CLINICAL PARASITOLOGY - MIDTERM

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W1 - LECTURE

PHYLUM CILIOPHORA - BALANTIDIUM COLI

Balantidium coli
- Biggest intestinal protozoa in man
- Only ciliate that infects man

Trophozoite Stage Cyst Stage - Infective Stage

● 2 nuclei ● 2 nuclei
○ With kidney-shaped ○ With macronucleus and LIFE CYCLE PATHOLOGY
macronucleus micronucleus
Portal of Entry - Mouth ● Causes Balantidiasis → painful
○ 0With rounded micronucleus ● Thick Cell wall
Mode of Transmission - ingestion of defecation; Ciliary dysentery;
● With cytostome (mouth) → oral ○ resistant to the environment
infective cyst → mononucleated cyst Balantodial dysentery (painful
opening ○ So they can stay viable until
Habitat - Intestine defecation)
● and Cytopyge (anus) → anal opening they get in contact w/ viable
Portal of Exit - Anus ● * with tissue invasion which is
● With cilia all over the organism host
*with tissue invasion - forms wide mouthed facilitates by
● Motility: Rolling Motion ● Involved in reproduction
ulcerations HYALURONIDASE
● With remnants of cilia from troph.
Ingestion of mononucleated cysts → small ○ Enzyme Resp. for
stage
and large intestine → invasion on the invasion of the
● Infective stage
intestinal tissue —> forms wide mouthed epithelium of the host
ulcerations forming wide mouth
ulcerations

EPIDEMIOLOGY DIAGNOSIS

● Associated with the presence of ● Stool examination identifying the

swine parasite through its diagnostic
● Reservoir - SWINE / PIGS features
● Zoonotic parasite ○ DFS
○ FECT

How will you control/prevent the infection of B. coli

● Proper Hygiene
● Regular fecalysis for swine takers
● Avoid use of night soil as fertilizers
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WEEK 2 The Trypanosomes

➔ Trypanosoma brucei gambiense
HEMOFLAGELLATES - Arthropod-borne parasites ➔ Trypanosoma brucei rhodisiense
➔ Trypanosoma cruzi
- Phylum Sarcomastigophora
➔ Trypanosoma rangeli
- Subphylum Mastigophora AFRICAN TRYPANOSOMES - Trypanosoma brucei complex
4 DEVELOPMENTAL FORMS ➔ Exhibits only epimastigote and trypomastigote forms
◆ Undulating membrane is stained blue
Amastigote - Leishmania Form Promastigote - Leptomonad Form ◆ Flagellum is stained red; runs along the edge of the undulating membrane
➔ Only intracellular stage ➔ INFECTIVE STAGE Trypanosoma brucei gambiense Trypanosoma brucei rhodesiense
◆ Found in the tissue cell ➔ Commonly seen in the Arthropod host
➔ Shape: oval ◆ Located at the gut of arthropod ➔ Found in West and Central Africa ➔ Found in East and Central Africa
➔ Nucleus: 1 (eccentric) w/ central going to the proboscis → the ➔ Causes Gambian Sleeping Sickness ➔ Causes Rhodesian Sleeping Sickness
karyosome mouth part of the arthropod (more virulent)
➔ Kinetoplast - umbrella term often used to ➔ Shape: spindle
refer to the blepharoplast and small ➔ Nucleus: 1 w/ central karyosome Life Cycle Pathogenesis
parabasal body. ➔ Kinetoplast: anteriorly located with single
◆ Blepharoplast - basal body flagellum | located at the AE
● Nucleation site for the growth of
➔ Vector: Glossina Fly - Tsetse Fly ➔ Sleeping Sickness
➔ Flagella: 1 extending from the axoneme ➔ Mode of Transmission: Through vector’s ◆ Gambian trypanosomiasis
the axoneme microtubules
◆ Axoneme - microtubule-based cytoskeletal (AE) bite ◆ Invades the CNS
structure that forms the core of a cilium ➔ Infective Stage: Metacyclic ◆ Mild to sever
or flagellum trypomastigote ◆ Acute to Chronic
➔ Habitat in Human: reticular tissues of ➔ Rhodesian trypanosomiasis
lymph and spleen; CSF ◆ More rapid and fatal than
➔ Reproduction: multiply through binary Gambian trypanosomiasis
fission ◆ Subsequent to kidney damage
and myocarditis → inflammation
of the heart
➔ Seen only if a blood sample is collected SOMNOLENCE → excessive sleepiness
immediately after transmission
Diagnosis Prevention and Control
➔ Found in tissue muscles and CNS within
macrophages where they multiply ➔ Demonstration of trypomastigotes ➔ Treatment of Cases
Giemsa-Wright’s stained samples ◆ Eflornithine (for Gambian only)
Epimastigote - Crithidia Form Trypomastigote - Trypanozoma Form - Blood ◆ Pentamidine and suramin (do not
- Lymph node aspirate reach CSF)
➔ Seen in arthropod vector ➔ Seen in peripheral blood - CSF ➔ Reproduction of contact with Tsetse fly
➔ Shape: Spindle ➔ reproduce in blood stream ➔ Serological Test ◆ Insecticides
➔ Nucleus: 1 with central karyosome ➔ Shape: Spindle, more slender - IHAT - ◆ Traps
➔ Kinetoplast: almost near the nucleus - ➔ Nucleus: 1 with central karyosome - IFAT ◆ Screens
anterior ➔ Kinetoplast: posteriorly located - ELISA
➔ Flagellum: a free flagellum at the anterior ➔ Flagellum: An anterior free flagellum may
end of the epimastigote or may not be present. Summary of Life Cycle
➔ Can be seen in histopath slide Mammalian Stages → tsetse fly takes blood meal (injects metacyclic trypomastigote to the
host) → IMT transforms into bloodstream trypomastigote that is carried to other site of the
body → trypomastigote multiply through binary fission in the body fluids (blood, lymph and
spinal fluid) → Trypomastigote in the blood→ Tsetse Fly → tsetse fly takes blood meal from
an infected host (ingested bloodstream trypomastigotes) → bloodstream trypomastigote
transform into procyclic trypomastigotes in the vector midgut (multiply through binary fission)
→ PTrypomastigote leaves midgut transform into epimastigotes → Epimastigotes multiply in the salivary gland and transform
into metacyclic trypomastigote
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Prevention and Control Diagnosis

Trypanosoma cruzi - American trypanosome
➔ Located only in Americas mainly in Rural Latin America ➔ Treatment of Cases ➔ Demonstration of trypomastigotes
◆ Nifurtimox and benznidazole - Giemsa-Wright’s stained samples
➔ Causes: Chagas disease or American trypanosomiasis
partially treatment of acute cases ◆ Blood
➔ An intracellular parasite ➔ Vector Control ◆ Lymph node aspirate
➔ Exhibits the 4 developmental stages ◆ Insecticides ◆ CSF
➔ In humans: ◆ Screens ➔ Xenodiagnosis - bugs are allowed to feed
◆ Housing improvement to reduce on suspected patients
◆ Amastigotes - Habitat: tissue cells (RES - binary fission)
breeding sites of bugs ➔ ECG - patients generally shows cardiac
◆ Trypomastigotes - Habitat: blood stream (do not multiply in the bloodstream) symptoms
➔ Serological Test
Amastigotes Trypomastigotes ◆ IHAT
◆ IFAT
➔ Develop in muscles and other tissues ➔ Flagellum: moderately long flagellum ◆ ELISA
➔ Shaped: round/ovoid found in small ➔ Shaped: C, U or S ◆ CFT
groups of cyst-like collections in ➔ Reproduction: do not multiply in the ➔ PCR - amplifying the DNA from
tissues bloodstream kinetoplast
➔ Reproduction: Multiply in the RES
TRYPANOSOMA RANGELI
through binary fission
➔ Trypomastigotes - are present in the blood throughout the infection
➔ Found in areas where T. cruzi is present - south and central america
*insert life cycle
Trypanosoma Cruzi → triatomine bugs passes metacyclic trypomastigotes through feces inside the host’s → HUMAN STAGE → MT penetrates various cells at the bite Life Cycle Diagnosis | Pathogenesis Prevention and Control
wound site, where they transform into amastigotes → Amastigotes multiply by binary fission fission in cells of the infected tissues → trypomastigotes transforms into
intracellular amastigotes then enter the bloodstream → TRIATOMINE BUGS → Triatomine bugs takes blood meal from an infected host and ingested trypomastigotes →
trypomastigote multiply in the midgut → it becomes metacyclic trypomastigotes in hindgut → takes blood meal to host injecting MT to the host. ➔ Vector: reduviid bug, ➔ Serological Test ➔ Treatment of Cases
Rhodius sp. ◆ IHAT ◆ Nifurtimox
➔ Mode of ◆ IFAT and
Life Cycle Pathogenesis
Transmission: through ◆ ELISA benznidazole -
➔ Vector: Triatomine bugs ➔ Chagoma - small painful reddish nodule vector’s feces that ◆ CFT partially
◆ Triatoma ◆ Inflammation on the site of entered the skin of the ➔ PCR - amplifying the treatment of
◆ Rhodnius inoculation host DNA from kinetoplast acute cases
◆ Panstrongylus ➔ Romana’s Sign - edema of the eyelid ➔ Vector Control
➔ Mode of Transmission: through vector’s ➔ Infective Stage: ◆ Insecticides
feces that entered the skin of the host Metacyclic ➔ INFECTED PATIENTS ◆ Screens
(metacyclic trypomastigotes) trypomastigote ◆ generally ◆ Housing
◆ Infective stage is passed out in the ➔ Habitat in Human: asymptomatic improvement to
bug’s feces → gains entrance to
RES and blood stream and do not reduce
host - scratched skin or through
➔ Reproduction: binary demonstrate breeding sites
mucous membranes that are
rubbed carrying the bug’s feces fission evidence of of bugs
➔ Infective Stage: Metacyclic illness
trypomastigote
➔ Habitat in Human: RES and blood stream
➔ Reproduction: binary fission
➔ Chronic Disease - no characteristics
symptoms for 20 years or more
➔ Manifestations: megaesophagus,
megacolon, cardiospasm,
cardiomyopathy related to congestive
heart failure
➔ Chaga’s disease is serious and often
fatal among young patients.
Leishmania spp.
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➔ Leishmania tropica
Pathogenesis - Leishmania donovani
➔ Leishmania braziliensis
➔ Leishmania donovani ➔ Causes Visceral leishmaniasis or Kala-azar
➔ Incubation Period: 1 to 3 months
Life Cycle
➔ Generally in the RES (Reticuloendothelial System) of the
➔ found in Africa, Eastern Europe, South ➔ Vector: Phlebotomus spp. (Sandfly) ◆ bone marrow
and Central America ➔ Mode of Transmission: through a ◆ Liver
➔ Intracellular flagellate that live vector’s bite ◆ Lymph nodes
◆ Congenital transmission ◆ Intestinal mucosa
inside the macrophages - Amastigotes
◆ Blood transfusion ➔ Signs and Symptoms:
- Monocytes, PMN, Endothelial Cells ◆ Contamination of bite wounds
➔ Promastigotes - found in the midgut ◆ Skin darkening
➔ Infective Stage: Promastigotes
and proboscis of the vector ◆ Splenomegaly
➔ Habitat in Human: macrophages
➔ Reproduction: multiply through ◆ Loss of appetite
binary fission ◆ Anemia
◆ Hepatomegaly
Pathogenesis - Leishmania tropica Pathogenesis - Leishmania braziliensis ◆ Lymphadenopathy
◆ Diarrhea
➔ Causes Cutaneous Leishmaniasis ➔ Causes Mucocutaneous ➔ Fatal is not treated
◆ Dry/Urban Oriental Sore - Leishmaniasis
➔ Post Kala-azar Dermal Leishmaniasis may develop after treatment
Leishmania Tropica minor ◆ Leads to disfiguring
leprosy-like tissue destruction
◆ Wet/Rural Cutaneous -
and swelling
Leishmania tropica major ◆ Metastatic spread to oronasal
→ Jericho’s boil and pharyngeal mucosa
→ Aleppa Button ◆ May produce chiclero ulcers
→ Btton de bistra (L. mexicana)- among forest
➔ Incubation Period - 2 weeks to workers
several months
➔ Skin Ulcerations - elevated; painless;
local or metastatic Visceral leishmaniasis
➔ Subcutaneous may occur
➔ Leave ugly scars Diagnosis Prevention and Control
➔ No Systemic signs and symptoms
➔ Tissue Biopsies - demonstration of ➔ Treatment of Cases
active leishmaniasis ◆ Kala-azar - Antimicrobials
◆ Skin for cutaneous (L) amphotericin B and Pentamidine
◆ Cutaneous (L) - Glucantime;
◆ Bone Marrow
Stibogluconate and Pentamidine
◆ Spleen or lymph nodes for
◆ Mucocutaneous (L)
visceral (L) Stibogluconate
➔ Serological Test ➔ Vector Control
◆ IHAT ◆ Insecticides
◆ IFAT ◆ Screens
◆ ELISA ➔ Avoidance of contact with infection
◆ Wounds should be protected
◆ CFT
from insect bites
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WEEK 10 ◆ Toxoplasma gondii

Phylum Apicomplexa Malarial Parasites → Plasmodium spp.
➔ Has no locomotory organelle ➔ Belongs to class sporozoa
➔ Possess APICAL COMPLEX → invasive organelle → necessary for the invasion of the ➔ Vector-borne parasite → female anopheles mosquito
parasite to the RBC ➔ 4 species that infects human
◆ Polar rings (conicoid) ◆ Plasmodium falciparum
◆ Rhoptries ◆ Plasmodium vivax
◆ Micronemes ◆ Plasmodium malariae
➔ Class Sporozoa ◆ Plasmodium ovale
◆ Subclass: coccidia ➔ Has more 100 species that infect other animal
● Order: eucocidiida History of Malaria
○ Suborder Haemosporina: Zygote motile (ookinete); sporozoites ➔ Disease known since ancient time
are naked with 3 membrane wall; inhabit the blood ➔ First Report: 1550 BC
◆ Plasmodium sp. ➔ Malaria → commonly found in swampy areas and was thought to be contacted by
● Order: Piroplasmisda breathing bad air in the swamps
◆ Babesia ➔ Associated with bad air in the swamps
○ Suborder Eimeriina: Zygote (not motile); sporozoites are enclosed ➔ First Breakthrough - Laveran
in sporocysts within oocyst; inhabit the intestinal epithelium ➔ Considered as the most important parasitic disease infecting human
◆ Cryptosporidium spp ◆ Vivax and falciparum → present in the philippines
◆ Isospora sp ◆ Mindoro, Palawan, Bicol, Mountainous Part of Mindanao and Rizal
◆ Sarcocystis spp ➔ Disease is curable: but with high mortality

Morphology of Human Plasmodia

Stages P. falciparum P. vivax P. malariae P. ovale

Ring Form ➔ Infects mature RBC (no nucleus) - functional ➔ RBC is enlarged and pale - RBC is mature and normal - RBC changes to ovalocyte
blood cells ➔ With one chromatin dot (⅓ if the RBC) - Thick cytoplasm - ring - Bigger than Falciparum
◆ Several ring form ➔ As the cell mature the cell size becomes smaller
◆ Double chromatin dot ➔ The younger the bigger size of the young cells
➔ Multiple infection of RBCs ➔ Not yet mature
➔ May have double chromatin dots ➔ Several rings in the RBC with different appearance
➔ Applique forms from each other
➔ Inclusion body
➔ Normal red blood cell with 1-2 chromatin dots in
an applique form

Developing - Not seen in the blood smear - Irregularly shaped (amoeboid) - Produced BAND across RBC - Amoeboid
Trophozoite - With thicker cytoplasm - may form a ring across
the RBC during the blood smear prep.

Schizont - Not seen; when present- bad prognosis → the - With 12-24 (average - 16) merozoites - With 6-12 (8) merozoites - rosette formation → - With 8-12 merozoites
patient is nearing death | severe type of the - Occupies ⅔ of the enlarged pale RBC flower like formation
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disease
- If found: it has 8-24 merozoites
- Cannot usually found in falciparum

Gametocyte - Crescent or banana shaped - Spherical / oval in shape inside the RBC - Spherical - spherical /oval
- RBCs are not enlarged - Occupy the whole RBC

Dot’s Present - Maurer’s dots - Schuffner's dots - Ziemann’s dots - James’ dots
- Christopher’s dots - are prominent in all stages
- Very distinct for vivax

◆ Oocyst - round shape with lots of chromatin granules

◆ Sporozoite - raptures and infects man
➔ Intermediate Host - Man
◆ Schizogony (asexual cycle) - takes place in the RBCs of vertebrates
◆ → schizont raptures and merozoites are formed.
◆ Attack → 48-72 hours - erythrocytic cycle
➔ Stages that are seen in the Man
◆ Sporozoite → infective stage in man
◆ Schizont → incubation period where we experience the malarial attack
◆ Merozoite → initial malarial attack
◆ Hypnozoite → Dormant stage that is only present in P. vivax and P. ovale infections
◆ Trophozoite → ring stage |
◆ Gametocyte → develops macro and micro gametes (infective stage to the FAM)
➔ Gametogony - some merozoites do not infect more RBCs nor undergo Schizogony → develop into
gametophytes

OTHER MODES OF TRANSMISSION

Blood Transfusion - TRANSFUSION MALARIA Mother to Fetus - CONGENITAL MALARIA

➔ Common in Endemic Areas ➔ Intrauterine transmission of infection from

➔ Donor may remain infective
◆ Any patient who has received a
transfusion three months prior to the
febrile illness should be suspected to
have malaria
mother to child is well documented
➔ Placenta become heavily infected with
parasites
➔ Congenital malaria is more common in first
pregnancy, among non-immune populations

NEEDLE STICK INJURY

➔ Accidental transmission can occur among drug users who share syringes and needles
➔ Asexual forms -
◆ directly inoculated into the blood and pre-erythrocytic development of the parasite in the liver
does not occur
◆ This type of malaria has a shorter incubation period and relapses do not occur
➔ Rarely, malaria can spread by the inoculation of blood from an infected person to a healthy person

LIFE CYCLE OF PLASMODIUM SPP. HUMAN PLASMODIA

➔ Vector - female Anopheles Mosquito PLASMODIUM FALCIPARUM PLASMODIUM VIVAX

➔ Mode of Transmission - vectors bite
➔ Infective Stage - sporozoite
➔ Causes: ➔ Causes : Benign Tertian Malaria
➔ Definitive Host - Mosquito
◆ Malignant Tertian Malaria ➔ Asexual cycle takes place within 48 hours
◆ Sporogony (sexual cycle) - takes place in mosquito
(Blackwater fever) ➔ Prepatent Period: 11-15 days
➔ Stages that are seen in the Mosquito
➔ Incubation Period: 10-17 days
◆ Gametocyte - ingested from the blood of the host ➔ Most dangerous specie of Plasmodium -
◆ Gamete - infects all stages of RBC
◆ Zygote ➔ Cause by: asynchronous release of
◆ Ookinete -bean shaped form merozoites in the circulation
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➔ Asexuall cycle takes place in 48 hours Dehemoglobinized - removal of

◆ ◆ Falci and Vimax - most common cause
◆ Prepatent Period: 11-14 days hemoglobin - distilled water → before of Mix Infection
◆ Incubation Period: 7-10 days staining ➔ Multiple Infection
➔ Prepatent Period: interval of time from ➔ Thin Smear ◆ In case of Falciparum
exposure to the detection of parasites in the ◆ Feathery edge - thinner portion ◆ Presence of many Pm in the RBC
blood ◆ Specie identification ➔ Acridine Orange Stain - stain the
GOLD STANDARD plasmodium
➔ Ideal Anticoagulant: EDTA ◆ Layer with malarial parasite
PLASMODIUM MALARIAE PLASMODIUM OVALE ➔ Heparin can distort the parasites
◆ For Pf: STAT procedure can be
➔ Causes: Quartan Malaria ➔ Causes: Ovale Tertian Benign Malaria considered
➔ Asexual cycle takes place within 72 hours ➔ Asexual cycle takes place within 48 hours
➔ Prepatent Period: 3-4 weeks ➔ Prepatent Period: 14-26 days
RAPID IMMUNOLOGICAL TEST SEROLOGICAL TEST
➔ Incubation Period: 18-40 days ➔ Incubation Period: 10-20 hours
➔ RAPID Testing → detects antigen ➔ IFAT
◆ HRP - histidine rich protein of Pv and ➔ ELISA
Pf ➔ Serological Test → detects antibody
➔ Parasight F
◆ Detects the histidine rich protein
MALARIAL PAROXYSM
(Ag) of Pf
COLD STAGE (15-60 MINUTES) HOT STAGE (2-6 HOURS) SWEATING STAGE (2-4 HOURS) ➔ Cart Test
◆ Detects the Histidine Rich Protein of
➔ Starts with a sudden ➔ High temperature: 40 - 41 ➔ Temperature lowers Pv and Pf
inappropriate feeling of C or higher ➔ Symptoms diminished ➔ Optimal Test
cold and apprehension ( ➔ Patient experiences ◆ Detects the Lactate Dehydrogenase
but core temperature is ◆ Headache
of Pf and Pv
high) ◆ Palpitations
◆ Patient may vomit ◆ Epigastric
◆ febrile discomfort
convulsions ◆ Skin flushes
develop at this ◆ Becomes confused CONTROL AND PREVENTION
stage among and delirious
children ➔ TAKING AN ANTIMALARIAL DRUGS
◆ Protective - prophylactic
◆ Curative - therapeutic
TOTAL DURATION OF ATTACK : 8-12 HOURS
◆ Preventive
APPROACH TO MALARIA DIAGNOSIS ● Chloroquine → (mainstay for the 50 years)
● CQ + Sulfadoxine – pyrimethamine → therapy for uncomplicated malaria
DIAGNOSIS ● Quinine (with toxic side effects e.g. cardiotoxicity) - used alone or with other
medications to treat malaria | should not be used to prevent malaria
➔ Is it malaria ● Atovaquone, pyronaridine and deferoxamine - (New antimalarial drugs)
➔ If yes: ◆ Personal protection against MOsquito bites
◆ What is the specie ● Use of mosquito nets and screens
◆ Is it sever ◆ Vector Control
◆ Is it new or recurrence ● Insecticides
◆ Development of Malaria vaccines
◆ Is it active
➔ At present, ONLY the Peripheral smear can provide answers to all these questions on a single test.
RECRUDESCENCE
Peripheral Smear (Wright’s stain / Giemsa Stain) QUANTITATIVE BUFFY COAT - for screening ➔ Is the renewal of parasitemia and/or clinical features arising from persistent undetectable asexual
parasitemia in the absence of an exo-erythrocytic cycle
➔ Thick Smear ➔ Acridine Orange Stain and Fluorescent ➔ reappearance of the parasite
◆ 1 drop of blood and another blood microscopy
➔ For falciparum and malariae
that would be spread out ➔ Nuclei of Plasmodium are stain with AO
➔ Mix Infection RELAPSE
◆ Use for screening - positive or ➔ is renewed asexual parasitemia following a period in which the blood contains no detectable parasite.
◆ Infection of 2 or more specie in one
negative ➔ recurrence
patient
➔ Applicable for ovale and vivax - in the liver (hypnozoite)
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➔ Hipnocyte becomes an active merozoites and attack again

➔ Examination of blood smear ➔ Treatment of Cases
Incubation period may range from nine days to 3 years depending on: ◆ Hard to differentiate from ◆ Combination of clindamycin and
➔ Parasite strain plasmodium spp. quinine or atovaquone and
➔ Dose of sporozoite inoculated ➔ Serological test azithromycin
➔ Immune status of the host ◆ Pyrimethamine and quinine (singly
➔ Host’s malaria chemoprophylaxis HX or combi)
➔ Avoid tick infested areas
➔ Used insect repellents for ticks and
eradication of ticks

BABESIA MICROTI WEEK 5

➔ RBC intracellular parasites
➔ Causes: Hemolytic Anemia HELMINTHOLOGY
➔ Can affect: spleen, liver and kidneys
➔ MOT: tick bite (ixodes scapularis) carrying the sporozoite Phylum Nemathelminthes
➔ Causes Babesiosis
◆ Self-limiting (self-recovering) disease - death rarely occurs ➔ Non-segmented, elongated, cylindrical
◆ Can be cured within certain method like chickenpox ➔ Possess a complete digestive system with
◆ Can be infectious and can be passed on to other host anterior end which may be provided with
◆ Spines, hooks, cutting plates or other
MORPHOLOGY LIFE CYCLE
structures for attachment or for
➔ Size: 3-5 um ➔ Vector: Ixodes ticks penetration tissues
➔ Cytoplasm: minila with 2 or more chromatin ➔ MOT: vector’s bite → buccal cavity → esophagus → intestines →
dots ➔ Infective Stage: sporozoites rectum → anus
➔ RBCs with 2-4 rings are often observed ➔ Definitive Host: Tick ➔ Lack of circulatory and respiratory system:
◆ Maltese Cross - distinct shape ◆ Sporogony (sexual cycle) - takes
◆ Respiration occurs in general body
appearance place in the tick
➔ Intermediate Host: Man and other animal surface
➔ Less complicated than plasmodium malariae
◆ (Asexual cycle) – trophozoites --à ● Aerobic - free living form
➔ Zoonotic → can be pass from human to
merozoites --à undergo binary fission ● Anaerobic - parasitic form
animal to produce more merozoites ➔ Possess a body cavity (pseudocele) line
➔ Infective to ticks: GAMETES muscle fibers and contains viscera, digestive,
excretory, nervous and reproductive systems.
➔ Reproduction: Oviparous or larviparous
➔ Body is covered with thick cuticle → body
➔ Life Cycle Includes
covering that is molted periodically ◆ Eggs stage
➔ Sexes ◆ Larval stages
◆ Female: ◆ Adult stages
● larger than Male ➔ Infections may be through:
● Posterior End: Pointed ◆ Ingestion of eggs
◆ Male ◆ Ingestion of encysted larva
◆ Penetration of larval
● Smaller than Female
◆ Inoculation of the arthropod vectors
● Posterior End: Usually Curved
➔ Some are Parthenogenetic
◆ Female can fertilize their eggs in the
absence of M
➔ Maybe free living and parasitic species

CLASS

Class Aphasmidia (Adenophorea) Class Phasmidia (Secernentea)

➔ Absence of Phasmid → caudal sensory organ ➔ Phasmids are present

➔ Amphids → olfactory sensory organ of ➔ Pore - like amphids
nematodes, of various types, rarely pore-like ➔ Well - developed excretory system
DIAGNOSIS PREVENTION AND CONTROL ➔ No caudal adhesive glands
➔ No Excretory system
➔ With several orders
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◆ Poorly developed if present ➔ * parasitic to human ● Being develop in the soil

➔ Present : Caudal adhesive glands
➔ Free Living Parasites

Soil-Transmitted Helminthes
➔ Ascaris lumbricoides
➔ Trichuris trichiura Adult - Male Adult - Female
➔ Hookworms
◆ Infective to man ➔ Measures 15-25 cm by 2-4 mm ➔ Measures 20-25 cm by 3-5 mm
● Necator americanus ➔ Curved posterior end ➔ Straight posterior end
● Ancylostoma duodenale ➔ With a pair of copulatory spicules ➔ With genitcal ring (middle 3rd of the worm)
➔ Anterior end: with trilobate lips ◆ Where
◆ Infective to Dogs
➔ Anterior end: with trilobate lips
● Ancylostoma caninum
◆ Infective to Cats LIFE CYCLE
● Ancylostoma braziliense
➔ Strongyloides stercoralis

ASCARIS LUMBRICOIDES (Giant Ringworm)

Morphology

FERTILIZED EGG UNFERTILIZED EGG

➔ male and female in the host ➔ only female specie in the host
◆ Ovoid (broader) ◆ Longer than the fertilized egg
◆ Measures 35-50 um by 45-75 um ◆ Ovoid (narrower)
◆ With thick egg cell ◆ Narrower than fertilized egg
◆ May have coarse manillated ◆ Measures 88-94 um by 39-44 um
albuminous layer ◆ With thin egg shell
● Corticated - present ◆ May have thinner albuminous layer
● Decorticated - absent ● Corticated
◆ Fine Granular germ cell ● decorticated
◆ Coarse granular germ cell ➔ Final Habitat - small intestine ➔ INFECTIVE STAGE: Embryonated egg with
➔ Presence of male → possible for fertilized developing larva within the egg
egg ➔ MODE OF TRANSMISSION: Ingestion of
➔ Absence of Male → unfertilized egg infective egg
➔ Pass out through → Defecation ➔ PORTAL OF ENTRY: mouth
➔ Upon ingestion it goes directly to the ◆ With larval migration (takes place in
intestine migrating to the lungs, heart and the lungs)
then back to the small intestine ➔ HABITAT: small intestine
➔ Larva would mold several time and migrate to ➔ PORTAL OF EXIT: anus
the lungs to get more oxygen, then to the ➔ Egg production: 240,00 eggs/day/female
heart and then back to the small intestine ➔ Eggs has Ascaroside → highly resistant to
where it develops into adult ordinary disinfectants and may remain viable
➔ WITH LARVAL MIGRATION IN ASCARIS for years ; may even survive in 10% formalin
EMBRYONATED EGG ADULT WORM LUMBRICOIDES

PATHOLOGY
◆ Developing larva is seen within the ◆ White, creamy or pinkish
shell ◆ Anterior end : buccal cavity with ➔ Migrating Larva ➔ Adult Worm - small intestine
◆ Primarily affects the respiratory tract of human ◆ Gets liquid nutrients
◆ INFECTIVE STAGE trilobate lips (three lips)
◆ Manifestations: ◆ Leads to malnutrition
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● Asthmatic Respiration ; Coughing ; ◆ Manifestations ◆ With straight posterior end

Chest pain ● Abdominal discomfort; diarrhea;
● Increase infection → Ascaris nausea; loss of appetite
pneumonitis ● When fever occurs, adult worm
● Allergic eosinophilic infiltration of migrates
lungs ○ Vomited or pass through the
● Hypersensitive patients (low infection) nose
○ LOEFFLER’S SYNDROME ◆ ERRATIC → lodge in different organs
(high eosinophils -
pneumonia)
◆ Migrating Larvae → may lodge in vital organs
where they become adults → pressure symptoms
in organs

DIAGNOSIS CONTROL AND PREVENTION

➔ Stool Analysis ➔ Treatment of cases :

◆ Direct Fecal Smear (broad spectrum anti-helminthes)
◆ Concentration Technique → more ◆ Albendazole ; Mebendazole
number of the specific specie ◆ Mass treatment is advisable - school
◆ For recovery of all the egg stages of children
the parasites and adult worm ● Cause effective and not time
➔ Sputum consuming LIFE CYCLE
◆ For recovery of larva ➔ Educating individuals
—--------ADDITIONAL INFORMATION—------------------- ◆ Proper hygiene
Infection maybe through ◆ Proper waste disposal Avoid the use of
➔ IE - ascaris night soil as fertilizer (for A.
➔ IEL - trichinillas speri lumbricoides and T. trichiura)
PL - hookworms
➔ IAV - tissue nematodes
Class Aphasmidia
➔ Phasmid - sensory organ
➔ No excretory system
➔ Tricuries tricura → also a sample of aphasmid

TRICHURIS TRICHIURA (Whipworm)

Morphology

➔ Barrel shaped/ football shaped with 2

transparent plugs at both ends
➔ INFECTIVE STAGE: Embryonated egg
➔ Meaures 50-54 um
➔ MODE OF TRANSMISSION: Ingestion of infective egg
➔ With thick, smooth, brown shell
➔ PORTAL OF ENTRY: mouth
➔ Adult (both F and M)
◆ No larval migration
◆ Anterior part
➔ HABITAT: large intestine
● Fine hair like structure
➔ PORTAL OF EXIT: anus
● Contains only the esophagus
➔ Hatching: takes place in the small intestine
○ Stichisome (the
esophagus)→ consists
*Embryonated egg is developed in the soil
of stichocytes
◆ Posterior Part
PATHOLOGY DIAGNOSIS
● Fleshy and contains the rest of
the systems of the worm
➔ Light Infection - asymptomatic ➔ Fecalysis
➔ Adult Male
◆ Attaches to the intestinal wall ◆ Used for recovery of egg and adult
◆ Measures 3-3.5 cm
◆ Feed on the intestinal tissue worm
◆ With curve posterior end
➔ Heavy infection ● DFS
➔ Adult Female
◆ May lead to anemia in Trichuriasis ● Concentration Technique
◆ Measures 3.5-5.5 cm
● Due to the ulceration of the
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intestines, creates ulceration

once attached
◆ RECTAL PROLAPSE
● Due to frequent bowel
movement resulting in the loss
of muscle tone of the anus
➔ Harder to treat than Ascaris lumbricoides

CONTROL AND PREVENTION

➔ Treatment of cases (Broad Spectrum anti helminthes)

◆ Albendazole ; Mebendazole
◆ Mass treatment is advisable
➔ Educating individuals
◆ Proper hygiene
◆ Proper waste disposal
◆ Avoid the use of night soil as fertilizer (for A. lumbricoides and T. trichiura)
➔ Has the tendency to penetrate the intestinal walls needing more dose to kill the parasite
➔ Ascaris - bigger but it is easier to treat

HOOKWORMS (Ao - D2 - C3 - B1)

➔ Infects Man
◆ Necator americanus
◆ Ancylostoma duodenale new world HW
➔ Infects the dog
◆ Ancylostoma caninum
➔ Infects the cats
◆ Ancylostoma braziliense

Human Hookworms

Necator americanus Ancylostoma Duodenale

➔ New world HW ➔ Old world HW

➔ With 1 pair of semilunar cutting plate ➔ With 2 pairs of large teeth
Animal Hookworms

Ancylostoma braziliense Ancylostoma caninum

➔ Cat Hookworm ➔ Dog hookworm

➔ With 2 pairs of teeth ➔ With 3 pairs of teeth

➔ With bi-feet dorsal ray ➔ With tri-feet dorsal ray

➔ With long thread like structure fused ➔ With simple and separated copulatory spicules
copulatory spicules ➔ Life Span - 1 year
➔ LifeSpan - 4 years
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HOOKWORM MORPHOLOGY ➔ Feeding stage

➔ Buccal cavity →
Egg - same with all type of hookworms Adult Worm ◆ Hookworm - long but narrow buccal
➔ Thin-shelted ➔ With cervical curvature
cavity
➔ Ovoid ➔ F is longer than M
➔ Colorless ➔ Male has fan-shaped posterior end (copulatory ➔ With flash-shaped muscular esophagus
➔ With 4-8 germ cells bursa) where RAYS and SPICULES can be ➔ Small genital primordium → where genetical
found of adults came from
➔ Anterior with different dental pattern ◆ small , can be seen in the middle of the
◆ Basis of species identification female hookworm

Filariform larva

➔ Infective stage → stage that penetrates the

skin of the human or animal host
➔ Longer and more slender with pointed
posterior end
➔ With sheath covering
◆ Remnants of the old cuticle → remove
being molding

LIFE CYCLE

Rhabditiform larva

➔ Infective Stage: Filariform Larva

➔ Mode of Transmission: skin penetration
➔ Portal of Entry: skin
➔ Habitat: small intestine
➔ Portal of Exit: Anus - eggs pass out

PATHOLOGY
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➔ Due to larva
◆ Ground itch or crolie itch
● Site of entrance of f.I STRONGYLOIDES STERCORALIS (THREADWORM;FACULTATIVE PARASITE)
◆ Pulmonary lesions - because it reaches the lungs
● Larval migrations MORPHOLOGY
◆ Creeping eruptions or cutaneous larva migrans
Female Worm Male Worm
● Caused by animal hookworms
◆ (hookworms are host specific) ➔ Free Living - shorter than parasitic ➔ Free Living -smaller than female
➔ Due to Adult Worm ◆ With double bulbed muscular ➔ No parasitic male
◆ Hookworm anemia esophageal pharynx ◆ Gradually passed in the feces
● Microcytic Hypochromic anemia ➔ Parasitic Female
○ hookworm anemia ◆ Delicate filiform worms 2.2.mm
◆ Parthenogenetic
○ Presence of hookworm in the intestines
● No male in fertilization
● Due to attachment to the intestines and sucking of blood
○ Loss of blood → loss of protein (HYPOALBUMINEMIA)

Adults in intestinal mucosa

Rhabditiform larva Filariform Larva

➔ Stages that is passed in stool ➔ Longer than RL

➔ Feeding stage ➔ With forked or notched tail
➔ With short buccal cavity and elongated
esophagus
➔ With prominent genetical primordium

LIFE CYCLE
DIAGNOSIS CONTROL AND PREVENTION

➔ FECALYSIS
◆ DFS ➔ Treatment of cases
◆ Concentration Technique ◆ Broad spectrum anti-helminthes
● Recovery of egg and adult ◆ Albendazole and Mebendazole
worm ◆ Mass treatment is advisable
➔ Harada Mori Stool Culture ➔ Educating individuals
◆ For recovery of larvae ◆ Proper hygiene
◆ Proper waste disposal
◆ Use of footwear (for HW and S.
Stercoralis)

END OF LESSON FOR MIDTERM

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Life Cycle (Parasitic Cycle)

➔ Infective stage : Filariform larva
➔ Mode of Transmission : Skin penetration
➔ Portal of Entry : Skin *** With larval migration
➔ Habitat : Small Intestine
➔ Portal of Exit : Anus
➔ *** with FREE – LIVING CYCLE
➔ *** AUTOINFECTION may also occur

PATHOLOGY DIAGNOSIS

Due to Larva ➔ Fecalysis - for recovery of larvae

➔ Petechial hemorrhages ; itching at the site of ◆ DFS
penetration ◆ COncentration Technique
➔ Pulmonary lesions ➔ Harada Mori Stool Culture
➔ Eosinophilia ◆ For recovery of larvae
Due to Adult Worm (F)
➔ Destruction of the intestinal mucosa
◆ Abdominal pain and diarrhea
◆ Malabsorption and hypoalbuminemia
***PARTHENOGENETIC --à Autoinfection (20-30yrs)

CONTROL AND PREVENTION

➔ Treatment of cases
◆ Broad spectrum anti-helminthes
◆ Albendazole and Mebendazole
◆ Mass treatment is advisable
➔ Educating individuals
◆ Proper hygiene
◆ Proper waste disposal
◆ Use of footwear (for HW and S. Stercoralis) PHYLUM CILIOPHORA
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Balantidium Coli - MOT - vector’s bite

- Infective Stage - mononucleated cyst - Congenital / blood transfusion / contamination of bite wounds
- Portal of Entry - mouth with tissue invasion - Infective Stage - promastigote
- Mode of Transmission - ingestion of mononucleated cyst - Habitat - macrophages
- Habitat - intestine - Reproduction - binary fission
- Portal of Exit - anus Leishmania tropica
PHYLUM SARCOMASTIGOPHORA - Cutaneous L.
Subphylum Mastigophora - Treatment : glucantime. Stibogluconate, pentamidine
HEMOFLAGELLATES - vector borne parasites Leishmania braziliensis
Developmental Stages - Mucocutaneous L.
Amastigote - intracellular / round ovoid no flagellate - Treatment: stibogluconate
Promastigote - arthropod host / infective stage / blood smear / spindle / 1 flagellum Leishmania donovani
Epimastigote - arthropod vector / spindle / 1 flagellum - Visceral L. (Kala-azar)
Trypomastigote - peripheral blood / spindle more slender / reproduce in blood stream / histopath slide - Antimicrobial amphotericin B. Pentamidine
AFRICAN TRYPANOSOMES Diagnosis
- Epimastigote - Tissue biopsies: Skin/Bone Marrow - CL, Spleen/Lymph Node - VL
- trypomastigote - Serological Test: IHAT, IFAT, ELISA, CFT
Trypanosoma brucei gambiense PHYLUM APICOMPLEXA
- west/central africa Plasmodium spp.
- Gambian trypanosomiasis
Trypanosoma brucei rhodesiense PHYLUM NEMATYHELMINTHES
- east/central africa Ascaris lumbricoides (Giant Ringworm)
- Rhodesian trypanosomiasis - Infective Stage → embryonated egg
– - Mode of Transmission → ingestion of infective egg
- Vector - glossina fly - tsetse fly - Habitat in Human → small intestine
- Mode of Transmission - vector’s bite - Portal of Entry → mouth - with larval migration
- Infective Stage - metacyclic trypomastigote - Portal of Exit → anus
- Habitat - reticular tissue (spleen, lymph and CSF) - Migrating Larvae → raffects man’s resp. Tract
- Reproduction - binary fission - High Infection → ascaris pneumonitis
Trypanosoma cruzi - Low Infection (Hypertensive patients) → Loeffler’s Syndrome (high Eosinophil)
- Amastigote - RES binary fission - Adult Worm → malnutrition
- Trypomastigote - CUS, do not multiply Trichuris Trichiura (Whipworm)
- Chaga’s disease | Romanas Sign | Chagoma - Infective Stage → embryonated egg
- Vector - triatomine bugs - Mode of Transmission → ingestion of infective egg
- MOT - vector - bugs feces - Habitat in Human → large intestine
- Infective Stage - metacyclic trypomastigote - Portal of Entry → mouth - no larval migration
- Habitat - RES / bloodstream - Portal of Exit → anus
- Reproduction - binary fission - Hatching takes place in the small intestine
Trypanosoma rangeli - Embryonated egg - takes place in the soil
- Amastigote - RES binary fission - Light Infection → asymptomatic - feed in the intestinal walls
- Trypomastigote - CUS, do not multiply / present in the blood throughout the infection - Heavy infection
- Chaga’s disease | Romanas Sign | Chagoma - Lead to anemia in trichuris, creates ulceration
- Vector - reduviid bugs, rhodius spp. - May cause Rectal prolapse
- MOT - vector - bugs feces Hookworms
- Infective Stage - metacyclic trypomastigote - Infective Stage - filariform larva
- Habitat - RES / bloodstream - Mode of transmission - skin penetration
- Reproduction - binary fission - Portal of Entry → skin
- Portal of Exit → anus - pass out eggs
- Habitat → small intestine
- Larva
- Causes ground itch / crolie itch
- Pulmonary lesions - lungs / larval migration
Leishmania spp. - Animal hookworms
- Vector - phlebotomus spp (sandfly) - Eruption , cutaneous larva migrans
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- Host specific
- Due to adult worm
- Hookworm anemia
- Microcytic hypochromic anemia - presence of hw in the intestine
- Due to attachment to the intestine and sucking of blood
- Hypoalbuminemia → loss of blood
- Fecalysis
- DFS
- Concentration technique
- Horada Mori stool culture
- Recovery of larvae