proglottids. This is how they multiple. striations reside. These eggs may be nonembryonated or
STAGES embryonated.
• Sparganum – a larval stage of a parasite that can become infective form
• Plerocercoid larvae – infective stage of tapeworm to a man (fish)
o Smaller fishes in the freshwater are intermediate host then
bigger fishes will eat the small so they become also infected and
then men will eat the fish raw so the men will be infected also
o Fish tapeworm has a lifespan of 20 years
o Fish tapeworm is known as Taenia lata (synonym)
o Head of fish tapeworm is described as spoon shaped scolex
• Disadvantage of having a fish tapeworm:
o Parasite is going to absorb the Vitamin B12 of the host, the host
will have B12 deficiency that will result to megaloblastic anemia
• Symptoms:
o Loss of weight, nervous disturbances
• Treatment:
o Niclosamide
• Prevention:
o Fish should be clean and well cooked
o Put the fish on the freezer (-10OC) for at least 2 days so that the
parasite will die
• Other countries use animal like raw snake (poultice) for the areas
affected like for soar eyes that can cause ocular sparganosis
• Life cycle will start on its infective stage which is the plerocercoid larvae
o The plerocercoid larvae will develop on the flesh of the fish
• The fish tapeworm will develop in the small intestine
• When a patient defecates, some of the fish tapeworm egg will pass out
o If the patient defecates on sea or stream, the eggs will go to the
water and will develop into a coracidium
o Coracidium – circle shaped, has cilia that will move on the water
o The cyclops will ingest coracidium (infected) then big fish eat
the cyclops (infected) then if men will catch a fish and eat it raw
(infected)

TAENIA SOLIUM
• Pork Tapeworm
• MOT: Ingestion
• IS: Cysticercus cellulosae • The typical Taenia spp. scolex measures from 1 to 2 mm in diameter
• Synonym: Taenia cucurbitina and is equipped with four suckers
• Life cycle: 25 years • The primary difference between those of T. saginata and T. solium is
• Habitat: Small intestine (jejunum) that the latter contains a fleshy rostellum and double crown (row) of
• Can transmit the infection by becoming themselves infected with what well-defined hooks whereas the former lacks these structures.
they eat like when they eat something infected on the ground, the PARAMETER DESCRIPTION
infection could transmit to them Size Range 28-40 µm by 18-30 µm
o The meat will be infected. The infective stage known as Hooklets Three pairs; hexacanth embryo
cysticercus cellulosae to men Radial striations on yellow-brown
o Men will eat the pork (raw) = infected Other features
embryophore

CLINICAL PARASITOLOGY | 8
• The average number of segments (proglottids) of typical T. saginata
and T. solium adult worms is 1048 and 898, respectively.
• There are two primary differences between the internal structures in
the proglottids of the two Taenia organisms, appearance and number
of uterine branches on each side of theuterus. A T. saginata proglottid
is typically rectangular, averaging 17.5 by 5.5 mm; 15 to 30 uterine
branches are usually present on each side of the uterus.
• Stool is the specimen of choice for the recovery of Taenia eggs and
gravid proglottids. The scolex may be seen only after the patient has
beentreated with antiparasitic medication.
• Furthermore, there is evidence to suggest that specimens collected
around the perianal area using the cellophane tape prep procedure
result in a very high recovery rate of Taenia eggs.
• It is important to note that the eggs of Taenia are identical. To speciate
in the laboratory, a gravid proglottid or scolex must be recovered and
examined.
LIFECYCLE
• Infection with Taenia spp. occurs following the ingestion of raw or
undercooked beef (T. saginata) or pork (T. solium) contaminated with
a cysticercus larva, a type of larva that consists of a scolex surrounded
by a bladder-like, thin-walled cyst that is filled with fluid. Scolex
attachment to the intestinal mucosa occurs after the larva emerges in
the small intestine, in which maturation into an adult worm occurs.
• The resulting adult multiplies, producing numerous eggs, some of
which may be passed into the feces.
• These eggs are then consumed by the proper animal species (cow or
pig) in which the oncosphere hatches. The oncosphere then migrates
• via the blood to the animal tissue and converts into the infective
cysticercus larval stage. A new cycle is initiated on human ingestion of
the infected animal meat.
• T. saginata is found primarily in these types of cosmopolitan areas.
areas of the world in which the inhabitants do not practice sanitary
conditions and beef or pork is eaten on a routine basis.
• Most people who become infected with Taenia spp. typically remain
asymptomatic.
• Nondescript symptoms, such as diarrhea, abdominal pain, change in
appetite, and slight weight loss, may be experienced by Taenia-
infected patients.
• In addition, symptoms including dizziness, vomiting, and nausea may
also develop.
• Laboratory tests often reveal the presence of a moderate eosinophilia.
The prognosis is usually good.
• The most important and, in some cases, difficult aspect of treatment
of Taenia infections is total eradication of the scolex. Fortunately,
praziquantel has proven effective against the entire adult worm;
however, it is not used when there is ocular or central nervous system
• (CNS) involvement. Paramomycin and quinacrine hydrochloride
(Atabrine) may also be used as alternative treatments.
ECHINOCOCCUS GRANULOSUS
● Sheep tapeworm
● Dogs eat the carcass of the sheep. If the sheep dies due to tapeworm
infection, the infections will be transferred to the dog.
● Human can be accidental host to Echinococcus granulosus
● Meat contains the hydatid cyst, develops starting from 1mm in
diameter, after 1 months it becomes the size of an orange. Cyst easily
develops or grows. So, when the infected individual has a cyst in the
body, it can grow and grow within 10-20 years, the size of the cyst can
grow into the size of a basketball. Scolexes are found inside
● Ultrasound can be used to diagnose it. Surgery can be performed to
remove the cyst from its location. If it is in the vital organs, they only
use medication for treatment. Albendazole
● In the brain, the cyst can also produce Jacksonian epilepsy, an epileptic
attack as a symptom. This is because of intracranial pressure.
● In the case of morphology, the only tapeworm having 3 proglottids
only- immature, mature, and gravid proglottids. Starts from the neck
down to the end.
● Same with taenia solium, it has suckers, an armed tapeworm.
● For the examination, aside from stool, there is a serological test known
as casoni test -skin test which includes intradermal injection of the
antigen, so when the result comes out positive the test result remains
for life even with medication.
● It has synonyms, echinococcus vogeli, echinococcus multilocularis.
DIPYLIDIUM CANINUM
● Dog tapeworm
● Synonym; taenia canina (from the word canines), taenia cucurmerima
● Also, this is a tapeworm of the dogs, insects like fleece and lice serve
as vectors of dog tapeworm. Can be transmitted to other things.
● Human are occasional host
● Fleece, genus pulex, genus ctenocephalides
● Lice, trichodectes canis
● To prevent this, infected dogs should have periodic deworming
● Can be detected by stool examination
● Armed tapeworm containing hooks
● The ova appear as egg pockets, because the eggs have many nuclei
unlike in the case of hookworms which contain 4-8 nuclei.
● Diagnosis: egg pockets can be seen in the stool.
CLINICAL PARASITOLOGY | 9
 Nematodes
Fecal Material
● Urobilin and Stercobilin
● Purple stool – not to worry, color due to mixture with other
substances in the body
● Real blood on stool – know the cause of blood
● Scybalous stool (hard) – Blood expected is fresh red blood on stool –
Proglottids of Dipylidium caninum due to irritation in lower GIT
RAT TAPEWORM ● Black stool
Hymenolepis nana (taenia murina) o Supplements containing Fe capable of producing black color of
● a common parasite of a house mouse. Common name is dwarf stool (no clinical significance)
tapeworm since it is small. Changed to vampirolepis nana. o Not taking supplements containing Fe, there is bleeding in the
● The infection is transmitted to men by ingestion, the infective stage is upper GIT (blood is mixed with acid in the stomach making
embryonated ova. blood black as well as the stool) Ex. Peptic ulcer – wound/injury
● Armed with hooks ● Always check stool before flushing to monitor if something is wrong in
● Diagnosis: find the eggs in the feces of the patient. Best method is zinc your body and to know when abnormalities has been starting
sulfate centrifugal flotation ● Soft – normal consistency of stool
● Symptoms: epilepsy ● Constipation - Scybalous stool (pain/irritation on the anus)
● Produce oncosphere, then penetrate in the intestine that develops to ● Enough water and fibrous foods to soften stool
cysticercoid larva. After 4 days, it matures to the adult stage. Then ● One day – minimum of once to defecate
reproduction again ● More than once a day of defecation is considered normal as long as
● Treatment: praziquantel not diarrheic stool
● Importance of defecating daily – cleaning of colon
● Colon cancer – usually people who cannot defecate
● Amount of stool – (from fingers to elbow), if only less like 3 inches then
other waste products can lead to poisoning which is why releasing of
waste products that are formed daily is important
● Alternate days of defecating – small waste product that has been
formed today (not released today), by tomorrow the moisture of the
waste product will be reabsorbed back into the circulation leaving
waste product dehydrated and hard
● Cellulose foods/Fibrous – encouraged
● Sprouted monggo – sometimes when defecating sprouted monggo is
seen (stem of monggo is cellulose giving roughage to wastre material)
● Water should be enough to soften stool
● Foul odor – normal odor of stool
● Indole and Skatole – substances responsible for odor of stool
● Obnoxious odor – (very foul odor)
● Diet high in protein (carnivorous) – leads to fouler odor even in urine
● Vegetarians – less foul odor
● pH 7-7.8 - Normal pH of the stool
● Steatorrhea – presence of fats on stool
○ Giardiasis
○ causes: protozoan infection
○ parasite associated: Giardia lambia
Hymenolepis diminuta ● Hematochezia, Melena - presence of blood on stool
● host/vectors are flour beetles, and flour moths. ● Normal volume/amount of waste products released every defecation
● No hooks – 150-300 grams
● Niclosamide is the treatment of choice
Methods
Methods
● Disease name: hymenolepiasis ● Nematodes
● Stool exam ●
● DFS – direct fecal smear
● Kato thick smear
● Concentration method – sedimentation method and flotation method
● Routine Fecalysis
● Macroscopic examination (physical - color and consistency)
● Obnoxious odor even from distance – presence of parasite even when
not high in protein
● Odor of stool is clue for Med Techs
● Dr. Benjamin Cabrera – Filipino physician
○ Went to Japan to study these methods, responsible for
introducing these methods in the Philippines
○ Kato thick smear
○ Harada mori culture
● Specimen for routine fecalysis aside from DFS, kato thick smear should
be done as well to have more efficient and accurate results
● Relying only on DFS more so one smear may differ the result from
different MedTechs using the same specimen (inconsistencies)
● If only DFS, at least prepare 2 fecal smears (more than one) using the
same specimen
● Poke specimen several times in all portions of the specimen to get the
parasite
● Kato thick – thicker than DFS
● NSS
● Turbid smear – homogenous
● Kato thick smear - poke the applicator stick on the specimen and make
a smear on the slide w/out any diluent (pure stool no NSS)

CLINICAL PARASITOLOGY | 10
● Cellophane – cut the cellophane into squares (size of a cover slip),
contain in a jar and soak it for a minimum of 24 hours using 1:1 of
glycerin and water
○ Used for fecal smear
○ Green coloured cellophane – under the microscope green
background
○ DFS – no background color
○ Cork stopper – press the cellophane to so that it will stick on
the fecal material versus the glass slide
○ Side to side pressing to remove air bubbles underneath the
cellophane
○ Presence of bubbles may be wrongly detected as ova of
parasite
○ After preparation leave for 3-5 minutes
● DFS – if there is ascaris ova on the smear ex. 0-1 on the kato thick
smear not only 0-1 but a higher result
● Advantageous – both DFS and Kato thick smear
● Very diluted smear (thin preparation) – lesser chance of finding
parasites
● Kato thick smear – (thick) more chance of finding the parasites
● Concentration method – based on the request of the physician, not
common prepared in the laboratory
● Flotation method – reagent needed Zinc Sulfate solution
○ Pea size – poke on the fecal smear on different portions
○ Place at least pea sized of the specimen on the bottom of the
test tube and pour distilled water (sterile) about ¾ full, using
the same applicator stick stir/mix the fecal material w/ the
water to come up with a fecal suspension
○ Test tube – place on centrifuge machine 5 minutes or more
○ Centrifuge - should be balanced
○ After centrifugation, remove test tube and you can see the
fecal material settle. Supernatant liquid (cloudy)
○ Decant (throw out the supernatant liquid) – container
disinfectant (Lysol) – pour the supernatant liquid leaving the
sediments behind
○ Add distilled water again to the test tube (3/4) full and mix the
sediments with the same applicator stick
○ Centrifuge the test tube again, after centrifugation decant
again the supernatant liquid (clearer than the first)
○ Then centrifuge again (same process) until such time that the
supernatant liquid is clear
○ If supernatant liquid is already clear, decant again leaving the
sediment behind
○ Instead of distilled water, add Zinc sulfate solution
○ Zinc sulfate solution – specific gravity of 1.180 – allow the ova
of the parasite to float on the solution
○ After adding the zinc sulfate solution, stir using the same
applicator stick and centrifuge for the last time
○ After centrifugation, there are 2 manners: wire loop used to
fish out the floating on the solution, liquid will be obtained
with the parasites that cannot be seen with the naked eye then
apply on the glass slide, another method, after centrifugation
with the Zinc sulfate, slowly pour zinc sulfate onto the test tube
until it is going to fill the brim of the tube, then position the
glass slide on the mouth of the tube
● Most ova of the parasites float on the solution having a specific gravity
heavier than the ova itself
● Sedimentation method – centrifuge using distilled water
● Unlike flotation method instead of floating the ova, ova will settle on
the bottom
○ Same process with flotation method, but reagent used will
allow the ova of the parasites to settle on the bottom of the
tube
○ Reagent is lighter than the parasites so that the parasite will
settle on the bottom
○ Acid and Ether – Formalin (acid)
○ Get the sediments and transfer on the glass slide and examine
on the microscope
ERRORS TO AVOID DURING MICRSCOPE EXAMINATION
• When you are going to focus under the microscope, the specimen on
the slide should not be allowed to dry.
• Smear on the glass slide, although it is covered, if we are going to delay
the examination in the microscope, take note that we are using
electronic microscope—there is a light and it is connected to the
electricity, it means the glass slide on the stage has light (galing sa baba
at pataas) so that it will clear on the objective lens and then going
towards the eyepiece.
• The light can heat up the smear, so when we delay the process of
scanning the specimen, the heat from the light can dry up the specimen
on the glass slide. When it dries up, it will be more difficult to recognize
the elements because fecal debris together with the microscopic
elements of the feces including the parasite the rbc, puss cells or crystal
becomes black.
• In preparation, avoid too thick or thin smear. If it is too thick it will be
difficult to recognize because it is dark. If it is too thin, chances to see
something significant are lesser.
• Too bright illumination should be avoided. If it is very bright, the outer
membrane of the ova cannot be seen. if the outer membrane cannot
be seen, we can no longer distinguish if it is corticated or not.
ADDITIONAL INFORMATION
• Fecal specimen that are diarrheic should be examined by direct fecal
smear. Because it cannot be processed by the kato thick smear if it is
diarrheic specimen. No NSS should be added to it. Using a dropper, stir
the diarrheic stool to make sure it is well mixed.
• Preservation of fecal specimen is not required before a routine stool
analysis. It depends on whether you have collected it very early before
bringing to the laboratory-no need for preservation.
• Usually for enterobius vermicularis, the ova appear somewhat similar
to inverted letter D, because one side is a little bit round but on the
opposite side it is flattened -lope sided ova. Under the microscope, we
will be finding embryonated ova
• From low power we shift to high power when we are scanning the
specimen under the microscope. Under low power, it is not so clear.
Cytoplasm can be seen on high power. If it is only on low power, inside
the pinworm ova we can see a small line on the center-we cannot
appreciate it. But if it is in high power, we can clearly view that the line
is only part of the embryo wherein the developing embryo is somewhat
folded.
• The difference of the C. philippinensis with T. trichiura is on the shape
of the ova – trichuris has barrel shape, where as capillaria has peanut
shape. The mucus plug, trichuris is elevated-convex shape, whil in the
capillaria is concave shape.
• Hookworm ancylostoma & necator, strongyloides has the same ova
appearance – oblong shape, doubled-walled cytoplasm. On the center
of the cytoplasm, we can see 4-8 nuclei. The number of nuclei depends
on the stages. We do not find the ova in the stool examination for
strongyloides. The laying of the eggs in the mucosa of the intestine,
and therefore it is going to hatch frist, after developing it becomes
larvae-this is the time it will go out with the stool. Usually, even though
the stool is collected freshly, we will not find egg – instead larvae.
Hookworms does not lay larvae, instead lay will only develop when the
stool is already considered old stool-collected several hours ago. Eggs
comes out with the feces.
• Trichinella spiralis, there are no eggs, they are laying larvae. In the
muscles, larvae are visible – immature larvae are still very small like
short lines, then when it becomes adult larvae this is the time it will coil
and encyst in the muscles.
• Ascaris and trichuris larvae are similar, the only difference is the shape
because trichuris larvae has one thin end-described as whipworm.
Trichuris larvae as having thread tail. To distinguish the male and
female larvae – usually, ascaris larvae both ends are tapering but the
posterior end for female is straight, male has coiling posterior end.
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