Ectoparasite Morphology
• 4 pair legs, 2 pair mouth parts,
no antennae, oval, separate
sex
• Ixodidae (hard ticks),
Argasidae (Soft ticks)
Ticks (Arachnida) kirna • No distinct head, thorax &
in Nepali abdomen
• Anterior Capitulum-dorsal side
(Hard ticks) & Ventral side
(Soft ticks)
• Scutum present in hard ticks,
lack in soft ticks
Mites (Arachnida) • Extremely small, still visible
Sulsule in Nepali with eyes, oval shape
• 3 pair powerful hairy leg, claw
like feet, rear feet are long for
jumping
Fleas (Insecta) Upiya in • mouth for piercing and sucking
Nepali • comb like structure above
mouth (genal ctenidia) and
pronotal ctenidia behind the
head
Flies (Crustacea) Jinga in
• Two pair wings (one pair small
than other), 1 pair eye, 1 pair
Nepali
antenna, 3 pair legs
W
• Wingless, 3 pair leg, claw like
feet extending from thorax, 1
pair antenna, Mouth parts for
Lice (Insecta) Jumra in piercing and sucking blood.
Nepali • Head louse and body louse are
N
hairless.
• Crab lice has hair on
extremities
KU
• Head, thorax, abdomen (10
Mosquitos (Insecta)
segments), 3 pair legs, 2 pair
Lamkhutte/Maxxad in
wings (one pair small), 1pair
Nepali
antenna
Life cycle and transmission Clinical Treatment Prevention
• Hard ticks: bacterial, viral and
rickettsia disease
AL
• primary vector for Borrelia • Few drops of
• Tick repellant, avoid tick
• Egg, larva, nymph, adult of separate burgdorferi (Lyme disease), ether/chloroform on
infesting area, protective
sexes. Range 1-2 yrs. and Babesia sp. head and pulling
clothing
• inflammation, edema, local straight out
hyperemia, hemorrhage, tick
paralysis
H
• Cleaning clothes, dressing,
• Burrow skin, hair follicle, sebaceous
bedding by hot water and
gland.
• Scabies • Treatment: creams and drying in hot cloth dryer.
• Egg, larva, nymph, adult (2 weeks
• Pimple like lesions, night time lotion (permethrin • If clothes cannot be
IS
from egg to adult)
pruritis lotion) washed right away then
• Transfer from one person to
put it in plastic, so spread
another.
can be prohibited.
• Vector for Dipylidium caninum,
Hymenolepsis nana,
• Egg deposited on ground-Larva (2-
• Protecting cats and dogs,
,B
Hymenolepsis dimunita,
10 days incubation period),3 larva
Yersinia pestis (plaque) cleaning the object which
stage-3rd stage mature larva spin • Remove the fleas
• Some are asymptomatic, are touched by these
into cocoon, remain in this pupal
intense itching, dermatitis, animals.
stage for 1 year-adult
ulcerations, nodular swelling at
bite
• Tsetse fly- Africa
(Trypanosoma)
R
• Egg-Larva (multiple stage)-cocoon
• Sand fly-Asia, S. America,
Central America,
Mediterranean Mexico
(Leishmaniasis)
• Black fly- Africa, Mexico,
• Topical ointment, Tx
for myiasis: complete
• repellant, protective
O
stage(pupa)-adult clothing, hygiene
excision of lesion.
Central and S. America
(onchocerca vulvus)
• Deer fly-Tropical Africa (Loa
Loa)
• Enteritis and myiasis
• Crab lice transmitted via sexual
contact • benzene hexachloride
• Eggs (nits)- Nymph (3 stage) - Adult
• Pediculosis -infestation of lice, lotion (destroys eggs • Personal hygiene
(takes 24-27 days) Lives for 30 days
Itching, inflammation at bite and adult)
site
• Anopheles – Worldwide: P.
vivax, P. ovale, P. malariae, P.
falciparum • Repellant, insecticide,
• lotion and ointments
• Culex, Ades, Anopheles: destroy the stagnant
• Egg-Larva (4 larval form)-pupa-Adult (calamine & Benadryl
Wucheria broncrafti water around
lotions)
• Anopheles, Mansonia, your house
Armigeres, Ades: Brugia malayi
• Irritating dermatitis
 Morphology, Infective stage and
AMEBA Diagnostic stage and Diagnosis Clinical Treatment Prevention
Transmission
• Trophozoites and cyst in feces
• Invasive trophozoite and
quadrinucleated cyst
• Direct fecal smear for seeing
Entamoeba • Cyst trophozoite motility • Flask shaped Amebic ulcer,

AL
• Safe disposal of feces, safe
histolytica • Swallowing food and water • Unidirectional liver abscess • Metronidazole
drinking water, food, hygiene
(pathogenic) contain cyst movement • Amebic dysentery
• Detection of antibodies for the
diagnosis of ALA
• Charcot Leyden crystal and RBC
ingested trophozoites positive
Entamoeba • Similar to Entamoeba histolytica

H
dispar but DNA and RNA differ • Cyst and trophozoites in the feces
(commensal) • Mature cyst
• Mature cyst
E. moshkovshii • Similar to E. histolytica and E.
• Cyst and Trophozoites in the feces

IS
(commensal) dispar but differ biochemically
and genetically
E. hartmanni • Similar to E. histolytica but small
• Trophozoites and cyst in feces • Doesn’t ingest RBC
(commensal) • Mature cyst
• Trophozoite blunted pseudopodia,
E. coli sluggish movement, more • No RBC ingested instead of
• Mature cyst (8 nuclei)

,B
(commensal) granular vacuoles RBC bacteria is ingested
• Cyst and trophozoites in feces
• Found in pigs and monkeys
E. polecki • Cysts and trophozoites in feces
• Mature cyst • Good hygiene and proper
(commensal) • Sluggish trophozoite motility • Not necessary
• Cyst uninucleate disposal of human waste
• Can be found in mouth
• Trophozoite with blunted
• Trophozoites
• Food vacuole contains
E. gingivalis
(commensal)
pseudopodia
• No cyst stages
• Can be transmitted via kissing,
sharing utensil
• Blunt hyaline pseudopodia
R
• swab between gums and teeth is
examined for trophozoites
leukocytes
O
E. nana • Quadrinucleated cyst and same
• Trophozoites and cyst in feces • food vacuole with bacteria
(commensal) size as trophozoite
• Mature cyst
• Trophozoite-large vesicular
Iodamoeba
• Large glycogen bodies-stained
W

nucleus
butschlii • Trophozoites and cyst in feces
• Uninucleate cyst dark brown with iodine
(Commensal)
• Mature cyst
Diagnosis for commensal except gingivalis:
• Stool examination, Cysts recovered from formed stool, trophozoites from
watery stool
N

• Use of FECT and zinc sulfate flotation for cyst recovery

• Trophozoites by direct fecal smear.
• Active trophozoite with thorn like
• Cyst and trophozoites in tissues
Acanthamoeba appendages
• Diagnosed by epithelia biopsy or • Acanthoma keratitis
• Cyst (1 nuclei) stage formed • Medical treatment in • Contact lens hygiene
KU

species
corneal scraping • Granulomatous amebic
(Free living when environment condition is not met yet • Robust immune system
• Diagnosis of GAE is usually in encephalitis
pathogenic) not favorable
postmortem
• Trophozoites infective stage
• Trophozoite, flagellate and cyst • Trophozoite form in CSF and brain
Naegleria fowleri form are present tissue and flagellate form occasionally • Chlorination can kill parasite
• Primary amebic • Amphoterin B +
(Free living • Trophozoite infective stage in CSF in water
meningocephalitis clotrimazole
pathogenic) • Transmission by contaminated • blunt, lobose pseudopodia,
water directional motility
 AL
CILIA AND Morphology, Infective stage and Diagnostic stage and Diagnosis Clinical Treatment Prevention
FLAGELLATES Transmission
Balantidium coli • Normal host pig • Cyst and trophozoites in feces • Balantidiasis • Metronidazole • Sanitation, pig feces
(pathogenic) • Trophozoite (macro and • Sedimentation/floating techniques • Only ciliate to cause human • tetracycline fertilizer should be
micro nucleus, 2 contractile infection avoided
vacuole) • Attack intestinal epithelium,
• cyst (2 nuclei) round base wide neck ulcer
• Infective stage: cyst • Can spread to mesenteric nodes,

H
• Ingestion of contaminated appendix, liver, pleura,
water and food containing lungs, genitourinary sites
cyst
result in infection

IS
Giardia Lamblia • lives in duodenum, jejunum, • Trophozoite and cyst in stool specimen. • Giardiasis • metronidazole, • Sanitation
(pathogenic) upper ileum • Trophozoite floating leaf like motility • Attach to intestine by sucking • tinidazole,
• Quadrinucleated cyst stage disc, decrease maltase and • furazolidone,
(4 nuclei) sucrase activity • albendazole
• trophozoites (pear • malabsorption,
shaped, 2 nuclei, 4 pair • maldigestion

,B
flagella) • Steatorrhea, low grade fever,
• Infective: cyst failure to thrive
Trichomonas • Only trophozoite stage • Trophozoite • Inflammation of vagina, • metronidazole/tinidazole • limiting sexual
vaginalis (pyriform shape) • Saline preparation of vaginal fluid prostatitis in male, other areas partner, use protective
(Pathogenic) • Four free anterior flagella, 5th affected are urethra also. device for sex
embedded in undulating • Trophozoite infect the surface
membrane but doesn’t invade
• One nucleus

R
• Sexual intercourse
T. hominis • Only trophozoite (pyriform
(Non- Pathogenic) shape)
• 5 anterior flagella, 1
posterior flagella
• 1 nucleus
O
• Cecal area of large intestine
is habitat
• Only trophozoite (pyriform • Diagnosis by swabbing of tartar between
W
T. tenax
(Non-pathogenic) shape) teeth
• Transmission from droplet Four equal flagella and 5th on margin of
spraying, kissing, common undulating membrane which don’t reach
utensil/glasses to drink. posterior end.
• Living in tartar of teeth • Single nucleus
N

Smaller and slenderer than T. vaginalis

Chilomastix • Lives in cecal region of large • Cyst or trophozoite in feces • Proper hygiene
mesnili intestine • Trophozoite is asymmetrically pear sanitation
(Non-pathogenic) • Trophozoite and cyst stage shaped
• Transmission-ingestion of • 3 anterior, one posterior flagella
U

cyst in food and drink • Cyst- pear or lemon shaped

 AL
COCCIDIANS Morphology, Infective stage and Diagnostic stage and Diagnosis Clinical Treatment Prevention
& other Transmission
Cryptosporidium • Sexual or sporogony producing • Two types of oocyst – thin walled • In immunocompromised people • No acceptable • Contamination of
hominis oocyst-asexual cycle or schizogony (infect other enterocyte) and thick diarrhea becomes severe treatment yet water by human feces
(merogony) producing walled (passed in feces) should be reduced.
merozoites-gametogony • Thick-walled oocyst

H
producing male(micro) and • Acid fast staining
female(macro) gametocytes.
• One Oocyst four sporozoites) –
Trophozoite (becomes

intracellular but extra cytoplasmic,
attached to brush border)
Cyclospora • Sporulated cyst
cayetanensis • 1 oocyst (2 sporocyst each
containing 2 sporozoite)
• Unsporulated cyst
• Direct microscopic examination of
fecal smears under high magnification
IS
• D-xylose malabsorption • Self-limiting disease • Fruits and vegetable
• Chronic and acute diarrhea with should be washed
alternating constipation before
eating

,B
Cystoisopora belli • Sporulated Oocyst contains 2 • Oocyst in feces • Cystoisporiasis • trimethoprim + • Sanitation
sporocyst with each having 4 • Self-limiting diarrhea to severe sulfamethoxazole
sporozoites diarrhea illness in
• Ingestion of contaminated food or immunocompromised person
water containing sporulated • Flattened mucosa and damaged
oocyst villi
• Infective stage: mature oocyst
with sporozoites

R
Toxoplasma • Infective stage: bradyzoite, • Trophozoites(tachyzoite) and cyst • In immunocompromised people: • trisulfapyrimidines • Avoiding contaminated
gondii tachyzoite and oocyst (filled with bradyzoite) encephalitis, myocarditis, focal and pyrimethamine meat.
• Extraintestinal (bradyzoite, • analyzing blood sample using pneumonia
tachyzoite) serologic test methods
Sarcocystis
species
• Simplest form is zoite (banana
shaped)
• Infective stage: Cyst with
bradyzoite ingested in
undercooked meat.
O
• Diagnosis: Identification of sporocyst
in feces
• Treatment is rarely
required
• cooking or freezing
meat to kill bradyzoites
in sarcocysts
W
Blastocyst • Glistening appearance in wet • Granular forms are multinucleated • Blastocystosis • Metronidazole • Consuming safe
hominis mount, absence of organelle of and found in old culture drinking water.
(other) locomotion • Vacuolated form is predominant in
• Four forms: vacuolated, ameba fecal specimen which causes diarrhea.
like, granular, multiple fission
Dientamoeba • Flagellate with only trophozoite • Trophozoites • doesn’t invade the tissue, irritate • Iodoquinol • Proper sanitation,
N

fragilis stage known. • Binucleated trophozoites in stool. mucosa, hypersecretion, disposal of human
(other) • One/two rosette shaped nuclei hypermotility of bowel waste
(rarely3/4)
• Lives in mucosal crypts of the
appendix, cecum and upper colon.
 222 Section 3 Helminthology

Table 12.3: Classification of nematodes based on habitat

Intestinal Human Somatic Human Animal nematodes infecting rarely to man

nematodes nematodes Larva migrans Other Animal nematodes
Small Intestine Filarial worm Visceral Larva migrans Zoonotic filariasis
Toxocara (Liver) Dirofilaria
Ascaris lumbricoides Lymphatics Angiostrongylus Intestine
(Common round worm) Wuchereria bancrofti cantonensis (CNS) Capillaria philippinensis
Ancylostoma duodenale Brugia malayi Angiostrongylus Trichostrongylus spp.
(Old world Hookworm) Brugia timori costaricensis (abdomen) Strongyloides fuelleborni
Necator americanus Anisakis Oesophagostomum
(American or new world Gnathostoma Ternidens spp.
Hookworm) Baylisascaris
Skin Conjunctiva
Loa loa (also eye) Thelazia spp.
Onchocerca (also eye) Cutaneous larva migrans Liver
Mansonella streptocerca Ancylostoma braziliensis Capillaria hepatica
Mansonella ozzardi Ancylostoma caninum
(Serous cavity) Kidney
Ancylostoma ceylanicum Dioctophyma spp.
Mansonella perstans Gnathostoma spp.
Large intestine Other Human Somatic Uncinaria stenocephala Respiratory tract/lungs
Trichuris trichiura nematodes Bunostomum spp. Mammomonogammus
(Whip worm) Trichinella spiralis Capillaria aerophila
Enterobius vermicularis Dracunculus medinensis Ascaris suum
(Thread or pin worm) (Guinea worm)
Abbreviations: CNS, central nervous system

Fig. 12.1: Developmental stages of nematodes

adult Worm (hookworm, Trichinella and Strongyloides)

z Shape: Nematodes are elongated, cylind­
rical or filariform in shape with both the
ends pointed. They are unsegmented
without any appendages
z Size: Variable, ranging from less than 5 mm
to as long as one meter (Dracunculus).
Female worms are longer than male worms
z Symmetry: Body is bilaterally symmetrical
(one plane) while head is radially symme­
trical (multiple plane)
z Body wall: Made up of outer layer of

Chapter 12.indd 222 5/19/2014 11:47:46 AM

 326

Appendix.indd 326
Contd...
Symptoms protozoa Helminths
Cestodes Trematodes Nematodes
Malignancy Schistosoma haematobium
Clonorchis sinensis
Opisthorchis viverrini
skin and sub- Entamoeba histolytica (amoebiasis cutis) Ta e n i a s o l i u m ( s c Schistosoma spp.(Cercarial Agents of cutaneous larva migrans
cutaneous Leishmania spp.(dermal leishmaniasis and nodules) dermatitis) (creeping eruption)
Essentials of Medical Parasitology

infections PKDL) Multiceps multiceps (sc Hook worm (ground itch)

Trypanosoma brucei nodules) Strongyloides stercoralis (lar va
Trypanosoma cruzi currens)
Onchocerca volvulus
(Onchocercoma)
Loa loa (Calabar swelling)
Dracunculus
medinensis
(blisters)
Mansonella streptocerca
Mansonella ozzardi
Opportunistic Toxoplasma gondii Strongyloides stercoralis ( c o -
infections in Cryptosporidium parvum infection)
AIDS patients Isospora belli
Microsporidia
Entamoeba histolytica
Giardia lamblia
Free- living amoebae
Cyclospora cayetanensis
Leishmania spp.(co-infection)
Abbreviations: CNS, central nervous system; SC, sub cutaneous; PKDL, Post Kala azar dermal leishmaniasis; AIDS, accquired immuno deficiency syndrome

5/17/2014 5:48:33 PM
 Chapter 14 Nematodes—III (Somatic Nematodes) 263

hatic system, skin, subcutaneous tissue and
rarely body cavity
z Adult worm: The adult worms are slender,
round measuring 2–10 cm in length (except
the female Onchocerca 35–50 cm). Some
adult filarial worms can survive for many
years in humans causing a number of
chronic obstructive and inflammatory
conditions including elephantiasis and
hydrocele
z Microfilariae: The female worm produces
large number of L1 larvae called as micro-
filariae which are highly motile thread like
larvae. They are usually non pathogenic
but sometimes, hypersensitivity reactions
can occur against the microfilarial antigen
resulting in tropical pulmonary eosino-
philia (TPE).
CLASSIFICATIon
Filarial nematodes belong to class Secer-
nentea, superfamily Filarioidea and family
Onchocercidae. They can be differentiated
by a number of properties such as (Table 14.2
and Fig. 14.1):
z Habitat: Whether they reside in lymphatics
or subcutaneous tissues or body cavities

Table 14.2: Differences between various filarial nematodes

parasite Location of Location of Microfilaria Vector Epidemiology

adult microfilaria periodicity
Lymphatic filariasis
Wuchereria Lymphatic Blood Nocturnal Culex-Worldwide Cosmopolitan, (South
Bancrofti tissue (mostly) America, Africa, South
Anopheles in rural Asia)
Africa
Subperiodic Aedes Pacific islands
(Rare)
Brugia malayi Lymphatic Blood Nocturnal Mansonia South-East Asia,
tissue (mostly) Anopheles Indonesia and India
Subperiodic Coquillettidia and South-east Asia
(rare) Mansonia
Brugia timori Lymphatic Blood Nocturnal Anopheles Indonesia
tissue
Subcutaneous filariasis
Loa loa Subcutaneous Blood Diurnal Chrysops (deerflies) West and Central Africa
tissue and
conjunctiva
Onchocerca Subcutaneous Skin and eye None Simulium (blackflies) South and Central
volvulus tissue America and Africa
Mansonella Subcutaneous Skin None Culicoides (midges) West and Central Africa
streptocerca tissue
Serous cavity
Mansonella Body cavities Blood None Culicoides (midges) South and Central
perstans and mesentery America and Africa
Mansonella Body cavities Blood None Culicoides (midges) South and Central
ozzardi America
Simulium (blackflies) Caribbean islands

Chapter 14.indd 263 5/17/2014 5:38:57 PM