Microbiology-Parasitology

Compre Review
Claire Anne Therese M. Hemedez
Assistant Professor
St. Luke’s Medical Center College of Medicine - WHQM
Outline
Notes in blue box:
• Bacteriology Things mentioned during
review
• Virology
• Parasitology Notes in orange box:
Things to review on
• Mycology

Notes in green box:

Things to take note of
https://microbenotes.com/gram-stain-principle-reagents-procedure-and-result-interpretation/
Normal Flora
Gram Positive Cocci
Bacteriology
 - Staphylococci: catalase (+); Streptococci: catalase (-)
- S. epidermidis - Normal flora; nosocomial infections: bacteremia associated with

Staphylococci indwelling vascular catheters; endocarditis involving prosthetic cardiac valves

(rarely involves native valves); infection at intravascular catheter sites
- S. saprophyticus – UTI in sexually active, young women
- MRSA – mecA gene

• Gram positive cocci in clusters

• Culture: gray to deep golden yellow, round, smooth, raised and
glistening colonies; beta-hemolytic (Staphylococcus aureus)

Coagulase

Novobiocin S. aureus

S. saprophyticus S. epidermidis

Tille, 2017. Bailey & Scott’s Diagnostic Microbiology

Streptococci
• Gram positive cocci in chains or in pairs

- Complete lysis of RBC - Partial/incomplete lysis → Hgb - No hemolysis

- Clear zone, approaching the color reduced to metHgb
and transparency of the base - Narrow green zone area surrounding
medium surrounding the colony the colony

https://microbenotes.com/hemolysis-of-streptococci/
Streptococcus pyogenes

Lyse RBC

Inhibit IL-1β

Split hyaluronic acid

- Taxo A (Bacitracin disk) –
sensitive (zone of
inhibition) for GABHS
Digest fibrin (grpA beta-hemolytic
Strep – S. pyogenes)

DNA degradation VIRULENCE!

Pharyngitis, Post- Strep
Spe A, B (TSS) Rheumatic fever, Post-Strep
Spe C (scarlet fever) Glomerulonephritis
Jones Criteria for RF
Cardiac histopath findings for RF
Streptococcus agalactiae Streptococcus pneumoniae
No Lancefield classification
Taxo P (Optochin) disk for which
Strep pneumo is sensitive

Arrowhead
area of
hemolysis

Positive Quellung reaction

https://www.cdc.gov/groupbstrep/lab/index.html
Highlights capsule after interaction of
polyvalent serum and Strep.
• GrpB Strep infection during
pregnancy → neonatal sepsis • Most common cause of bacterial
Histopath? Lobar
(chorioamnionitis) AOG for GBS screening? CAP (comm acquired pneumonia) pneumonia VS
Prophylaxis for mom and Bronchopneumonia
baby?
• Viridans strep
• Group of organisms (e.g. S. mitis, S. mutans, S. bovis).
• Infection of native heart valves are associated with staphylococcal infection.
Viridans causes subacute bacterial endocarditis affecting abnormal valves
(congenital malformations, rheymatic or atherosclerotic lesions). Duke Criteria for IE?

• Enterococci
• Previously group D strep with E. faecalis as the most common
• Common cause of HAIs (hospital acquired infections) due to its easy
transmissibility and high resistance to vancomycin (VRE, vancomycin resistant
enterococci)
• Multiple resistance phenotypes have been reported but VanA is the most studied.
Gram Negative Bacilli
Bacteriology
 Group of heterogenous gram negative bacilli found in
the intestinal tract of humans and animals.
Either motile with peritrichous flagella or nonmotile

Enterobactericiae Grow well on MacConkey agar

Facultative anaerobes or aerobes
Ferment a wide range of carbohydrates

• Culture: Catalase positive and oxidase negative.

• Escherichia coli – circular, convex, smooth colonies with

distinct edges; greenish metallic sheen (EMB agar)
• Klebsiella sp. – large, mucoid colonies that coalesce with
prolonged incubation
• Proteus sp. – swarming pattern colonies
• Biochemical tests (some of…)
• Lactose fermentation – yellow colonies (lactose
fermenters)
• TSI (triple sugar iron) agar – fermentation of
lactose/sucrose (slant) and glucose (butt), formation of
hydrogen sulfide and production of gas (bubbles)
• E. coli – A/A, gas+, H2S-
• Pseudomonas – K/K, gas-, H2S- A – acid - yellow
K – alkaline – red
• Salmonella – K/A, H2S+ Read from slant – butt – gas – H2S
 Enterobactericiae
• Diseases:
• Escherichia coli – UTI, sepsis, meningitis
• Enteropathogenic (EPEC) – diarrhea in infants
ETEC - heat-labile toxin
increases cyclic
• Enterotoxigenic (ETEC) – “traveler’s diarrhea”, diarrhea in
adenosine children
monophosphate
triggering a cascade • Shiga-toxin producing (STEC) – O157:H7 serotype; mild, non-
that results in bloody diarrhea, hemorrhagic colitis, hemolytic uremic
prolonged
hypersecretion of syndrome
water and chlorides
and inhibition of the
• Enteroinvasive (EIEC) – similar to shigellosis
reabsorption of Na. • Enteroaggregative (EAEC) – acute and chronic diarrhea;
Serratia marcescens
persistent diarrhea in HIV patients - UTI, pneumonia, bacteremia,

• Klebsiella pneumoniae – lobar pneumonia (“currant jelly”

wound/bone/soft tissue
infections, endocarditis

sputum), UTI, wound and soft tissue infections, Proteus sp.

bacteremia/sepsis - UTI (P. mirabilis > P. vulgaris)
Enterobactericiae
• Diseases:
• Shigella sp.
• Blood or non-bloody diarrhea; “pseudomembrane” on the
ulcerated area
• HUS (S. dysenteriae), Reiter’s chronic arthritis syndrome (S.
flexneri)
• Salmonella sp.
• Thypoidal (S. typhi, S. paratyphi) -> Enteric fever (fever, malaise,
myalgia, diarrhea/constipation, general abdominal pain, “rose
spots”, hepatosplenomegaly
• Enterocolitis (nausea, headache, vomiting, profuse diarrhea),
bacteremia SSA (Salmonella-Shigella agar) – selective
media for Salmonella and Shigella

Typing for Salmonella done using agglutination

test (Widal test)
Pseudomonas aeruginosa
• Culture: smooth, round colonies with a fluorescent
greenish color; sweet or grape-like or corn taco-like
odor; pigments: pyocyanin (blue), pyoverdine (green),
pyorubin (dark red), pyomelanin (brown-black);
patients with CF have mucoid colonies (alginate)
• Diseases:
• Wound and burn infection, meningitis, UTI, necrotizing
pneumonia, otitis externa, sepsis
• Ecthyma gangrenosum – hemorrhagic skin necrosis
• Exotoxin A, exoenzyme S, exoenzyme T, exoenzyme U and
exoenzyme Y

http://textbookofbacteriology.net/pseudomonas.html
Vibrio cholera
• Gram negative, comma-shaped, curved bacilli
• Culture (TCBS): yellow colonies against the dark-green
background of the agar
• Disease/s
• Cholera
• Serogroup O1 (biotypes: classic and ElTor) and O139 – epidemic
and pandemic cholera
• Nausea, vomiting, profuse diarrhea with “rice water” stools https://microbenotes.com/vibrio-cholerae-
owaga-on-tcbs-agar/
(mucus, epithelial cells, large numbers of vibrios)
TCBS (Thiosulfate, citrate, bile salts,
sucrose)

ElTor causes milder disease than

classic biotype

V. parahaemolyticus, V. vulnificus –
green colonies on TCBS
Other important GNBs
• Campylobacter jejuni
• GS: curved, comma or S-shaped (seagull shaped) GNB
• Skirrow’s media
• Gastroenteritis (crampy abdominal pain, profuse diarrhea that may be grossly
bloody)
• Helicobacter pylori
• GS: spiral, curved, furisform GNB
• Gastritis, PUD, gastric adenocarcinoma, gastric MALT
Other important GNBs
• Yersinia pestis
• GNB with bipolar staining
• Plague (rat flea, Xenopsylla cheopis)
• Cause of “Black Death” in Europe (1300s)
• Bubonic plague– high fever, painful and enlarged lymph nodes (neck, groin, axilla)
• Septicemic plague– intravascular spread
• Pneumonic plague– inhalation from contacts; chest pain, cough, hemoptysis, resp
distress
Other important GNCB
• Haemophilus influenzae
• GN short or coccobacilli
• Chocolate agar: flat, grayish, translucent colonies; displays “satellite
phenomenon” when streaked with S. aureus in blood agar plate
• Requires both Factor X (hemin) and V (NAD)
• H. influenzae type b capsular antigen→ otitis media, sinusitis, bronchitis and
pneumonia (low mucociliary clearance), meningitis, septic arthritis, epiglottitis
• Bordatella pertussis
• Bordet-Gengou medium/ Regan-Lowe medium
• Pertussis
• Catarrhal stage – mild symptoms, very infectious
• Paroxysmal stage – whooping cough → vomiting, cyanosis and convulsions
Gram Positive Bacilli
Bacteriology
 Bioterrorism agent

GPB in singles, pairs or serpentine chains

Bacillus anthracis Spore stain: Malachite green (primary

stain) stains the endospores. Vegetative
cells will remain pink.

• Culture (BAP): nonhemolytic gray to white,

tenacious colonies with rough texture and a
ground-glass appearance; comma shaped or
Medusa head outgrowths https://www.health.ny.gov/guidance/oph/wadswor
th/bacillus_anthracis.pdf

• Disease/s:
• Anthrax (cutaneous, gastrointestinal, inhalation
[woolsorter’s]; injection)
• Protective antigen (PA), edema factor (EF), lethal factor (LF)
• PA for receptor binding and mediate cell entry of EF and LF
• EF + PA = edema toxin (cell and tissue edema)
• LF + PA – lethal toxin (major virulence factor)
For anthrax, humans as incidental hosts with herbivores as its main victims (goats, sheep, cattles, horses) and their
products. Portal of entry : skin, mucuous membranes or inhalation of spores into the lung. Injection anthrax has been
reported among persons who inject contaminated heroin. 95% of cases are cutaneous, 5% inhalation
Cutaneous – papule (insect bite) → vesicle → necrotic ulcer → black eschar + marked edema BMC Research Notes 2012;5(1):464
 Gram positive slender bacilli with
rounded ends, singly, in pairs, and in
short chains.

Bacillus cereus
https://cmr.asm.org/content/23/2/382

• Culture (BAP): beta-hemolytic; large, feathery, spreading colonies

• Disease/s: B cereus is a soil organism that can contaminate rice.
Germination of spores is enhanced when large amounts of rice
• Food poisoning are cooked and allowed to cool slowly. In the stool, a
concentration of 10^5 bacteria or more per gram is diagnostic.
• Emetic type (fried rice, milk, pasta); cereulide toxin Enterotoxins and pyogenic toxin are virulence factors.

• Diarrheal type (meat dishes and sauces); hemolysin BL, nonhemolytic enterotoxin and
cytotoxin K
• Eye infections
• Localized (wound) and systemic (endocarditis, catheter-associated
bacteremia, CNS infections, osteomyelitis, pneumonia, etc) infections
Clostridium botulinum
• Subterminal spore
• Heat-resistant spores (diminished by low pH or
high salt conc) https://www.asmscience.org/content/education
/imagegallery/image.2786
• Disease/s:
Most common: spiced, smoked, vacuum
• Botulism packed, or canned alkaline foods that
are eaten without cooking.
• Types A, B, E and F – variety of foods
• Infant botulism (types A, B or F) - honey
• Proteolysis of SNARE proteins (synaptobrevin, SNAP25,
syntaxin) → inhibition of acetylcholine release at the synapse
→ lack of muscle contraction and flaccid paralysis
• Rare: wound botulism, intestinal botulism

https://www.healthing.ca/symptoms/hypotonia
Clostridium tetani
• Terminal spore
Vlaams Diergeneeskundig Tijdschrift.2011; 80(5)
• Disease/s:
• Tetanus
• Tetanospasmin → blocks glycine and GABA release → hyperreflexia, muscle spasms,
spastic paralysis
• Management??
Management?
Prophylaxis?
Clostridium difficile
• Pseudomembranous colitis
• Dx: toxins in stool and
pseudomembranes on endoscopy
• Ampicillin, Clindamycin,
Fluoroquinolones
• Toxin A (enterotoxin) and B
(cytotoxin)
Clostridium perfringens
• Gas gangrene (clostridial
myonecrosis)
• Alpha toxin (lecithenase) → splits
lecithin; aggregates platelets –
thrombi formation, poor tissue
perfusion, destruction of viable
tissue
Clostridium sordelli – toxic shock syndrome after
medical abortion (mifepristone, intravaginal
misoprostol)
Clostridium septicum – bacteremia in patients
with neoplasms
Corynebacterium diphtheriae
• “club-shaped”; metachromatic granules;
parallel/palisading or at acute angels to one another
• Culture
• BAP: small, granular, gray colonies with irregular edges
• Potassium tellurite (Cystine Tellurite agar/modified Tinsdale
agar): brown to black colonies with a brown-black halo
• Loeffler’s medium
• Modified Elek immunoprecipitation method
• Disease/s:
• Diphtheria
• Diphtheria toxin – destruction of epithelium
and inflammatory response → pseudomembrane http://textbookofbacteriology.net/diphtheria.html

in the tonsils, pharynx or larynx

Bull neck edema (reactive lymph nodes)
Gram Negative Cocci
Bacteriology
Neisseria
• GN diplococci (gonococci, meningococci)
• Modified Thayer-Martin agar
• N. gonorrhoeae – oxidize glucose
• Mucous membranes of the genitourinary tract, eye, rectum, throat
• Ophthalmia neonatorum
• N. meningitides – oxidize glucose, maltose
• Portal of entry – nasopharynx
• Invasive meningococcal disease (meningitis, sepsis [ie meningococcemia])
• Fulminant meningococcemia → high fever, hemorrhagic rash; Waterhouse-
Friderichsen syndrome (DIC, bilateral hemorrhagic necrosis of adrenal glands
with subsequent adrenal failure)
Mycobacteria
Bacteriology
Mycobacterium tuberculosis

Kaiser, 2020. www.biolibretexts.org

https://webpath.med.utah.edu/LUNGHTML/LUNG038.html
Mycolic acid - allows the organism to resist Histology of granuloma?
decolorization with acid alcohol thereby retaining the
primary stain which is carbol fuschsin
 Latent infection

Mycobacterium tuberculosis Mantoux test/tuberculin skin test – measures induration

diameter 48-72hrs after intradermal injection of PPD or purified
protein derivative. Interpretation is based on risk grouping.
Interferon gamma release assay - measure Tcell (CD4, CD8)
response to peptide antigens that simulate mycobacterial
proteins.
Treatment regimen for PTB and
EPTB???

Jawetz, 2015
MGIT (Mycobacteria growth Lowenstein-Jensen agar
indicator tube
Mycobacterium tuberculosis
• Drug resistance
• Isoniazid – katG, inhA
• Streptomycin – rpsL and rrs
• Rifampicin – rpoB
• Fluoroquinolones – gyrA

• MDR – Mutidrug-resistant (HR)

• XDR – Extensively drug-resistant (HR, any fluoroquinolone, any of
three injectable 2nd line drugs) Mycobacterium leprae – leprosy

MAC – disseminated infection associated with

HIV patients, especially those with CD4+
counts below 100uL
Spirochetes
Bacteriology
Leptospira interrogans
• Dark-field microscope
• Ellinghausen-McCullough-Johnson-Harris, EMJH medium
• Serology – agglutinating antibody titers
• Leptospirosis
• Anicteric syndrome
• Septicemic phase – fever, headaches, myalgia, lack of appetite, chills, sweating, nausea,
vomiting
• Immune phase – meningitis
• Icteric syndrome (Weil’s disease)
• Fever, renal failure, jaundice, hemorrhage, respiratory distress; may also involve the
heart, CNS and muscles
Treponema pallidum
• Immunofluorescent stain or dark-field illumination
• Syphilis
• Acquired
• Primary lesion → papule that breaks down to form an ulcer with a hard base (hard
chancre)
• Secondary lesion → maculopapular rash; meningitis, chorioretinitis, hepatitis, nephritis
• Tertiary stage → granulomatous lesions (gummas) in the skin, bones, liver; CNS
degenerative changes; cardiovascular lesions
• Congenital
• Instertitial keratitis, Hutchinson’s teeth, saddlenose, periostitis, CNS anomalies
• Non-treponemal tests (VDRL, RPR) – screening; treatment efficacy monitoring
• Treponemal antibody tests (TPPA/TPHA/MHA-TP, FTA-ABS) - confirmatory
Virology

DNA or RNA virus (ss or ds, naked or enveloped)

Clinical presentation
Diagnosis (serologic)
Respiratory Viruses
• Adenovirus
• Naked, icosahedral, linear, dsDNA
• Different serotypes
• Serotypes 3, 7, 11, 14, 16, 21, 34, 35 – freq epidemics of acute respiratory illness
• Serotypes 5, 8, 19 – epidemic keratoconjunctivitis
• Serotypes 3 and 7 – conjunctivitis and pharyngoconjunctival fever
• Serotypes 11 and 21 – acute hemorrhagic cystitis
• Serotypes 40 and 41 – GI tract infections
• Rhinovirus
• Respiratory Syncytial virus
• Bronchiolitis (fever, cough, dyspnea, cyanosis in children <1 year old)
• Febrile rhinitis, pharyngitis; common cold
Respiratory Viruses
• Influenza viruses
• Enveloped, RNA virus
• Hemagglutinin and Neuraminadase
• Parainfluenza virus
• Croup (laryngotracheobronchitis)
• Coronavirus
• Enveloped, ssRNA
• 3 glycoproteins
• S (spike) – receptor biding, cell fusion
• E (envelope)
• M (membrane) – transmembrane; for budding and envelope formation
• 4 genera: alpha (229E, NL63), beta (SARS-CoV, SARS-Cov2, MERS-Cov, HKU1, OC43),
gamma and delta

Hu, et al. Nature Reviews Microbiology, 2021. 19:141-154

https://www.nature.com/articles/s41579-020-00459-7
Diarrhea Viruses
• Rotavirus
• Non-enveloped, dsRNA
• Family Reoviridae, subfamily Sedoreovirinae
• Major cause of diarrheal illness in infants
• NSP4 protein → stimulate 5-hydroxytrptamine → increased GI motility,
diarrhea, vomiting
• Norovirus (Norwalk virus)
• Non-enveloped, ssRNA
• GII.4 serotype → viral gastroenteritis worldwide
 Flaviviridae – yellow fever,

Hepatitis Viruses dengue fever, Japanese enceph,

West Nile virus, Zika virus

A B C D E
Family Picornaviridae Hepadnaviridae Flaviviridae Unclassified Hepeviridae
Genus Hepatovirus Orthohepadnavirus Hepacivirus Deltavirus Hepevirus
Virion 27nm, 42nm, spherical 60nm, spherical 35nm, spherical 30-32nm,
icosahedral icosahedral
Envelope No Yes (HbsAg) Yes Yes (HbsAg) Non
Genome ssRNA dsDNA ssRNA ssRNA ssRNA
Genome size 7.5 kb 3.2 kb 9.4 kb 1.7 kb 7.2 kb
Stability Heat and acid Acid sensitive Ether and acid Acid sensitive Heat stable
stable sensitive
Transmission Fecal-oral Parenteral Parenteral Parenteral Fecal-oral
Prevalence High High Moderate Low, regional Regional
Fulminant Rare Rare Rare Frequent In pregnancy
Disease
Chronic Never Often Often Often Never
Oncogenic No Yes Yes Unknown No
Jawetz, Melnick & Adelberg’s Medical Microbiology, 27th ed.
Viral Exanthems
• Chickenpox (Varicella)
• Measles (Rubeola virus)
• Rubella (Rubella virus)
• Roseola (Herpes virus 6B)
• Erythema infectiosum (parvovirus B19)

Characteristic spread of exanthems (cephalic,

caudal)
Presentation of disease
Transmission
Virus and/or Family of the virus
Rabies
• Rabies
• Rhabdovirus, RNA bullet-shaped virus
• Animal reservoirs:
• Asia: Dog
• Africa: dog; Americas: dog, bat, fox, raccoon; Europe: fox
• Virus-laden saliva or other infectious material from rabid animals
• 99% fatal once symptoms occur
• Bx from brain: Negri body
WHO category of exposure
Post-exposure prophylaxis?
Slow viruses
Protozoans
Parasitology
Lumen-dwelling protozoans G. duodenalis/lamblia/intestinal – major cause of diarrhea
outbreaks from contaminated water supplies.
“Traveler’s diarrhea”.
Troph – pear shaped, symmetrical, four pairs of flagella; falling leaf
Trophozoite: Progressive and directional motility, E. Coli – nonpathogenic motility
amoeboid/fingerlike; ingestion of RBC Cyst – 2 nuc as immature, 4 nuc as mature cysts; ellipsoid; old man
Cyst: 1-4 nuclei, chromatoidal bar with rounded ends Trophozoite sluggish and face
Infective: mature cyst; Dx: cyst and trophozoite nondirectional with short I: cyst which are highly resistant forms unlike the troph
Amoebiasis – intestinal tract flask shaped ulcer; extraintestinal and blunt pseudopodia D: cyst and troph
colonization → liver abscess, anchovy paste
Cysts 1-8 nuclei, splintered
Entamoeba histolytica chromatoidal bars Giardia duodenalis

Entamoeba coli

Smallest intestinal amoeba
Trophozoite with sluggish and
Prominent glycogen vauole
random movement
No cyst stage.
Flagellate and not an amoeba
Rarely ingest rbc but never invades tissues.
Reports of transmission with eggs of
Enterobius vermicularis.

Iodamoeba butschlii Endolimax nana Dientamoeba fragilis

Only ciliate known to parasitize man.

Large and hairy troph (cilia).
Motility: thrown football.
Binucleate: smaller nucleus for
genetics and cell division.
May invade tissues and cause
diarrhea or dysentery Strawberry cervix (colpitis
macularis)
No cyst stage
Balantidium coli
Trichomonas
(Neobalantidium coli
/ Balantoides coli) vaginalis
 Blood and Tissue Protozoa
Cryptosporidium parvum Cyclospora cayetanensis Cystoisospora belli

Crypto – HIV; Cystoisosopora – least common

All: modified AFB → acid fast oocysts
Cryto and Cyclospora are round. Crypto sporulated (infective) and smaller than Cyclospora (4-5um vs 8-10um).
Blood and Tissue Protozoa
Toxoplasma gondii Free-living Amoeba
Naegleria fowleri Primary amebic Freshwater
Sexual reproduction meningoencephalitis exposure; high
occurs in the cat. (PAM) case fatality
Asexual reproduction in
humans and cats.
Different routes of
infection. Acanthamoeba Granulomatous Immunocompr
Tachyzoites: quick
multiplying form for
spp. amebic encephalitis omised
spread and destruction (GAE)
of tissue
bradyzoites: slow
Amebic keratitis Unilateral
developing form, keratitis
formation of tissue cysts

Granulomas
(skin, lungs)
Congenital toxoplasmosis
Stillbirths, chorioretinitis, intracerebral Balamuthia Granulomatous Granulomas
calcifications, psychomotor disturbances, and
hydrocephaly or microcephaly mandrillaris amebic encephalitis (skin, lungs)
1st trim → stillbirth, major CNS anomalies (GAE)
2nd and 3rd trim → less severe neurologic
damage may be delayed until long after birth,
even beyond childhood
Blood and Tissue Protozoa
Trypanosomes
• Trypanosoma brucei
• Trypanosoma brucei rhodesiense
• Trypanosoma brucei gambiense
• Trypanosoma cruzi
Leishmania
Cutaneous/ mucocutaneous/ visceral leishmaniasis
Vector
Infective and diagnostic stages
Clinical manifestations

Common name
Vectors
Infective and diagnostic stages
Clinical manifestations
Diagnosis (characteristic features)
Plasmodium
Which species:
- 48hr intervals (PV, PF, PO), 72 hrs
(PM)
- Associated with cerebral
complications (PF)
- Have dormant forms (hypnozoites)
(PV, PO)
- Characteristic features of
gametocytes, schizonts and
trophozoite

Plasmodium species.
https://www.cdc.gov/dpdx/resources/pdf/benchAids/malaria/
VS Babesia microti – tickborne infection (Ixodes sp) – malaise, anorexia, nausea,
Malaria_Comparison_p1-2.pdf fatigue, fever, sweats, myalgia, arthralgia → symptoms that may mimic falci malaria
Dx: “maltese cross” form in the red cell without pigment or gametocytes
Helminths
Parasitology
Nematodes - STH
Males with incurved tail; adults with three lips at the anterior
end. The fertile eggs further mature in the envt and ingestion of
such become infective to man. Can cause obstruction and even
perforation allowing further migration of the adult worms. In
the lungs, – Loeffler’s pneumonia: cough, infiltrates, eos)
T. Trichura – whipworm; slender anterior portion that
attaches to bowel mucosa.
Eggs: barrel or football shaped, polar plugs (refractile
prominences)
Sever infection – profuse bloody diarrhea, cramps,
tenesmus, urgency and rectal prolapse (edema of the
rectum)
Route of transmission: skin penetration of L3 (filariform
larvae. Eggs are the same.
Ancylostoma: Two pairs of teeth, tripartite dorsal rays in
copulatory bursa
Necator: Cutting plates, bipartite dorsal rays
Both ground itch, eosinophilia, abdominal discomfort
and diarrhea, iron deficiency anemia (blood loss greater
in ancylostoma)

Ascaris lumbricoides Trichuris trichiura Hookworms

Chemoprophylaxis for
soil-transmitted
helminths?

Ancylostoma

americanus
duodenale

Necator
 Nematodes
Pinworms. E. verm. Oxycuris verm.
Strongy much like hookworms, skin penetration. Eggs are seldom
recovered and identification is based on the rhabtidiform larva (D); L3
filariform as infective.
Cuticular alar expansions on the anterior end. iMPORTANt to ID because of its capacity for autoinfection →
Eggs are D shaped or flattened on one side. Fully embryonated when excreted and is hyperinfection leading to severe complications and morbidity for the
highly infective when ingested. patient.
Perianal pruritus (night) → irritability and fatigue from loss of sleep. Eggs are best Parthenogenetic females in the intestines!
recovered early in the morning before bowel movement (scotch tape technique)
Enterobius vermicularis Strongyloides stercoralis

S stercoralis Hookworms
Rhabtidiform larvae Rhabtidiform larvae
- 200-300 x 15-18um - 100-150 x 15-17um
- Buccal cavity short (4um) - Buccal cavity long (15um)
- Esophagus 1/3 of body - Esophagus 1/3 of body
length with two swellings length with two swellings
- Genital primordium large - Genital primordium small
(22um) (7um)
- Anal pore 50um from - Anal pore 80um from
posterior end posterior end

AUTOINFECTION HYPERINFECTION
Nematodes
Lymphatic filariasis Culex, Wuchereria bancrofti, Brugia Acute lymphangitis, lymphadenitis
Anopheles, malayi Hydrocoele, scrotal elephantiasis
Aedes, Tropical pulmonary eosinophilia
Mansonia

Ochocerciasis (“River Blackfly Onchocerva volvulus Subcutaneous nodules

blindness”) (Simulium) Ocular lesions
Dx: skin snips
Loiasis (African eye worm Chrysops fly Loa loa Adults in ocular conjunctivae
disease) Calabar swelling
Mansonellosis Culicoides M. ozzardi, M. perstans, Ms. Eosinophilia
midges streptocerca Often asymptomatic

Guinea worm disease Copepods Dracunculus medinensis Worm as whitish filament emerging from
center of painful ulcer

Paniker’s Textbook of Medical Parasitology, 7thed

Nematodes

Paniker’s Textbook of Medical Parasitology, 7thed

 Cestodes

Taenia saginata
Taeniasis caused by T. saginata (beff tapeworm) T. solium (pork
tapeworm).
It causes mild abdominal symptoms except for T solium which can
cause cysticercosis (cysticerci encyst in skin, muscle, kidney, heart,
liver and brain).
Eggs of the two are indistinguishable
ID through scolex. Solium with rostellum and rostellar hooks
(armed rostellum)
Proglottids. Solium 7-13 primary lateral uterine branches, 12-30 for
saginata

Other cestodes:
Diphyllobothrium latum (broad fish tapeworm) – mild abdominal
symptoms; abnormalities in the absorption of vitamin B12
pernicious anemia
Taenia solium
Hymenolepis nana (dwarf tapeworm) – minor intestinal symptoms
but has the capacity for autoreinfection hyperinfection
Dipylidium caninum (dog tapeworm) – double-pored segments
containing egg clusters. Mostly asymptomatic in humans.
Trematodes
Schistosoma – not hermaphroditic, non-operculated
eggs, cercaria as infective stage.
Rest of trematodes are hermaphroditic, with
operculated eggs and metacercaria as infective stage

Schistosoma spp.

S. mansoni S. Japonicum S. haematobium

(Oriental blood fluke)
Inferior mesenteric Inferior and superior Veins of urinary
veins of the large mesenteric veins of bladder
intestine small intestines
Biomphalaria sp. Oncomelania hupensis Bulinus sp.
quadrasi
“Clay pipestem” fibrosis Katayama fever/ snail Urinary / Female
of Symmers fever genital schistosomiasis
CNS symptoms Lung symptoms
Fasciolopsis - Largest
Echinostoma ilocanum - Oral sucker with collar of spines, single ovary near paired testis. Echinostoma ilocanum, with high
prevalence rates in the country, int host Pila luzonica
Heterophyes - Smallest trematode, large paired testis
Trematodes
Clonorchis - Branches testis.
Opistorchis - Deeply lobed testis. Eggs of both
have prominent opercular shoulders with a small
comma-shaped process at abopercular end. Their Paragonimus westermani
propensity to infect the biliary system can lead to
cholangiocarcinoma or biliary duct carcinoma. Adult worm is large and robust. Eggs are golden brown, flat
Fasciola - Cephalic cone at anterior end. Due to operculum with raised opercular shoulders, thick abopercular
size, light infections can cause signs & symptoms end
of biliary obstruction and cholangitis Maturation in the lungs causes an inflammatory reaction (fever).
Patient may present with increased production of sputum and
even hemoptysis. Severe infections can lead to cerebral
paragonomiasis.

Clonorchis sinensis
Opistorchis spp.
Fasciola hepatica

Fasciolopsis buski
Echinostomes
Heterophyids
Mycology
Superficial Mycoses

Dermatophytes: superficial mycoses because they infect the keratin of skin, hair and
nails. There are three dermatophytes and they are responsible for Tinea (varies on site of
infection): capitis (scalp), cruris (jock itch), pedis (athlete’s foot), unguium
(onychomycosis), manuum (hand,feet combi), barbae (beard), corporis (anywhere except
mentioned)

Malassezia furfur – Tinea/pityriasis versicolor: Superficial skin infection causing

hypopigmented, often scaly lesions.
KOH or LPCB = spaghetti and meatballs
Subcutaneous Mycoses
• Sporothrix
• “rose gardener’s disease”
• Lymphocutaneous tract
Systemic Mycoses
Candida albicans Cryptococcus neoformans

Aspergillus fumigatus
Candida albicans – presentations: oral thrush, fungal cervicitis; invasive
candidiasis: blood, heart, brain, eyes, bones
GS, KOH – budding yeast cells and hyphae

Cryptococcus neoformans – immunocompromised; lung, brain

KOH, India ink stain/Nigrosin (stains the background/negative staining
thereby highlighting the capsule of the yeast cells.

Aspergillus fumigatus – immunocompromised; lung masses

(aspergilloma)
KOH, culture, H&E lung mass with narrow septate hyphae with acute
angle branching; GMS or PAS special stains.
 Endemic Mycoses
• Dimorphic fungi
• Blastomyces dermatitidis
• Coccidioides immitis
• Histoplasma capsulatum
• Paracoccidioides brasiliensis

Salzer, et al. Respiration 208;96:283-301

https://doi.org/10.1159/000489501