Microbiology Parasytology and Entomology

UNITED REPUBLIC OF TANZANIA
Ministry of Health and Social Welfare
CMT 04104 Microbiology,

Parasitology and
Entomology
NTA Level 4 Semester 1
Student Manual
August 2010
Copyright © Ministry of Health and Social Welfare – Tanzania 2010
CMT 04104 Microbiology, Parasitology and Entomology NTA Level 4 Semester 1 Student Manual
ii
Table of Contents
Background and Acknowledgement .............................................................................................. iv

Introduction .................................................................................................................................... ix
Abbreviations .................................................................................................................................. x
Microbiology Sessions
Session 1: Overview of Normal Flora, Pathogenic Organisms and Vectors .................................. 1
Session 2: Bacteria Cell Structure and Classification ..................................................................... 9
Session 3: Gram Positive Bacteria of Medical Importance .......................................................... 19
Session 4: Gram Negative Bacteria of Medical Importance ......................................................... 25
Session 5: Mycobacteria and Spirochaetes ................................................................................... 33
Session 6: Fungi ............................................................................................................................ 39
Session 7: Fungi of Medical Importance ...................................................................................... 47
Session 8: Viruses ......................................................................................................................... 55
Session 9: Classification of Viruses .............................................................................................. 61
Session 10: Herpes Viruses........................................................................................................... 69
Session 11: Human Immunodeficiency Virus [HIV].................................................................... 75
Session 12: Hepatitis B, Hepatitis C, Ebola and Marburg Viruses ............................................... 81
Session 13: Varicella Zoster, Measles, Mumps and Rubella Viruses........................................... 87
Session 14: Influenza and Respiratory Syncytial Viruses ............................................................ 91
Session 15: Poliovirus, Hepatitis A, Yellow Fever and Rabies Viruses ....................................... 95
Prasitology Sessions
Session 1: Overview and Classification of Parasites .................................................................. 105
Session 2: Entamoeba Histolytica, Giardia Lamblia and Balantidium Coli .............................. 115
Session 3: Cryptosporidium Parvum, Isospora Belli .................................................................. 125
Session 4: Ascaris Lumbricoides and Trichuris Trichiura .......................................................... 133
Session 5: Ancylostoma Duonale, Necator Americanus and Enterobius Vermicularis ............. 141
Session 6: Strongiloides Stercoralis ............................................................................................ 147
Session 7: Intestinal Cestodes -Taenia Saginata and Taenia Solium .......................................... 151
Session 8: Blood Trematodes – Schistosomes ............................................................................ 157
Session 9: Blood Protozoa - Trypanosomes ............................................................................... 163
Session 10: Blood Protozoa - Plasmodium ................................................................................. 167
Session 11: Blood Borne Helminths - Wucherelia Bancrofti ..................................................... 175
Session 12: Toxoplasma Gondii and Echinococcus Granulosus ................................................ 181
Session 13: Tissue Helminths - Onchocerca Volvulus ............................................................... 189
Session 14: Genito Urinary Protozoa - Trichomonas Vaginalis ................................................. 193
Entomology Sessions
Session 1: Overview and Classification of Vectors .................................................................... 199
Session 2: Insecta of Medical Importance [Diptera-Mosquito] .................................................. 203
Session 3: Insecta of Medical Importance: Diptera-Tsetse Flies, Simulium and Bed Bugs....... 209
Session 4: Insecta of Medical Importance - Siphonaptera (Fleas) .............................................. 217
Session 5: Insecta of Medical Importance-Anoplura [Lice] ....................................................... 223
Session 6: Mechanical Vectors of Medical Importance - Cockroaches and House Fly ............. 229
Session 7: Arachnids of Medical Importance (Ticks and Mites) ................................................ 239
Session 8: Mollusca of Medical Importance (Snails) ................................................................. 247
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Background and Acknowledgement
In April 2009, a planning meeting was held at Kibaha which was followed up by a Task
Force Committee meeting in June 2009 at Dodoma and developed a proposal which guided
the process of the development of standardised Clinical Assistant (CA) and Clinical Officer
(CO) training materials which were based on CA/CO curricula. The purpose of this process
was to standardize the entire curriculum with up-to-date content which would then be
provided to all Clinical Assistant and Clinical Officer Training Centres (CATCs/COTCs).
The perceived benefit was that, by standardizing the quality of content and integrating
interactive teaching methodologies, students would be able to learn more effectively and that
the assessment of students’ learning would have more uniformity and validity across all
schools.
In September 2009, MOHSW embarked on an innovative approach of developing the

standardised training materials through the Writer’s Workshop (WW) model. The model
included a series of three-week workshops in which pre-service tutors and content experts
developed training materials, guided by facilitators with expertise in instructional design and
curriculum development. The goals of WW were to develop high-quality, standardized
teaching materials and to build the capacity of tutors to develop these materials.
The new training package for CA/CO cadres includes a Facilitator Guide, Student Manual
and Practicum. There are 40 modules with approximately 600 content sessions. This product
is a result of a lengthy collaborative process, with significant input from key stakeholders and
experts of different organizations and institutions, from within and outside the country.
The MOHSW would like to thank all those involved during the process for their valuable
contribution to the development of these materials for CA /CO cadres. We would first like to
thank the U.S. Centers for Disease Control and Prevention’s Global AIDS Program
(CDC/GAP) Tanzania, and the International Training and Education Center for Health (I-
TECH) for their financial and technical support throughout the process. At CDC/GAP, we
would like to thank Ms. Suzzane McQueen and Ms. Angela Makota for their support and
guidance. At I-TECH, we would especially like to acknowledge Ms. Alyson Shumays,
Country Program Manager, Dr. Flavian Magari, Country Director, Mr. Tumaini Charles,
Deputy Country Director, and Ms. Susan Clark, Health Systems Director. The MOHSW
would also like to thank the World Health Organization (WHO) for technical and financial
support in the development process.
Particular thanks are due to those who led this important process: Dr. Bumi L.A.
Mwamasage, the Assistant Director for Allied Health Sciences Training, Dr. Mabula Ndimila
and Mr. Dennis Busuguli, Coordinators of Allied Health Sciences Training, Ministry of
Health and Social Welfare, Dr. Stella Kasindi Mwita, Programme Officer Integrated
Management of Adults and Adolescent Illnesses (IMAI), WHO Tanzania and Stella M.
Mpanda, Pre-service Programme Manager, I-TECH.
Sincere gratitude is expressed to small group facilitators: Dr. Otilia Gowele, Principal, Kilosa
COTC, Dr. Violet Kiango, Tutor, Kibaha COTC, Ms. Stephanie Smith, Ms. Stephanie
Askins, Julie Stein, Ms. Maureen Sarewitz, Mr. Golden Masika, Ms. Kanisia Ignas, Ms.
Yovitha Mrina and Mr. Nicholous Dampu, all of I-TECH, for their tireless efforts in guiding
participants and content experts through the process. A special note of thanks also goes to
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Dr. Julius Charles and Dr. Moses Bateganya, I-TECH’s Clinical Advisors, and other Clinical
Advisors who provided input. We also thank individual content experts from different
departments of the MOHSW and other governmental and non-governmental organizations,
including EngenderHealth, Jhpiego and AIHA, for their technical guidance.
Special thanks goes to a team of I-TECH staff namely Ms. Lauren Dunnington, Ms.
Stephanie Askins, Ms. Stephanie Smith, Ms Aisling Underwood, Golden Masika, Yovitha
Mrina, Kanisia Ignas, Nicholous Dampu, Michael Stockman and Stella M. Mpanda for
finalising the editing, formatting and compilation of the modules.
Finally, we very much appreciate the contributions of the tutors and content experts
representing the CATCs/COTCs, various hospitals, universities, and other health training
institutions. Their participation in meetings and workshops, and their input in the
development of content for each of the modules have been invaluable. It is the commitment
of these busy clinicians and teachers that has made this product possible.
These participants are listed with our gratitude below:
Tutors
Ms. Magdalena M. Bulegeya – Tutor, Kilosa COTC
Mr. Pius J.Mashimba – Tutor, Kibaha Clinical Officers Training Centre (COTC)
Dr. Naushad Rattansi – Tutor, Kibaha COTC
Dr. Salla Salustian – Principal, Songea CATC
Dr. Kelly Msafiri – Principal, Sumbawanga CATC
Dr. Joseph Mapunda - Tutor, Songea CATC
Dr. Beda B. Hamis – Tutor, Mafinga COTC
Col Dr. Josiah Mekere – Principal, Lugalo Military Medical School
Mr. Charles Kahurananga – Tutor, Kigoma CATC
Dr. Ernest S. Kalimenze – Tutor, Sengerema COTC
Dr. Lucheri Efraim – Tutor, Kilosa COTC
Dr. Kevin Nyakimori – Tutor, Sumbawanga CATC
Mr. John Mpiluka – Tutor, Mvumi COTC
Mr. Gerald N. Mngóngó –Tutor, Kilosa COTC
Dr. Tito M. Shengena –Tutor, Mtwara COTC
Dr. Fadhili Lyimo – Tutor, Kilosa COTC
Dr. James William Nasson– Tutor, Kilosa COTC
Dr. Titus Mlingwa – Tutor, Kigoma CATC
Dr. Rex F. Mwakipiti – Principal, Musoma CATC
Dr. Wilson Kitinya - Principal, Masasi ( Clinical Assistants Training Centre (CATC)
Ms. Johari A. Said – Tutor, Masasi CATC
Dr. Godwin H. Katisa – Tutor, Tanga Assistant Medical Officers Training Centre (AMOTC)
Dr. Lautfred Bond Mtani – Principal, Sengerema COTC
Ms Pamela Henry Meena – Tutor, Kibaha COTC
Dr. Fidelis Amon Ruanda – Tutor, Mbeya AMOTC
Dr. Cosmas C. Chacha – Tutor, Mbeya AMOTC
Dr. Ignatus Mosten – Ag. Principal, Tanga AMOTC
Dr. Muhidini Mbata – Tutor, Mafinga COTC
Dr. Simon Haule – Ag. Principal, Kibaha COTC
Ms. Juliana Lufulenge - Tutor, Kilosa COTC
Dr. Peter Kiula – Tutor, Songea CATC
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Mr. Hassan Msemo – Tutor, Kibaha COTC
Dr. Sangare Antony –Tutor, Mbeya AMOTC
Content Experts
Ms. Emily Nyakiha – Principal, Bugando Nursing School, Mwanza
Mr. Gustav Moyo - Registrar, Tanganyika Nursesand Midwives Council, Ministry of Health
and Social Welfare (MOHSW).
Dr. Kohelet H. Winani - Reproductive and Child Health Services, MOHSW
Mr. Hussein M. Lugendo – Principal, Vector Control Training Centre (VCTC), Muheza
Dr. Elias Massau Kwesi - Public Health Specialist, Head of Unit Health Systems Research
and Survey, MOHSW
Dr. William John Muller - Pathologist, Muhimbili National Hospital (MNH)
Mr. Desire Gaspered - Computer Analyst, Institute of Finance Management (IFM), Dar es
Salaam
Mrs. Husna Rajabu - Health Education Officer, MOHSW
Mr. Zakayo Simon - Registered Nurse and Tutor, Public Health Nursing School (PHNS)
Morogoro
Dr. Ewaldo Vitus Komba - Lecturer, Department of Internal Medicine, Muhimbili University
of Health and Allied Sciences School (MUHAS)
Mrs. Asteria L.M. Ndomba - Assistant Lecturer, School of Nursing, MUHAS
Mrs. Zebina Msumi - Training Officer, Extended programme on Immunization (EPI),
MOHSW
Mr. Lister E. Matonya - Health Officer, School of Environmental Health Sciences (SEHS),
Ngudu, Mwanza.
Dr. Joyceline Kaganda - Nutritionist, Tanzania Food and Nutrition Centre (TFNC),
MOHSW.
Dr. Suleiman C. Mtani - Obstetrician and Gynecologist, Director, Mwananyamala Hospital,
Dar es salaam
Mr. Brown D. Karanja - Pharmacist, Lugalo Military Hospital
Mr. Muhsin Idd Nyanyam - Tutor, Primary Health Care Institute (PHCI), Iringa
Dr. Judith Mwende - Ophthalmologist, MNH
Dr. Paul Marealle - Orthopaedic and Traumatic Surgeon, Muhimbili Orthopedic Institute
(MOI),
Dr. Erasmus Mndeme - Psychiatrist, Mirembe Refferal Hospital
Mrs. Bridget Shirima - Nurse Tutor (Midwifery), Kilimanjoro Chrician Medical Centre
(KCMC)
Dr. Angelo Nyamtema - Tutor Tanzania Training Centre for International Health (TTCIH),
Ifakara.
Ms. Vumilia B. E. Mmari - Nurse Tutor (Reproductive Health) MNH-School of Nursing
Dr. David Kihwele - Obs/Gynae Specialist, and Consultant
Dr. Amos Mwakigonja – Pathologist and Lecturer, Department of Morbid Anatomy and
Histopathology, MUHAS
Mr. Claud J. Kumalija - Statistician and Head, Health Management Information System
(HMIS), MOHSW
Ms. Eva Muro, Lecturer and Pharmacist, Head Pharmacy Department, KCMC
Dr. Ibrahim Maduhu - Paediatrician, EPI/MOHSW
Dr. Merida Makia - Lecturer Head, Department of Surgery, MNH
Dr. Gabriel S. Mhidze - ENT Surgeon, Lugalo Military Hospital
Dr. Sira Owibingire - Lecturer, Dental School, MUHAS
Mr. Issai Seng’enge - Lecturer (Health Promotion), University of Dar es Salaam (UDSM)
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Prof. Charles Kihamia - Professor, Parasitology and Entomology, MUHAS
Mr. Benard Konga - Economist, MOSHW
Dr. Martha Kisanga - Field Officer Manager, Engender Health, Dar es Salaam
Dr. Omary Salehe - Consultant Physician, Mbeya Referral Hospital
Ms Yasinta Kisisiwe - Principal Nursing Officer, Health Education Unit (HEU), MOHSW
Dr. Levina Msuya - Paediatrician and Principal, Assistant Medical Officers Training Centre
(AMOTC), Kilimanjaro Christian Medical Centre (KCMC)
Dr. Mohamed Ali - Epidemiologist, MOHSW
Mr. Fikiri Mazige - Tutor, PHCI-Iringa
Mr. Salum Ramadhani - Lecturer, Institute of Finance Management
Ms. Grace Chuwa - Regional RCH Coordinator, Coastal Region
Mr. Shija Ganai - Health Education Officer, Regional Hospital, Kigoma
Dr. Emmanuel Suluba - Assistant Lecturer, Anatomy and Histology Department, MUHAS
Mr. Mdoe Ibrahim - Tutor, KCMC Health Records Technician Training Centre
Mr. Sunny Kiluvia - Health Communication Consultant, Dar es Salaam
Dr. Nkundwe Gallen Mwakyusa - Ophthalmologist, MOHSW
Dr. Nicodemus Ezekiel Mgalula -Dentist, Principal Dental Training School, Tanga
Mrs. Violet Peter Msolwa - Registered Nurse Midwife, Programme Officer, National AIDS
Control Programme (NACP), MOHSW
Dr. Wilbert Bunini Manyilizu - Lecturer, Mzumbe University, Morogoro
Editorial Review Team

Dr. Kasanga G. Mkambu - Obstertric and Gynaecology specialist, Tanga Assistant Medical
Officers Training Centre (AMOTC)
Dr. Ronald Erasto Msangi - Principal, Bumbuli COTC
Mr. Sita M. Lusana - Tutor, Tanga Environmental Health Science Training Centre
Mr. Ignas Mwamsigala - Tutor (Entrepreneurship) RVTC Tanga
Mr. January Karungula - RN, Quality Improvement Advisor, Muhimbili National Hospital
Prof. Pauline Mella - Registered Nurse and Profesor, Hubert Kairuki Memorial University
Dr. Emmanuel A. Mnkeni – Medical Officer and Tutor, Kilosa COTC
Dr. Ronald E. Msangi - Principal, Bumbuli COTC
Mr. Dickson Mtalitinya - Pharmacist, Deputy Principal, St Luke Foundation, Kilimanjaro
School of Pharmacy
Dr. Janeth C. Njau - Paediatrician/Tutor, Kibaha COTC
Mr. Fidelis Mgohamwende - Labaratory Technologist, Programme Officer National Malaria
Control Programme (NMCP), MOHSW
Mr. Gasper P. Ngeleja - Computer Instructor, RVTC Tanga
Dr. Shubis M Kafuruki - Research Scientist, Ifakara Health Institute, Bagamoyo
Dr. Andrew Isack Lwali - Director, Tumbi Hospital
Librarians and Secretaries

Mr. Christom Aron Mwambungu - Librarian MUHAS
Ms. Juliana Rutta - Librarian MOHSW
Mr. Hussein Haruna - Librarian, MOHSW
Ms. Perpetua Yusufu - Secretary, MOHSW
Mrs. Martina G. Mturano -Secretary, MUHAS
Mrs. Mary F. Kawau - Secretary, MOHSW
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IT support
Mr. Isaac Urio - IT Consultant, I-TECH
Mr. Michael Fumbuka - Computer Systems Administrator – Institute of Finance and
Management (IFM), Dar es Salaam
Dr. Gilbert Mliga

Director of Human Resources Development, Ministry of Health and Social Welfare
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Introduction
Module Overview
This module content has been prepared to enhance learning of students of Clinical Assistant
(CA) and Clinical Officer (CO) schools.. The session contents are based on the sub-enabling
outcomes of the curricula of CA and CO. The module sub-enabling outcomes are as follows:
2.1.1 Describe micro-organisms, their characteristics, disease they cause and drug of choice
2.2.1. Describe parasites of medical importance, their life cycle and transmission, disease
they cause and drug of choice
2.2.2 Describe vectors of medical importance
Who is the Module For?

This module is intended for use primarily by students of CA and CO schools. The module’s
sessions give guidance on contents and activities of the session and provide information on
how students should follow the tutor when he/she teaches the module. It also provides
guidance and necessary information for students to read the materials on his/her own. The
sessions also include different activities which focus on increasing students’ knowledge,
skills and attitudes.
How is the Module Organized?

The module is divided into 37 sessions; each session is divided into several sections. The
following are the sections of each session:
• Session Title: The name of the session.
• Learning Objectives – Statements which indicate what the student is expected to have
learned at the end of the session.
• Session Content – All the session contents are divided into subtitles. This section
includes contents and activities with their instructions to be done during learning of the
contents.
• Key Points – Each session has a step which concludes the session contents near the end
of a session. This step summarizes the main points and ideas from the session.
• Evaluation – The last section of the session consists of short questions based on the
learning objectives to check if you understood the contents of the session. The tutor will
ask you as a class to respond to these questions; however if you read the session by
yourself try answering these questions to evaluate yourself if you understood the session.
• Handouts – Additional information which can be used in the classroom while the tutor is
teaching or later for your further learning. Handouts are used to provide extra information
related to the session topic that cannot fit into the session time. Handouts can be used by
the students to study material on their own and to reference after the session. Sometimes,
a handout will have questions or an exercise for students to answer.
How Should the Module be Used?

Students are expected to use the module in the classroom and clinical settings and during self
study. The contents of the modules are the basis for learning Microbiology, Parasitology and
Entomology. Students are therefore advised to learn all the sessions including all relevant
handouts and worksheets during class hours, clinical hours and self study time. Tutors are
there to provide guidance and to respond to all difficulty encountered by students. One
module will be assigned to 5 students and it is the responsibility of the tutor to do this
assignment for easy use and accessibility of the student manuals to students.
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Abbreviations
3TC Lamivudine
ABC Abacavir
AFB Acid Fast Bacilli
AIDS Acquired Immunodeficiency Syndrome
ATV Atazanavir
AZT/ZDV Zidovudine
BBE Benzyl benzoate emulsion
BHC Benzene Hexachloride
CMV Cytomegalo virus
CSF Cerebral Spinal Fluid
d4T Stavudine
ddI Didanosine
DDT Dichlorodiphenyltrichloroethane
DEET Diethyltoluamide
DIMP Dimethylpthalate
DNA Deoxyribonucleic acid
ds Double Stranded
EBV Epstein Bar Virus
ELISA Enzyme-Linked Immunosorbent Assay
FTC Emtricitabine
HA Hemagglutinin
HAV Hepatitis A virus
HBV Hepatitis B virus
HCV Hepatitis C virus
HHV Human Herpes Virus
HIV Human Immunodeficiency Virus
HSV Herpes Symplex Virus
HVS High Vaginal Swab
IGRS Insect Growth Regulators
LPV Lopinavir
mRNA Messenger Ribonucleic acid
NA Neuraminidase
NNRTIs Non-nucleoside reverse transcriptase inhibitors
NRTIs Nucleoside reverse transcriptase inhibitor
NVP Nevirapine
OCS Organochlorides
OPS Organophosphates
PCR Polymerace Chain Reaction
PID Pelvic inflammatory disease
PIs Protease inhibitor
RIA Rapid Immuno Assey
RNA Ribonucleic acid
RPR Rapid Plasma Reagin
RTV Ritonavir
SARS Severe Acute Respiratory Syndrome
x
SQV Saquinavir
ss Single Stranded
STI Sexually Transmitted Infections
TB Tuberculosis
TDF Tenofovir
U.V Ultra Violet
URTI Upper Respiratory Tract Infection
USA Unites States of America
UTI Urinary tract infection
VZV Varicella Zoster Virus
ZN Ziehl Nelsen Stain
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Microbiology
Session 1: Overview of Normal Flora, Pathogenic
Organisms and Vectors
Learning Objectives
By the end of this session, students are expected to be able to:
• Define normal flora, pathogens and vectors
• Identify normal flora found in different body parts
• Explain the importance of normal flora
• Explain different types of pathogens and vectors
• Describe general characteristics of pathogens and vectors
Definitions of Terms
• Normal floras: Are bacteria, fungi, and protozoa that live on or within the bodies of
animals and plants without doing any harm in healthy individuals.
o They may be commensalists or mutualists with regard to the host.
o Basically they do not harm the host; however they can even do some good.
• Pathogen: Is an organism which is capable to cause pathological condition to another
organism.
o Invasion of the body by pathogenic organism is called infection.
• Vector: Is an organism that conveys pathogens from one host to another.
Normal Flora Found in the Body and their Importance

• Normal flora tends to be commensal or mutual symbionts adapted to the special
conditions found in various body locations.
• Normal flora are found mostly:
o On Skin
o In Eyes
o In the nose
o In mouth and pharynx
o In urethra
o In lower GIT
o In vagina
o External ear
Refer to Handout 1.1: Bacterial Normal Flora of Different Parts of the Body
Types of Normal Flora
• Resident flora: Members of the normal flora that are always present at their specific site
of the body or re-establishes after being eliminated by antibiotics.
• Transient flora: Members of the normal flora that are not always present or present for
only a few days, weeks, or months before disappearing.
CMT 04104 Microbiology NTA Level 4 Semester 1 Student Manual

Session 1: Overview of Normal Flora, Pathogenic Organisms and Vectors 1
Importance of Normal Flora
• They compete for space and nutrients with pathogens (microbial antagonism)
• They are protective against pathogens hence they add up to the immunity of the body
• Some of them synthesize vitamins
• Enteric normal flora help with digestion
Types of Pathogens and Vectors
Types of Pathogens
• Microbiological pathogens
o These are the pathogens of microscopic size and include viruses, bacteria and fungi.
• Parasitological pathogens
o These are the pathogens which are larger in size as compared to microbiological
pathogens and include protozoans and helminths (worms).
Types of Vectors
• Biological vectors
o Vectors which can support life and/ or development of pathogenic organisms in their
tissues and transmit. Examples, mosquitoes, tsetse flies
• Mechanical vectors
o Vectors which transmit pathogens mechanically (no development of the pathogens
take place). Examples, houseflies and cockroaches.
Refer to Handout 1.2: Classification of Pathogens and Vectors
Characteristics of Pathogens and Vectors
Activity: Small Group Discussion
Instructions
You will work in groups to list characteristics of pathogens and vectors. Your group will
have approximately 5 minutes to discuss. One group will present their findings and other
groups will share in the discussion.
Characteristics of Pathogens
• All are living organisms
• They all cause disease by various mechanisms
• Can be found inside or outside the human body
• Some of them reproduce while in the human host, some of them in the vector
(intermediate host) and some of them outside the host
Refer to Handout 1.3: Characteristics and Comparison of Pathogens

Characteristics of Vectors
• They are all arthropods however snails which are intermediate hosts are conveniently
considered vectors.
• They are invertebrates.
• They are capable of transmitting diseases.
• Biological vectors can support development of pathogenic organisms in their tissues then
transmit the pathogens.
• Mechanical vectors cannot support development of the pathogenic organisms but can
transmit pathogens mechanically.
• The biological vectors feed on the host. For the pathogenic transmission to occur the
vector has to come in contact with the host looking for blood.
Key Points
• Normal flora is bacteria, fungi, and protozoa that live on or within the bodies of animals
and plants without doing any harm in healthy individuals.
• Pathogens are organisms which are capable of causing pathological condition to other
organisms.
• Pathogens are classified into different groups like viruses, bacteria, fungi, protozoa and
helminths based on their different characteristics.
• Vectors also bear different characteristic, therefore they are also classified into different
groups like mechanical and biological vectors respectively.
Evaluation
• What is a pathogen?
• What is a normal flora?
• What is the importance of normal flora?
• List types of microbiological pathogens?
• What are the characteristics of vectors?
References
• Becker, F.J. & Silverton, R.E. (1985). Introduction to Medical Laboratory Technology
(6th ed.). London: Butterworth.
• Black, J.G. (1996). Microbiology. Principles and Applications (3rd ed.). Prentice Hall.
Upper Saddle River, New Jersey. pp. 392-394, 395-397.
• Cook, G. (2000). Manson’s Tropical Diseases (22nd ed.). London: WB Saunders
Company Ltd.
• Greenwood, D., Richard, C.B.S. & John, F.P. (1992). Medical Microbiology
(4th ed.). Hong Kong: ELBS with Churchill Livingstone, Medical Division of Longman
Group, UK Ltd.
• Harwood, R.F. & James, M.T. (1979). Entomology in Human and Animal Health
(7th ed.). Pulman: Washington State University.
• Jawetz, Melnick, & Adelberg's. (2007). Medical Microbiology (24th ed.). USA: The
McGraw-Hill Companies, Inc.
• Levinson, W. (2004). Medical Microbiology and Immunology. Examination & Board,
(8th ed.). New York: International Edition Lange Medical Books /McGraw Hill Medical
Publishing & Davson,
• Monica, C. (1987). Medical Laboratory Manual for Tropical Countries. Volume 1
(2nd ed.). Oxford: ELBS Butterworth, Heinemann Ltd.

• Monica, C. (1998). District Laboratory Practice in Tropical Countries. Part 1. Tropical
Health Technology. NOIDA, India: Gapson Papers Ltd.
Health Technology. UK: Cambridge University Press
• Satish, G. (1982). The short Handbook of Medical Microbiology. New Delhi. India:
Jaypee Brothers Medical Publishers PVT Ltd.
• Tortora, G.J., Funke, B.R., & Case, C.L. (1995). Microbiology. An Introduction (5th ed.).
The Benjamin/Cummings Publishing, Co., Inc., Redwood City, CA, pp. 366-369.
• United Republic Of Tanzania. (2007). Training Course on Laboratory Diagnosis of
Malaria. Malaria Control Series 17. National Malaria Control Programme of the Ministry
of Health and Social Welfare.

Handout 1.1: Bacterial Normal Flora of Different Parts of the
Body
Body part Example of normal flora

Skin Staphylococcus epidermidis
Corynebacteria
Mycobacteria
Streptococcus pyogenes
Staphylococcus aureus
Eyes Staphylococcus epidermidis
Streptococcus pneumoniae
Neisseria species.
Escherichia coli
Proteus sp
Haemophilus influenzae
Corynebacteria
Nose Mycobacteria
Staphylococcus epidermidis
Neisseria sp.
Escherichia coli
Proteus sp
Haemophilus influenzae
Corynebacteria
Mouth and pharynx Staphylococcus epidermidis
Neisseria sp.
Escherichia coli
Proteus sp
Haemophilus influenza
Corynebacteria
Mycobacteria
Streptococcus mitis
Streptococcus salivarius
Streptococcus mutans
Enterococcus faecalis
Pseudomonas aeruginosa
Lactobacillus sp.
Actinomycetes
Spirochetes
Mycoplasmas

Clostridium species
Urethra Staphylococcus epidermidis
Streptococcus mitis
Neisseria sp
Escherichia coli
Proteus sp.
Bacteroides sp.
Corynebacteria
Mycobacteria
Mycoplasmas
Lower GIT Staphylococcus epidermidis
Streptococcus mitis
Escherichia coli
Proteus sp
Bacteroides sp.
Bifidobacterium bifidum
Lactobacillus sp.
Clostridium sp
Corynebacteria
Mycobacteria
Spirochetes
Mycoplasmas
Vagina Streptococcus pyogenes)
Streptococcus mitis
Neisseria sp.
Neisseria meningitidis
Escherichia coli
Proteus sp.
Bacteroides sp.
Lactobacillus sp.
Corynebacteria
Mycoplasmas
External ear Corynebacterium spp

Handout 1.2. Types of Pathogens and Vectors
PATHOGENS
Microbiological Parasitological
Viruses Bacteria Fungi Protozoans Helminths

(HIV) (Vibrio chorela) (candida/yeast) (Plasmodium) (Worms)
VECTORS
BIOLOGICAL MECHANICAL
VECTORS VECTORS
Musca Domestica
Cocroaches
INSECTA ARRACHINIDA MOLLUSCS
Mosquitoes
Tsetsefly Tick Mites
Simulium
Bed bugs
Fleas
Bullinus Biomphalaria Ornithodorus

Handout 1.3: Characteristics and Comparison of Pathogens
The table below shows characteristics of Pathogens (Fungi, Viruses, Bacteria, Protozoa and
Helminthesis)
Characteristics Viruses Bacteria Fungi Protozoa and

Helminths
Cell No Yes Yes Yes
Approximate 0.02 – 0.2 1-5 3-10 (Yeasts) 15-25
diameter (µm)1 (Trophozoites)
Nucleic acid DNA or RNA DNA and RNA DNA and RNA DNA and RNA
Type of No Nucleus Prokaryotic Eukaryotic Eukaryotic
Nucleus
Ribosomes Absent 70S 80S 80S
Mitochondria Absent Absent Present Present
Nature of outer Protein capsid Rigid cell wall Rigid wall Flexible
surface and lipoprotein containing containing chitin membranes
envelope peptidoglycan
Motility None Some None Most
Method of Not by binary Binary fission Budding or Mitosis3
replication fission mitosis 2
1
For comparison, a human red blood cell has a diameter of 7µm
2
Yeasts divide by budding where as mould divide by mitosis
3
Helminths cells divide by mitosis but the organism reproduces itself by complex, sexual life
cycles

Session 2: Bacteria Cell Structure and Classification
Learning Objectives
• Define the terms bacteriology, prokaryotic cell, eukaryotic cell and bacteria
• Describe the characteristics of a prokaryotic cell
• Describe structure and functions of each part of a bacterial cell
• Compare prokaryotic cells and eukaryotic cells
• Classify bacteria according to various criteria
Definitions of Terms
• Bacteriology: Is the study of bacteria.
• Prokaryotic cells: Are simple unicellular organism without a distinct nucleus and other
specialized cell structures. Example of prokaryotic cell is bacterial cell.
• Eukaryotic cells: Are cells that contain nucleus, a sack like structure that encloses a
cell’s genetic materials. The presence of nucleus differentiates eukaryotic cell from
prokaryotic cell.
• Bacteria: Are unicellular free living organisms without chlorophyll having both DNA
and RNA. They are capable of performing all essential processes of life example growth,
metabolism and reproduction.
Characteristics of Prokaryotic Cells

• The genetic material (DNA, RNA) of prokaryotic cells is not membrane-bounded
• Prokaryotes have no true nucleus and other membrane-bound structures known as
organelles.
• They normally possess just a single chromosome that is separated from other cell contents
by a membrane.
• The characteristics of prokaryotic cells apply to the bacteria, cyanobacteria (formerly
known as blue-green algae) and archaebacteria.
Structure of Bacterial Cell and Function of Each Part

Parts of a Bacterial Cell and their Functions
• Bacterial cell is comprised of the following parts
o Cell wall
o Capsule
o Flagella
o Pilli (Fimbriae)
o Cytoplasmic/Plasma membrane
o Mesosomes
o Cytoplasm
o Ribosomes
o Nucleoid material (DNA and RNA)
• Not all bacteria possess all of these components

Session 2: Bacteria Cell Structure and Classification 9
Figure 1: General Structure of Bacterial Cell
Source: Fox, 2010
Figure 2: Functions of Each Part of the Bacterial Cell

Cell Description Functions
component
Cell wall Is the outer most supporting • Protection of internal structures
layer which protects the (supporting layer)
internal structure of a cell • Gives shape to the cell
• Confers stability to osmotic pressure
(mucopeptide toughens the cell wall)
• Role in division of bacterial
• Offers resistance to harmful effect of
environment
Capsule Is gelatinous secretion of • Protection against deleterious agents
bacteria which gets organised (antibacterial agents) example lytic
as a thick coat around cell enzymes
wall • Contributes to the virulence of
pathogenic bacteria by inhibiting
phagocytosis
Flagella Are long contractile • They are organs of movements
filamentous appendages
Pilli Are (Fimbriae) hair like • They are organs of adhesion
filaments that extend from the • Facilitate transfer of genetic materials
cell surface. They are shorter from one bacteria to another
and straighter than flagella.

Cytoplasmic/ Is a thin and elastic layer • Controls the movement of water, ions,
Plasma surrounding a cytoplasm. It is nutrients and excretory substances in
membrane made of lipoproteins and and out of the cell.
phospholipids • Secrets extracellular hydrolytic enzymes
Cytoplasm Is a viscous watery solution or • Supports cellular structures like
soft gell containing a variety ribosome, nutrient granules, metabolites
of organic and inorganic plasmids and nucleoid materials
solutes
Mesosomes Is the invagination of the • Sites of respiratory enzymes in bacteria
cytoplasm membrane • Coordinates nuclear and cytoplasmic
division during binary fission
• Responsible for compartmenting DNA
at sporulation
Ribosomes Are small granules and pack • They are the sites for protein synthesis
the whole cytoplasm.
Nucleoid (site Is the area of the cytoplasm in • To store genetic information
for DNA and which DNA and RNA are • Responsible for mutation of a bacteria
RNA) located
Plasmids Are extra chromosomal DNA • They carry the genes and structures of
capable of independent medical importance example antibiotic
replication. They are found in resistance
the cytoplasm • Resistance to heavy metals such as
mercury
• Resistance to ultraviolet light
Comparison of Prokaryotic and Eukaryotic Cells
Instructions
You will work in small-sized groups.
Refer to:
• Worksheet 2.1: Comparison of Eukaryotic and Prokaryotic Cells
• Handout 2.1 Structure of Eukaryotic Cell
• Figure 1: General Structure of Bacterial Cell
Discuss and answer the questions listed in the worksheet for 10 minutes. One group will
present their findings and other groups will share in discussion.
Major Similarities between Prokaryotes and Eukaryotes

• They both have DNA and RNA as their genetic material
• They are both membrane bound
• They both have ribosomes
• They have similar basic metabolism
• They are both diverse groups

Figure 3: Main Distinguishing Features of Prokaryotic and Eukaryotic Cells
Features Prokaryotes Eukaryotes
Nucleus No enclosing membrane Enclosed by a membrane
Nucleolus Absent Present
Cell membrane Sterols absent Sterols present
composition
Cell wall composition Usually contain Usually contain cellulose or
peptidoglycan chitin
Mitochondria & Absent May be present
chloroplasts
Location of In the cytoplasm, usually Within a true nucleus separated
chromosomes attached to the cell membrane from the cytoplasm by a
nuclear membrane
Reproduction Normally asexual Asexual or sexual
Pilli Present Absent
Size Typically 1-5 micrometer Normally greater than 10
micrometer
Chromosome number One (1) More than one (1)
Nuclear division Mitosis & meiosis are absent Exhibit mitosis & meiosis
Classification of Bacteria
• Bacteria are classified according to a number of criteria, including:
o Morphology
o Staining characteristics
o Nature of cell wall
o Ability to form spores
o Ability to grow in the presence or absence of oxygen
Classification of Bacteria According to Morphology/Shape

• Cocci: These are round or oval shaped bacteria. When multiplying cocci may form
o Pairs (called diplococci for example meningococci and gonococci)
o Chains (called streptococci example Streptococcus pyogenes)
o Irregular groups or clusters (called staphylococci, example is staphylococcus aureus)
• Bacilli: These are rod shaped bacteria. When multiplying bacterial rods do not usually
remain attached to one another, but separate. Occasionally however, they may form
o Chains, example are Streptobacilli
o Branching chains, example are Lactobacilli
o Mass together; example is Mycobacterium leprae
o Remains attached at various angles example Corynebacterium diphtheria
• Spiral: These are small regularly coiled, rigid organisms. Examples Spirillum minus
• Comma shaped: These are small slightly curved rods (comma shaped). Example Vibrio
cholera
• Spirochaetes: These are flexible, coiled, motile organisms they progress by rapid body
movement. Example, treponema species, borrelia species, and leptospires.
Refer to Handout 2.2: Classification of Bacteria According to Morphology

Classification of Bacteria according to Staining Characteristics.

• Gram positive: When stained by Gram stain, appears blue reflecting the colour of primary
stain (either gentian violet, crystal violet or methyl violet). Examples, Staphylococci
species, Streptoccoci species. Clostridium tetani.
• Gram negative bacteria are bacteria which appears red, after losing the colour of primary
stain and adapting the colour of a counter stain (dilute carbofuchsin or safranin, or neutral
red) when stained by Gram stain
o Examples, neisseria species, salmonella species, haemophilus species
Classification of Bacteria According to Nature of Cell Wall

• Rigid thick wall for examples streptococcus, staphylococcus
• Wall less for example Mycoplasma
Classification of Bacteria According to Ability to Form Spores

• Spores are highly resistant dormant state of bacteria with dense thick walls able to
withstand dehydration heat, cold and action of disinfectants.
• In this kind of classification there are
o Spore forming bacteria for examples bacillus species and clostridium species
o Non spore forming bacteria for examples corynebacteria species like corynebactrium
diphtheria
Classification of Bacteria According to Ability to Grow in the Presence or Absence of

Air
• Grows in the presence of air (aerobic bacteria) for example bacillus anthracis
• Grows in the absence of air (anaerobic bacteria) for example clostridium species.
Key Points
• Bacteria fall under the group of prokaryotic cells which are simple cells as compared to
eukaryotic cells.
• Absence of the membranes to bind the internal organelle structures in the prokaryotes
makes the major difference with the eukaryotic cells.
• Bacteria are classified based on their morphology, staining characteristics, nature of cell
wall, ability to form spores and ability to grow in the presence or absence of oxygen.
Evaluation
• What are the structural features of bacterial cell?
• What are the differences between prokaryotic cell and eukaryotic cell?
• What are the 5 criteria for classification of bacteria and give examples?
References
• Arabslab. (2010). The Morphology and Fine Structure of Bacteria. Retrieved on 16th
March 2010 from www.arabslab.com/vb/showthread.php?t=577.
• Fox, A. (2010). Bacteriology - Chapter One, the Bacterial Cell. Microbiology and
Immunology. University of South Carolina School of Medicine. Retrieved on 16th March
2010 from pathmicro.med.sc.edu/fox/protype.htm.

• Greenwood, D., Richard, C.B.S. & John, F.P. (1992). Medical Microbiology
(4th ed.). Hong Kong: ELBS with Churchill Livingstone, Medical Division of Longman
Group, UK Ltd.
• Jawetz, Melnick, & Adelberg's. (2007). Medical Microbiology (24th ed.). USA: The
• Levinson, W. (2004). Medical Microbiology and Immunology. Examination & Board,
(8th ed.). New York: International Edition Lange Medical Books /McGraw Hill Medical
Publishing & Davson.
• Michael W. Davidson (2004). Anatomy of the Animal Cell. Retrieved on 16th March
2010 from http://micro.magnet.fsu.edu/cells/animals/animalmodel.html.
Health Technology. Noida, India: Gapson Papers Ltd.
Health Technology. UK: Cambridge University Press.
• Satish, G. (1982). The Short Handbook of Medical Microbiology. New Delhi. India:

Worksheet 2.1: Comparison of Eukaryotic and Prokaryotic
Cells
Instructions
1. Choose a presenter for your group. The presenter will share your group’s opinions and
answers with the larger group.
2. Choose a recorder for your group. The recorder will document group’s opinions on flip
chart or on this worksheet.
3. Discuss the questions together and answer them in 10 minutes.
1. What are the similarities between prokaryotic and eukaryotic cells?
2. What are the differences between prokaryotic and eukaryotic cells?

Handout 2.1: Structure of Eukaryotic Cell
Source: Michael W. Davidson, 2004

Handout 2.2: Classification of Bacteria According to
Morphology
Source: Arabslab, 2010

Session 3: Gram Positive Bacteria of Medical
Importance
Learning Objectives
• Define Gram positive bacteria
• List Gram positive bacteria of medical importance
• Describe characteristics of Gram positive bacteria of medical importance; diseases they
cause, diagnostic techniques and drug of choice
Definition of Gram Positive Bacteria

• Gram positive bacteria: Bacteria which appear blue when stained by Gram staining
technique; reflecting the colour of primary stain (either gentian violet, crystal violet or
methyl violet).
• Examples of Gram positive bacteria of medical importance include, Staphylococci
aureus, Staphylococcus epidemidis, Staphylococcus saprophyticus, Streptococci
pyogenes, Streptococcus agalactiae, Streptococcal pneumoniae, Clostridium and Bacillus
species.
Staphylococcus Bacteria of Medical Importance
General Characteristic
• They are Gram positive cocci bacteria in clusters
• They are round shaped
• All are catalase positive (produce enzyme, catalase that resists the effect of hydrogen
peroxide.)
• They produce beta lactamase enzyme making it resistant to penicillin
• Staphylococcus aureus is coagulase positive (they cause clotting of plasma, hence they
are resistant to phagocytosis)
Figure1: Staphylococci Bacteria: Disease they Cause, Diagnosis and Drugs of Choice
Species Diseases they Cause Lab Diagnosis Drug of Choice
S. aureus • Abscesses Specimens • Cloxacillin
• Food poisoning • Pus • Penicillin
• Toxic shock • Blood • Erythromycin
syndrome • Other body fluids • Azithromycin
• Surgical wound • Ceftriaxone
infections Techniques • NB Depending on
• Septicaemia • Gram stain (pus smear sensitivity
• Cellulitis and other body fluids )
• Osteomyelitis • Culture
S. epidemidis • Neonatal sepsis Specimens • Vancomycin +
• Endocarditis on • Pus Rifampicin
prosthetic • Blood • NB Depending on
(artificial) heart • Other body fluids sensitivity
valves
Techniques

Session 3: Gram Positive Bacteria of Medical Importance 19
• Gram stain (pus smear
and other body fluids )
• Culture
S. Saprophyticus • Urinary tract Specimens • Penicillin G +
infection (UTI) • Urine Gentamycin
• Blood
• High Vaginal Swab • Note: Depending
(HVS) on sensitivity
Techniques
• Culture
• Gram stain
Streptococci Bacteria of Medical Importance
General Characteristics
• Gram positive cocci in short and long chains
• All are catalase negative
Classification of Streptococci
• According to their level of haemolysis in blood agar
o Alpha haemolytic streptococci (partial hemolysis) for example S. pneumoniae,
o Beta haemolytic streptococci (complete haemolysis) for examples S. pyogenes
• According to lancefield grouping (based on antigenic differences in their cell walls)
o Streptococci are arranged into lancefield groups A to U denoting the antigenic mark.
Example of lancefield group A is S. pyogenes and lancefield group B S. agalactiae
Note: Lancefield grouping does not apply to S. pneumoniae
The rest of lancefield groups ‘C’ to ‘U’ will not be discussed at this point
Figure.2: Streptococci Bacteria: Disease They Cause, Diagnosis and Drugs of Choice
Species Diseases they Cause Laboratory Diagnosis Drug of Choice
S. pyogenes • Pharyngitis (URTI) Specimens include • Penicillin G
• Cellulitis • Throat swabs • Erythromycin
• Immunological • Urine • Azithromycin
diseases for example • Blood
o Rheumatic
fever Techniques
o Glumeruloneph • Culture
ritis • Gram stain
• Serology of blood sample
(Antibody antigen
reaction)
S. pneumoniae • Pneumonia Specimens include • Penicillin G
• Mengitis • Cerebral spinal fluid • Chloramphenical
• Otitis Media (CSF) • Benzylpenicillin
• Sinusitis • Pus • Cloxacillin
• Blood • Ceftriaxone
Techniques
• Gram stain

• Culture of CSF and blood
S. agactiae • Neonatal Meningitis Specimens include • Penicillin G
• Sepsis • Cerebral spinal fluid • Chloramphenical
(CSF) • Benzylpenicillin
• Blood • Cloxacillin
• Ceftriaxone
Techniques
• Gram stain
• Culture of CSF and blood
Clostridium Bacteria of Medical Importance
General Characteristics of Clostridium Bacteria

• Contain species of Gram positive anaerobic spore forming rods
• Few are aero tolerant (Aerobic)
• They are widely distributed in soil and in the gut of man and animals
• They are saprophytic bacteria
• The spores are resistant to environmental conditions
• The major diseases associated with these species are tetanus, gangrene, botulism food
poisoning, and pseudo membranous colitis
• In each of these, the production of potent protein exotoxins is an important course of
pathology. Example clostridium tetani, clostridium perfringens, clostridium botulinum,
clostridium difficile
Figure 3: Morphological Feature (Bacilli, Drum Stick Appearance) of Clostridium Species

After Gram Stain
Source: Todar, 1997

Figure 4: Characteristics of Clostridium Bacteria, Disease they Cause, Diagnosis and Drugs
of Choice
Species and Diseases they Lab Diagnosis Drug of Choice
Characteristics Cause
C. Tetani • Tetanus Specimens include • Metronidazole
• Round terminal • Pus • Penicillin G
spores • Infected tissue
• Strictly anaerobic
• Non-branching Techniques
rods • Gram stain
• Culture
C. perfringens • Gas gangrene Specimens include • Penicillin
• Facultative from infected • Pus • Metronidazole
anaerobes ischemic • Infected tissue • Clindamycin
• Spore forming, wound
but spores rarely • Food Techniques
seen in infected poisoning • Gram stain
materials • Culture
C. botulinum • Botulism Specimens include • Penicillin
• Facultative • Food sample
anaerobes
Techniques
• Culture
C. difficile • Gastroenteritis Specimens include • Vancomycin
• Facultative • Pseudo • Stool • Metronidazole
anaerobes membranous
• Spore forming colitis Techniques
• Motile • Culture
Bacillus Species of Medical Importance
General Characteristic of Bacillus Group

• Widely distributed in nature
• Most of them live as saprophytes in the soil, dust, water and vegetation
• They are able to form resistant spores
• Their spores are centrally located
• Spores are formed only after the organism is shed from the body
• They are strictly aerobes
• Bacillus anthracis is a major pathogen of cattle, sheep, goats, and pigs
• The bacilli are excreted in the feaces, urine, and saliva of infected animals
• Bacilli can also be found in pastures which have been contaminated by anthrax spores
form bodies of dead animals, and can remain the source of infection for many years
• The size of the spore is the same as the size of the width of the bacteria

Figure 5: Morphological features of Bacillus Species after Gram Stain
Source: Todar, 1997
Figure 6: Bacillus Bacteria, Disease they Cause, Diagnosis and Drugs of Choice

B. anthracis • Cutaneous anthrax Specimens include • Penicillin
• Enteric (intestinal) • Pus • Streptomycin
anthrax • Body fluid • Cotrimoxazole
• Pulmonary anthrax • Blood
• Meningitis (Occurs • Sputum
following bacteraemia)
Techniques
• Gram stain
• Culture
Key Points
• Gram positive bacteria are determined by Gram staining when they retain the colour of
primary stain.
• There is a large group of Gram positive bacteria but only some causes diseases to man.
These including staphylococcus species, streptococcus species, clostridium species and
bacillus species.
• Most of these bacteria are detected or diagnosed by Gram staining of the direct sample
however, most of clostridium species requires culture of the tissue or sample before
staining.
Evaluation
• What are Gram positive bacteria?
• What are the examples of Gram positive organisms of medical importance?
• What are the morphological differences of staphylococci and streptococci groups?
• What are the diseases caused by staphylococci aureus?

References
(6th ed.). Butterworth London.
• Cook, G. (2000). Manson’s Tropical Diseases. (22th ed.). London: WB Saunders
Company Ltd.
• Greenwood, D. Richard, C.B.S., & John, F.P. (1992). Medical Microbiology (4th ed.).
Hong Kong: ELBS with Churchill Livingstone, Medical Division of Longman Group,
UK Ltd.
• Jawetz, Melnick, & Adelberg's. (2007). Medical Microbiology (24th ed.) USA: The
• Levinson, W. (2004). Medical Micribiology and Immunology (8th Ed.). Examination &
Board. New York: International Edition Lange Medical Books /McGraw Hill Medical
• Monica, C. (1987). Medical Laboratory Manual for Tropical Countries (2nd ed.) Volume
1 Oxford: ELBS Butterworth, Heinemann Ltd.

Session 4: Gram Negative Bacteria of Medical
Importance
Learning Objectives
• Define gram negative bacteria
• Describe characteristics of gram negative cocci bacteria
• Classify gram negative bacilli of medical importance
• List laboratory diagnosis, diseases caused and drug of choice for gram negative cocci
bacteria
• Describe individual characteristics of Gram negative bacilli of medical importance
• Describe individual characteristics of Yersinia and Brucella
Definition of Gram Negative Bacteria

• Gram negative Bacteria: Bacteria which appears red, after losing the colour of primary
stain and adapting the colour of a counter stain (dilute carbofuchsin or safranin, or neutral
red) when stained by Gram stain.
o Examples of Gram negative bacteria of medical importance are neisseria species,
salmonella species, haemophilus species, and vibrio cholera.
Characteristics of Gram Negative Cocci

• Bean shaped cocci
• The pathogenics are intracellular (they live inside the host cell normally
polymorphonuclear cells like macrophages)
• Oxidase positive
• Have pilli
• Non motile
• Non sporing
Figure 1: Gram Negative Cocci Bacteria, Diseases they Cause, Laboratory Diagnosis and
Drug of Choice (Neisseria Species)
Species Diseases They Cause Lab Diagnosis Drug of Choice
Neisseria • Gonorrhea Specimens include • Ceftriaxone
Gonorrhoea • Conjuctivitis in • HVS • Doxcycline
(gonococci) infants • Blood • Ciprofloxacine
• Human cell is (Conjuctivitis • Urethral • Azithromycin
the only host neonatorum) Pelvic discharge • Erythromycin
• Beta lactamase inflammatory • Eye swab
group disease (PID) • Synovial (Joints)
• URTI Culture fluid
Technique
• Gram staining
• Culture
Neiseria • Meningitis Specimens include • Penicillin G
Meningitidis • Meningococcemia • CSF • Ceftriaxone
• Blood • Benzylpenicillin

Session 4: Gram Negative Bacteria of Medical Importance 25
• They have large
polysaccharide Techniques
capsule • Gram staining
• Culture
Classification of Gram Negative Bacilli (rods) of Medical Importance
According to the Site of Infection

• Those related to gastrointestinal tract
o Examples, Eschelichia colli, Salmonella species, Shigella species, Vibrio species
(Enterobacteriaceae)
• Those related to respiratory tract
o Example, Haemophilus species
• Related to Reticulo endothelial organs like liver and spleen
o Example, Brucella species
According to Animal Source

• Those which are transmitted from animals to humans (zoonotic organisms)
o Examples Brucella species and Yersinia species
Characteristics of Vibrio Cholera and Escherichia Coli

V. Cholerae
• Curved, comma shaped Gram negative rod
• Motile
• Tolerant to alkaline environment
• Grows rapidly in the pH range of 7.4 to 9.6
• Facultative anaerobe
Figure 2: Vibrio Cholera
Source: CDC, 2009
E.Coli
• Motile with or without capsule
• Facultative anaerobe
• Capable of growing at 44 Degree Centigrade

• Lactose fermentors
Figure 3: E.coli
Source: Wadsworth Centre, 2010
Figure 4: Vibrio and E. coli: Diseases Caused, Laboratory Diagnosis and Drug of Choice
V. cholerae Cholera Specimen • Tetracycline
• Rectal swab • Erythromycin
• Stool • Doxycycline
• Vomitus
• Food sample
Technique
• Culture
• Serology
E. coli • UTI Specimen • Cotrimoxazole

• Sepsis • CSF • Nitrofurantoin
• Neonatal Meningitis • Blood • Amoxicillin
• Diarrhoea • Urine • Cephalosporins
• Stool • Gentamicin
Techniques
• Gram stain
• Culture
Characteristics of Shigella and Salmonella

• Gram negative rods
• Non spore forming
• Capable of aerobic and anaerobic respiration

Figure 5: Salmonella and Shigella Bacteria
Species Diseases Tthey Cause Lab Diagnosis Drug of Choice
S.typhi • Typhoid fever Specimens • Chloromphenical
• Capsulated • Meningitis • Stool • Co-trimoxazole
• Non lactose • Diarrhoea diseases • Blood • Ciprofloxacin
fermentor • Osteomyelitis • Urine
Techniques
• Gram stain
• Culture
• Serology ( widal
and rapid test)
S.paratyphi • Enterocollitis Specimens • Chloromphenical
• Motile • Septicemia • Stool • Co-trimoxazole
• Non lactose • Food poisoning • Blood • Ciprofloxacin
fermentor • Vomitus
• Produces • Food remains
hydrogen
sulphide Techniques
(H2S) • Gram stain
• Culture
• Serology
S. boydii • Shigellosis Specimens • Co-trimoxazole
S. dysenteriae • Stool • Nalidixic acid
S. flexneri • Ciprofloxacin
S. sonnei Techniques
• Gram stain
Non motile • Culture
Characteristics of Yersinia and Brucella

Genus Yersinia
• The genus Yersinia includes species which are short, pleomorphic Gram-negative rods
that can exhibit bipolar staining.
• Catalase-positive, oxidase-negative, and microaerophilic or facultatively anaerobic.
• Most have animals as their natural hosts, but they can produce serious disease in humans.
• Yersinia species of medical importance includes
o Yersinia pestis, cause of plague in human
o Yersinia pseudotuberculosis cause of disease which resembles tuberculosis
o Yersinia enterocolitica, important causes of human diarrhea diseases
Characteristics of Yersinia Pestis

• Y. pestis is a Gram-negative rod that exhibits striking bipolar staining with special stains
giving its characteristic safety pin appearance.
• Not motile
• Grows as a facultative anaerobe on many bacteriologic media
• Growth is more rapid in media containing blood or tissue fluids and fastest at 30 °C
• Aerobic

Figure 6: Morphological Appearance of Giemsa Stained Yersinia Pestis
Source: Brooks, Butel, Morse et al, 2007
Figure 7: Yersinia: Diseases They Cause, Laboratory Diagnosis and Drug of Choice
Species Diseases they Cause Lab Diagnosis Drug of choice
Y. pestis Plague Specimen • Gentamicin
• Blood • Streptomycin
• Sputum
• Bubo aspirate
• CSF
Techniques
• Gram stain
• Culture
Characteristics of Breucella Group

• Gram negative rods
• Intracellular
• Aerobic
• Non capsulated

Figure 8: Brucella Group: Diseases Caused, Laboratory Diagnosis and Drug of Choice
Diseases they
Species Lab Diagnosis Drug of Choice
Cause
B. abortus Undulant fever Specimen • Doxycycline
B. Melitensis • Blood • Gentamicin
B. suis • Pus • Streptomycin
Technique
• Serology
• Gram staining
• Culture
Haemophilus Species [Haemophilus Influenza and Haemophilus Ducreyi]
• Small non motile Gram negative coccobacillae (rods with round ends)
• Aerobic
• Capsulated
Figure 9: Brucella Group: Diseases they Cause, Laboratory Diagnosis and Drug of Choice
Species Diseases They Cause Lab Diagnosis Drug of Choice
H. influenza • Meningitis in young Specimen • Ceftriaxone

children under 5 years • CSF
• Pneumonia • Nasal pharyngeal
• Acute epiglotitis swabs
• Cellulitis • Blood
Technique
• Culture
• Gram staining
H. ducreyi • Chancroid Specimen • Ceftriaxone
• Pus • Co-trimoxazole
• Doxycycline
Technique
• Culture
• Gram staining
Key Points
• Gram negative bacteria lose the colour of primary stain and adapt the colour of secondary
(Counter stain) stain.
• There is a large group of Gram negative bacteria but only some causes diseases to man,
including Neisseria spp, Haemophilus spp, Vibrio. Gonorhoea, N.meningitids, Vibrio
cholera.
• Most of these organisms are diagnosed by doing Gram staining, culture, and serological
tests.

Evaluation
• What is the Gram negative bacteria related to gastrointestinal tract?
• Which specimen is collected in order to diagnose cholera?
• What are the diseases caused by Neisseria gonorrhoea?
References
(6th ed.) London: Butterworth.
• Brooks, G.F., Butel, J.S., Morse, S.A. et al, (2007). Medical Microbiology (24th ed.). New
York: McGraw- Hill.
Company Ltd.,
• Greenwood, D., Richard, C.B.S, & John, F.P. (1992). Medical Microbiology (4th ed).
Hong Kong: UK: ELBS with Churchill Livingstone, Medical Division of Longman
Group, UK Ltd.
• Jawetz, Melnick, & Adelberg's. (2007). Medical Microbiology (4th ed.). United States of
America: The McGraw-Hill Companies, Inc.
• Levinson, W. (2004). Medical Micribiology and Immunology. (8th ed.). Examination &
Board Review. (8th ed.). New York: International Edition Lange Medical Books /McGraw
Hill Medical Publishing & Davson.
• Monica, C. (1987). Medical Laboratory Manual for Tropical Countries. (2nd ed.).
Volume 1. (2nd ed.). Oxford: ELBS Butterworth, Heinemann Ltd.
Health Technology, UK: Cambridge University Press.
• Satish, G. (1982). The Short Handbook of Medical Microbiology. New Delhi, India:
• Wadsworth Centre. (2010). Bacteria: Escherichia coli. New York : State Department of
Health. Retrieved May 5th, 2010 from www.wadsworth.org/databank/ecoli.htm.

Session 5: Mycobacteria and Spirochaetes
Learning Objectives
• Define mycobacterium and spirochaetes
• Describe general characteristics of mycobacterium and spirochaetes of medical
importance
• Describe mycobacterium and spirochaetes of medical importance on diseases they
cause, laboratory diagnosis and drug of choice
Definition of Mycobacterium
• Mycobacterium: Is a rod-shaped, aerobic bacteria that do not form spores.
• They do not stain readily by conventional stains, once stained by Ziehl Neelsen stain they
resist decolorization by acid or alcohol and are therefore called "acid-fast" bacilli (AFB).
Examples include Mycobacterium tuberculae, mycobacterium leprae, Mycobacterium
bovis, M. kansasii, M. avium intracellulare
General Characteristics and Morphology of Mycobacteria

(Acid Fast Bacilli)
• They are slightly curved rod shaped, thin, and filamentous forms are common
• Cell wall contains high concentration of lipids - mycolic acids (hence Mycobactirum)
• Obligate aerobes
• Acid-fast bacilli
• They are very sensitive to UV light
• Very slow growing (temperature for growth ranges from 35 to 37oC)
• They are also called Acid Fast bacilli however they are resistant to acids
Figure 1. Mycobacteria
Source: Dennis Kunkel

Microscopy, Inc, 2010

Session 5: Mycobacteria and Spirochates 33
Figure 2: Mycobacterium Tuberculae
Source: Delisie & Tomalty, (2002)
• The figure shows rod-shaped Acid-fast stain viewed through electronic

microscope. 1000X magnification
Mycobacteria of Medical Importance

• Mycobacteria specie of medical importance includes M.tuberculae and M. leprae.
Figure 3: Mycobacterium Species of Medical Importance

Diseases they
Cause
M. tuberculae • Tuberculosis Specimen • Rifampicin, (R)
• Obligate aerobe o Pulmonary • Sputum Isoniazid, (H)
• Replication takes o Extra • Gastric washings Ethambutol, (E)
place pulmonary TB • Urine Pyrazinamide
extracellularly • Pleural fluid (Z),
• Cerebrospinal fluid Streptomycin
• Synovial fluid (S)
• Biopsy material
• Blood
Technique
• Ziehl Neelsen Stain
(ZN stain)
• Culture
M. leprae • Leprosy Specimen • Dapsone
• Replication is • Skin smear • Clofazimine
intracellular • Nasal scrapings • Rifampicin
within
macrophages Technique
• Found singly or • ZN
in bundles

Definition of Spirochaetes
• Spirochaetes: Are thin walled, flexible spiral shaped bacteria.
• Examples of spirochaetes include Treponema species, Borrelia species.
General Characteristics and Structure of Spirochaetes

• They are thin walled flexible, spiral rods
• They are motile
• They are flagellated (endoflagella)
• They are not readily stained by Gram stain
• They have a lipid rich outer membrane
General Structure
• The spirochaetes cell consists of a protoplasmic cylinder surrounded by plasma
membrane and Gram-negative type cell wall.
• They have axial fibrils, periplasmic flagella or endoflagella located in the periplasm.
• The whole complex of periplasmic flagella is called axial filament.
• Both the axial filament is surrounded by a multilayered but flexible outer membrane.
Refer to Handout 5.1: Structure of Spirochaetea
Spirochaetes of Medical Importance

Figure 4: Spirochaetes of Medical Importance
Diseases they
Cause
T. pallidum Syphilis Specimen • Benzathin Penicillin
• Fine • Serous fluid from • Benzyl penicillin
cytoplasmic chancre • Erythromycin
filaments • Blood
• Biopsy
Technique
• Dark field illumination
• Serology (RPR)
• Silver impregnation
B. duttoni • Tick borne Specimen • Penicillin
relapsing • Blood • Tetracycline
fever • Doxycycline
Technique
• Giemsa stained blood
slide
B. recurentis and • Louse borne Specimen • Penicillin
B. hermsii relapsing • Blood • Tetracycline
fever • Doxycycline
Technique
• Giemsa stained blood
slide

Key Points
• Mycobacterium is a rod-shaped, aerobic bacteria, acid-fast" bacilli that do not form
spores.
• Mycobacterium species are the causative agents of tuberculosis and leprosy in human.
• Mycobacterium contains wax material (mycolic substance) at an outer part which is
removed by heating and use of strong acids (Sulphuric acid).
• Species of medical importance are Mycobacterium tuberculae and Mycobacterium
leprae.
• Spirochaetes are thin walled, flexible spiral shaped bacteria.
• Sprachaetes are responsible for causation of a number of diseases to human including
Syphilis and relapsing fever.
• Spirochates of medical importance includes Treponema pallidum the causative agent of
syphilis and Borreia duttoni the causative agent of relapsing fever.
Evaluation
• What are the characteristics of Mycobacterium?
• What are the diseases caused by Mycobacterium?
• What are the general characteristics of spirochaetes?
• What are Spirochaetes of medical importance?
References
(6th ed.). Butterworth.
• Cook, G, (2000). Manson’s Tropical Diseases (22th ed.). London: WB Saunders
Company Ltd.
• Delisle, G., & L. Tomalty. (2002). Mycobacterium Tuberculosis. MicrobeLibrary,
American Society for Microbiology, Washington, DC. Retrieved from http://www.
microbelibrary.org/Laboratory%20Diagnostics/details.asp?id=703&Lang=English.
• Dennis Kunkel Microscopy Inc. (2010). Microscopy Photographs (science images,
electron microscope images, photomicrographs, microscopy photos, microscope photos,
microscopic pictures). Retrieved from http://www.denniskunkel.com/.
• Greenwood, D. Richard, C.B.S., John, F.P. (1992). Medical Microbiology (4th ed). Hong
Kong: ELBS with Churchill Livingstone, Medical Division of Longman Group, UK Ltd.
• Melnick, J. & Adelberg's (2007). Medical Microbiology (24th ed). United States of
• Levinson, W. (2004). Medical Microbiology and Immunology. Examination & Board
Review (8th ed.). New York: International Edition Lange Medical Books /McGraw Hill
Medical Publishing & Davson.
• Monica, C. (1987). Medical Laboratory Manual for Tropical Countries (2nd ed.).
Volume 1. Oxford: ELBS Butterworth, Heinemann Ltd.
• Satish, G. (1982). The Short Handbook of Medical Microbiology. New Delhi. India:

Handout 5.1: Structure of Spirochaetes
The figure below shows Spirochaetes

• A: Cross section of a spirochete showing the location of endoflagella between the inner
membrane and outer sheath;
• B: Borrelia
• C: Treponema pallidum
A B C
Source: Todar, 1997
1. Insertion pore
2. Axil Fibril
3. Protoplasmic Cylinder
4. Outer Sheath
Cross Section Showing Morphological Details
1. Nucleoid
2. Ribosome
3. Axial Fibril
4. Plasma Membrane
5. Protoplasmic Cylinder
6. Cell wall
7. Microtubule
8. Outer Sheath
Source: Todar, 1997

Session 6: Fungi
Learning Objectives
• Define fungi
• List the characteristics of fungi
• Describe the structure of fungi
• Classify fungi
Definition of Fungi
• Fungi: Are eukaryotic organisms that exist in two forms; yeasts (cells) and moulds
(filaments). Examples of fungi include Candida albicans, Cryptococcus newformans,
and Dermatophytes species.
• Mycology: Is the study of fungi.
Structure and Characteristic of Fungi
Morphological Characteristics
• They have at least one nucleus and nuclear membrane
• They have endoplasmic reticulum and Mitochondria
• They do not have chlorophyll or chloroplast
• Cell wall is made of chitin by forming spores
• Most fungi are obligate or facultative aerobes.
• They are chemotrophic
• They secrete enzymes that degrade a wide variety of organic substrates into soluble
nutrients which are then passively absorbed or taken into the cell by active transport
(saprophytic organism)
• There are three basic forms of fungi
o Yeasts (cells) for example Cryptococcus neuformans
o Moulds (filamentous)
o Dimorphic (yeast/filamentous)
Yeasts
• Yeasts are single fungal cells
• They reproduce asexually by the process called budding. Examples of yeasts include
Cryptococcus neoformans, Candida albicans

Session 6: Fungi 39
Figure 1: Yeast Cells
Yeast cells
Moulds
• Are fungi which grows in multinuclear filamentous forms
• Are composed of branching cylindrical filaments called hyphae
• The mass of intertwined hyphae that accumulates during active growth is a mycelium.
• There are two types of hyphae
o Septate their hyphae are separated by cross-walls or septa, typically forming at regular
intervals during hyphal growth
o Aseptate their hyphae are not separated by cross-walls or septa
• Hyphae that penetrate the supporting medium and absorb nutrients are the vegetative or
substrate hyphae.
• Aerial hyphae project above the surface of the mycelium and usually bear the
reproductive structures of the mold, these are called sporangio spores.
Dimorphic Fungi
• These are fungi that can grow both as yeast and as moulds depending on temperature and
other environmental conditions. Example Histoplasma capsulatum.

Session 6: Fungi 40
Figure 2: Different Forms of Fungi
Spore
Septa
A: Hyphae intertwining and forming spore
Spores
spongium
Vegatative/ substrate hyaphae
B: Germination of moulds
Instructions
Work in small manageable groups to identify the structural parts of fungi.
Refer to Worksheet 6.1: Identification of Structural Parts of Fungi.
Your group will have approximately 10 minutes to work in this activity and there will be
plenary presentation afterwards. One group will present their findings and other groups will
participate in the discussion.
Classification of Fungi
• Fungal species is assigned to a phylum, as well as the appropriate class, order, and family,
based on its mode of sexual reproduction, phenotypic properties for example morphology
and physiology, and phylogenetic relationships.
• Fungi are classified in four phyla
o Ascomycota
o Zygomycota
o Basidiomycota
o Chytridiomycota

Session 6: Fungi 41
Ascomycota (Ascomycetes)
• Is the largest group, which includes more than 60% of the known fungi and about 85% of
the human pathogens
• Sexual reproduction involves a sac or ascus in which karyogamy (nucleus division) and
meiosis occur, producing ascospores
• Asexual reproduction is via conidia
• Moulds have septate hyphae
• Examples include:
o Blastomyces and Histoplasma
o Microsporum and Trichophyton
o Coccidioides, and yeast (Saccharomyces and Candida)
Zygomycota (Zygomycetes)
• Sexual reproduction results in a zygospore
• Asexual reproduction occurs via sporangia
• Vegetative hyphae are sparsely septate
Examples are Rhizopus, Absidia, Mucor, and Pilobolus
Basidiomycota (Basidomycetes)
• Sexual reproduction results in four progeny basidiospores supported by a club-shaped
basidium
• Hyphae have complex septa
Examples: Mushrooms, Filobasidiella neoformans, Cryptococcus neoformans
Chytridiomycota
• They are none of medical significance
Key Points
• Fungi are eukaryotic organisms that exist in two forms; yeasts (cells) and moulds
(filaments).
• The cell wall of fungi is made of chitin
• Fungi are classified into four phyla namely; Ascomycota, Zygomycota, Basidiomycota,
Chytridiomycota.
Evaluation
• What are fungi?
• What is the difference between yeast and mould?
• How do you classify fungi?
References
• Brooks, G.F., Butel, J.S., Morse, S.A, (2010). Jawetz,Melnick, & Adelberg’s Medical
Microbiology (24th ed.). Retrieved 5 May 2010 from http://www.accessmedicine.com
• Cook. G, (2000). Manson’s Tropical Diseases (22th ed). London: WB Saunders Company
Ltd.
• Greenwood, D., Richard, C.B.S, John, F.P. (1992). Medical Microbiology (4th ed.). Hong

Session 6: Fungi 42
• Jawetz, Melnick, & Adelberg's. (2007) .Medical Microbiology (24th ed). United States of
• Levinson, W. (2004). Medical Microbiology and Immunology (8th ed). Examination &
• Monica, C. (1987). Medical Laboratory Manual for Tropical Countries (2nd ed). Volume
1, Oxford: ELBS Butterworth, Heinemann Ltd.
Health Technology. UK: Cambirige University Press.

Session 6: Fungi 43
Worksheet 6.1: Identification of Structural Parts of Fungi
Instructions
4. Choose a presenter for your group. The presenter will share your group’s decisions and
answers with the larger group.
5. Choose a recorder for your group. The recorder may write on note paper or flip chart
paper.
6. Discuss the questions together and answer them in the time you are given
Questions
1. What are A, B, C, D and E in the diagram?
2. What are the functions of A, B, D and E?
D
E
Answers Question 1
A-
B-
C-
E-

Session 6: Fungi 44
Answers Question 2
A-
B-
D-
E-

Session 6: Fungi 45
Session 6: Fungi 46
Session 7: Fungi of Medical Importance
Learning Objectives
• Identify fungi of medical importance
• Describe the fungi of medical importance on characteristics, diseases they cause,
laboratory diagnosis and drug of choice
Fungi of Medical Importance

• Fungi of medical importance come from different phyla and genera.
• Examples of genera that leads to fungal infection include:
o Trichophyton, Micosporum and Epidemophyton making the group of Tinea or skin
mycoses
o Candida albicans, Cryiptococcus neoformans and Histoplasma capsulatum making
the group of opportunistic infections
o Coccidioidomides imitis leading to systemic mycoses
Refer to Handout 7.1: Major Mycoses and Causative Agent
Fungi that Cause Tinea Mycoses

General Characteristics of Fungi Causing Tinea (Cutaneous Mycoses)
• Infect only the superficial keratinized tissue (skin, hair, and nails).
• Restricted to the nonviable skin
• Most are unable to grow at 37 °C.
o They are identified by presence of hyaline, septate, branching hyphae or chains of
arthroconidia
Tinea
• Are cutaneous mycoses which are caused by fungi that infect only the superficial
keratinized tissue (skin, hair, and nails).
• The most important of these are the dermatophytes which include Epidermophyton
floccosum, Trichophyton mentagrophyte, Microsporum audonii .
Laboratory Diagnosis
• Specimen
o Skin scrapings
o Nails
o Hairs
o Swabs from the lesions
• Laboratory techniques
o Fluorescent direct microscopy
o Wet preparation using 10% Potassium Hydroxide
o Culture

Session 7: Fungi of Medical Importance 47
Drug of Choice
• Topical Antifungal agents (like clotrimazole, Ketoconazole creame, Benzoic acid
containing ointment)
• Oral Griceofulvin
Fungi that Cause Opportunistic Infections

• Opportunistic fungi are organisms which induce disease when immunity of an individual
is compromised.
• Usually are non pathogenic and are part of microbial normal flora. Examples include
Candida albicans, Criptococcus neoformans
Candida
• Species of Candida include: C. albicans, C. tropicalis, and C. glabrata
General Characteristics of Candida

• They are oval budding yeast cells
• Can produce pseudohyphae when in the host
• They are Gram positive
• They germinate to form tube tube like structure (germ tube) while in the serum at 37oC
Disease Caused by Candida

• Thrush (for example white patches occurring like pseudomembranes on the mouth,
vagina)
• Vaginitis (vaginal itching and discharge favoured by high pH, Diabetes and long term use
of broad spectrum antibiotics)
• Chronic mucocutaneous candidiasis (following immunosuppression, candida may affect
the mucous membranes and the cutaneous tissues)
Laboratory Diagnosis of Candida

• Specimens
o HVS
o Skin scraping
o Exudates or tissues
• Technique
o Gram staining
o Culture
o Germ tube

Figure 1: Microscopic Appearance of Candida albicans
Source: MVST BOD & NST PART IB 2009
Source: University of Adelaide, 2010
Drugs of Choice for Candidiasis

• Fluconazole
• Clotrimazole
• Nystatin
• Ketoconazole
Cryptococcus neoformans:
• Is oval budding yeast surrounded by a wide polysaccharide capsule
• Species of medical importance under the genus Cryptococcus is only Cryptococcus
neoformans
• There are two variants of Cryptococcus neoformans
o C. neoformans var neoformans (causes cryiptococcal disease in immunocompromised
individuals)
o C. neoformns var gatii (causes cryptococcal disease in immunocompetent individuals)

Characteristic of Cryptococcus neoformans
• Encapsulated (have large round capsule)
• Occur in the form of yeast cells
• Gram positive
• In Giemsa stain the capsule can be seen as clear unstained area
• In india ink C. neoformans shows a clear large round capsule surrounding the cell
Diseases caused by Cryptococcus

• Cryptococcosis especially cryptococcal meningitis (C. neoformans var neoformans)
o Cryptococcosis is the most common life threatening fungal disease in
immunocompromized patients
Lab Diagnosis
• Specimen
o CSF
• Technique
o India ink
o Gram stain
o Culture
Drug of Choice for Cryptococcal Meningitis

• Fluconazole
Activity: Case Study
Instructions
You will work into small manageable groups.
Refer to Worksheet 7.1: Opportunistic Mycoses
Read to the case study scenario and questions on the worksheet.
One third of the class will answer one question on the worksheet. Your group will have 10
minutes to answer the questions in the groups. One group to share their answers and other
groups will share in the discussion.
Key Points
• Fungi of medical importance includes dermatophytes (Tinea), opportunistic fungi
(Candida albicans and Cryptococcus neoformans)
• Laboratory diagnosis of fungi is based on collection of skin scrapings, fluid, nails cuts
and hairs, cerebral spinal oral and cervical swabs for microscopy and culture.
• Treatment is mainly based on administration of topical oral and parenteral antifungal
drugs.

Evaluation
• What are the fungi of medical importance?
• What are opportunistic fungi and the disease they cause?
References
(6th ed). London: Butterworth .
• Greenwood, D., Richard, C.B.S, John, F.P. (1992). Medical Microbiology (4th ed). Hong
• Jawetz, Melnick, & Adelberg's, (2007). Medical Microbiology (24th ed). United States of
• Levinson, W. (2004). Medical Microbiology and Immunology (8th ed.). Examination &
Health Technology. UK: Cambirige University Press.
• MVST BOD & NST PART IB (2009). Pathology Practical Class 17. Retrieved May 5,
2010 from www.path.cam.ac.uk/partIB_pract/P17/
• University of Adelaide. (2010). Mycology online Mould Identification: A Virtual Self
Assessment. Retrieved March 16, 2010 from www.mycology.adelaide.edu.au/.../ID2-
Dec08.html

Handout 7.1: The Major Mycoses and Causative Agent
Type of
Causative Fungal Agents Mycosis
Mycosis
Malassezia species Pityriasis versicolor
Hortaea werneckii Tinea nigra

Superficial
Trichosporon species White piedra
Piedraia hortae Black piedra

Microsporum species, Trichophyton
Dermatophytosis
species, and Epidermophyton floccosum
Cutaneous
Candida albicans and other Candida Candidiasis of skin, mucosa, or
species nails
Sporothrix schenckii Sporotrichosis
Phialophora verrucosa, Fonsecaea
Chromoblastomycosis
pedrosoi
Subcutaneous
Pseudallescheria boydii, Madurella
Mycetoma
mycetomatis
Exophiala, Bipolaris, Exserohilum Phaeohyphomycosis
Coccidioides immitis, C posadasii Coccidioidomycosis
Endemic Histoplasma capsulatum Histoplasmosis
(primary,
systemic) Blastomyces dermatitidis Blastomycosis
Paracoccidioides brasiliensis Paracoccidioidomycosis

Candida albicans and other Candida
Systemic candidiasis
species
Cryptococcus neoformans Cryptococcosis
Aspergillus fumigatus and other
Opportunistic Aspergillosis
Aspergillus species
Species of Rhizopus, Absidia, Mucor, and
Mucormycosis (zygomycosis)
other zygomycetes
Penicillium marneffei Penicilliosis

Worksheet 7.1: Opportunistic Mycoses
Instructions for the Activity

Read the scenario and answer the questions below.
Scenario
A 35 years old man complains on difficult in swallowing, physical examination revealed
white patches around the mouth; Laboratory diagnosis shows Gram positive budding yeast
cells.
1. What is the clinical diagnosis?
2. What is the possible causative organism?
3. What is the drug of choice?

Session 8: Viruses
Learning Objectives
• Define different terms used in virology
• Describe characteristic of viruses
• Describe structure of the virus
• Compare virus and bacteria cell structures
Definitions of Terms in used in Virology

• Viruses: Are smallest infectious agents (ranging from about 20 nm to about 300 nm in
diameter) and contain only one kind of nucleic acid (RNA or DNA) as their genome
• Virology: Is study of viruses
• Capsid: The protein shell, or coat that encloses the nucleic acid genome
• Nucleocapsid: The protein-nucleic acid complex plus a capsid. Sometimes it is a
complete virion
• Capsomeres: Morphologic units of a capsid
• Virion: The complete virus particle. In some instances the virion is identical with the
nucleocapsid. In more complex virion, it includes the nucleocapsid plus a surrounding
envelope
• Envelope: A lipid-containing membrane that surrounds some virus particles
• Structural units: The basic protein building blocks of the coat. They are usually a
collection of more than one identical protein subunit. The structural unit is often referred
to as a protomer
• Subunit: A single folded viral polypeptide chain
• Defective virus: A virus particle that is functionally deficient in some aspect of
replication
Characteristics of Viruses
• They are small in size ranging from about 20 nm to about 300 nm in diameter.
• They are akaryotic particles (neither eukaryotes nor prokaryotes)
• They contain either DNA or RNA and not both as their genome
• They exhibit living properties when inside the living cells (i.e. they are incapable of
independent reproduction unless they are in the living cell)
• They are non motile
• They can be grown in cell cultures
• Viruses are known to infect unicellular organisms such as mycoplasmas, bacteria, and
algae and all higher plants and animals
Structure of Viruses
• Generally the virus structure is made of three basic units
o Envelop made of glycoprotein and lipids
o Capsid
o Viral core (RNA or DNA)

Session 8: Viruses 55
Figure 1: Basic Structure of Virus
Envelope
Capsid
Viral Core (RNA or DNA)
Source: Jawetz, Melnick, & Adelberg's, 2007
Figure 2: A: Enveloped Virus with Icosahedral Symmetry. B: Virus with Helical Symmetry
Source: Jawetz, Melnick, & Adelberg's, 2007
Parts of the Viral Structure and its Function

• Envelop is the outermost coat of the virus made of lipid and proteins
o Its function is to support glycoproteins or spikes used for attachment to the host cell
o Gives stability to the virus
o Protects the inner parts of the virus
o It is usually derived from the host cell during release (budding)
o Virus with an envelop are less stable than non enveloped virus (they can be destroyed
by disinfectants or adverse condition of the environment)

• Capsid is a protein coat which covers the viral genome, it is made up of repeating
subunits called capsomers
o The repeating subunits of the capsid give the virus a symmetric appearance that is
useful for classification purposes
o Some viral nucleocapsids have spherical (icosahedral) symmetry where as others
have helical symmetry
o All human viruses that have a helical nucleocapsid are enveloped (there are not naked
helical viruses that infect humans)
o Viruses that have an icosahedral nucleocapsid can be either enveloped or naked
• Viral Core contains genetic materials necessary for replication. They include either DNA
or RNA, never both
o Deoxyribonucleic acid (DNA) containing viruses are double stranded except
parvoviruses which have single strand DNA
o Ribonucleic Acid (RNA) containing viruses are single stranded. Example human
immunodeficiency virus (HIV)
o Nucleic acid can either be linear or circular, continuous or segmented
Comparison between Viral and Bacterial Cell Structures

Instructions
You will work into small manageable groups.
Refer to Worksheet 8.1: Comparison between Virus and Bacterial Cell
Structures.
Read instructions on the worksheet and answer the questions that follow. You will have 15
minutes to work in the groups. One representative from each group will make plenary
presention and other groups will participate in discussion.
Key Points
• A virus is the smallest infectious agent (ranging from about 20 nm to about 300 nm in
diameter) and contains only one kind of nucleic acid (RNA or DNA) as its genome
• Most viruses are pathogenic to human
• Viruses are obligate intracellular i.e replicate only when they are inside the living cells
• Viruses contain either DNA or RNA but not both
Evaluation
• List basic structures of a virus.
• What are characteristics of a virus?
References
(6th ed.) London: Butterworth.
• Brooks, G.F., Butel, J.S., Morse, S.A. et al. (2007). Medical Microbiology (24th ed.). New
York: McGraw- Hill.
Company Ltd.

• Greenwood, D., Richard, C.B.S & John, F.P. (1992). Medical Microbiology (4th ed.).
Ltd.
• Harwood, R.F., James, M.T. (1979). Entomology in Human and Animal Health. (7th ed.)
Washington State University Pulman.
• Jawetz, Melnick, & Adelberg. (2007). Medical Microbiology (4th ed.). United States of
• Levinson, W. (2004). Medical Micribiology and Immunology. Examination & Board
Satish G. (1982). The short Handbook of Medical Microbiology. New Delhi. India:
• NMCP (2007). Training Course on Laboratory Diagnosis of Malaria. Malaria Control
Series 17. Ministry of Health and Social Welfare.

Worksheet 8.1: Comparison between Virus and Bacterial Cell
Structure
Instructions
1. Choose a presenter for the group. The presenter will share group’s decisions and answers
with the larger group.
2. Choose a recorder for the group. The recorder may write on notes book or flip chart
3. Discuss the question below together and answer them in the 15 minutes.
Question
What are the differences and similarities of virus and bacterial cell structures?

Session 9: Classification of Viruses
Learning Objectives
• Explain the criteria used to classify viruses
• Classify viruses based on the size, morphology and capsid symmetry of the virus particle
• Classify viruses based on type of nucleic acid and mode of replication
• Outline reproductive cycle of a virus
Criteria Used to Classify Viruses

• Viruses are classified based on the number of criteria which include
o Size, morphology and capsid symmetry of the virus particle
o Type of nucleic acid and mode of replication
o Mode of transmission
Classification of Viruses According to Morphology and Capsid Symmetry

of the Virus
• Symmetry of the capsid
o Helical symmetry
o Icosahedra symmetry
o Complex symmetry
• Envelope as the outer coat
o Enveloped viruses
o None enveloped viruses (naked viruses)
Helical Symmetry Viruses

• In replication of viruses with helical symmetry, identical protein subunits (protomers)
self-assemble into a helical array surrounding the nucleic acid, which follows a similar
spiral path.
• Such nucleocapsids form rigid, highly elongated rods or flexible filaments shaped like a
spiral stare case.
o Examples of the helical symmetry viruses are measles virus, mumps viruses, rabies
viruses, respiratory syncytial virus.

Session 9: Classification of Viruses 61
Figure 1: Helical Symmetry of a Virus
Source: Brooks, Butel, Morse et al. 2007
Icosahedral Symmetry
• An icosahedron is a polyhedron having 20 equilateral triangular faces and 12 vertices
• Overall appearance of such viruses is spherical
• There are exactly 60 identical subunits on the surface of an icosahedron
o Examples of viruses with icosahedral symmetry are Adenoviruses, herpes simplex
virus, cytomegalovirus, varicela zoster virus, hepatitis B virus and papiloma virus
Figure 2: Icosahedral Symmetry Viruses

• An envelope is an outer (bounding) lipoprotein bilayer membrane possessed by many
viruses
• Some viruses contain lipid as part of a complex outer layer, but these are not usually
regarded as enveloped unless a bilayer unit membrane structure is clearly demonstrable
• Most of the enveloped viruses are helical in shape
• Most of the enveloped helical viruses are RNA viruses
o Example influenza viruses, measles virus, mumps virus, rabies virus, respiratory
syncytial virus
• Enveloped viruses which are icosahedral in shape are also DNA viruses. These include
Herpes simplex virus, Varisella zoster virus, and cytomegalovirus
Non Enveloped Viruses

• Viruses which are not enveloped are all icosahedra in shape
• RNA viruses which are not enveloped include Poliovirus, Hepatitis A virus, and
Enteroviruses
• DNA viruses which are not enveloped include Adenoviruses, Papilloma viruses and
Polyoma viruses
Classification of Viruses According to the Nucleic Acid

• Based on the nucleic acid viruses are classified into
o RNA viruses
o DNA viruses
RNA Viruses
• RNA viruses, comprising 70% of all viruses, vary remarkably in genome structure
• Because of the error rate of the enzymes involved in RNA replication, these viruses
usually show much higher mutation rates than do the DNA viruses
• The viral RNA may be single-stranded (ss) or double-stranded (ds), and the genome may
occupy a single RNA segment or be distributed on two or more separate segments
(segmented genomes)
• The proteins necessary for the construction of complete virions are always made via the
information coded in the host messenger RNA (mRNA)
• RNA viruses can either have positive sense or negative sense genome
• Virus with positive sense strand can function as messenger RNA (mRNA), while a
negative sense strand cannot function as mRNA protein translation.
• Positive sense viral RNA alone can replicate if injected into cells, since it can function as
mRNA and initiate translation of virus-encoded proteins.
• Negative sense RNA, on the other hand, has no translational function and cannot per se
produce viral components without the help of the host cell messenger RNA.
• Examples of double stranded RNA viruses include , reoviridae family (Reoviruses spp)
• Examples of single stranded RNA viruses include, Retroviridae (example HIV),
Rhabdoviridae (example Rabies virus), Orthomyxoviridae (example Influenza virus),
Filoviridae (example Murbug and Ebola Viruses), Paramyxoviridae (examples Measles
viruses, Mumps viruses, Respiratory syncytial viruses and Parainfuenza viruses),
Pircornaviridae (examples Polioviruses, Hepatitis A, Enteroviruses)

Figure 3: Structures of Various Families of Double Stranded (dsRNA) and Single Stranded
(ssRNA) Viruses
DNA Viruses
• Most DNA viruses contain a single genome of linear double stranded DNA (dsDNA).
• However the papovaviruses (papillomaviruses, polyoma and vacuolating agents), have
circular DNA genomes.
• dsDNA serves as a template both for mRNA and for self-transcription.
o Examples of double stranded DNA (dsDNA) viruses include Herpadnaviridae
(Hepatitis B virus), Poxviridae (Small pox virus), Herpesviridae (Herpex simples
viruses, Varisela zoster viruses, cytomegaloviruses)
o Examples of Single stranded DNA(ssDNA) viruses include Parvoviridae (B19 virus)

Figure 4: DNA Viruses: Double Stranded (dsDNA) and Single Stranded (ssDNA) Viruses
Classification of Viruses According to the Mode of Transmission

• Contact
o Examples Herpes viruses, HIV, Hepatitis viruses, Ebola virus, Rabies virus, Marburg
virus
o Viruses under this group are transmitted through contact with virus from the vesicle,
blisters. This may be via sexual contact, during birth, kissing
• Inhalation
o Examples measles viruses, varicella zoster virus, mumps virus, variolla virus, rubella
virus, respiratory syncytial virus, Influenza virus
• Fecal Oral Route
o Examples enteroviruses
• Vector
o Examples yellow fever viruses
• Transfusion
o Examples HIV, Hepatitis B
Replicative Cycle of Viruses

• Viruses are inert in the extracellular environment
• They replicate only in living cells, being parasites at the genetic level
• The viral nucleic acid contains information necessary for programming the infected host
cell to synthesize virus-specific macromolecules required for the production of viral
progeny (new virus particle)
Steps in Viral Replication

• Attachment and adsorption
• Uncoating (viral genome is injected to the host nucleus/cytoplasm)
• Viruses must synthesize mRNA by using the host cell mechanisms
o RNA viruses produce mRNA by several different routes
• Viral mRNA is then translated in the host cytoplasm to produce viral proteins
• Replication of viral DNA or RNA occurs in the host nucleus except for pox viruses where
it takes place in the cytoplasm

• Assembly of the viral proteins and genome
o During the replicative cycle, numerous copies of viral nucleic acid and coat proteins
are produced
• Release of the viral particles
o This takes place on the host cell plasma membrane
• The figure below shows example of a viral replicative cycle. The replicative cycle of
HIV, an enveloped DNA virus
Figure 5: Summary of the Reproductive Cycle of HIV
Source: National Institute of Allergy and Infectious Diseases, 2009

Key Points
• Viruses are classified according to
o Morphology, size and capsid symmetry
o Nucleic acid type
• Most RNA viruses have helical capsid symmetry and DNA viruses have icosahedral
capsid symmetry
• For viruses to replicate viral proteins must be synthesized by the host cell protein
synthesizing machinery
• Important steps for viral replication includes attachment, fusion (adsorption), penetration,
un coating, transcription, assembling and release
• All human viruses with helical nucleocapsid poses an envelope
Evaluation
• What are the criteria used to classify viruses?
• What are the differences between enveloped and none enveloped viruses?
• What are the important steps involved during viral replication?
References
• Brooks, G.F., Butel, J.S., Morse, S.A. et al, (2007). Medical Microbiology (24th ed.). New
York: McGraw- Hill.
Company Ltd.
• Greenwood, D., Richard, C.B.S & John, F.P. (1992). Medical Microbiology (4th ed).
UK Ltd.
• Harwood, R.F., James, M.T., (1979). Entomology in Human and Animal Health (7th ed.).
Washington: State University Pulman.
Health Technology. Noida India: Gapson Papers Ltd.
• National Institute of Allergy and Infectious Diseases. (2009). HIV Replication Cycle.
Department of Health and Human Services. USA: Retrieved March 23rd, 2010 from
www3.niaid.nih.gov/.../hivReplicationCycle.htm

Session 10: Herpes Viruses
Learning Objectives
By the end of this session students are expected to be able to:
• Define herpes viruses
• List general characteristics of herpes viruses
• Describe herpes viruses of medical importance
Definition and Characteristics of Herpes Viruses

• Herpes viruses: Are DNA viruses which include the etiologic agents of herpes simplex,
herpes zoster, chickenpox, infectious mononucleosis, and cytomegalic inclusion disease
in humans, and of pseudorabies and other animal diseases.
Characteristics of Herpes Viruses

• They are dsDNA viruses, enveloped, icosahedra in shape
• Causes latent infections with frequent reactivation and viral shedding
• All are transmitted by contact except varisella zoster virus (VZV)
• Causes cytopathic effect in cell culture (after being infected cells dies, and the died cells
may clamp together and form inclusion bodies, cells may be lysed or mutated)
• Causes lifelong infections
Herpes Viruses of Medical Importance

• Herpes viruses are viruses that cause latent infections. It can stay in the body without
causing signs and symptoms until the host immunity gets reduced like in HIV situation.
o Examples of herpes viruses of medical importance include
Herpes simplex viruses 1 & 2 (HSV 1 & HSV 2)
Cytomegaloviruses
Epstain bar viruses
Human herpes virus 6
Human herpes virus 8 (Kaposis Sarcoma virus)
Herpes Simplex 1
• Diseases caused by Herpes simplex 1 are
o Herpes labialis
o Herpes labialis is characterized by fever blisters on the mouth or face, keratisitis, and
encephalitis
o Genital blisters
Laboratory Diagnosis for Herpes Simplex 1

• By identifying cytopathic effect in tissue culture
• By antibody neutralization of florescent antibody test (compliment fixation test)
Drug of Choice (for Palliative Care)

• Acyclovir tablets
• Acyclovir cream/ ointment
• Trifluorothymidine
• Iudoxuridine

Session 10: Herpes Viruses 69
Herpes Simplex 2
• Diseases caused by Herpes simplex 2 include:
o Genital herpes (blisters occurring below the waist)
o Aseptic meningitis (non - bacterial inflammation of meninges)
o Neonatal herpes (Infection to neonates that occur during birth)
o Herpes labialis
Laboratory Diagnosis for Herpes Simplex 2

• Identifying cytopathic effect in tissue culture
• Antibody neutralization of florescent antibody test (compliment fixation test)
Drug of Choice (for Palliative Care)

• Acyclovir tables
• Acyclovir cream/ointment
Cytomegalovirus Virus (cytomegalo = enlarged cell)

• Cytomegalo virus (CMV) causes a number of diseases characterized by enlargement
(ballooning) of the infected host cells
• The diseases include
o Pneumonia and hepatitis in immune-compromised patients
o Retinitis and enteritis especially in AIDS patients
o Cytomegalic inclusion body disease in infants
o Mononucleosis in transfusion recipients
o Congenital abnormalities
Laboratory Diagnosis for Cytomegalovirus Virus

• Cytopathic effect in tissue culture (cell enlargement)
• “Owls eye” nuclear inclusions are seen in cell culture
• Serum for serological tests to determine rise in antibody titer
Treatment
• Ganciclovir
Figure 1: Typical Morphology of CMV: The Circled Area Shows Owls Eye Appearance of
CMV in Infected Cells as Seen in Electron Microscope in a Special Staining
Source: American Society for Microbiology, 2010

Epstein Bar Virus (EBV)
• Diseases caused by Epstein Bar Virus are
o Burkitts lymphoma in East African children (occurs as a tumor of the face and jaw
and sometimes as an abdominal tumor) in East African children
Burkitts Lymphoma is associated with high endemicity of Plasmodium falciparum
o Infectious mononucleosis
• Tumor aspirates
• Full blood picture
Drug of Choice
• No effective drugs is available
Human Herpes Virus 8 (HHV8)

• Disease they cause: Kaposi’s sarcoma especially in AIDS patients
• Laboratory diagnosis: Biopsy for pathological examination of cells
• Drug of choice: No specific antiviral treatment
Genital Herpes
Activity: Case Study
Instructions
Read the scenario below.
Scenario
A 28 year old women came to your clinic with a complaint of fever, painful genital blisters
which express clear fluid when ruptured, burning sensations around the blisters.
Refer to Worksheet 10.1: Herpes Simplex.
You will work in small manageable groups to answer questions listed on the worksheet for
15 minutes and record the answers on the worksheet. Your answers will be shared in plenary
presentation afterwards. One group will share their answers and other groups will participate
in discussion.
Key Points
• Herpes viruses are characterized by latency infections
• They cause lifelong infections
• All Herpes virus are DNA viruses
• Herpes viruses includes Herpes simplex viruses type 1&2, Human Herpes Virus type 6,
Human Herpes Virus type 8, Cytomégalovirus and Epstein Bar virus (EBV)
Evaluation
• What are Herpes viruses?
• What are the disease caused by Herpes simplex 1 and 2?
• List four viruses which cause latent infections.

References
• American Society for Microbiology. (2010). Retrieved March 22nd, 2010 from
http://www.microbelibrary.org/ASMOnly/details.asp?id=658&Lang=English>
Company Ltd.
UK Ltd.

Worksheet 10.1: Herpes Simplex
Scenario
A 28 years old woman came to your clinic with a complaint of fever, painful genital blisters
which expresses clear fluid when ruptured, burning sensations around the blisters.
Questions
1. What is the diagnosis?
2. What is the most probable causative organism?
3. If you were at the reference laboratory, what kind of laboratory tests would you like to
do?
4. What is the treatment of choice?

Session 11: Human Immunodeficiency Virus [HIV]
Learning Objectives
• Define the term HIV
• Describe general characteristics of HIV
• Describe structure of HIV
• Describe replication cycle of HIV
• List common diseases associated with HIV
• List laboratory diagnosis of HIV
• List drugs used in treatment of HIV
Definition and Characteristics of HIV

• HIV is an abbreviation of Human Immunodeficiency Virus
• A retrovirus that causes Acquired Immunodeficiency Syndrome (AIDS) by infecting CD4
cells of the immune system
• The virus attacks the cells of immune system causing immune suppression
General Characteristics of HIV

• HIV is a member of a family known as Retroviruses (Retroviridae)
• Retroviruses consist two pieces of single strand RNA as their genetic material
• Retroviruses are unusual because they are capable of making copies of DNA from RNA
hence their name retroviruses (backward transcription)
o This is possible because they have a reverse transcriptase enzyme
Structure of HIV
• HIV is a particle composed of lipid bilayer known as the envelope
• In the lipid bilayer there are two glycoprotein called gp120 and gp41.
• Inside the lipid bilayer, there is a core consisting proteins called p24 and p17
• Inside the inner core, there are 2 pieces of single stranded RNA and important enzymes
(reverse transcriptase, integrase and protease)
Refer to Handout 11.1: Structure of HIV

Session 11: Human Immunodefficiency Virus (HIV) 75
Figure 1: Structure of HIV Cell
Source: Avert, 2010
Replication Cycle of HIV

• Replication cycle of HIV involves steps in which the virus reproduces to make several
copies of itself
• The major steps happening during replication can be outlined into 7 steps namely
o Attachment through the interaction between viral glycoprotein and the CD4 receptor
and co-receptors
o Fusion, uncoating and release of RNA into the cytoplasm of the cell
o Reverse transcription to produce proviral DNA (Reverse Transcriptase)
o The proviral DNA migrates into the nucleus of the cell
o Integration of proviral DNA to host DNA (integrase)
o Synthesis of viral proteins (protease)
o Assembly and release of a complete virion
o Release of new virus particles

Figure 2: How HIV Works (Replicative Cycle of HIV)
Source: National Institute of Allergy and Infectious Diseases, 2009
Disease Associated by HIV

• HIV does not cause one disease condition but associated with a group of diseases and
conditions
• Main effect of HIV in the human is that it weakens the immune system hence rendering it
incapable of fighting against diseases
• Example of diseases associated with HIV can be grouped as follows:
o Viral infections for example herpes virus infections and reactivation diseases.
o Bacterial infections for example. Mycobacteria specie, salmonella, shigella,
staphylococcal and streptococcal.
o Fungal infections for example. Candida spp, Cryptococcus spp, Pneumocystis spp and
histoplasma spp.
o Parasitic infections, example Toxoplasmosis, strongyloidiasis, cryptosporidiosis.
o Malignant conditions for example Kaposi’s sarcoma, Lymphoma, carcinoma of the
cervix.
• HIV can also directly affect other organs of the body example brain, heart, kidney and
skin.

Laboratory Diagnosis of HIV and Drugs Used in HIV
Specimen
• Whole blood
• Serum
• Plasma
• Dried blood spot and
• Other body fluids
Techniques
• Serological Tests (rapid and ELISA test)
o Detection of antibodies produced against by the virus
o Detection of viral components for example p24
• Detection of viral genetic material (RNA)
Drug Used in HIV

• Management of HIV includes treatment of the associated infections or conditions and
specific treatment to control the HIV (HIV can not be cured but just controlled).
• All the drugs used in HIV target the enzymes used in the viral replication cycle
• Treatment involves simultaneous use of more than one drug of different classes
• Drugs used to treat/control HIV can be divided into classes as follows:
o Nucleoside reverse transcriptase inhibitor (NRTIs) e.g. Lamivudine (3TC),
Zidovudine (AZT/ZDV), Emtricitabine (FTC), Tenofovir (TDF), Didanosine (ddI),
Abacavir (ABC)
o Non-nucleoside reverse transcriptase inhibitors (NNRTIs) e.g. Efavirenz and
Nevirapine
o Protease inhibitor (PIs) for example, Lopinavir (LPV), Ritonavir (RTV), Atazanavir
(ATV), Saquinavir (SQV)
Key Points
• A retrovirus causes Acquired Immunodeficiency Syndrome (AIDS) by infecting CD4
cells of the immune system.
• HIV attacks cells of immune system particularly CD4 cells.
• T-helper cells have receptors (CD4 receptors) through which HIV attaches before it is
uncoated.
• HIV paves the way to other pathogenic and opportunistic infections.
• Diagnosis involved doing serological rapid tests and ELISA.
• Treatment involves simultaneous use of more than one drug of different classes.

Evaluation
• What are characteristics of HIV?
• What are the important viral enzymes of HIV?
• What are the classes of antiretroviral drugs used in treatment of HIV&AIDS?
References
• Avert, (2010). The Structure of HIV. Retrieved May13th, 2010 from www.avert.org/hiv-
virus.htm on 23rd March 2010
• Greenwood, D. Richard, C.B.S, John, F.P. (1992). Medical Microbiology (4th ed.) Hong
• Jawetz, Melnick, & Adelberg's. (2007). Medical Microbiology. (24th ed.) United States of
• Levinson, W. (2004). Medical Microbiology and Immunology (8th ed.). Examination &
Board Review. New York: International Edition Lange Medical Books /McGraw Hill
Medical Publishing & Davidson.
• National Institute of Allergy and Infectious Diseases, (2009). Retrieved May 23rd, 2010
from www3.niaid.nih.gov/.../hiv ReplicationCycle.htm.
• National Institute of Allergy and Infectious Diseases. (2009). HIV Replication Cycle.
Department of Health and Human Services. USA: Retrieved March 23rd, 2010 from
www3.niaid.nih.gov/.../hivReplicationCycle.htm.
• University of Cape Town, (2001). Human Retroviruses and HIV. Retrieved March 23rd,
2010 from web.uct.ac.za/.../teaching/notes/retro.htm.

Handout 11.1: Structure of HIV
• p17 (matrix protein): forms the outer shell of the core of the virus, lining the inner
surface of the viral membrane.
• gp120 (envelope protein): a glycoprotein exposed on the surface of the HIV envelope.
gp120 is essential for virus entry into cells as it plays a vital role in seeking out specific
cell surface receptors for entry.
• gp41 (envelope protein): a glycoprotein that supports entry of HIV into the cell.
• Reverse transcriptase (p64): a DNA polymerase enzyme that transcribes single-stranded
RNA into double-stranded DNA. Normal transcription involves the synthesis of RNA
from DNA; hence, reverse transcription is the reverse of this.
• Protease: HIV protease cleaves newly synthesized polyproteins at the appropriate places
to create the mature protein components of an infectious HIV virion. Without effective
HIV PR, HIV virions remain uninfectious (defective virus).
• Integrase: an enzyme produced by HIV that enables its genetic material to be integrated
into the DNA of the infected cell. It is also produced by viruses containing double
stranded DNAs for the same purpose.
• p24 (core proteins): A major core protein of the human immunodeficiency virus.

Session 12: Hepatitis B, Hepatitis C, Ebola and
Marburg Viruses
Learning Objectives
• Define Hepatitis viruses
• Describe characteristics and the structure of Hepatitis virus
• Describe medical importance of Hepatitis B and C
• Define Ebola and Marburg viruses
• Describe characteristics and the structure of Ebola and Marburg viruses
• Describe medical importance of Ebola and Marburg viruses
Definition of Hepatitis Viruses

• Hepatitis viruses are a group of viruses which principally affect the liver cells and cause
inflammation.
o Examples of hepatitis viruses transmitted by contact are Hepatitis B virus and
Hepatitis C virus.
Characteristics and Structures of Hepatitis B and C
Hepatitis B Virus (HBV)

• HBV is a member of hepadna virus family
• HBV is a DNA enveloped virus
• Has icosahedral nucleocapsid core containing partially double stranded circular DNA
genome
• The envelope contains a protein called surface “antigen” (Hepatitis B surface antigen)
Figure 1: Schematic of Hepatitis B Virus and Surface Antigen
Schematic of Hepatitis B virus Hepatitis B virus as seen in

Electron Microscope
Source: Highleyman, 2008

Session 12: Hepatitis B, Hepatitis C, Ebola and Marburg Viruses 81
Replication of Hepatitis B virus
Figure 2: Summary of Replication of Hepatitis B Virus
Hepatitis C Virus (HCV)

• HCV is a single stranded RNA virus, classified as family Flaviviridae, genus Hepacivirus
• It is an enveloped virus, surrounded by a protective shell of protein, and further encased
in a lipid (fatty) envelope of cellular material
• The genome of HCV is highly mutable
• By constant mutation, HCV may be able to escape host immunologic detection and
elimination
Figure 3: Hepatitis C Virus

Medical Importance of Hepatitis B and C Virus
Diseases Caused by Hepatitis B Virus
• The virus causes serum hepatitis characterized by persistent infection leading to chronic
hepatitis, liver cirrhosis, hepatocellular carcinoma, and liver necrosis.
• Hepatitis B is not directly cytopathic, instead damage to the liver is mediated by the
immune response.
• This virus can cause an acute infection, which appears 6 weeks to 6 months after
exposure, as well as a chronic infection, which lasts for more than 6 months.
• It is common for acute infections to become chronic, the probability of someone
becoming chronically infected with HBV is inversely related to the age of infection.
• Infections at an earlier age increase the chances of becoming a chronic carrier of the
virus.
• Thus, babies born to infected mothers are at very high risk of to becoming carriers and
developing liver pathology
• Blood for serology: for example ELISA, Counter-immune-electrophoresis (CIE), and
PCR
Drug of Choice
• Alpha interferon and Lamivudine,
Hepatitis C
• Diseases caused by Hepatitis C virus are
o Hepatitis
o Hepatocellular carcinoma
o HCV infection sometimes results in an acute illness, but most often becomes a
chronic condition that can lead to cirrhosis of the liver and liver cancer.
• Blood for serology, for example ELISA, Counter-immuno-electrophoresis (CIE), and
PCR
Drug of Choice
• Alpha interferon plus Ribavirin
Characteristics and Structures of Ebola and Marburg Viruses

• Ebola and Marburg viruses are single-stranded RNA viruses belonging to the family
Filovirus
• Filoviruses are enveloped with helical nucleocapsid
• They are single-stranded RNA
• They are highly pleomorphic (vary in shapes)
• There is minor antigenic overlap between Marburg and Ebola viruses
Characteristic of Ebola Virus

• Ebola is a member of the Filovirus family
• Ebola viruses are single-stranded RNA
• Enveloped

• The capsomer-covered nucleocapsid is helicoids in shape
• The virion is tubular in appearance
Figure 4: Ebola virus
Source: Koprowski, 2008
Characteristic of Marburg Viruses

• Marburg is a member of the Filovirus family
• Marburg viruses are single-stranded RNA
• Enveloped
• The virion is tubular in appearance
Figure 5: Marburg Virus
Source: Filoviridae, 2010

Medical Importance of Ebola and Marburg Viruses
Disease Caused by Ebola
• Ebola haemorhagic fever (EHF): is a severe, often-fatal disease in humans and non-
human primates that has appeared sporadically since its initial recognition in 1976.
• Common found in West and Central Africa
Laboratory Diagnosis of Ebola

• Specimen: Blood
• Technique: Electron microscopy
• Drug of choice: There is no specific therapy
Disease Caused by Marburg

• Marburg hemorrhagic fever: is a rare, severe type of hemorrhagic fever which affects
both humans and non-human primates.
• Common found in Eastern Europe
Laboratory Diagnosis for Murburg

• Specimen: Blood
• Technique: Electron microscopy and tissue culture
• Drug of choice: There is no specific therapy
Key Points
• Hepatitis B is classified as family hepadnaviridae
• Hepatitis B is the causative agent of serum hepatitis
• The envelop of hepatitis B consists of hepatitis B surface antigen
• Hepatitis C is classified as family flaviviridae
• Hepatitis C is the causative agent of post transfusion hepatitis
• Ebola and Marburg viruses belong to family filoviridae
• Ebola viruses causes a fatal haemorrhagic fever while Marbug causes mild type of
hemorrhagic fever
• Ebola and Marburg viruses are pleomophic viruses
Evaluation
• What are the characteristics of Hepatitis B and C viruses?
• What are the diseases caused by Hepatitis B and C viruses?
• What are the characteristics of Ebola and Marburg Viruses?
• What is the medical importance of Ebola and Marburg Viruses?
References
• Brooks, G.F., Butel, J.S., Morse, S.A. et al. (2007). Medical Microbiology (24th ed.). New
York: McGraw- Hill.
• CDC (2009). DPDx, Laboratory Identification of Parasites of Public Health Concern.
Retrieved May 13th , 2010 from http://www.dpd.cdc.gov/dpdx/HTML/Image_Library.
htm/ Retrieved on 23rd March 2010.

Company Ltd.
UK Ltd.
• Highleyman, L. (2008). HIV Positive Individuals are at Higher Risk of Occult Hepatitis B
Virus Infection, but Occult Hepatitis C Virus is Rare. HIV and Hepatitis.com Coverage of
the XVII International AIDS Conference (AIDS 2008). Retrieved March 23rd, 2010 from
www.hivandhepatitis.com/.../docs/082208_e.html.
• Koprowski, G.J. (2008). Ebola Virus. Care mates. Retrieved March 23rd, 2010 from
www.care-mates.com/blog/?cat=608.
• Mike, S. (2004). Medical Entomology for students. London: Oxford University Press.
• Service, M.W. (1986). Lecture Notes on Medical Entomology for students. London:
Blackwell Scientific Publications.
• Virazone, (2010). Filoviridae: Molecular biology. Retrieved March 23rd , 2010 at
www.expasy.ch/viralzone/all_by_species/23.html.

Session 13: Varicella Zoster, Measles, Mumps and
Rubella Viruses
Learning Objectives
• List viruses transmitted through inhalation
• Describe characteristics of Varicella Zoster, Measles, Mumps, and Rubella Viruses
• Describe medical importance of Varicella Zoster, Measles, Mumps, and Rubella Viruses
Viruses Transmitted through Inhalation

• Viruses transmitted through inhalation include: Varicella zoster virus, Measles viruses,
Mumps virus, Rubella virus, Respiratory syncytial virus, Influenza virus
Varicella Zoster Virus
Characteristics
• It is a member of Herpesviridae family
• They are dsDNA viruses, enveloped, icosahedra in shape
• Transmitted by inhalation
• Causes cytopathic effect in cell culture (after being infected, cells dies, and the died cells
may clamp together and form inclusion bodies, cells may be lysed or mutated)
• Varicella is transmitted primarily by respiratory droplets while zoster is not
• Zoster (shingles) is a reactivation of varicella (chicken pox) during adulthood especially
in immunocompromized situation
• Is responsible for slow cytopathic changes in human tissues
Figure 1: Structure of Varicella Zoster Virus
Source: Quinlivan & Breuer, 2005
Disease Caused by Varicella Zoster Virus

• Varicella (chicken pox) in children
• Zoster (shingles) in adults
o Zoster usually occurs in persons immunocompromised as a result of disease, therapy,
or aging, but it occasionally develops in healthy young adults. (Reactivation of the
primary infection varicella)
Note: Both diseases are caused by the same virus

Session 13: Varicella Zoster, Measles, Mumps and Rubella Viruses 87
• Specimen
o Scrapings of base of vesicles or skin
o Vesicle fluid
o Biopsy
• Technique
o Smear to see mutilated cells (Tzanck cells)
o Serological test for Antigen or viral DNA detection
Drug of Choice
• Acyclovir
Measles Virus
Characteristic and Morphology

• Measles viruses belong to the family Paramyxoviridae
• Measles viruses are enveloped with helical nucleocapsid
• Possess one piece of single-stranded, RNA
• The envelope is covered with spikes which contain hemaglutinin, neuraminidase, or
fusion protein that causes cell fusion and haemolysis
Figure 2: Structure of a Paramyxovirus
Disease Caused by Measles Virus

• Measles
• Specimen
o Nasal scrapings
o Blood sample
• Technique
o Tissue culture
o Hemaglutination test
Drug of Choice
• No antiviral therapy is available

Mumps Virus
Characteristic and Morphology
• Mumps viruses are enveloped with a helical nucleocapsid and one single-stranded RNA
• The virion has two types of envelope spikes; one with both hemaglutinin and
neuraminidase activities and other with cell fusing and hemolytic activities.
• The internal nucleocapsid protein is the S (soluble) antigen detected in the complement
fixation test used for diagnosis.
• Human is the natural host
Disease Caused by Mumps Virus

• Mumps
• Orchitis
• Oophritis
• Specimen
o Blood
• Technique
o Complement fixation test
Rubella Virus
Characteristics and Morphology

• Rubella viruses belongs to the Togaviridae family
• An enveloped viruses with an icosahedral nucleocapsid
• Possess one piece single-stranded RNA
• Replication takes place in the cytoplasm of the host cell
• Assembly and budding occurs through host cell membranes
Disease Caused by Rubella Virus

• Rubella (german Measles)
• The consequences of rubella in uterus are referred to as the congenital rubella syndrome
Laboratory Diagnosis of Influenza

• Specimen
o Blood
• Technique
o Serology
o Tissue culture
Drug of Choice
• No antiviral therapy available

Key Points
• Viruses transmitted through inhalation includes: Varicella zoster viruses, Measles viruses,
Mumps virus, Rubella virus, Respiratory syncytial virus, Influenza virus.
• Varicella zoster viruses cause Varicella (chicken pox) in children and Zoster (shingles) in
adults especially in immune compromised situation.
• Paramyxoviruses including the measles and mumps have fusion (F), matrix polymerase
and nucleocapsid proteins necessary for penetration and spread of the viruses in the host.
• The internal nucleocapsid protein of mumps virus has S (soluble) antigen detected in the
complement fixation test used for laboratory diagnosis.
• Rubella viruses belong to the family Togaviridae and are the causative of German
measles.
Evaluation
• What is zoster?
• What are characteristics of measles and mumps viruses?
• What are the diseases caused by Varicella, Measles, Mumps, and Rubella viruses?
References
• Computational System Biology Laboratory. (2009). Influenza Virus, Structure and
Function. Retrieved March 23rd, 2010 from csb.yonsei.ac.kr/1160.
Company Ltd.
Hong Kong: UK: ELBS with Churchill Livingstone, Medical Division of Longman
Group Ltd.
• Highleyman, L. (2008). HIV Positive Individuals are at Higher Risk of Occult Hepatitis B
Virus Infection, but Occult Hepatitis C Virus is Rare. HIV and Hepatitis.com Coverage of
the XVII International AIDS Conference (AIDS 2008). Retrieved March 23rd, 2010
from www.hivandhepatitis.com/.../docs/082208_e.html.
• University of Cape Town. (2010) Introduction to Molecular Virology. Department of
Molecular and Cell Biology, University of Cape Town. Retrieved March 23rd, 2010 from
www.mcb.uct.ac.za/.../MCB3011S%20Virology.htm.

Session 14: Influenza and Respiratory Syncytial
Viruses
Learning Objectives
• Describe characteristics of Influenza and Respiratory syncytial viruses
• Describe medical importance of Influenza and Respiratory syncytial viruses
Influenza Virus
Characteristics and Morphology

• Influenza viruses belong to the family Orthomyxoviridae which bears the following
characteristics
o The Virion is spherical, pleomorphic, 80–120 nm in diameter
o Bears helical nucleocapsid
o Genome is single-stranded RNA, segmented (eight molecules)
o Envelope contains viral hemagglutinin (HA) and neuraminidase (NA) proteins located
at different spikes
o Replication is by nuclear transcription; particles mature by budding from plasma
membrane
o The viral multiplication cycle proceeds rapidly
o New progeny viruses are produced within 8–10 hours
o Antigenic shifting is common among members of the same genus.
Influenza viruses especially influenza A show changes in the antigenicity of their
haemagglutinin and neuraminidase proteins
This property contributes to the capacity to cause devastating worldwide
epidemics
Figure 1: Structure of Influenza Virus
Source: Computational System Biology Laboratory, 2009

Session 14: Influenza and Respiratory Syncytial Viruses 91
Two Types of Antigenic Changes
• Antigenic shifts: These are major changes based on the reassortment of segments of the
genome RNA
• Antigenic drift: These are minor changes based on mutations in the genome RNA
o The antigenicity of the internal nucleocapsid protein determines whether the virus is
an A,B or C influenza virus
o Influenza A virus is the main cause of worldwide epidemics
Diseases Caused by Influenza Virus

• Influenza attacks mainly the upper respiratory tract. It poses a serious risk for the elderly,
the very young, and people with underlying medical conditions such as lung, kidney, or
heart problems, diabetes, or cancer
Laboratory Diagnosis of Influenza

• Specimen
o Blood
o Nasal scrapings
• Technique
o Serology
o Tissue culture
Drug of Choice
• Amantadine
• Rimantadine
Characteristics of Respiratory Syncytial Virus (RSV)

• The respiratory syncytia virus belong to the family Paramyxoviridae
• RSV are enveloped, with a helical nucleocapsid
• One piece of single-stranded RNA
• Have fusion protein in its surface spikes, which is the major pathogenicity factor
Figure 2: Structure of Respiratory Syncytia Virus
Source: ICTVdB Management, 2006.

Disease Caused by Syncytial Virus
• Bronchiolitis and pneumonia in infants
• Otitis media in older children
• Pneumonia in immunocompromised children and adults
• Specimen
o Respiratory secretions
• Technique
o Tissue culture
Drug of Choice
• Aerosolized Ribavirin
Key Points
• Influenza viruses belong to the family Orthomyxoviridae
• Influenza pandemic is caused by antigenic shift
• The envelopes of influenza virus is covered with spikes which contain hemaglutinin,
neuraminidase, and fusion protein that causes cell fusion and hemolysis
• Repiratory syncythial virus has spikes which contain fusion protein that causes cell fusion
• Giant cell formation by RSV is a result of cell fusion
Evaluation
• What are the characteristics of Influenza viruses?
• What are the characteristic features of the Respiratory syncytial virus?
• What is the medical importance of Influenza and RSV?
References
• Cook, G. (2000). Manson’s Tropical Diseases (22nd ed). London: WB Saunders Company
Ltd.
• Greenwood, D. Richard, C.B.S. John, F.P. (1992). Medical Microbiology (4th ed). Hong
• Hickey, T. (2004). Smallpox: Then and Now. The science Creative Quartely; (4).
Retrieved March 24th , 2010 from www.scq.ubc.ca/smallpox-then-and-now/
• ICTVdB Management. (2006). 01.048.2.01.001. Human respiratory syncytial virus. In:
ICTVdB - The Universal Virus Database, version 4. Büchen-Osmond, C. (ed), New York:
Columbia University.
• Jawetz, Melnick, & Adelberg's. (2007) .Medical Microbiology (24th, ed.). USA: The
• Levinson, W. (2004). Medical Micribiology and Immunology (8th ed.) Examination &

• Quinlivan, M. & Breuer, J. (2005). Structure of the varicella–zoster virus particle. Expert
Reviews in Molecular Medicine. Cambridge University Press. Retrieved March 14th ,
2010 from journals.cambridge.org/fulltext_content/ERM/E...

Session 15: Poliovirus, Hepatitis A, Yellow Fever and
Rabies Viruses
Learning Objectives
• Define enteroviruses and arboviruses
• Describe characteristic of poliovirus, hepatitis A, yellow fever and rabies viruses
• Describe medical importance of poliovirus, hepatitis A, yellow fever and rabies viruses
Definition of Enteroviruses and Arboviruses

• Enteroviruses: Are subgroup of picornaviruses, including polioviruses, coxsackieviruses,
and echoviruses that infect the gastrointestinal tract and often spread to other areas of the
body, especially the nervous system
o They are transmitted through fecal oral route in contaminated food or water
• Arboviruses: Are large group of RNA viruses that are transmitted primarily by
arthropods, such as mosquitoes and ticks
o This is a biological group divided among families: Togaviridae, Flaviviridae,
Bunyaviridae, Arenaviridae and Rhabdoviridae
o These viruses cause a variety of infectious diseases in humans, including rubella,
yellow fever, dengue and rabies.
Poliovirus
Morphology and Characteristics of Poliovirus
• They all belong under the family Picornaviridae
• They are the smallest viruses
• They are non enveloped viruses with icosahedra nucleocapsid symmetry.
• Single stranded linear non segmented RNA
• Genome RNA acts as mRNA and is translated into 1 large polypeptide which is cleaved
by virus encoded protease to form functional viral proteins (vp)
• They are all stable under acid conditions, pH 3-5 which enables them to survive exposure
to gastric acid
• The virus replicates in the pharynx and the GI tract
• It can spread to the local lymph node and then through the blood stream to the central
nervous system
• Human is the only natural host

Session 15: Poliovirus, Hepatitis A, Yellow Fever and Rabies Viruses 95
Figure 1: Structure of Poliovirus
Source: Lederman, M. 2010
Disease Caused by Poliovirus

• Paralytic poliomyelitis and aseptic meningitis
• Specimen
o CSF
o Stool
• Technique
o Tissue culture
Drug of Choice
• No antiviral therapy is available
• However, the disease can be prevented by both inactivated vaccine and live attenuated
vaccine
Hepatitis A Virus (Enterovirus 72)
Morphology and Characteristics

• Naked nucleocapsid virus with single stranded RNA
• Is a spherical particle with icosahedral capsid symmetry
• The nucleotide and amino acid sequences of Hepatitis A Virus (HAV) are sufficiently
distinct
• The virus replicates in the GI tract and then spreads to the liver during a brief viremic
period

Figure 2: Hepatitis A Virus under Electron Microscope
Source: Baron, 1996
Disease Caused by Hepatitis A virus

• Infectious Hepatitis
• Specimen
o Blood
• Technique
o Serology (Counter-immuno-electrophoresis)
Drug of Choice for Hepatitis A Virus

• There is no antiviral drug available
• Vaccine contain killed virus
Yellow Fever Virus

• Yellow fever virus falls under the group of the Arthropod borne viruses (Arboviruses),
the viruses that are transmitted from one host to another by the bite of infected
bloodsucking arthropods
Characteristics of Arboviruses
• The viruses multiply in the tissues of the arthropod without evidence of disease or
damage.
• Some arboviruses are maintained in nature by transovarian transmission in arthropods.
• The major arbovirus diseases worldwide are yellow fever, dengue, viral haemorhagic
fevers, west nile fever, and sandfly fever.
• Rabies however, is not transmitted by arthropods but share biological characteristics with
Arboviruses.

Characteristics and Morphology of Yellow Fever Virus
• Fall under the family flaviviridae
• It is enveloped virus with an icosahedral capsid
• Single stranded linear non segmented RNA
• The envelope has three structural polypeptides, two are glycosylated
• Replication takes place in the cytoplasm
• Assembly occurs within endoplasmic reticulum
• Yellow fever virus multiplies in many different types of animals and in mosquitoes and
grows in embryonated eggs, chick embryo cell cultures, and cell lines, including those of
monkey, human, hamster, and mosquito origin
Figure 3: Structure of Yellow Fever Virus
Source: Maggiano & Thomas, 2010
Disease Caused by Yellow Fever Virus

• Yellow fever an acute, febrile, mosquito-borne illness characterized by liver and renal
dysfunction and hemorrhage
• Specimen
o Blood
o Biopsy
• Technique
o Tissue culture
o Immunohistochemistry
o Serology
o PCR
Treatment
• No Antiviral therapy available
• Live attenuated vaccine is effective for humans

Rabies Virus
• Rabies virus: An RNA virus of the Rhabdovirus group that causes rabies
Morphology and Characteristics of Rabies Virus

• Are elongated, distinctive “bullet shaped” appearance of size 70-180 nm in diameter
• They are enveloped viruses with helical nucleocapsid structure
• Virions contain single strand RNA, RNA polymerase enzymes (L and P proteins) that
transcribes and replicates genome RNA, external (G) glycoprotein, internal (M) matrix
protein, and Nucleocapsid (N)
• Replication occurs in the cytoplasm of host cell which acts as a virus “factory” creating
cytoplasmic inclusion bodies (Negri bodies)
• Rabies virus can cause a deadly encephalitis
Figure 4: Structure of Rabies Virus
Source: Vincent, R. 2010
Disease Caused by Rabies Virus

• Rabies
o This is an acute infection of the central nervous system (Encephalitis) that is almost
always fatal
• Specimen
o Biopsy specimen from the skin
o Serum
o Autopsy (Brain impression)
• Technique
o Tissue culture
o Srology (immunofluorescence or Nutralization tests)
Treatment
• No antiviral therapy available
• Human Diploid Cell Vaccine (HDCV)

Key Points
• Enteroviruses are viruses of the family Piconaviridae which are stable under acid
conditions to enable them survive exposure to gastric acid.
• Human is the only natural host of enteroviruses
• Yellow fever virus falls under the group of the Arthropod borne Viruses (Arboviruses),
the viruses that are transmitted from one host to another by the bite of infected blood
sucking arthropods
• Rabies viruses are elongated, distinctive “bullet shaped” appearance with helical
nucleocapsid structure which can cause fatal encephalitis
Evaluation
• What are the general characteristics of entetroviruses?
• What is the medical importance of enteroviruses?
• What are the characteristics of yellow fever virus?
References
• Baron, S. (1996). Hepatitis Viruses: Hepatitis A virus (4th ed.) Medical Microbiology.
USA: The University of Texas Medical Branch at Galveston.
• Cook, G. (2000). Manson’s Tropical Diseases (22nd ed). London: WB Saunders Company
Ltd.
• Greenwood, D. Richard, C.B.S. John, F.P. (1992). Medical Microbiology (4th ed). Hong
• Hickey, T. (2004). Smallpox: Then and Now. The science Creative Quartely; (4).
Retrieved March 24th , 2010 from www.scq.ubc.ca/smallpox-then-and-now/
• ICTVdB Management. (2006). 01.048.2.01.001. Human respiratory syncytial virus. In:
ICTVdB - The Universal Virus Database, version 4. Büchen-Osmond, C. (ed), New York:
Columbia University.
• Jawetz, Melnick, & Adelberg's. (2007) .Medical Microbiology (24th, ed.). USA: The
• Lederman, M. (2010). Virus Structure. Retrieved March 12th, 2010 from www.biol.vt.edu
/ .../biol4664 /text/text78.html.
• Lederman, M. (2010). Virus Structure. Virginia Polytechnic Institute and State
University. Department of biological Sciences. Retrieved March 24th, 2010 from
www.biol.vt.edu/.../biol4664/text/text78.html.
• Levinson, W. (2004). Medical Micribiology and Immunology (8th ed.). Examination &
• Maggiano, E. & Thomas, D. (2010). Retrieved March 13th, 2010 from http://
slavirusportfolio.wikispaces.com/Yellow+Fever...
• Maggiano, E. & Thomas, D. Yellow Fever. Sla Virus Portfolio. Retrieved March 24th,
2010 from slavirusportfolio.wikispaces.com/Yellow+Fever.

• Quinlivan, M. & Breuer, J. (2005). Structure of the varicella–zoster virus particle. Expert
Reviews in Molecular Medicine. Cambridge University Press. Retrieved March 14th ,
2010 from journals.cambridge.org/fulltext_content/ERM/E...
• Vincent, R. (2010). Architecture of a bullet-shaped virus. Virology Blog: About viruses
and viral disease URL www.virology.ws/.../

Parasitology
Session 1: Overview and Classification of Parasites
Learning Objectives
At the end of this session, students are expected to be able to:
• Define Parasitology
• Describe the concept of parasitism
• List types of parasites
• Describe types of hosts and vectors
• Classify parasites of medical importance
Definition of Terms
• Parasitology: Is the study of parasites, their hosts, and the relationship between them. As
a biological discipline, the scope of parasitology is not determined by the organism or
environment in question, but by their way of life.
• It is a science which deals with organisms that take up their residence, temporarily or
permanently, in or on other organisms for the purpose of procuring nourishment. The host
may also provide shelter and protection.
Concept of Parasitism
• A Parasite: Is an organism that lives in or on another organism called ‘host’, usually
larger than itself, from which it obtains nourishment and which may or may not harm the
host.
• Usually the host also provides shelter and protection to the parasite.
• Parasitism: Is any life association in which one species depends on another species. But
usually refers to an association in which one organism, the ‘host’ is injured, to some
degree, by the activities of the other, the ‘parasite’.
• A host: Is an organism that harbours a parasite
• Infestation: Is the invasion of the epithelial surfaces of the outer body surfaces and body
cavities by the parasite
• Infection: Is the invasion of the body tissues and organs by the parasite
Types of Parasitism
• Symbiosis
o The word symbiosis is derived from the greek word ‘symbioum’ meaning ‘living
together’
o Symbiosis is the relationship in which the two associates cannot exist independently
o They provide protection, nutrition or other advantages to one another
Example normal flora in the GIT produces Vitamin K and Vitamin B-complex,
while the host provides shelter
• Mutualism
o The word is derived from the Latin word ‘mutuus’ meaning ‘exchanged’
o Is the relationship in which both associates benefit from each other.
CMT 04104 Parasitology NTA Level 4 Semester 1 Student Manual

Session 1: Overview and Classification of Parasites 105
• Commensalism
o Commensalism is the relationship where the parasite derives benefit without
reciprocation but also without injury to the host, e.g. Entamoeba coli in the intestine
and Entamoeba gingivalis in the buccal cavity.
• Parasitism
o In parasitism, the host is injured by the parasite: i.e. pathogenesis and pathology
occur.
o The majority of parasites of man fall into this group.
• Examples
o Plasmodium causing malaria
o Entamoeba histolytica causing amoebic dysentery
o Trypanosoma gambiense causing trypanosomiasis
o Wuchereria bancrofti causing hydrocoele and elephantiasis
o Ascaris lumbricoides causing intestinal worm infection
Types of Parasites
Ectoparasite
• This is a parasite that lives on the surface of the host and its presence is referred to as
infestation.
• Examples
o Ascaris lumbricoides causing worm infestation in the gastro intestinal tract
o Sacorptes scabei causing the disease called scabies which is a form of dermatitis
Endoparasite
• This lives inside the host, i.e. invades various organs and tissues giving rise to an
infection
• Examples
o Plasmodium falciparum causing malaria invades the liver and red blood cells
o Hookworm Necator americanus causes hookworm anaemia
Obligate Parasites
• These are parasites that cannot exist when separated from the host
• Examples
o Filariae, malaria, and trypanosomes.
Facultative Parasites
• These can exist away from the host, they can exist both as parasites and as free-living
organisms
• Example
o Strongyloides stercoralis
Accidental or Incidental Parasites

• These are not normal parasites of man but enter or attach to the body and cause parasitism
in man
• Example
o Dirofilaria immitis; the dog heart filaria
o Toxocara canis; an ascarid of dogs that causes visceral larva migrans in man

Opportunistic Parasites
• These are usually commensals or non-pathogenic organisms
• They invade the body and cause disease when the host’s immune status is compromised
• Examples
o Toxoplasma gondii, Cryptosporidium parvum, Isospora belli, Microspora
Larval Parasites
• Larval Parasites are pathogenic parasites which infect man and cause pathology during
their larval stage of development.
• Their adults may be parasites of other animals, man or they may be free-living.
• Example
o Echinoccocus granulosus, Taenia solium, Spirometra mansonoides, Multiceps
multiceps.
Types of Hosts and Vectors

Instructions
Work in small manageable groups and list differences between vectors and hosts. Your
group will have 5 minutes to discuss and present afterwards. One group will present and
other groups will participate in discussion.
Types of Hosts
• Definitive/Final Host
o This is the host that harbours the adult stage or the sexual stages of the parasite.
o It is the host in which the mature or most developed form of the parasite occurs.
o Example
Man is the definitive host of trypanosomes that cause African sleeping sickness.
• Intermediate Host
o Harbours the larval or the asexual form of the parasite
o Example
Cow an intermediate host for T. saginata, Man is an intermediate host of malaria
parasites.
• Paratenic Host
o Host in which the parasite does not undergo any development but in which it ramains
alive and infective to another host.
o Example
Plerocercoides of Diphyllobothrium latum can be carried from smaller fish to
larger fish which are then consumed by humans and they proceed to develop into
adults in humans.
• Reservoir Hosts
o Harbour the same parasites as man and serves as source of infection to man
o Example
Rats with Trichinella spiralis, dogs harbour infection with Leishmania,
Armadillos harbour the parasite Trypanosoma cruzi that causes Chaggas disease.

• Host Specificity
o Most parasites develop only in a restricted range of host species, i.e. parasite exhibit a
varying degree of host specificity; some infecting only a single host, e.g. Taenia
solium adult can only develop in humans. But Trichinella spiralis is able to mature in
almost any mammal.
Types of Vectors
• Mechanical Vectors
o Are vectors which assist in the transfer of parasite forms between host but are not
essential in the life cycle of the parasite, i.e. no parasite development occurs in such
vectors.
o Examples of mechanical vectors are Musca domestica which can transfer cysts of
Entamoeba histolytica from faeces to food that is eaten by man.
• Biological Vectors
o These are vectors in which there is biological development of the parasite before it
can be transmitted
o Example mosquitoes are biological vectors of malaria parasites, filarial worms, and
yellow fever virus
Classification of Parasites of Medical Importance
• Parasites of medical importance can be classified according to two criteria

o Biological nature (taxonomic)
• Location in human body
Classification According to Biological Nature (Taxonomic)

• Parasites are classified into kingdom, phylum, class, order, family, genus and species.
• The parasites of humans in the kingdom protozoa are classified under four phyla:
Sarcomastigophora , Apicomplexa, Ciliophora and Microspora.
• The parasitic worms, or helminthes, of human belong to two phyla; platyhelminthes
(flatworms) and nemathelminthes (roundworms).
• Within these great assemblages (phyla) are found the important human parasites,
conveniently listed as subphyla.
The Parasites of the Kingdom Protozoa
Sarcomastigophora
• The important subphyla include
• Sarcodina (amoebas)
o These are ameboid in shape and the species infecting humans include Entamoeba
histolyitica and Naegleria floweri.
• Mastigophora (flagellates)
o These are flagellates which have one or more flagella.
o In some cases they contain an undulating membrane (example in trypanosomes).
o Mastigophora include intestinal and genitourinary flagellates (Giardia, Trichomonas,
Chilomastix) and blood and tissue flagellates (Trypanosoma, Leishmania).

Apicomplexa
• Sporozoa
o Undergo a complex life cycle with alternating sexual and asexual reproductive phases
usually involving two different hosts (arthropods and vertebrate) and the number of
parasites multiplies in each host.
o Sporozoa contains two classes of medical importance which include Coccidia,
Hematozoa
o The class Coccidia contains the human parasites like Isospora and Toxoplasma
species
o The class Haematozoa contains the blood sporozoans like the Plasmodium species.
• Ciliophora (containing the ciliates)
o Ciliophora are complex protozoa bearing cilia distributed in rows or patches.
o They bear two kinds of nuclei in each individual.
o The medical important cilliophora and only human parasite representative of this
group include Balantidium coli (a giant intestinal ciliate of humans and pigs).
• Microspora
o This is a distinctive group, formerly listed with the protozoa, often within the
sporozoa.
o It is now considered a separate phylum
o It comprises microsporidians which are seen as opportunistic parasites of immuno
suppressed hosts (microsporidiasis)
Refer to Handout 1.1: Major Pathogenic Protozoan Organisms
The Parasitic Worms, or Helminthes, of Medical Importance

• These belong to two phyla: Platyhelminthes and Nemathelminthes
Platyhelminthes (flatworms)
• Lack a true body cavity (coelom) and are characteristically flat in dorsoventral section
• There are two medically important classes which include
o Cestoda (tapeworms)
These are band-like and segmented
Examples of the genera of medical importance include Diphyllobothrium,
Spirometra, Taenia, Echinococcus, Hymenolepis, and Dipylidium
o Trematoda (flukes)
Flukes are typically leaf-shaped
Flukes and tapeworms of humans are hermaphroditic except schistosomes
Schistosomes are cylindrical and worm like
Examples of trematodes of medical importance include Schistosoma,
Paragonimus, Clonorchis, Opisthorchis, Heterophyes, Metagonimus, Fasciolopsis,
and Fasciola
Nemathelminthes
• These have separate-sexes and unsegmented roundworms
• They have body cavities
• They have complete digestive, reproductive and nervous systems
• They include many parasitic species that infect humans.

o Examples Necator americanus/ Ankylostoma duodenale (hook worm) , Enterobius
vermicularis, Trichuris trichiura, Ascaris lumbricoides and Strongiloides stercoralis,
Wuchereria bancrofti, Onchocerca volvulus and Dipetalonema persitans.
• An essential procedure in diagnosis of many helminthic infections is microscopic
recognition of ova or larvae in faeces, urine, blood, or tissues.
Classification of Parasites of Medical Importance According to Location in the Body

• Parasites that cause infection to human are classified according to location they infect.
• This gives the four major categories of parasites
o Intestinal (gut) parasites
o Tissue parasites
o Blood parasites
o Genital urinary parasites
Refer to Handout 1.2: Parasites and Site of the Body Parasitized
Key Points
• Parasitology is a science which deals with organisms that take up their residence,
temporarily or permanently, in or on, other organisms for the purpose of procuring
nourishment and shelter
• Parasitism is the relationship between the parasite(small) and the host(large)
• Parasites may be endo or ectoparasite
• Classification of parasites of medical importance is done by biological nature (taxonomic
classification) and site of residence within the body
• Major groups of parasites that infect man include single celled parasites called protozoa
and multicellular parasitic worms which are called metazoa or helminthes
Evaluation
• What is parasitism?
• List types of hosts and vectors.
• How are the parasites of medical importance classified?
References
• Brooks, G.F., Carroll, K.C., Butel, J.S. et al. (2007). Jawetz, Melnick, & Adelberg's
Medical Microbiology (24th ed.). USA: The McGraw-Hill Companies, Inc.
• Brown .H.W. (1968). Basic clinical Parasitology (3rd ed). New York: Meredith
Corporation.
Retrieved March 27th , 2010 from http://www.dpd.cdc.gov/ dpdx/HTML/Image_
Library.htm/
Company Ltd.
• Levinson, W. (2004). Medical Microbiology and Immunology. (8th ed.). Examination &

(2nd , ed.). Oxford: ELBS Butterworth, Heinemann Ltd.

Handout 1.1: Major Pathogenic Protozoan Organisms
Source: CDC 2009

Handout 1.2: Parasites and Site of the Body Parasitized
SITE PROTOZOA HELMINTHS

Intestinal parasites • Entamoeba histolytica • Taenia saginata
• Giardia lamblia • Taenia solium
• Balantidium coli • Schstosoma mansoni
• Isospora belli • Ascaris lumblicoides
• Cryptosporidium • Trichuris trichiura

parvum
• Trichnella spiralis
• Enterobius vermicularis
• Hookworm
o Ancylostoma duonale
o Necator americanus
• Strongyloides stercoralis
Blood borne parasites • Plasmodium spp • Filarial worm-Wucherelia

bancrofti
• Toxoplasma gondii
• Trypanosoma
o T. gambiense
o T. rhodensience
Tissue parasites • Toxoplasma gondii • Filarial worm-Onchocerca

volvulus
• Trichnella spiralis
• Taenia solium
• Echnococus granulosus
• Drancunculus medinesis
Genital urinary • Trichomonas vaginalis • Schistosoma haematobium

Session 2: Entamoeba Histolytica, Giardia Lamblia
and Balantidium Coli
Learning Objectives
• Define intestinal parasites
• List the intestinal parasites of medical importance
• Describe the characteristics of Entamoeba histolytica, Giardia lamblia, and Balantidium
coli
• Describe the life cycle of Entamoeba histolytica, Giardia lamblia, and Balantidium coli
• Explain the medical importance of Entamoeba histolytica, Giardia lamblia, and
Balantidium coli
Definition of Intestinal Parasite

• Intestinal parasites: Parasites that inhabit the gastro-intestinal tract.
• In humans, they are often spread by poor hygiene related to faeces, contact with animals,
or poorly cooked food containing parasites.
• Intestinal parasites include both helminths and protozoa.
• Protozoans include Amoeba, Giardia, Balantidium, Cryptosporidium, Microsporidia, and
Isospora. (Cryptosporidium, Microsporidia, and Isospora are opportunistic parasites
most common in HIV-infected persons).
• Helminths are worms such as Taenia saginata and T. Solium (tapeworms), Ascaris
lumbricoides (roundworms), Ancylostoma duonale and Necator americanus
(Hookworms), Trichuris trichiura, Schistosoma mansoni, Enterobius vermicularis, and
Strongyloides stercoralis.
Entamoeba Histolytica
• Size 15-30 µm
• Cytoplasm has 2 zones, hyaline outer margin (ectoplasm) and granular inner margin that
may contain red cells (endoplasm).
• Movement of trophozoites in fresh material is active, progressive and unidirectional
(galloping amoeba)
• Exist in both trophozoite and cystic forms
• Movement is through pseudopodia

Session 2: Entamoeba Histolytica, Giardia Lamblia and Balantidium Coli 115
Figure 1: Morphological Features of Trophozoites and Cysts of Entamoeba Histolytica
Mode of Acquiring the Disease

• Infection by Entamoeba histolytica occurs by ingestion of mature cysts in faecally
contaminated food, water, or hands
Life Cycle
Figure 2: Life Cycle of Entamoeba Hystolytica
Source: CDC 2009

Note : The numbers and letters in the text below refer to the diagram in Figure 2 on the
previous page.
• Cysts and trophozoites are passed in faeces

o Cysts are typically found in formed stool, whereas trophozoites are typically found in
diarrheal stool
• Infection by Entamoeba histolytica by ingestion of mature cysts in faecally
contaminated food, water, or hands
• Excystation and trophozoites release
o This occurs in the small intestine and trophozoites are released, which migrate to the
large intestine
o The trophozoites multiply by binary fission and produce cysts , and both stages are
passed in the faeces
o Because of the protection conferred by their walls, the cysts can survive days to
weeks in the external environment and are responsible for transmission
o Trophozoites passed in the stool are rapidly destroyed once outside the body, and if
ingested would not survive exposure to the gastric environment
o In many cases, the trophozoites remain confined to the intestinal lumen
• Noninvasive infection
o This is infection of individuals who are asymptomatic carriers
o They pass cysts in their stool
• Intestinal disease
o In some patients the trophozoites invade the intestinal mucosa and cause intestinal
disease
• Extraintestinal disease
The trophozoites may also invade through the bloodstream to the extraintestinal sites such
as the liver, brain, and lungs resulting to pathologic manifestations
• It has been established that the invasive and noninvasive forms represent two separate
species, respectively E. histolytica and E. dispar.
• The two species are morphologically indistinguishable unless E. histolytica is observed
with ingested red blood cells (erythrophagocystosis).
Disease Caused by Entamoeba Histolytica

• Amoebiasis
o Amoeibic dysentery
o Amoebic liver abscess
o Amoebic encephalitis
• Specimen
o Fresh stools
o Rectal scrapings
o Liver aspirate
o Blood
• Techniques
o Wet preparation for cyst and trophozoites
o Serological (complement fixation test)

Drug of Choice
• Metronidazole/Tinidazole
• Diodohydroxyquinoline
o Hepatic amoebiasis is best treated by chloroquine
Giardia Lamblia
• Occurs in two forms: Trophozoite and cystic forms
• The trophozoite is bilaterally symmetrical and binucleated
• It is pear shaped with 6 to 8 flagellas
• The trophozoite measures 12 – 15 µm with a broad, rounded anterior and a tapering
posterior extremity.
• The dorsal surface is convex
• The cyst is ellipsoid measuring 12 µm diameter
• Has a smooth well –defined wall and contains two or four – nuclei and many of the
structures of the trophozoite
Figure 3: Giardia Lamblia
A: Face and
B: Profile of Vegetative Forms
C and D are Cysts (Quadrinucleate – C and B inucleated – D, Stages)
Mode by which Giardia Lamblia is Transmitted

• Transmission is by ingestion of Giardia lamblia cysts in contaminated food or water.
o Cysts are resistant forms and are responsible for transmission of giardiasis.
o The cysts are hard and can survive several months in cold water.

Life Cycle
Figure 4: Life Cycle of Giardia Lambria
Source: CDC 2009
Note : The numbers in the text below refer to the diagram in Figure 4 above.
• Cysts and trophozoites are passed in the faeces (diagnostic stages).

• Infection occurs by the ingestion of cysts in contaminated water, food.
• Excystation in the small intestine releases trophozoites (each cyst produces two
trophozoites).
• Trophozoites multiply by longitudinal binary fission, remaining in the lumen of the
proximal small bowel where they can be free or attached to the mucosa by a ventral
sucking disk.
• Encystation occurs as the parasites transit toward the colon.
o The cyst is the stage found most commonly in nondiarrheal faeces.
o Because the cysts are infectious when passed in the stool or shortly afterward, person-
to-person transmission is possible.
o While animals are infected with Giardia, their importance as a reservoir is unclear.

Diseases Caused by Giardia Lamblia
Giardiasis characterized acute or chronic enteritis, with varied gastrointestinal symptoms
accompanied by general and nervous manifestations.
• Specimen
o Stools
o Duodenal aspirate
• Teachniques
Wet preparation for cyst and trophozoites
Drug of Choice
• Metronidazole /Tinidazole/Secnidazole
Balantidium Coli
• Exist in both trophozoite and cyst stage
• The trophozoite is ciliated oval organism, 60 x 45 µm or large
• The cell wall is lined with spiral rows of cilia
• Cytoplasm surrounds two contractile vacuoles, food particles and vacuoles and two nuclei
– a large kidney – shaped macronucleus and a much smaller, spherical genetic
micronucleus
• When the organism encysts, it secretes a double-layered wall
• The macronucleus, contractile vacuoles, and portions of the ciliated wall may be visible
with cyst, which ranges from 40 µm – 70µm in diameter
Figure 5: Morphological Features of Balantidium Coli
Brooks, Butel, Morse et al, 2007
Mode of Transmission
• Infection results from ingestion of viable cysts previously passed in the faeces of humans
and possible pigs.
• Cysts are the parasite stage responsible for transmission of balantidiasis

Life Cycle
Figure 6: Life Cycles of Balantidium Coli
Source: CDC 2009
• Cysts are passed into faeces

• The host most often acquires the cyst through ingestion of contaminated food or water
• Following ingestion, excystation occurs in the small intestine, and the trophozoites
colonize the large intestine
• The trophozoites reside in the lumen of the large intestine of humans and animals,
where they replicate by binary fission, during which conjugation may occur
• Trophozoites undergo encystation to produce infective cysts
• Mature cysts are passed with faeces .
Disease Caused By Balantidium coli

• Balantidiasis
o Balantidial dysentery
o Chronic recurrent diarrhoea

• Specimen
o Stools
o Mucosal scraping (from the sigmoid colon)
• Teachniques
o Wet preparation for cyst and trophozoites
o Culture
Drug of Choice
• Metronidazole
• Tetracycline
• Iodoquino
Key Points
• Entamoeba histolytica is an intestinal parasite which exist in both trophozoite and cyst
forms.
• Movement of Entamoeba histolytica is through pseudopodia.
• Entamoeba histolytica is transmitted by ingestion of mature cysts in faecally
contaminated food, water, or hands.
• Giardia lamblia parasite also exist in both trophozoite and cystic forms.
• Transmission of Giardia lamblia is also by ingestion of cysts in contaminated food or
water causing giardiasis.
• Balantidium coli is the largest intestinal protozoon of human and is the only pathogenic
ciliate.
• The infective form of Balantidium coli is cyst which depends on ingestion of faecally
contaminated food, water, or hands.
Evaluation
• What are the morphological characteristics of Entamoeba hystolytica?
• What are the diseases caused by Entamoeba histolytica?
• What are the major steps in the life cycle of Giardia lamblia?
• List the characteristics of Balantidium coli.
• What is the common drug of choice for the intestinal protozoa?
References
(Sixth ed). London: Butterworth
Retrieved March 27th, 2010 from http://www.dpd.cdc.gov/ dpdx/HTML/Image_
Library.htm/
Company Ltd.
(2nd, ed.). Oxford: ELBS Butterworth, Heinemann Ltd.


Session 3: Cryptosporidium Parvum, Isospora Belli
Learning Objectives
• Describe characteristics of Cryptosporidium parvum and Isospora belli
• Describe life cycle of Cryptosporidium parvum and Isospora belli
• Describe the medical importance of Cryptosporidium parvum and Isospora belli
Definition of Cryptosporidium Parvum
• Cryptosporidium parvum: Is a tiny coccidian parasite that causes outbreaks of diarrhoea.

• It is one of several species that cause cryptosporidiosis, a parasitic disease of the
mammalian intestinal tract.
• Cryptosporidium is a protozoan pathogen of the Phylum Apicomplexa
Characteristics of Cryptosporidium Parvum

• This is a typical coccidian parasite known to infect domestic animals especially cattle
causing cryptosporidiosis.
• The sporozoite measures 2-6 µm diameter.
• Cryptosporidium is capable of completing its life cycle within a single host, resulting in
microbial cyst stages (oocyst).
• Oocysts are rounded and measure 4.2 to 5.4 µm in diameter.
• Oocysts are excreted in feces and are capable of transmission to a new host.
• Sporozoites are sometimes visible inside the oocysts, indicating that sporulation has
occurred.
• In modified acid fast stain oocysts appear as bright pink to red organisms containing some
dark granules and usually have a central clear area.
Figure 1: Morphological Features of Cryptosporidium Parvum Oocyst
Double arrows indicate C. parvum

oocyst
Single arrow indicate a budding yeast

cells in a wet mount of stool
Source: CDC 2009

Session 3: Cryptosporidium Parvum, Isospora Belli 125
• Through ingestion (faecal-oral) of oocysts in contaminated food and water
• In healthy human hosts, the median infective dose is 132 oocysts
Life Cycle of Cryptosporidium Parvum

• The life cycle of Cryptosporidium parvum consists of an asexual stage and a sexual stage
• The life cycle begins with oocysts which contain 4 naked sporozoites.
• Oocysts are infective at the time of excretion
• The ingested oocysts excysts when reaches the small intestine to release sporozoites
• The sporozoites invade epithelial cells of small intestine and become intracellular.
• The sporozoites undergo schizogony (merogony) to form schizonts
• Schizonts burst to release merozoites which invade other epithelial cells.
• Some of the merozoites changes to macrogamonts and microgarmonts and initaiate the
sexual life cycle where by oocyct are produced.
• Oocyst are not intracellular
• Ocysts are passed into faeces and cause infections to other hosts
Figure 2: Life Cycle of Cryptosporidium Parvum
Source: CDC 2009
Refer to Handout 3.1: Detailed Life Cycle of Cryptosporidium Parvum
Medical Importance of Cryptosporidium Parvum

• Cryptosporidium parvum causes
o Unremitting, profuse diarrhoea in HIV&AIDS for months
o Biliary disease can occur

Diagnosis
• Specimen
o Stool
o Serum
• Technique
o Microscopy
Wet mount
Modified ZN stain
o Serological tests
ELISA
Treatment
• Most people who have healthy immune systems will recover without treatment
• Fluid replacement is very important and depends on the degree of dehydration.
o Oral rehydration solution (ORS) and drinking a lot of fluids will help in the mide
dehydration
o IV fluids will help in severe dehydration
• In non-HIV infected patients Nitazoxanide 500 mg PO bid x 3d
• In HIV infected patients no drug has proven efficacy against cryptosporidiosis especially
in advanced AIDS. Treatment with HAART is the mainstay of therapy.
• Otherwise, drugs may be tried to decrease diarrhea and intractable Malabsorption of
antimicrobial drugs, which can occur with chronic cryptosporidiosis. The drugs include
o Nitazoxanide or
o Paromomycin or
o A combination of paromomycin and azithromycin or
o Azithromycin or
o Atovaquone
Characteristics of Isospora Belli

• It is opportunistic parasite associated with AIDS
• The oocyst is elongate-ellipsoid constricted at one end and asymmetrical at the other end
(rugby ball shape)
• The wall is smooth, colourless and refractive
• The rounded granular sporoblast occupies the central area, this is the most prominent
feature x 660 magnification
• Its size measures about 28 x 14µm
• The sporocyst and sporozoite are subspheroid to ellipsoid measuring 14 x 10 µm in size
• It is sausage-shaped with 1 acentric RB

Figure 3: Morphology of Oocysts of Isospora Belli showing a Central Individual Mass of
Protoplasm
Source: Arcari,Baxendine & Bennett, 2000
• Ingestion of Oocyst in faeces

Life Cycle of Isospora Belli
Figure 4: Life Cycle of Isospora belli
Source: CDC 2009

Note : The numbers in the text below refer to the diagram in Figure 4 on the previous page.
• The immature oocyst containing usually one sporoblast (rarely two) are excreted in
faeces.
o In further maturation after excretion, the sporoblast divides in two (the oocyst now
contains two sporoblasts).
o The sporoblasts secrete a cyst wall, thus becoming sporocysts; and the sporocysts
divide twice to produce four sporozoites each. Now they are infective sporocysts.
• Infection occurs by ingestion of sporocysts-containing oocysts.
o The sporocysts excyst in the small intestine and release their sporozoites, which
invade the epithelial cells and initiate schizogony.
• Schizogony forms schizonts in the enterocytes of the small intestine.
• Upon rupture of the schizonts, the merozoites are released, invade new epithelial cells,
and continue the cycle of asexual multiplication.
o Trophozoites develop into schizonts which contain multiple merozoites.
• After a minimum of one week, the sexual stage begins with the development of male
and female gametocytes
o Fertilization results in the development of oocysts that are excreted in the stool .
Medical Importance of Isospora Belli

•Isospora belli causes
o Diarrhoea (usually self-limiting) in immunocompetent patients
o Chronic diarrhoea in the immunocompromised patients like in HIV&AIDS
Diagnosis
• Specimen
o Stool
o Serum
• Technique
o Microscopy
Wet mount
Modified ZN stain
o Serological tests
ELISA
Drugs of Choice
• Trimethoprim-sulfamethoxazole (Co-trimoxazole).
• Sulfadoxin-Pyrimethamine (Fansidar or SP).
Key Points
• Cryptosporidium parvum is a typical coccidian parasite 2-6 µm
• It is a causative agent of Cryptosporidiosis in man
• Isospora belli is also a coccidian parasite associates with HIV&AIDS (it is opportunistic)
• Identification of both C.parvum and I. Belli is based on microscopic examination of wet
mount and stained stool preparations for oocysts

Evaluation
• What are the morrpholgical characteristics of Cryptosporidium parvum?
• What are the methods of transmission of Cryptosporidium parvum and I. Belli?
• What is the medical importance of Cryptosporidium parvum and Isospora belli?
References
• Arcari, M., Baxendine, A. & Bennett, C. E. (2000). The Ciliates, Coccidia and
Microsporidia. Diagnosing Medical Parasites through Coprological Techniques.
• Brown, H.W. (1968). Basic Clinical Parasitology (3rd ed). New York: Meredith
Corporation.
• CDC (2007). Laboratory Identification of Parasites of Public Health Concern.
“Cryptosporidiosis.” Retrieved March 27th, 2010 from http://www.dpd.cdc.gov/dpdx/
HTML/Cryptosporidiosis.htm
Retrieved March 27th , 2010 from http://www.dpd.cdc.gov/ dpdx/HTML/Image_
Library.htm/
Company Ltd.
• Levinson, W. (2004). Medical Microbiology and Immunology. (8th ed.). Examination &
• Mike, S. (2004). Medical Entomology for Students. London: Oxford University Press.

Handout 3.1: Detailed Life Cycle of Cryptosporidium Parvum
• The life cycle of Cryptosporidium parvum consists of an asexual stage and a sexual stage.
• After being ingested the oocysts excyst in the small intestine.
• They release sporozoites that attach to the microvilli of the epithelial cells of the small
intestine.
• Sporozoites become trophozoites that reproduce asexually by multiple fission, a process
known as schizogony.
• The trophozoites develop into Type 1 meronts that contain 8 daughter cells.
o These daughter cells are Type 1 merozoites, which get released by the meronts.
o Some of these merozoites can cause autoinfection by attaching to epithelial cells to
continue the asexual cycle.
• Others of these merozoites become Type II meronts which contain 4 Type II merozoites.
o These merozoites get released and they attach to the epithelial cells.
o From there they become either macrogamonts or microgamonts.
o These are the female and male sexual forms, respectively.
o This stage, when sexual forms arise, is called gametogony.
o Zygotes are formed by microgametes from the microgamont penetrating the
macrogamonts.
• The zygotes develop into oocysts of two types.
o 20% of oocysts have thin walls and so can re-infect the host by rupturing and
releasing sporozoites that start the process over again.
o The thick-walled oocysts are excreted into the environment.
The oocysts are mature and infective upon being excreted.
They can survive in the environment for months.

Session 4: Ascaris Lumbricoides and Trichuris
Trichiura
Learning Objectives
• List intestinal nematodes
• Describe the characteristics of ascaris lumbricoides and trichuris trichiura
• Describe the life cycle of ascaris lumbricoides and trichuris trichiura
• Describe the medical importance of ascaris lumbricoides and trichuris trichiura
Overview of Intestinal Nematodes

• Intestinal nematodes are round worms that infest the gastrointestinal tract of human and
other animals.
• They are characterized by having separate-sexes and unsegmented body, body cavities
and complete digestive, reproductive and nervous systems.
• Examples of intestinal nematodes include Ascaris lumbricoides, Trichuris trichiura,
Necator americanus/ Ankylostoma duodenale (hook worm), Enterobius vermicularis,
Trichuris trichiura and Strongiloides stercoralis
Refer to Handout 1.2: Parasites and Site of the Body Parasitized of Session 1
Characteristics of Ascaris Lumbricoides (True Round Worm)

• Large size of about 15 – 31cm length and 2-4 mm width, where females are relatively
larger than males
• The mouth is surrounded by three prominent lips
• Males have the posterior end which is curved ventrally and the tail is curled with two
prominent specules
• The female tail is straight and pointed
Figure 1: Morphology of Adult Ascaris Lumblioides
Source: CDC 2009
Eggs
• Size 45-70 x 35-50 µm
• There are three types of eggs
Fertilized egg
Decorticated and
Unfertilized

Session 4: Ascaris Lumbricoides and Trichuris Trichiura 133
• The fertilized egg is layered with outer albuminous covering which is coarsely
mammilated (= warty), thick egg shell, unsegmented embryo when laid.
• Decoticated egg is devoid of the mammilated coat. Can easily be confused with the
hookworm ova.
• Unfertilized egg is has all the layers fused together and resemble vegetable fibres.
Figure 2: Morphological Features of Different Types of Ascaris Lumbricoides Ova
A fertilized egg of Ascaris A "decorticated," fertilized Unfertilized egg of

lumbricoides egg of Ascaris lumbricoides A. lumbricoides
Note: The egg is covered
with a thick shell that appears
lumpy (bumpy) or
mammillated
Source: Atlas of Medical Parasitology
Mode of Transmission of Ascaris Lumbricoides

• Ascaris lumbricoides is transmitted through ingestion of eggs from food, water or fingers
contaminated with faeces (Faecal oral route).
Life Cycle of Ascaris Lumbricoides

Note : The numbers in the text below refer to the diagram in Figure 3 below.
• Adult worms live in the lumen of the small intestine
• A female may produce approximately 200,000 eggs per day, which are passed with the
faeces
• Eggs are not infective immediately when passed in the faeces
o Unfertilized eggs may be ingested but are not infective
o Fertile eggs develop an embryo and become infective after 18 days to several weeks
depending on the environmental conditions (optimum: moist, warm, shaded soil)
• Infective eggs are swallowed
• The egg hatches to release the larvae
• The larvae invade the intestinal mucosa, and are carried via the portal vein to the
systemic circulation, to the heart and eventually reach to the lungs (heart lung migration)
o The larvae mature further in the lungs (10 to 14 days)
• They break out from the blood capillaries and appear in the alveoli, ascend the
inverted bronchial tree to the throat, and are swallowed again

• Upon reaching the small intestine, they develop into adult worms in the period of 2 to
3 months after ingestion of the infective eggs
• The male fertilizes the females and the female’s starts oviposition
• Adult worms can live from 1 to 2 years
Figure 3: Life Cycle of Ascaris Lumbricoides
Source: CDC 2009
Medical Importance of Ascaris Lumbricoides

• Ascaris lumbricoides causes
o Ascaris pneumonitis (Loeffler’s syndrome)
o Allergic manifestations (asthma)
o Migrating larvae may reach the brain and cause encephalitis and meningitis
o Adult worms can cause
Intestinal ascariasis
Malnutrition and general body debility
Intestinal obstruction
Appendicitis

Intestinal perforation
Migrating adults may reach the brain and cause encephalitis (rarely occurs)
Diagnosis
• Specimen
o Stool
• Technique
o Microscopy
Wet mount and concentration method to detect ova
o Clinical observation of worms passed
Drugs of Choice
• Albendazole
• Mebendazole
• Levamisole
• Pyrantel pamoate
• Piperazine
Characteristics of Trichuris Trichiura (Whipworm)

• The adult worm is greyish white or pinkish and lives in the caecum with the slender
anterior end embedded in the mucosa between intestinal villi
• The male
o Is 3 – 4.5 cm long
o Has a thin anterior portion which is half as long as the thicker posterior portion
o The tail end is curved and terminates in a spicule
• The female
o Is 3.5 – 5.5 cm long
o Has a thin anterior portion which is twice as long as the thick posterior half containing
a stout uterus packed with eggs
• The eggs
o Measures 50x22 µm is brown and has characteristically barrel shaped
o Has a single thick egg shell with a translucent plug at each end (bipolar plug)
o It contains an unsegmented embryo at oviposition

Figure 4: Trichuris Trichiura - Adult Worms and Eggs
The eggs
Source: Smith, 2005 Source: CDC (2009)
• Trichuris trichiura is transmitted through ingestion of eggs from food, water or fingers
contaminated with faeces (Faecal oral route).
Life Cycle of Trichuris Trichiura

• The undeveloped (unembryonated) eggs are passed with the stool
• In the soil,
o The eggs develop into a 2-cell stage,
o An advanced cleavage stage,
o Then develop an embryo
o The whole process from oviposition to infective stage takes about 15 to 30 days
• After ingestion, the eggs hatch in the small intestine, and release larvae
• The larvae mature and establish themselves as adults in the colon
• The adult worms (approximately 4 cm in length) live in the cecum and ascending colon
• The adult worms are fixed in that location, with the anterior portions threaded into the
mucosa
• The females begin to oviposit 60 to 70 days after infection
• Female worms in the cecum shed between 3,000 and 20,000 eggs per day
• The life span of the adults is about 1 year
Note : The numbers in the text above refer to the diagram in Figure 5 on the following page.

Figure 5: Life Cycle of Trichuris Trichiura
Source: CDC 2009
Medical Importance of Trichuris Trichiura

• Adult worms cause
o Intestinal Trichuriasis
o Appendicitis
o Dysentery
o Rectal prolapse
o Anaemia
Diagnosis
• Specimen
o Stool
• Technique
o Microscopy
Wet mount and concentration method to detect ova
o Clinical observation of worms when the rectum has prolapsed

Drugs of Choice
• Albendazole
• Mebendazole
• Levamisole
• Pyrantel pamoate
• Piperazine
Key Points
• Ascaris lumbricoides and Trichuris trichiura are intestinal round worms which are
transmitted through ingestion of eggs from food, water and fingers contaminated with
faeces.
• Acaris lumbicoides causes Ascariasis (Ascaris pneumonitis, allergic manifestations,
encephalitis and meningitis).
• The life cycle of Ascaris lumbricoides follows heart-lung migration.
• Infection of Trichuris trichiura leads to dysentery and rectal prolapse.
• Diagnosis of both Ascaris lumbricoides and Trichuris trichiura depend on recovery and
identification of eggs in the faeces.
Evaluation
• What are the morphological characteristics of Ascaris lumbricoides?
• What are the differences between ova of Ascaris lumbricoides and that of Trichuris
trichiura?
• What are the laboratory techniques used to identify both Ascaris lumbricoides and
Trichuris trichiura?
References
• Ballantyne, J.W. (2009). Parasitic Diseases (5th ,ed.). Apple Trees Productions, LLC
• Brown, H.W. (1968). Basic Clinical Parasitology (3rd ed.). New York: Meredith
Corporation.
• Carlo Denegri Foundation. (2000). Atlas of Medical Parasitology. Retrieved May 13th,
2010 from http://www.cdfound.to.it/
th
• CDC (2009). Life Cycle of Trichuris Trichiura. Retrieved May 5 ,2010 from
http://www.dpd.cdc.gov/pdx.
Company Ltd.
• Levinson, W. (2004). Medical Micribiology and Immunology (8th ed.). New York:
McGraw Hill Medical Publishing & Davson.

Session 5: Ancylostoma Duonale, Necator Americanus
and Enterobius Vermicularis
Learning Objectives
• List characteristics of Ancylostoma duonale, Necator americanus and Enterobius
vermicularis
• Describe the life cycle of Ancylostoma duonale, Necator americanus and Enterobius
vermicularis
• Describe the medical importance of Ancylostoma duonale, Necator americanus and
Enterobius vermicularis
Characteristics of Ancylostoma Duonale, Necator Americanus

(Hookworms)
The Hookworms
• Hookworms are parasitic round worms that lives in the small intestine of its host, which
may be a mammal such as a dog, cat, or human.
• Two species of hookworms which are pathogenic to human are
o Ancylostoma duodenale
o Necator americanus
Ancylostoma duodenale
• Are small grayish white or pink with the head slightly bent in relation to the rest of the
body. This bend forms a definitive hook shape at the anterior end for which hookworms
are named.
• They possess well developed mouths with two pairs of ventral teeth.
• Males measure approximately one centimeter by 0.5 millimeter, the females are often
longer and stouter.
• Additionally, males can be distinguished from females based on the presence of a
prominent posterior copulatory bursa.
Necator americanus
• Is very similar in morphology to Ancylostoma duodenale.
• Is generally smaller than Ancylostoma duodenale with males usually 5 to 9 mm long and
females about 1 cm long.
• Possesses a pair of semi lunar cutting plates in the buccal capsule.
• Additionally, the hook shape is much more defined in Necator than in Ancylostoma.
Eggs
• The eggs are oval or elliptical, measuring 60 µm by 40 µm, colorless, not bile stained
with a single thin transparent hyaline shell membrane.
• When released by the worm in the intestine, the egg contains an unsegmented ovum.
• During its passage down the intestine, the ovum develops; thus the eggs passed in faeces
have a segmented ovum, usually with 4 to 8 blastomeres.

Session 5: Ancylostoma Duonale, Necator Americanus and Enterobius Vermicularis 141
• As the eggs of both Ancylostoma and Necator (and most other hookworm species) are
indistinguishable, to identify the genus, they must be cultured in the lab to allow larvae to
hatch out.
Figure 1: Morphology of Hookworm
Mouth parts (teeth) Mouth parts Rhabditiform larva of Hookworm ova

of Ancylostoma (cutting plates) of hookworm
duodenale Necator
americanus
Carlo Denegri Foundation, 2000
• Through skin penetration of infective filariform larvae (third stage larvae or L3)
contained in the soil. In addition, infection by A. duodenale may probably also occur by
the oral route.
• In rare cases, trans-mammary transmission (mother to child) can occur via breast milk
when a mother is heavily infected.
Life Cycle of Hookworms

Note : The numbers in the text below refer to the diagram in Figure 2 on the following page.
• Eggs are passed in the stool and under favorable conditions (moisture, warmth, shade),
larvae hatch in 1 to 2 days.
• The released rhabditiform larvae grow in the faeces and/or the soil.
o The rhabditiform larvae are active and feed on dead organic matter in the soil.
• After 5 to 10 days (after two molts) they become filariform (third-stage) larvae that are
infective.
o The filariform larvae are not active and do not feed
o They can survive 3 to 4 weeks in favorable environmental conditions in the soil.
• Upon contact with the human host, the larvae penetrate the skin, invade the blood
capillaries and are carried through the blood vessels to the heart and then to the lungs.
o They break from the blood capillaries and appear into the pulmonary alveoli, ascend
the inverted bronchial tree to the pharynx, and are swallowed.
• The larvae reach the small intestine, where they reside and mature into adults.
o Adult worms live in the lumen of the small intestine, where they attach to the
intestinal wall.
• The life span of adult worms in the small intestines is about 1 to 2 years.

Figure 2: Life Cycle of Hookworms
Source:CDC 2009
Medical Importance of Hookworms

Disease they Cause
• Ground itch at the time of skin penetration: irritating vesicular rash limited to the site of
invasion, usually in the sole of feet or hands
• Pneumonia during heart lung migration
• Iron deficiency anemia, secondary to loss of iron (and protein) in the gut
Diagnosis
• Specimen
o Stool
• Technique
o Microscopy
Wet mount and concentration technique to detect ova.
o Culture (Kato Katz technique) for recovery of rhabditiform larvae (but not routine)
o Clinical to when the worms are passed
Drug of Choice
o Albendazole
o Mebendazole
o Pyrantel pamoate

Characteristics of Enterobius Vermicularis (Pinworm, Seat Worm)
• Female
o They are small, 9-12 mm x 0.4 mm
o Has a cervical alae (wing like expansion) at the anterior end
o There is a bucal cavity that terminates into a prominent oesophageal bulb
o Has a long pointed tail
o The uteri of the gravid female are distended with eggs
• Male
o 2-5 mm with a curved tail and a single spicule
o Males are seldom seen
• Egg
o 50-54 x 20-27 µm with characteristic shape – flattened on one side. Almost colourless
with bean-shaped double contour shell
Figure 3: Eggs of Enterobius Vermicularis

A B
Source: CDC 2009
A. Eggs of Enterobius vermicularis in wet mount

B. Eggs of Enterobius vermicularis in cellulose preparation
• Ingestion of eggs from contaminated fingers, bedding and formites
• Inhalation of eggs from dust
• Autoinfection
• Retroinfection

Life Cycle of Enterobius Vermicularis
Figure 4: Life cycle of Enterobius Vermicularis
Source: CDC, 2009
• 1Eggs are deposited on perianal folds. Self-infection occurs by transferring infective eggs
to the mouth with hands that have scratched the perianal area (Autoinfection).
• 2The ingested eggs hatch in the small intestine to produce larva 3.
• 4& 5The larva matures and become adult in the large intestine where the male fertilizes
the female.
• 1. The female migrates to the perianal folds where deposit eggs on perianal skin folds.
The female worm dies after laying eggs.
• These would be swallowed and follow the same development
• Sometimes eggs hatch at the perianal area and the larva migrates to the caecum where
they mature to become adults and fertilization takes place (Retroinfection)
o Under optimal conditions, it takes 4 to 6 hours for the eggs become infective.
• The time interval from ingestion of infective eggs to oviposition by the adult females is
about one month.
• The life span of the adults is about two months.
Medical Importance of Enterobius Vermicularis
Disease they Cause

• Pruritus ani is the main symptom and varies from mild itching to acute pain which occurs
mainly at night.

• The pruritus provides scratching of the perianal region resulting in excoriation and
secondary infection.
• Vulvitis may be caused by pinworms entering the vulva causing a mucoid discharge and
pruritus vulvi.
Diagnosis
• Specimen
o Scotch tape swab
o Stool
• Technique
o Microscopy
Wet mount and concentration technique to detect ova
o Examination of the tape swab for ova and adult worm
Drugs of Choice
• Albendazole
• Mebendazole
Key Points
• Hookworm and Enterobius vermicularis are intestinal small round worms
• Hookworm follows heart lung migration in its life cycle while Enterobius vermicularis
follows direct life cycle without heart lung migration.
• Hookworm is transmitted through skin penetration by filariform larvae in the soil
• Enterobius vermicluaris is transmitted through
o Ingestion of eggs from contaminated fingers, bedding, and formites
o Autoinfection
o Retroinfection
Evaluation
• What is the mode of transmission of hookworm?
• Mention the most common complication of hookworm infection.
• Mention drugs of choice for enterobiasis and hookworms.
References
Corporation
• Carlo Denegri Foundation. (2000). Atlas of Medical Parasitology. Retrieved May 13th,
2010 from http://www.cdfound.to.it/
Retrieved May 27th, 2010 from http://www.dpd.cdc.gov/dpdx/
HTML/Image_Library.htm/
Company Ltd.

Session 6: Strongiloides Stercoralis
Learning Objectives
• List characteristics of Strongiloides stercolralis
• Explain life cycle of Strongiloides stercolralis
• Describe the medical importance of Strongiloides stercolralis
Chracateristics of Strongiloides Stercolralis

• Strongyloides stercoralis is a roundworm parasite that infects many warm-blooded
organisms including humans, causing strongyloidiasis.
• S. stercoralis parasitizes the tunnels in the mucosa of the small intestine.
• Other hosts for Strongyloides infection include mammals, birds, reptiles and amphibians
• Two species of Strongyloides can infect humans, S. stercoralis and S. fuelleborni.
• S. Fuelleborni is however common in African primates where infection can be shared
with humans.
• Males are about 0.9 mm in length and females can be anywhere from 2.0 to 2.5 mm.
• Both male and female possess a tiny buccal capsule and cylindrical esophagus without a
posterior bulb.
• Their developmental forms consist of adult, rhabditiform larva and filariform larva
(infective).
• In the free-living stage, both sexes are rhabditiform larva.
• Males can be distinguished from their female counterparts by two structures: the spicules
and gubernaculums
• It occurs in either of the two forms, parasitic forms and free living.
• The larva of strongiloides has a notched tail (This can help in distinguishing it the larva of
hookworm)
Figure 1: Morpholgy of Strongiloides Stercorilis Larva
Source: Mark, Viney & James, 2010
• Transminision of Strongyloides stercoralis is by the infective filariform larvae in
contaminated soil penetrating the human skin.
• Sometimes auto infection occurs
o Auto infection can result into overwhelming infection which can be life threatening.

Session 6: Strongiloides Stercoralis 147
Life Cycle of Strongiloides Stercolralis
Source: CDC, 2009
• The Strongyloides life cycle is more complex than that of most nematodes with its
alternation between free-living and parasitic cycles, and its potential for autoinfection and
multiplication within the host.
Three Types of Cycle Exist
Free-living Cycle
Note: The numbers in the text below refer to the diagram above.
• The rhabditiform larvae passed in the stool

• It can either molt twice and become infective filariform larvae (direct development)
• Or molt four times and become free living adult males and females
• Free living males and females mate and produce eggs
• Eggs hatch to produce rhabditiform larvae
• The rhabditiform larva can either develop into a new generation of free-living adults
(as represented in ), OR
• Rhabditiform larva develop into infective filariform larvae

Parasitic Cycle
• The filariform larvae in contaminated soil penetrate the human host skin to initiate the
parasitic cycle
• The filariform larvae transported via the blood stream to the lungs where they
penetrate the alveolar spaces; they are carried through the bronchial tree to the pharynx,
are swallowed and then reach the small intestine
• In the small intestine they molt twice and become adult female worms
• The females live threaded in the epithelium of the small intestine and produce eggs
o Eggs hatch and produce rhabditiform larvae and migrate to lumen
• The rhabditiform larvae can either be passed in the stool to start the Free-living cycle
OR
• The rhabditiform causes autoinfection
Autoinfection Cycle
• In autoinfection, the rhabditiform larvae become infective filariform larvae.
• The filariform larvae can penetrate either the intestinal mucosa (internal autoinfection) or
the skin of the perianal area (external autoinfection).
• In either case, the filariform larvae may follow the heart lung migration route, being
carried successively to the lungs, the bronchial tree, the pharynx, and the small intestine
where they mature into adults.
• Or they may disseminate widely in the body.
• Strongyloides autoinfection may explain the possibility of persistent infections for many
years in persons who have not been in an endemic area and of hyperinfections in
immunodepressed individuals.
Medical Importance of Strongiloides Stercolralis
Diseases Caused by Strongiloides stercoralis

• Strongiloidiosis that can manifest in the form of
o Worm infestation in duodenum and jejunum leading to chronic diarrhoea
o Skin rashes due to larvae
o Blindness due to larvae migrating into the eyes
o Viscera larva migrants due to autoinfection
o Pulmonary and neurologic complications
Instructions
You will work in small manageable groups to list specimens needed for laboratory diagnosis
of Strongiloides stercolaris. Your group will have 10 minutes to complete this work. One
group will present their findings and other groups will participate in the discussion.
• Specimen
o Stool
• Technique
o Microscopy
Wet preparation for larva

Drug of Choice
• Invermectine
• Mebendazole
• Albendazole
• Thiabendazole
Key Points
• Strongyloides stercoralis is a roundworm parasite that infects many warm-blooded
organisms including humans, causing strongyloidiasis
• Transminision of Strongyloides stercoralis is primarily by the infective filariform larvae
in contaminated soil penetrating the human skin.
• Auto infection can result into overwhelming infection which can be life threatening.
• Laboratory diagnosis is dependent on microscopic examination of stool to detect larva.
Evaluation
• What are the characteristics of Strongyloides stercoralis?
• What are the three types of life cycles of Strongyloides stercoralis?
• What is the Laboratory identification method for Strongyloides stercoralis?
• What are the drugs of choice for Strongyloides stercoralis?
References
• Brown, H.W. (1968). Basic clinical Parasitology (3rd ed.). New York: Meredith
Corporation.
• CDC (2009). DPDx, Laboratory Identification of Parasites of Public Health Concern
Retrieved May 13th, 2010 from http://www.dpd.cdc.gov/dpdx/HTML/Image_Library.htm/
• Cook, G. (2000). Manson’s Tropical Diseases (22nd Ed.). London: WB Saunders
Company Ltd.
• Drisdelle, R. (2010). Strongloides Stercoralis, Threadworm. Retrieved May 14th, 2010
from http://human-infections.suite101.com/article.cfm/strongyloides_stercoralis_
threadworm.
(7th ed.). Washington State University Pulman.
• Levinson, W. (2004). Medical Micribiology and Immunology (8th Ed.) New York:
• Mark, E.,V., James, B. L. (2010). Worm Book. Retrieved May 13th 2010 from
http://www.wormbook.org/chapters/www_genomesStrongyloides/genomesStrongyloides.
html.
• Mike, S. (2004). Medical Entomology for Students. London: Oxford University Press
• Monica, C. (1987). Medical Laboratory Manual for Tropical Countries (2nd Ed.).
Volume 1, Oxford: ELBS Butterworth, Heinemann Ltd.
Health Technology, Noida, India: Gapson Papers Ltd.

Session 7: Intestinal Cestodes -Taenia Saginata and
Taenia Solium
Learning Objectives
• Define Cestoda (Cestoidea)
• List characteristics of Taenia Saginata and Taenia solium
• Describe life cycle of Taenia Saginata and Taenia Solium
• Describe medical importance of Taenia saginata and Taenia solium
Definition of Cestoda and Tapeworms
Introduction of Cestodes
• Cestoda (Cestoidea) is a class of parasitic flatworms, commonly called tapeworms that
live in the digestive tract of vertebrates as adults and often in the bodies of various
animals as juveniles. Main cestodes that affect humans are Taenia saginata (from beef)
and Taenia solium (from pork).
• Tape worms: Are parasitic flatworms of the class Cestoda that live in the digestive tract
of vertebrates as adults.
• Two tapeworms of medical importance include Taenia satrginata and Taenia solium
• Taenia saginata, or the beef tapeworm, is a parasite of both cattle and humans.
• Taenia saginata occurs where cattle are raised by infected humans maintaining poor
hygiene, human faeces are improperly disposed, meat inspection programs are poor, and
where meat is eaten without proper cooking.
• Taenia solium also called the pork tapeworm infects pigs and humans.
Characteristics of Taenia Saginata

• The adult is 4-10m long and has 1000-4000 proglottides.
• The attachment organ (scolex) is pyriform and has 4 prominent hemispherical suckers.
• There no rostellum or hooks.
• The mature proglottides are about 12 mm broad and shorter.
• The gravid proglottides, are differentiated from those of T. solium by the more numerous
lateral branches on each side of the uterus.
• The gravid uterus which has no uterine pore contains 100,000 eggs.
• The yellow brown eggs cannot be distinguished from those of T. solium.

Session 7: Intestinal Cestodes -Taenia Saginata and Taenia Solium 151
Figure 1: Taenia Saginata Proglottid Showing Uterine Branches
Source: CDC2005
Figure 2: Scolex of Taenia Saginata

Suckers
Scolex
Source: Duarte, A. 2010
Eggs
• The eggs of both Taenia solium and Taenia saginata are indistinguishable.
• Eggs develop in hyaline capsules and are shed after leaving the proglottid.
• They have thick striated shell (outer membrane)
• Several of the larval hooks can be seen from inside of the egg.
• Approximate size is about 40 µm.
Figure 3: Taenia Species Eggs by Direct Wet Preparation
Source: Fabbrizi, 2010

Characteristics of Taenia Solium
• T. solium is a flattened ribbon like tapeworm that is white in color
• They are relatively shorter than T. saginata,
• The scolex, has 4 large suckers with a double row of hooks (Figure 6.4)
• The adult T.solium grows to be about 6mm in width and 2-7 m in length.
• It has about 800 proglottids
• Mature (Gravid) proglottid is less motile and has relatively few lateral uterine branches as
compared to T. saginata
• Each gavid proglottids contains both male and female reproductive organs and houses 30-
40 thousand eggs.
Figure 4: Scolex of Taenia Solium

Hook
Suckers
Source: Smith, D.S., 2006
Figure 5: Proglotid of Taenia Solium
Source: Mclaughling, 2010
Mode of Transmission of Taenia Saginata

• Taenia saginata is transmitted to humans through ingestion of contaminated beef
(Cysticercus bovis)
• Taenia solium is transmitted through ingestion of encysted larve (Cysticercus cellulosae)
in pork.

Life Cycle of Taenia Saginata and Taenia Solium
• Life cycle begins with either the eggs or the gravid proglottids being passed in the faeces,
which can last for days to months in the environment.
• Then, cattle or pigs ingest the contaminated vegetation with eggs or proglottids
• The oncospheres hatch in the small intestine of the cattle or pig and invade the intestinal
wall to travel to the striated muscles to develop into cysticerci.
• Humans can become infected when eating raw beef or pork meat.
• In the human, the cysticercus develop into adults in two months in the intestines.
• Using their scolex, adults attach to the small intestine where they reside.
• Proglottids, which contain eggs, break off the posterior end of the tapeworm, are either
passed intact in the host's faeces or they dissolve in the host's intestine and eggs are
passed in the faeces.
Figures 6: Life Cycle of Taenia Saginata and Taenia Solium
Source: Barbee & Smith, 2006

Medical Importance of Taenia Saginata and Taenia Solium
• Taenia saginata causes
o Appendicitis
o Intestinal obstruction
o Anal irritation
o Taeniasis
• Taenia soliun causes
o Appendicitis
o Intestinal obstruction
o Anal irritation
o Taeniasis
o Cysticercosis that leads to epilepsy
Diagnosis
• Specimen
o Stool
• Technique
o Microscopy
Wet preparation for eggs
Concetration method for eggs
o Inspection
Identification of proglotties
Drugs of Choice
• Praziquantel
• Niclosamide (Yomesan).
Key Points
• Tape worms are parasitic flatworms of the class cestoda that live in the digestive tract of
vertebrates as adults.
• Both T. sarginata and T. solium are characterized by proglottids for reproduction and a
prominent scolex for attachment.
• Eggs have thick striated shell (outer membrane) and the larval hooks can be seen from
inside of the egg.
• Infective stage of Taenia solium is Cystycercus cellulosae and Taenia saginata is
Cystycercus bovis
Evaluation
• What are the characteristics of Taenia saginata and Taenia solium?
• What are the intermediate hosts of Taenia saginata and Taenia solium?
• What is the medical importance of Taenia saginata and Taenia solium?

References
• Barbee, G. & Smith. D. S. (2006). Taenia Solium. Stanford University, Parasites &
Pestilence: Infectious Public Health Challenges. Retrieved May 4th 2010 from
www.stanford.edu/.../Taenia_solium/Home.html.
• Brown .H.W. (1968). Basic Clinical Parasitology (3rded.). New York: Meredith
Corporation.
• CDC (2005). Taenia Saginatad.JPG. Retrieved May 12th 2010 from http://www.ff.ul.pt
/paginas/aduarte/p_paraprog.html
Company Ltd.
• Duarte, A. (2010). Actividade, Pedagogica: Bacteriologia – Parasitologica. Retrieved
May 10th 2010 from http://www.ff.ul.pt/paginas/aduarte/p_paraprog.html
• Fabbrizi, (2010). Taenia Saginata/T.Solium. Retrieved May 10th 2010 from
www.stanford.edu/.../ cysticercosis/ lifecycle.htm
• Levinson, W. (2004). Medical Micribiology and Immunology (8th ed.) New York:
• Mclaughling, E. (2010). General Medicine Community. Retrieved May 4th 2010 from
adventuredoc.net/
Volume 1, Oxford: ELBS Butterworth, Heinemann Ltd.
Health Technology, Noida, India: Gapson Papers Ltd.

Session 8: Blood Trematodes – Schistosomes
Learning Objectives
• Define blood trematodes
• Describe the characteristics of schistosoma haematobium, schistosoma mansoni and
schistosoma japonicum
• Describe the life cycle of schistosoma haematobium, schistosoma mansoni and
• Describe the medical importance of schistosoma haematobium, schistosoma mansoni and
Overview of Blood Trematodes

• The blood trematodes (Schistosomes) belong to the phylum platyhelminthes.
• Differ from other trematodes in that they have separate sexes.
• Three species of schistosomes are responsible for human diseases. These include
o S. mansoni and S. japonicum which are responsible for intestinal shistosomiasis.
o S. haematobium which is responsible for urinary tract schistosomiasis.
Characteristics of Schistosoma Haematobium, Schistosoma Mansoni and

Schistosoma Japonicum
Adult
• Have a basic bilateral symmetry, cylindrical shape with oral and ventral suckers.
• Has a blind-ending digestive system consisting of mouth, oesophagus and bifurcated
caeca (No anus).
• Adult worms are about 10–20 mm long and use globins from their hosts' hemoglobin for
their own circulatory system.
• Male body folded to form the Gynaecophoric canal that enfolds the female.
• Male and female are held permanently in copula.
Egg of Shistosoma haematobium

• It is pale yellow brown, large and oval shape measuring about 145 x 55 µm
• Has a characteristics small spine atone end (terminal spine)
• Contains a fully developed miracidium
• A viable egg (in fresh unpreserved urine) show what is called flame cell movement
• A calcified egg is usually smaller and appears black and often distorted with a less
distinct terminal spine
Egg of Schistosoma mansoni

• It is pale yellow-brown, large and oval, measuring about 150 x 60 µm
• Has a characteristic side. (Lateral spine)
• Contains a fully developed miracidium
• A non viable egg is dark-coloured and shows no structure detail or flame cell movement
• A calcified egg is usually smaller and appears black and often distorted with a less
distinct spine

Session 8: Blood Trematodes - Schistosomes 157
Egg of Schistosoma japonicum
• It is colourless or pale yellow-brown, large and round to oval, measuring about
90 x 65µm
• A very small hook-like spine (rudimentary) can sometimes be seen projecting from the
egg wall but often is hidden by faecal debrils and red cells
• Contain a fully developed miracidium
• Calcified egg is usually smaller and appears black
Figure 1: Egg of Schistosoma Haematobium Under Wet Preparation
Egg of S. haematobium Egg of S. japonicum Egg of S.mansoni

Source:Upton, 2010
Mode of Transmission of Schistosomes

• For schistosomes to be transmitted there has to be a series of these events.
o Man contaminates water by urine (in the case of S. haematobium) or faeces (in the
case of S. manosni and S. japonicum) containing eggs.
o Presence of right species of snail hosts (Bulinus, Oiompharalia and Ocomelania) in
water that carries the asexual stages of schistosomes.
o Snail hosts: Bulinus for S. haematobium, Biomphalaria for S. mansoni, and
Onchomelania for S. japonicum.
o Human contact with contaminated water through bathing, swimming, wading,
washing, drinking or farming (paddy and sugar cane fields) lead to infection.

Figure 2: Intermediate Hosts of Schiostosomes
Biomphalaria species for S. Oncomelania humpensis for Bulinus globosus for S.

Mansoni S. japonicum hematobium
Source: CDC 2009
Life Cycle of Schistosoma Haematobium, Schistosoma Mansoni and

Schistosoma Japonicum
Schistosomes
Note: The numbers in the text below refer to the diagram in Figure 3 on the following page.
• Eggs are eliminated with feces or urine
• Under optimal conditions the eggs hatch and release miracidia
• Miracidia swim and penetrate specific snail intermediate hosts
• The stages in the snail include 2 generations of sporocysts
• After Sporocysts cercariae are produced within the snail
• Upon release from the snail, the infective Cercariae Swim, penetrate the skin of the
human host
• During penetration to human host, the Cercariae shed their forked tail and become
schistosomulae
• & The schistosomulae migrate through several tissues and stages to their residence
in the veins and mature into adult worms
• Adult worms in humans reside in the mesenteric venules in various locations, which at
times seem to be specific for each species
o Schistosoma japonicum is more frequently found in the superior mesenteric veins
draining the small intestine
o Schistosoma mansoni occurs more often in the superior mesenteric veins draining the
large intestine
o Both S. japonicum and S. mansoni can occupy either location, and they are capable of
moving between sites
o Schistosoma haematobium most often occurs in the venous plexus of bladder , but it
can also be found in the rectal venules
• The females deposit eggs in the small venules of the portal and perivesical systems
• The eggs are moved progressively toward the lumen of the intestine (Schistosoma
mansoni and Schistosoma japonicum) and of the bladder and ureters (Schistosoma
haematobium), and are eliminated with feces or urine, respectively
• Various animals, such as dogs, cats, rodents, pigs, horse and goats, serve as reservoirs for
Schistosoma japonicum

Figure 3: Life Cycle of Schistosomes
Source: CDC 2009
Medical Importance of S.Haematobium, S.Mansoni and Japonicum

• Schistosoma haematobium causes
o Urinary schistosomiasis
o Cercarial dermatitis and Katayama syndrome
o Hydronephrosis
o Calcification of the bladder
o Carcinoma of the bladder
• Schitosoma mansoni and Schistosoma japonicum
o Cercarial dermatitis (swimmer’s itch) within 24 hours after cercarial invasion
o Katayama syndrome
o Chronic schistosomiasis
Instructions
You will work in small manageable groups to discuss the laboratory diagnosis of
schistosomiasis. Your group will have 5 minutes to answer the question. One of the groups
will present their findings and other groups will participate in discussion.

Diagnosis
• Specimen
o Urine
o Stool
o Biopsy (Rectal snip)
• Technique
o Microscopy
Wet preparation of stool for eggs
Concentration method for eggs
Hatch test of urine
Histological examination of biopsy
• Other Tests
o Serological tests
o Radiology: Ultrasound and CT scan.
o Kato-Katz technique
Drugs of Choice
• Praziquantel
Key Points
• Schistosomes belong to the Phylum Platyhelminthes which have three species responsible
for human diseases; S. mansoni and S. japonicum and S. haematobium.
• Schistosomes infect through penetration of infective cercariae to the skin of human.
• Human contact with contaminated water through bathing, swimming, wading, washing,
drinking or farming is necessary for infection to occur.
• Routine laboratory diagnosis of schistosomes relies on microscopic examination of stool
and urine to detect presence of eggs.
Evaluation
• What are the three species of Schistosomes of medical importance?
• What are the distinguishing features of eggs of schistosomes?
• What is the drug of choice for schistosomiasis?
References
Corporation.
http://www.dpd.cdc.gov/dpdx/HTML/Image_Library.htm/ Last modified on 20th July 2009
Company Ltd.
• Harwood, R.F. &James, M.T. (1979). Entomology in Human and Animal Health (7th ed.).
Pulman: Washington state University.
• Levinson, W. (2004). Medical Micribiology and Immunology( 8th ed.). New York:

Monica, C. (2000). District Laboratory Practice in Tropical Countries. Part 2. Tropical
• Upton, S.J. (2010). Animal and Human Parasite Images. Retrieved May 10th, 2010 from
http://www.k-state.edu/parasitology/625tutorials/

Session 9: Blood Protozoa - Trypanosomes
Learning Objectives
• Explain an overview of trypanosomes
• Describe the characteristics of Trypanosoma gambiense and Trypanosoma rhodensience
• Describe the life cycle of T. gambiense and T. rhodensience
• Describe the medical importance of T. gambiense and T. rhodensience
Overview of Trypanosomes
• Trypanosomes are protozoan parasites belonging to the subphylum Mastigophora.
• Trypanosomaes of medical importance are
o Trypanosoma brucei gambiense
o Trypanosoma brucei rhodesiense
• Both species are responsible for causing African Trypanosomiasis in humans. The disease
is also known as sleeping sickness.
• The parasites are closely related and belong to the Trypanosoma brucei group.
• T. brucei belongs to the salivarian group of trypanosomes which develop in the mid gut of
the vector and transmission is by inoculation when the vector feeds.
• The vector is the Tse-Tse fly (Glossina species).
• Other tyrpanosomes of medical importance is T. cruzi that causes American
trypanosomiasis (Chaga’s disease).
Characteristics of T. Gambiense and T. Rhodesiense

• Trypanosomes are minute, actively motile, fusiform protozoa, flattened from side to side.
• The long sinuous body has a tapering anterior and a blunt posterior end.
• The flagellum runs the length of the body along the undulating membrane and usually
beyond it as an anterior free flagellum.
• It has a large oval nucleus, which has a central karyosome.
• The nucleus is situated toward the middle of the body.
• Tryponosomes travel with a wavy spiral motion produced by the contractile flagellum and
undulating membrane.
• Reproduction is by binary longitudinal fission.
Figure 1: Morphological Feature of Trypanosomes
Source: FAO 2010

Session 9: Blood Protozoa - Trypanosomes 163
Figure 2: Trypanosomes in a Stained Slide
Source: FAO, 2010
A T.gambiense and T. rhodesiense are transmitted through the bite of infected tsetse flies
(Glosina species)
Life Cycle of T. Gambiense and T. Rhodesiens

• During a blood meal on the mammalian host, an infected tsetse fly (genus Glossina)
injects metacyclic trypomastigotes into skin tissue.
• The parasites enter the lymphatic system and pass into the bloodstream.
o Inside the host, they transform into bloodstream trypomastigotes, are carried to other
sites throughout the body, reach other blood fluids (e.g., lymph, spinal fluid)
• Inside the body fluids the parasite continues the replication by binary fission.
o The entire life cycle of African Trypanosomes is represented by extracellular stages.
• , The tsetse fly becomes infected with bloodstream trypomastigotes when taking a
blood meal on an infected mammalian host.
• In the fly’s midgut, the parasites transform into procyclic trypomastigotes, multiply by
binary fission.
• Procyclic trypomastigotes leave the midgut, and transform into epimastigotes.
• The epimastigotes reach the fly’s salivary glands and continue multiplication by binary
fission.
• When the tse-tsefly takes the blood meal at this time, they transmit the parasite and the
cycle repeats.
o The cycle in the fly takes approximately 3 weeks.
o Humans are the main reservoir for Trypanosoma brucei gambiense, but this species
can also be found in animals.
o Wild game animals are the main reservoir of T. b. rhodesiense.

Figure 3: Life Cycle of Trypanosomes
Source: CDC 2009
Medical Importance of T. Gambiense and T. Rhodesiense

Disease Caused by T. Gambiense and T. Rhodesiense
• African trypanosomiasis (sleeping sickness)
• Inflammation at the site of inoculation
• Lymph node enlargement
Diagnosis
• Specimen
o Blood
o Aspirates from the lymph nodes
o Cerebral spinal fluid (CSF)
• Routine Techniques
o Microscopy
Wet preparation (for motile trypanosomes during acute phase)
Capillary tube (microhaematocrit) concentration technique
• Other Techniques
o Culture
o Serology
Indirect fluorescence antibody test (IFAT)

Complement fixation test (CFT)
Indirect haemaglutination test (IHAT)
Enzyme linked immunoabsorbent assay (ELISA)
Drugs of Choice
• Pentamidine
• Suramin
• Trypasamide
• Melasorprol
• Eflonithine
• Nifurtimox
Key Points
• Trypanosomes are protozoan parasites that are responsible for causing African
Trypanosomiasis.
• Trypanosomes are minute, actively motile, flagellated and flattened protozoa which has a
large oval nucleus situated toward the middle of the body.
• Transmission of the T. Gambiense and T. rhodesiense is through the bite of infected tsetse
flies of the Glosina species group.
• Routine laboratory diagnosis relies on microscopy to identify the parasite.
Evaluation
• What are characteristics of T. Gambiense and T. rhodesiense?
• What are three drugs of choice for treatment of African trypanasomiasis?
• What are reservoir host of T. Gambiense and T. rhodesiense?
References
Corporation.
http://www.dpd.cdc.gov/dpdx/HTML/Image_Library.htm/
Company Ltd.
• FAO (2010). African Animal Trypanosomes. Retrieved from www.fao.org/docrep/006/
x0413e/ X0413E02.htm
Pulman: Washington state University

Session 10: Blood Protozoa - Plasmodium
Learning Objectives
• Define plasmodium
• Describe characteristics of Plasmodium falciparum, P. vivax, P. ovale and P. malariae
• Describe life cycle of Plasmodium falciparum, P. vivax, P. ovale and P. malariae
• Describe medical importance of Plasmodium falciparum, P. vivax, P. ovale and
P. malariae
Overview of Plasmodium Species

• Plasmodium is one of the genus in the class hematozoa of the phylum protozoa
• They are parasites of human that reside in the red blood cells
• There are four species of plasmodium of medical importance namely
o Plasmodium falciparum
o P. vivax
o P. ovale
o P. Malariae
• The four species of plasmodium are responsible for causation of malaria to human
• The vast majority of infections in Africa are caused by the following
o Plasmodium falciparum and Plasmodium vivax
o Plasmodium malariae causes a small percentage of infections and Plasmodium ovale
is extremely rare
• Malaria occurs throughout the tropical world
• It is transmitted by the female anopheles mosquito
Characteristics of Plasmodium Falciparum, P. Vivax, P. Ovale and P.

Malariae
• Plasmodium species occur in different forms depending on the stage of its life cycle
• Plasmodium undergoes four major forms throughout its life cycle. These include
o Sporozoite stage
o Trophozoite stage
o Merozoites stage
o Gametocytes stage
Stages for Plasmodium falciparum

• Sporozoites
o A plasmodium sporozoite is the form that infects new hosts from a mosquito.
o The sporozoites develop in the mosquito's salivary glands, leave the mosquito during
a blood meal, and enter the liver through circulatory system where they multiply.
• Trophozoites
o Trophozoites of P. falciparum can be found on the edge of the red blood cells
o They occur as rings with dots (chromatin dots)
o The ring may present in either of the following forms (marginal, central, double
dotted rings, multiple rings)

Session 10: Blood Protozoa - Plasmodium 167
o It is unusual to see the developed trophozoite forms in peripheral blood
o Maurer's dots may be present and are distinctive features of P.falciparum.
• Merozoites
o Merozoites have a “signet-ring” appearance due to a large vacuole that forces the
parasite’s nucleus to one pole
o Merozoites appear in tissues of the liver and in red blood cells
o Schizonts (Merozoites) are usually found in capillaries sinuses of internal organs and
in the bone marrow
• Gametocytes
o Gametocytes are banana shaped (halter-shaped) but the pigment granules are more
confined
o Gametocytes can be seen within erythrocytes
o Gametocytes are the sexual stage of the malaria parasite
o Gamet6ocytes are seen in peripheral blood smears
o Usually only young trophozoites and gametocytes are seen in peripheral blood smears
Figure 1: Characteristics of Plasmodium Falciparum in Blood Smear
Source: CDC 2009
Characteristics of Plasmodium vivax in Blood Smear

• Red cells containing parasites are usually enlarged
• Schuffner's dots are frequently present in the red cells as shown in figure 2
• The mature ring forms tend to be large and coarse.
• Developing forms are frequently present.

Figure 2: Characteristics of Plasmodium Vivax in Blood Smear
Source: CDC2009
Characteristics of Plasmodium ovale

• Only found in Africa
• Red cells become enlarged
• Comet forms are common (top right)
• Rings are large and coarse
• Schuffner's dots, when present, may be prominent
• Mature schizonts are similar to those of Plasmodium malariae but larger and coarser

Figure 3: Characteristics of Plasmodium Ovale in Blood Smear
Source: CDC 2009
Characteristics of Plasmodium malariae

• Ring forms may have a squarish appearance
• Band forms are a characteristic of this species
• Mature schizonts may have a typical daisy head appearance with up to ten merozoites
• Red cells are not enlarged
• Chromatin dot may be on the inner surface of the ring
Figure 4: Morphological characteristics of Plasmodium malariae in blood smear
Source: CDC 2009

• By bite of an infective female anopheles mosquito injecting sporozoites from its salivary
glands into the blood circulation of man.
Other Mode of Transmission of Malaria

• Blood transfusions with infected blood
Life Cycle of P. Falciparum, P. Vivax, P. Ovale and P. Malaria

Figure 5: Life Cycle Plasmodium Falciparum
Source: CDC 2009
Life Cycle of Plasmodium

Note: The numbers in the text below refer to the diagram in Figure 5 above.
• 1Sporozoites from the salivary glands of an infected female anopheles are injected into
the blood stream when the mosquito takes a blood meal
• 2 & 3 Within 30 minutes enter liver cells in which they develop into liver schizonts
(= tissue schizonts). This is exo-erythrocytic schizogony
• 4 Liver schizonts burst and produce merozoites which enter the circulation
• 5In the circulation, these merozoites enter red blood cells to form trophozoites. These
form schizonts which divide to form new merozoites
• 6The blood schizonts burst to release the merozoites
• 7 Some of these merozoites develop to male (microgametocytes) and female
(macrogametocytes)

• This cycle 5, 6 & 7 in the red blood cells is called erythrocytic schizogony
• 8 The male and female gametocytes are ingested by the female Anopheles mosquito
• 9 In the stomach of the mosquito, the female gametocyte matures into a female gamete
while the male gametocyte undergoes exflagellation to form several male gametes.
• 10 The male gamete fertilizes the female gamete to form a zygote. The zygote then
develops into an ookinete
• 11The ookinete traverses the mosquito stomach cells producing oocyst
• 12 In the oocyst large numbers of sporozoites are formed. The sporozoites migrate to the
salivary glands of the female Anopheles
• 1 During the next blood meal a mosquito inoculated the sporozoites into human body and
the cycle repeats
Medical Importance of P. Falciparum, P. Vivax, P. Ovale and P. Malaria
Disease Caused
• Malaria
• Specimen
o Blood smear (thick or thin smear)
o Fresh whole blood
• Technique
o Microscopy
o Malaria Rapid Diagnostic Test (mRDT)
Drug of Choice
• Artemisinin combination therapy (ACT) for uncomplicated malaria
o Example Artemether – Lumefantrine (ALU)
• Quinine for severe and complicated malaria
Key Points
• Plasmodium is one of the protozoan parasites of human that reside in the red blood cells.
• Four plasmodium species that cause malaria include Plasmodium falciparum, P. vivax, P.
ovale and P. Malariae.
• Female anopheles mosquito is a vector responsible for transmission of plasmodium
species.
• Routine diagnostic techniques used to identify plasmodium parasite include microscopic
examination of blood smear and mRDT.
Evaluation
• What are species of plasmodium responsible for causing malaria?
• List characteristics of P.Falciparum trophozoites?
• What are the modes of transmission of malaria parasite?

References
Corporation.
Company Ltd.
• FAO (2010). African Animal Trypanosomes. Retrieved from www.fao.org/docrep/006/
x0413e/ X0413E02.htm

Session 11: Blood Borne Helminths - Wucherelia
Bancrofti
Learning Objectives
• Define Wucherelia bancrofti
• Describe characteristics of Wucherelia bancrofti
• Describe life cycle of Wucherelia bancrofti
• Explain medical importance of Wucherelia bancrofti
Overview of Wuchereria Bancrofti

• Wuchereria bancrofti is the blood borne helminth that belongs to the superfamily
Filarioidea of the phylum nematoda.
• Filarioidea group include spilurate filliform nematodes adapted in inhabiting the deeper
tissues like the circulatory, lymphatic, and connective tissue layers.
• Wuchereria bancrofti is responsible for causing bancroftian filariasis.
Characteristics of Wucherelia Bancrofti

• Thread like white worms found in the lymphatic vessels and glands.
• It contains short, thick proximal and a whip like distal portion ending in a hook shape
• The egg lies in the upper uterus enclosed in a chorionic membrane.
• The chorionic membrane becomes a sheath for the living embryos after the egg hatch into
a microfilaria.
• Wuchereria bancrofti are viviparous (reproduce by giving birth to young living
microfilaria).
• Female adult measures 80-100 x 0.25 mm and the male measures 40 x 0.1 mm.
• Adults of both sexes lie tightly coiled in the nodular dilatations of the lymphatic vessels
and sinuses of the lymph nodes while the microfilariae live in the blood and lymph.
• The length of life span in man is considered to be 5 years.
• Microfilaria circulate at night (nocturnal periodicity), when their mosquito vector is most
likely to bite.
• Decreased peripheral temperature may attract more microfilariae to circulate to peripheral
blood.

Session 11: Blood Borne Helminths - Wucherelia Bancrofti 175
Figure 1: Morphological Feature of W. Bancrofti Microfilaria
Source: Beye & Lawless, 2004
• Man is the only known definitive host
• Filariasis is spread from infected persons to uninfected persons through mosquitoes bites
• Mosquitos involved include
o Culex sppww
o Mansonia spp
o Aedes spp
o Anopheles spp
• In Africa, the vectors are mainly Culex spp in urban areas and mainly Anopheles spp in
rural areas
Life Cycle of Wucherelia Bancrofti

• 1 During the blood meal, the developed larvae (L3) emerge from the proboscis into the
skin of man.
• 2 After penetrating the skin through the bite would, the larvae pass into lymphatic vessels
and nodes where they grow to maturity. This takes about a year.
• The adult worms tend to inhabit the varices of the lymphatic vessels of the lower limbs,
the groin glands and epididymis in the male, and the labial glands in the female leading to
filariasis.
• 3 The adult females release large numbers of very small sheathed worm larvae
(microfilariae), which circulate in an infected person's bloodstream.
• 4 When the person is bitten by a mosquito, the mosquito can ingest the microfilariae.
• 5, 6 & 7 In the mosquito the microfilariae shed the sheath and migrate into muscles of the
mosquito where they develop from L1 to L3 stages of development. This takes about 6 to
20 days.
• 8 After 6 to 20 days of development, the larvae force their way out of the muscles,
causing considerable damage and migrate to the proboscis.
• 1 During the blood meal, the developed larvae (L3) emerge from the proboscis into the
skin of man and the cycle starts over.

Figure 2: Life Cycle of W. Bancrofti
Source: CDC 2009
Medical Importance of Wucherelia Bancrofti

Disease Caused by Wuchereria bancrofti
• Bancroftian filariasis which presents in the form of
o Lymphangitis
o Hydrocele
o Elephantiasis
Diagnosis
• Specimen Collection
o Blood to be drawn at night
• Routine technique
o Microscopy
Wet preparation to see the live microfilaria
Giemsa stain of thick blood film to identify microfilariae
• Other techniques
o Polymerase chain reaction (PCR)
o Rapid diagnostic test

Drugs of Choice
• Ivermectin
• Diethylcarbamazine
Key Points
• Wuchereria bancrofti are helminths which are adapted in inhabiting the deeper tissues
like the circulatory, lymphatic, and connective tissue layers.
• Wuchereria bancrofti is the causative agent for bancroftian filariasis in man and man is the
only definitive host.
• The infective stage is filariform larvae.
• Vectors of microfilariae include Culex, Anopheles spp, Aedes spp, and Mansoni
mosquitoes.
• Laboratory diagnosis of Wuchereria bancrofti infection is based on microscopic
examination of fresh blood to identify microfilariae.
Evaluation
• What are the characteristics of W. Bancrofti?
• What are the vectors involved in the transmission of W. bancrofti?
• What are the drugs of choice for the treatment of W. bancrofti infection?
References
• Beye, H.K. & Lawless, D.K. (2004) Viability of Microfilariae of Wuchereria Bancrofti
during Prolonged Storage at −25 °C. Retrieved May 27th , 2010 from
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WFH-4C52H6T-
WW&_user=10&_coverDate=11%2F30%2F1961&_rdoc=1&_fmt=high&_orig=search&
_sort=d&_docanchor=&view=c&_acct=C000050221&_version=1&_urlVersion=0&_use
rid=10&md5=d5a50ed7d201ccc481ba48c26c55b485
Corporation.
• C D C (2009), "Lymphatic Filariasis Treatment", Retrieved May 27th 2010 from
http://www.cdc.gov/ncidod/dpd/parasites/lymphaticfilariasis/treatment_lymphatic_filar.ht
m.
Company Ltd.
• Levinson, W. (2004). Medical Microbiology and Immunology (8th ed.). New York:


Session 12: Toxoplasma Gondii and Echinococcus
Granulosus
Learning Objectives
• Define Toxoplasma gondii and Echinococcus granulosus
• Explain the characteristics Toxoplasma gondii and Echinococcus granulosus
• Describe life cycle Toxoplasma gondii and Echinococcus granulosus
• Explain the medical importance of Toxoplasma gondii and Echinococcus granulosus
Overview of Toxoplama Gondii

• Toxoplama gondii are intracellular coccidian protozoan parasite that occurs in either of
the forms of trophozoite, tissue cyst and oocyst.
• Toxoplasma gondii infects most species of warm blooded animals, including humans, and
can cause the disease toxoplasmosis.
• The poarasite is commonly found in the gut of cats and normally toxoplasmosis is the
disease of cats and other feline animals but accidentally the parasite can also infect
humans.
Characteristics of Toxoplama Gondii
• Trophozoite
o Found in tissues during the acute phase of infection
o Invade all mammalian cells except erythrocytes
o Are crescent or oval in shape with one end pointed and the other rounded
o They are about of 3 x 7 µm of size
o Nucleus is located near the rounded end of the trophozoite
o Multiplication takes place by internal budding whereby two daughter trophozoites are
formed within the parent cell
• Tissue Cysts
o Formed during the chronic phase of infection and can be found in any organ of the
body particularly in skeletal and cardiac muscle and brain
o Size of a tissue cyst is 10 to 200 µm and may contain thousands of organisms
o Tissue cysts can remain viable in tissues for several years
o They are important in transmission of infection and source of recrudescent
disseminated infection in immuno compromised individuals.
• Oocysts
o Develop only in the definitive host (the cat and other felines)
o Oocyst is spherical or ovoid; 10-12 µm
o Cats shed millions of oocysts per day in their faeces during early infection
o Freshly passed oocysts are not infective
o Oocysts become infective after development in the soil or water for a few days
o Mature oocyst containing 8 sporozoites which is the infective stage

Session 12: Toxoplasma Gondii and Echinococcus Granulosus 181
• Ingesting food containing tissue cysts or contaminated with oocysts
• Transplacental transmission to foetus
• Occupational transmission to laboratory personnel and slaughter house workers
• Organ transplantation and granulocyte transfusion
• Transfusion of unscreened blood
Life Cycle of Toxoplama Gondii

Figure 1: Life Cycle of Toxoplasma Gondii
Source: CDC. 2009
Note: The numbers in the text below refer to the diagram in Figure 1 on the previous page.
• Unsporulated oocysts are shed in the cat’s faeces.

o Usually large numbers of oocysts may be shed within 1-2 weeks.
o Oocysts take 1-5 days to sporulate in the environment and become infective
• Intermediate hosts in nature (including birds and rodents) become infected after
ingesting soil, water or plant material contaminated with oocysts.
o Oocysts transform into tachyzoites (rapid replicating trophozoites) shortly after
ingestion.
• Tachyzoites localize in neural and muscle tissue and develop into tissue cyst
bradyzoites (slow replicating trophozoites).

• Cats become infected after consuming intermediate hosts harboring tissue cysts.
o Cats may also become infected directly by ingestion of sporulated oocysts.
• Animals bred for human consumption and wild game (pigs, sheep, birds) may also
become infected with tissue cysts after ingestion of sporulated oocysts in the
environment.
• Humans can become infected by any of several routes:
o Eating undercooked meat from animals harbouring tissue cysts.
o Consuming food or water contaminated with cat faeces or by contaminated
environmental samples (such as faecal-contaminated soil or changing the litter box of
a pet cat)
o Blood transfusion or organ transplantation
o Transplacentally from mother to fetus
• In the human host, the parasites form tissue cysts, most commonly in skeletal
muscle, myocardium, brain, and eyes; these cysts may remain throughout the life of the
host.
Medical Importance of Toxoplama Gondii
Diseases Caused by Toxoplasma Gondii

• Toxoplasmosis
o Ocular toxoplasmosis
o CNS toxoplasmosis
o Pulmonary toxoplsmosis
o Congenital toxoplasmosis which is asymptomatic at birth, then after weeks, months
and years leads to
Chorioretinitis
Blindness
Epilepsy
Mental retardation
o Abortions or still birth
Diagnosis
• Specimen
o Blood
• Techniques
o Serology
Drugs of Choice
• Pyrimethamine + Trisulfapyrimidine
• Pyrimethamine + Sulfadiazine
• Spiramycin
Overview of Echinococus Granulosus

• Echinococcus granulosus is a cestode that belong to phylum platyhelminthes (flat worms)
that cause hydatidosis to human
• Hydatidosis disease is actually a disease of dogs (zoonotic)
• It causes enlarged cysts mainly in the liver
• These cysts may also occur in the lungs, kidney, spleen or bone

• Infection of Echinococcus granulosus to human depends on close association of humans
and infected dogs
• Humans get infected (usually in childhood) through ingestion of eggs of Echinococcus
granulosus after close association with infected dogs or through contaminated foods,
water, soil or fomites
• Other species of medical importance that leads to hydatidosis is Echinococcus
multilocularis
Characteristics of Echinococus Granulosus

• A small cestode tape worm of size 3-6 mm long
• Fimbria are attached to the mucosa of the small intestine of predominantly dogs and other
canids
• Has a pyriform scolex with 4 suckers and rostellar crown with 28 to 50 hooks
• Gravid proglottid is 2 x 0.5 – 1 mm long
• The gravid proglottid may contain up to 500 eggs
• Shedding of gravid proglotids or eggs in the faeces occur within four to 5 weeks of
prepatency
• E.granulosus eggs are infective for intermediate host immediately after they are released
into the surrounding
Figure 2: Morphological Feature of Adult Echinococus Granulosus
Source: CDC 2009

Life Cycle of Echinococus Granulosus
Source: CDC 2009
• The adult Echinococcus granulosus resides in the small bowel of the definitive hosts
(dogs or other canids).
• Gravid proglottids release eggs that are passed in the faeces.
• After ingestion by a suitable intermediate host (under natural conditions: sheep, goat,
swine, cattle, horses, camel) the egg hatches in the small bowel and releases an
oncosphere.
o Onchosphere hatches and then penetrates the intestinal wall and migrates through the
circulatory system into various organs, especially the liver and lungs.
• In liver and lungs of the intermediate host, the oncosphere develops into a cyst that
enlarges gradually, producing protoscolices and daughter cysts that fill the cyst interior.
• The definitive host becomes infected by ingesting the cyst-containing organs of the
infected intermediate host.
• After ingestion, the protoscolices evaginate, attach to the intestinal mucosa and
develop into adult stages . This takes 32 to 80 days.
• Humans become infected by ingesting eggs, with resulting release of oncospheres in the
intestine and the development of cysts in various organs.
Medical Importance of Echinococus Granulosus
Diseases Caused by Echinococus granulosus

• Hydatid diseases

• Specimen
o Blood
• Technique
o Serology
Haemoagglutination antibody test (HA)
Complement Fixation test (CF)
Casoni test
Drugs of Choice
• Albendazole
• Mebendazole
• Praziquantel
• Surgical removal of cyst
Key Points
• Toxoplasma gondii is an intracellular coccidian parasite which causes toxoplasmosis in
man.
• Toxoplasmosis is the disease of animals, but human gets infected when eating
undercooked meat of animals harbouring tissue cysts or food and/or water contaminated
with cat faeces.
• Man to man transmission may also occur through blood transfusion, organ
transplantation, and transplacental transmission.
• Echinococcus granulosus is a tapeworm that causes hydatidosis to human
• Echinococcus granulosus is a parasite that primarily infects dogs and other animals
• Humans become infected by ingesting eggs of parasite passed in faeces of infected dogs
Evaluation
• What is Toxoplasma gondii?
• What are the morphologic forms of Toxoplasma gondii?
• What are the drugs of choice to manage Toxoplasma gondii?
• What is Echnococcus granulosus?
• What is the disease caused by Echnococcus granulosus?
• What are the drugs of choice for treatment of Echnococcus granulosus?
References
Corporation.
• CDC (2009), "Lymphatic Filariasis Treatment", Retrieved May 27th 2010 from http://
www.cdc.gov/ncidod/dpd/parasites/lymphaticfilariasis/treatment_lymphatic_filar.htm.
Company Ltd.


Session 13: Tissue Helminths - Onchocerca Volvulus
Learning Objectives
• Define Onchocerca volvulus
• Describe the characteristics of Onchocerca volvulus
• Describe the life cycle of Onchocerca volvulus
• Explain the medical importance of Onchocerca volvulus
Overview of Onchocerca Volvulus

• Onchocerca volvulus is a tissue helminth that belongs to the group of filarial worms
• Onchocerca volvulus is a filarial worm that is adapted to living in the tissues of the host
• Infection with Onchocerca volvulus result in a diseases called onchocerciasis (river
blindness)
• Infection with onchocerciasis is spread by the vector called black flies (Simuliums
species)
• Human is the natural host
Characteristics of Onchocerca Volvulus

• The adult worms are tight together in pairs or groups in subcutaneous tissues
• They are slender and blunt at both ends
• The body is white and filiform, tapering at both ends
• They are usually found in the nodules, but can reproduce outside them
• Males measures 2-4 cm x 0.2 mm
• The female measures 35-40 cm x 0.4 mm
• The tail of the male is curved ventrally
• The microfilariae are unsheathed and measures 300 x 8µm
• The body tapers to a sharp-pointed tail which is curved
• Nuclei extend to tip of tail
• Microfilariae are often found in the eye thus causing river blindness
Figure 1: Morphological Features of Onchocerca Volvulus
Adult Onchocerca volvulus Larva of Onchocerca volvulus

Source:CDC 2009 Source: CDC 2009

Session 13: Tissue Helminths - Onchocerca Volvulus 189
• Through bite of Simulium fly injecting infective filariae into the skin of man.
Life Cycle of Onchocerca Volvulus

Note: The numbers in the text below refer to the diagram in Figure 2 below.
• During a blood meal, an infected black fly (genus Simulium) introduces third-stage
filarial larvae onto the skin of the human host, where they penetrate into the bite wound.
• In subcutaneous tissues the larvae develop into adult filariae.,
• The adults form and reside in nodules in subcutaneous connective tissues.
o Adults can live in the nodules for approximately 15 years.
o Some nodules may contain numerous male and female worms.
• In the subcutaneous nodules, the female worms are capable of producing microfilariae
for approximately 9 years.
o The unsheathed microfilariae have a life span that may reach 2 years.
o They are occasionally found in peripheral blood, urine, and sputum but are typically
found in the skin and in the lymphatics of connective tissues.
• A black fly ingests the microfilariae during a blood meal.
• After ingestion, the microfilariae migrate from the black fly's midgut through the
hemocoel to the thoracic muscles.
• There the microfilariae develop into first-stage larvae.
• Development continues subsequently into third-stage infective larvae.
• The third-stage infective larvae migrate to the black fly's proboscis.
• A black fly can infect another human when it takes a blood meal and the cycle begins.
Figure 2: Life Cycle of Onchocerca Volvulus
Source: CDC 2009

Medical Importance of Onchocerca Volvulus
Disease caused by Onchocerca Volvulus
• Onchocerciasis that occurs in the form of:
o Skin nodules
o Ocular onchocerciasis (blindness)
o Dermatitis
o Hanging groin
• Specimen
o Skin snip
o Blood
• Technique
o Microscopy
Wet preparation of skin snip
Giemsa staining
o Serology
Compliment fixation test (CFT)
Immunofluorescence Test (IFT)
Drugs of Choice
• Ivermectin
Key Points
• Onchocerca volvulus is a tissue helminth that is responsible for causing onchocerciasis.
• Transmission of Oncocerca volvulus is through bite of the black fly (Simulium species).
• Man is the only definitive host of Onchocerca volvulus.
• The infective stage of Onchocerca volvuls is the filariform larvae.
• Laboratory diagnosis of Onchocerca volvulus includes skin snip for microscopic
examination of live microfilariae and serological tests.
Evaluation
• What are the life stages of Ochocerca volvulus?
• What is the intermediate host of Onchocerca volvulus?
• What are the laboratory diagnostic techniques for Onchocerca volvulus?
References
Corporation.
Company Ltd.

• CDC (2009), "Lymphatic Filariasis Treatment", Retrieved May 27th, 2010 from http://
www.cdc.gov/ncidod/dpd/parasites/lymphaticfilariasis/treatment_lymphatic_filar.htm.

Session 14: Genito Urinary Protozoa - Trichomonas
Vaginalis
Learning Objectives
• Define Trichomonas vaginalis
• Describe characteristics of Trichomonas vaginalis
• Describe the life cycle of Trichomonas vaginalis
• Explain the medical importance of Trichomonas vaginalis
Overview of Trichomonas Vaginalis

• The Trichomonas vaginalis are flagellate protozoa (mastigophora) that are characterized
by having an undulating membrane and a number of flagella.
• They are adapted to living in the genital urinary tract of man.
• Trichomonas vaginalis is responsible for causing a sexually transmitted disease called
Trichomoniasis.
Characteristics of Trichomonas Vaginalis

• Trichomonas vaginalis is a colourless pear-shaped, with a short undulating membrane
lined with a flagellum and four anterior flagella
• It measures about 10 x 7µm, though its length may vary from 5 to 30µm and its width
from 2 to 14µm
• The organism moves with a characteristic wobbling and rotating motion
• The nonpathogenic trichomonads, Trichomonas hominis and Trichomonas tenax, cannot
readily be distinguished from Trichomonas vaginalis when alive
• For clinical purposes, trichomonads found in the mouth are Trichomonas tenax; in the
intestine, Trichomonas hominis; and in the genitourinary tract (both sexes) are
Trichomonas vaginalis
• It is actively phagocytic
• Optimal growth occurs under moderately anaerobic conditions
• Reproduction is by binary fission
• Unlike many pathogenic protozoa, they don’t form cyst
Figure 1: Morphological Features of Trichomonas Trophozoites
A: Normal trophozoite
B: Round form after division
C: Common form seen in stained preparation
Source: Brooks, Butel, and Morse et al, 2007

Session 14: Genito Urinary Protozoa - Trichomonas Vaginalis 193
• Transmission is primarily by unprotected sexual intercourse
• Contaminated towels, douche equipment, examination instruments, and other objects may
be responsible for some new infections
• Infants may be infected during birth
Life Cycle of Trichomonas Vaginalis

Figure 2: Life Cycle of Trichomonas Vaginalis
Source: CDC 2009
Life Cycle
Note: The numbers in the text below refer to the diagram in Figure 2 above.
• Trichomonas vaginalis resides in the female lower genital tract and the male urethra
and prostate.
• In the genital tract the parasite replicates by binary fission.
o The parasite does not appear to have a cyst form, and does not survive well in the
external environment.
• Trichomonas vaginalis is transmitted to another person (man being the only known
host) by unprotected sexual intercourse.

Medical Importance of Trichomonas Vaginalis
Disease Caused by Trichomonas vaginalis
• Trichomoniasis
Activity: Small Group Activity
Instructions
You will work in small manageable groups to answer the question that ask ‘which specimens
are needed for laboratory diagnosis of Trichomonas vaginalis?’ Your group will have 10
minutes to complete the task. One group will present their findings and other groups will
participate in discussion.
Diagnosis
• Specimen
o Urine
o High Vaginal Smear
• Technique
o Microscopic
Wet preparation of urine sediments and high vaginal swab for trophozoites
Field staining
Treatment
• Metronidazole
• Tinidazole
• Clotrimazole for prevention secondary fungal infection
Key Points
• Trichomonas vaginalis are flagellate protozoa that are adapted to living in the genital
urinary tract of man.
• They are responsible for causing trichomoniasis which is primarily transmitted by
unprotected sexual intercourse.
• Indemnification of the parasite relies on microscopic examination of the wet prepared
urine and high vaginal swab.
• Metronidazole, Tinidazole and clotrimazole are drugs of choice for treatment of
Trichomonas vaginalis infection
Evaluation
• What are the characteristics of Trichomonas vaginalis?
• What is the mode of transmission of Trichomonas vaginalis?
• What are the laboratory diagnostic techniques for Trichomonas vaginalis?
References
• Brown, H.W. (1968). Basic Clinical Parasitology (3rd Ed.). New York: Meredith
Corporation.

Retrieved November 20th 2010 from http://www.dpd.cdc.gov/dpdx/HTML/Image_
Library.htm/.
Company Ltd.
• Harwood, R.F. &James, M.T. (1979). Entomology in Human and Animal Health (7th Ed.).
Pulman: Washington states University.
• Levinson, W. (2004). Medical Microbiology and Immunology (8th Ed.). New York:

Entomology
Session 1: Overview and Classification of Vectors
Learning Objectives
• Define medical entomology, vector, biological vector and mechanical vector
• Describe characteristics of vectors
• Classify vectors of medical importance
• Describe distinguishing characteristics of each vector of medical importance
Definition of Terms
• Medical entomology: Is a study of arthropods of medical importance.
• Vector: Is an organism that conveys pathogens from one host to another. Vectors can be
biological or mechanical.
• A biological vector: Is the one in which the pathogens undergo development into
infective stage.
• Mechanical vector: Is an arthropod vector that transmits the infective organisms from
one host to another but is not essential to the life cycle of the parasite.
General Characteristics of Vectors

• All vectors transmit pathogens either biologically or mechanically.
• For transmission of pathogens to occur vectors need to come into contact with hosts.
• All vectors are arthropods though snails (which are intermediate hosts) are conveniently
considered as vectors for medical purposes.
• Biological vectors seek their host for blood meal while mechanical vectors do not.
Classification of Vectors
• Vectors are classified into two groups namely:
o Biological vectors
o Mechanical vectors
• Biological vectors comprise of three classes which are:
o Insecta
Example mosquitoes
o Arrachinida
Example ticks
o Molluscs (Also serves as intermediate host)
Example Bullinus
• Mechanical vectors include Musca domestica(houseflies) and cockroaches
CMT 04104 Entomology NTA Level 4 Semester 1 Student Manual

Session 1: Overview and Classification of Vectors 199
Figure 1: Classification of Vectors
VECTORS
BIOLOGICAL MECHANICAL
VECTORS VECTORS
Musca Domestica
Cocroaches
INSECTA ARRACHINIDA MOLLUSCS
Mosquitoes
Tsetsefly Tick Mites
Simulium
Bed bugs
Fleas
Bullinus Biomphalaria Ornithodorus
Distinguishing Characteristics of each Vector of Medical Importance
Vectors of Medical Importance

• Insecta
• Arachnida
• Mollusca
Insecta
• Characteristics
o The body of an insect is divided into head, thorax and abdomen.
o The head bears mouth parts and a single pair of antennae.
o There are three pairs of legs attached to the thorax and many insects have two pairs of
wings; one or both of which can be vestigial.
• Orders under insecta include:
o Diptera (flies) Mosquitoes, tsetse flies, simulium species, bed bugs
o Siphonaptera (fleas) Pulex irritants, tunga penetrans, Xenopsylla cheopis)
o Hemiptera (bugs) Reduviid bugs, Cimicidae
o Anoplura (Lice) Pediculus, Phthirus
o Dictyoptera (Cocroaches)
Arachinida
• Characteristics
o Arachinida are characterized by having eight legs, and a body which appears in some
species undivided while in others is segmented into cephlalothorax and abdomen.
o The cephalothorax has mouth parts, simple eyes, but no antennae.

o Not all arachinida transmit disease.
o Some arachinids bites and cause pain, discomfort, irritation and serious conditions.
• Orders under Arachinida
o Argasidae (soft ticks)
example Ornithodorous moubata
o Ixodidae (hard ticks)
example (Boophilus species)
o Mites (example)
Sarcoptes
Trombicula (transmits scrub typhus in oriental countries)
Mollusca (Snails)
• This group falls under the group of intermediate hosts rather than vectors per se.
• They are discussed here because they carry pathogens that infect human when human are
in contact with them in water.
o Characteristics
Head has a pair of retractable tentacles with eyes located at the ends
Have a single shell or valve (snails).
May be freshwater or terrestrial
Aquatic snails breathe through gills & use their radula to scrape algae for food
Terrestrial snails use their mantle cavity as a modified lung & saw off leaves
Retreat into shell in dry periods & seals opening with mucus
Have open circulatory system
Secrete mucus & use muscular foot to move
Aquatic snails have separate sexes
Use internal fertilization
• Snails of medical importance include:
o Bulinus
o Biompharalia
o Onchomelania
Key Points
• Medical entomology is a study of arthropods of medical importance.
• Vector is an organism that conveys pathogens from one host to another.
• Vectors can be biological or mechanical.
• All vectors are arthropods though snails (which are intermediate hosts) are conveniently
considered as vectors.
• Biological vectors seek their host for blood meal while mechanical vectors do not.
• Vectors are classified into groups of Insecta, Arachnida and mollusca.
• Mollusca (Snails) this group falls under the group of intermediate hosts rather than
vectors per se because they carry pathogens that infect human when human are in contact
with them in water.
Evaluation
• What is the meaning of
o Biological vector?
o Mechanical vector?
• What are the four characteristics of Mosquito?

References
Company Ltd.
• Hagner, R. Root, M. Augustine, L. & Huff, G. (1939). Parasitology, with Special
Reference to Man and Domestic Animals. New York Inc: D. Appleton-Century Company.
(7th Ed.). Pulman: Washington State University.
(2nd Ed.). Heinemann Ltd, Oxford: ELBS Butterworth.
Health Technology. Cambridge University Press UK.
• Service, M.W. (2004). Medical Entomology for Students. London: Oxford University
Press.
• United Republic of Tanzania. (2007). Training Course on Laboratory Diagnosis of
Malaria: Malaria Control Series 17. National Malaria Control Programme of the Ministry

Session 2: Insecta of Medical Importance [Diptera-
Mosquito]
Learning Objectives
• Define diptera and mosquitoes
• Describe distinguishing characteristics of diptera and mosquito
• Classify mosquito of medical importance
• Describe life cycles of mosquito
• Describe the way by which mosquitoes transmit pathogens
• Describe control measures of mosquitoes
Definition of Terms
• Diptera is a branch of insecta which describe the two winged insects e.g. Mosquitoes
• Mosquitoes are slender, delicate two winged flying insects
Distinguishing Features and Characteristics of Diptera and Mosquitoes

Distinguishing Features of Diptera
• Thorax consisting of fused segments and one pair of wings.
• Mosquitoes differ from other members of diptera by:
o The elongated mouth parts of females are adapted for piercing and sucking blood.
o The long 15-jointed antennae, plumose in both males and in the females.
o The characteristics wing venation and scales.
Refer to Handout 2.1: Structure of a Female Mosquito
Behaviour of Adult Mosquitoes

• Only females suck blood
• Biting: Diurnal(biting during the day time) or nocturnal (biting during the night)
• Feeding: Endophagic (indoors) or exophagic (outdoors)
• Feeding preferences: Anthropophilic (on human); zoophilic (on animals); ornithophilic
(in the soil)
• Resting: Endophilic (After feeding some blood, mosquitoes prefer to rest indoors) or
exophilic (resting outdoors)
o All these behaviours have implications in disease transmission and control
methodologies
Classification and Life Cycle of Mosquitoes

• Mosquitoes of medical importance fall under the family culicidae which form the groups
of Anopheline and Culicine group.
• In Anopheline group there is one important genus.
o Anopheles
• In culicine group there are three important genera which include:
o Aedes, Culex and Mansonia.

Session 2: Insecta of Medical Importance [Diptera-Mosquito] 203
Life Cycle
• Female anopheles mosquitoes feed on blood before they lay eggs.
• After blood meal, they lay eggs (oviposit).
o This process takes three days.
• Usually a single mosquito lays 30-300 eggs at each oviposition.
o Eggs are laid singly or in rafts on water or wet surfaces, most do not survive
desiccation.
• Eggs hatch into larvae in stagnant water.
o Mosquito eggs hatch in three days if the environment is humid and temperature is
high.
• Larvae develop into pupae.
• Pupae are comma shaped and motile.
• Pupae release adult.
• Mosquitoes mate shortly after emergence from pupae.
• The whole life cycle takes 7 days under favourable conditions.
Figure 1: Life Cycle of Mosquito
Source: Winipeg City, 2009

Figure 2: Distinguishing Characteristics of Different Stages of Development of Three
Mosquitoes Anopheles, Aedes and Culex
Key: an = antennae, la = labella, p = proboscis, pa = palp

Source: Knight & Laffoon, 1971

Pathogen Transmission by Mosquitoes
• Mosquitoes transmit pathogens by bite.
• Pathogens that are transmitted by mosquitoes are:
o Malaria parasites (plasmodium).
o Larvae stage of filaria worms.
o Yellow fever viruses, dengue fever viruses, rift valley fever viruses and other
arboviruses.
Control Measures of Mosquitoes
Instructions
You will work in small manageable groups to discuss the control measures for mosquitoes.
Your group will have 5 minutes to complete the task. One group will present their findings
and other groups will participate in discussion.
• Adult mosquitoes are controlled by using insecticides

o Use of Insecticides Treated Nets (ITNs)
o Organochlorides (OCS) e.g. DDT
o Organophosphates (ops) e.g. malathion
o Fenitrothion
o Chlopyriphos
o Pyrethroids; carbamates.
Larval Measures
• Environnemental management. Source reduction
o Destroy breeding places
Filling in ponds
Drain and remove stagnant water
Burry or cover containers
Intermittent flushing and flooding
o Sanitation systems
o Polystyrene beads
o Removal of aquatic vegetation
• Biological control: Use of predators and pathogens
o Fish: Gambusia, Tilapia and Northobranchius
o Mosquitoes: Toxorhynchites
o Fungi
o Nematodes
• Larvicides
o Organophosphates
o Pyrethroids: Permethrin, Deltamethrin
o Insect Growth Regulators(IGRS) e.g. Methopren, Diflubenzuron
o Biocides: Bacillus thuringiensis, Bacillus Sphaericus.
o Use of herbicides: Diquat or Pentachlorophenol

Key Points
• Diptera is a branch of insecta which describe the two winged insects.
• Thorax consisting of fused segments and one pair of wings
• Mosquitoes of medical importance fall under the family culicidae which form the groups
of Anopheline and Culicine group.
• Only female anopheles mosquito sucks blood and introduces the parasites.
• Mosquitoes are controlled by using insecticides, environmental management, source
reduction, biological control and larvicides
Evaluation
• What are the features which distinguish mosquitoes from other flies?
• What are the behaviours of adult mosquitoes?
• What are the pathogens transmitted by mosquitoes?
References
Company Ltd.
• Knight, K. L. & Laffoon, J.N. (1971). A Mosquito Taxonom Glossary. Vol 3 (1) March.
Retrieved on 15 May, 2010 from
http://www.mosquitocatalog.org/files/pdfs/MS03N01P008.pdf.

Session 3: Insecta of Medical Importance: Diptera-
Tsetse Flies, Simulium and Bed Bugs
Learning Objectives
• Describe characteristics, life cycles, pathogen transmission and control measures of
Tsetse flies
• Describe characteristics, life cycles, pathogen transmission and control measures of
simulium
• Describe characteristics, life cycles, pathogen transmission and control measures of bed
bugs
Tsetse Flies
Tsetse Flies (Glossina)
• Tsetse flies are bloodsucking flies in the genus Glossina.
• Tsetse flies are diptera which plays a role as vectors of trypanosomes of man and animals.
• The genus Glossina includes several species which are vectors of trypanosomes of man
and animals.
• Tsetse flies of medical importance belong to two groups, the palpalis group and morsitans
group.
o Palpalis group
Glossina palpalis
Glossina tachnoides
Glossina fuscipes
o Morstans group
Glossina morsitants
Glossina pallidipes
Glossina swynnertoni
• A typical tsetse fly has a yellow to brown body or black, depending on the species, and is
generally larger than a housefly measuring 6-13 mm
• Resting position of the wings, which fold over each other like scissors
• Slender, horizontal proboscis with its bulbous base
• Branched, curved bristles on the arista of the three-jointed antennae. The arista are the
prominent bristle on the largest, distal, segment of the antenna
• Presence of the ‘hatchet’ cell or ‘cleaver cell’ enclosed between 4th and 5th longitudinal
wing veins
• Palps are as long as the proboscis

Session 3: Insecta of Medical Importance: Diptera-Tsetse Flies, Simulium and Bed Bugs 209
Figure 1: Morphological Features of Glossina Species
Tsetse flies. A Glossina palpalis, male; B, Glossina morsitans, female; C, Glossina palpalis lateral view, before
feeding; D, Glossina palpalis, lateral view after blood meal; E, larva of Glossina palpalis; F, puparum of
Glossina pallidipes; G, Head and mouth parts of Glossina palpalis; H, wing of Glossina. palpalis, showing
venation.
An = Antenna; la = labella; p = palps; 1-6, longitudinal veins,
Source: Hagner, Root, Augustine et al, 1939
Environmental Occurrence of the Vector

• The various species occupy a wide range of habitats, each species having preferred
climate, vegetation, and fauna, but all requiring warmth and moisture environment
• There are two general classes
o The riverine species, (Palpalis group) e.g. Glossina palpalis is frequently found in hot
damp areas along the streams, rivers, and lakes in West, East and Central Africa
o The woodland species (Morsitans group) e.g. Glossina morsitans, are found in
wooded and bush country that provides moderate shade in East Africa
• Tsetse flies are found only in Africa
• The fly belts are irregular zones of varying dimensions surrounded by localities that are
practically fly-free
• The life span of the male is about ½ that of the female, which for female is about 13
weeks
• Both males and females are day time biters of animals and man
• Vision and smell are the primary factors in directing the flies to their hosts. Glossina
palpalis is attracted by black or blue clothing
• The effective flight range is about ½ a km for glossina morsitans and about 3 km wide for
glossina palpalis.

Life Cycle
• The breeding grounds for the riverine species are sandy beaches and loose soil near water.
• The breeding grounds for the bush species are loose soil near fallen trees or low-
branching limbs of trees.
• The female produces a single, large, mature, 3rd stage larva at intervals of about 10 days.
• Glossina palpalis yields a total of nine larvae.
• The larva burrows to a depth of 2 inches in the ground and immediately pupates.
• The adult fly emerges in about 5 weeks.
Medical Importance of Tsetse Flies

• Transmits by injecting trypanosomes to man and domesticated animals leading to
trypanosomiasis.
Control of Tsetse Flies

• Riverine tsetse flies
o Clearing trees and bush from stretches of river banks
o Selective removal of shrubs and trees along the stream
o Adult flies can be reduced by trapping and by selective insecticiding.
o Male sterilization
• Woodland tsetse
o Clearance of tracts for agricultural purposes
o Selective bush clearance
o Trapping of flies
o Use of insecticides e.g. Dieldrin, BHC, and DDT to eliminate residual flies
o Sterile male technique
o Spraying of vehicles entering and leaving the tsetse fly infested areas
Simulium
Common Names
• Black flies
• Buffalo gnats
• Black flies are identified by their small size (2-3 mm), stout hump-backed forms, short
legs, conspicuous compound eyes, short smooth antennae, and venation of the unspotted
wings.
• Proboscis is short and has blade-like cutting organs.
• Body covered with short golden or silver hairs that give it a longitudinally striped
appearance.

Figure 2: Morphological Features of Simulium Spp
A= the adult fly, B= eggs, C= Cocoon and pupa of S.mexicanum lateral view. D =larva
dorsal view
Environmental Occurrence of Simulium

• Simulium breeds in moderately swift woodland streams in upland regions.
• They remain near, or move along, these shaded watercourses.
• Their migratory range is usually 2 to 3 miles, rarely over 8.
• The females bite during the daytime, especially in the morning and toward evening in
open places at the edge of thick vegetation.
• They may enter darkened houses, and they bite humans in the vicinity of buildings.
• Fishermen are particularly at high risk.
Life Cycle
• Eggs are laid in batches of 300 – 500 and are attached by a gelatinous secretion to stones,
leaves, submerged plants, stakes, and branches.
• In 3 to 5 days, a yellowish-green, cylindrical larva emerges and attaches itself in an
upright position to rocks, aquatic vegetation, fresh-water crabs, and other debris.
• It moults seven times in 13 days to become a pupa.
• The adult emerges in about 3 days.
• Emerging adults live from two to three weeks, to as long as 85 days.
Medical Importance of Simulium Species

• Simulium transmits Ochocerciasis in man and cattle
• They bite and lead to bleeding and swelling
o The bite often is painless at first but bleeds profusely.
o Later swelling, pruritus, and pain develop which may continue for some days.
o In susceptible individuals even a few bites may cause marked local inflammation and
general incapacity.

Control
• Control of black flies is difficult because of the number of potential breeding sites.
• Mechanical destruction of breeding places is effective but expensive.
• Fine head nets, tight sleeves, and trousers, and repellents are used for personal protection.
Bed Bugs
• Bed bugs are small wingless insects that feed solely upon the blood of warm-blooded
animals.
• They belong to the genus Cimex.
• The common species are Cimex lectularius and Cimex hemipterus.
• Bed bugs are oval, dorsoventrally flattened, brown coloured insects whose bodies are
covered with short, stout, or serrated hairs
• The female is 5.5mm and is slightly larger than the male
• Its flattened triangular head bears prominent compound eye, slender antennae and
specialized mouth parts in along proboscis
• The proboscis is flexed backwards beneath the head and thorax when not in use
• Each of the three thoracic segments bears a pair of legs that terminate in a pair of simple
claws
Figure 3: Morphological Features of Bed Bug and Eggs
Bed bug-Cimex lectularius Eggs of Cimex lectularius

Life Cycle of Bed Buds

• The female lays about two eggs per day.
• The eggs are white, avoids, and about 1mm in length.
• Hatching takes place in 4-10 days.
• Development is by incomplete metamorphosis.
• The larva passes through 5-6 nymph stages at intervals of a week and become sexually
mature adult.
• The life span of the adult is 6-12 months.

Figure 4: Life Cycle of Bed Bug
Source: CDC 2009
Medical Importance of Bed Bugs

• Bed bugs are not known to transmit any pathogen but their bites are painful and produce
itching wheals.
• Some people, especially children develop urticaria, allergic reactions example asthma.
• However, it is reported to be capable of transmitting pathogens mechanically.
• They are nuisance insects.
Control of Bed Bugs

• Bedbug may be controlled by
o Plastering cracks and crevices of houses.
o Application of insecticides, example DDT, Lindane, or Malathion.
These insecticides can be applied to floors, walls, furniture and mattresses.
Key Points
• The genus glossina includes several species which are vectors of trypanosomes of man
and animals.
• Tsetses flies of medical importance belong to two groups namely palpalis group and
Morsitans group.
• Simulium transmits Ochocerciasis in man and cattle. They bite and lead to bleeding and
swelling.
• Bed bugs are small wingless insects that feed solely upon the blood of warm-blooded
animals.
• The common species of bed bugs are Cimex lectularius and Cimex hemipterus.

• Bed bugs are not known to transmit any pathogen but their bites are painful and produce
itching wheals.
• Control measures of Tsetse-flies, Simulium and Bed bugs are based on environmental
factor and use of insecticides.
Evaluation
• What is the medical importance of tsetse-flies?
• What are the factors which favour occurrence of the simulium species?
• What are the control measures of bed bugs?
References
• CDC (2009). Parasites and Health: Bed Bugs. Retrieved on 4th May 2005 from
http://www.dpd.cdc.gov/dpdx/HTML/Bedbugs.htm.
Company Ltd.
• Hagner, R. Root, M. Augustine, L.et al. (1939). Parasitology, with Special Reference to
Man and Domestic Animals. New York Inc.: D. Appleton-Century Company.
Health Technology.UK: Cambridge University Press.

Handout 2.1: The Structure of (Female) Mosquito
Source: McGregor, 1927, Marshall, 1938

Session 4: Insecta of Medical Importance -
Siphonaptera (Fleas)
Learning Objectives
• Describe general characteristics of fleas
• Describe fleas of medical importance and disease they cause
• Describe life cycle of fleas
• Describe control measures of fleas
Definition and General Characteristics of Fleas

• Fleas are small wingless insects 2.0-2.5 mm which feed on the blood of mammals and
birds.
• Adults feed on their host while larvae live on any nutritive debris, particularly dried blood
and the faeces of adult fleas
• The females ingest more blood than males.
• Fleas occur in a wide range of host including domesticated animals.
• They are brown in colour with laterally compressed bodies.
• The males are smaller than the females.
• The small chintinous head may bear eyes and; all have antennae and suctoral mouth parts.
• Each segment of the three-segmented thorax bears a pair of powerful legs terminating in
two curved claws.
• Fleas are powerful jumpers and can jump from one host to another.
• Copulate frequently to be able to produce large numbers of eggs.
• Life span is about 1year.
Figure 1: Shows Morphological Features of Flea
Source: Hagner, Root, Augustine et al. 1939

Session 4: Insecta of Medical Importance: Siphonaptera (Fleas) 217
Fleas of Medical Importance and Disease they Cause
• The medically important fleas belong to three general category; Pules, Xenopsylla and
Tunga
• Examples of species and the diseases they cause in each genera.
o Pulex Irritans
It is a nuisance insect of man which occasionally plays a minor role in the
transmission of diseases.
It causes discomfort and irritation.
o Tunga penetrans (jigger flea or chigoe)
The female penetrates into the tissues of the human host and becomes a jigger.
A jigger can lead to various physical discomfort, disability and other medical
conditions (like tetanus, and nerve damage).
o Xenopsylla Species
Are responsible for the transmission of plague and murine typhus.
Life Cycle of Fleas

• Fleas have a four-part life cycle consisting of eggs, larvae, pupae, and adults.
• However, the chigoe flea (Tunga penetrans) has different life cycle.
Life Cycle of Pulex and Xenopsylla Species

Note: The shaded numbers in the following content relate to the numbers in Figure 2: Life
Cycle of Pulex and Xenopsylla Species below.
• Eggs are shed by the female in the environment .
• Eggs hatch into larvae in about 3-4 days and feed on organic debris in the
environment.
• The number of larval instars varies among the species.
• Larvae eventually form pupae .
• The larval and pupal stages take about 3-4 weeks to complete.
• Afterwards, adults hatch from pupae and seek out a warm-blooded host for blood
meals.
• The primary hosts for Ctenocephalides felis and Ctenocephalides canis are cats and dogs,
respectively, although other mammals, including humans, may be fed upon.
• The primary hosts for Xenopsylla cheopis are rodents, especially rats.
• Humans are the primary host for Pulex irritans.

Figure 2: Life Cycle of Pulex and Xenopsylla Species
Source: CDC, 2009
Life Cycle of Tunga Penetrans

Note: The shaded numbers in the following content relate to the numbers in Figure 3: Life
Cycle of Tunga Penetrans below.
• Eggs are shed by the gravid female into the environment .
• Eggs hatch into larvae in about 3-4 days and feed on organic debris in the
environment.
• Tunga penetrans has two larval stages before forming pupae .
• The larval and pupal stages take about 3-4 weeks to complete.
• Afterwards, adults hatch from pupae and seek out a warm-blooded host for blood
meals.
• Only mated females burrow into the skin (epidermis) of the host, where they cause a
nodular swelling .
• After penetrating the stratum corneum, they burrow into the stratum granulosum, with
only their posterior ends exposed to the environment .
• Females shed about 100 eggs over a two-week period, after which they die and are
sloughed by the host’s skin.
• Secondary bacterial infections are common with tungiasis.

Figure 3: Life Cycle of Tunga Penetrans
Source: CDC, 2009
Control Measures of Fleas
Instructions
You will work in small manageable groups and answer the question that asks ‘What are the
control measures for fleas?’ Your group will have 10 minutes to complete the task. One
group will present their findings and other groups will participate in the discussion.
• Killing of rodents should be done after killing fleas, otherwise the fleas will leave the
dead rodents and jump onto man and result in increased disease transmission.
• Fleas may be controlled in the following methods:
Chemical Control
• For the control of rodent fleas xenopsylla cheopis and Pulex irritans, insecticides can be
applied to the floors of houses, and runways of rodents.
o The following organochlorides are used: DDT, HCH, or Dieldrin.
o Also insecticides dust can be blown into rodent burrows.
o In situations where fleas are resistant to organochlorides, use organophosphate and
carbamate insecticides such as:
Diaznon
Fenthion (Baytex)
Malathion
Fentrothion (Sumithion) or

Carbaryl (Sevin)
o House fumigation with insecticides
• Use of pesticides
Personal Protection
• To protect humans from flea bites, repellents, e.g. Dimethylpthalate (DIMP)
Diethyltoluamide (DEET) or benzyl benzoate emulsion (BBE) may afford personal
protection.
Key Points
• Fleas are small wingless insects 2.0-2.5 mm which feed on the blood of mammals and
birds.
• Fleas occur in a wide range of host including domesticated animals.
• The medically important fleas belong to three genera; Pules, Xenopsylla and Tunga.
• Fleas have a four-part life cycle consisting of eggs, larvae, pupae, and adults.
• Fleas could be dangerous for they transmit plague, murrain fever and cause jiggers.
• Control of fleas involves use of chemicals and personal protection.
Evaluation
• What are the general characteristics of fleas?
• What are the two species of fleas and the disease they cause?
• What are the methods of control of fleas?
References
Company Ltd.
• Hagner, R, Root M, Augustine L. & Huff G. (1939). Parasitology, with Special Reference
to Man and Domestic Animals New York Inc.: D. Appleton-Century Company.

Session 5: Insecta of Medical Importance-Anoplura
[Lice]
Learning Objectives
• Explain the classification of lice
• Describe morphology and characteristics of lice
• Explain medical importance of lice
• Describe ways by which lice transmit pathogens and life cycle
• Describe control measures of lice
Definition and Classification of Lice

• Lice are small, flat-bodied, wingless biting or sucking insects of the order Anoplura
(without wings).
• Lice are host specific parasites of man and animals
• The medically important lice belong to two genera
o Pediculus (Example Pediculus humanus var capitis, Peduculus humanus var coporis)
o Pthirus (Example Pthirus pubis)
Morphology and Characteristics of Lice
Morphology of Pediculus
• Head is round with antennae
• Body is elongated-oval
• Legs are all of similar size which terminate in long slender claw.
• An adult louse is about 3-4 mm
Morphology of Pthirus
• Shaped like a crab;
• Have massive claws on the 2nd and 3rd legs by which it clings to hairs.
General Characteristics of Lice

• Lice are obligate ectoparasites, requiring the environment of the host’s skin and under fur
at all stages of the life cycle
• The temperature requirements of lice keep them within a few millimetres of the skin of
the host
• The insulating properties of human clothing enables Pediculus humanus corporis to
become adapted in some ways to living on clothing
• The majority of lice are strictly host-specific and it is uncommon to find a species of
louse parasitizing more than a single host species
• Pthirus capitis females cement their eggs to head hairs while those of Pthirus corporis
attach their eggs to clothing fibres along seams or fold but sometimes to body hairs
• Pthirus pubis is found exclusively on man
Refer to Handout 5.1: Morphological Features of Lice

Session 5: Insecta of Medical Importance-Anoplura [Lice] 223
Life Cycle and Transmission of Pathogens by Lice
• When a female louse finds its way onto body of a person or seams of clothing, she starts
laying eggs (nits), along with glue that firmly attaches the nits to the hair or seams of
clothing.
• Female produces an average of 4 – 5 eggs per day throughout their laying life, which may
last for one month.
• Eggs hatch to nymphs in 8 days.
• Nymphs undergo 3 moults in 18 days before becoming adults.
• Nymphs and adults feed on blood.
• Adult lice live for 9-10 days, making the total life span of a louse from egg to adult about
25 days
Figure 1:The Life Cycle of Lice
• Lice spread from person to person when people are in close contact or when they share
clothing or personal items that have been in contact with the head or neck example coats,
scarves, hats, brushes and combs.
Medical Importance of Lice

• Pediculus humanus corporis is chiefly a hygienic nuisance
o May cause itchy dermatitis and is a vector of several diseases, example:
Louse-borne typhus caused by Rickettsia prowazeki.
Louse-borne relapsing fever caused by Borrelia recurrentis.
Trench fever caused by Rickettsia quintana
Murine typhus caused by Rickettsia mooseri is chiefly transmitted by fleas but
also possibly by lice.
• Pthirus pubis (Crab louse or pubic louse) is only a hygienic nuisance in adults after
puberty

Control Measures of Lice
Instructions
You will work in small manageable group to answer the question that asks ‘what are the
control measures for lice?’ Your group will have 5 minutes to complete the task. One group
will present their findings and other groups will participate in discussion.
Control Measures of Lice

• Adults and eggs on clothes can be destroyed by hot water at 70ºC for 30 minutes: this is
for Pediculus humanus
• Ironing of clothes kills adults and eggs (nits)
• Combing hair with a fine comb and soap or hair cutting removes Pediculus capits adults
and nits
• Permethrin dusts or malathion, and carbaryl lotions or shampoo are effective in
pediculosis
• Removal of pubic hair can control Pthirus pubis also insectcides are effective.
• Body and clothes hygiene
Key Points
• Lice are host specific parasites of man and animals
• The medically important lice belong to two general Pediculus (Pediculum humanus) and
Pthirus (Pthirus pubis)
• Lice are important in transmitting pathogens that cause diseases such as borrelia and
rickettsia
• Lice are transmitted from person to person by close body contact or sharing items which
are of body contact
• Control measures are based on personal hygiene, cleaning and ironing of clothes, and use
of insecticide
Evaluation
• What are the morphological features of lice?
• What are the three species of lice of medical importance?
• What are the pathogens that are transmitted through lice?
• What are the control measures of lice?
References
Company Ltd.

(2nd ed.). Heinemann Ltd, Oxford: ELBS Butterworth.
Press.
Malaria. Malaria Control Series 17. National Malaria Control Programme of the
Ministry of Health and Social Welfare.

Handout 5.1: Morphological Features of Lice
Morphological Features of Lice
Head louse Crab louse

Source: Howard, Weems, 2007
Source: Root, Augustine & Huff, 1939

Session 6: Mechanical Vectors of Medical Importance
- Cockroaches and House Fly
Learning Objectives
• Classify cockroaches
• Describe morphology and characteristics of cockroaches, nymphs and eggs
• Describe life cycle of cockroaches
• Describe medical importance and control measures of cockroaches
• Describe morphology and characteristics of house fly
• Describe life cycle of house fly
• Describe medical importance and control measures of house fly
Classification of Cockroaches
• Cockroaches are winged dark brown or black insects measuring 1-5cm long, flattened
dorsoventrally and have a smooth, shiny and tough integument.
• Cockroaches are insects that belong to the family Blattidae and order Blattaria.
• Among the best-known pest species are the American cockroach, Periplaneta americana
which is about 30 millimetres (1.2 inch) long, the German cockroach, Blattella
germanica, about 15 millimetres (0.59 inch) long.
• Tropical cockroaches are often much bigger.
Morphology and Characteristics of Cockroaches
Adults
• Cockroaches live in a wide range of environments around the world.
• Pest species of cockroaches adapt readily to a variety of environments, but prefer warm
conditions found within buildings.
• Cockroaches are nocturnal - active at night.
• Roaches that are active during the day may be victims of overcrowding or may be looking
for food or water.
• Cockroaches are rather large insects. Most species are about 1-5cm long
• Are dark brown or black in colour flattened dorsoventrally and have a smooth, shiny and
tough integument.
• Have a pair of long and prominent filiform antennae arising from the front of the head
between the eyes.
• The mouthparts are developed for chewing, gnawing and scraping, therefore cockroaches
cannot suck blood.
• Have narrow and thickened hard forewing which is lathery in texture called tegmina, and
membranous hind wings.
• Viewed from above, the head appears small and it is sometimes almost hidden by the
large, rounded pronotum.
• There are 3 pairs of legs which are well developed and covered with prominent small
spines and bristles; the five-segmented tarsi end in a pair of claws.
• The abdomen is segmented and more or less oval in shape but is either completely or
partly hidden from view, by the overlapping wings.

Session 6: Mechanical Vectors of Medical Importance - Cockroaches and House Fly 229
• In both sexes, there is a pair of prominent segmented abdominal spicala (pilose cerci)
which arise from the last abdominal segment.
• Cockroaches are most readily distinguished from beetles (order coleoptera) by having the
fore-wing placed over the abdomen in a scissor-like manner.
Figure 1: Morphological Features of a Cockroach
Source: Sun Yat-sen University,2009
Nymph
• Cockroach nymphs are greyish-brown in colour and darken with each progressive moult.
• The nymph stage ranges in length from 9 – 13 months.
• Unlike many other insects, cockroach nymphs are similar to the adults.
• Cockroach nymphs undergo a series of moults, known as instars.
• They emerge as full adults from their final moult.
Cockroach Eggs
• Female cockroaches produce egg cases, known as oothecae.
• The oothecae are normally dark brown in colour and ranges from 5mm to 10mm in
length.
• Oothecae contain many eggs and are enveloped by a protein substance, which gradually
hardens into a strong, protective casing.
• The oothecae of most cockroach species contain 16 nymphs.
• Some cockroach species drop the egg case, while other species carry it until the eggs are
ready to hatch.
• The female in favourable conditions can produce 300 to 400 offspring.
Refer to Handout 6.1: Morphological Features of Cockroaches and Oothecae

Life Cycle of Cockroaches
• Cockroaches develop through egg and nymphal stages before emerging as adults.
• Eggs produced by female cockroaches are enclosed in oothecae.
• It takes 6 – 7 weeks for eggs to hatch into nymphs depending on species and
environmental conditions.
• Nymphs resemble adults in appearance and behaviour, although they are smaller in size
and do not have wings.
• Nymphs undergo 8 moults before becoming fully mature adults.
• After the final moult, nymphs are equipped with wings.
• Adult cockroaches have an average lifespan of up to two years.
• Temperature and other environmental conditions greatly affect the survival of
cockroaches.
• Adult cockroaches reproduce rapidly
Figure 2: Life Cycle of Cockroach
Source: Alan & Meng, 2010

Medical Importance and Control of Cockroaches
Instructions
You will work in small manageable groups to answer the question ‘what is the medical
importance of cockroaches?’ Your group will have 10 minutes to complete the task. One
group will present their findings and other groups will participate in discussion.
Medical Importance of Cockroaches

• Cockroaches are important household pests and mechanical vectors of pathogenic
organisms.
• They are mechanical vectors of:
o Entamoeba histolytica
o Salmonella typhi
o Arspergillus spp
o Trichomonas hominis
o Giardia lamblia
o Balantidium coli.
• They are biological vectors of helminths
• They are intermediate host of:
o Acanthrocephalid and Moniliformis
o Gonglyonema pulchrum
o Echinococus verminculari’s
o Toxoplasma gondii
• Some people are allergic to cockroaches
o It appears that sensitized people can react to cockroach by eating cockroach-
contaminated food, or inhaling their dried feacal pellets.
Control of Cockroaches
• Cleanliness in kitchens and protection of stored foods.
• Repair of cracks and tight fitting plumbing installations in the walls.
• House fumigation using kerosene sprays, chlordane, Malathion or diazinon.
• Dusting using Chlordane or Malathion.
Morphology and Characteristics of House Fly (Musca Domestica)
Introduction
• The house fly, Musca domestica linnaeus, (insecta: diptera: muscidae) is a well-known
cosmopolitan pest of both farm and home. This species is always found in association
with humans or activities of humans.
• Not only are house flies a nuisance, but they can also transport disease-causing
organisms.
Eggs
• Are white, about 1.2 mm in length, is laid singly but are piled in small groups.

Larva
• Early instars larvae are 3 to 9 mm long, typical creamy whitish in color, cylindrical but
tapering toward the head.
• The head contains one pair of dark hooks.
• The posterior spiracles are slightly raised and the spiracular openings are sinuous slits
which are completely surrounded by an oval black border.
Pupa
• Is about 8 mm long, is passed in a pupal case formed from the last larval skin which
varies in color from yellow, red, brown, to black as the pupa ages.
• The shape of the pupa is quite different from the larva, being bluntly rounded at both
ends.
Adult
• The house fly is 6 to 7 mm long, with the female usually larger than the male.
• Female can be distinguished from the male by the relatively wide space between the eyes
(in males, the eyes almost touch).
• The head of the adult fly has reddish-eyes and sponging mouthparts.
• The thorax bears four narrow black stripes and there is a sharp upward bend in the fourth
longitudinal wing vein.
• The abdomen is gray or yellowish with dark midline and irregular dark markings on the
sides.
• The underside of the male is yellowish.
• Adults usually live 15 to 25 days, but may live up to two months. Without food, they
survive only about two to three days.
• Longevity is enhanced by availability of suitable food, especially sugar.
• The house fly overwinters in either the larval or pupal stage under manure piles or in
other protected locations.
• Warm summer conditions are generally optimum for the development of the house fly,
and it can complete its life cycle in as little as seven to ten days.
• However, under suboptimal conditions the life cycle may require up to two months.
• As many as 10 to 12 generations may occur annually in temperate regions, while more
than 20 generations may occur in subtropical and tropical regions.

Life Cycle and Descriptions of House Fly
Figure 3: Life Cycle of House Fly
Source: Novartis Animal Health Inc., (2007)
• The house fly has a complete metamorphosis with distinct egg, larva or maggot, pupal
and adult stages.
• Each female fly can lay up to 500 eggs in several batches of 75 to 150 eggs over a three to
four day period.
• Maximum egg production occurs at intermediate temperatures, 25 to 30°C.
• Often, several flies will deposit their eggs in close proximity, leading to large masses of
larvae and pupae.
• Eggs must remain moist or they will not hatch.
• The legless maggot emerges from the egg in warm weather within eight to 20 hours, and
immediately feeds on and develops in the material in which the egg was laid.
• The larva goes through three instars and a full-grown maggot, 7 to 12 mm long, has a
greasy, cream-colored appearance.
• High-moisture manure favors the survival of the house fly larva.
• The optimal temperature for larval development is 35 to 38°C, though larval survival is
greatest at 17 to 32°C.
• Larvae complete their development in four to 13 days at optimal temperatures, but require
14 to 30 days at temperatures of 12 to 17°C.
• Nutrient-rich substrates such as animal manure provide an excellent developmental
substrate.
• Very little manure is needed for larval development, and sand or soil containing small
amounts of degraded manure allows for successful belowground development.
• When the maggot is full-grown, it can crawl up to 15 metres to a dried, cool place near
breeding material and transform to the pupal stage.
• Pupae complete their development in two to six days at 32 to 37°C, but require 17 to 27
days at about 14°C).
• The emerging fly escapes from the pupal case through the use of an alternately swelling
and shrinking sac, called the ptilinum, on the front of its head which it uses like a
pneumatic hammer to break through the case.

Medical Importance and Control of House Flies
• Potential transmission of pathogens (viruses, bacteria, fungi, protozoa, and nematodes)
associated with this fly.
o Pathogenic organisms are picked up by flies from garbage, sewage and other sources
of filth, and then transferred on their mouthparts, through their vomitus, feces and
contaminated external body parts to human and animal food.
o Some pathogens can be harbored in the mouthparts or alimentary canal for several
days, and then be transmitted when flies defecate or regurgitate.
o Among the pathogens commonly transmitted by house flies are Salmonella, Shigella,
Campylobacter, Escherichia, Enterococcus, Chlamydia, and many other species that
cause illness.
o Are most commonly linked to outbreaks of diarrhea and shigellosis, but also are
implicated in transmission of food poisoning, typhoid fever, dysentery, tuberculosis,
anthrax, ophthalmia (trachoma), and parasitic worms.
• Annoyance
Control of House Fly

• The more commonly used control measures for house flies are:
o Sanitation
o Use of traps
o Insecticides
Key Points
• Cockroaches are winged dark brown or black insects measuring 1-5cm long, flattened
dorsoventrally and have a smooth, shiny and tough integument.
• The life cycle of cockroaches involves adult, eggs and nymph stages.
• Cockroaches are important household pests and vectors of pathogenic organisms.
• Control of cockroaches is based on cleanliness in kitchens, protection of stored foods and
application of pesticides.
• House fly, like most insects, has four stages during its life cycle, that is, egg, larva, pupa
and adult. Lays its eggs on decaying substances.
• These larvae pass from three development sub stages, within a week or less, during the
hottest periods and up to 8 weeks, when temperatures are lower.
• Adult house flies have many hairs on their body, on which germs and dirt is easily
carried. The insect’s digestive system is also full of germs, which are left on every surface
by droppings and fluid secreted from its mouth.
Evaluation
• What are the common types of cockroaches?
• What are the medical importances of cockroaches and house fly?
• What are the control measures of cockroaches and house fly?
References
• Alan & Meng, H. (2010). Life Cycle of a Cockroach. Retrieved on 25th March 2010 at
www.vtaide.com/png/cockroach.htm.

Company Ltd.
• Orkin, (2010). Cockroach Eggs. Retrieved March 15th ,2010 from http://www.orkin.com/
cockroaches/
Press.
• Sun Yat-sen University. (2009). Medical Arthropods: Class Insecta. The Department of
Parasitology of the Preclinical Medical College of Sun Yat-sen University. Retrieved on
May 5th ,2010 from jpkc.sysu.edu.cn/jscx/Textbook/senven-3.htm.

Handout 6.1: Morphological Features of Cockroaches and
Oothecae
Cockroaches
C D
A. Oriental Cockroaches (Blatta orintalis) male

B. Oriental Cockroaches (Blatta orientalis)female
C. German Cockroaches (Blattela germanica) female
D. American Cockroaches (Periplaneta amaricana
Oothecae
Source: Orkin, 2010
Female Blatella Germanica with Ootheca.
Source: Orkin, 2010

Session 7: Arachnids of Medical Importance (Ticks
and Mites)
Learning Objectives
• Classify ticks and mites
• Describe the morphological characteristics of the subclass Acarina
• Describe characteristics, and life cycle of ticks and mites
• Describe the medical importance of ticks and mites
• Explain the control measures against ticks and mites
Classification of Ticks and Mites

• Ticks are wingless, louselike, eight legged, un-segmented body and bloodsucking insect
• Mites are minute arachnids usually transparent or semitransparent, wingless, eight legged,
un-segmented body and bloodsucking insect
• Ticks and mites belong to the class arachnida subclass acarina
• Two genera of ticks are of medical importance
o Ornithodorous (soft tick)
Pathogenic species- ornithodorous moubata
o Boophilus (hard tick)
Pathogenic species-Boophilus microplus
• Two genera of mites are of medical importance
o Sarcoptes (itch mite)
Pathogenic species- Sarcoptes scabei
o Trombicula (chiggers)
Pathogenic species-Trombiculus species
Morphological Characteristics of Acarina Group

• Order acarina (ticks & mites) includes many parasites and vectors of diseases of man and
animals
• Head, thorax, and abdomen of these arachnids are fused into an un-segmented body
• Head and thorax are fused into cephalothorax
• Mouth parts and their base, the capitulum are attached to the anterior of the body by a
movable hinge
• They bear no wings
• They have 4 pairs of legs in the adult stage
Morphological Characteristics of Ticks
Hard Ticks
• The cephalothorax and abdomen are fused into an oval body with 4 pairs of six-jointed
legs that arise from the anterior end
• Consists of a basal plate or basis capituli
• Mouth parts comprises of hypostome, chelicerae, and palps
• Median hypostome has teeth which anchor the parasite to the host
• Chelicerae act as cutting organs to permit the insertion of the hypostome

Session 7: Arachnids of Medical Importance (Ticks and Mites) 239
• Palps do not penetrate the host but act as supports
• Scutum covers the entire dorsal surface in male and only the anterior part in female
• Eyes, when present are on or near the anterior lateral margin of the scutum
Soft Ticks
• It is oval, yellowish-brown, tuberculated and leathery
• It is 8-9 mm in size
• The capitulum is not visible dorsally
• Sexes are similar; there is no dorsal shield (scutum)
• Coxal glands between the first two coxae, secrete a tenacious fluid during feeding and
copulation
• It inhabits the cracks in the floors of local houses and bites its victims at night
• Cosmopolitan in distribution but are more abundant in warm climates
• They are nocturnal feeders and seldom travel from their local habitat
• Soft ticks are primarily ectoparasites of birds, mammals and man
• It is an important vector of endemic relapsing fever caused by Borrelia dutoni
Refer to Handout 7.1: Morphology Ticks
Life Cycle, Medical Importance and Control Measures of Ticks
Life Cycle of Ticks

• Both sexes are blood suckers
• After taking a blood meal, the female tick, Dermacentor, drops off the host to deposit its
eggs in soil
• It oviposits 2000-8000 eggs and then dies
• Soft ticks lay 100-200 eggs in several batches following successive blood meals
• After 2-7 weeks, eggs hatch into hexapod larvae (seed ticks)
• Seed ticks attach themselves to small animals for a blood meal, and then drop off to
moult into nymphs with four pairs of legs
• The life cycle of ticks is completed in 1-2 years
• Hard ticks have a single nymphal stage but soft ticks have several
• Various modifications of the cycle such as change of host, length of time on the host,
number of moults, and frequency of oviposition occur in different species
• During the larval, nymphal, and adult stages, ticks are intermittent parasites of animals
and spend most of their existence on the ground
• Some species e.g. boophilus, however, spend most of their lives on the animals
Medical Importance of Ticks

• Hard Ticks Causes
o Tick paralysis
o Transmission of bacterial, viral, rickettsial, and protozoal diseases
Rickettsial diseases
African tick fever (R. conorii): amblyomma, dermacentor
Q fever (R. burneti) is transmitted by dermacentor and amblyomma
• Soft ticks are important vector of endemic relapsing fever caused by Borrelia dutoni
• Mechanical injury of their bites

o After the chelicerae have cut the skin, the toothed capitulum anchors the tick during
the blood meal
o Its insertion produces an inflammatory reaction of the perivascular tissues with local
hyperaemia, oedema, haemorrhage, and thickening of the stratum corneum
Control of Ticks
• Soft ticks are best controlled by destroying their nests or lairs
• Floors and walls should be plastered to eliminate the crevices
• Spraying with DDT or benzene hexachloride (BHC). More than one application is
required, since these insecticides are ineffective against the eggs
• Hard ticks may be eliminated by eradicating their rodent hosts and destroying their
habitats
• Prevention of house infestation can be done by the removal of infested clothing and the
treatment of dogs with BHC
Characteristics, Life Cycle, Medical Importance and Control Measures of

Mites
Morphology and Characteristics
• Are very small, oval, dorsally convex, ventrally flattened, and have no eyes
• The male measures about 200-250µm
• Female is larger than male and measures about 330-450 µm
• The anterior notothorax bears the first two pair of legs, and the posterior bears the second
two pairs of legs
• First pairs of legs terminate in long tubular processes each with a bell-shaped sucker and
claws
• The posterior legs end in long bristles except in the fourth pair in the male which has four
suckers
• Dorsal surface is ridged transversally and bears spines, scales and bristles
• The mouth parts consists of toothed chelicerae, three jointed conical palps, and labial
palps fused to the hypostome

Figure 1: Morphological Features of Mite
Source: Anastasia, 2009
Life Cycle of Mites

• Mites infest the skin
• When activated by warmth from the skin the female mite, usually at night, burrows into
the skin, progressing at the rate of about 2 to 3 mm per day
• The burrow is confined to the corneous layer of the skin. The male excavates lateral
pockets or branches in the burrows
• The female, during her life span of 4 to 5 weeks, deposits up to 40 to 50 eggs in the
burrow
• Larvae emerge from the eggs usually in 3 days, but sometimes up to 10 days depending
on the warmth
• The hexapod larva either forms a lateral branch or a new tunnel, in which it becomes an
eight-legged nymph
• The female has two nymph stages while male has only a single one
• The life cycle is completed in 8 to 15 days
• The female may survive off the host for 2 to 3 days at room temperature

Medical Importance of Mites
• Leads to dermatitis or other tissue damage
• Causes loss of blood or other tissue fluids
• Sacorptes scabei causes Scabies
• Vector of pathogenic agents
o Rickettsia tsutsugamushi which leads to scrub typhus
• Leads to strong allergic reactions example asthma
Control
• Prevention requires the treatment of infected individuals, sterilization of garments and
bedding and personal cleanliness
• The following dugs can be used for the control of scabies
o Benxy benzoate emulsion
o Mitigal
o HCH cream
o Ivermectin
• General cleanliness of the environment and body
Key Points
• Ticks and mites belong to the class Arachnida
• Ticks and mites are characterized by four pairs of legs, wingless, and fused cephalothorax
• The life cycle of ticks involves changes from the adults, eggs, larva and nymph stages
• Ornithodoros moubata is a soft tick of medical importance which transmits relapsing
fever
• Mites are very small arachnids that inhabit the skins of animals and birds
• Species of medical importance comprise the Sacorptes scabei which causes Scabies
Evaluation
• What are the morphological characteristics of the subclass acarina?
• What are the ticks and mites of medical importance?
• What are the medical importance of ticks and mites?
• What are the control measures against ticks?
References
• Anastasia, (2009). Mite Biology: Bugsinmybed. Hearts Consulting Group.
Retrieved on 5th May 2010 from www. bugsinmybed.com/mite-biology.php
• Callagan, J.(2007). Chigger. Encyclopedia 2007 http://encarta.msn.com Retrieved from
http://www.everythingabout.net/articles/biology/animals/arthropods/
arachnids/mite/chigger.shtml
Company Ltd.
• Hardin. (2010). Lyme Disease Pictures: Male Female Ticks. Retrieved on 26th March
2010 from www.lib.uiowa.edu/haRDIN/MD/cdc/5978.html
• Harwood, R.F. & James, M.T. (1979). Entomology in Human and Animal Health (7th
ed.). Pulman: Washington State University.

• Orkin. Cockroach Eggs. Retrieved on March 15th 2010 from http://www.orkin.com/
cockroaches/
Press.
• Sun Yat-sen University. (2009). Medical Arthropods: Class Insecta. The Department of
Parasitology of the Preclinical Medical College of Sun Yat-sen University. Retrieved on
5th May 2010 from www.jpkc.sysu.edu.cn/jscx/Textbook/senven-3.htm.

Handout 7:1: Morphology of Ticks
Hard Ticks
Source: Hardin, 2010

Soft Ticks-Ornithodoros Moubata Ornithodoros Moubata ‘A’. Dorsal View, Female.
‘B’ Ventral View Female
source:CDC 2009 Source: Hagner, Root, Augustine et al, 1939

Session 8: Mollusca of Medical Importance (Snails)
Learning Objectives
• Define snail
• Classify snail of medical importance
• Explain the morphological characteristics of snails
• Explain steps in the life cycles of snails
• Describe medical importance of snails
• Describe the control measures of snails
Classification and Characteristics of Snails of Medical Importance

• Snails are terrestrial and aquatic invertebrate of the order gastropoda that can be identified
by hamped shell, mucus secretion and use of its soft shapeless muscles for locomotion.
Classification
• Snails (Mollusca) of medical importance belong to three genera
o Bulinus example bulinus truncates and bulinus africanus
o Biomphalaria example biomphalaria alexandrina and Biomphalaria glabrata
o Onchomelania example oncomelania quadrasi and oncomelania nosophora
General Characteristics of Snails of Medical Importance

• The head has a pair of retractable tentacles with eyes located at the ends
• Have a single shell or valve (snails)
• May be freshwater or terrestrial
• Aquatic snails breath through gills
• Aquatic snails also use their radula to scrape algae for food
• Terrestrial snails use their mantle cavity as a modified lung
• They use radula to saw off leaves for food
• Retreat into shell in dry periods and seals opening with mucus
• Have open circulatory system
• Secrete mucus and use muscular foot to move
• Aquatic snails have separate sexes while terrestrial are hermaphrodite

Session 8: Mollusca of Medical Importance (Snails) 247
Figure 1: Morphology of Terrestrial Snail
Source: Paddy, 2009
Distinguishing Features of Snails of Medical Importance
Bulinus
• Bulinus snails are ovoid with a short conical body (spire) measuring about 1-2 cm.
• The opening (aperture) is on the left side of the snail.
• These snails feed on vegetation and prefer muddy habitats.
• They prefer light and avoid darkness
Figure 2: Bulinus
Source: CDC, 2009
Biomphalaria
• These are flat and round resembling a disc (discoid)
• They measure 1- 3 cm
• These snails feed on vegetation and prefer muddy habitats.
• They prefer light and avoid darkness
Figure 3: Biomphalaria
Source: University of York, n.d.

Onchomelania
• These snails are both aquatic and terrestrial (they are amphibious)
• They are very small measuring about 1cm
• They are ovoid with a steep conical spire
Figure 4: Onchomelania
Source: University of York, 2010
Life Cycles of Snails

• All species of Biomphalaria and Bulinus are hermaphrodite, possessing both male and
female organs and being capable of self or cross-fertilization.
• A single specimen can invade and populate a new habitat.
• The eggs are laid at intervals in batches of 5–40, each batch being enclosed in a mass of
jelly-like material.
• The young snail hatches from an egg after 6–8 days and reach maturity in 4–7 weeks,
depending on the species and environmental conditions.
• Temperature and food availability are among the most important limiting factors.
• A snail lays up to 1000 eggs during its life time, which may last more than a year.
• The amphibious onchomelania snails, which may live for several years, have separate
sexes.
• The female lays its eggs singly near the water margin.
Figure 5: General Life Cycle of a Snail
Source: University of York, 2010

Medical Importance of Snails
• The snails are considered to be intermediate hosts because they harbour asexual stages of
the human parasite schistosoma.
Bulinus
• Transmits Schistosoma haematobium that leads to urinary schistosomiasis.
Biompharalia
• Biomphalaria transmits Schistosoma mansoni that leads to intestinal schistosomiasis.
Oncomelania
• Oncomelania transmits Schistosoma japonicum that leads to intestinal schistosomiasis.
Control Measures for Snails

• Molluscicides (although are potential for environmental destruction )
o The destruction of snails using molluscides is costly and difficult to achieve in rivers
and lakes
o Plant herbicides are selectively used
• Drainage of swamps and flooding
• Change salinity of water
• Biological control using ducks, fish and other predator snails.
Key Points
• Snails are terrestrial and aquatic invertebrate of the order gastropoda.
• The snails are considered to be intermediate hosts because they harbour the asexual stages
of parasites.
• Snails of medical importance belong to three genera including bulinus that transmits
schistosoma haematobium , biomphalaria that transmits schistosoma mansoni and
onchomelania that transmits schistosoma japonicum.
Evaluation
• What are the morphological characteristics of snails of medical importance?
• What is the importance of each of the three snails of medical importance?
• What are the ways to control snails?
References
Company Ltd.

• Orkin. Cockroach Eggs. Retrieved on 15th March 2010 from http://www.orkin.com/
cockroaches/
• Paddy, R. (2009). 'Snails and slugs', Te Ara - Encyclopedia of New Zealand, Updated 16-
Mar-09 URL: http://www.teara.govt.nz/en/snails-and-slugs/1/2
Press.
• University of York. Schistosomiasis. Department of Biology. Retrieved on 5 May 2010
from http://www.york.ac.uk/res/schisto/background.htm.

The development of these training materials was supported through funding from the President’s Emergency Plan for AIDS Relief
(PEPFAR) through the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA)
Cooperative Agreement No. 6 U91 HA 06801, in collaboration with the U.S. Centers for Disease Control and Prevention’s Global AIDS
Programme (CDC/GAP) Tanzania. Its contents are solely the responsibility of the authors and do not necessarily represent the official
views of HRSA or CDC.

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UNITED REPUBLIC OF TANZANIA

Ministry of Health and Social Welfare

CMT 04104 Microbiology,

Background and Acknowledgement .............................................................................................. iv

In September 2009, MOHSW embarked on an innovative approach of developing the

These participants are listed with our gratitude below:

Editorial Review Team

Librarians and Secretaries

Dr. Gilbert Mliga

Who is the Module For?

How is the Module Organized?

How Should the Module be Used?

Normal Flora Found in the Body and their Importance

CMT 04104 Microbiology NTA Level 4 Semester 1 Student Manual

Types of Pathogens and Vectors

Refer to Handout 1.2: Classification of Pathogens and Vectors

Characteristics of Pathogens and Vectors

Activity: Small Group Discussion

Refer to Handout 1.3: Characteristics and Comparison of Pathogens

CMT 04104 Microbiology NTA Level 4 Semester 1 Student Manual

CMT 04104 Microbiology NTA Level 4 Semester 1 Student Manual

CMT 04104 Microbiology NTA Level 4 Semester 1 Student Manual

Body part Example of normal flora

CMT 04104 Microbiology NTA Level 4 Semester 1 Student Manual

CMT 04104 Microbiology NTA Level 4 Semester 1 Student Manual

Viruses Bacteria Fungi Protozoans Helminths

Bullinus Biomphalaria Ornithodorus

CMT 04104 Microbiology NTA Level 4 Semester 1 Student Manual

Characteristics Viruses Bacteria Fungi Protozoa and

CMT 04104 Microbiology NTA Level 4 Semester 1 Student Manual

Characteristics of Prokaryotic Cells

Structure of Bacterial Cell and Function of Each Part

CMT 04104 Microbiology NTA Level 4 Semester 1 Student Manual

Source: Fox, 2010

Figure 2: Functions of Each Part of the Bacterial Cell

CMT 04104 Microbiology NTA Level 4 Semester 1 Student Manual

Comparison of Prokaryotic and Eukaryotic Cells

Activity: Small Group Discussion

Major Similarities between Prokaryotes and Eukaryotes

CMT 04104 Microbiology NTA Level 4 Semester 1 Student Manual

Classification of Bacteria According to Morphology/Shape

Refer to Handout 2.2: Classification of Bacteria According to Morphology

CMT 04104 Microbiology NTA Level 4 Semester 1 Student Manual

Classification of Bacteria According to Nature of Cell Wall

Classification of Bacteria According to Ability to Form Spores

Classification of Bacteria According to Ability to Grow in the Presence or Absence of

CMT 04104 Microbiology NTA Level 4 Semester 1 Student Manual

CMT 04104 Microbiology NTA Level 4 Semester 1 Student Manual

1. What are the similarities between prokaryotic and eukaryotic cells?

2. What are the differences between prokaryotic and eukaryotic cells?

CMT 04104 Microbiology NTA Level 4 Semester 1 Student Manual

Source: Michael W. Davidson, 2004

CMT 04104 Microbiology NTA Level 4 Semester 1 Student Manual

Source: Arabslab, 2010

CMT 04104 Microbiology NTA Level 4 Semester 1 Student Manual

Definition of Gram Positive Bacteria

Staphylococcus Bacteria of Medical Importance

CMT 04104 Microbiology NTA Level 4 Semester 1 Student Manual

Streptococci Bacteria of Medical Importance

CMT 04104 Microbiology NTA Level 4 Semester 1 Student Manual

Clostridium Bacteria of Medical Importance

General Characteristics of Clostridium Bacteria

Figure 3: Morphological Feature (Bacilli, Drum Stick Appearance) of Clostridium Species