ASIAN DEVELOPENT FOUNDATION COLLEGE

BLISS SAGKAHAN, TACLOBAN CITY, LEYTE

Worksheet on
Research
PARASITIOLOGY

Submitted by:

HEIDEE B. HILVANO
BSN 1B

Submitted to:
 MR. FILIPE SIA
INSTRUCTOR

DISEASE CAUSED
BY PARASITIC
INFECTION

PARASITIC INFECTIONS

I. ASCARIASIS – Ascaris lumbricoides

II. AMOEBIASIS – Entamoeba histolytica

III. SCHISTOSOMIASIS – Schistosomiasis japonicum

IV. ENTEROBIASIS or OXYURIASIS – Enterobius vermicularis

V. TRICHOMONIASIS – Trichomonas vaginalis

 I.ASCARIASIS
Ascaris lumbricoides

Signs and Symptoms…

 Vague abdominal pain
 Nausea
 Vomiting
 Diarrhea or bloody stools.

Causative Agent
Ascaris lumbricoides
Ascariasis is caused by the intestinal nematode
Ascaris
lumbricoides belonging to a class of parasites often referred
to as “soil-transmitted helminths”.
Transmission
Ascaris lives in the intestine
and Ascaris eggs are passed in
the feces of infected persons. If
the infected person defecates
outside (near bushes, in a
garden, or field), or if the feces
of an infected person are used
as fertilizer, then eggs are
deposited on the soil.

Pathogenesis
The pathogenesis of ascariasis is generally related to organ damage
and host reactions to larval migration as well as the number and location
of adult worm in the body. Ascaris larvae migrating through the intestinal
mucosa, liver and lungs provoke hypersensitivity reaction in the human
host.

Diagnosis
Health care providers can diagnose ascariasis by taking a stool
sample and using a microscope to look for the presence of eggs. Some
people notice infection when a worm is passed in their stool or is coughed
up. If this happens, bring in the worm specimen to your health care
provider for diagnosis.
Prevention
Avoid contact with soil that may
be contaminated with human feces,
including with human fecal matter
(“night soil”) used to fertilize crops.
Wash your hands with soap and warm
water before handling food. Teach
children the importance of washing
hands to prevent infection.

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.

Prognosis
Studies from Asia and Africa reveal that single-dose treatment with
albendazole results in cure rates of over 95% with a gradual reduction in
eggs over the next few weeks in 995 of cases.
 However, patient relocation is vital to prevent a recurrence. There
is also a great need to improve basic sanitation and provide clean drinking
water in these areas.
Many communities are now being targeted for improvement in
socioeconomics to help reduce the burden of ascariasis.
Avoiding contact with manure, wearing proper shoes, and
education are vital in preventing ascariasis.

Epidemiology
Ascariasis is one of the most common human parasitic infections.
It is found worldwide. Ascariasis has been a disease that has affected the
world population for centuries. It was described in ancient Egyptian
papyruses and has been identified in Egyptian mummies from around 800
B.C. Even Hippocrates and Aristotle described the helminth. This disease
has been described in children and adults in tropical and subtropical areas
with poor sanitation and poor personal hygiene and in places where
human feces are used as fertilizer. There is a higher risk of infection in
nonendemic areas due to the increased rate of migration and travel.
 II.AMOEBIASIS
Entamoeba Histolytica

Signs and Symptoms…

 nausea (a feeling of sickness in the stomach)
 diarrhea (loose stool/poop)
 weight loss
 stomach tenderness
 occasional fever
 liver abscess (a collection of pus).

Causative Agent
Entamoeba Histolytica
Amebiasis is a disease caused by the parasite
Entamoeba histolytica. It can affect anyone, although it is
more common in people who live in tropical areas with poor
sanitary conditions.
Transmission
Infection begins when cysts
are swallowed. The cysts hatch,
releasing trophozoites that multiply
and can cause ulcers in the lining
of the intestine. Occasionally, they
spread to the liver or other parts of
the body. Some trophozoites
become cysts, which are excreted
in stool (feces) along with
trophozoites. Outside the body, the
fragile trophozoites die. However,
the hardy cysts can survive.

Cysts can be spread directly

from person to person or indirectly
through food or water. Amebiasis
can also be spread through oral-
anal sex.

Pathogenesis
The pathogenesis of ascariasis is generally related to organ damage
and host reactions to larval migration as well as the number and location
of adult worm in the body. Ascaris larvae migrating through the intestinal
mucosa, liver and lungs provoke hypersensitivity reaction in the human
host.

Diagnosis
 Stool tests
 Sometimes blood tests to detect antibodies to the amebas
 Sometimes examination of a tissue sample from the large intestine

To diagnose amebiasis, a doctor collects stool samples for analysis.

The best approach is to test the stool for a protein released by the amebas
(antigen testing) or to use the polymerase chain reaction (PCR) technique
to check the stool for the ameba's genetic material. The PCR technique
 produces many copies of the ameba's genetic material and thus makes the
ameba easier to identify. These tests
are more useful than microscopic
examination of stool samples, which is
often inconclusive. Also, microscopic
examination may require three to six stool
samples to find the amebas, and even
when they are seen, Entamoeba histolytica
cannot be distinguished from some other
related amebas. For example, Entamoeba
dispar, which looks the same but is
genetically different, does not cause
disease.

A flexible viewing tube (endoscope) may be used to look inside the

large intestine. If ulcers or other signs of infection are found there, the
endoscope is used to obtain a sample of fluid or tissue from the abnormal
area.

When amebas spread to sites outside the intestine (such as the

liver), they may no longer be present in the stool. Ultrasonography,
computed tomography (CT), or magnetic resonance imaging (MRI) can
be done to confirm an abscess in the liver, but these tests do not indicate
the cause. Blood tests are then done to check for antibodies to the
amebas. (Antibodies are proteins produced by the immune system to help
defend the body against a particular attack, including that by parasites.)
Or, if doctors suspect that a liver abscess is due to amebas, they may start
a drug that kills amebas (an amebicide). If the person improves, the
diagnosis is probably amebiasis.

Prevention
Preventing food and water from being contaminated with human
feces is key to preventing amebiasis. Improving sanitation systems in
areas where the infection is common can help.
When traveling to areas where the infection is common, people
should avoid eating uncooked foods, including salads and vegetables, and
should avoid consuming potentially contaminated water and ice. Boiling
water kills cysts. Hand washing with soap and water is important.
 Filtering water through a 0.1 or 0.4 micron filter can remove Entamoeba
histolytica and other parasites, as well as bacteria that cause diseases.
Dissolving iodine or chlorine in the water may help. However, the
effectiveness of iodine or chlorine against Entamoeba histolytica depends
on many factors, such as on how cloudy or muddy the water is (turbidity)
and what its temperature is.

Treatment

The primary therapy for symptomatic amebiasis requires hydration

and the use of metronidazole and/or tinidazole. These two agents are
dosed as follows:
 Metronidazole dosing for adults is 500 mg orally every 6 to 8 hours for 7
to 14 days.
 Tinidazole adult dosing is 2 g orally each day for 3 days.
Luminal agents such as paromomycin and diloxanide furoate are
also used. An amoebic liver abscess can be managed by aspiration using
CT guidance in combination with metronidazole. Surgery is sometimes
required to treat massive gastrointestinal bleeding, toxic megacolon,
perforated colon, or liver abscesses not amenable to percutaneous
drainage.

Prognosis
If left untreated, amoebic infections have very high morbidity and
mortality. In fact, mortality is second only to malaria. Amoebic infections
tend to be most severe in the following populations:
 Pregnant women
 Postpartum women
 Neonates
 Malnourished individuals
 Individuals who are on corticosteroids
 Individuals with malignancies
When the condition is treated, the prognosis is good, but recurrent
infections are common in some parts of the world. The mortality rates
after treatment are less than 1%. However, amoebic liver abscesses may
be complicated by an intraperitoneal rupture in 5% to 10% of cases,
potentially increasing the mortality rate. Amoebic pericarditis and
pulmonary amebiasis have a high mortality rate exceeding 20%.
Today with effective treatment, mortality rates are less than 1% in
patients with uncomplicated disease. However, rupture of an infected
amebic liver abscess carries a high mortality.

Epidemiology
Amebiasis occurs worldwide but is predominantly seen in
developing countries due to decreased sanitation and increased fecal
contamination of water supplies. Globally, approximately 50 million
people contract the infection, with over 100000 deaths due to amebiasis
reported annually. The principal source of infection is ingestion of water
or food contaminated by feces containing E. histolytica cysts. Hence,
travelers to developing countries can acquire amebiasis when visiting the
endemic region. Those who are institutionalized or immunocompromised
are also at risk. The organism E. histolytica is viable for prolonged
periods in the cystic form in the environment. It can also be acquired after
direct inoculation of the rectum, from anal or oral sex, or from equipment
used for colonic irrigation. Despite the global public health burden, there
are no vaccines or prophylactic medications to prevent amebiasis.
 III.SCHISTOSOMIASIS
Schistosomiasis Japonicum

Signs and Symptoms…

 a high temperature (fever)
 an itchy, red, blotchy and raised rash.
 a cough.
 diarrhoea.
 muscle and joint pain.
 tummy pain.
 a general sense of feeling unwell.

Causative Agent
Schistosomiasis Japonicum
Schistosomiasis (Bilharziasis) is caused by some
species of blood trematodes (flukes) in the genus
 Schistosoma. The three main species infecting humans are
Schistosoma haematobium, S. japonicum, and S. mansoni.

Transmission
People become infected when larval forms of the parasite –
released by freshwater snails – penetrate the skin during contact with
infested water. Transmission occurs when people suffering from
schistosomiasis contaminate freshwater sources with their excreta
containing parasite eggs, which hatch in water.

Pathogenesis
Schistosomiasis (or bilharziasis) is unusual amongst helminth
diseases for two reasons: much of the pathogenesis is due to the eggs
(rather than larvae or adults); and most of the pathology is caused by host
 immune responses (delayed-type hypersensitivity and granulomatous
reactions).

Diagnosis
Schistosomiasis is diagnosed through the detection of parasite eggs
in stool or urine specimens. Antibodies and/or antigens detected in blood
or urine samples are also indications of infection.

Prevention
 avoid paddling, swimming
and washing in fresh water
– only swim in the sea or
chlorinated swimming
pools
 boil or filter water before
drinking – as the parasites
could burrow into your lips
or mouth if you drink
contaminated water
 avoid medicines sold
locally that are advertised
to treat or prevent
schistosomiasis – these are
often either fake, sub-
standard, ineffective or not
given at the correct dosage
 don't rely on assurances
from hotels, tourist boards
or similar that a particular
stretch of water is safe – try
to find out from an official
or reliable source
Treatment
The recommended treatment for schistosomiasis is the
anthelminthic praziquantel, dosing regimens vary:

40 mg/kg given as a single dose,

or
20 mg/kg every 4-6 hours for three doses

Praziquantel in these dosages effectively kills adult worms and

prevents the release of eggs and the development of new urogenital
lesions. As it is primarily effective against adult worms, treatment is best
initiated at least four to six weeks post-exposure.
While some resistance has been noted in other species of
Schistosoma, it has been minimal in S. haematobium. Praziquantel is
generally safe in pregnancy, rated category B.
If there is one documented case of urogenital schistosomiasis, there
are likely many other individuals that use the same water source that are
affected. Mass treatment regimens have been undertaken in multiple
communities and countries with significant success. In 1997, Egypt
launched a Praziquantel mass treatment program. Before treatment, the
studied villages had prevalence ranging from greater than 30% to 10% to
20%; following treatment prevalence had decreased to less than 3% in the
vast majority.

Prognosis
In early chronic infection, proper administration of praziquantel
can alleviate symptoms and minimize long term inflammation and
granuloma formation. However, urogenital lesions are often only partially
 reversible depending on the degree and type of tissue damage. Sequalae
of these lesions can also be chronic.
After treatment with praziquantel, a study of 527 women found no
significant reduction in the “sandy patches” seen on colposcopy
following treatment. Symptoms to include contact bleeding and vessel
abnormalities also remained.
Prognosis also depends on the likelihood of re-exposure and the
need for subsequent treatment.

Epidemiology
Per the World Health Organization (WHO), 78 countries have
reported transmission of schistosomiasis in all forms, and it is endemic in
52. The WHO Global Health Estimates from 2016 estimated that
schistosomiasis had a death rate of 0.3 per 100,000. There were also
estimated to be 24,000 deaths in 2016, which decreased from 55,000 in
2000.
Schistosoma haematobium is the species responsible for urogenital
schistosomiasis. It is endemic to many countries in sub-Saharan Africa, as
well as some parts of the Middle East. It is especially prevalent in tropical
and subtropical areas, particularly affecting communities that lack access
to sanitation and safe drinking water.
The most prevalent form of urogenital schistosomiasis is chronic.
While acute schistosomiasis (or Katayama fever) can be caused by S.
haematobium, it is more recognized in other schistosome species. In
endemic areas, the average age of initial infection is age 2, with an
increasing worm burden for the next 10 years. Infection intensity and
prevalence in a region of Kenya were highest in children aged 5 to 14
years old. Infection prevalence and intensity are possibly due to the
frequency of contact with water during daily activities, as adult
individuals with high water contact during their daily activities (fishing,
laundry, etc.) have also been shown to have persistence of prevalence and
infection.
Serology has shown that endemic areas have almost a 100%
infection rate, with 60% to 80% of school-age children and 20% to 40%
of adults remaining actively infected.
 In endemic regions, up to 65% of patients with bladder cancer
(typically squamous cell carcinoma) had concomitant urogenital
schistosomiasis.

IV.ENTEROBIASIS
Enterobius Vermicularis

Signs and Symptoms…

 itching in the anal area
 restlessness
 difficulty sleeping

Causative Agent
Enterobius Vermicularis
Pinworm infection is caused by a small, thin, white
roundworm called Enterobius vermicularis.
Transmission
Transmission can occur via contact with contaminated clothes,
bedding, personal care products, and furniture. Fecal-oral is the most
common mode of transmission. Rarely, transmission can occur via
inhalation mode when eggs are inhaled and then subsequently swallowed.

Pathogenesis
It is postulated that Enterobius vermicularis triggers an
inflammatory response which is associated with the low-grade
eosinophilia. Allergic response to the worm protein is considered the
cause of pruritus; usually pruritus ani (perianal pruritus).

Diagnosis
 Diagnosis is made by
identifying the worm or its
eggs. Worms can sometimes
be seen on the skin near the
anus or on underclothing,
pajamas, or sheets about 2 to
3 hours after falling asleep.
Pinworm eggs can be
collected and examined using
the “tape test” as soon as the
person wakes up.

Prevention
Washing your hands with soap and warm water after using the
toilet, changing diapers, and before handling food is the most successful
way to prevent pinworm infection.

Treatment
 Treatment consists of the following antihelminthic medications:

Albendazole: Given
on an empty stomach,
a 400-mg, one-time
dose followed by a
repeat dose in 2
weeks

OR

Mebendazole: A 100-
mg, one-time dose
followed by a repeat
dose in two weeks

OR

Pyrantel Pamoate:
Available over the
counter in the United
States; Dose of 11
mg/kg up to a
maximum 1 gm given
2 weeks apart
Other medications that have been used to treat enterobiasis are
ivermectin and piperazine, although the latter has lower efficacy and
higher toxicity.
Enterobiasis can cause recurrent reinfection, so treating the entire
household, whether symptomatic or not is recommended to prevent a
recurrence.
Treatment of Enterobius infection in pregnancy should be reserved
for patients who have significant symptoms. In pregnant patients,
pyrantel pamoate is preferred over other medications.
 Young pinworms tend to be resistant to treatment and hence two
doses of medication, two weeks apart are recommended. At the same
time, all members of the infected child must be treated. If a large number
of children are infected in a class, everyone should be treated twice at 2-
week intervals. Follow up is vital to ensure that a cure has been obtained.

Prognosis
Prognosis following a pinworm infection is excellent. Patients are
recommended to follow up with their physicians after completion of the
treatment to make sure they do not have any reinfection. Is symptoms
recur then testing and treatment as above should be re-initiated.
Ectopic pinworm infections have been described in many organs
including the vagina, inguinal area, genitals, peritoneum, liver, oral
cavity, lungs, and pelvis. There are even reported cases of appendicitis
caused by impaction of the organ by pinworms. While death is very rare,
recurrences are common.
Eradicating pinworms from institutions is very difficult and long-
term surveillance is required. To completely eradicate the pinworm,
everyone in the classroom or in the family has to be treated.

Epidemiology
The male to female infection frequency is 2 to 1. However, a
female predominance of infection is seen in those between the ages of 5
and 14 years. It most commonly affects children younger than 18 years of
age. It is also commonly seen in adults who take care of children and
institutionalized children. Center for Disease Control and Prevention data
indicates that there are about 40 million people estimated to have been
infected in the United States. Transmission can occur via contact with
contaminated clothes, bedding, personal care products, and furniture.
Fecal-oral is the most common mode of transmission. Rarely,
transmission can occur via inhalation mode when eggs are inhaled and
then subsequently swallowed.
 V.TRICHOMONIASIS
Trichomonas Vaginalis

Signs and Symptoms…

 For Women
 abnormal vaginal discharge that may
be thick, thin or frothy and yellow-
green in colour
 producing more discharge than
normal, which may also have an
unpleasant fishy smell
 soreness, swelling and itching
around the vagina – sometimes the
inner thighs also become itchy
 pain or discomfort when passing
urine or having sex
For Men
 pain when peeing or during
ejaculation
 needing to pee more frequently than
usual
 thin, white discharge from the penis
 soreness, swelling and redness
around the head of the penis or
foreskin

Causative Agent
Trichomonas Vaginalis
Trichomoniasis (or “trich”) is a very common STD
caused by infection with Trichomonas vaginalis (a protozoan
parasite).

Transmission
Sexually active people can get trich by having sex without a condom with
a partner who has trich. In women, the infection is most commonly found in the
lower genital tract (vulva, vagina, cervix, or urethra). In men, the infection is
most commonly found inside the penis (urethra).
Pathogenesis
The parasite Trichomonas
vaginalis (Tv) causes a highly
prevalent sexually transmitted
infection. As an extracellular pathogen,
the parasite mediates adherence to
epithelial cells to colonize the human
host. In addition, the parasite interfaces
with the host immune system and the
vaginal microbiota.

Diagnosis
Trichomoniasis is also
commonly diagnosed by seeing the
organism when a Papanicolaou (Pap)
test is done. Alternatively,
immunochromographic flow dipstick
tests or NAATs, which are available
from some laboratories, may be done.
In women, these tests are more
sensitive than microscopic examination
or culture.

Prevention
The following measures will help protect you from trichomoniasis and
most other STIs, including chlamydia and gonorrhoea. They'll also help prevent
you passing it on to your partner:
 use condoms (male or female) every
time you have vaginal or anal sex
 if you have oral sex, cover the penis
with a condom or the female genitals
 with a latex or polyurethane square (a
dam)
 if you're a woman and rub your vulva
against your fe25male partner's
vulva, one of you should cover your
genitals with a dam
 avoid sharing sex toys – if you do share them, wash them or cover them with
a new condom before anyone else uses them

Treatment
According to the 2015 CDC STI treatment guidelines, there are three
recommended strategies for the treatment of trichomoniasis. These include a
single 2-gram dose of metronidazole, a single 2-gram dose of tinidazole, or a
seven-day course of 500 mg metronidazole twice daily.

In patients with known HIV infection, the recommended treatment

regimen is a seven-day course of 500 mg metronidazole twice daily.
According to a study, the percent of women positive for trichomoniasis
on their test of cure was 19% when given a single dose of metronidazole versus
11% when patients completed a seven-day course of metronidazole.
If left untreated, trichomoniasis may remain subclinical or may resolve
with host immunity.
Pregnant women must be treated otherwise it can result in adverse
outcomes. The drug of choice is metronidazole. Women should stop
breastfeeding during treatment.

Prognosis
Patients who are treated with metronidazole have a 90% - 95% cure rate.
The cure rates are even higher when the sexual partner is treated. Unfortunately,
recurrent infections are common in sexually active individuals. Trichomoniasis
is strongly associated with the presence of other STIs including HIV, gonorrhea,
human papillomavirus (HPV), herpes, and chlamydia. Pregnant women are at
risk for preterm delivery, low birth weight infant, and premature rupture of
membranes. There is also a high risk of developing pelvic inflammatory
disease.
Epidemiology
Trichomoniasis occurs more frequently in people with multiple sexual
partners who also have other sexually transmitted infections. In one study with
4057 participants, T. vaginalis infection was found in 0.5% of males and 1.8%
of females in the study population. They found prevalence among Black study
participants to be higher, with 4.2% and 8.9% infection rates noted in males and
females, respectively.
According to another article, the estimated infection rate of
Trichomoniasis vaginalis is 3.2%. T. vaginalis infection rates in the United
States are higher than combining Neisseria gonorrhoeae and Chlamydia
trachomatis infection rates. Trichomoniasis is most prevalent amongst women
ages 40 to 49, which is starkly different from the rate of chlamydia infections,
which peaks in the 19 to 24-year-old age group.