I.

NEMATODES
1) Ascaris lumbricoides
a. Other Names
- Roundworm
b. Morphology
 Adult worm
 Largest intestinal nematode
  Females measure 20–35 cm long with straight taisl
 males are smaller at 15–31 cm and tend to have curved
tails.
 Adults of both sexes possess three “lips” at the anterior
end of the body.
 Light brown or pink in color – fresh,but gradually
changes to white
 Round and tapered at both ends,anterior end being
thinner than posterior


 Fertilized Eggs
 Round and oval in shape 60-75 um x 40-50 um
 Bile stained and golden brown in color
  Surrounded by the thick smooth translucent shell
with an outer albuminous coat.
 Sometimes outer coat is lost called decorticated
egg
 Contain very large conspicuous unsegmented
ovum
 There is a clear crescentic area at the pole.
 Floats in sodium chloride ( NaCl) solution
 Narrow, longer ( 80 x 55 um) and more elliptical,
brownish in color
Irregular coating of albumin (thinner cell)
 Contain a small atrophied ovum with a mass of
disorganized highly refractile granules of various
size
 Does not float in NaCl solution (heaviest of all
helminth egg)
c. Life Cycle
- Adult worms live in the lumen of the small intestine. A
female may produce approximately 200,000 eggs per
day, which are passed with the feces. Unfertilized eggs
may be ingested but are not infective. Larvae develop to
infectivity within fertile eggs after 18 days to several
weeks, depending on the environmental conditions
(optimum: moist, warm, shaded soil). After infective
eggs are swallowed, the larvae hatch invades the
intestinal mucosa, and are carried via the portal, then
systemic circulation to the lungs. The larvae mature
further in the lungs (10 to 14 days), penetrate the
alveolar walls, ascend the bronchial tree to the throat,
and are swallowed. Upon reaching the small intestine,
they develop into adult worms. Between 2 and 3
months are required from ingestion of the infective eggs
to oviposition by the adult female. Adult worms can live
1 to 2 years.
d. Disease Association
 - People infected with Ascaris often show no symptoms,
regardless of the species of worm. If symptoms do
occur they can be light and include abdominal
discomfort. Heavy infections can cause intestinal
blockage and impair growth in children. Other
symptoms such as cough are due to migration of the
worms through the body. Ascariasis is treatable with
medication prescribed by your health care provider.
e. Treatment
- Anthelmintic medications (drugs that remove parasitic
worms from the body), such as albendazole and
mebendazole, are the drugs of choice for treatment
of Ascaris infections, regardless of the species of worm.
Infections are generally treated for 1–3 days. The drugs
are effective and appear to have few side effects.
f. Laboratory Techniques
- In stool:
direct microscopic examination of a saline emulsion of the stool
Concentration methods may be used.
- Blood examination:
Eosinophilia at the early stage of invasion but if present in the
intestinal phase suggest strongyloidiasis or toxocariasis
Dermal reaction (allergic):
scratch test-variable result
Traditional allergy tests utilize the Skin Prick method (also known
as a Puncture or Scratch test) to determine whether an allergic
reaction will occur by inserting possible triggers into your skin
using a needle prick. If you are allergic to the substance, you are
forced to suffer through your body’s reaction to the allergen.
Serological tests
The epidemiological study, also useful in the diagnosis of extra-
intestinal ascariasis (Loeffler’s syndrome). Larva may be found in
the sputum during the stage of migration.

g. Point of Interest
2) Hookworm spp
a. Other Names
Scientific name. Necator americanus/Ancylostoma duodenale
Common name. New World Hookworm/Old World Hookworm
-
b. Morphology

- Adult hookworm
- Male hookworm:
- Size: Smaller ( 8-11 mm long ×0.45 mm)
- Posterior end: Umbrella like expansion
- Genital opening: Posteriorly opens with cloaca.
- Female hookworm
- Size: Larger ( 10-13 mm long ×0.6 mm)
- Posterior end:  Tapering no umbrella-like expansion
- Genital opening: At the junction of the posterior and middle
third of the body
- Egg
- Shape: oval or elliptical with flattened poles( one pole more
often flattened than other), size: 65 X 40 um, color: colorless (
no bile stain), dark brown as stained with iodine. Shell: very
thin transparent hyaline shell membrane, appears as a black
line and contains: segmented ovum with 4 blastomeres, has
a clear space between eggshell and segmented ovum. Float
in saturated NaCl. Type: A( fresh stool) : 4 ,8, 16 grey granular
cell clear blastomeres. Type: B( few hours old): a uniform
mass of many grey granular cells. Type: C( 12-48 hr): the
whole egg is filled with larva, embryonated.
-
c. Life Cycle
Eggs are passed in the stool, and under favorable
conditions (moisture, warmth, shade), larvae hatch in 1 to 2
days and become free-living in contaminated soil. These
released rhabditiform larvae grow in the feces and/or the
soil, and after 5 to 10 days (and two molts) they become
filariform (third-stage) larvae that are infective. These
infective larvae can survive 3 to 4 weeks in favorable
environmental conditions. On contact with the human
host, typically bare feet, the larvae penetrate the skin and
are carried through the blood vessels to the heart and then
 to the lungs. They penetrate into the pulmonary alveoli,
ascend the bronchial tree to the pharynx, and are
swallowed. The larvae reach the jejunum of the small
intestine, where they reside and mature into adults. Adult
worms live in the lumen of the small intestine, typically the
distal jejunum, where they attach to the intestinal wall with
resultant blood loss by the host. Most adult worms are
eliminated in 1 to 2 years, but the longevity may reach
several years.
d. Disease Association
- High-intensity hookworm infections occur among both
school-age children and adults, unlike the soil-
transmitted helminths Ascaris and whipworm. High-
intensity infections with these worms are less common
among adults. The most serious effects of hookworm
infection are the development of anemia and protein
deficiency caused by blood loss at the site of the
intestinal attachment of the adult worms. When children
are continuously infected by many worms, the loss of
iron and protein can retard growth and mental
development.
e. Treatment
- Anthelminthic medications (drugs that rid the body of
parasitic worms), such as albendazole and
mebendazole, are the drugs of choice for treatment of
hookworm infections. Infections are generally treated
for 1-3 days. The recommended medications are
effective and appear to have few side effects. Iron
supplements may also be prescribed if the infected
person has anemia.
f. Laboratory Techniques
- A direct microscopical examination of stool (wet mount
preparation), concentration technique may be used. Duodenal
intubation may reveal eggs or adult worms. Indirect method-
Examination of blood: Eosinophilia, occult blood test: positive,
 serologic tests for hookworms, including ELISA and
immunoblotting (Western blotting). Presence of Charcot-Leyden
crystals in the stool.
g. Point of Interest
3) Trichuris trichiura
a. Other Names
- human whipworm
b. Morphology

- Morphology of adult worm

The worm is oviparous.
Male:
It measures 3-4 cm in length.
Its caudal extremity is coiled ventrally.
Female:
It measures 4—6 cm in length.
The caudal extremity is either shaped like a “comma” or an
arc.
- Morphology of egg
- Size about 50μm in length by 25μm in a breath.
color, brown (bile–stained ), has a double shell, the outer one
is bile-stained. Barrel-shaped with a mucous plug at each
pole.
contains an unsegmented ovum when the egg leaves the
human host.
Floats in a saturated solution of common salt. The eggs when
freshly passed are not infective to man.
-
c. Life Cycle
- The unembryonated eggs are passed with the stool. In
the soil, the eggs develop into a 2-cell stage, an
advanced cleavage stage, and then they embryonate;
eggs become infective in 15 to 30 days. After ingestion
(soil-contaminated hands or food), the eggs hatch in the
small intestine, and release larvae that mature and
establish themselves as adults in the colon. The adult
worms (approximately 4 cm in length) live in the cecum
and ascending colon. The adult worms are fixed in that
location, with the anterior portions threaded into the
 mucosa. The females begin to oviposit 60 to 70 days
after infection. Female worms in the cecum shed
between 3,000 and 20,000 eggs per day. The life span of
the adults is about 1 year.
d. Disease Association
- Rectal prolapsed in children, appendicitis, iron deficiency anemia, diarrhea,
and eosinophilia
e. Treatment
- Anthelminthic medications (drugs that rid the body of
parasitic worms), such as albendazole and
mebendazole, are the drugs of choice for treatment.
Infections are generally treated for 3 days. The
recommended medications are effective. Health care
providers may decide to repeat a stool exam after
treatment. Iron supplements may also be prescribed if
the infected person suffers from anemia.
f. Laboratory Techniques

- Microscopic identification of whipworm eggs in feces is

evidence of infection. Because eggs may be difficult to
find in light infections, a concentration procedure is
recommended. Because the severity of symptoms
depend on the worm burden, quantification of the latter
(e.g. with the Kato-Katz technique) can prove useful.

- Examination of the rectal mucosa by proctoscopy (or

directly in case of prolapses) can occasionally
demonstrate adult worms.

-
g. Point of Interest
4) Capillaria philippinensis
a. Other Names
b. Morphology
- Capillaria philippinensis eggs are 35 to 45 µm in length
by 20-25 µm in width, somewhat smaller than C.
hepatica. They have two flat polar prominences and a
 striated shell. Eggs are unembryonated when passed in
feces.
- Capillaria philippinensis adult males are 2.0—3.5 mm in
length and females are 2.5—4.5 mm in length. Females
may contain embryonated or unembryonated eggs in
utero.
c. Life Cycle
- Typically, unembryonated, thick-shelled eggs are passed
in the human stool and become embryonated in the
external environment in 5—10 days; after ingestion by
freshwater fish, larvae hatch, penetrate the intestine,
and migrate to the tissues. Ingestion of raw or
undercooked fish results in infection of the human
host. The adults of Capillaria philippinensis are very small
(males: 2.3 to 3.2mm; females: 2.5 to 4.3 mm) and
reside in the human small intestine, where they burrow
in the mucosa. In addition to the unembryonated,
shelled eggs which pass into the environment, the
females can also produce eggs lacking shells
(possessing only a vitelline membrane), which become
embryonated within the female’s uterus or in the
intestine. The released larvae can re-invade the
intestinal mucosa and cause internal autoinfection. This
process may lead to hyperinfection (a massive number
of adult worms).
d. Disease Association
e. Treatment
- Mebendazole 400 mg/day given in divided doses for 20 days for new
cases and for 30 days for relapses of cases.
- Albendazole has also been found effective in treating intestinal
capillariasis using the same dosage as Mebendazole.
f. Laboratory Techniques
- The specific diagnosis of C. philippinensis is established
by finding eggs, larvae and/or adult worms in the stool
or in intestinal biopsies. Unembryonated eggs are the
 typical stage found in the feces. In severe infections,
embryonated eggs, larvae, and even adult worms can be
found in the feces. No valid serologic testing is available
for diagnosis.
g. Point of Interest
5) Enterobius vermicularis
a. Other Names
- human pinworm
- seatworm
- threadworm
b. Morphology
- Adult worm
- Appearance: small, white, thread-like.
- Size : male – 2-5mm x 0.1-0.2mm female – 8-13mm x 0.3-0.5mm.
- Cervical alae: a wing-like expansion of the cuticle near the anterior
end.
- Double bulb esophagus: posterior dilated end of the esophagus
which forms the globular bulb.
- Male: the posterior end is tightly curved, bearing a copulatory
bursa with spicules at the posterior end.
- Female: posterior one-third is tapering, straight, thin, and pointed.

- Eggs
- Shape: oval, planoconvex.
- Size : 50-60μm x 20-30μm.
- Surrounded by double-layered eggshell
- Embryonated when passed fresh; contains a tadpole larva inside.
- Survives some weeks in fairly high humidity and moderate
temperature, few days in dry dust.
-
c. Life Cycle
- Gravid adult female Enterobius vermicularis deposit eggs
on perianal folds. Infection occurs via self-inoculation
(transferring eggs to the mouth with hands that have
scratched the perianal area) or through exposure to
eggs in the environment (e.g. contaminated surfaces,
clothes, bed linens, etc.). Following ingestion of infective
eggs, the larvae hatch in the small intestine and the
adults establish themselves in the colon, usually in the
 cecum. The time interval from ingestion of infective eggs
to oviposition by the adult females is about one month.
At full maturity adult females measure 8 to 13 mm, and
adult males 2 to 5 mm; the adult life span is about two
months. Gravid females migrate nocturnally outside the
anus and oviposit while crawling on the skin of the
perianal area. The larvae contained inside the eggs
develop (the eggs become infective) in 4 to 6 hours
under optimal conditions.
d. Disease Association
- The most common clinical manifestation of a pinworm
infection is an itchy anal region. When the infection is
heavy, there can be a secondary bacterial infection due
to the irritation and scratching of the anal area. Often
the patient will complain of teeth grinding, and insomnia
due to disturbed sleep, or even abdominal pain or
appendicitis. Infection of the female genital tract has
been well reported.
e. Treatment

- The medications used for the treatment of pinworm are

either mebendazole, pyrantel pamoate, or albendazole.
Any of these drugs are given in one dose initially, and
then another single dose of the same drug two weeks
later. Pyrantel pamoate is available without prescription.
The medication does not reliably kill pinworm eggs.
Therefore, the second dose is to prevent re-infection by
adult worms that hatch from any eggs not killed by the
first treatment. Health practitioners and parents should
weigh the health risks and benefits of these drugs for
patients under 2 years of age.

- Repeated infections should be treated by the same

method as the first infection. In households where more
than one member is infected or where repeated,
symptomatic infections occur, it is recommended that
 all household members be treated at the same time. In
institutions, mass and simultaneous treatment,
repeated in 2 weeks, can be effective.

f. Laboratory Techniques

- Sample collection
- The adult worms may be detected in the perineal region or
on the surface of the stool. These may also be detected in
the appendix during an appendectomy. Since eggs are not
discharged by the worm into feces, therefore, the fecal
examination is not useful in the laboratory diagnosis of
threadworm infection. However, in a small proportion of
patients stool examination may show the presence of eggs
of E. vermicularis.  Eggs that are deposited in large numbers
on the perianal and perineal skin at night can be
demonstrated by scrapping these with NIH swab similar to
the adhesive cellophane tape method.
- NIH SWAB
- Consists of a glass rod at one end of which a piece of
transparent cellophane (with sticky surface out) is wrapped
and held in place with a rubber band. The other end of the
glass rod is fixed in a rubber stopper and kept in a test tube.
The cellophane part is used for swabbing by rolling over the
perianal area which is then detached, spread over a glass
slide, and examined microscopically. Swabs should be taken
from three successive days to be considered negative.
Cellophane tape preparation
- Microscopy  examination
- Detect eggs ( planoconvex, 50-60 μm x 20-30μm), with a
translucent shell of moderate thickness, containing a larva
inside.
g. Point of Interest

II. TREMATODES
1) Schistosoma japonicum
a. Other Names
- Oriental Blood flukes
b. Morphology
- Schistosomes are dioecious and measure 10 to 20 mm in length and 0.5-1.0
mm in width. The male has a deep ventral groove known as the gynaecophoric
 canal, in which the female lies during copulation. Both sexes have 2 suckers, an
anterior and a ventral sucker. The gut of the female worm appears dark because
it is filled with deposits of haematin (breakdown product of haemoglobin). The
life span may extend to 30 years but the mean longevity is about 5 years.
c. Life Cycle
- The three common parasites of man, S. haematobium, S. japonicum and S.
mansoni have similar life cycles. Eggs are passed out from the urine (S.
haematobium) or from the feces (S. japonicum and S. mansoni); they hatch in
aggregations of water such as ponds, lake edges, streams and canals. From the
eggs, miracidia hatch into the water where they penetrate into the suitable snails.
In the snails, they develop two generations of sporocysts; the second of which
produces fork-tailed cercariae. These penetrate the skin when a new host comes
into contact with contaminated water. Once get into the skin, the cercariae shed
their tails to become schistosomulae, which migrate through the tissues until they
reach the portal venous system of the liver. The males and females copulate
before settling down in pairs in the venous system of the liver. S. haematobium
usually migrates to the venous plexus of the bladder; other species (including the
geographically localized S. intercalatum and S. mekongi), to the rectum where
spiny eggs are laid. The eggs penetrate into the bladder or rectum.
d. Disease Association

e . Intestinal and
hepatic
f. schistosomiasis
g . Oriental 

h. schistosomiasis
i . Schistosomias 

is
j. japonica or Katayama
k. disease
- Intestinal and Hepatic Schistosomiasis
- Oriental Schistosomiasis
- Schistosomiasis Japonica or katayama disease
 l. Treatment
- Praziquantel
- Niridazole
m. Laboratory Techniques
- Direct Fecal Smear
- Kato-katz or concentration techniques
- Serological Tests
n. Point of Interest
2) Paragonimus westermanii
a. Other Names
- Lung Fluke
b. Morphology
- Living adult worms are pinkish-brown in color and bean-shaped (7 to 15 mm in
length, 3 to 8 mm in width, and 3 to 5 mm in thickness). It contains
characteristic ovary in the middle part of the worm. The golden brown colored
large immature eggs are approximately 45-60 x 80-100 µm. They contain
operculum at one side and abopercular thickening at other side. The
metacercariae in the 2nd intermediate host are spherical in shape measuring
220-450 µm. It has two testes, the ovary, and the uterus are situated side by
side – characteristics configuration
- Paragonimus westermani eggs range from 80-120 µm
long by 45-70 µm wide. They are yellow-brown, ovoid or
elongate, with a thick shell, and often asymmetrical with
one end slightly flattened. At the large end, the
operculum is clearly visible. The opposite (abopercular)
end is thickened. The eggs are unembryonated when
passed in sputum or feces.
c. Life Cycle
- Paragonimus is a typical digenean trematode of carnivorous mammals. Large
immature eggs are spread throughout in stool, and mature to miracidia in
freshwater. They infect snails in which they undergo three generations of asexual
reproduction (redia, daughter redia, and cercaria). Microcercous cercariae are
released into water where they infect freshwater crustaceans (crabs and
crayfish). As encysted, they become metacercariae. The metacercariae are
infective to definitive hosts. They also infect paratenic (transport) hosts.
Carnivorous mammals are the most important definitive hosts. In case of P.
westermani, rodent and boar are known to be transport hosts. The
metacercariae excyst in the duodenum, penetrate the intestinal wall, and stay in
the peritoneal cavity for a while. The parasites finally arrive to the lung in which
they become adult worms approximately 8-10 weeks after metacercarial
infection. They liberate eggs in sputum and stool. The worms are thought to
thrive approximately 5 years in men. Main habitat of the parasite in the definitive
hosts is the bronchiolar lumen and peribronchial tissues.
d. Disease Association
- Paragonimiasis is infection with the lung fluke Paragonimus
westermani and related species. Humans are infected by
eating raw, pickled, or poorly cooked freshwater
 crustaceans. Most infections are asymptomatic, but
pulmonary symptoms may occur, including chronic cough,
chest pain, dyspnea, and hemoptysis. Allergic skin reactions
and central nervous system abnormalities due to ectopic
flukes, including seizures, aphasia, paresis, and visual
disturbances, can also occur. Diagnosis is by identifying eggs
in sputum, stool, or pleural or peritoneal fluid. Serologic
tests are also available. Praziquantel is the treatment of
choice.
e. Treatment
- Praziquantel is a drug of choice with more than 95% efficiency. Praziquantel is
definitely effective in early stage of active cerebral paragonimiasis. Its adverse
effects include headache, dizziness, gastrointestinal disturbance, and blurred
vision, albeit mild and transient. Triclabenazole is also effective. Any significant
side effect has not been reported. In the cases of chronic calcified cerebral
paragonimiasis, surgical removal is recommended.
f. Laboratory Techniques
-  Detection of eggs in feces is the diagnostic choice. Intradermal test is also
available in large-scale based screening but not good for individual patient due
to its low specificity. Enzyme-linked immunosorbent assay (ELISA) and
immunoblot are reliable in detecting specific IgG antibodies. In case of cerebral
paragonimiasis, CSF tests are highly recommended. Radiologic examination by
high resolution chest CT provide definitive clue for paragonimiasis. Brain CT/MRI
are also highly diagnostic either in active or in chronic calcified
neuroparagonimiasis.
g. Point of Interest
3) Heterophyid
a. Other Names
b. Morphology
c. Life Cycle
d. Disease Association
e. Treatment
f. Laboratory Techniques
g. Point of Interest
4) Fasciolid
a. Other Names
- Cattle liver fluke
b. Morphology

Fasciola hepatica  possesses mainly three stages of life egg, larva ( in snail), and adult
worm. The adult worm has following properties –
Large, broad, flat body
Leaf-shaped
Anterior end forms a prominent cephalic cone
Small oral and ventral suckers
Long and highly branched intestinal caeca
The life span of the adult worm in sheep is 5 years and in men 9 to 13 years.
Female adult: 25,000 eggs/day
Egg: The characteristics of the egg are as follows-

 Large ( having size of 140 X 80 µm)

 Hen’s egg-shaped
 Ovoid in shape
 Operculated
 Bile stained ( brownish-yellow in color) and
 Unsegmented ovum in a mass of yolk cells
 Excreted with the bile into the duodenum and then passed out along with
stool
 It does not float in the saturated solution of common salt.
 It can develop only in water.

Larval Stage: It may be of following phase- miracidium, cercaria, and metacercaria

c. Life Cycle
- It completes its life cycle in two different hosts. Definite host-
Sheep, goat, cattle, or man. Adult worm in the biliary passages of
the liver and reservoir host is primarily the sheep. Intermediate
host (where the larval stages of the worm develop)-Snails of the
genus Lymnaea and larval development proceeds in this snail and
a carrier (entailing suitable aquatic plants). The process starts
when infected animals defecate in fresh-water sources. Since the
worm lives in the bile ducts of such animals, its eggs are evacuated
in feces and hatch into larvae that lodge in a particular type of
water snail. Once in the snail, the larvae reproduce and eventually
release more larvae into the water. These larvae swim to nearby
aquatic or semi-aquatic plants, where they attach to the leaves
and stems and form small cysts (metacercariae). When the plants
with the small cysts attached are ingested, they act as carriers of
the infection. Watercress and water-mint are good plants for
transmitting fascioliasis, but encysted larvae may also be found on
many other salad vegetables. Ingestion of free metacercariae
floating on water may also be a possible mode of transmission.
 Metacercariae excsts in the duodenum or jejunum and liberate
the juvenile fluke. Juvenile fluke penetrates the intestinal wall and
reaches the liver capsule. The parasite burrows into the liver
parenchyma where it grows and develops. It becomes sexually
mature in the bile ducts. The eggs are liberated in the feces
through the bile in about  3-4 months after infection. The cycle is
then repeated.
d. Disease Association
- fascioliasis
e. Treatment
- The drug of choice for the treatment of fascioliasis is
Triclabendazole, a benzimidazole compound active against
immature and adult  Fasciola parasites. The recommended
due to having following properties-

 Efficacy
 Safety
 Ease of use

Other drugs are-

  Bithionol
 Nitazoxanide

Note-Praziquantel, which is active against most trematodes (flukes), typically is not

active against Fasciola parasites, and therefore, praziquantel therapy is not
recommended for fascioliasis.
-
f. Laboratory Techniques

- Specimens: Stool,  duodenal or biliary aspirates, blood

- Microscopy: Demonstration of eggs in the feces.
- Serological test:  Complement fixation test (CFT),
haemagglutination test, immunofluorescence assay,
immunodiffusion, immunoelectrophoresis, counter-
current electrophoresis (CCIE -most sensitive) whereas
testing using an immunoblot assay that detects IgG antibody
to FhSAP2, a recombinant antigen derived from Fasciola
hepatica is also most sensitive specific test.
- Molecular Test: RFLP(restriction Fragment Length
Polymorphism ): PCR-RFLP, is a technique that exploits
 variations in homologous DNA sequences. It refers to a
difference between samples of homologous DNA molecules
that come from differing locations of restriction enzyme
sites, and to a related laboratory technique by which these
segments can be illustrated.
- Additional types of testing: Abdominal imaging, such as USG, 
computerized axial tomography (CAT scan), magnetic resonance
imaging (MRI) scan, and endoscopic retrograde
cholangiopancreatography (ERCP as shown below); and
histopathologic examination of a biopsy specimen of liver or other
pertinent tissue.
g. Point of Interest

III. PROTOZOANS
1) Entamoeba histolytica
a. Other Names
b. Morphology
c. Life Cycle
d. Disease Association
e. Treatment
f. Laboratory Techniques
g. Point of Interest
2) Entamoeba coli
a. Other Names
b. Morphology
c. Life Cycle
d. Disease Association
e. Treatment
f. Laboratory Techniques
g. Point of Interest
3) Blastocystis hominis
a. Other Names
b. Morphology
c. Life Cycle
d. Disease Association
e. Treatment
f. Laboratory Techniques
g. Point of Interest
4) Gardia lamblia
a. Other Names
b. Morphology
c. Life Cycle
d. Disease Association
 e. Treatment
f. Laboratory Techniques
g. Point of Interest
5) Trichomonas vaginalis
a. Other Names
b. Morphology
c. Life Cycle
d. Disease Association
e. Treatment
f. Laboratory Techniques
g. Point of Interest

IV. CESTODES
1) Taenia spp
a. Other Names
b. Morphology
c. Life Cycle
d. Disease Association
e. Treatment
f. Laboratory Techniques
g. Point of Interest
2) Hymenolepis nana
a. Other Names
b. Morphology
c. Life Cycle
- H.nana can develop directly in the small intestine of the definitive hosts as well
as in an intermediate hosts (insects). If larva-bearing eggs enter the human
gastrointestinal tract, the oncospheres are released into the duodenum and
attatch to the villi, where each develops into a cysticercoid. Within 2-3 weeks,
the cysticercoid develops into a tapeworm. It is a common parasite of the house
mice and is found in human, especially in children.
d. Disease Association
e. Treatment
f. Laboratory Techniques
g. Point of Interest
3) Hymenolepis diminuta
a. Other Names
b. Morphology
c. Life Cycle
-
d. Disease Association
e. Treatment
f. Laboratory Techniques
g. Point of Interest
4) Diphyllobothrium latum
 a. Other Names
b. Morphology
c. Life Cycle
- Infection with the adult worm is acquired by the ingestion of raw, poorly cooked,
or pickled salmon, trout, perch, pike, white fish, grayling, ruff, eel, etc.,
harboring the plerocercoid larvae. After five or six weeks, the larva matures to the
adult worm. Both eggs and proglottids are passed in the stool. The eggs develop
in 2 weeks, and hatch to become ciliated coracidium larvae, and are ingested by
the first intermediate host, the copepod. The copepods, containing the
procercoid larvae, are ingested by fish, the second intermediate host, contains
the plerocercoid larvae.
d. Disease Association
e. Treatment
f. Laboratory Techniques
g. Point of Interest

V. BLOOD PARASITES
1) Plasmodium vivax
a. Other Names
b. Morphology
c. Life Cycle
- A malaria-infected female Anopheles mosquito inoculates sporozoites into the
human host during a blood meal. Sporozoites infect liver cells and mature into
schizonts, which rupture and release merozoites (exo-erythrocytic schizogony).
In P. vivax and P. ovale a dormant stage (hypnozoites) can persist in the liver for
weeks, or even years. The merozoites infect red blood cells. The ring stage
trophozoites mature into schizonts, which rupture releasing merozoites
(erythrocytic schizogony). Some parasites differentiate into sexual erythrocytic
stages (gametocytes). The gametocytes are ingested by an Anopheles mosquito
during a blood meal. The microgametes penetrate the macrogametes generating
zygotes in the mosquito's stomach. The zygotes become ookinetes and invade
the midgut wall where they develop into oocysts. The oocysts grow, rupture, and
release sporozoites, which make their way to the mosquito's salivary glands
(sporogonic cycle).
d. Disease Association
e. Treatment
f. Laboratory Techniques
g. Point of Interest
2) Plasmodium falciparum
a. Other Names
b. Morphology
c. Life Cycle
- An infected female Anopheles mosquito inoculates sporozoites into the human
during a blood meal. Sporozoites infect liver cells and mature into schizonts,
which release merozoites (exo-erythrocytic schizogony). The merozoites infect
red blood cells. The ring stage trophozoites mature into schizonts, which rupture
releasing merozoites (erythrocytic schizogony). Some parasites differentiate into
sexual erythrocytic stages (gametocytes). The gametocytes are ingested by an
Anopheles mosquito during a blood meal. The microgametes penetrate the
macrogametes generating zygotes in the stomach. The zygotes become
ookinetes and invade the midgut wall where they develop into oocysts. The
 oocysts release sporozoites, which make their way to the mosquito's salivary
glands (sporogonic cycle).
d. Disease Association
e. Treatment
f. Laboratory Techniques
g. Point of Interest
3) Plasmodium malariae
a. Other Names
b. Morphology
c. Life Cycle

- The malaria parasite life cycle involves two hosts. During

a blood meal, a malaria-infected
female Anopheles mosquito inoculates sporozoites into
the human host. Sporozoites infect liver cells and
mature into schizonts, which rupture and release
merozoites. After this initial replication in the liver (exo-
erythrocytic schizogony), the parasites undergo asexual
multiplication in the erythrocytes (erythrocytic
schizogony). Merozoites infect red blood cells. The ring
stage trophozoites mature into schizonts, which rupture
releasing merozoites. Some parasites differentiate into
sexual erythrocytic stages (gametocytes). Blood stage
parasites are responsible for the clinical manifestations
of the disease. The gametocytes, male
(microgametocytes) and female (macrogametocytes),
are ingested by an Anopheles mosquito during a blood
meal. The parasites’ multiplication in the mosquito is
known as the sporogonic cycle. While in the mosquito’s
stomach, the microgametes penetrate the
macrogametes generating zygotes. The zygotes in turn
become motile and elongated (ookinetes) which invade
the midgut wall of the mosquito where they develop
into oocysts. The oocysts grow, rupture, and release
sporozoites, which make their way to the mosquito’s
salivary glands. Inoculation of the sporozoites into a
new human host perpetuates the malaria life cycle.

d. Disease Association
 e. Treatment
f. Laboratory Techniques
g. Point of Interest
4) Wuchereria bancrofti
a. Other Names
b. Morphology
c. Life Cycle
- During a blood meal, an infected mosquito introduces
third-stage filarial larvae onto the skin of the human
host, where they penetrate into the bite wound. They
develop in adults that commonly reside in the
lymphatics. The female worms measure 80 to 100 mm
in length and 0.24 to 0.30 mm in diameter, while the
males measure about 40 mm by .1 mm. Adults produce
microfilariae measuring 244 to 296 μm by 7.5 to 10 μm,
which are sheathed and have nocturnal periodicity,
except the South Pacific microfilariae which have the
absence of marked periodicity. The microfilariae migrate
into lymph and blood channels moving actively through
lymph and blood. A mosquito ingests the microfilariae
during a blood meal. After ingestion, the microfilariae
lose their sheaths and some of them work their way
through the wall of the proventriculus and cardiac
portion of the mosquito’s midgut and reach the thoracic
muscles. There the microfilariae develop into first-stage
larvae and subsequently into third-stage infective
larvae. The third-stage infective larvae migrate through
the hemocoel to the mosquito’s prosbocis and can
infect another human when the mosquito takes a blood
meal.
d. Disease Association
e. Treatment
f. Laboratory Techniques
g. Point of Interest

VI. PREPARED SLIDES

1) Trichinella spiralis
 a. Other Names
b. Morphology
c. Life Cycle
- When the meat harboring the infective-stage larvae are ingested, the larvae
excyst in the stomach or duodenum to invade the mucosal epithelium of small
intestine. They then rapidly develop through the 4-larval stages and mature in
second day of infection. The adult worms live intracellularly within the superficial
enterocytes of small intestine. After mating, females are inseminated, and begin
to produce eggs that develop into minute larvae in the uterus. The larvae come
of out the uterus, migrate into the blood stream via intestinal lymphatics or
mesentric venules, and finally reach the striated muscles. They become
encapsulated within the muscle fibers with exception those of T. pseudospiralis.
d. Disease Association
e. Treatment
f. Laboratory Techniques
g. Point of Interest
2) Balantidium coli
a. Other Names
b. Morphology
c. Life Cycle
- Cysts are the stage responsible for transmission of
balantidiasis. The host most often acquires the cyst
through ingestion of contaminated food or water.
Following ingestion, excystation occurs in the small
intestine, and the trophozoites colonize the large
intestine. The trophozoites reside in the lumen of the
large intestine and appendix of humans and animals,
where they replicate by binary fission, during which
conjugation may occur. Trophozoites undergo
encystation to produce infective cysts. Some
trophozoites invade the wall of the colon and multiply,
causing ulcerative pathology in the colon wall. Some
return to the lumen and disintegrate. Mature cysts are
passed with feces.
d. Disease Association
e. Treatment
- Three medications are used most often to
treat Balantidium coli: tetracycline, metronidazole,
and iodoquinol.
 Tetracycline*: adults, 500 mg orally four times
daily for 10 days; children ≥ 8 years old, 40
 mg/kg/day (max. 2 grams) orally in four doses for
10 days.
 Metronidazole*: adults, 500-750 mg orally three
times daily for 5 days; children, 35-50 mg/kg/day
orally in three doses for 5 days.
 Iodoquinol*: adults, 650 mg orally three times
daily for 20 days; children, 30-40 mg/kg/day (max
2 g) orally in three doses for 20 days. (Note:
iodoquinol should be taken after meals.)
f. Laboratory Techniques
g. Point of Interest