PARASITOLOGY

- EXAMPLE:
- W. bancrofti
- B. malayi
INTRODUCTION TO PARASITOLOGY
Domestic animals
- EXAMPLE:
Parasitology - the area of biology concerned with the phenomenon
- D. caninum
of dependence of one living organism on another
- H. diminuta
Another person
Definition of terms:
- EXAMPLE:
PARASITE - organism depending on another living creature for
-T. vaginalis (sexually transmitted)
existence
Oneself
HOST - organism that supports or harbors parasite
VECTOR - are responsible for transmitting the parasite from one
PORTALS
host to another
Portal of entry - particular site of the body where the parasite
INCIDENCE - number of new cases of infection in a population in a
prefers to enter
given period of time
Portal of exit - site of the body where the parasite moves out
EXPOSURE - the act or process of inoculation
PATHOGEN - animal parasites which are harmful, frequently causing
I. MOUTH
local and systemic damage of one type or another
• lumbricoides
SUPERINFECTION - when an individual harboring a parasite is
reinfected with the same species of parasites • T. trichuria
AUTOINFECTION - when the infected person is his own direct source • E. vermicularis
of reexposure • E. histolytica
• G. lamblia
2 Types of Vector • philippinensis
Mechanical Vector – the parasite is only seen on the surface of this II. SKIN
organism and there will be no development on the parasite • N. americanus
• e.g.: cockroaches, flies • duodenale
Biological Vector – the parasite is seen inside the body of this • S. stercolaris
organism and the parasite needs this organism for its development • S. japonicum
• eg.: mosquitoes, tsetse flies III. PERCUTANEOUS
• Malarial parasites
Types of parasites according to the mode of living • Filarial worms
• Leishmania
OBLIGATE PARASITE – depend entirely upon their host for existence • Trypanosomes
FACULTATIVE PARASITE – exist in a free-living state or may become IV. INHALATION
parasitic when the need arises • E. vermicularis
INCIDENTAL PARASITE - attack an unusual host V. SECRETIONS
SPUROUS PARASITE - free-living organisms in nature that are • S. stercolaris
parasitic to others but not in human • Ancylostoma spp.
VII. SEXUALLY TRANSMITTED
ECTOPARASITE • T. vaginalis
- parasite living outside the body of the host
- will not penetrate into the tissues PROTOZOA
- living on the surface of the skin PARASITIC AMOEBA
- the infection caused by these are called as infestation ❖ PATHOGENIC
ENDOPARASITE o Entamoeba histolytica
- parasite living inside the body of the host ❖ NON-PATHOGENIC
- living within the body of the host (infection) o Entamoeba dispar
- usually these are responsible to cause human infections o Entamoeba hartmanii
SAPROPHYTES - that which lives in organic substances in state of o Entamoeba coli
decomposition o Entamoeba gingivalis
o Entamoeba polecki
TYPES OF HOST o Entamoeba moshkovskii
DEFINITIVE (FINAL HOST) - harbors mature / adult parasite o Endolimax nana
INTERMEDIATE - harbors immature / larval parasite o Iodamoeba butschlii
RESERVOIR - serves as repository of the parasite o Blastocystis hominis
PARATENIC - carries infective stage of parasite ❖ PATHOGENIC AND FREE-LIVING
o Naegleria fowleri
Sources of parasite infections o Acanthamoeba spp
❖ CILIATA
Contaminated soil and water o Balantidium coli
- EXAMPLE: CYST OF ❖ OTHER INTESTINAL PROTOZOAN
- E. histolytica o Diantamoeba fragilis
- G. lamblia
Food containing immature infective stage of the parasite (1) Entamoeba histolytica
- EXAMPLE: EGGS OF “Named by Schaudinn”
- A. lumbricoides
- T. trichiura Entamoeba histolytica
Eating raw or inadequately cooked foods (TROPHOZOITE)
- EXAMPLE: PARAMETERS DESCRIPTION
- E. ilocanum (snails) Size range: 8-65 µm
- C. philippinensis (fish)
Motility: progressive, finger-like pseudopodia
- D. latum (fish)
No. of nuclei: 1
- T. saginata (beef)
Karyosome: Small and central
- T. solium (pork)
Peripheral
Blood sucking insects Fine and evenly distributed
chromatin:
 Cytoplasm: Finely granular
Cytoplasmic (4) Endolimax nana
Ingested red blood cell
inclusions: • TROPHOZOITE: sluggish, mononuclear
• CYST: “cross-eyed cyst”, QUADRINUCLEATE
Entamoeba histolytica
(CYST) (5) Iodamoeba butschlii
PARAMETERS DESCRIPTION • TROPHOZOITE: mononuclear; large vesicular nucleus with
Size range: 8-22 µm a large endosome surrounded by achromatic granules
Shape: Spherical to round • CYST: large glycogen vacuole (stains with IODINE)
No. of nuclei: 1-4
Karyosome: Small and central (6) Entamoeba gingivalis
Peripheral chromatin: Fine and evenly distributed -CYST: NO CYST
Cytoplasm: Finely granular
Cytoplasmic inclusions: -Chromatoid bars, rounded ends on (7) Entamoeba polecki
young cysts
-Diffuse glycogen mass in young cysts -parasite of pigs and monkeys; rarely infect humans
-can be distinguished from E. histolytica by: cyst
-CYST: consistently uninucleated
A. PATHOLOGY CAUSED:
1. Intestinal Amebiasis
(8) Naegleria fowleri
Characteristic ulcer: FLASK SHAPE ULCER
2. Extraintestinal amebiasis
a. Hepatic amebiasis: Laboratory diagnosis
• Microscopic examination of CSF (Trophozoite)
Amebic Liver Abscess: ANCHOVY SAUCE LIKE
b. Pulmonary amebiasis • Saline and Iodine wet preparation
c. Cerebral amebiasis • Tissue and nasal discharge
d. Amebic pericarditis Epidemiology
• Found in warm bodies of water, including lakes, streams,
e. Cutaneous amebiasis
ponds, and swimming pools
f. Genital amebiasis
• Higher in the summer months of the year
B. VIRULENT FACTORS:
1. Gal/Gal Nac lectin: cytoadherence • Can be acquired in contaminated dust
2. Amebapores: poreformers Clinical symptoms
• Asymptomatic
3. Cysteine proteinase: tissue invasiveness
C. LABORATORY DIAGNOSIS: • Kernig’s sign
1. Direct Fecal Smear • PAM (Primary Amebic Meningoencephalitis)
a. Unstained
(9) ACANTHAMOEBA
b. Stained
2. Liver aspiration biopsy
Laboratory diagnosis
3. Culture
• CSF is the specimen of choice
4. Serologic test
5. Concentration test • Brain tissue
• Corneal scrapings
6. Radiographic non-invasive techniques:
Epidemiology
X-ray/MRI/CT scan
• Reported from many countries worldwide both CNS and
(2) Entamoeba coli eye infection
• CNS infection appears in patient who are
immunocompromised
Entamoeba coli
• Wearing contact lens
(TROPHOZOITE)
Clinical symptoms
PARAMETERS DESCRIPTION
• GAE (Granulomatous Amebic Encephalitis)
Size range: 12-55 µm
• Acanthamoeba keratitis
Motility: Non-progressive, finger-like pseudopodia
No. of nuclei: 1 (10) Balantidium Coli
Karyosome: Large, irregular shape eccentric
Peripheral Infective stage: cyst, viable for several weeks
Unevenly distributed
chromatin: • Human infection results from ingestion of food or water
Cytoplasm: Coarse and granulated contaminated with fecal material containing Balantidium
Cytoplasmic coli cysts
Vacuoles containing bacteria often visible
inclusions: • Incubation period: 4-5 days
• Ingested cysts excysts in the small intestine
Entamoeba coli • Trophozoites inhabit the lumen, mucosa and submucosa
(CYST) of the large intestine, primarily the cecal region
PARAMETERS DESCRIPTION
Size range: 8-35 µm Balantidosis
Shape: round to spherical • Balantidiasis, balantidial dysentery
No. of nuclei: 1-8 • Balantidium coli invades the intestinal epithelium through
Karyosome: Large, irregular shape eccentric release of the enzyme hyaluronidase and creates a
Peripheral chromatin: Unevenly distributed characteristic ulcer with a rounded base and wide neck
Cytoplasm: Coarse and granulated • Acute diarrhea with mucus and blood, cramps
Cytoplasmic Inclusions: Diffuse glycogen mass present in young • Complications include intestinal perforation and acute
cyst thin chromatoidal bars w/ pointed appendicitis
to splintered ends in young cyst
(9) Blastocystis hominis
(3) Entamoeba hartmanii
• Can be distinguished from E. histolytica by size Laboratory diagnosis
• Stool is the specimen of choice for the recovery of
• CYST: quadrinucleated with coarse cytoplasm;
immature cyst has chromatoidal bars Blastocystis
• Iodine wet preparation
 • Four pairs of flagella are located anterior, lateral, ventral,
Epidemiology and posterior on the body of the organism.
• B. hominis infections indicated that they occurred as • The pair of anterior flagella, known as axome, is straight,
epidemic in subtropical countries closely approximated and parallel to each other, dividing
Clinical Symptoms the body of the organism into two halves longitudinally.
• Blastocystis hominis infection • Motility brought by the four pairs of flagella is essential for
- diarrhea, vomiting, nausea, fever as well as abdominal pain and virulence of the parasite.
cramping
Morphology of Trophozoites
ATRIAL FLAGELLATES • pear shape
• Giardia lamblia • 12-15 x 5-10 x 2-4 m
• Trichomonas vaginalis • 2 nuclei
• Trichomonas tenax • large karyosome, no peripheral chromatin
• Trichomonas hominis • fibrils (axonemes) evident
• Chilomastix mesnili • bilateral symmetry
• pair of median bodies
• Giardia lamblia and Chilomastix mesnili both have cyst and • adhesive disk (not always evident)
trophozoite forms in their life cycle, while others exist in • 4 pair flagella
the trophozoite forms only. • motility likened to falling leaf
• Pathogenic ones include Giardia lamblia and Trichomonas
vaginalis Diagnosis
• The others are considered commensal parasites of man • suspect: acute or chronic symptoms
• confirmed: detection of parasite in feces or duodenal
Giardia lamblia aspirate or biopsy
• Synonymous with Giardia duodenalis, Lamblia intestinalis • parasite easy to identify
• Giardiasis, lambliasis • parasite can be difficult to detect
• Intestinal flagellate that colonizes and reproduce in the • inconsistent excretion in feces
small intestine • patchy loci of infection

Mode of Transmission Parasite Detection

Giardiasis is caused by the ingestion of infective cysts. Stools
– Person-to-person transmission accounts for a • 3 non-consecutive days
majority of Giardia infections and is usually • wet mounts or stained
associated with poor hygiene and sanitation. • IFA, copro-antigens
– Water-borne transmission often associated with Aspirate or Biopsy
the ingestion of unfiltered water (contaminated). • Enterotest (or string test)
– Diaper changing and inadequate hand washing
are risk factors for transmission from infected String Test for Giardia
children. • This test is also called the Enterotest.
– Food-borne epidemics of Giardia have • The string test may be done if other methods (especially
developed through the contamination of food by examination of stool samples and antigen tests) have
infected food-handlers failed to detect giardiasis.
• This test is rarely done.
Giardia lamblia cyst • For this test, you swallow a gelatin capsule attached to a
• The cysts are non-motile and egg-shaped. They measure long string.
8–14 μm by 7–10 μm. • The end of the string remains outside the mouth and is
• The cysts are encased by a smooth and colorless, thick and taped to your cheek.
refractile wall. • The capsule dissolves in the stomach and the string passes
• Immediately after encystations, newly formed cysts into the upper part of the small intestine (duodenum).
contain two genetically identical nuclei. • The string is left in place for 4 to 6 hours or overnight.
• However, each organelle duplicates so that in permanently Then it is withdrawn and the end is examined under the
stained mature cysts, four prominent nuclei and four microscope for parasites that are attached to it.
median bodies are observed.
• The cysts are the infective form of the parasite and each Trichomonads
cyst gives rise to two trophozoites. • Provided with 4 flagella and a fifth one lying along the
margin of the undulating membrane.
• Morphology of Cysts • There is a costa at the base of the undulating membrane
and a conspicuous axostyle.
-oval shape
-11-14 x 6-10 m There are three species of Trichomonas species that infect
-distinct cell wall set apart from cytoplasm human being.
-4 nuclei at anterior end • These organisms exist in the trophozoite form only
large karyosome, no peripheral chromatin • They multiply by longitudinal binary fission
-fibrils (axonemes) evident • Trichomonas species exhibit what is known as “habitat
-median bodies specificity”
• They are less likely to be able to survive if they are placed
Giardia lamblia trophozoites in places of the human not “natural” to them.
• Trophozoites are motile and non-infectious because they
cannot survive long outside the host body. Comparison Between Trichomonads
• The parasite is bilaterally symmetrical and dorsoventrally Trichomonas Trichomonas Trichomonas
flattened. vaginalis hominis tenax
• A large sucking disk, which allows the parasite to attach to
the surface of the intestinal mucosa of the host, takes up Site of genito-urinary large intestine oral cavity
most of the ventral surface of the parasite. Inhabitation tract such as the
urethra,
• Behind the sucking disks, two rods known as median prostate, vaginal
bodies are seen. walls, and the
 cervix
Specimen of Urine Feces Gingival
choice for Scrappings
diagnosis
Pathogenecity Pathogen Commensal Commensal
Trichomonas vaginalis
• Most commonly acquired sexually transmitted disease.
• co-infection w/other STDs
• The vaginal walls, cervix, urethra, prostate glands, and
epididymis are the natural habitats.
• Prefers a medium or environment that is slightly alkaline
or somewhat more acidic than that of the healthy vagina.
• It can survive on wet sponges for several hours and in the
urine for more than 24 hours.
• The peak incidence of infection of “vaginal trichomoniasis”
occurs between ages16 to 35 at which time that sexual
activity is at its greatest.
• Both sexes equally susceptible but symptoms more
common in females
• More prevalent in at risk groups (sexually active,
commercial sex workers)
• The incidence tends to be higher among females with poor
personal hygiene.
Mode of Transmission
• Transmitted in the trophozoite form through sexual
intercourse.
• Non-venereal (non-sexual) transfer is also possible such as:
• Communal bathing or sharing of douche equipments or
materials.
• Contaminated toilet seats or the use of contaminated
toilet articles.
• Direct contact with infected females.
• From infected mother to female newborn.
Pathogenesis
• Trichomoniasis, Ping-Pong Disease
• The incubation period ranges from 4 to 28 days.
• The trophozoites produce irritation and inflammation of
the mucosal cells they are attached.
• The proliferating colonies of the organism cause
degeneration and desquamation of the vaginal epithelium
followed by white blood cell infiltration.
• The surface area is covered with a frothy, sero-purulent,
creamy, yellowish discharge, frequently forming a pool in
the posterior fornix of the vagina.
• Maybe associated with an increase incidence of
endometritis (inflammation of the endometrium) after
delivery and erosion of the cervix that may result to
chronic cervicitis, which in turn predisposes the woman to
the development of cervical malignancy.
Clinical Manifestations
Females:
• ranges from asymptomatic, to mild or moderate irritation,
to extreme vaginitis
• onset or exacerbation often associated with menstruation
or pregnancy
• vaginal erythema, ‘strawberry cervix’ (~2%)
• 50-75% “leukorrhea”: abnormal discharge contains plenty
of white blood cells (Large number of trophozoites and
leukocytes are present in the vaginal secretion that is
frothy greenish or yellowish in color)
• 25-50% vulvar and vaginal pruritus (itchiness), discharge
and difficulty in urination (dysuria)
• 50% painful coitus
Laboratory Diagnosis
• Specimen: urine, vaginal secretions or scrapings, cervical
swabs, prostatic discharge
• Proper collection of urine sample should be strictly
observed to prevent fecal contamination since
Trichomonas hominis, which maybe present in the
patient’s stool, maybe mistaken for Trichomonas vaginalis.
• demonstration of parasite through direct observation
• The organisms, to increase the yield of positive results,
maybe grown using the modified Diamond’s culture
medium.
• Serologic tests, such as the direct hemagglutination test
(IHA) or gel diffusion test (GD) may also be used for
diagnostic or research purposes.
Trichomonas tenax
• Primarily lives in the tartar around the teeth, cavities of
carious teeth, in necrotic mucosal cells in the gingival
margins of the gums, pyorrhetic pockets and tonsilar
crypts.
• Associated with oral spirochete in Vincent’s Angina and
quite common among people with poor oral hygiene.
• It is quite resistant to changes in temperature and able to
survive for several hours in drinking water.
Mode of Transmission
• -Droplet spray from the mouth of infected individual.
• -Common use of contaminated dishes, eating utensils, and
drinking glasses
Trichomonas hominis
• 8-20 μm trophozoite
• single nucleus
• axostyle
• 3-5 anterior flagella
• 1 posterior flagella
• undulating membrane extending the length of the body
• Costa
• Pear-shaped
• Rapid, jerking motility
• Maybe identified in diarrheic stools of infected individuals.
• More common in warm climate than cool countries.
• More common among children than older age group.
• The usual habitat is the cecal region of the large intestine,
but does not invade the intestinal mucosal cells.
• It moves very rapidly with a jerky, non-directional
movement.
Manner of Transmission
• Ingestion of food or drinks contaminated with the
trophozoite forms.
• Filth flies may serve as mechanical vectors.
• It survives passage through the stomach and small
intestine, provided it is ingested in a medium such as milk,
gruel or in case of achlorhydria (anacidity of the stomach)
Other Flagellates Found in Human Feces
*Dientamoeba fragilis
*Chilomastix mesnili
*Enteromonas hominis
*Retortamonas intestinalis
Dientamoeba fragilis
-no cyst stage
-trophozoites
9-12 mm
often binucleated
-nuclear structure
no peripheral chromatin
fragmented karyosome
• related to trichomonads
• no flagella (basal bodies)
• 15-30% of infections associated with diarrhea
-An amoeboid pathogen that infects the colon
-Associated with diarrheal disease, especially in young children
-The organism is provided with pseudopodia and does not have any
flagella.
-Although similar to amebae, it has been reclassified as a flagellate
based on ultrastructural details and antigenic similarities
-This organism has a worldwide distribution.
-Only the trophozoite form has been demonstrated.
 -The name “fragilis” is inappropriate because the organism, being in names, Dum Dum Nepal and Sudan, in part
the trophozoite form, is not necessarily easily destroyed but can Fever, Death Fever and of China, such as
survive better than other trophic form of other parasite. Kala azar. Province and Xinjiang
Uygur Autonomous
Manner of Transmission Region.
-The exact manner of transmission is “unknown”.
-The trophozoite of Dientamoeba fragilis maybe carried inside the Clinical types of cutaneous leishmaniasis
egg of some common nematode such as Enterobius vermicularis. Leishmania major
-In Germany, both D. fragilis and E. vermicularis are highly prevalent
• found in sparsely inhabited areas
parasites among pre-school children.
• Zoonotic cutaneous leishmaniasis
Chilomastix mesnili • Wet lesions with severe reaction
-Non-pathogenic lumen-dwelling flagellate • rapid ulceration; few amastigotes
-6-24 μm trophozoite Leishmania tropica
-Pear-shaped
• found in more densely populated regions
-Consistent location of the single nucleus at one end and tapering of
the end opposite the nucleus • Anthroponotic cutaneous leishmaniasis
-3 anterior flagella, 1 flagella in cytostome • Dry lesions with minimal ulceration
-Stiff, rotary motility • Many amastigotes; persists for months
- Both cause cutaneous ulcer or oriental sore (classical self-
-6-10 μm cyst limited ulcer)
-1 nuclei
Also called Jericho, Aleppo or Delhi boil
-Lemon-shaped cysts with anterior hyaline knob or “nipple”
-Cytostome with supporting fibrils (Safety pin-like appearance)
Leishmania braziliensis
Enteromonas hominis -Causes espundia, uta or mucotaneous leishmaniasis
-Small non-pathogenic, intestinal flagellates
-4-10 μm cyst and trophozoite -Found in Central Mexico and Northern Argentina
-Elongated or oval
-Trophozoites: 1 nucleus, 3 anterior flagella, 1 posterior flagella, -Find LD bodies in tissues
jerking motility
-Cysts: 1-4 nuclei, usually 2 lying at opposite ends of cyst, resembles
E. nana cyst -Once cured, lifelong immunity; if dormant – may re-occur

Retortamonas intestinalis Diagnosis:

-Small non-pathogenic, intestinal flagellates *Smear: Giemsa stain – microscopy for LD bodies (amastigotes)
-4-9 μm *Biopsy: microscopy for LD bodies or culture in NNN medium for
-Pear-shaped or oval promastigotes
-Trophozoites: 1 nucleus, 1 anterior and 1 posterior flagella,
prominent cytostome extending approximately ½ length of body,
-Visceral leishmaniasis
jerking motility
-Cyst: 1 nucleus, resembles Chilomastix cyst There are geographical variations.
-The diseases is called kala-azar
BLOOD AND TISSUE FLAGELLATES -Leishmania infantum mainly affect children
-Leishmania donovani mainly affects adults
Transmission
-The reservoir hosts are rodents, dogs, foxes and jackals Clinical Presentation
-The infection is usually transmitted by the bite (blood feed) of the -Fever
female sandfly, genus Phlebotomus and Lutzomyia -Splenomegaly, hepatomegaly, hepatosplenomegaly
-Human infection has been reported from blood transfusion, -Weight loss
congenital transmission, and by sexual intercourse. -Anemia
-Epistaxis
Types of Leishmaniasis -Cough
Cutaneous The most common is Cutaneous infections are -Diarrhea
leishmaniasis (localized the Oriental Sore most common in -Loss of weight
and diffuse) infections (caused by species L. Afghanistan, Brazil, Iran, -Lymphadenopathy
appear as obvious skin major, L. tropica, Peru, Saudi Arabia and -Pancytopenia
reactions. and L. aethiopica, L. Syria.
-Hypergammaglobinemia
mexicana.)
Mucocutaneous L. braziliensis Mucocutaneous -Darkening of the skin
leishmaniasis infections are most
(espundia) infections common in Bolivia, Visceral leishmaniasis or kala-azar
will start off as a Brazil and Peru, in -The parasites multiply abundantly in the medulla of the spleen and
reaction at the bite, Karamay, China Xinjiang bone marrow.
and can go via Uygur Autonomous
metastasis into the Region.
Untreated disease can be fatal
mucous membrane and
become fatal. After recovery it might produce a condition called post
Visceral leishmaniasis Caused exclusively Found in tropical and kala-azar dermal leishmaniasis (PKDL)
infections are often by species of the L. subtropical areas of all
recognized by fever, donovani complex continents except Trypanosoma cruzi
swelling of the liver (L. donovani, L. Australia. • causative agent of Chagas disease / American
and spleen, and infantum syn. L. Visceral infections are
Trypanosomiasis
anemia. They are chagasi). most common in
known by many local Bangladesh, Brazil, India, • 16-18 million infected
• 100 million at risk
 • 50,000 deaths annually • Plasmodium vivax
• leading cause of cardiac disease in S. and Central America – Producing vivax malaria or benign tertian
malaria.
– Most widespread, found in most endemic areas
Biological Vector
including some temperate zones
❖ Common Names – It is more common in temperate than in tropical
triatomine bugs region.
reduviid bugs – It is the second common Malaria in the
assassin bugs Philippines.
Conenose bugs • Plasmodium malariae
kissing bugs – Producing malariae or quartan malaria.
– Similar range as P. falciparum, but less common
❖ Genera
and patchy distribution
Triatoma – Common in tropical Africa, Burma, Sri lanka,
Rhodnius India, Malaysia and Indonesia.
Panstrongylus – It is occasionally seen in the Philippines.
• Plasmodium ovale
Factors Influencing Human Transmission – Producing ovale malaria.
-early’ defecation (i.e., during triatomine feeding) – It is the least common Plasmodium infecting
man.
-colonization of human habitats
– It occurs mostly in tropical Africa, principally on
adobe walls the west coast and is endemic in Ethiopia.
thatched roofs Plasmodium knowlesi
-para-domiciliary cycles • a primate malaria parasite commonly found in Southeast
animal stalls adjacent to domicile Asia.
• It causes malaria in long-tailed macaques (Macaca
Pathology fascicularis), but it may also infect humans, either naturally
or artificially.
-cardiomegaly
• the fifth major human malaria parasite. This is an
-apical aneurysm (left ventricle) emerging infection that was reported for the first time in
-extensive fibrosis* humans in 1965.
-hypertrophy* • It accounts for up to 70% of malaria cases in South East
-cellular infiltration Asia where it is mostly found
*correlates best with cardiac symptoms
Invertebrate Phase
• 4-15 days after ingestion of gametocyte
Diagnosis
• Female Anopheles mosquito takes a blood meal containing
C-shaped Trypomastigotes gametocytes from infected person
o Microgametocytes – male
African sleeping sickness o Nuclear division and exflagellation
o Macrogametocytes – female
-Human African Trypanosomiasis o Shifting of nucleus to the surface to
form a projection
o Microgamete penetrates
-It is caused by two subspecies of Trypanosoma brucei, namely: macrogametes producing an ookinete
Vertebrate Phase
-Trypanosoma brucei rhodesiense: East Africa, wild and domestic • Mosquito injects sporozoites to man
animal reservoirs • Sporozoites disappear from the blood
– Some are destroyed by the host immune system
-Trypanosoma brucei gambiense: West and Central Africa, mainly – Enters liver parenchymal cells (hypnozoites in P.
human infection vivax and P. ovale)

Insect Vectors in the Philippines

Transmission
Through the bite of the tsetse fly, Glossina spp., the metacyclic
trypomastigotes will be inoculated to the blood of the host
Clinical Manifestation
Gambian trypanosomiasis – Winterbottom’s sign (enlarged, non-
tender posterior cervical lymph nodes with a consistency of ripe
plums
SPOROZOA & COCCIDIA
Phylum Apicomplexa
Malarial Parasites
• Plasmodium falciparum
– Produce malignant malaria, estivo-autumnal,
falciparum malaria, subtertian malaria or
pernicious.
– It is most prevalent in the tropics and subtropics
– It causes the most severe form of malaria
– It still remains almost unchallenged as the
greatest killer of the human race over most parts
of Africa and elsewhere in the tropics.
• Anopheles flavirostris – primary vector in the Philippines,
night biter, breeds in slow-flowing clean water mountain
streams
• Anopheles balabacensis- rest either indoors or outdoors,
in puddles, pools, ponds, and in shades.
• Anopheles lesteri-rest either indoors or outdoors, in pools,
ponds, lakes, and in ricefields.
• Anopheles philippinensis-rest either indoors or outdoors,
in pools ponds or lakes.
• Anopheles umbrosus- rest out-of-doors, in pools, ponds,
lakes, running streams and canals in shades.
• Anopheles leucosphyrus – vector of Plasmodium knowlesi,
typically found in forest areas in South East Asia but with a
greater clearing of forest areas for farmland
Plasmodium falciparum
• Size of Erythrocytes: normal, multiple-infected RBC are
common
• Maurer’s dots occasionally seen
• Young rings are small, delicate, often with double
chromatin dots, accole, applique
• > 1 ring form can be found in 1 RBC (multiple infection)
• Gametocytes are crescent or elongated
• Pigment: black, coarse and conspicuous in parasite
 • Number of merozoites: 6-32, average is 20-24 • Microscopic identification of the malarial parasites
• Schoizonts: bad prognosis • Thick and thin blood smear
• Stages found in Circulating Blood: Young, growing • thick film: screening for positivity and parasite
trophozoites (ring forms) and gametocytes count
• thin film: species identification easier
Plasmodium vivax • Stained with Giemsa or Wright’s stain
• Size of Erythrocytes: enlarged, maximum size may be 1 ½ - • Gold standard for malarial diagnosis
2 times normal (attained with mature trophozoites and • Taken at the height of the fever (schizogony), highest
schizonts) number of parasite in the blood
• Ring forms occupies 1/3 diameter of RBC • repeat smears every 12 hours for 48 hours if negative
• Schuffner’s dots present in all stages except early young
forms Quantitative Buffy Coat (QBC)
• Irregular, ameboid trophozoites, has spread-out • Usually prepared capillary tube coated with acridine
appearance orange
• Pigment: Golden brown, inconspicuous • Malaria parasites take up the stain and appear bright
• Number of merozoites: 12-24, average is 16 green and yellow under a fluorescent microscope
• Stages found in circulating blood: all stages
Rapid Diagnostic Tests (RDT)
Plasmodium ovale • Makes use of immunochromatographic methods in order
• Size of erythrocytes: enlarged, maximum size may be 1 ¼ - to detect Plasmodium-specific antigens in a finger-prick
1 ½ times normal, approximately 20% or more infected blood sample
RBC are oval and fimbriated (border has irregular • Paracheck Pf Test, ParaHIT f Test, Diamed Optimal IT
projections) • Advantages: Can be performed in 15-30 mins, 90% specific
• Schuffner’s dots present in all stages except early ring • Disadvantages: lack of sensitivity at low levels of
forms parasitemia, inability to quantify, more costly
• Rounded, compact trophozoites, occasionally slightly
ameboid Serological Tests
• Growing trophozoites have large chromatin mass • Indirect Hemagglutination (IHA)
• Pigment: dark brown, conspicuous • Indirect Fluorescent Antibody Test (IFAT)
• No. of merozoites: 6-14, average is 8 • Enzyme-linked Immunosorbent Assay (ELISA)
• Stages found in circulating blood: all stages • Cannot differentiate current and past infections
• Most helpful in epidemiological studies
Plasmodium malariae
• Size of erythrocytes: normal • Culture
• Ziemann’s dots rarely seen • Polymerase chain reaction (PCR)
• Rounded, compact trophozoites with dense cytoplasm. – To significantly enhance the microscopic
• Band form trophozoites occasionally seen diagnosis of malaria especially in cases of low
• Pigment: dark brown, conspicuous parasitemia and in cases of mixed infection
• Rosette schizonts occasionally seen
• No. of merozoites: 6-12, average is 8 Babesia Taxonomy
• Stages found in circulating blood: all stages • Phylum Apicomplexa
• Class Sporozoea
Plasmodium knowlesi • Subclass Coccidia
• Subclass Piroplasmia – no oocyst
• In developing trophozoites of P. knowlesi, band forms may • Order Piroplasmida
appear that are similar in appearance to P. malariae. • Genus Babesia
• As the vacuole is lost during maturation of the trophozoite
stage, the parasite becomes smaller and more compact. Babesia
• The pigment appears as dark grains and the red nucleus • Common tick-borne parasite of domestic and wild animals
increases in size. • Parasites of red blood cells, causes malaria-like infections
• Stippling appears, often referred to as 'Sinton and • No intracellular pigment in developmental stages
Mulligan's' stippling • Rare zoonotic human infection, natural host are the
rodents and deers
In developing schizonts of P. knowlesi, Sinton and
Mulligan's stippling may be observed.
• The nucleus continues to divide until there are up to 16 B. microti B. divergens
(average 10) merozoites. Location United States Europe
• As the schizont matures, it fills the host RBC and the Reservoir field mice, voles cattle, ruminents
pigment collects into one or a few masses. Ixodes scapularis Ixodes ricinus
• In the mature schizont, the merozoites may appear Vector (black-legged tick)
'segmented' and the pigment has collected into a single Ixodes dammiini
mass. Cases ~300 ~30
Fatality 5% 50%
Malaria Transmission
• natural (sporozoites/Anopheles) Mode of Transmission
• blood transfusions • Tick-bite
• shorter incubation period • Transplacental
• fatality risk (P. falciparum) • Blood transfusion
• no relapses possible (vivax/ovale)
• syringe sharing Babesia microti
• congenital • Common species diagnosed in human.
• relatively rare although placenta is heavily • Small rings within the red blood cell, very much
infected like Plasmodium falciparum with a darkly
Diagnosis staining nucleus and very little cytoplasm.
• Prompt and adequate diagnosis is necessary • It do not have associated pigment in the red
• Clinical diagnosis: symptoms blood cell.
• History of being in endemic area
 • Asexual multiplication by binary fission in the
RBC with production of merozoite that invade
other RBC.
• When taken up by the ticks, there is complex
cycle of multiplication that includes a sexual
stage, resulting ultimately in the presence of the
parasites in the salivary gland of the tick.
Definitive Host
• A tick is the definitive host.
• Transmission occurs from an animal to a human, normally
using the northern deer tick or black-legged tick (Ixodes
scapularis) as the vector.
Babesia divergens
• transmitted by the tick Ixodes ricinus.
• main agent of bovine babesiosis, or "redwater fever", in
Europe
• it can also infect immunocompromised humans, causing
medical emergencies characterized by rapid fulmination
and parasitemias that may exceed 70%.
Diagnosis
• parasite in thin or thick blood smear
• Tetrad-forms or Maltese-cross arrangement of merozoites
• no travel history
• Serology (IFA)
• lack of response to anti-malarials
Coccidia
• Class Sporozoea
• Coccidian parasites infect the intestinal tracts of animals
• The largest group of apicomplexan protozoa.
• obligate, intracellular parasites, which means that they
must live and reproduce within an animal cell.
• with no definite organ of locomotion.
• It may have body flexion, gliding or undulating of
longitudinal ridges.
• characterized by thick-walled oocysts excreted in feces
In Humans
• Cryptosporidium
• Isospora
• Cyclospora
• Toxoplasma
• Sarcocystis
Coccidia
• In Isospora, Cyclospora and Cryptosporidium only a single
direct cycle of transmission occurs, both the asexual and
sexual stages of multiplication occurs in a single host and
that is to man.
• In Sarcocystis and Toxoplasma, the sexual stages are
usually in the intestinal mucosa of a carnivorous host (the
predator). The result in an oocyst or sporocyst that passes
out in the feces to infect an intermediate host (the prey) in
which asexual multiplication of the parasite occur.
Toxoplasma gondii
• cosmopolitan distribution
• seropositive prevalence rates vary
• generally 20-75%
• generally causes very benign disease in immunocompetent
adults
• tissue cyst forming coccidia
• predator-prey life cycle
• felines are definitive host
• infects wide range of birds and mammals
(intermediate hosts)
Human Transmission
• ingestion of sporulated oocysts (cat feces + incubation)
• ingestion of zoites (undercooked meat)
• congenital infection (only during acute stage)
• organ transplants
• chronic infection in donor
• immunosuppression
• blood transfusions (only during acute stage)
Clinical Manifestations
• Most of the cases are asymptomatic.
• Congenital toxoplasmosis is often severe and even fatal.
• Sabin syndrome (tetrad of signs)
– Chorioretinitis
– Cerebral calcification
– Convulsion or psychomotor disturbances
– Hydrocephalus or microcephalus
Isospora belli
• Though rare, it has a wide geographical distribution
(higher prevalence in warmer climates)
• The least common of the intestinal coccidia that infect
humans
• Can cause severe disease with fever, malaise, persistent
diarrhea and even death in AIDS patients
• Monoxenous (required one host) , probably not zoonosis:
Asexual and sexual multiplication occurs in man
• Mode of Transmission: Human are probably infected by
accidental hand-to-mouth ingestion of mature oocyst in
food and water.
• Habitat: Distal duodenum and proximal jejunum.
• 30 x 12 mm oocyts
• 2 sporocysts
• 4 sporozoites each
Diagnosis
• Stool examination to demonstrate the immature oocyst
from the feces
– Concentration technique such as Zinc sulfate
centrifugal flotation method, Formalin-ether
sedimentation method, Sheather’s sugar
flotation
– Iodine stain which facilitates identification.
– Modified acid fast stain wherein oocyst wall does
not stain and sporoblast is deep red stained.
Sarcocystis
• The name is dervived from Greek: sarx = flesh and kystis =
bladder
• rare human infection
• heteroxenous parasite
• predator-prey life cycle
• humans support both stages
• originally identified as 2 species
• intestine ~ Isospora
• tissue ~ Sarcocystis
• taxonomic confusion
• generally named after host species
• Sarcocystis bovihominis
• Sarcocystis suihominis
Cryptosporidium
• fecal-oral transmission (monoxenous)
• wide range of animal hosts (C. parvum)
• several host-adapted species
• C. hominis for human species
• first human case reported in 1976
• self-limiting diarrhea in immunocompetent persons
• profuse, watery diarrhea associated with AIDS (life
threatening)
Cryptosporidium parvum
• Cryptosporidiosis.
• World wide in distribution.
• Common cause of diarrhea among traveller’s and in day
care centers.
• Can occur as water-borne outbreaks
• Zoonosis from domestic animals.
• More common in children than adult.
• 4-5 m oocysts
• 4 sporozoites
• no sporocysts
 -Culex, and anopheles
-W. bancrofti may be found in the subtropical and tropical areas of
Diagnosis the world including the philippines.
• Stool examination to identify the oocyst.
• Duodenal string test (Enterotest) to recover oocyst. Brugia malayi
• Modified acid-fast stain Common name: Malayan filarias
• concentration test Disease associated: Malayan filariasis, Elephantiasis
• Serological test
Laboratory Diagnosis
Cyclospora cayetanensis • Examination of stained blood films
• first human case in 1979 • Specimen collection is during night hours
• named in 1993 • Knott technique
• initially called ‘cyano-bacteria like body’ (CLB) or • Serological method
large Cryptosporidium
• no known animal reservoir Epidemiology
• more common in tropical and sub-tropical areas • Areas of the world in which the mosquitoes breed are the
• Infection most common in HIV/AIDS patients. primary locations in which B. malayi may be found
including Philippines
• Although humans are considered to be the primary
In freshly passed in stools, the oocyst is not infective definite host, it is also known to infect felines and
(direct fecal-oral transmission cannot occur; this monkeys
differentiates from Cryptosporidium). • Transmitted by the mosquito
• In the environment, sporulation occurs after days or weeks - Mansonia spp.
at temperatures between 22°C to 32°C, resulting in - Anopheles , Aedes
division of the sporont into two sporocysts, each
containing two elongate sporozoites. Loa loa
• Fresh produce and water can serve as vehicles for Common name: African eye worm, Oculi Humanis
transmission. Disease associated: Loaisis

Transmission Laboratory Diagnosis

• associated with food-borne outbreaks • Specimen of choice for the recovery of L.loa microfilariae
• luncheons, social events, weddings, etc. is Giemsa-stained blood
• possible source always involved foreign country and fresh • Knott technique
fruit or vegetables • Collection is done during the midday hours between 10:15
• raspberries from Guatemala am to 2:15 pm
• salad from Peru • The migrating adult worms may be extracted from a
• presumed source: contaminated water or human waste as variety of body location including the eye.
fertilizer • Eosinophilia and calabar or transient subcutaneous
swelling
Cyclospora
Life cycle notes
• 8-10 m oocyts • Human infection of L.loa is initiated by the bite of an
• 2 sporocysts infected Chrysops fly, Tabanid, mango fly.
• 2 sporozoites each • Adult worms multiply throughout the subcutaneous
tissues
Diagnosis • The microfilariae are present in the blood but not until
• demonstration of oocysts in feces years after the initial infection making the diagnosis more
acid-fast stain difficult.
Autofluorescence
PCR (to differentiate with closely related Eimeria species) Onchocerca volvulus
Common name: Blinding convulated worm
Comparison: Oocyts of Different Genera Disease associated: River Blindness, Onchocerciasis
Sporocyst Sporozoites
Cryptosporidium 0 4 Laboratory Diagnosis
Cyclospora 2 2 • Skin snips
Isospora 2 4 • Adult worms may recovered from infected nodules
Toxoplasma 2 4 • Organisms residing in the eye are best seen by
Sarcocystis 2 4 opthalmologic examination using slit lamp
• Presence of Eosinophilia and ocular discomfort
FILARIAE • Serologic examination

Wuchereria bancrofti EPIDEMIOLOGY

Common name :(Bancroft’s Filaria) • O. volvulus is distributed primarily in equatorial Africa and
Disease associated: Bancroft’s Filariasis, Elephantiasis central america.
• Vector: Simulium or Black fly
Laboratory Diagnosis
• Examination of fresh Giemsa-stained blood Mansonella ozzardi
• Using a nucleopore filter Common name: New world filaria
• Knott Technique Disease associated: NONE
• Using 2% Formalin
• Peak hour of specimen collection are between 9:00 pm to Life cycle notes
4:00 am • Transferred by the injection of infective larvae to the
• Serologic Test human definitive host.
• The transmission is carried out by the culicoides sucking
Life cycle Notes midges and simulium blackfly
Intermediate host and vector: • Microfilaria is found in the blood as well as in the
-Aedes, capillaries and intravascular spaces of skin.
 • The emerging adults may take up residence in the body - Patients who suffer from slight whipworm infection.
cavities, visceral fat and mesenteries • Trichuriasis
- Ulcerative colitis
Mansonella perstans - Chronic dysentery
Common name: Perstans filaria - Severe anemia
Disease associated: NONE - Growth retardation
- Rectal prolapse
- Peristalsis
Life cycle notes - Mimic the inflammatory bowel disease
• The life cycle of M. perstans is similar to that of M. ozzardi
• Culicoides sucking midges is the only known vector Ascaris lumbricoides
• Humans are the primary definitive host in the life cycle Epidemiology
• The incubation period of this organism once inside the • Ascariasis is considered as the most common intestinal
host is unknown helminth infection in the world
• The regions of the world and of the United State most
NEMATODES susceptible to harbor.
• A. lumbricoides infection in children who place their
Enterobius vermicularis contaminated hands into their mouths.
Life cycle notes • Sources of contamination range from children’s toys to the
• Humans are the only known host of E. vermicularis soil itself.
• Self-limiting
• Initiated ff. the ingestion of infective eggs Ancylostoma duodenale
• The eggs migrate through the digestive tract into the small and
intestine, where they hatch and release young larvae Necator americanus
• Adult worms reside in the colon
• Female worms migrates outside the body to the perianal Laboratory Diagnosis
region , where she may deposit. • Recovery of the eggs in stool samples
• Larvae may mature and hatch from the eggs in stool.
• Eggs can be acquired through air • Examination of the buccal capsule
• Retroinfection Life cycle Notes
- Infective pinworm that migrates back into the host body, • Humans contract hookworm when third-stage filariform
develop and reproduce larvae penetrate through the skin
• Autoreinfection • Adult females lay 10,000 to 20,000 eggs/day.
- Infective pinworm eggs are ingested via hand-to-mouth Epidemiology
contamination • The frequency of hookworm infection is high in warm
areas in which the inhabitants practice poor sanitation
LAB DIAGNOSIS practice.
Scotch Tape Method • Person at risk for contracting hookworm in areas are those
who walk barefoot in feces contaminated soil
Clinical Symptoms • N. americanus – primarily found in North and South
• Asympomatic America
• Enterobiasis • A. duodenale – may be found in europe, china, africa,
- Intense itching and inflammation of the anal or vaginal south america and caribbean.
areas Clinical Symptoms
- Intestinal irritation • Asymptomatic Hookworm Infection
- Mild nausea - Some person infected with light hookworm burden do not exhibit
- Vomiting irritability clinical symptoms
- Difficulty sleeping
- Minute ulcer • Hookworm Disease: Ancylostomiasis, Necatoriasis
- Mild intestinal inflammation - Patients who are repeatedly infected may develop intense
- Abdominal pain allergic itching at the site of hookworm penetration.
- A number of symptoms experienced by infected persons
Trichuris trichiura are associated with larvae migration into lungs, including
sore throat, bloody sputum, wheezing, headache, and mild
Laboratory Diagnosis pneumonia with cough
• Specimen of choice is stool
• Zinc Sulfate flotation method • In chronic infection, patients may experience vague mild,
gastrointestinal symptoms, slight anemia, and weight loss
Life cycle Notes or weakness.
• Ingestion of infective T. trichiura eggs containing larvae • In acute infection, may develop a number of symptoms
initiates human infection. including diarrhea, anorexia, edema, pain, enteritis, and
• The larvae emerge from the eggs in the small intestine epigastric discomfort
• Growth and development of the larvae occur as they • Adult hookworms compete with the human host for
migrate within the intestinal villi. nutrients as they feed, infected patients may develop a
• The larvae return to the intestinal lumen and proceed to microcytic hypochromic iron deficiency, weakness, and
the cecum, where they complete their maturation. hypoproteinemia.
• The life span of the adult worms in untreated infections
may be from 4 to 8 years Strongyloides stercolaris
• The female lays her undeveloped eggs. Passed into the
feces, 1 month outside the human body, the egg Life Cycle Notes
embryonate, become infective, and ready to initiate a new • The rhabditiform larvae develop directly into the third-
cycle. stage infective filariform larvae in warm, moist soil.
• Considered the 3rd most common helminth • In the indirectly cycle, threadworm rhabditiform larvae are
• Found primarily in warm climates passed into the outside environment and mature into free-
living adults that are non-parasitic.
Clinical Symptoms
• Asymptomatic
 • Autoinfection occurs when the rhabditiform larvae ADULT:
develop into the filariform stage inside the intestine of the • averaging 30 mm in length and 13 mm in width
human host. • Leaf-shaped
• Each worm possesses ovaries and testes which are highly
LABORATORY DIAGNOSIS branched and allow for individual flukes to produce eggs
• Stool concentration w/ zinc sulfate independently
• Duodenal aspirates
• Enterotest • The primary difference in the life cycles of F. buski and F.
• Flotation Technique hepatica is where the adult worms reside in the human
• Serological Test host.
Clinical Symptoms 1st intermediate host:
• Asymptomatic Snail: (Lymnaea philippinensis)
• Strongyloidiasis: Threadworm Infection (Lymnaea auricularia rubiginosa)
- Diarrhea 2nd intermediate host:
- Abdominal pain Aquatic plants
- Urticaria accompanied by eosinophilia Ipomea obscura
- Vomiting Nasturtium officinale
- Constipation Mode of transmission:
- Weight loss Ingestion of aquatic plants cont. with metacercaria
- Variable anemia
• Heavy infection Fasciolopsis buski
- Malabsorption syndrome (Intestinal flukes)
• When the larvae migrates into the lungs patient may Common name: Giant intestinal fluke
develop pulmonary symptoms Disease: Fasciolopiasis

Trichinella spiralis Epidemiology

Laboratory Diagnosis • The prevalence of fasciolopiasis is related to growing
• Examination of the affected skeletal muscle water plants and feeding pigs on water plants
• Serologic methods • F. buski is prevalent in Southeast Asia and lives in human’s
• Eosinophilia and pigs intestine.
• Leukocytosis
• Elevated serum muscle enzyme lvl MORPHOLOGY
ADULT:
Clinical Symptoms - 20-75 x 8-20x1-3 mm
• Trichinosis, Trichinellosis - the body is long elliptic, flesh-colored looks like a slice of
- T. spiralis is known as the great imitator raw meat
• Light infection - largest one of human trematodes
- Diarrhea - Ventral sucker is near by the much smaller oral sucker
- Slight fever - 2 coral-liked testes are located in the posterior half of the
- Flu body

• Heavy infection MORPHOLOGY

- Vomiting EGG:
- Nausea - 130-140x80-85 u
- Abdominal pain - Oval in shape
- Headache - Slightly yellow in color
- Fever - Thinner shell with an operculum encloses an ovum and 20-
40 yolk cells
• Migration of larvae
- Eosinophilia Life cycle
- Pain in pleural area Site of inhabition: Small intestine
- Fever Infective stage: Metacercariae
- Blurred vision Mode of transmission: Eating raw water plants with metacercariae
- Edema Medium of water plants: Chestnut, water, bamboo and caltrop
- Cough I.H: Planorbis snail
Life span: 1-4 years
Capillaria philippinensis
1st I.H.:
Lab. Diagnosis Snail (Segmentia, Hippeitis)
• Direct smear or wet mount 2nd I.H.:
• Stool concentration method Aquatic plants
• Duodenal aspiration - Trapa bicornis
- Eliocharis tuberosa
Epidemiology - Ipomea obscura
• Intestinal capillariasis was first recorded in Northern Luzon - Nymphaea lotus
in the Philippines. RESERVOIR: PIG
• Migratory fish-eating birds are considered the natural
host. Clonorchis sinensis
(LIVER FLUKE)
TREMATODES
ADULTS:
Liver Flukes - 10-25x3-5 mm
- Sunflower seed-like
Fasciola hepatica - Oral sucker at the top is slightly larger than the ventral
and sucker loc. in the anterior 1/5 part of the body
Fasciola gigantica - The digestive tract is divided into two ceca
 - The pouched-liked excretory bladder opens at the
posterior end Life cycle Notes
RESERVOIR HOST: Pigs, dogs, and feline species
Life cycle 1st Intermediate Host: Antemelania asperata
Infective stage: Metacercariae Antemelania dactylus
Mode of transmission: Eating raw fresh water and shrimps with 2nd Intermediate Host: Mountain crab
metacercariae Sunsathelpusa philippina
Site of Inhabitation: Bile ducts MODE OF TRANSMISSION:
1st I.H.: Bithynia snail P. westermani is transmitted in undercooked crayfish or crabs
2nd I.H.: Fish
Pseudorasbora parva Clinical Symptoms
Cyprius carpio • Paragonimiasis, Pulmonary Distomiasis
Aristichthys nobilis - Typically experience symptoms associated with pulmonary
Mylopharyngodon piceus discomfort: cough, fever, chest pain, and increased
Reservoir Host: Cat, dog production of blood-tinged sputum.
Life span: 20-30 years - Bronchitis
- Eosinophilia
Clinical symptoms - Production of fibrous tissue
• Asymptomatic - Mimic the infection of person suffering TB
• Clonorchiasis • Cerebral Paragonimiasis
- include fever, abdominal pain, eosinophilia, diarrhea, anorexia, - Migration of immature P. westermani organisms to the
epigastric discomfort, and occasional jaundice. brain may result in development of a serious neurologic
- Enlargement and tenderness of the liver and leukocytosis condition.
may also occur. - Seizures, visual difficulties, and decreased precision of
- Liver dysfunction may result in persons severely infected motor skills
over a long period of time
- Cholelithiasis, pancreatitis, and cholangocarcinoma Schistosoma mansoni
Schistosoma haematobium
Opistorchis felineus Schistosoma japonicum
(Cat Liver Fluke)
Opistorchis viverrini Laboratory Diagnosis
(Southeast Asian liver fluke) • S. mansoni and S. japonicum is accomplished by recovery
ADULT: of the eggs in stool.
- Measure from 7-12 mm in length • S. haematobium is recovered in a concentrated urine
- They have 2 testes lying one behind the other in the specimen.
posterior portion of the body
- The ovary is anterior to the testes and a uterus is coiled Life Cycle Notes
between the ovary and ventral sucker • Human infection of Schistosoma occurs in fresh water ff
the penetration of fork-tailed cercariae into the skin.
EGG: • Schistosomule migrates into the bloodstream, where
- 19-29um long by 12-17 um wide maturation into adulthood is complete.
- Similar to Clonorchis sinensis • S. mansoni and S. japonicum reside in the veins that
- They have knob at the abopercular end that may be surround the intestinal tract, as well as in the blood
prominent, insconspicuous, or absent passages of the liver.
• S. haematobium resides in the veins surrounding
Echinostoma surrounding the bladder.
Common name:(Garrison’s fluke) • Females lay thousand eggs daily, which make their way
Diease: Echinostomiasis from the bloodstream through the tissue of colon or the
urine.
• Garrison first discovered this food-borne, intestinal, • Once an egg reaches fresh water, the miracidium is
zoonotic, snail-mediated parasitosis in 1907 in Manila released from the egg and must locate a snail, where it
• Found in intestine of birds and mammals throughout the develops into the cercariae.
world
Morphology Epidemiology
- 3-25 mm in length 1-3 mm wide • Cattle, monkey, rodents, dogs, cats, and other livestock.
- Echinostomes are characterized by a collar of spines • S. mansoni – parts of Africa
around their anterior ends • S. japonicum – parts of Far East
- Oral and ventral sucker • S. haematobium – almost all of Africa and portions of the
- Ellipsoidal, yellow to yellow brown eggs Middle East.

Reservoir Host: Wild animals and Birds Clinical Symptoms

• Asymptomatic
- Brown hematin pigment is present in the macrophages
Paragonimus westermani and neutrophils
Common name:(Oriental Lung Fluke) • Schistosomiasis, Bilharziasis, and Swamp fever
Disease: (Paragonimiasis, Pulmonary distomiasis, Endemic - Inflammation at the cercariae penetration site
hemoptysis) - Symptoms of acute infection include abdominal pain,
fever, chills, weight loss, cough, bloody diarrhea, and
ADULTS: - 16 mm by 4-8 mm eosinophilia
- reddish brown and ovoid - Painful urination and hematuria.
- possess oral and ventral sucker - Necrosis, lesions, and granuloma
- Obstruction of bowel or ureters
Laboratory Diagnosis • Katayama Fever
• The recovery of eggs in sputum specimens. - Systemic hypersensitivity rxn to the schistosomule
• These eggs are commonly found in bloody samples migrating to tissue
• Serologic Test - Rapid onset of fever, nausea, myalgia, malaise,
fatigue,cough, diarrhea, and eosinophilia.
 • Examining stool for the presence of egg or proglottids
CESTODES
Epidemiology
• Found in variety of temperate regions worldwide
DIFFERENCES PSEUDOPHYLLIDEAN CYCLOPHILLIDEAN • It is in areas that raw and/or freshwater fish are routinely
Diphyllobotrium Species which require consumed.
latum vertebrae IH: Clinical Symptoms
Taenia solium • Asymptomatic
Taenia saginata • Diphyllobothriasis
Species which require - Overall weakness
invertebrae IH: - Weight loss
Dipylidium caninum - Abdominal pain
Species which may or - Vitamin B12 Deficiency
may not require IH:
Hymenolepis nana Echinococcus granulosus
SCOLEX -Spoon shaped - Quadrate, with four Common name: Hydatid worm
with slit-like cup-like suckers
sucking grooves Laboratory Diagnosis
-No hooklets • Hydatid cyst fluid may be examined on biopsy samples for
STROBILA - anapolytic - apolytic the presence of scolices, daughter cyst, brood capsules, or
OVA - Oval, operculated - Spherical, non hydatid sand.
immature operculated emb. • Serologic test
LARVAL STAGES - Coracidium, procercoid, - Cysticercoid,
plerocercoid or cysticercus, hydatid Epidemiology
sparganum • Primarily found in areas in which sheep or other
INTERMEDIATE - 2 Intermediate Host - Only one, usually herbivores are raised and in close contact with dogs or
HOST lower forms of
wild canines.
mammal or arthropod
Clinical Symptoms
Echinococcosis
Taenia saginata
Anaphylactic shock
Common name: (Beef tapeworm)
Eosinophilia
Disease: Taeniasis
Allergic reaction
And
E. granulosus lung infection
Taenia solium
Chest pain
Common name: (Pork tapeworm)
Coughing
Disease: Taeniasis
Shortness of Breath
Liver involvement
Laboratory Diagnosis
Obstructive jaundice
• Stool is the specimen of choice for recovery of egg and
gravid proglottids
• Cellophane Tape Prep

Life cycle Notes

• Infection occurs following the ingestion of raw or
undercooked beef or pork contaminated with cysticercus
larva.

Hymenolepis diminuta
Common name: Rat tapeworm

Laboratory Diagnosis
• Recovery of eggs in the stool

Life cycle notes

• Primarily parasite of rats
• Contaminated droppings from infected rats are the source
of parasite transmission into an intermediate host, such as
grain beetle or flea
• Considered as accidental parasitic disease

Hymenolepis nana
Common name: Dwarf tapeworm

Laboratory Diagnosis
• Examining stool sample for eggs

Dipylidium caninum
Common name: Double pored tapeworm

Laboratory Diagnosis
• Recovery of the characteristic egg packets or gravid
proglottids in stool sample

Diphyllobothrium latum
Common name: Broad fish tapeworm

Laboratory Diagnosis