*Parasitology I and Parasitology II*

Contents

Chapter 1: Trematodes 3

Chapter 2: Nematodes 12

Chapter 3: Filarial Nematodes 19

Chapter 4: Cestodes 21

Chapter 5: Amoebas 28

Chapter 6: Intestinal Flagellates 31

Chapter 7: Flagellates 32

Chapter 8: Entamoebas 40

2
 Trematodes
Scientific Name Fasciola hepatica
Common Name Sheep liver fluke
Intermediate Host Fresh water snail - Lymnaea
Definitive Host Sheep
Humans (accidental host)
Final Habitat Liver (specifically bile duct)
Diagnostic Stage Unembryonated egg
Infective Stage Encysted metacercaria
Mode of Infection Ingestion of water plant/liver infected with encysted metacercaria
-Fasciolosis
~Symptoms begins when encysted metacercaria migrates through
Pathology liver
~Chronic phase:
-Halzoun syndrome
-Hyperplasia of bile duct
-Hepatomegaly
-Jaundice
Diagnosis -Sample: stool (egg)
-Direct wet mount (Saline and Iodine)
-Thick smear (Kato Katz smear and Cedarwood Oil smear)
-Concentration methods (Formal-ether sedimentation/Ritchi)
-ELISA
-Serology
-Liver biopsy
-Radiographic techniques and magnetic resonance as confirmatory
Morphology Egg: Adult:
-Size: 140 x 70 um -Size: 3.0 x 1 cm
-Shape: oval, thin eggshell -Shape: Fleshy fluke with:
and small operculum Anterior conical projection, converging
-Colour: light yellow borders,
-Content: immature -Suckers: two equal suckers
-Intestinal caeca: lateral branches and
simple medial ones
-Testes: two highly branched, mainly in
the middle of the body
-Ovary: branched in front of the testes on
one side
-Vitelline glands: small follicles on both
sides
-Uterus: short, convoluted

3
Scientific Name Fasciola gigantica
Common Name Cattle liver fluke
Intermediate Host Fresh water snail - Lymnaea
Definitive Host Cattle
Humans (accidental host)
Final Habitat Liver (specifically bile duct)
Diagnostic Stage Unembryonated egg
Infective Stage Encysted metacercaria
Mode of Infection Ingestion of water plant/liver infected with encysted metacercaria
-Fasciolosis
~Symptoms begins when encysted metacercaria migrates through
Pathology liver
~Chronic phase:
-Halzoun syndrome
-Hyperplasia of bile duct
-Hepatomegaly
-Jaundice
Diagnosis -Sample: stool
-Direct wet mount (Saline and Iodine)
-Thick smear (Kato Katz smear and Cedarwood Oil smear)
-Concentration methods (Formal-ether sedimentation/Ritchi)
-ELISA
-Serology
-Liver biopsy
-Radiographic techniques and magnetic resonance as confirmatory
Morphology Egg: Adult:
-Size: 140 x 70 um -Size: 6.0 x 1.5 cm
-Shape: oval, thin eggshell -Shape: Fleshy fluke with:
and small operculum Anterior conical projection, converging
-Colour: light yellow borders,
-Content: immature -Suckers: two equal suckers
-Intestinal caeca: lateral branches and
simple medial ones
-Testes: two highly branched, mainly in
the middle of the body
-Ovary: branched in front of the testes on
one side
-Vitelline glands: small follicles on both
sides
-Uterus: short, convoluted

4
Scientific Name Clonorchis sinensis
Common Name Chinese/Oriental liver fluke
Intermediate Host Snail: Parafossarulus manchouricus
Fish: 12 species
Definitive Host Any fish eating mammals
Humans (accidental host)
Pigs, dogs, cats, rats
Final Habitat Liver (specifically bile duct)
Diagnostic Stage Embryonated egg
Infective Stage Encysted metacercaria
Mode of Infection Ingestion of raw/uncooked fresh water fish infected with encysted
metacercaria
Pathology -Clonorchiasis:
~Usually asymptomatic due to its small size
~Heavy infection may cause biliary obstruction
Diagnosis -Sample: stool
-Direct wet mount (Saline and Iodine)
-Concentration methods (Formal-ether sedimentation/Ritchi)
- Duodenal aspiration
- Entero-test capsule
- Multiplex PCR
Morphology Egg: Adult:
-Size: 30 x 15 um -Size: 1-2.5 x 3-5 mm
-Shape: egg plant, -Shape: spindle-shaped
thick eggshell, small -Suckers: two suckers
operculum, small -Intestinal caeca: simple
knob at the other -Testes: two deeply branched, seen in the
end, shoulders posterior part
-Colour: light yellow -Ovary: in front of the anterior testis and usually
-Content: mature has 3 lobes
miracidium -Vitelline glands: small follicles in the lateral
fields of the middle
-Uterus: very long folded, extends between the
ovary and ventral sucker

5
Scientific Name Paragonimus westermani
Common Name Japanese lung fluke
Intermediate Host Snail
Crustacean
Definitive Host Humans
Final Habitat Lungs
Diagnostic Stage Unembryonated egg
Infective Stage Encysted metacercaria
Mode of Infection Ingestion of raw/uncooked crab/crayfish/crustaceans infected with
encysted metacercaria
Pathology -Paragonimiasis
~No symptoms till it reaches the lungs
~Invading a migrating stage larva (no pathology)
~Suppurative stage Abscess
~Cystic stage chocolaty fluid eggs + Charcot Leyden crystals
~Fibrous scar stage dead worm, pus expelled or absorbed and
replaced by fibrous scar tissue.
Diagnosis -Sample: stool or sputum
-Direct wet mount (Saline and Iodine)
-Concentration methods (Formal-ether sedimentation/Ritchi)
-Skull radiographs
-CT
-Magnetic resonance imaging
-ELISA
-Serology
Morphology Egg: Adult:
-Size: 90 x 50 um -Size: 7.5-12 x 4-6 x 1-3 mm
-Shape: broad oval, -Shape: Dorsally convex and flattened
thick shell, flat ventrally
operculum and thicker -Colour: reddish-brown
at the non-operculated -Suckers: two sub-equal suckers with a central
end sucker
-Colour: golden-brown -Intestinal caeca: divided into two lobulated
-Content: immature caeca
-Testes: two that lay side by side to ovary and
uterus
-Ovary: side by side to testes and uterus
-Vitelline glands: well developed
-Uterus: side by side to testes and ovary
-Excretory bladder: extends forward to the
level of pharynx

6
Scientific Name Fasciolopsis buski
Common Name -----------------------------
Intermediate Host Fresh water snail
Definitive Host Humans
pigs
Final Habitat Small intestine
Diagnostic Stage Unembryonated egg
Infective Stage Encysted metacercaria
Mode of Infection Ingestion of water plant infected with encysted metacercaria
Pathology -light and asymptomatic
-heavy infection:
~Diarrhoea, abdominal pain, fever, ascites, oedema
~Intestinal obstruction mucosal diarrhoea
~Inflammation, ulceration, abscess
~Destruction of intestinal wall haemorrhage
~Toxicity due to absorption of toxic waste
Diagnosis -Sample: stool
-Direct wet mount (Saline and Iodine)
-Concentration methods (Formal-ether sedimentation/Ritchi)
Morphology Egg: Adult:
-Size: 130-150 x 160-90 um -Size: 20-75 x 8-20 mm
-Shape: Oval, operculated -Shape: pear-shaped with rounded
-Colour: yellowish-brown posterior end
-Content: immature -Suckers: two suckers
-Intestinal caeca: simple unbranched
-Testes: branched at the posterior half
-Ovary: branched above the testis
-Vitelline glands: lateral on both sides
-Uterus: convoluted

7
Scientific Name Heterophyes heterophyes
Common Name -----------------------------
Intermediate Host Fresh water snail
Fish
Definitive Host Humans
Fish eating mammals
Final Habitat Small intestine
Diagnostic Stage Embryonated egg
Infective Stage Encysted metacercaria
Mode of Infection Ingestion of uncooked fish infected with encysted metacercaria
Pathology -Diarrhoea
-Colicky abdominal pain caused by attachment of worm to
intestinal mucosa myocardial and valvular damage
-Migration to other organs
Diagnosis -Sample: stool
-Direct wet mount (Saline and Iodine)
-Concentration methods (Formal-ether sedimentation/Ritchi)
Morphology Egg: Adult:
-Size: 30 x 15 um -Size: 1.0 x 0.5 mm
-Shape: short ellipse, -Shape: pear-shaped with broad rounded
operculum, small shoulders posterior end
-Colour: yellowish-brown -Suckers: three suckers small oral
-Content: mature sucker, large middle ventral suck, genital
miracidium sucker with 70-80 pines
-Intestinal caeca: two simple
-Testes: two, oval, in the posterior part of
the worm
-Ovary: rounded, above the testes
-Vitelline glands: few large follicles on
both sides posteriorly
-Uterus: convoluted, opens in the genital
sucker

8
Scientific Name Schistosoma mansoni
Common Name -----------------------------
Intermediate Host Fresh water snail Biomphalaria
Definitive Host Humans
Final Habitat Intestine (mesenteric venules of bowl/rectum)
Diagnostic Stage Embryonated egg
Infective Stage Biforked cercariae
Mode of Infection Skin penetration by biforked cercariae
Pathology -Acute:
~Urticarial rash
~Swimmers itch
~Kateyama fever
-Chronic:
~Intestinal granuloma formation
~Hepatical hepatosplenomegaly, portal hypertension, ascites
~Ectopic lung, heart, kidney, brain
Diagnosis -Sample: stool or urine
-Direct wet mount (Saline and Iodine)
-Thick smear (Kato Katz and Cedarwood oil smear)
-Concentration methods (Formal-ether sedimentation/Ritchi)
-Rectal biopsy
-Serological test
- Circumoval precipitation test, cercaria-Hullen reaction, indirect-
fluorescent-antibody test, indirect hemagglutination test and ELISA
Morphology Egg: Adult male: Adult female:
-Size: 150 x 65 um -Size: 6-13 x 1.1 mm -Size: 10-20 x 0.16 mm
-Shape: oval, thin -Shape: shorter and -Shape: longer and
egg shell, sharp broader than the thinner than the male,
lateral spine, non- female, lateral margins cylindrical
operculated folded-ventrally to -Suckers: oral and
-Colour: light form gynaecophoric ventral suckers (poorly
yellow canal developed)
-Content: mature -Suckers: oral and -Intestinal caeca: two
miracidium ventral suckers simple that unite to form
-Intestinal caeca: two a single one (at 1/3 of
simple that unite to the body)
form a single one (at -Ovary: oval and
1/3 of the body) smooth, pre-equatoral
-Testes: 6-9 -Cuticle: smooth
posterolateral to the -Vitelline glands: 2/3 of
ventral sucker the body
Cuticle tubercles: -Uterus: very short
coarse teguments

9
Scientific Name Schistosoma japonicum
Common Name -----------------------------
Intermediate Host Fresh water snail Oncomelania
Definitive Host Humans
Final Habitat Intestine (mesenteric venules of bowl/rectum)
Diagnostic Stage Embryonated egg
Infective Stage Biforked cercariae
Mode of Infection Skin penetration by biforked cercariae
Pathology -Acute:
~Urticarial rash
~Swimmers itch
~Kateyama fever
-Chronic:
~Intestinal granuloma formation
~Hepatical hepatosplenomegaly, portal hypertension, ascites
~Ectopic lung, heart, kidney, brain
Diagnosis -Sample: stool or urine
-Direct wet mount (Saline and Iodine)
-Thick smear (Kato Katz and Cedarwood oil smear)
-Concentration methods (Formal-ether sedimentation/Ritchi)
-Rectal biopsy
-Serological test
- Circumoval precipitation test, cercaria-Hullen reaction, indirect-
fluorescent-antibody test, indirect hemagglutination test and ELISA
Morphology Egg: Adult male: Adult female:
-Size: 90 x 60 um -Size: -Size:
-Shape: Short -Shape: shorter and broader -Shape: longer and
ovoid, thin shell, than the female, lateral thinner than the male,
small knob, non- margins folded-ventrally to cylindrical
operculated form gynaecophoric canal -Suckers: oral and
-Colour: light -Suckers: oral and ventral ventral suckers (poorly
yellow suckers developed)
-Content: mature -Intestinal caeca: two -Intestinal caeca: two
miracidium simple that unite to form a simple that unite to form
single one (at 2/3 of the a single one (at 2/3 of
body) the body)
-Testes: 6-7 posterolateral -Ovary: oval and smooth
to the ventral sucker -Cuticle: smooth
Cuticle tubercles: smooth -Vitelline glands:
tegument posterior half
-Uterus: long

10
Scientific Name Schistosoma haematobium
Common Name -----------------------------
Intermediate Host Fresh water snail Bulnisis
Definitive Host Humans
Final Habitat Bladder (venous plexus)
Diagnostic Stage Embryonated egg
Infective Stage Biforked cercariae
Mode of Infection Skin penetration by biforked cercariae
Pathology -Acute:
~Urticarial rash
~Swimmers itch
~Kateyama fever
-Chronic:
~Urogenital obstruction
~Obstructive uropathy
~Bladder calcification
~Bladded carcinoma
~Ectopic
Diagnosis Sample: stool (in heavy infection) or urine
-Direct wet mount (Saline and Iodine)
-Thick smear (Kato Katz and Cedarwood oil smear)
-Concentration methods (Formal-ether sedimentation/Ritchi)
- Nucleopore filtration
Circumoval precipitation test, cercaria-Hullen reaction, indirect-fluorescent-
antibody test, indirect hemagglutination test and ELISA
Confirmed by EITB test
Pathology Egg: Adult male: Adult female:
-Size: 40 x 60 um -Size: 12 x 1 mm -Size: 20 x 0.25 mm
-Shape: oval, thin -Shape: shorter and -Shape: longer and
egg shell, terminal broader than the female, thinner than the male,
spine, non- lateral margins folded- cylindrical
operculated ventrally to form -Suckers: oral and
-Colour: light gynaecophoric canal ventral suckers (poorly
yellow -Suckers: oral and ventral developed)
-Content: mature suckers -Intestinal caeca: two
miracidium -Intestinal caeca: two simple that unite to form
simple that unite to form a a single one (at the
single one (at the middle middle of the body)
of the body) -Ovary: oval and
-Testes: 3-5 posterolateral smooth, post-equatorial
to the ventral sucker -Cuticle: smooth
Cuticle tubercles: fine -Vitelline glands: 1/3 of
tegument the body
-Uterus: long

11
 Nematodes
Scientific Name Ascaris Lumbricoides
Common Name Giant roundworm
Definitive Host Human
Final Habitat Intestine
Diagnostic Stage Unfertilised/fertilised egg
Infective Stage Embryonated egg
Mode of Infection Ingestion of embryonated egg from contaminated soil
-Ascariasis:
~Ascaris pneumonitis
Pathology ~Loeffler’s syndrome
~Serious sequelae and intense tissue reaction due to worm
migration
Diagnosis -Sample:
~Stool specimen (egg)
~Sputum specimen (larvae)
~Gastric washings
-Direct wet mount (Saline and Iodine)
-Thick smear (Kato Katz and Cedarwood oil smear)
-Concentration methods (Formal-ether sedimentation/Ritchi and
Floatation/Faust/Brine)
-Imaging
-Ultrasound
-ELISA
-PCR
Morphology Egg: Adult male: Adult female:
-Size: 50-70 x 40-50 um -Size: 15-30 cm -Size: 20-30 cm
-Shape: short oval -Shape: -Shape:
-Colour: yellow-brown unsegmented unsegmented
-Content: immature or cylindrical cylindrical
mature -Colour: pinkish -Colour: pinkish
-Egg shell: thick smooth, white/creamy white/creamy
corticated or decorticated -Posterior end: -Posterior end:
curved straight

12
 Scientific Name Trichuris trichiura
Common Name Whipworm
Definitive Host Human
Final Habitat Intestine
Diagnostic Stage Unembryonated egg
Infective Stage Embryonated egg
Mode of Infection Ingestion of embryonated gg
-Trichuriasis:
~Light infection are usually asymptomatic
Pathology ~Heavy infection leads to non-specific symptoms
~Dysentery, severe rectal tenesmus and rectal prolapse.
~Severe anaemia
Diagnosis -Sample: (egg)
~Stool specimen
~Sputum specimen
~Gastric washings
-Direct wet mount (Saline and Iodine)
-Concentration methods (Formal-ether sedimentation/Ritchi and
Floatation/Faust/Brine)
-ELISA
-PCR
-Proctoscopy
Morphology Egg: Adult male: Adult female:
-Size: 50-55 x 45 -30 um -Size: 30 - 35 mm -Size: 30-50 mm
-Shape: barrel shaped -Shape: -Shape:
-Colour: yellow-brown to unsegmented unsegmented
red-brown cylindrical with the cylindrical with
-Content: immature anterior 2/3 of the the anterior 2/3 of
-Egg shell: thick with 2 body being thin, the the body being
mucoidal polar plugs remaining posterior thin, the
part is curved. It has remaining
a single spicule posterior part is
enveloped with thick and thin
sheath

13
Scientific Name Ancylostoma duodenale, Necator americanus
Common Name Hook worm
Definitive Host Human
Final Habitat Intestine
Diagnostic Stage Filariform larva
Infective Stage Unembryonated egg
Mode of Infection Filariform larva penetrates skin
-Dermatitis
Pathology -Ground itch
-Pneumonitis
-Anaemia
Diagnosis -Sample:
~Stool (egg)
-Direct wet mount (Saline and Iodine)
-Concentration methods (Formal-ether sedimentation/Ritchi)
-Haradan-mori filter paper culture
-Serology
-Radiographic finding of intestine
-PCR
-ELISA

Morphology Egg:
-Size: 60-75 x 36-40 um
-Shape: oval with clear space between embryo and egg shell
-Colour: colourless
-Content: immature, usually in early cleavage stage (4-8 cells)
-Egg shell: thin hyaline egg shell

14
 Ancylostoma duodenale morphology
Adult male:
-Size: 8-11 x 0.5 mm
-Shape: Unsegmented cylindrical with a big
mouth located on the dorsal side of the
anterior end
-Mouth: Pair of outer ventral teeth, inner
ventral teeth and accessory teeth. Pair of
small dorsal teeth. Buccal cavity.
-Oesophagus: Well developed muscular and
club-shaped
-Posterior end: Characteristic copulatory
bursa with rays, 2 spicules and cloaca
Rhabditiform larva:
-Size: 200 – 400 um long
-Shape: Thin, long, small unsegmented with
characteristic rhabditiform oesophagus
-Buccal cavity: long
-Genital primordium: very small
-Tail end: pointed
Necator American morphology
Adult male:
-Size: 7-9 x 0.3 mm
-Shape: Unsegmented cylindrical with a
mouth located on the dorsal side of the
anterior end
-Mouth: Pair of large ventral cutting plates
and small dorsal cutting plates. Buccal
cavity
-Oesophagus: Well developed muscular and
club-shaped
-Posterior end: Characteristic deep
copulatory bursa with the branches of the
lateral ray tightly adhered to each other, 2
spicules with hooks on each tip
Rhabditiform larva:
-Size: 200 – 400 um long
-Shape: Thin, long, small unsegmented with
characteristic rhabditiform oesophagus
-Buccal cavity: Short or shallow
-Genital primordium: Large
-Tail end: Pointed
Adult female:
-Size: 10-13 x 0.6 mm
-Shape: Unsegmented cylindrical with a
big mouth located on the dorsal side of the
anterior end
-Mouth: Pair of outer ventral teeth, inner
ventral teeth and accessory teeth. Pair of
small dorsal teeth. Buccal cavity.
-Oesophagus: Well developed muscular
and club-shaped
-Posterior end: Pointed with a mini spine
Filariform larva:
-Size: 0.4 - 0.7 mm long
-Shape: Sheathed thin long unsegmented
cylindrical with characteristic oesophagus
(1/3 of the body)
-Tail end: pointed
Adult female:
-Size: 9-11 x 0.4 mm
-Shape: Unsegmented cylindrical with a
mouth located on the dorsal side of the
anterior end
-Mouth: Pair of large ventral cutting plates
and small dorsal cutting plates. Buccal
cavity
-Oesophagus: Well developed muscular
and club-shaped
-Posterior end: Pointed without a spine
Filariform larva:
-Size: 0.4 – 0.7 mm long
-Shape: Unsheathed thin long
unsegmented cylindrical with
characteristic oesophagus (more than half
of the body)
-Tail end: Notched or slightly dented
15
Scientific Name Strongyloides stercoralis
Common Name Threadworm
Definitive Host Human
Final Habitat Intestine
Diagnostic Stage Rhabditiform larvae
Infective Stage Filariform larvae
Mode of Infection Filariform larva penetrates skin
-Strongyloidiasis:
~ Cutaneous-
>larva currens
~Pulmonary-
Pathology >Loeffler’s syndrome
~Gastrointestinal-
>Abdominal bloating
~Hyper-infection syndrome and disseminated strongyloidiasis
~Sepsis
Diagnosis -Sample
~Stool specimen
~Sputum specimen
~Duodenal aspiration
(Rhabditiform larvae)
-Direct wet mount (Saline and Iodine)
-Concentration methods (Formal-ether sedimentation/Ritchi and
Floatation/Faust/Brine)
-Baermann concentration
-Haradan-mori filter paper culture
-Nutrient agar plate culture
- Immunodiagnostic assays
-ELISA
-Enterotest
-PCR and LAMP
-Egg counting technique (Stoll’s technique)
Morphology Egg: Larvae:
-Size: 50-58 x 30-35 um -Size: 200-400 um
-Shape: oval -Short buccal cavity
-Colour: colourless -Pointed tail
-Content: usually in early -Large genital primordium
cleavage stage (4-8 cells) -Intestine
-Egg shell: thin -Oesophagus

16
Scientific Name Toxocara canis, Toxocara cati (VLM & CLM)
Intermediate Host Humans (accidently)
Definitive Host Dogs or cats
Final Habitat Visceral or cutaneous
Diagnostic Stage Larvae in tissues
Infective Stage Embryonated egg
Mode of Infection Ingestion of embryonated egg
~VLM:
Pathology -Mostly asymptomatic
-Ocular larva migrans causes blindness mostly in one eye
-VLM causes fever, coughing, enlarged liver or pneumonia
~CLM:
-Non-specific dermatitis
-Larvae migration causes serpiginous itchy traits
-Scratching can lead to secondary bacterial infection
Diagnosis -Based on physical examination and history
-Eosinophilia
-Antibody detection by ELISA or western-blot analysis
-Biopsy (not recommended): negative for VLM
-Imaging for lesion detection; CT, MRI, Ultrasound
- Stool analysis is not recommended
-PCR

Scientific Name Dracunculus medinesis

Common Name Medina worm, Guinea worm
Definitive Host Human
Final Habitat Intestine
Diagnostic Stage Female worm emerges from skin
Infective Stage Filariform (L3)
Mode of Infection Drinking water infected copepods with L3 larvae
-Blister formation
Pathology -Systemic reaction
-Removal of worm leads to inflammatory reaction
Diagnosis -Clinical assessment of cutaneous lesion (female worm appearing from
ruptures blister)
-Milky cloud water when lesion is placed in water
-X-ray may show calcified worms
-Leukocytosis
-Eosinophilia
-Increased IgE, IgG1 and IgG4
-Removal technique of female worm
-ELISA
-PCR

17
Scientific Name Enterobius vermicularis
Common Name Pin worm
Definitive Host Human
Final Habitat Intestine
Diagnostic Stage Embryonated egg
Infective Stage Embryonated egg
Mode of Infection Ingestion of embryonated egg
-Asymptomatic
-Migration of female worms leads to pruritis. Scratching and
Pathology scarification
-Urogenital infection
-Nervousness, insomnia, nightmares, convulsions.
Diagnosis Adult:
-Perianal skin examination
-Microscopically in stool sample
-In urine of female patients
-Cellulose tape (scotch tape)
-Perineal or perianal swab
-NIH swab
Egg:
-In urine of female patients
-Cellulose tape (scotch tape)
-Perineal or perianal swab
-NIH swab
-Egg and parasite in stool examination:-
-Direct wet mount (Saline and Iodine)
-Concentration methods (Formal-ether sedimentation/Ritchi and
Floatation/Faust/Brine)
-PCR
-ELISA
Morphology Egg: Adult male: Adult female:
-Size: 50-60 x 20-30 um -Size: 2-5 mm -Size: 8-15 cm
-Shape: one side is flatter -Shape: -Shape:
than the other (D shaped) Unsegmented Unsegmented
-Colour: colourless cylindrical, spindle, long pointed
-Content: mature curved tail, 2 tail, 2 cuticle
-Egg shell: thin double cuticular elevation (alae),
elevation (alae), double bulbed
double bulbed oesophagus, uterus
oesophagus filled with eggs

18
 Filarial Nematodes

Morphology
Differentiation
of Filaria

Blood Skin

Sheathed Unsheathed Unsheathed

Wuchereria Mansonella Mansonella Mansonella Onchocerca

Brugia malayi Loa loa
bancrofti ozzardi perstans streptocerca volvulus

Scientific name Mansonella spp.

Sample -Blood (M. perstans)
-Skin biopsy (M. streptocerca)
-Blood and skin biopsy (M. ozzardi)
Thin and thick blood -Using ‘Haematoxylin and Eosin’ or ‘Giemsa’
smear -Detection of microfilariae
Concentration: -Advantage:
~Less risk of infection
-Formal ether ~Increase the chance of seeing microfilariae
sedimentation ~Clear examination with eliminated debris
-Disadvantage:
~Using flammable carcinogenic materials
---------------------------------------------------------------------------
-Advantage:
-Floatation ~Simple
~Clear of debris
~No chemical hazardous
-Membrane filter
Other techniques -Knott’s concentration
-Serology techniques; antigen detection, ELISA
-PCR
-Ultrasonography

19
 Scientific name Wuchereria bancrofti & Burgia malayi
Sample -Tissue biopsy
-Blood
Thin and thick blood -Using ‘Haematoxylin and Eosin’ or ‘Giemsa’
smear -Detection of microfilariae
-Knott’s technique
Other techniques -Nuclear filtration
-Serology techniques; antigen detection, ELISA
-PCR

Scientific name Loa loa

Sample -Blood
-Urine
-Sputum
-CSF
Thin and thick blood -Using ‘Haematoxylin and Eosin’ or ‘Giemsa’
smear -Detection of microfilariae
-Knott’s technique
Other techniques -Nuclear filtration
-Serology techniques; antigen detection, ELISA
-PCR
Additional notes -Microfilariae exhibits diurnal periodicity; sample should be collected
during the day (10 am – 2 pm is preferred)
-Diagnosis of infection is also obtained from the removal or detection of
adult from eye or Calabar swelling.

Scientific name Onchocerca volvulus

Sample -Skin biopsy
Techniques -Using ‘Haematoxylin and Eosin’ or ‘Giemsa’ for the detection of
microfilariae.
-Slit lamp examination; may reveal microfilariae in eye anterior chamber.
-Serology techniques; antigen detection, ELISA
-Mazzotti reaction; now replaced with skin patch test
-Nodulectomy; removes adult worm in palpable nodules but misses
deeper worms

Microfilaria Morphology
Wuchereria bancrofti Brugia malayi Loa loa Onchocerca
volvus
Size 250 – 350 um 200 – 250 um 250 – 300 um 250 – 350 um
Shape -Sheathed -Sheathed -Sheathed -Unsheathed
-Rounded anterior end -Body slightly -Rounded -Rounded
-Tapering end undulating anterior end anterior end
-Head and tail free of -Tail has two -Nuclei extends -Curved tail
nuclei terminal nuclei to the end -Tail tip free of
nuclei

20
 Cestodes
Scientific Name Diphyllobothrium latum
Common Name Fish or broad tapeworm
Intermediate Host First; crustaceans
Second; small fish
Definitive Host Human
Final Habitat Small intestine
Diagnostic Stage Unembryonated egg
Infective Stage Plerocercoid larva
Mode of Infection Ingestion of fish infected with plerocercoid larva
-Mostly asymptomatic
-Symptoms; abdominal pain, discomfort, vomiting and weight loss
Pathology -Vitamin B12 deficiency leads to megaloblastic anaemia
-Complications;
~Intestinal obstruction
~Gall bladder disease due to migration of proglottids
Diagnosis -Sample: (egg or gravid proglottids)
-Direct wet mount (Saline and Iodine)
-Thick smear (Kato Katz and Cedarwood oil smear)
-Concentration methods (Formal-ether sedimentation/Ritchi)
-ELISA
-PCR
Morphology Egg: Scolex: Mature proglottid:
-Size: 70 x 50 um -Size: 2-3 mm -Shape:
-Shape: ellipsoid, -Shape: ~Slightly wider than
thick egg shell, ~elongated almond longer
flat operculum, shaped ~Ventral common
small knob ~two pseudo genital pore (c.g.p)
-Colour: ~suckers/bothria/grooves, -Testes: small
yellowish brown ~no rostellum/hooks multiple follicles
-Content: -Ovary: two lobed
immature -Vitelline glands:
small follicles at the
end ducts on both
sides
-Uterus: rosette-
shaped in the centre
with a uterine pore
behind the c.g.p

21
Scientific Name Spirometra spp.
Intermediate Host First; crustaceans
Second; fish, reptiles, amphibians, humans
Definitive Host Cats, dogs
Final Habitat May locate anywhere
Diagnostic Stage Larva in tissues
Infective Stage Plerocercoid larva
Mode of Infection -Drinking water contaminated with infected copepods
-Consuming the flesh of undercooked second intermediate
Pathology -Symptoms various according to site of infection
-Sparganosis
Diagnosis -Sample: Tissue biopsy
- Using ‘Haematoxylin and Eosin’ or ‘Giemsa’
-Detection of microfilariae
-Serology techniques; antigen detection, ELISA
-PCR
-CT
-MRI

Scientific Name Taenia asiatica

Common Name Asian tapeworm
Intermediate Host Pig
Definitive Host Human
Final Habitat Small intestine
Diagnostic Stage Eggs or gravid proglottids
Infective Stage Cysticerci
Mode of Infection Ingestion of pig meat infected with cysticerci
Pathology -Mostly asymptomatic
Diagnosis -Sample:
~Stool (egg or gravid proglottids)
-Direct wet mount (Saline and Iodine)
-Thick smear (Kato Katz and Cedarwood oil smear)
-Concentration methods (Formal-ether sedimentation/Ritchi and
Floatation/Faust/Brine)
-NIH swab, scotch tape; perianal area examination.
-Brain scan, CT, MRI
-ELISA
-PCR
Morphology Egg:
-Size: 30 x 45 um
-Shape: spherical
-Colour: yellowish brown
-Content: mature onchosphere

22
Scientific Name Taenia saginata
Common Name Beef tapeworm
Intermediate Host Cattle
Definitive Host Human
Final Habitat Small intestine
Diagnostic Stage Eggs or gravid proglottids
Infective Stage Cysticerci
Mode of Infection Ingestion of beef meat infected with cysticerci
-Mostly asymptomatic
-Symptoms; abdominal pain, upset stomach, vomiting and weight
Pathology loss
-Taeniasis
-Visible symptoms of taeniasis is active passing of proglottids
through anus
-Complications;
~Appendix, bile and pancreatic duct obstruction
Diagnosis -Sample:
~Stool (egg or gravid proglottids)
-Direct wet mount (Saline and Iodine)
-Thick smear (Kato Katz and Cedarwood oil smear)
-Concentration methods (Formal-ether sedimentation/Ritchi and
Floatation/Faust/Brine)
-NIH swab, scotch tape; perianal area examination.
-Brain scan, CT, MRI
-ELISA
-PCR
Morphology Egg: Scolex: Gravid proglottid:
-Size: 30 x 45 um -Size: 1.5 – 2.5um -Narrow than longer
-Shape: spherical -Shape: -Size: 2-2.5 x 0.5-0.8 um
-Colour: ~Globular -Uterus: 18 – 32 lateral
yellowish brown ~Four true strong branches
-Content: mature muscular suckers
onchosphere ~No
rostellum/hooks

23
Scientific Name Taenia solium
Common Name Pork tapeworm
Intermediate Host Pig
Definitive Host Human
Final Habitat Small intestine
Diagnostic Stage Eggs or gravid proglottids
Infective Stage Cysticerci
Mode of Infection Ingestion of pig meat infected with cysticerci
-Mostly asymptomatic
-Symptoms; abdominal pain, upset stomach, vomiting and weight
Pathology loss
-Taeniasis
-Visible symptoms of taeniasis is active passing of proglottids
through anus
-Complications;
~Appendix, bile and pancreatic duct obstruction
Diagnosis -Sample:
~Stool (egg or gravid proglottids)
-Direct wet mount (Saline and Iodine)
-Thick smear (Kato Katz and Cedarwood oil smear)
-Concentration methods (Formal-ether sedimentation/Ritchi and
Floatation/Faust/Brine)
-NIH swab, scotch tape; perianal area examination.
-Brain scan, CT, MRI
-ELISA
-PCR
Morphology Egg: Scolex Gravid proglottid:
-Size: 30 x 45 um -Size: 1 mm -Longer than wider
-Shape: spherical -Shape: -Size: 1-1.5 x 0.5-0.8 um
-Colour: yellowish ~Globular -Uterus: 7 – 13 lateral
brown ~Four true strong branches
-Content: mature muscular suckers
onchosphere ~Rostellum (2
circles of short and
long hooks
arranged
alternately)
~ 22 – 32 hooks

24
Scientific Name Hymnelopis diminuta
Common Name Rat tapeworm
Intermediate Host Grain beetle, other insects
Definitive Host Human, rodents
Final Habitat Small intestine
Diagnostic Stage Eggs, gravid proglottids, or scolex
Infective Stage Cysticercoid larvae
Mode of Infection Ingestion of cysticercoid contaminated food such as dried fruits or
cereal.
Classified as NTD (neglected tropical disease)
-Light infections are asymptomatic
Pathology -Heavy infections; abdominal pain, diarrhoea, headache and non-
specific symptoms.
-Complications;
~Damage to intestinal mucosa causes inflammation and
haemorrhage.
Diagnosis -Sample:
~Stool (egg)
-Direct wet mount (Saline and Iodine)
-Thick smear (Kato Katz and Cedarwood oil smear)
-Concentration methods (Formal-ether sedimentation/Ritchi and
Floatation/Faust/Brine)
-Ultrasound
-ELISA
-PCR
Morphology Egg: Adult:
-Size: 50 x 40 um -Size: 1 -3 cm
-Shape: round to oval -Scolex: 4 suckers, retractable
-Colour: greenish yellow rostellum with 20 – 30 hooks
-Content: mature onchosphere -Shape: Broader than longer
(hexacanth larva) ~Mature proglottid
~Marginal common genital pore
-Ovary: between testes
-Uterus: blind sac without
pores, full of eggs

25
Scientific Name Hymnelopis nana
Common Name Dwarf tapeworm
Intermediate Host Fleas and beetles (NOT REQUIRED)
Definitive Host Human, mice, rats
Final Habitat Small intestine
Diagnostic Stage Eggs, gravid proglottids, or scolex
Infective Stage Embryonated egg
Mode of Infection -Direct; ingestion of food or soil contaminated with embryonated
egg
-Indirect; ingestions of infected IH with cysticercoide
-Autoinfection
Classified as NTD (neglected tropical disease)
-Light infections are asymptomatic
Pathology -Heavy infections; abdominal pain, diarrhoea, headache and non-
specific symptoms.
-Complications;
~Damage to intestinal mucosa causes inflammation and
haemorrhage.
Diagnosis -Sample:
~Stool (egg)
-Direct wet mount (Saline and Iodine)
-Thick smear (Kato Katz and Cedarwood oil smear)
-Concentration methods (Formal-ether sedimentation/Ritchi and
Floatation/Faust/Brine)
-Ultrasound
-ELISA
-PCR
Morphology Egg: Adult:
-Size: 60 x 80 um -Size: 1 -3 cm
-Shape: round to oval -Scolex: 4 suckers, retractable
-Colour: yellowish rostellum with 20 – 30 hooks
-Content: mature onchosphere -Shape: Broader than longer
(hexacanth larva) ~Mature proglottid
~Marginal common genital pore
-Ovary: between testes
-Uterus: blind sac without
pores, full of eggs

26
Scientific Name Echinococcus grangulosus
Common Name hydatid tapeworm, dog worm
Intermediate Host Sheep, cattle, pigs, humans
Definitive Host Dogs, wild animals
Final Habitat Intestine
Diagnostic Stage Hydatid cyst
Infective Stage Embryonated egg
Mode of Infection Ingestion of contaminated food with hydatid cyst
Pathology ~Cystic Hydatid disease/Cystic echinococcosis/Unilocular hydatid
disease
-Symptoms depend on site of infection (mostly in lungs or liver)
-Allergic reaction if cyst bursts and hydatid fluid leak
-Cyst in tissues may lead to abscess, organ enlargement, emboli or
development of additional cyst at secondary sites.
Diagnosis -Radiological: brain scan, CT or MRI, X-rays and ultrasound
-Serological tests to detect host antibodies against purified parasitic
antigen
-Molecular: PCR
-Histological examination of removed cyst
-Microscopic examination of hydatid cyst fluid may reveal the hydatid
sand or, under certain circumstance, just the hooklets
-Casoni test: skin test – immediate hypersensitivity reaction to hydatid
fluid antigens
Morphology Egg: Adult: Hydatid cyst:
-Size: 25-40 um -Size: 3-6 mm -Size: varied
-Shape: ovoid -Shape: Scolex with -Shape: spherical
-Colour: Brown four suckers, 32-40 cyst
-Content: mature rostellum hooks, -Layers:
onchosphere (3 short neck ~Laminated/cuticular
pairs of hooks + -Three proglottids outer layer
resistant envelope) “segments”: ~Germinal/inner
~Immature layer
~Mature -Content:
~Gravid proglottid ~pale yellow fluid
~Brood capsules
~Protoscoleces
~Daughter cysts
~Hydatid sand

27
 Amoebas
Trophozoites
Entamoeba Entamoeba Entamoeba coli Endolimax Iodamoeba Entamoeba
histolytica hartmanni nana butschlii gingivalis
Shape Irregular amoeboid Irregular amoeboid Irregular amoeboid Irregular amoeboid Irregular amoeboid Irregular
with occasional with occasional with occasional with occasional with occasional amoeboid with
pseudopodium pseudopodium pseudopodium pseudopodium pseudopodium occasional
pseudopodium
Size 10-60 um (mainly >20 um 15-50 um (mainly 8-10 um 8-20 um 8-20 um
20 um) 25 um)
Cytoplasm (ecto- Well differentiated Well differentiated Poorly Poorly
and endo-) differentiated differentiated
Motility -Progressive -Progressive -Sluggish Sluggish Active Active
(Pseudopodia) -Active -Active -Non-directional
-Rapid -Rapid
-Directional -Directional

Nucleus: -Small, central -Small, central -Small, eccentric -Large, central -Large, central -Small, central
-Karyosome -Fine regular -Fine regular -Coarse, irregular -Absent -Absent -Fine, regular
-Peripheral granules granules granules
chromatin
RBC’s Present/Absent Absent Absent Absent Absent Present/Absent
Habitat Large intestine Large intestine Large intestine Large intestine Large intestine Non-intestinal
(Oral cavity)
Pathogenicity Pathogenic Non-Pathogenic Non-Pathogenic Non-Pathogenic Non-Pathogenic Pathogenic

Notes Only amoeba

that ingests WBC

28
 Cyst
Entamoeba Entamoeba Entamoeba coli Endolimax Iodamoeba Entamoeba
histolytica hartmanni nana butschlii gingivalis

Shape 10-20 um (mainly 15 >15 um 20 um 5-14 um 5-18 um

um)
Size Spherical Spherical Spherical Oval Oval

Number of nuclei 1-4 1-4 1-8 1-4 1

Glycogen Diffused in immature Diffused in Diffused in immature Compact

cyst immature cyst cyst
Chromatoidal body Cigar shaped Cigar shaped Needle/splinter
shaped
Nucleus: -Small, central -Small, central -Small, eccentric -Large, central -Large, central
-Karyosome -Fine regular -Fine regular -Coarse, irregular -Absent -Absent
-Peripheral chromatin granules granules
Notes Fully mature;
- 4 nuclei
-Chromatoidal bars
and glycogen
disappears

29
 Amoebas Diagnosis
Sample
- Stool specimen (egg)
Direct Wet Mount
- Must not be thick so it is not obscured by stool debris
-Use only a small amount of stool
Direct Saline Wet Mount -Advantage:
~Easy, fast and not expensive
~Motility of trophozoites in fresh stool
-Disadvantage:
~Not suitable for light infections
Direct Iodine Wet Mount -Must not use too much iodine as to not stain the egg darkly
and mistaken it for debris
-Advantage:
~Morphological features can be seen clearly
~Fast, simple and not expensive
~Cyst morphology
-Disadvantage:
~Not suitable for light infections
~Can be mistaken for debris as the egg is the same colour.
Permanent stained smear
-e.g. trichome stain
-structural details of trophozoites or cysts
Concentration Method
Formal-ether -Advantage:
Sedimentation (Ritchi) ~Less risk of infection
~Increase the chance of seeing egg
~Clear examination with eliminated debris
-Disadvantage:
~Using flammable carcinogenic materials
Floatation (Faust of brine) -Advantage:
~Simple
~Clear of debris
~No chemical hazardous
-Disadvantage:
~Walls of egg will often collapse if left for too long and
becomes distorted in appearance, making identification hard.
~Not suitable for heavy eggs.
Intestinal diagnosis
-Sigmoidoscopy aspirates or biopsies for trophozoites
-Radiological examination
-Serological tests not recommended
-Immunological (rapid card test) for stool samples
-Molecular
Extra-intestinal
-Serological (ELISA, IHA, IFA)
-Imaging (ultrasound, CT and MRI)
-Abscess aspiration

30
 Intestinal Flagellates
Scientific name Giardia lamblia
Habitat Small intestine (duodenum)
Definitive Host Humans
Infective Stage Cyst
Diagnostic Stage Cyst and trophozoites
Mode Of Infection -Ingestion of food or drinking water contaminated with cyst
-Direct transmission from one person to person in children
Diseases -Guardiasis
(significant) -Acute infection:
~Majority asympotmatic
~steatorrhea
-Chronic infection
~Malabsorption and lactose intolerance
~Growth retardation
Diagnosis -Stool examination:
-Diarrhoeal stool cyst and trophozoites
-Formed stool cyst
-Macroscopic examination offensive odour, pale colour and fatty
stool
-Microscopic examination:
~Direct saline smear for motility
~Direct iodine smear for morphological features
~Permanent stained smear (e.g. trichrome) for morphological
features
~Concentration (sedimentation kills motility, or floatation)
-Duodenal aspiration/ biopsy
-Immunologic tests (ELISA, DFE, rapid card test)
-molecular PCR, EG
-String test (Entero-test)
Morphology Trophozoites: Cyst:
-Size: 14 x 7 um -Size: 12 x 8 um
-Shape : pear/tear drop -Shape: Oval
-Features: -Features:
~Two sucking discs with two ~Thick cyst wall
nuclei (large central karyosome) ~Four nuclei usually at one pole
~Four pairs of flagella ~Remnants of flagella, axonemes
~Two axonemes (axostyles) and median bodies
~Two median/parabasal bodies
~Motility: falling leaf motility

31
 Flagellates
Scientific name Trichomonas vaginalis
Causative Agent Trichomonas vaginalis
Habitat Genital tract
Definitive Host Humans
Infective Stage Trophozoites
Diagnostic Stage Trophozoites
Mode Of Infection -Sexual intercourse
Diseases (significant) -HIV
-Infertility
-Women:
~Greeny-yellow vaginal discharge with unpleasant/fishy smell
~Itchy vagina and vulva
~Pelvis inflammatory disease
~Bacterial vaginosis
-Men:
~Discharge from the penis
~Prostatitis
Diagnosis -Macroscopic examination (physical examination)
~Greeny yellow vaginal discharge with o foul odour
~Cervical microhaemorrhage (Strawberry cervix)
-Microscopic examination:
~Wet mount preparation of vaginal swab/penis discharge
~Urine sample
~In vitro culture
~Giemsa, trichrome, immunofluorescent staining
~PCR
~Serological tests
Morphology Trophozoites:
-Size: 10 x 25 um
-Shape: Pear-shaped
-Features:
~4 anterior flagella
~1 posterior flagella
~Undulating membrane extends about two-thirds of its length
~Axostyle
-Motility: jerky motility

32
Scientific name Cryptosporidium spp
Habitat Small intestine
Definitive Host Humans
Infective Stage Oocyst
Diagnostic Stage Oocyst
Mode Of Infection Ingestion of contaminated water/food with oocyst
Diseases -Cryptosporidiosis
(significant) ~watery diarrhoea with mucus flecks
Diagnosis - Stool analysis
~Microscopic examination of stool smear using acid fast stain (modified
Ziehl-Neelsen or modified Kinyoun’s)
~Prier concentration techniques is used (sedimentation or Sheather’s sugar
floatation)
-Phase contrast microscopy
-PCR
-Antigen/antibody detction
Morphology Oocyst:
-Size: 2-5 um
-Content: 4 sporozoites (no sporocyst)

Scientific name Cystoisospora belli (isospora belli)

Habitat Small intestine
Definitive Host Humans
Infective Stage Oocyst
Diagnostic Stage Oocyst
Mode Of Infection Ingestion of mature oocyst with sporozoites
Diseases -Often asymptomatic
(significant) -mild gastrointestinal distress to severe dysentery (watery-soft foamy
offensive stool)
Diagnosis -Easily recovered in wet mount
-Concentration techniques and staining can be applicable
-PCR
Morphology Oocyst:
-Size: 30-12 um
-Content:
~2 sporocysts
~4 sporozoites each

Scientific name Blastocystis hominis

Habitat Digestive tract
Definitive Host Humans
Infective Stage Cyst
Diagnostic Stage Cyst
Mode Of Infection -Faecal oral
-Animal to human
Diseases -Bloating
(significant) -Flatulence
-Watery diarrhoea
Morphology Cyst:
-Size: 6 x 40 um
-Features: Large central vacuole, Small multiple nuclei

33
Scientific name Toxoplasma gondii
Habitat Intestine of Felidae family
Intermediate Host -Humans (accidental)
-Rodents
-Mammals
-Birds
Definitive Host Felidae (cats/wild cats)
Infective Stage -Tachyzoite
-Bradyzoite
-Oocysts (containing sporozoites)
Diagnostic Stage -Tachyzoite
-Bradyzoite
Mode Of Infection -Congenital (Tachyzoite)
-Blood transfusion (Tachyzoite)
-Organ transplantation (Bradyzoite/Tachyzoite)
-Consumption of undercooked meat infected with tissue cyst
(Bradyzoite)
-Consumption of contaminated food or water with cat faeces
contained oocyst
-Accidental injection and contamination of mucus membrane in
the laboratory (Tachyzoite)
-Consumption of unpasteurized goat’s milk (Tachyzoite)
Diseases (significant) -Toxoplasmosis
-Encephalitis toxoplasmosis in AIDS patients
-Ocular toxoplasmosis; congenital (most common consequences)
or acquired
- Auditory toxoplasmosis (congenital)
Diagnosis -Serological:
~ELISA
-Sabin fieldman dye test not stained (infected +)
-PCR
-Histopathology
-Tissue culture

34
Scientific name Plasmodium spp.
Species -Plasmodium falciparum
-Plasmodium vivax
-Plasmodium ovale
-Plasmodium malariae
-Plasmodium knowlesi
Habitat RBC
Intermediate Host Humans
Definitive Host Anopheles mosquito
Vector Anopheles mosquito
Infective Stage Sporozoites
Diagnostic Stage -Ring stage (immature trophozoite)
-Mature trophozoite
-Schizont
-Gametocytes
Mode Of Infection -Bite of infected Anopheles (gravid female)
-Blood transfusion
-Through needles of drug addicts
-Congenital (rare)
Diseases (significant) -Malaria
-Febrile attack (Malaria paroxysm)
-Anaemia
-Black water fever
-Recrudescence
-Recurrence/True relapse
Diagnosis -Blood examination
-Thick blood film
-Thin blood film
-Quantitative buffy coat technique
-ParaSight-F test (antigen detection)
-Immunoassays
-Flow cytometry
-PCR and DNA

35
 Exoerythrocytic schizogony
Duration Number of merozoites Relapse
Plasmodium falciparum 6 40 -
Plasmodium vivax 8 10 +
Plasmodium ovale 9 15 +
Plasmodium malariae 16 2 -

Erythrocytic schizogony (Ring stage)

RBC Parasite size Multiparasites Shuffners dot
size
Plasmodium falciparum Normal 1/6 + -
Plasmodium vivax Normal 1/3 +/- -
Plasmodium ovale Normal 1/3 - +/-
Plasmodium malariae Normal 1/3 - -

Erythrocytic schizogony (Trophozoites)

RBC size Parasite shape Maurer’s Shuffners Parasites
dot dot occupying
Plasmodium falciparum Normal Compact + - 67% of
RBC
Plasmodium vivax Enlarged Ameboid - + 100% of
RBC
Plasmodium ovale Enlarged/ Ameboid/compact - + 67% of
fembriated RBC
Plasmodium malariae Normal Compact - - 100% of
RBC

Erythrocytic schizogony (Schizont)

RBC size Number of merozoites Parasites
occupying
Plasmodium falciparum Normal 8-28 67% of RBC

Plasmodium vivax Enlarged 12-24 100% of RBC

Plasmodium ovale Enlarged/fembriated 6-12 67% of RBC

Plasmodium malariae Normal 6-12 100% of RBC

Erythrocytic schizogony (Gametocytes)

RBC age preference Type Duration
Plasmodium falciparum Any Malignant 36-48 hr

Plasmodium vivax Young Benign tertian 48 hr

Plasmodium ovale Young Benign tertian 48 hr

Plasmodium malariae Old Benign quatrain 72 hr

36
Scientific name Leishmania spp.
Species -Leishmania donovani (VL)
-Leishmania tropica (CL) (Old world)
-Leishmania major (CL) (Old world)
-Leishmania aethiopica (CL) (Old world)
-Leishmania Mexicana (CL) (New world)
-Leishmania brazillinesis (MCL) (New W)
-Leishmania peruviana (New world)
-Leishmania infantum (VL/CL) (Old world)
-Leishmania chagasi (VL) (New world)
Habitat Macrophages/mononuclear phagocytic cells
Reservoir Host -Dogs
-Rodents
-Fox
Intermediate Host Sand-fly
Definitive Host Humans
Vector Sand-fly mosquito;
-Phlebotomus spp. Old world
-Lutzomyia spp. New world
Infective Stage Promastigote
Diagnostic Stage Amastigote
Mode Of Infection Bite of infected sand-fly (blood meal)
Diseases (significant) -Visceral leishmaniasis
(Kala-azar)
Aplastic anaemia
Post-kala-azar-dermal leishmaniasis

-Cutaneous leishmaniasis
Baghdad sore/Aleppo sore

-Mucocutaneous leishmaniasis
Chiclero’s ulcer
Diagnosis -Direct microscopic examination of leishmania amastigotes in
tissue aspirates or biopsies (Romnowsky’s. H&E,
immunoperoxidase stains)
-Skin slit smear
-Culture examination (solid NNN medium, liquid Schneider’s
insect medium)
-PCR
-Montenegro test (Leishmanin test)
-Immunological (IFAT, DAT, ELISA, rapid antibody detection
methods)
Morphology Amastigote: Promastigote:
-Size: 2.5-5 um -Size: 5-20 um
-Shape: -Shape:
~No external flagellum ~A long flagellum (no
~Spheroid to ovoid undulated membrane)
~Nucleus ~Elongated spindle shaped
~Kinetoplast ~Central nucleus
~Kinetoplast

37
Scientific name Trypanosomes spp.
Species -African trypanosomes;
T. brucei gambiense (West Africa)
T. brucei rhodesiense (East Africa)
-American trypanosomes;
T. cruzi
T. rangeli
Habitat -African trypanosomes;
Body fluids
-American trypanosomes;
Tissues
Reservoir Host Animals/humans
Intermediate Host -African trypanosomes;
Tsetse fly
-American trypanosomes;
Triatomine bug/reduviid bug/kissing bug/assassin bug
Definitive Host Humans
Vector -African trypanosomes;
Tsetse fly
-American trypanosomes;
Triatomine bug/reduviid bug/kissing bug/assassin bug
Infective Stage Metacyclic trypomastigotes
Diagnostic Stage Trypomastigotes
Mode Of -African trypanosomes;
Infection Bite of infected tsetse fly (blood meal)
-American trypanosomes;
Bite of infected Triatomine bug (blood meal)
Diseases -African trypanosomes;
(significant) Chancre
Winter bottle sign
T.b. rhodesiense infection is more progressive
-American trypanosomes;
Roamn’s sign
Chages
Diagnosis -Sample: body fluids (lymph node fluids of a chancre, blood and CSF)
~Blood examination (thick and thin)
~Concentration techniques (parasite found in buffy coat)
~Ag and Ab detection
~Culture and animal inoculation
~PCR
Morphology African trypanosomes; American trypanosomes;
~Trypomastigotes: ~Trypomastigotes:
-Size: 15-30 um -Size: 20 um
-Shape: -Shape:
~Polymorphic (short without free ~C shaped
flagellum, intermediate/elongated ~Central nucleus
spindle shaped) ~Kinetoplast at the posterior end
~Central nucleus ~Undulating membrane extending
~Kinetoplast at the posterior end the entire length
~Undulating membrane extending
the entire length

38
 General Diagnosis
Direct Wet Mount
- Must not be thick so it is not obscured by stool debris
-Use only a small amount of stool
Direct Saline Wet Mount -Advantage:
~Easy, fast and not expensive
-Disadvantage:
~Not suitable for light infections
Direct Iodine Wet Mount -Must not use too much iodine as to not stain
the egg darkly and mistaken it for debris
-Advantage:
~Morphological features can be seen clearly
~Fast, simple and not expensive
-Disadvantage:
~Not suitable for light infections
~Can be mistaken for debris as the egg is the
same colour.
Thick Smear
-Larger amount of stool sample is used (between 50-60 mg)
-Higher chance of seeing parasite or the egg.
Kato Katz Smear -Advantage
~Rapid examination of multiple samples
~Used in field survey
~Used as an egg counting technique
Cedarwood Oil Smear -Disadvantage:
~High risk of infection
~Eggs will collapse if left in with the reagent
too long time.
Concentration Method
Formal-ether Sedimentation (Ritchi) -Advantage:
~Less risk of infection
~Increase the chance of seeing egg
~Clear examination with eliminated debris
-Disadvantage:
~Using flammable carcinogenic materials
Floatation (Faust of brine) -Advantage:
~Simple
~Clear of debris
~No chemical hazardous
-Disadvantage:
~Walls of egg will often collapse if left for too
long and becomes distorted in appearance,
making identification hard.
~Not suitable for heavy eggs.
~Not suitable for unfertilised Ascaris egg

39
 Entamoebas
Mosquitoes
Family Anophelinae Culicinae
Genera Anopheles Culex Aedes
(Scientific
name)
Common name -------------------- ------------------ ---------------------
General info -Found just about anywhere in the -Found -Originally found
world throughout the in tropical and
-Eggs are laid singly and remains globe, except subtropical
on the water by the use of floats at the extreme zones, but now
(boat shaped). northern found on all
-Larvae without siphon (for latitudes continents
breathing) lay parallel to the water -Prefers to bite excluding
surface. mainly at night Antarctica
-When resting, the stomach area of -Prefer to bit
the Malaria Mosquito species mainly during
points upward 45* with the surface. day or early
-Mostly nocturnal. evening
Morphology -Have spotted wings -Eggs are -Eggs are black,
-Palps are as long as proboscis brownish, oval, and laid
(clubbed in males) long, singly
cylindrical and -Larvae with
laid in rafts on short siphon
the surface of -Adults are dark
standing water mosquitoes with
-Larvae with white lyre shaped
long siphon markings and
-Palps are long banded legs
and hairy in
males, short in
female
Medical -Biting nuisance -Biting -Biting nuisance
importance -Malaria nuisance -Filariasis
-Filariasis (W.bancrofti and -Filariasis (W.bancrofti and
B.malayi) (W.bancrofti) B.malayi)
-Arbovirus; -Arbovirus;
West Nile Dengue, Yellow
Virus, Eastern fever, Zika,
and Western Chikungunya
equine
encephalitis,
Rift valley
fever, Japanese
encephalitis.

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 Flies
Genera Phlebotomus Old world Simulium Glossina
(scientific name) Lutzomyia New world
Common name Sand fly Black fly Tsetse
Morphology -Sand coloured --------------------- --------------------
General info --------------------- -Three genera that -Glossina is the
bite people but only genus in the
only one that is family
medically Glossinidae with
important many species and
-Worldwide subspecies
distribution -Most species are
restricted to sub-
Saharan Africa
Medical importance -Annoyance (harara) -Annoyance -African
-Leishmaniasis ~Painful bites trypanosomiasis
-Sand-fly fever ~Causes swelling (Sleeping
-Bartonellosis and inflammation sickness)
for several days
-Onchocerciasis
(river blindness)

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 Fleas
Order Siphonaptera
Genus and species Pulex Xenopsylla Nosopsyllus Ctenocephalides
(Scientific name) irritans cheopis fasciatus canis &
Ctenocephalides
felis
Common name Human Tropical or Temperate rat Dog & cat flea
flea Oriental rat flea flea
General info -Both species take blood meal
-Prefer dark, shady areas
Morphology -Siphon (sucking mouthparts)
-Aptera (wingless)
Medical importance -Flea nuisance:
~It is the most widespread complaint
~Cause considerable discomfort
~Cause intense itching in sensitized individuals leading to sleepless
nights and secondary infections
-Plague:
~Xenopsylla cheopis (tropical or oriental rat flea) is the major
vector of the plague
~Caused by Yersinia pestis
~It is a disease of wild animal and rodent as well
-Flea-born endemic typhus (murine typhus)
~Caused by Rickettsia typhi
~Infection is by infected faeces rubbed into abrasions
-Cestodes:
~Can be transmitted if children accidently eat and infected flea or
contact infected faeces:
>Dipylidium caninum
>Hymenolepis diminuta
-Tunga penetrans:
~Caused by chigoe flea or jigger
~It does not transmit a disease but female barrows into soft skin
and the entire flea becomes buried under the skin. This causes
itching, inflammation and secondary infections

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 Lice
Genus and species Pediculus humanus Pediculus capitis Pthirus pubis
(Scientific name)
Common name Body louse Head louse Pubic louse
General info -Worldwide distribution
-Every stage requires blood meal
Morphology -Body and head lice are indistinguishable morphologically
Medical importance -Body louse (Pediculus humanus):
~Pediculosis:
>Exposure to louse saliva will cause weariness, irritability,
pessimistic mood
~Louse-born epidemic typhus:
>It is a rickettsial disease
>Infection is by rubbing pathogen (passed in faeces) into abrasions
~Trench fever:
>Caused by bartonella quintana
>Infection is by rubbing pathogen (passed in faeces) into abrasions
~Louse borne epidemic relapsing fever (Borrelia recurrentis)
-Head louse (Pediculus capitis)
~Pediculosis
~May occasionally transmit both rickettsiae and spirochaetes
-Pubic louse (Pthirus pubis)
~Severe allergic reactions

Ticks
Family Argasidae Ixodidae
(Scientific name)
Common name Soft ticks Hard ticks
General info -Belong to the class Archanida (Octopoda)
-All ticks are obligate parasites; must feed on blood to reproduce and grow
Morphology -Sac-like, unsegmented body -Sac-like, unsegmented body
-No scutum (dorsal shield) -Scutum (dorsal shield); covers the
-Capitulum located ventrally and not entire dorsal surface of the male’s
visible dorsally in nymphs and adults body, but only anterior part of
female’s body
- Capitulum projects forward and
dorsally visible distinguishes
adult hard from adult soft ticks
Medical -Tick borne relapsing fever: -Tick paralysis and allergies:
importance ~Caused by Borrelia duttoni ~Caused by various toxins in saliva
(spirochaete) ~Causes paralysis in motor nerves
-Q-fever: ~Affects legs, breathing,
~Rickettsial disease by Coxiella swallowing, and speaking
burnett -Arboviruses:
-Viruses: ~Around 120 arboviruses
~Alkurma haemorrhagic fever transmitted by hard ticks to humans
-Rickettsiae
-Spirochetes (Lyme disease)
-Tularemia (bacterial disease)

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 Mites
Genus and Sarcoptes scabiei Demodex Leptrombidium Dermatophagoides
species folliculorum akamushi pteronyssinus
(Scientific
name)
Common Scabies or itch mites Hair follicle Scrub typhus or House dust mite
name mites chigger mites
General info -Not insects but belong to the Archanida class
Morphology -Distinguished from ticks by absence of teeth on the hypostome
Medical -Scabies -Found on -Feeds on -Lives in rugs,
importance ~Scabies is a the nose, humans only in furniture,
contagious disease forehead the larval stage pillows,
which is transmitted
only by close contact
and eyelids; -Scrub typhus mattresses and
and spreads easily feeds on caused by other places and
between members of cells in the Rickettsia house dusts.
the same family, follicular -Trombiculosis; -Some people
crowded areas (wars, epithelium rash or become allergic
disasters) and schools -Causes infestation to the mites or
(15-20 min) dermatitis caused by larvae their faeces
-Scabies characterised
by intense itching
bite which may cause
which is due to the asthma and
sensitization of the rhinitis
patient to the mite and
their eggs and faecal
deposits. Secondary
infections; pustules are
common complications
if the hygiene is poor.
-Rash appears not only
in sites of the
burrowing but also in
different parts of the
body, It happens in
response to allergic
reactions.
-Crusted or Norwegian
scabies.

Bugs
Family Reduviidae
Subfamily (Scientific name) Triatomine
Common name Kissing bug, reduviid bug, assassin bug, winged bug,
barbeiros and cone-nosed bug
General info -Blood sucking bugs
-All medically important species are restricted to southern
USA, Central and South America
Morphology ------------------------------------------------------------------------
Medical importance -Transmission of Chagas disease
-Transmission of the non-pathogenic T.rangeli

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