MEDICAL TECHNOLOGY ASSESSMENT PROGRAM

PARASITOLOGY REVIEW NOTES

PREPARED BY: MA. CARMEN S. DIZON
INTRODUCTION PARASITE ACCORDING TO LOCATION

PARASITOLOGY ECTOPARASITE

✓ Area of science that deals with the study of ✓ Inhabits the surface/outside the host without
organisms – parasites penetrating the host
✓ Infestation is term used
CLINICAL PARASITOLOGY ✓ E.g., Ticks and mites

✓ Concerned primarily in the animal parasites of ENDOPARASITE

human as well as their medical importance
✓ Inhabits inside the body of the host
BIOLOGICAL RELATIONSHIP ✓ Most parasites fall under this category
✓ E.g., Ascaris lumbricoides and Entamoeba
SIDE NOTES histolytica
Host – it harbors the parasite
Organism – could be parasite; depends on the host PARASITES ACCORDING TO THEIR EFFECT TO THE
for survival HOST

PATHOGENIC
SYMBIOSIS
✓ Can cause harm or injury to the host
✓ Association between two different species
living together NON-PATHOGENIC/COMMENSAL
MUTUALISM ✓ Cannot set up a disease process in mam
✓ No harmful effects
✓ Both the host and the organism are benefited

COMMENSALISM PARASITES ACCORDING TO HABITAT/LOCATION

✓ One organism is benefited and the other one ✓ Erratic – usually lives in the organ which is
is either benefited or harmed different from the one it parasitizes
✓ E.g., Entamoeba histolytica
PARASITISM
PARASITE ACCORDING TO HOST
✓ One organism/parasite depends on the other
organism for survival A. Obligate Parasite – cannot survive without
✓ Organism benefits, host is damaged the host
• i.e., Plasmodium spp.
COMPONENTS OF PARASITISM B. Facultative parasite – live as parasitic form
of free-living parasite
DIFFERENT TYPES OF HOSTS • i.e., Strongyloides stercoralis
C. Accidental parasite – usual host is being
A. Definitive – harbors the adult/sexual stage of infected
parasite • i.e., Echinococcus granulosus
B. Intermediate – harbors the larval/asexual D. Aberrant Parasite – the infected site is not
stage the normal location
C. Paratenic – remains viable but no further • i.e., Trichinella spiralis
development; transmission is also possible E. Hyperparasite – another parasite as the host
D. Reservoir – important source of infection for • i.e., Ctenophalides canis –
susceptible host Dipylidium caninum
E. Accidental – unusual host
PARASITE ACCORDING TO HOST (Other Types)
PARASITE
F. Permanent - parasite lives in the host from
✓ Effect to the host
early life to maturity
✓ Habitat/location
G. Incidental – a.k.a. accidental; occurs in an
✓ Structures
unusual host
✓ Other types of parasites

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MEDICAL TECHNOLOGY ASSESSMENT PROGRAM
PARASITOLOGY REVIEW NOTES
PREPARED BY: MA. CARMEN S. DIZON
H. Intermittent – visits the host during feeding 1. Direct – only one host; definitive host
time (i.e., flies/vectors) 2. Indirect - requires two or more host
I. Periodic – larval and adult stages are usually 3. Intermittent or temporary – visits host during
passed in different host feeding time (i.e., Anopheles spp.)
J. Transitory – larval stage goes to the host; if 4. Erratic – lives in the organ different from the
adult – free living one it usually lives (i.e., Entamoeba
K. Copozoic/Spurious – parasite that passes histolytica)
alimentary tract
L. Zoonotic – non-human parasites; usually MODE OF TRANSMISSION
animal parasites but can still cause human
infections 1. Through skin bites (arthropods, vectors)
M. Pseudoparasites – debris/artifacts usually2. Through digestive system – ingestion of contaminated
mistaken as a parasite food and water
N. Caprophilic – parasite that may be readily3. Through reproductive system – transplacental/through
cultivated at room temperature but actually sexual activity
die at 37 deg. C 4. Through respiratory system – inhalation/saliva/sputum
O. Hematozoic – blood dwelling parasite 5. Through the placenta – most frequent transplacental
P. Cytozoic – parasites that are attached to a6. Through contact with the animals – from zoonotic types
cell
Q. Coelozoic – parasite that lives in the body METHODS OF PARASITIC CONTROL
cavities of the host
R. Enterozoic – usually lives in the lumen of the 1. Use of insecticide and other chemicals
intestine 2. Use of protective clothing
3. Use of protective netting
PARASITES ACCORDING TO STRUCTURE 4. Proper water treatment
5. Good personal hygiene
PROTOZOA 6. Proper sanitation practices
7. Proper handling, cooking and protection of
✓ Unicellular parasites; usually smaller in size food
8. Avoidance of unprotected sexual relations
ANIMALIA
PARASITES
✓ Multicellular; bigger in size
PROTOZOA
IMPORTANT TERMS
✓ Amoeba - most pathogenic: E.
Vector – transmitting arthropods, flies that are histolytica
considered as a carrier from one host to another ✓ Ciliates - B. coli
✓ Flagellates
Carrier – they are the one that usually harbors the
o Atrial – G. lamblia
infectious pathogen without signs and symptoms
o Hemoflagellates – Leishmania
Infection – endoparasite ✓ Apicomplexa – group of malaria or
Plasmodium spp.
Infestation – ectoparasite
ROUNDWORMS
Sporadic – gets food/nutrients from the host
✓ Intestinal – Ascaris lumbricoides
Endemic – disease or condition which is found among
✓ Extraintestinal – Trichinella spiralis
particular people
✓ Blood – Wuchereria bancrofti
Epidemic – wide spread occurrence of infectious
disease
FLATWORMS

Pandemic – global epidemic, spreads more than one ✓ Trematodes – Taenia saginata
continent ✓ Cestodes – Fasciola hepatica

Superinfection – an infected individual can be

reinfected by the same species; massive infection
SARCODINA/AMOEBA
TYPES OF LIFE CYCLE

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MEDICAL TECHNOLOGY ASSESSMENT PROGRAM
PARASITOLOGY REVIEW NOTES
PREPARED BY: MA. CARMEN S. DIZON
✓ Equipped with locomotory organelle o Nucleus: Spherical in size and
pseudopodia contains central karyosome,
surrounded by clear halo and
INTESTINAL AMOEBA – FREE LIVING AMOEBA anchored to the nuclear membrane
usually not pathogenic – Opportunistic, from by fine radiating fibrils cartwheel
water appearance.
E. histolytica – only Naegleria fowleri ✓ Cyst:
pathogenic o Chromatoidal bodies which are cigar
E. dispar Acanthamoeba shaped or rod shape
E. coli o Quadrinucleated
E. polecki
E. hartmanni ENTAMOEBA HISTOLYTICA TROPHOZOITE
E. gingivalis DIAGRAM MICROSCOPIC
Endolimax nana
I. butschlii

STAGES SEEN IN AMOEBA

A. TROPHOZOITE
✓ Vegetative stage a.k.a. feeding stage DISTINGUISHING FEATURES
✓ Tissue invader ✓ Uninucleated
✓ Susceptible to damage ✓ Clear Cytoplasm (Fine Granules)
✓ Can only be stained by permanent ✓ Bull’s Eye karyosome
stain such as Iron Hematoxylin and ✓ Finger Like Pseudopodia
Trichrome stain ✓ Rapid unidirectional progressive motility
✓ Motile ✓ With Ingested RBC
✓ Larger as compared to cyst
✓ Uninucleated
✓ Watery feces MORPHOLOGICALLY SIMILAR TO
B. CYST PATHOGENIC ENTAMEOBA HISTOLYTICA
Entameoba dispar RNA & DNA contents
✓ Active state – infective
Entamoeba polecki Usually seen in pigs;
✓ Non-tissue invader
uninucleated
✓ Resistant to damage Entamoeba hartmanni Small
✓ Can be stained by iodine
✓ Immotile
✓ Smaller as compared to trophozoite TABLE OF DIFFERENTIATION
✓ Can be multinucleated E. histolytica E. coli
✓ Usually in formed feces TROPHOZOITE
Size (um) 12-60 20-50
TRANSITORY STAGES SEEN IN AMOEBA
Motility Progressive/unid Sluggish non
irectional directional
✓ Reproductive process
Pseudopodia Long and finger Blunt and
1. Excystation = Cyst → Trophozoite = like rounded
Metacystic trophozoite (transitory stage prior Cytoplasm Ground glass Trashy
to excystation) Inclusion RBC Bacteria and
2. Encystation = Trophozoite → Cyst = Precyst debris
Nucleus Central but Eccentric
Entamoeba histolytica
indistinct
Karyosome Bull’s eye Large/eccentr
✓ Amoebic dysentery intraintestinal or
karyosome ic
extraintestinal
CYST
✓ Trophozoite
Size(um) 10-15 10-30
o Cytoplasm: Outer ectoplasm is
# of nucleus 4 8
clear, transparent, and refractile.
Shape Spherical Spherical or
Inner endoplasm is finely granular, oval
having a ground glass appearance. Chromatoidal Rod Broom stick
The endoplasm contains RBCs. bodies shaped/cigar
shaped

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MEDICAL TECHNOLOGY ASSESSMENT PROGRAM
PARASITOLOGY REVIEW NOTES
PREPARED BY: MA. CARMEN S. DIZON

COMMENSAL INTESTINAL AMOEBA

E. nana I. butschlii E.
gingivali
s
TROPHOZOITE
Size(um) 6-15 6-20 5-25
Pseudop Bluntly Bluntly Multiple
odia rounded rounded bluntly
rounded
Nuclear Large, blot Central Central ACANTHAMOEBA
karyosom like achromati
e c granules ✓ Acanthopodia – mode of locomotion
Movemen SLUGGISH NON- DIRECTIONAL ✓ Sample is CSF or Corneal Scrapings from
t contaminated contact lenses
CYST ✓ Can cause primary amebic keratitis
Size(um) 5-14 5-18 ABSEN
T Amoebic Trophozoite Amoebic cyst
Spine like pseudopods Double cell wall with
Shape Oval Irregular known as acanthopodia outer ragged edges
Number 4 1 Large Eccentric Large central
of nuclei karyosome karyosome
Chromato Small and
idal body Spherical
CILIATA

NAEGLERIA FOWLERI Balantidium Coli

✓ Opportunistic protozoan ✓ Can cause intraintestinal lesion

✓ Sample is CSF ✓ Largest protozoa
✓ Associated with primary meningoencephalitis ✓ Only pathogenic Ciliata to human
from stagnant water or through inhalation ✓ Presence of two nucleus
o Macronucleus – vegetative stage –
Amoebic Trophozoite Elongated with broad for storage of food
anterior and tapered o Micronucleus – for reproduction
posterior – seen in ✓ Presence of contractile vacuoles
CSF ✓ Trophozoite: Cytosome: considered as the
cell mouth; Cytopyge: cell anus
✓ Trophozoite exhibits directional tumbling
motility
✓ Cystic stage is the infective stage
✓ Can cause balantidial dysentery
Amoebic Cyst Uninucleated with ✓ Mode of transmission: ingestion of
thick cell wall contaminated food
✓ Zoonotic: dogs or pigs (?)

TROPHOZOITE CYST

Flagellate Pear shape flagellate

with two whiplike
structure; Jerky or
spinning movement

FLAGELLATES

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MEDICAL TECHNOLOGY ASSESSMENT PROGRAM
PARASITOLOGY REVIEW NOTES
PREPARED BY: MA. CARMEN S. DIZON
Lumen Habitat DIAGRAM MICROSCOPIC
Dwelling/ Giardia
Atrial Flagellate lamblia
Chilomastix Large
mesnili Intestine
Enteromonas Large
hominis Intestine
Retortamonas Large
intestinalis Intestine
DISTINGUISHING FEATURES
Dientamoeba Large
fragilis Intestine ✓ Ovoid in Shape
✓ Two – immature cyst Four – mature
Trichomonas Mouth
✓ Cytoplasm retracted in cell wal
tenax
✓ Median bodies (2-4)
Trichomonas Large
✓ Can cause giardiasis
hominis Intestine
Trichomonas Vagina and
vaginalis urethra Trichomonas
Hemoflagellates Leishmania Reticuloendot
helial cells ✓ No cystic stage
Trypanosoma Connective
✓ Pear shaped; five anterior flagella and one
brucei tissue
posterior flagellum
Trypanosoma BOTH
cruzi ✓ Nervous jerky (non-pathogenic); rapid jerky
(pathogenic)

Trichomonas tenax ✓ Buccal scrapping

Giardia lamblia or Giardia intestinalis
Non-Pathogenic ✓ One ovoid nucleus
filled with chromatin
✓ Most common protozoan pathogen worldwide
granules undulating
✓ Causes traveler’s diarrhea due to membrane
contaminated water extending 2/3 of the
✓ ONLY flagellate that inhabits the small body length
intestine ✓ Thick axostyle
✓ NOT a tissue invader but attaches to mucosal curved around
linings by means of sacking disks nucleus
✓ Associated with gay bowel syndrome and ✓ Small cytosome
malabsorption syndrome Trichimonas vaginalis ✓ Stool
Pathogenic ✓ Spherical nucleus
GIARDIA INTESTINALIS TROPHOZOITE with central
DIAGRAM MICROSCOPIC karyosome
✓ Whole body length
undulating
membrane
✓ Axostyle extends
beyond the
posterior part
✓ Conical cytostome
cleft
DISTINGUISHING FEATURES Trichimonas vaginalis ✓ Vaginal
✓ Presence of sucking disk, two axonemes and Pathogenic discharge/urine
two parabasal bodies ✓ Ovoid nucleus filled
✓ Pear-shaped or teardrop which is bilaterally with chromatin
similar granules
✓ Falling leaf like motility ✓ Undulating
✓ 4 pairs of Flagella (8) membrane half part
✓ One pair anterior of the body
✓ One pair posterior ✓ Axostyle coiled
✓ Two pairs central extending lateral around the nucleus
✓ Absence of
cytostome but
GIARDIA INTESTINALIS CYST granules along
axostyle is present

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MEDICAL TECHNOLOGY ASSESSMENT PROGRAM
PARASITOLOGY REVIEW NOTES
PREPARED BY: MA. CARMEN S. DIZON
OTHER INTESTINAL FLAGELLATES Leishmania

Chilosmastix mesnili ✓ Mammalian type of parasite

✓ Has oval shape; length: 2/3
Distinguishing Features
✓ Intermediate host: Phlebotomus (samdfly)
Trophozoite Pear shaped
✓ Developmental stages: amastigote and
Stiff rotary movement
4 flagella: 3 anterior, 1 promastigote
extending to posterior ✓ Infective stage to man: promastigote
Prominent cytostome
with fibrils Leishmania forms
Spiral groove Amastigote (Human) Lives intracellularly
Curved posterior (can be seen on
Cyst Ovoid in shape monocytes,
Lemon shape with clear polymorphonucleocyte
hyaline knob on its s and endothelial cells)
anterior end Round to oval
Well-defined cytostome Kinetoplast is present
at side of nucleus with dot like
blepharoblast
Parabasal body
Dientamoeba fragilis adjacent to
blepharoblast no
Distinguishing Features
flagellum
Trophozoite No cystic stage
usually found in cells
amoebaflagellate
Irregularly round Lectomonas/Promastigo Usually seen in
Broad hyaline leaflike te (Vector) intermediate host
Long and Slender
pseudopodia
One near center
Fragmented karyosome
Kinetoplast present
(4-8)
Free single flagella
Binucleate condition

Trypanosoma brucei
Enteromonas hominis
Distinguishing Features ✓ Intermediate host: Glossina (Tse-tse fly)
Trophozoite Body flattened on one ✓ Developmental stages: epimastigote,
side trypomastigote and metacystic
Four flagella: 3 anterior,
trypomastigote
1 posterior
✓ Infective stage to man
Cyst Quadrinucleated with
two at each opposite Trypanozoma cruzi
side
✓ Intermediate host: Reduviid bug/Triatomine
✓ Kissing bug/assassin bug
Retortamonas intestinalis
✓ Developmental stages: epimastigote,
Distinguishing Features
metacystic trypomastigote, amastigote
Trophozoite Two anterior flagella
✓ Infective stage to man: metacystic
Cytostome extending
halfway with well trypomastigote
defined fibril boarder
Trypanosoma gambiensi and rhodesiense forms
Cyst Lemon shaped
Two fused fibrils Epimastigote (Vector) Long and Wider than
resembling bird’s beak promastigote
near nucleus Undulating membrane
half of body length
Free flagellum
Trypomastigote Long and Slender (C, S
HEMOFLAGELLATES
(human) or U shape)
Undulating membrane
✓ Definitive host: man whole body length
✓ Intermediate host: vectors/arthropods Free flagellum

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MEDICAL TECHNOLOGY ASSESSMENT PROGRAM
PARASITOLOGY REVIEW NOTES
PREPARED BY: MA. CARMEN S. DIZON
Trypanosomes ✓ Trophozoites: compact (rarely seen in
peripheral blood
Disease Associated ✓ Schizonts: 8-24 metrozoites (rarely seen in
Trypanosome West African Sleeping peripheral blood)
gambiensi Sickness
MOT: salivary/skin Winterbottom sign and Plasmodium Plasmodium vivax
inoculation Kerandel sign falciparum
Trypanosoma East African Sleeping RBC inclusions: RBC inclusions:
rhodesiensi Sickness Maurer’s dots schuffner’s granules
MOT: salivary skin
inoculation
Trypanosoma cruzi South American
MOT: fecal Trypanosomiasis/Chaga
transmission after skin Chagoma and Romana
inoculation Sign

Pathogenicity of Leishmania Plasmodium malariae Plasmodium ovale

RBC inclusion: RBC inclusion:
Leishmania donovani Visceral leishmaniasis/
Zieman’s dots James’ dots/schuffners
Spx of choice: aspiration Kalazar fever/ Dumdum
fever/ Black disease/
Tropical Splenomegaly
Notes to remember:
Leishmania tropica Cutaneous
✓ Sickle cell trait: resistant to Plasmodium
Spx of choice: skin leishmaniasis/ Oriental falciparum
biopsy sore/ Aleppo/ Baghdad
✓ Relapse: P. vivax and P. ovale
boil/ Delhi ulcer
✓ Duffy negative (Fy (a-b-)) - resistant to P.
Leishmania braziliensis Mucocutaneous vivax
Spx of choice: tissue leishmaniasis/
biopsy Espundia/ Chiclero
ulcer/ American
P. P. P. P.
leishmaniasis
falcip vivax malaria ovale
arum e
RBC All Reticul Senesc Reticul
PLASMODIUM spp.
preferenc size ocytes ent/old ocytes
e
Apicomplexa
Hypnozoit A P A P
e
✓ No definite locomatory organelle
Stages in Gametocyte/RF/trop
✓ Most common worldwide: Plasmodium vivax PBS
✓ Infective Stages Microgam Spherical, pale blue cytoplasm
o Man etocyte
▪ Intermediate host Macroga Spherical, deep blue cytoplasm
▪ Infective Stage: sporozoite metocyte
o Mosquito (Vector)
▪ Definitive host
▪ Infective: gametocyte BLOOD

Plasmodium vivax ✓ Thick smear: rapid diagnosis

✓ Thin Smear: identification of spp.
✓ Schizonts: 12-24 merozoites ✓ For demonstration of malaria, blood should be
✓ Trophozoites: ameboid, deforms the collected during the peak of fever (paroxysm)
erythrocytes ✓ Rule: Smear for suspicion and another smear
✓ Gametocytes: round-oval after bout of fever
✓ Smears should be done before antimalarial
Plasmodium falciparum
treatment
✓ Rings: double chromatin dots; accole forms, Giemsa – commonly Leishman stain
multiple infections in the same red cell used stain No fixation needed:
✓ Gametocytes: mature (M) and immature (I) alcohol
forms; (I) is rarely seen in peripheral blood

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MEDICAL TECHNOLOGY ASSESSMENT PROGRAM
PARASITOLOGY REVIEW NOTES
PREPARED BY: MA. CARMEN S. DIZON
✓ Buffered H2O +
fixed in
methanol
DIFFERENT STAGES OF MALARIAN PARASITE
✓ Cryptozoite – stage that initially develop in
hepatic cells (extracellular infection) → infect
RBC (intracellular infection)
✓ Trophozoite – ring form; earliest form after
the invasion of the red cells; known as the
RUBY RING STAGE; vegetative stage
containing 1 nucleus and develops within
RBC
✓ Schizonts – trophozoite in which nucleus has
divided
✓ Merozoites – infect healthy RBC
✓ Hypnozoites – domant stage that persist in
liver cells but only in P. vivax and P. ovale
✓ Gametocytes – large parts that suck RBC →
gametes (mature) → zygote → ookinete
(motile zygote) → oocyst (encysted form) →
sporocyst → sporozoite
o Asexual cycle – there’s no union of
gametocytes in the human body
Babesia microti
✓ Due to tick bites (pulgas/ixodes)
✓ Intraerocytic parasite
Merozoite
✓ Four trophozoite attached with Maltese cross
appearance; somewhat similar to malariae
✓ Lack of blood pigment; no large growing
trophozoite/gametocyte
✓ Many ring forms (4-5); much smaller
✓ Babesiosis – disease cause by B. microti
✓ Not a malarial parasite but similar because of
the 4-5 ring forms
SPOROZOANS
Isospora Belli
✓ MOT: Ingested of ripe oocyst
✓ Transparent and oval; cell wall has 2 layers
✓ Develops 2 sporoblasts and contained
sporozoites
✓ Comes from contaminated water/food
✓ HABITAT: intestinal
✓ DISEASE: Human coccidiosis
Sarcocystis
✓ MOT: Oocyst → ingestion of infected muscle
✓ Sausage shape sporocyst
✓ Found in uncooked pork or cattle
✓ HABITAT: striated muscle
✓ Sarcocystosis/sarcosporodiosis → fever,
diarrhea, and abdominal pain
Cryptosporidium parvum
✓ From contaminated food and water
✓ Oocyst; roundish and 4-6 numbers in size
✓ Thick cell wall
✓ 1-6 dark granules
Blastocystis hominis
✓ Oocyst; from contaminated food and water
✓ Centrally located large vacuole
✓ 2-4 nuclei at the periphery
✓ Vacuolated form (infective stage)
✓ Together with C. parvum, it is seen in
immunocompromised people (full blown
AIDS)
Microsporidia
✓ Spore
✓ Polar filaments
✓ “Extruding” → 1-5 um; equipped and
extruding polar filaments/tubules which
initiates the infection by injecting sporoplasm
(infectious material that injects to the host that
comes from the feces)
✓ Enteritis and keratoconjunctivitis
Toxoplasma gondii
✓ Tachyzoite – crescent shape
✓ Bradzoite – enclose to form cyst
✓ Seen in ingestion of oocyst/transplacental
transmission (cat)
✓ Intracellular and can infect RBC including
macrophage
✓ Toxoplasmosis – disease produced
Pneumocystis jirovecii
✓ Trophozoite
✓ Four to eight unorganized nuclei in rosette
✓ Somewhat circular in shape; almost the same
with E. histolytica
✓ MOT: Unknown but could be person to person
✓ Resides in the alveolar spaces of lung tissue,
spleen, lymph nodes, and bone marrow
✓ Found in children, full blown AIDS patients,
and other immunocompromised patients
LABORATORY DIAGNOSIS
✓ Direct fecal smear (intestinal)
✓
✓
Concentration technique
PCR
✓ Serological test – mostly (IFAT, ELISA, IHA)
✓ For toxoplasma – muscle biopsy
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