PARASITOLOGY LECTURE Prepared by: Chester F.

Ebersole

Strongyloides stercoralis – also known as ______________

Smallest nematode to infect human
RECALL: Ovoviparous, Skin penetration of filariform larva
Pathogenicity
1. Strongyloidosis – benign and asymptomatic; Diarrhea or Vietnam Diarrhea or Cochin China Diarrhea
With presence of honey comb worm that may cause protein losing enteropathy and paralytic ileus
2. Racing larva or Larva currens – after skin penetration of ___________
3. Autoinfection
4. Bronchopneumonia - ________ of S. stercoralis may be seen
Laboratory Diagnosis
1. Qualitative and Quantitative Stool or Duodenal Aspirates
2. Concentration Method – Zinc Sulfate Flotation Method
3. Stool Culture – Harada Mori; Baermann Technique
4. ELISA
5. CBC
Life Cycle – Three different cycles
1. Direct Cycle – The rhabditiform larva in stool molts twice from the soil and becomes a filariform
larva. Filariform larva enters the host by skin penetration. The larvae undergo heart and lung
migration and finally reaching the small intestine. They mature into adult male and female in 15-
20 days. Female worms burrow in the lumen of small intestine. The females lay egg and hatched from
the feces as rhabditiform larvae and the cycle continues. Maturation in man is 17 days

2. Free living phase / indirect cycle phase – The rhabditiform larvae passed in stool and developed into
filariform and eventually mature female and male in the soil. They mate and release new
rhabditiform larva that eventually become filariform larva and enter the skin of humans by
penetration.

3. Autoinfection
Internal Autoinfection – It is typically seen in immunocompromised host. The rhabditiform larva from
egg becomes filariform larvae inside the host and undergoes heart and lung migration and
becomes and adult and completing its life cycle.
External Autoinfection – The rhabditiform larva becomes filariform larva after passing to the intestine.
The filariform larvae pierces the perianal region and undergo heart and lung migration and
becomes an adult completing its life cycle
OVA
-> Smaller than Hookworms
-> Well Developed Larva
-> Rarely seen in stool
-> “Chinese Lantern Ova”

Two Types of Larva of S. stercoralis

Rhabditiform Larva – 1st stage Filariform Larva – 2nd stage
1. Diagnostic Stage - ___________/ Feeding 1. Infective stage
2. Short double esophageal bulb 2. Long esophagus and notched tail
PARASITOLOGY LECTURE Prepared by: Chester F. Ebersole

Difference Between the Filariform larva of hookworm and S. stercoralis

Hookworm Strongyloides stercoralis
Esophagus Shorter Longer
Tail Pointed Fork/ Notched
Sheath Sheathed Non-sheathed

-> PARTHENOGENIC – ABLE TO LAY

_______________ even without male
-> 1/3 esophagus and 2/3 intestine
-> Male contains copulatory spicule

Trichinella spiralis – also known as ______________ or Trichina worm

Adult: ________________, Encysted Larva: ____________
Human becomes the __________________
RECALL: Viviparous, Ingestion of inadequately cooked pork within a definitive host
Smoking, salting or drying the meat do not destroy infective larva ( FREEZER CAN)
Pathogenicity
1. Trichinosis
STAGE 1: Intestinal Invasion: presence of diarrhea and GIT disturbances
STAGE 2: Muscle Invasion: myalgia ( highest eosinophilia seen)
STAGE 3: Encystment: Symptoms subside
Laboratory Diagnosis
1. Muscle biopsy
2. Bachman Intradermal Test
3. X-ray – presence of calcified cyst
4. Serological Test – Bentonite flocculation test and ELISA
5. Elevation of muscular enzymes such as Lactate Dehydrogenase, Aldolase and Creatine Kinase
Life Cycle of Trichinella spiralis – Optimum definitive host – PIGS
Human acquires T. spiralis by ingestion of encysted larva in the muscle of pigs. It is
digested in the stomach where excystation occurs. The larvae become adult in the small intestine.
The male dies after fertilizing the female. Larva migrates to different parts of the body but only
ENCYSTED in the muscle. It is END OF LIFE CYCLE BECAUSE HUMAN TISSUE IS NOT CONSUMED.
PARASITOLOGY LECTURE Prepared by: Chester F. Ebersole

Adult Encysted Larva

MALE: presence of pear shaped clasping

papillae at the posterior end ( claspers) –
holding female
Dracunculus medinensis or Guinea worm / Medina worm/ Serpent worm / Dragon worm
Considered as eradicated by WHO
RECALL: Viviparous, Ingestion of larvae within intermediate host
DEFINITIVE HOST: _________ INTERMEDIATE HOST: __________
May secrete a toxin that causes blister formation discharging a milky fluid with numerous larva
Once gravid female settles into the subcutaneous tissues and lays her larvae, a painful ulcer
develops at site. Nodule and calcification may occur if adult worm is not completely removed
Released worm after bathing the ulcer with water ( Detection) – winding first stage larva (L1)

Capillaria philippinensis – also known as pudoc worm

RECALL: Oviparous and Ovoviparous / Ingestion of larvae within intermediate host
DEFINITIVE HOST: ____________
( Piscivorous birds – reservoir for pudoc worm) - herons, egrets and bitterns
INTERMEDIATE HOST: _______ ( Hypselotris bipartita)/ Brackish Water Fishes
Causative agent of Mystery disease or Borborygmus ( Gurgling stomach) – Chronic diarrhea
Autoinfection may occur in man
OVA OF Capillaria philippinesis ( Eggs become embryonated in water)
Typical Ova Atypical Ova Adult
Peanut Shape Not peanut shape Male: Long unspined sheath
Flattened bipolar plugs No flattened polar plug Both: thin filamentous
Single non-segmented cell Multi segmented cell anterior and shorter posterior
(Striated Shell) end
PARASITOLOGY LECTURE Prepared by: Chester F. Ebersole

Capillaria hepatica - hepatic capillariasis

Angiostrongylus cantonensis – also known as Rat lung worm
Definitive Host: Rat
Intermediate hosts: molluscs, slugs and snails ( Human as terminal host)
Man acquired it through ingestion of contaminated snail containing larva
LARVA goes to the brain and cannot develop further (Eosinophilic meningoencephalitis or
Cerebral angiostrongyliasis) – High Eosinophilia; SAMPLE: CSF
Adult worm resembles barber pole appearance
Eggs resemble hookworms
Angiostrongylus costaricensis – intestinal angiostrongyliasis
Gnathostoma spinigerum – prominent cephalic bulb and body spines
Primarily by eating undercooked freshwater fish, eels, frogs, birds, and reptiles with larva
Definitive Host: Dog, Cat , Paratenic: Snake, Birds and Human ( Terminal)
1st intermediate host: copepods 2nd Intermediate host: fish and frogs
Associated with migratory swellings in the skin or Indurated nodules
Anisakiasis
Can be acquired by human with infective fish or squid containing larva
Inflamed mass in the esophagus, stomach, or intestine
FILARIAL WORMS – transmitted by blood sucking insects
RECALL: Viviparous/ Skin inoculation of vector with L3 larva
Definitive Host: _____________ Intermediate Host: ______________
LIFE CYLE OF MICROFILARIA
L3 Larva will be introduced by the vector through skin inoculation. Inside the body, larva
migrates to the tissue and becomes adult. The adult worms may reside in the lymphatic,
subcutaneous tissue or internal body cavities. Adult female worms lay live microfilariae, which take
up residence in the blood or dermis. The microfilariae (L1) exit the body via a blood meal by the
arthropod vector. L1 transforms until L3 in body of the blood sucking insects and repeat life cycle.
SPECIMEN REQUIREMENTS – microfilaria is in the lungs if cannot be found in blood
A. Nocturnal Periodic ( 9PM – 4AM) - largest number of microfilaria at night
B. Diurnal Periodic (10:15AM-2:15PM) - largest number of microfilaria at day
C. Non periodic - constant levels day and night
D. Subperiodic or nocturnal subperiodic - Can be detected at day but high numbers in late afternoon or night
Laboratory Diagnosis
1. Blood – Giemsa Stained or filtering of heparinized blood using nucleopore filter
2. Scraping from infected nodule and skin snip
3. Concentration technique – Knott ( for small amount of microfilaria) or 1mL blood immersed in 10mL
2% formalin solution to lyse red cells.
4. Serological Test
5. Opthalmologic examination using slit lamp – filarial worms residing in eyes
6. Ultrasonography – presence of filarial dance sign
Summary of Microfilaria ( Pathogenecity)
W. bancrofti Elephantiasis – tissue swelling due to obstruction of lymph glands
“Malabar Leg”
Hyrocoele
Loa loa Fugitive Swelling or Calabar Swelling or transcient subcutaneous swellings
Onchocerva volvulus River Blindness – second causing blindness in the world
Onchocercomata – painless nodules
Sowdah / Onchodermatitis
Nodding Syndrome – believed to be associated with this parasite
TROPICAL EOSINOPHILIA or OCCULT FILARIASIS MAY HAPPEN IN BOTH Wuchureria bancrofti and
Brugia malayi – with pulmonary and asthmatic reaction ( hypersensitibity) but absence of microfilaria
Mansonella streptocerca – skin disease; Mansonella perstans and ozzardi – non-pathogenic
PARASITOLOGY LECTURE Prepared by: Chester F. Ebersole

Description W.bancrofti B. malayi L.loa M. perstans M. ozzardi O. volvulus

Sample Blood Skin Snips
SHEATH PRESENT ABSENT

NOTE: Sheathed microfilaria retain their egg membrane

Periodicity Vector Location
Wuchureria bancrofti Nocturnal Culex ; Aedes; Anopheles Lower Lymphatic’s
Brugia malayi Nocturnal subperiodic Aedes; Anopheles; Mansonia Upper Lymphatic’s
Loa loa Diurnal Chrysops; Deer Fly; Mango Fly Subcutaneous tissue
Conjunctiva
Onchocerca volvulus Non Periodic Simulium; Black Fly Subcutaneous nodule
Conjunctiva
Mansonella streptocerca Non Periodic Culicoides Subcutaneous
Mansonella ozzardi Non Periodic Culicoides; Simulium Serous Cavity
( New World Filaria)
Mansonella perstans Non Periodic Culicoides Serous cavity
M. streptocerca is also known as Acanthocheilonema, Dipetalonema or Tetrapetalonema streptocerca

Zoonotic Filariasis
A. Dirofilaria immitis = “ Dog Heart Worm”
Definitive Host: Dog Intermediate Host: Aedes, Culex, Anopheles and Mansonia

Partial nocturnal, Unsheathed and Arthropod borne infection

In human heart, dead worm becomes embolus producing pulmonary infarct
Dead worm in hearts – coin lesion on x-ray
QUIZ 3 up to here
END OF PRELIMS