Parasitology: Prepared By: Charriz A. Amoyan

PARASITOLOGY
Prepared by:
CHARRIZ A. AMOYAN
INTRODUCTION TO PARASITOLOGY
• Symbiosis – a relationship where unlike organisms exist
together.
• Three types of symbiotic relationships:
• Commensalism – two species live together and one species benefits
from the other without harming or benefiting the other.
• Mutualism – two organisms mutually benefit from each other.
• Parasitism – one party or symbiont (parasite) benefits to the detriment

of the other (host).
• Parasites are classified in several ways:
1. Based on habitat
• Ectoparasites – live outside the host’s body (fleas, lice).
• Invasion of the body by ectoparasites is called infestation.
• Endoparasites – live inside the body of the host (helminths or worms).
• Invasion of the body by endoparasites is called infection.
2. Based on ability to live independently of the host
• Facultative parasites – can live independently of the host (free-living).
• Obligate parasites – must live inside a host (hookworms).
3. Based on mode of living
• Permanent parasites – remain in a host from early life to maturity
(Plasmodium).
• Intermittent parasites – simply visit the host during feeding time (non-
pathogenic parasites).
• Incidental parasites – occur in unusual host (dog tapeworm in
humans).
• Transitory parasites – larva develops in a host while the adult is free-
living (dog tapeworm).
• Erratic parasites – seen in unusual organ, different from that which ot
ordinarily parasitizes (Ascaris lumbricoides in lungs or kidney).
• Hosts – organisms that harbour the parasite and provide
nourishment to the parasite.
• There are four types:
• Definitive hosts – harbour the adult stage of the parasite (humans for
intestinal worm Ascaris) or where the sexual stage or phase of the life
cycle occurs (mosquito of the malarial parasite Plasmodium).
• Intermediate hosts – harbour the larval stage of the parasite (cow for
the larva of beef tapeworm) or where the asexual stage of the life cycle
occurs (humans for the malaria parasite Plasmodium).
• Reservoir hosts – vertebrate hosts that harbour parasite and may act
as additional source of infection in man (migratory birds for Capillaria
philippinensis in contaminated fresh water).
• Paratenic hosts - serve as a means of transport for the parasite
(insect vectors) so that the infective stage of certain parasite may reach
its final host.
Sources of Exposure to Infection or Infestation
• Exposure to parasites may occur through one or more of the

following sources:
• Contaminated soil or water
• Food containing the parasite’s infective stage
• A blood-sucking insect
• A domestic or wild animal harbouring the parasite
• Another person and his/her clothing, bedding or immediate
environment he/she has contaminated
• One’s self (auto-infection).
Modes of Transmission
• Ingestion of contaminated food and water (fecal-oral
transmission) is the most common.
• Penetration of the skin from the soil or contaminated water
• Bite of blood-sucking insect vectors
• Inhalation of eggs
• Transplacental or congenital infection
• Transmammary (mother’s milk) infection
• Sexual intercourse
Portal of Exit
• Most common portal of exit of parasites is through the anus.
• Urine may serve as the portal of exit.
• Others may be excreted with sputum (lung fluke).
• Others may be isolated from vaginal discharge (Trichomonas
vaginalis).
Mechanisms of Disease Production by Parasites
• Pathogenesis – dynamics of any disease process.

• Parasites damage the host through one or more of the
following:
• Trauma or physical damage
• Lytic necrosis
• Stimulation of host tissue reaction
• Toxic and allergic phenomena
• Opening of pathways for entry of other pathogens into the tissues.
General Life Cycle of Parasites
Parasite comes in
contact with humans
Parasites emerge (Mode of
from water, food, soil, Transmission)
or intermediate hosts Parasite enters and
establishes residence
in or on human
Parasite comes in contact (Infective Stage)
with soil or water and
other intermediate hosts
(Source of Infection)
Parasite multiplies and
competes with humans
for nutritional needs
Parasite enters (Pathogenic Stage)
outside environment
Parasite emerges
from humans
(Diagnostic Stage)
Classification of Parasites
Subkingdom
Protozoa
Phylum Phylum Phylum

Sarcomastigophora Ciliophora Apicomplexa
Subphylum Subphylum
Sarcodina Mastigophora
Class Class Class Class

Lobosea Zoomastigophora Kinetofragminphorea Sporozoa
(Amoebas) (Flagellates) (Ciliates)
Classification of Parasites
Subkingdom
Metazoa
Phylum Phylum
Nemathelminthes Platyhelminthes
Class Class Class Class

Nematoda Filariae Cestoda Trematoda
(Roundworms) (Tissue Roundworms) (Tapeworms) (Flukes)
PROTOZOA
Definition of Terms
• Infective Stage – stage of the parasite that enters the host or
the stage that is present in the parasite’s source of infection.
• Pathogenic Stage – stage of the parasite that is responsible for
producing the organ damage in the host leading to the clinical
manifestations.
• Encystation – process by which trophozoites differentiate into
cyst forms.
• Excystation – process by which cysts differentiate into
trophozoite forms.
General Properties of Protozoa
• Kingdom Protozoa consists of single-celled eukaryotic organisms,
spherical to oval or elongated in shape.
• Classification is mainly based on the organ of locomotion utilized.
• Not all protozoa are parasitic.
• Some are facultative parasites capable of a free-living state.
• Majority of protozoa divide by mean of binary fission.
• Sporozoans reproduce both sexual and asexual (merogony or
shizogony) means.
• Most of the parasitic protozoa infections are diagnosed by
demonstrating the motile, feeding, dividing and pathogenic stage
called trophozoites or the dormant, non-motile and infective stage
form called cyst.
Intestinal and Urogenital Protozoa
1. Subphylum Sarcodina: Entamoeba histolytica
• Properties and Life Cycle
• Intestinal and tissue amoeba and is the only known pathogenic
intestinal amoeba.
• Life cycle consists of two stages – the non-motile cyst (infective stage)
and the motile trophozoite (pathogenic stage).
• Epidemiology and Pathogenesis
• More common in tropical countries in areas with poor sanitation
• Transmitted through fecal-oral route
• Water as major source of infection
• Disease: Amoebiasis
1. Acute intestinal amoebiasis
• blood, mucus-containing diarrhea (dysentery) accompanied by lower
abdominal discomfort, flatulence (release of gas), and tenesmus
(feeling of incomplete defecation).
• Chronic infection may occur, with symptoms such as occasional
diarrhea, weight loss, and fatigue.
• Lesion called amoeboma may form in the cecum or in the rectosigmoid
area of the colon, may be mistaken for a malignant tumor in the colon.
2. Extraintestinal amoebiasis
• Parasite enters the circulatory system.
• Common form is the amoebic liver abscess.
• Characterized by right upper quadrant pain, weight loss, fever, and a
tender, enlarged liver.
• Abscess on the right lobe of the liver may penetrate the diaphragm and
cause amoebic pneumonitis.
• Other organs may become infected included the pericardium, spleen,
skin, and brain (meningoencephalitis).
3. Asymptomatic carrier state
• Occurs under the following conditions:
• If the parasite involved is a low-virulence strain;
• If the parasite load is low;
• If the patient’s immune system is intact.
• Laboratory Diagnosis
• Finding trophozoites in diarrheic stool or cysts in formed stools.
• Stool specimen should be examined within one hour of collection to
see the motility of the trophozoites.
• Serologic testing for the diagnosis of invasive amoebiasis.
• Treatment
• Metronidazole is the drug of choice.
• Alternative drug is tinidazole
• Asymptomatic carriers treated with diloxanide furoate, metronidazole,
or paromomycin.
• Surgical drainage of amoebic liver abscess may be necessary.
• Prevention and Control
• Observance of good personal hygiene.
• Proper handwashing, especially food handlers.
• Proper waste disposal to avoid fecal contamination of water sources.
• The use of “night soil” (human feces) for fertilization of crops must be
avoided.
• Adequate washing and cooking of vegetables should be observed.
2. Subphylum Mastigophora: Giardia lamblia (Giardia intestinalis)
• Exists in a cyst form and a trophozoite form.
• Trophozoite is pear-shaped or teardrop-shaped with four pairs of
flagella and has motility likened to a fallen leaf.
• Trophozoite has been described as resembling an old man with
whiskers (“old man facies”).
• Cyst is typically oval and thick-walled with four nuclei.
• It divides through binary fission.
• Each cyst gives rise to two trophozoites during excystation in the
intestinal tract.
Oval-shaped cyst Trophozoite with four pairs of flagella
• Worldwide distribution through contaminated water sources.
• 50% individuals do not present symptoms and serve as carriers.
• Other mammals may act as reservoir.
• Common among individual engaging oral-anal contact.
• High incidence in day care centers and patients in mental hospitals.
Life Cycle of Giardia lamblia
• Disease: Giardiasis
1. Asymptomatic carrier state
• Infected individual unknowingly passes out the parasite with the feces which
can contaminate water.
2. Giardiasis (Traveler’s diarrhea)
• Characterized by non-bloody, foul-smelling accompanied by nausea, loss of
appetite, flatulence, and abdominal cramps.
• Symptoms may persist for weeks or months.
• Malabsorption of fat lead to the presence of fat in stool (steatorrhea).
• Patients are usually afebrile.
• Relapses may occur, especially in patients with IgA deficiency.
• Made by demonstration of cyst or trophozoite (or both) in diarrheic stools.
• Only cysts are isolated from the stools of asymptomatic carriers.
• If microscopic examination is negative, string test may be performed.
• Treatment
• Metronidazole, tinidazole, and nitazoxanide
• Proper waste disposal to avoid fecal contamination of water supplies.
• Drinking water should be boiled, filtered, or iodine-treated.
• Proper handwashing
2. Subphylum Mastigophora: Trichomonas vaginalis
• Pear-shaped organism with a central nucleus, four anterior flagella, and an
undulating membrane.
• Exists only in the trophozoite form (infective and pathogenic).
• Causes urogenital infection and transmitted through sexual intercourse.
• Isolated from the urethra and vagina of infected women as well as the
urethra and prostate gland of infected men.
• Highest among sexually-active women in their thirties and lowest in post-
menopausal women.
• Occasionally, may be transmitted through toilet articles and clothing of
infected individuals.
• Infants may be infected as they pass through the infected birth canal during
delivery.
Trophozoite of Trichomonas vaginalis Life Cycle of Trichomonas vaginalis
• Disease: Trichomoniasis
• Infection in men
• Asymptomatic and men serve as the reservoir for infection in women.
• In men with develop symptoms, manifestations are related to
development of prostatitis (inflammation of prostate), urethritis (manifest
as discharge), and other urinary tract involvement.
• Persistent urethritis is the common symptoms.
• Infection in women
• Also asymptomatic, some women may present with scant, watery
vaginal discharge.
• Infection in women
• Also asymptomatic, some women may present with scant, watery
vaginal discharge.
• In severe cases, discharge may be foul-smelling and greenish-yellow in
color.
• Accompanied by itching (pruritus) and a burning sensation in the
vagina.
• Cervix appears very red, with small punctuate haemorrhage, giving rise
to a strawberry cervix.
• Other common symptoms include dysuria and increased frequency of
urination.
• Infection in infants
• Infected infants may manifest conjunctivitis or respiratory infection.
• Finding of the characteristic trophozoite in a wet mount of vaginal or prostatic
secretions, urine, and urethral discharges.
• Treatment
• Metronidazole
• Practice safe sex
• Use of condoms
• Health and sex education
• Maintenance of the acidic pH of vagina
3. Phylum Ciliophora: Balantidium coli
• Has a primitive mouth called a cytostome, a nucleus, food vacuoles,
and a pair of contractile vacuoles.
• Largest protozoan to infect humans.
• Trophozoites exhibit a rotary, boring motility (cilia) and contain two
nuclei (micronucleus adjacent to a kidney bean-shaped macronucleus).
• Cyst also contains two nuclei.
Balantidium coli trophozoite
• Most common reservoir is the pig.
• Monkeys may occasionally act as reservoirs.
• Main source of infection is water contaminated by pig feces and
transmitted through fecal-oral route.
• Person-to-person transmission via food handlers
Life Cycle of Balantidium coli
• Disease: Balantidiasis
• Most infected are asymptomatic.
• A dysenteric type of diarrhea in patients with high parasite load.
• Acute infections may manifest with liquid stools containing pus, blood,
and mucus.
• Chronic infections may manifest with a tender colon, anemia, wasting
(cachexia), and alternating diarrhea and constipation.
• Extraintestinal infection is rare and may involve the liver, lungs,
mesenteric nodes, and urogenital tract.
• Finding trophozoites and cysts in the stool specimen.
• Parasite can be readily detected in fresh, wet microscopic preparations.
• Treatment
• Oxytetracycline and iodoquinol
• Metronidazole may be used as an alternative
• Maintenance of sanitary hygiene, proper disposal of pig feces, and
boiling of drinking water.
Blood and Tissue Protozoa
1. Subphylum Sarcodina: Acanthamoeba (Free-living Amoeba)
• Acanthamoeba causes infection in immunocompromised patients.
• Free-living amoeba that causes the inflammation of the brain substance
and its meningeal coverings (meningoencephalitis).
• Found widely in soil, contaminated freshwater lakes, and other water
environment.
• Able to survive in cold water.
• Infective stage is the cyst while the pathogenic stage is the trophozoite.
• Acquired in two ways – through aspiration or nasal inhalation or through
direct invasion in the eye.
• Acquire usually while swimming in contaminated water.
• Also inhalation of the cysts from dust.
• Trophozoites enter the lower respiratory tract or through ulcers in the
mucosa or skin.
• Parasite then migrates through the bloodstream and invade the CNS.
• Eye infection occurs in patients who wear contact lenses.
• Tap water contaminated with the parasite is the source of infection for
contact lens users.
• Disease
• Granulomatous amoebic encephalitis
• Occurs primarily in immunocompromised individuals.
• Parasite produces a granulomatous amoebic encephalitis and brain abscesses.
• Symptoms develop slowly which include headache, seizures, stiff neck, and
vomiting.
• In rare cases, parasite may spread and produce granulomatous lesions in the
kidneys, pancreas, prostrate, and uterus.
• Keratitis
• Infection of the cornea of the eye.
• Symptoms include severe eye pain and vision problems.
• Loss of vision may occur due to perforation of the cornea.
• Finding of both trophozoite and cysts in the cerebrospinal fluid as well
as the brain tissue and corneal scrapings.
• Histologic examination of corneal scrapings.
• Calcofluor white, a stain used to demonstrate parasite in corneal
scrapings.
• Treatment
• Pentamidine, Ketoconazole, or Flucytosine
• For eye and skin involvement, topical miconazole, chlorhexidine,
itraconazole, ketoconazole, rifampicin, or propamidine
• Adequate boiling of water.
• Regular disinfection of contact lenses.
• Contact lens wearers are advised to avoid using homemade non-sterile
saline solutions.
1. Subphylum Sarcodina: Naegleria
• Also classified as free-living protozoan.
• Also found worldwide in soil and contaminated water environment.
• Can survive in thermal spring water.
• Known pathogen is Naegleria fowleri, only amoeba with three morphologic
forms – trophozoite, flagellate, and cyst forms.
• Trophozoite exhibits the typical amoeboid motility described as “slug-like”.
• Flagellate form is pear-shaped and equipped with two flagella responsible for
the jerky or spinning movement.
• Non-motile form is the cyst.
• Amoeboid trophozoite form is the only form known to exist in humans.
• Acquired transnasally when swimming in contaminated water.
• Parasite penetrates the nasal mucosa and cribriform plate, enters the CNS,
and produces a rapidly fatal meningitis and encephalitis.
• Parasite produces infection in healthy individuals, usually children.
• May also be acquired through inhalation of dust containing the parasite.
• Disease
• Asymptomatic infection
• Most common clinical presentation in patients with colonization of the nasal
passages.
• Primary amoebic meningoencephalitis (PAM)
• Result of colonization of the brain by the amoeboid trophozoites leading to rapid
tissue destruction.
• Patients initially complain of sore throat, nausea, vomiting, fever, and headache.
• Usually develop signs of meningeal irritation (Kernig’s sign) as well as alteration in
senses of smell and taste.
• If untreated, patients may die within one week after onset of symptoms.
• Finding of the amoeboid trophozoites in the cerebrospinal fluid.
• Treatment
• Treatment is ineffective because of its rapidly fatal course.
• Some recover due to early detection and initiation of treatment.
• Treatment of choice is amphotericin B in combination with miconazole
and rifampicin.
• Prevention of contamination water sources.
• Adequate chlorination of swimming pools and hot tubs.
1. Subphylum Mastigophora: Hemoflagellates Leishmania spp.
• Life cycle involves a vector, the female sandfly of the Phlebotomus and
Lutzomyia genera.
• Obligate intracellular parasites.
• Has three morphologic forms – amastigote, promastigote, and epimastigote.
• Infective stage is promastigote and seen only if a blood sample is collected
and examined immediately after transmission.
• Epimastiogtes are found primarily in the vector.
• Amastigote is the pathogenic and diagnostic stage found primarily in tissue
and muscle, as well as the CNS within the macrophages and in cells of the
reticuloendothelial system.
• Amastigote is round to oval in shape and contains a nucleus, a basal
body structure called s blepharoblast, and a small parabasal body
located adjacent to the blepharoblast.
• Blepharoblast and parabasal body are collectively known as the
kinetoplast.
• Promastigote is long and slender, with a kinetoplast in its anterior end,
and a single free flagellum extending from the anterior portion.
Amastigote Promastigote
• Natural reservoirs include rodents, ant eaters, dogs, and cats.
• Transmitted in a human-vector-human cycle.
• Three major strains differ in the tissue affected and the resulting clinical
manifestations: Leishmania donovani (visceral leishmaniasis), Leishmania
tropica (cutaneous leishmaniasis), and Leishmania braziliensis
(mucocutaneous leishmaniasis).
Life Cycle of Leishmania spp.
A. Leishmania donovani complex
• Causative agent of visceral leishmaniasis (also known as kala-azar or
dumdum fever).
• The complex consists:
1. L. donovani chagasi mainly seen in Central America is transmitted by the
Lutzomyia sandfly
2. L. donovani donovani found in parts of Africa and Asia is transmitted by the
Phlebotomus sandfly
3. L. donovani infantum, also transmitted by the Phlebotomus sandfly and is found
in Mediterranean Europe, Near East, and Africa.
• Disease: Visceral Leishmaniasis (Kala-azar, Dumdum Fever)
• After incubation period of 2 weeks to 18 months, disease begins with
intermittent fever, weakness, and weight loss.
• Massive enlagement of spleen (splenomegaly) leading to
hypersplenism and resulting anemia.
• Hepatomegaly or enlargement of the liver also occurs.
• In light-skinned patients, hyperpigmentation of the skin may be seen
(kala-azar means “black sickness” or “black fever”)
• Disease: Visceral Leishmaniasis (Kala-azar, Dumdum Fever)
• Leads to bone marrow destruction causing anemia, bleeding due to
thrombocytopenia, and increased secondary infection (leukopenia).
• Glomerulonephritis or inflammation of the glomeruli of kidney may
occur.
• Fatal if untreated.
• Screening test is called the Montenegro skin test similar to the
tuberculin skin test for the diagnosis of tuberculosis.
• Definitive diagnosis is done by demonstration of the amastigote from
Giemsa stained slides of specimen from blood, bone marrow, lymph
nodes, and biopsies of infected areas.
• Culture of blood, bone marrow, and other tissues may also be done
which will show the promastigote forms.
• Serologic tests such as indirect fluorescent antibody (IFA), enzyme-
linked immunosorbent assay (ELISA), or direct agglutination test (DAT).
• Treatment
• Drug of choice is liposomal amphotericin B (Ambisome).
• Sodium stibogluconate also been found to be effective but the
development of resistance may occur.
• Other patients shown favourable responses to gamma interferon in
combination with pentavalent antimony.
• Control of the vector population.
• Use of insect repellents, protective clothing, and installation of screens.
• Prompt treatment of infected humans help halt the spread of disease.
B. Leishmania braziliensis complex
• Causative agent of mucocutaneous leishmaniasis involves skin,
cartilage, and mucous membranes.
• Occurs most commonly in Brazil and Central America, primarily in
construction and forestry workers.
• Complex consists of L. panamensis (Panama and Colombia), L.
peruviana (Peruvian Andes), and L. guyanensis (The Guianas, parts of
Brazil and Venezuela).
• Transmitted by sandflies (Lutzomyia and Psychodopigus).
• Disease: Mucocutaneous Leishmaniasis
• Also called espundia, begins with papule at the site of insect bite, then
forms metastatic lesions, usually at the mucocutaneous junction of the
nose and mouth.
• Disfiguring granulomatous, ulcerating lesions destroy the nasal cartilage
(tapir nose) but not the adjacent bone.
• Death can occur from secondary infections.
• Diagnosis
• Ulcer biopsy specimen
• Microscopic examination of Giemsa-stained ulcer biopsy
• Culture of infected material
• Serologic testing
• Treatment
• Sodium stibogluconate is widely used.
• Alternative drugs include liposomal Amphotericin B and oral antifungal
drugs (fluconazole, ketoconazole, and itraconazole).
• Control of the insect vector.
• Protect individuals from sandfly bites by using netting, window screens,
protective clothing, and insect repellents.
• Prompt treatment also help prevent spread of the disease.
C. Leishmania tropica complex
• Complex consists of L. tropica, L. aethiopica, and L. major.
• Causative agents of what is referred to as Old World cutaneous
leishmaniasis.
• All three members of the complex are transmitted by the Phlebotomus
sandfly and attacks the lymphoid tissue of the skin.
• Disease: Old World Cutaneous Leishmaniasis
• Also known as oriental sore, and Baghdad or Delhi boil.
• Characterized by one or several pus-containing ulcers that may heal
spontaneously.
• Initial lesion is a small, pruritic red papule at the bite site.
• In patients with anergy and hypersensitivity responses, spontaneous
healing does not occur.
• Thick skin plaques with multiple nodules may develop, especially on the
limbs and face.
• Diagnosis
• Microscopic examination of Giemsa-stained slides of fluid aspirated from
beneath the ulcer bed.
• Microscopic examination and culture of specimen.
• Serologic tests
• Treatment
• Drug of choice is sodium stibogluconate.
• Steroids with application of heat to infected lesions.
• Alternative drugs are meglumine antimonite, pentamidine, and oral
ketoconazole.
• Paromomycin ointment heal ulcers.
• Unlike other Leishmania, a vaccine has been developed against L.
tropica which is currently undergoing clinical trials.
Cutaneous leishmaniasis Mucocutaneous leishmaniasis Visceral leishmaniasis
1. Subphylum Mastigophora: Hemoflagellates Trypanosoma spp.
• Amastigote for Leishmania, trypomastigote for the trypanosomes.
• Trypomastigotes are curved, assuming the shape of letters C, S, or U.
• Unlike Leishmania, the kinetoplast of the trypomastigote is posteriorly located,
with the single large nucleus located anterior to it.
• Trypomastigotes are visible in the peripheral blood.
• Trypanosoma cruzi
• Found primarily in South and Central America, transmitted by the bite of
the reduviid or triatomid bug (Triatoma or “cone-nose” bug or “kissing
bug”).
• Transferred to a human host when the feces of the bug containing the
infective trypomastigotes deposited near the bite site.
• Other routes of transmission include blood transfusion, sexual
intercourse, transplacental transmission, and the mucous membranes
when the bite site is near the eye or mouth.
• Humans and animals serve as the reservoir hosts.
• Disease: Chagas Disease (American Trypanosomiasis)
• Acute phase begins with a nodule (chagoma) near the bite site and
unilateral swelling of the eyelid with conjunctivitis (Romana’s sign).
• Eyelid swelling due to the bug feces accidentally rubbed into the eye.
• Accompanied by fever, chills, malaise, myalgia, and fatigue.
• Patients may recover or may enter the chronic phase.
• Hepatosplenomegaly, enlargement of lymph nodes (lymphadenopathy),
and myocarditis with cardiac arrhythmia characterize the chronic phase.
• Disease: Chagas Disease (American Trypanosomiasis)
• Loss of tone of colon and esophagus due to destruction of Auerbach’s
plexus lead to abnormal dilation of theses organs called megacolon,
and megaesophagus.
• CNS involvement my be seen in the form of meningoencephalitis and
cysts.
• Death may occur due to cardiac failure and arrhythmias.
Chagoma on the lower lip Reduviid bug Romana’s sign
• Acute disease is diagnosed by finding trypomastigotes in thick or thin
films of the patient’s blood.
• Bone marrow aspiration, muscle biopsy, culture on special medium, and
xenodiagnosis.
• Both serologic test and xenodiagnoses are useful in the chronic form of
the disease.
• Treatment
• Drugs of choice are benznidazole, and nifurtimox but less effective
during chronic phase.
• Alternative agents are allopurinol and ketoconazole.
• Protection from the bite of the reduviid bug, improvement of housing
conditions, and insect control.
• Education regarding the disease and its transmission is also helpful.
• Trypanosoma brucei gambiense and Trypanosoma brucei rhodesiense
• Their life cycle involves the tsetse fly (Glossina) as the vector.
• Humans are the reservoir for T. brucei gambiense, while domestic
animals (cattle) and wild animals for T. brucei rhodesiense.
• Infective and pathogenic stage is the trypomastigote.
• T. gambiense infection (West African or Gambian Sleeping Sickness) is
chronic while T. rhodesiense infection (East African or Rhodesian
Sleeping Sickness) is more rapidly fatal.
• Disease: African Sleeping Sickness
• Initial lesion is an undurated ulcer called chancre at the site of the insect
bite.
• Intermittent weekly fever and lymphadenopathy develop.
• Enlargement of the posterior cervical lymph nodes (Winterbottom’s sign)
is commonly seen.
• Red rash accompanied by pruritus, localized edema, and a delayed
pain sensation (Kerendel’s sign).
• Encephalitis is characterized by headache, insomnia, and mood
changes.
• Disease: African Sleeping Sickness
• Muscle tremors, slurred speech, and apathy follow, progressing to
somnolence (sleeping sickness) and coma.
• Untreated disease is fatal.
• T. brucei rhodesiense is more virulent than T. brucei gambiense.
• Death is seen usually within 9-12 months following infection in untreated
patients and may be due to glomerulonephritis and myocarditis.
• Microscopic examination of Giemsa-stained slides of the blood, lymph
node aspirations and CSF will reveal the trypomastigotes during the
early stages of the disease.
• Aspiration of the chancre or enlarged lymph nodes
• Isolated from CSF of patients with CNS involvement
• Serologic tests – detection of IgM and proteins in the CSF
• Treatment
• Melarsoprol, suramin, pentamidine, and eflornithine
• Protection against the bite of the fly.
• Use of netting and protective clothing.
• Use of fly traps and insecticides.
• Clearing the forest around the villages.
1. Phylum Apicomplexa: Plasmodium spp.
• Malaria is caused by five plasmodia species: Plasmodium vivax, Plasmodium
malariae, Plasmodium ovale, Plasmodium knowlesi, and Plasmodium
falciparum.
• The vector and definitive host is the female Anopheles mosquito.
• Sexual cycle (sporogony) occurs in mosquitoes, and the asexual cycle
(schizogony) occurs in humans (intermediate hosts).
• Infective stage is sporozoite from saliva of biting mosquito, taken up by liver
cells.
• Exoerythrocytic phase – multiplication and differentiation of sporozoites into
merozoites.
• P. vivax and P. ovale produce a latent form (hypnozoite or sleeping form),
causes relaps.
Comparison of morphological forms of the different Plasmodium species
• Occurs primarily in tropical and subtropical areas (Asia, Africa, and Central
and South America).
• Primary vector of P. falciparum and P. vivax is Anopheles flavirostris, breeds in
clear, slow-flowing streams near foot hills and forests.
• Mode of transmission of malaria is the bite of female mosquito vector.
• Also be transmitted through blood transfusion (transfusion malaria),
intravenous drug abuse with sharing of IV needles (“main-line malaria”), and
transplacental transmission (congenital malaria).
• P. falciparum and P. knowlesi infect both young and old RBC’s leading to high
level of parasitemia.
• P. vivax and P. ovale infects young RBC’S while P. malariae infects old RBC’s.
• Disease: Malaria
• Paroxysms are divided into three stages: cold stage, hot stage, and the
sweating stage.
• Malarial paroxysm presents with abrupt onset of chills (rigors) accompanied by
headache, muscle pain (myalgia), and joints pains (arthralgia) which lasts for
approximately 10-15 minutes or longer.
• Spiking fever lasting 2-6 hours follows, reaching up to 41°C, accompanied by
shaking chills, nausea, vomiting, abdominal pain, then followed by drenching
sweats.
• Patients usually feel well between febrile episodes.
• Splenomegaly is often present and anemia is prominent.
• Disease: Malaria
• The timing of fever cycle is 72 hours for P. malariae, in which symptoms recur
every 4th day (quartan malaria).
• P. vivax, P. ovale, and P. falciparum recur every 3rd day (tertian malaria).
• P. falciparum causes malignant tertian malaria causes severe infection
potentially life-threatening due to extensive brain (cerebral malaria) and kidney
damage.
• Dark color of patient’s urine is due to kidney damage giving rise to term “black
water fever”.
• P. vivax and P. ovale cause benign tertian malaria characterized by relapses
occur up to several years after initial illness.
• P. knowlesi severity is due to high parasitemia levels which infect all stages of
RBC’s and its 24-hour erythrocyte cycle (quotidian malaria).
• Based on examination of Giemsa-stained or Wirhgt-stained thick and thin smears of
the blood.
• Thick blood smears used for screening purposes while the thin blood smears used to
differentiate various Plasmodium species.
• Best time to take blood films is midway between paroxysms of chills and fevers or
before the onset of fever.
• Treatment
• Drug of choice for acute malaria infection are chloroquine or parenteral quinine.
• For vivax and ovale malaria, primaquine is given to destroy hypnozoites.
• For chloroquine-resistant strains of P. falciparum, mefloquine +artesunate,
arthemeterlumafantrine, atovaquone-proguanil, quinine, quinidine, pyrimethamine-
sulfadoxine, and doxycycline.
• Chemoprophylaxis of malaria for travellers to endemic areas consists of
mefloquine or doxycycline.
• Avoidance of the bite of the vector through the use of mosquito netting,
window screens, protective clothing, and insect repellents.
• Protection is important during the night.
• Reduction of mosquito population is also helpful, including the use of
insecticide sprays, as well as the drainage of stagnant water and ditches.
2. Phylum Apicomplexa: Toxoplasma gondii
• Definitive host is the domestic cat or other felines while humans and other
mammals serve as the intermediate hosts.
• Humans ingest oocyst (infective form) in undercooked meat or from contact
with cat feces.
• Oocysts rupture into trophozoites (tachyzoites or bradyzoites)
Tachyzoite Bradyzoite
Life Cycle of Toxoplasma gondii
• Infection is usually sporadic but outbreaks associated with ingestion of raw
meat or contaminated water can occur.
• Immunocompromised are more likely to develop severe disease.
• Parasite can be transmitted in two ways: ingestion of improperly cooked meat
of animals (intermediate hosts) and ingestion of oocyst from contaminated
water.
• Transplacental transmission may occur.
• Sharing of IV needles as well as blood transfusion
• Disease: Toxoplasmosis
• Infection in immunocompetent individuals
• Usually asymptomatic.
• Chills, fever, headache, and fatigue accompanied by inflammation of lymph nodes
(lymphadenitis).
• Chronic infection may manifest with lymphadenitis, hepatitis, myocarditis, and
encephalomyelitis.
• Chorioretinitis leading to blindness may occur.
• Congenital infection
• Occurs in infants born to mothers who were infected during pregnancy.
• Infection during the trimester of pregnancy may result to miscarriage, stillbirth, or severe
infection (encephalitis, microcephaly, hydrocephalus, mental retardation, pneumonia).
• Infection in immunocompromised hosts
• Manifest with neurologic symptoms similar to patients with diffuse
encephalopathy, meningoencephalitis, or brain tumors.
• Other sites of infection include the lungs, eye, and testes.
• Immunofluorescence assay
• Microscopic examination of Giemsa-stained preparations
• Prenatal diagnosis through ultrasonography and amniocentesis
with PCR analysis of the amniotic fluid.
• Treatment
• For immunocompromised, especially with AIDS, initial high-dose
pyrimethamine plus sulfadiazine given for and indefinite period.
• Alternative regimen for those who develop symptoms of drug toxicity is
clindamycin plus pyrimethamine.
• For pregnant women, clindamycin or spiramycin.
• Adequate cooking of meat.
• Pregnant women should refrain from eating undercooked meat and should
avoid contact with cats and refrain from handling litter boxes.
• Cats should not be fed raw meat.

Parasitology: Prepared By: Charriz A. Amoyan

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Parasitology: Prepared By: Charriz A. Amoyan

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PARASITOLOGY

• Mutualism – two organisms mutually benefit from each other.

• Parasitism – one party or symbiont (parasite) benefits to the detriment

• Exposure to parasites may occur through one or more of the

• Pathogenesis – dynamics of any disease process.

Phylum Phylum Phylum

Class Class Class Class

Class Class Class Class

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