PARASITOLOGY

CASE SCENARIO – Round worm

A 30 year old male presented to the hospital with complaints of intermittent colicky pain and loss
of appetite. He also gave history of 6-7 inches long worm vomited out through the mouth. On
examination no abnormality was found in abdomen but he appeared malnourished. His stool
specimen was collected and sent for microscopic examination. Normal saline and iodine
preparations of stool were prepared. Microscopic examination of these preparations showed bile
stained, oval shaped eggs surrounded by a thick translucent shell with rugosities.

Questions:

1. Identify the Causative agent associated with this condition.

Ascaris lumbricoides (Round worm)

2. Draw a labeled diagram of eggs of the agent involved.

3. What is the infective form and mode of transmission of this infection?

Embryonated eggs containing L2 larve
Ingestion of embryonated eggs from the contaminated soil, food and water.
4. What are the clinical manifestations of this disease?
Due to adult worm: Colicky cramps, anorexia, malnutrition, intestinal obstruction,
allergic manifestations.
Due to migrating larvae: Loeffler’s syndrome.

5. How will you diagnose this condition in laboratory?

Direct microscopic examination of stool for the detection of eggs by wet mount.
Serology: ELISA, IFA.

6. How will you treat this patient?

Albendazole 400mg (single dose) or Mebendazole 100mg (twice daily for 3 days)
 CASE SCENARIO – Hook worm
A 10 year boy presented to medical out-patient department (OPD) with complaints of epigastric
pain, vomiting and diarrhoea for last two weeks. He had been feeling malaise and tiredness. On
examination, he was pale but appeared normal. Abdominal examination did not reveal any
abnormality. His stool specimen was collected for microscopic examination. Blood specimen
was collected for complete blood count (CBC). CBC results showed eosinophilia and microcytic
hypochromic anemia. Wet mount of stool specimen showed colourless, segmented ova
surrounded by a thin membrane.

Questions:

1. Identify the Causative agents associated with this condition.

Ancylostoma duodenale (Old world hookworm) or
Necator americanus (New world hookworm)

2. Draw a labeled diagram of egg of the agent involved.

3. What is the infective form and mode of transmission of this infection?

Third stage filariform (L3) larva.
Through penetration of skin by the L3 larva.

4. What are the clinical manifestations of this disease?

Due to migrating larvae: Ground itch, creeping eruption, mild transient pneumonitis.
Due to adult worm: Iron deficiency anemia, Wakana disease.
5. How will you diagnose this condition in laboratory?
Direct microscopic examination of stool for the detection of eggs and larvae by wet
mount, indirect method like CBC.

6. What is the treatment of choice?

Albendazole 400mg (single dose) or Mebendazole 100mg (twice daily for 3 days) or
Pyrantel pamoate.
 CASE SCENARIO – Pin worm

A 4 year old boy was brought to the hospital with complaints of anal itching. The mother
had noticed her son is scratching and rubbing his anal area frequently for the last five
days. He had no diarrhea. On examination he appeared well. His general physical
examination and vital signs were normal. Examination of perianal area revealed red raw
skin due to scratching. For microscopic examination, the specimen was collected by
touching the perianal region with a piece of cellophane tape.

Questions:

1. Identify the Causative agent associated with this condition.

Enterobius vermicularis (Pin worm or thread worm)

2. Draw a labeled diagram of egg of the agent involved.

3. What is the infective form and mode of transmission of this infection?

Embryonated eggs, Autoinfection or ingestion of eggs through contaminated fingers.

4. What are the clinical manifestations of this disease?

Perianal pruritus, excoriation of the perianal skin and bacterial superinfection.

5. How will you diagnose this condition in laboratory?

Microscopy of perianal skin samples by cellophane tape method or NIH swab.

6. What is the treatment of choice?

Albendazole 400mg (single dose) or Mebendazole 100mg (single dose).
 CASE SCENARIO – Tape worm

A 40 year old man presented to the hospital with complaints of chronic headaches,
confusion and recurring seizures. No history of chronic cough and weight loss was
present. He had no family or past history of tuberculosis. On physical examination, he
had only decreased level of consciousness. Magnetic resonance imaging (MRI) of brain
was performed. MRI report was suggestive of cysticercosis of brain.

Questions:

1. Identify the Causative agent associated with this condition.

Taenia solium (The Pork tapeworm)

2. What is the definitive and intermediate host for this agent involved?
Definitive host: Man
Intermediate host: Pig

3. What is the infective form and mode of transmission of this infection?

Cysticercus cellulosae (larval form), Ingestion of contaminated undercooked pork
containing the larvae.

4. What are the clinical manifestations of this disease?

Subcutaneous nodules, Muscular cysticerosis, Neurocysticerosis

5. How will you diagnose this condition in laboratory?

Direct microscopic examination of stool for the detection of eggs and proglottids by wet
mount, ELISA, PCR.

6. What is the treatment of choice?

Praziquantel 10mg/Kg (single dose), Niclosamide 2g (single dose)
 CASE SCENARIO – Liver fluke

A 27-year-old female came to OPD with the complaints of painful swelling around
umbilical region in upper right quadrant for 3 days associated with low grade fever. She
was working as a laborer in the field apart from routine domestic works including feeding
of domestic cattle. She had developed liver abscess after 1 month of cholecystectomy. On
examination, 6 cm ×7 cm ill-defined extra peritoneal lump in umbilical region was found.
The swelling was associated with mild tenderness and erythema. Differential leucocyte
count showed eosinophilia. FNAC showed eosinophilic granuloma. On incision just
adjacent to the red vesicle lesion, a leaf like organism came out.

Questions:

1. Identify the Causative agent associated with this condition.

Fasciola hepatica (The Liver fluke)

2. What is the definitive and intermediate host for this agent involved?
Definitive host: Man, sheep, goat
First intermediate host: Snails
Second intermediate host: Aquatic vegetations

3. What is the infective form and mode of transmission of this infection?

Metacercariae on water plants, Ingestion of aquatic plants containing metacercaria.

4. What are the clinical manifestations of this disease?

Abdominal pain, tender hepatomegaly, eosinophilia, liver rot.

5. How will you diagnose this condition in laboratory?

Direct microscopic examination of stool for the detection of operculated eggs, ELISA,
PCR.

6. What is the drug of choice?

Triclabendazole10mg/Kg (Single dose)