Parasitology Notes

PARASITOLOGY
Intestinal Roundworms
Species Ascaris lumbricoides Trichuris trichiura Enterobius vermicularis Capillaria philippinensis
Seatworm
Giant Intestinal Roundworm Human Pinworm
Common name Whipworm Pudoc worm
Lumbricus teres Society worm
Oxyuris vermicularis
Final/Definitive host Man Man Man Man
Glass fish (Bagsit, Birot, Bagsang,
Hypselotris bipartite: Ipon)
Intermediate host N/A N/A N/A
Fresh-water fish
Brackish-water fish
Natural host Soil-transmitted helminth (STH) Soil-transmitted helminth (STH) N/A Migratory birds
Large Intestine (Cecum,
Habitat Small Intestine Large Intestine (Cecum) Small Intestine (Jejunum)
Appendix)
Infective stage Embryonated egg Embryonated egg Embryonated egg Larva
Fecal-oral (Ingestion)
Autoinfection: Same host (E.
Ingestion of
vermicularis, S. stercoralis)
Mode of transmission Fecal-oral (Ingestion) Fecal-oral (Ingestion) undercooked/raw/contaminated
Retroinfection (migration of
fish (w/ larva)
hatched larvae back)
Inhalation
1. Ingestion of embryonated egg 1. Ingestion of embryonated egg 1. Adult worms in colon 1. Larval stages in raw or
2. Larva hatch in S.I 2. Larva hatch in S.I. 2. Adult worms reproduce & lay undercooked fish ingested by
3. Heart-Lung migration 3. Larva matures into adults in eggs humans
4. Larva is swallowed back into the S.I. colon (attach permanently) 3. Gravid female migrates to 2. Larval stage mature to become
5. Larva mature to become male & 4. Adult worms reproduce & lay perianal area to oviposit eggs & adult male & female worms in S.I.
female adult worms eggs female dies (happens at night) 3. 1st generation females are
Life cycle
6. Adult worms reproduce & lay 5. Eggs are relased in feces & 4. Man ingest embryonated eggs, LARVIPAROUS
eggs embryonate in soil hatch in S.I to release larva 4. Adults reproduce & lay eggs
7. Eggs are released in feces & are 5. Larva matures in colon to (2nd Generation)
embryonated in soil become adults 5. Typical eggs are released in
feces; Atypical eggs hatch inside
the S.I.
LARIOSA, K.A.M. RMT ni Lord 2024

PARASITOLOGY
6. Eggs are released in the water
& embryonates (not like
Helminths that embryonate in
soil)
7. Embryonated eggs are ingested
by brackish or freshwater fish
- Slender  Females larger Anterior (lash):  Females larger Anterior:  Meromyarian: - Caudal ale  Same family
Anterior: than males 3/5th fine, hair- than males Cephalic alae 2–5 - Chitinized w/ Trichuris &
Triobate lips  Polymyarian: cells like  Holomyarian: (wing-like) cells/dorsal or spiculed tail Trichinella:
Posterior: are numerous & Posterior cells are small, around head, ventral half (shiny Sheath Trichinelloidea
Ventrally project well into (stock): 2/5th numerous, Flask-bulb  Light extending from  First observed
curved, the body cavity robust, thicker, closely packed shaped yellowish tip): 230 – 300 in Ilocos Sur
Male Spiculed (2)  Whitish or pinkish presence of in a narrow esophagus white um  Stichocytes:
(creamy white “string of zone Posterior:  Rhabditiform rows of
color with a tint of beads”  Thin colorless Blunt, spiculed larva: 140 – secretory cell
pink) esophagus, anterior & (1) 150 um X 10 in the
 Pepsin Inhibitor 3 coiled, spiculed pinkish gray um (has esophagus
(PI-3): protects (1), retractile posterior esophageal  Stichosome:
them from sheath  TT47: pore- bulb but no entire
- Thick digestion - 3,000 – forming - 4,672 – cephalic alae) Typical: Single esophageal
Adult - 250,000  Phosphorylcholine: 10,000 protein 16,888  Only intestinal row of eggs structure
morphology eggs/day suppresses eggs/day (allows to eggs/day nematode that Atypical: 2 or
Anterior: lymphocyte Anterior (lash): imbed the (11,105 ave.) cannot be more rows of
Triobate lips proliferation 3/5th fine, hair- entire whip- Anterior: controlled eggs
Posterior:  Life span: 1 year like like portion) Cephalic alae through
Pointed tail; Posterior (wing-like) sanitary
paired (stock): 2/5th around head, disposal of the
Female reproductive robust, thicker, Flask-bulb feces
organs (2/3rd) presence of shaped (contaminates
“string of esophagus underwear,
beads” Posterior: long, beddings)
esophagus; thin, sharply
pointed, blunt pointed
tail; single set
of reproductive
organs

PARASITOLOGY
Male 10 cm – 31 cm 30 mm – 45 mm 2 - 5 X 0.1 – 0.2 mm 1.5 – 3.9 mm
Adult size
Female 22 cm – 35 cm (L) 35 mm – 59 mm (L) 8 – 13 X 0.4 mm 2.3 – 5.3 mm
 Unfertilized – glycogen layer (thin),  Barrel-shaped  D-shaped/Lopsided  Typical:
lecithin coarse, granular (refractile)  Lemon-shaped - Oval, asymmetrical - Peanut/Guitar-shaped (mucus
 Fertilized – corticated type: coarsely  Football-shaped - Slightly flattened on one side, bipolar plugs, slightly striated
albuminous thick mammillary layer  Japanese lantern concave on the other shell; mistaken as Trichuris
(golden brown due to bile); - Hyaline Bipolar mucus plug - translucent shell: triple eggs)
decorticated type; thick, transparent, (refractile prominences) albuminous covering (mechanical  Atypical: no mucus plugs
Egg morphology
hyaline shell with a thick outer layer - Bile-stained (yellowish outer protection); inner embryonic
(supporting structure); delicate shell) lipoidal membrane (chemical Diagnostic stage
vitelline, lipoidal, inner membrane - Non-striated shell (transparent) protection)
(highly impermeable) Un-embryonated when passed in 4 – 6 hrs: maturation of embryo
 Embryonated – with larva (never stool outside the host
recovered in stool only in SOIL)
 Unfertilized: 85 – 95 um X 38 – 45
Egg size um 50 – 55 um X 20 – 25 um 50 - 60 um X 20 - 30 um 35 – 45 um X 20 – 25 um
 Fertilized: 40 – 75 um X 30 – 50 um
Ascariasis (lung infiltration, asthma, Trichuriasis/Trichocephaliasis Enterobiasis or Oxyuriasis: poor Mystery disease/Intestinal
edema of the lips, DoB, fever, (abdominal pain & appetite, weight loss, irritability, Capillariasis/Pudoc disease:
eosinophilia) tenderness, nausea & vomiting, grinding of teeth, & abdominal Severe diarrhea, abdominal pain,
1. Migrating larva: Loeffler’s weight loss, poor appetite, pain) Borborygmus (gurgling of the
Syndrome wasting, stunting, reduced 1. Pruritus/Pruritus ani (perianal stomach), protein-losing
2.Adult worm: Obstruction, intellectual & cognitive itching) enteropathy, electrolyte loss,
perforation, rupture of intestines, Bolus development in children) Aberrant adult worm: malabsorption
of worms (abdominal pain, 1. Trichuris dysentery syndrome appendicitis, vaginitis, Lethal if untreated
intussusception, volvulus) (Chronic dysentery & Rectal endometritis, salpingitis &
Disease manifestation 3. Erratic migration: regurgitated, prolapse) peritonitis
vomited, escape through nostrils 2. Diarrhea (blood-streaked) Familial disease
(inhaled through trachea), invade bile 3. Blood loss (anemia)
ducts & enter gallbladder or liver, >200 worms (children): chronic
appendicitis, pancreatitis, acute dysentery profound anemia,
peritonitis, chronic granulomatous growth retardation
peritonitis Petechial hemorrhages predispose
- amebic dysentery (E. histolytica)
500 - 5,000 eggs/gram:
symptomatic
PARASITOLOGY
1. Stool Examination (DFS: less 1. Stool Examination (DFS w/ 1. Graham’s scotch adhesive tape Stool examination (DFS)
sensitive, Kato-Katz: sensitive, Kato drop of saline, Kato-Katz, Kato swab (perianal cellulose tape
thick) thick) swab): very sensitive & specific
Laboratory diagnosis 2. Concentration technique (FECT: 2. Concentration technique 2. NIH cellophane swab: Hall
sensitive than DFS, SAF) 3. Zinc sulfate flotation method 3. Swellengrebel test (Wet Pestle
3. Sputum examination (demonstration of eggs): best lab Swab: Schuffner & Swellengrebel
diagnosis for T. trichiura egg

PARASITOLOGY
Intestinal Roundworms
Hookworms
Species Ancylostoma duodenale Necator americanus Strongyloides stercoralis Trichostrongylus
New World Hookworm
Common name Old World Hookworm American Hookworm Threadworm Pseudohookworms
American Murderer
Mammalian herbivores (Rabbits,
Final/Definitive host Man Man
sheep, cattle, rodents)
Intermediate host N/A N/A N/A
Natural host Soil-Transmitted Helminth (STH) N/A N/A
Small Intestine (Intestinal mucosa:
Habitat Small Intestine pylorus to rectum; duodenal & Small Intestine
upper jejunal regions)
Infective stage Filariform Larva (L3) Filariform Larva (L3) Filariform Larva (L3)
Ingestion of the infective larva
Mode of transmission Skin penetration Skin penetration; Autoinfection
(contaminating plant material)
1. Filariform larva penetrates the skin of humans 1. Adult free-living worms in the 1. Eggs are passed in the stool of the
2. Larva undergoes Heart-Lung migration environment reproduce to produce definitive host, usually a
3. Larva swallowed back into the S.I eggs herbivorous mammal
4. Larval stages mature to become adult worms (attached to the linings 2. Eggs hatch to release 2. Larva hatches in the environment,
of S.I) rhabditiform larva becomes a rhabditiform larva &
5. Adult worms reproduce & lay eggs 3. When the environment is transforms into the Filariform
6. Eggs are released in feces (into soil for embryonation) unfavorable, rhabditiform larva within days
7. Eggs hatch in soil to release the rhabditiform larva transforms into a parasitic 3. Filariform larva is ingested by
8. Rhabditiform larva matures into the filariform larva (which begins/ filariform larva humans
Life cycle
restarts infection) 4. Filariform larva penetrates skin 4. Larva migrates into the S.I
of humans & undergoes Heart- 5. Larva matures & becomes adult
Lung migration male & female worms
5. Larva matures in the S.I to 6. Adult worms inhabit the digestive
become male & female adult tract of their definitive hosts &
worms occur as incidental infections in
6. Female adult worms undergo humans
parthenogenesis (self-fertilization)
to release eggs

PARASITOLOGY
7. Eggs hatch in the lumen of S.I
8. Rhabditiform larva are released
in the feces
9. Some rhabditiform may undergo
autoinfection
Curvature C-shaped  Grayish white  Penetrate S-shaped S-shaped  Colorless  Trichostrongylus
or pinkish through skin  Semi- orientalis
Ventral teeth: 6 No Ventral teeth No buccal
 Infections may only transparent (Japan, Korea,
Buccal (2 pairs above, 1 2 pairs or Short buccal capsule
be  Hook-shaped  Finely striated China, Taiwan,
cavity pair below) semilunar canal
percutaneous, cuticle Armenia)
cutting plates
Tripartate: 2
oral,
Bipartite/Bell- Parasitic:  Female: vulva
transmammary,
separate spicules shaped: 2 fused Slender to short (1/3 the length
transplacental of the body
Male & 1 dorsa spicule & split conical
Copulatory dorsa Free-living: 2 from the
Bursa equal posterior end)
Copulatory - Uteri: single
spicules file (8-12 thin
shelled,
Plain, bristle- Barbed & fused,
transparent,
like, long, blunt short, pointed
segmented ova
Adult tail tail
50 – 58 um X
morphology
30 – 34 um);
capable of
Pathogenesis
 Free-living
(male):
Spicule ventrally
curved tail, 2
copulatory
spicule,
gubernaculum,
no caudal alae
 Parasitic males:
eliminated from
the body in
early infection
PARASITOLOGY
Male 8 – 12 mm 5 – 9 mm X 0.30 mm Free-living: 0.7 mm X 0.004 mm 2 – 8 mm X 50 – 60 mm
Parasitic: 2.2 mm X 0.04 mm
Adult size (L)
Female 10 – 15 mm 9 – 11 mm X 0.35 mm (L) Free-living: 1mm X 0.06 mm 3 – 10 mm X 55 – 80 mm
(smaller)
Rhabditiform stage: Feeding stage; open-mouthed Rhabditiform stage: Feeding stage
- Short & Stout (Open-mouthed)
- Buccal capsule: long - Short buccal capsule & stout
- Genital primordium: small genital primordium
- Buccal capsule: Short
L1 Larval stage
- Genital primordium: Prominent
- elongated esophagus w/ pyriform
posterior bulb
- Smaller than hookworm
- 225 um X 16 um
Filariform stage: Non-feeding stage; Infective stage; closed-mouthed Filariform stage: Non-feeding
- Long & slender stage (Close-mouthed)
- Posterior: pointed - Posterior: notched/fork tail
- Sheathed - Unsheathed larva
L3 Larval stage
- Slender
- Cleft at the tip of the tail
- Smaller than hookworm
- 550 um (length)
INDISTINGUISHABLE Similar to Hookworms Similar to Hookworms (larger)
Diagnostic stage Rarely seen (freshly collected; - More blastomeres
Unsegmented when passed adults are usually more present) - Slightly tapered (pointed tip)
Egg morphology
Transparent, single, thin-shelled (hyaline), prominent developing - Thin-shelled
blastomeres
Must be >400 to be detected in DFS
Egg size 50 – 58 um X 30 – 34 um 50 – 58 um X 30 – 34 um 75 – 95 um X 40 – 50 um
Ancyclostomiasis/Necatoriasis 3 Phases of Acute Infection: Asymptomatic diseases but can
Skin penetrating larva: Dew Itch/Ground itch (itchiness/redness at site of 1.Larva penetrating the skin: Larva cause G.I. complications
penetration; Mazza Mora/Water sore curens (Chronic cutaneous larval
Disease manifestation
Migrating larva: Wakana disease; Creeping eruption/Cutaneous larva migration); Strongyloidiasis
migrans (erythema, pruritic elevated
Adult stage: Blood loss (Iron deficiency anemia) hemorrhagic papules)

PARASITOLOGY
2.Migrating larva: Pneumonitis
(lobular pneumonia w/
hemorrhage, mimics bronchitis)
3.Adult worms: Intermittent
Diarrhea (Cochin China
Diseases/Vietnam Diarrhea)
Light infection: no intestinal
symptoms
Moderate infection: Diarrhea
alternating w/ constipation
Heavy infection: intractable,
painless, intermittent diarrhea
(numerous episodes of watery &
bloody stools)
Stool Examination: DFS; Kato-Katz/Kato Thick; Concentration Stool Examination: Larval stages Stool examination (DFS)
technique (FLOTAC: higher sensitivity; Zinc sulfate, FECT) identification Concentration techniques
Culture Techniques: Harada-Mori Culture Technique (Filter paper Culture Techniques: Harada-mori,
culture technique); Baermann funnel technique Baermann Technique
Other tests: Beale’s string test;
Laboratory diagnosis
Duodenal aspiration; Small bowel
biopsy
Disseminated Strongyloidiasis:
larvae may be found in urine or
sputum

PARASITOLOGY
Extra-Intestinal Roundworms
Anisakis spp.
Species Trichinella spiralis Parastrongylus cantonensis (Anisakis simplex, Dracunculus medinensis
Pseudoterranova decipiens)
Trichina worm, Muscle worm, Garbage Herring worm, Cod worm, Seal Guinea worm, Fiery serpent,
Common name Rat Lungworm
worm, Pork roundworm worm Medina worm
Marine mammals (whales,
Final/Definitive host Pigs & some vertebrae Rats dolphins, porpoises, walruses, Man
seals, sea lions)
Achatina fulica (Giant African
Snail), Hemiplecta sagittifera,
Copepods (Cyclops fresh-water
Intermediate host Pigs & some vertebrae Helicostyla macrostoma, Micro-crustaceans
flea)
Vaginilus plebeius, Veronicella
altae
Paratenic host N/A N/A Cephalopods, Mollusks, Fish N/A
Accidental host Man Man Man N/A
Adult: Small Intestine Subcutaneous tissues
Habitat Brain, Lungs, Eyes Stomach, Digestive areas
Larva: Striated muscles (legs, arms, back)
Infective stage Encysted larva L3 larva L3 larva L3 larva
Ingestion of
undercooked/raw/contaminated
snails
Ingestion of leafy vegetables
Ingestion of contaminated by mucus secretions Ingestion of improperly cooked Ingestion/Drinking of
Mode of transmission
undercooked/raw/contaminated pork of mollusk carrying infective infected fish or squid contaminated water
stage
Ingestion of paratenic host (prawn
or crab), drinking contaminated
water
1. Infective encysted larvae enter the host - Definitive host (rats): Definitive host (marine 1. Humans accidentally ingest
through ingestion of raw insufficiently 1. Ingestion of 3rd stage larva mammals): copepods with infective larva
cooked meat. 2. Larva penetrates the stomach 1. Adult worms embedded in 2. Larva is released & penetrates
Life cycle
2. Cysts are digested in the stomach & wall, travels to the CNS through gastric wall of the host discharge walls of S.I &
larva excyst either in the stomach or in bloodstream unembryonated eggs into the sea develops in body cavity or
S.I. connective tissues

PARASITOLOGY
3. Larvae burrows into the subepithelium 3. Undergoes 2 molts (2 weeks) 2. 1st stage larva develops inside 3. Gravid female migrates to
of the villi (they undergo 4 molts); before reaching maturity; Early the eggs molt into 2nnd stage subcutaneous tissues & causes
Maturation takes about 2 days development occurs in the brain larva that hatch out ulcer
4. Adult worms begin to mate 5 – 7 days’ 4. After final molt, young adults 3. 2nd stage larva is ingested by 4. From the ulcer, larva is
post infection. The female produces migrate to the pulmonary arteries micro-crustaceans (3rd stage released
eggs that grow into larva in the uterus to complete the development larva develops)
5. Female worm deposits larvae in the 5. After 2 weeks, female adult Paratenic host:
mucosa states to lay eggs (bloodstream) 4. 3rd stage larva is transported to
6. Larva penetrate the mucosa, pass which are transported into smaller various paratenic host (squid,
through the lymphatic system into the vessels of the lungs fish where it is concentrated
circulation, then into striated muscle 6. After 6 days, eggs hatch & more in the fish viscera or fish
7. In muscles, larvae grow & coil into releases 1st stage larva that muscles)
individual cysts (average lifespan: 5 – penetrates into the respiratory 5. Marine mammals ingest & 3rd
10 years; can survive up to 40 years in tract stage larva molt twice
humans)) 7. larvae then migrates up to - Accidental host (Man):
8. Encapsulation is completed 4 – 5 trachea & reach the oropharynx 6. Humans may ingest the 3rd
weeks after infection (may remain where they are swallowed & larva from raw or improperly
viable for many years) expelled in feces (6 – 8 weeks cooked infective fish (larva does
from infection before rat excretes not develop into the adult in the
1st stage larvae) gut)
- Intermediate host (snails): 7. Ingested larvae invade the
8. 1st stage larva infects the submucosa of the stomach or
molluscan intermediate host intestines
(slugs & snails) through ingestion
or active penetration
9. larva develops into 3rd stage
larva (12 days)
- Accidental host (man):
10. Man ingest
contaminated/undercooked/raw
snails, vegetables, water
11. Larva pass through stomach
into the intestine, enter circulatory
system & migrate to the brain or
spinal cord, occasional to the eye
chamber (larva remains in the

PARASITOLOGY
brain for long periods of time &
does not develop into the adult
stage)
- W/ conical papillae - well- - Previously - milky white - coils itself at - longest
- Single testis (near the developed under in color least once roundworm to
posterior end) caudal bursa Angiostrongylus - elongated (anterior end) cause human
- Genital tube (joins (Kidney- - transparent vermiform disease
the testis in the mid shaped & cuticle bodies without
Male
body), this extends single-lobed) - Lives in 2 segmentation
back to the cloaca - single spicule main branches
- Posterior cloaca: pair of the
of caudal appendages pulmonary
& 2 pairs of papillae arteries (rat)
Adult Larviparous/viviparous - Barber’s pole - Incubation - Prominent
morphology (lives for 30 days, appearance period 6 – 15 blunt, rounded
capable of producing (uterine tubules days (may vary anterior end
more than 1,500 that wound from 12 – 47 - tapering
larvae) spirally around days) recurved tail
- Single ovary in the the intestine) - filled w/ the
Female
posterior - posterior end branches of an
- Oviduct, seminal is blunt shaped enormous
receptacle, coiled - lay up to uterus (3 mil
uterus, vagina 15,000 eggs embryos)
- Vulva: anterior 5th on daily - viviparous
the ventral side
16 – 22 mm (length)
Male 0.62 – 1.58 mm X 0.025 – 0.033 mm 21 X 0.4 mm
0.25 – 0.35 mm (diameter)
Adult size
19 – 33 mm (length)
Female 1.26 – 3.35 mm X 0.029 – 0.038 mm 840 mm X 1.5 mm
0.28 – 0.50 mm (diameter)
- Elongated, ovoidal, with hyaline
Egg morphology N/A N/A N/A
shells
46 – 48 um X 68 – 74 um
Egg size N/A N/A N/A
Unembryonated when oviposited
1st stage larva: found in the lungs 3rd stage larva: milky white in 1st larva stage: consumes 1/3 of
Larva morphology Spear-like, borrowing anterior tip (rodent host); distinct small knob color, long stomach, blunt tail body length; culminates in a
(tip if the tail) with mucron (Type 1); shorter point
PARASITOLOGY
3nd stage larva: 2 well-developed stomachs, blunt tails (Type 2); - broad anterior end & slender
chitinous rods (have expanded Psudoterranova: yellowish filiform tail
knob-like tips) below its buccal brown in color - cuticle: prominent striations
cavity - swims by coiling & uncoiling
At birth: 80 – 120 um X 5.6 um 3rd stage larva (Type 1): 19 – 36 1st stage larva: 620 X 15 um
After it enters a muscle fiber: 0.65 – 1.45 mm 500-700 um X 15-25 um
Larva size
mm X 0.026 – 0.040 mm 3rd stage larva (type 2): 25 – 50
mm
Light infection (up to 10 larvae): Parastrongyliasis Anisakidosis: acute presentation Dracunculiasis/Guinea worm
asymptomatic Eosinophilic meningoencephalitis (1 – 12 hrs after ingestion of disease
Moderate infection (50 – 500 larvae): Chief complaint: acute, severe, infective larvae); severe - body fluid of the female worm
Gastroenteritis, diarrhea, abdominal pain intermittent occipital/bitemporal abdominal pain w/ nausea & is toxic (sterile yellowish liquid)
(2 days post infection); symptomatic headache vomiting; hemorrhage & = blister formation
trichinellosis (100 – 300 larvae); severe Common symptoms: stiffness of inflammation; usually mimics
disease (1,000 – 3,000 larvae) neck, paresthesia, vomiting, fever, appendicitis, Crohn’s disease,
Cardinal signs of trichinellosis: severe nausea, blurred vision (diplopia), intestinal obstruction,
myalgia, periorbital edema, eosinophilia body or muscle pain, fatigue diverticulitis
Confusion, incoherence, Allergy
disorientation, memory lapses, If penetration is deep: tumor-like
coma (can also be observed) granuloma surrounded by
Complications: intraocular inflammatory cells &
hemorrhage, retinal detachment eosinophils develops
Muscle Biopsy: Deltoid; Gastrocnemius Postmortem exam: Endoscopy Physical removal of the worm
ELISA leptomeningitis, Serologic test: ELISA, RAST
Bachman Intradermal test encephalomalacia, moderate
Bentonite Flocculation Test ventricular dilation
Beck’s Xenodiagnosis CSF (100 – 1,000 leu/uL):
Eosinophils (>10%), monocytes,
foreign giant cells, protein (mildly
elevated)
Adult worms can be recovered in
the eyes
Large Charcot-Leyden crystals in
the meninges
Blood: high proportion of Eo (7%
- 36% of WBC count)

PARASITOLOGY
Computed tomography (CT): non-
specific cerebral edema,
ventricular dilation
- Magnetic resonance imaging
(MRI): lesion with hyperintense
T2 signal
- dot-blot ELISA: 100% sensitive
& specific
_ PCR: serum antigens can be
detected

PARASITOLOGY
Filarial Worms
Lymphatic Filariasis Subcutaneous Filariasis
Species Brugia malayi Wuchereria bancrofti Loa loa Onchocerca volvulus
African eye worm Convoluted filarial
Common name Malayan filarial worm Bancroft’s filarial worm
Loa worm Blinding worm
Final/Definitive host Man
Swamps: Mansonia bonneae Urban type: Aedes poecilus Chrysops spp. Simulium spp.
Rice fields: Mansonia uniformis (abaca/banana) Mango flies (Tabanid/day biting Black flies (Dammed black
Intermediate host/Vector Rural type: Anopheles minismus flies fly/Buffalo gnat)
flavirostris
Culex
Infective stage to I.H. Microfilariae
Infective stage to F.H. L3 larva
Mode of transmission Bite of an insect (mosquito) Bite of an insect (flies)
Habitat Upper lymphatic Lower lymphatic Subcutaneous tissue
Skin snips or skin shavings
Specimen Blood
Urine
1. Female mosquito bites a susceptible human & the filiform larva penetrates the bite wound
2. Filariform larva migrate to the lymphatics to become adult worms
3. Adult worms reproduce & produce microfilaria (L1)
4. Microfilaria are released into blood stream
Life cycle
5. Microfilaria are picked up by another mosquito or the same carrier
6. Microfilaria penetrate the mosquito mid-gut & migrates to thoracic muscles
7. L1 larva transforms into L3 filariform larva inside mosquito after molting twice
8. L3 larva migrates to mosquito head & proboscis
Life span 5 years 5 years
Diurnal (lungs during non-
Nocturnal subperiodic Nocturnal periodic
Periodicity circulation phase) Non-periodic
(10pm – 2 am) 9:00 pm – 4:00 am
1-:15 am – 2:15 pm
Prevalence <3% 4% - 10 %
- creamy white - typically white in color - thin, wire-like appearance
- long (thread-like) - cylindrical threadlike appearance - coil up in knots in the skin
Adult morphology - filiform in shape module
- found tightly coiled in nodular dilated nests (lymphangiectasia) in
lymph vessels & sinuses in lymph glands
Size Male 13 – 23 mm 20 – 40 mm 28 – 35 mm 2.5 – 50 mm
PARASITOLOGY
Female 43 – 55 mm 80 – 100 mm 38 – 72 mm 500 mm
Anal pore 82.2% (smaller) 82.4% (bigger)
Nucleus Discrete/separate Overlapping
Genital cell Big Small
Excretory cell Big Small
Cephalic space Twice as long as broad (2:1) Long as broad (1:1)
Slightly bulb w/ nuclei (single row Tapering w/out nuclei (single row Tapering gradually (nuclei Nuclei absent in tail
Tail end of nuclei (2) that reaches the end) of nuclei that does not reach the continuous up to the tip of the tail)
Somewhat pointed end) pointed
- enclosed sheath - snake-like - sheathed - unsheathed
- angular curvatures w/ secondary - constantly moving among RBCs - nuclei that extend from the
kinks (kinky-appearance) - enclosed in hyaline sheath (longer anterior end
- 2 nuclei & confluent nuclei (2 than the microfilaria)
Microfilariae rows) - stained: central axis shows dark-
morphology - stained sheath: pink staining nuclei
- sweeping curves (several)
- graceful appearance
- column of nuclei: arranged in 2 or
3 rows, distinctly conspicuous
Microfilariae size 200 – 280 um 240 – 300 um 248 – 300 um 150 – 355 um
Malayan Lymphedema: most common Bancroftian Loiasis: pruritus itchiness, Onchocerciasis (River blindness):
filariasis chronic manifestation filariasis localized pain, calabar swellings, chronic but non-fatal;
Lymphangitis Wuchereriasis adult worms are noticeable when
Expatriate Syndrome (px from Elephantiasis migrating under conjunctiva of the
outside endemic areas): clinical & (chronic) eye or crossing under the skin of
immunologic hyper- the bridge of the nose
Diseases manifestations responsiveness; hives, rashes, Px in endemic areas: Eo, calabar
blood eo (transient subcutaneous swellings)
Acute dermatolymphangioadenitis
(ADLA): most common
manifestation
Co-infection can theoretically be
possible

PARASITOLOGY

PARASITOLOGY
Filarial Worms
Subcutaneous Filariasis Serous Cavity Filariasis
Species Mansonella streptocerca Mansonella perstans/Dipetalonema perstans Mansonella ozzardi
Persistent filarial Ozzard’s filarial
Common name
Perstans filaria New world filaria
Culicoides spp. (gnats, sandflies)
Intermediate host/Vector
Biting midges
Infective stage to I.H. Microfilariae
Infective stage to F.H. L3 larva
Mode of transmission Bite of an insect (flies)
Body cavities
Habitat Skin & subcutaneous tissues Body cavities
(peritoneal & pleural cavity, mesentery)
Specimen Skin snips Blood Blood & skin biopsies
1. Female mosquito bites a susceptible human & the filiform larva penetrates the bite wound
2. Filariform larva migrate to the lymphatics to become adult worms
3. Adult worms reproduce & produce microfilaria (L1)
4. Microfilaria are released into blood stream
Life cycle
5. Microfilaria are picked up by another mosquito or the same carrier
6. Microfilaria penetrate the mosquito mid-gut & migrates to thoracic muscles
7. L1 larva transforms into L3 filariform larva inside mosquito after molting twice
8. L3 larva migrates to mosquito head & proboscis
Periodicity Non-periodic (present both day & night)
Male 43 mm 32 mm
Size
Female 82 mm 65 – 80 mm
- Nuclei continuous to the tip - Nuclei continuous to the tip - no nuclei on tail
Tail end - Shepherd’s crook curve: Relatively straight - blunt & rounded - tail is tapering into thin filaments
but strongly bent
Nuclei Numerous Numerous
- non-sheathed - non-sheathed - non-sheathed
Microfilaria morphology - nuclei fills the body all the way to the tip - rounded blunt anterior end
- posterior end is short & not tapered
Microfilaria size 200 um 220 um

PARASITOLOGY
Streptocerca filariasis Dipetalonemiasis: moderate eo, calabar Mansoneliasis
Dermatitis swellings, headache, edema, lymphatic Ozzard’s filariasis
Disease manifestation discomfort - urticaria, lymphadenitis, skin itching,
- may be responsible for joint & bone pain, arthralgia, eo
enlargement & associated pain in the liver

PARASITOLOGY
Ascaris lumbricoides

PARASITOLOGY
Trichuris trichiura

PARASITOLOGY
Enterobius vermicularis

PARASITOLOGY
Capillaria philippinensis

PARASITOLOGY
Ancylostoma duodenale & Necator americanus

PARASITOLOGY
Strongyloides stercoralis

PARASITOLOGY
Trichinella spiralis

PARASITOLOGY
Parastrongylus cantonensis

PARASITOLOGY
Anisakis spp.

PARASITOLOGY
Dracunculus medinensis

PARASITOLOGY
Cestodes (Tapeworm)
Pseudophyllidea (False tapeworms)
Spirometra spp.
Species Diphyllobothrium latum
(S. mansoni, S. ranarum, S. manonoides, S. erinacei)
Common name Broad Fish tapeworm
Final/Definitive host Man Dogs & Cats
st st
1 I.H.: Copepods (Cyclops) or Diaptomus 1 I.H.: Copepods/Crustaceans
Intermediate host
2nd I.H.: Freshwater fish (salmon, trout, pike, perch) 2nd I.H.: Fish, Frogs, Snakes, Chickens, Man
Infective stage Plerocercoid larva
Ingestion of contaminated water/ Ingestion of a second intermediate host
Ingestion of raw/undercooked/contaminated fish carrying plerocercoid
Mode of transmission such/ Contact between a second intermediate host & an open wound or
larva
mucous membrane
Habitat Small intestine (jejunum: proximal part) Small intestine, Subcutaneous tissues
1. Immature unembryonated eggs are passed in feces 1. Eggs are passed in feces & embryonate in the environment
2. Eggs become embryonated in free-living water & develop into 2. Eggs hatch in water/ soil & release coracidium which is ingested by
coracidia copepods
3. Coracidia is ingested by crustaceans or copepods where it develops into 3. Coracidium develop into procercoid larva inside 1st Intermediate host
the procercoid larva 4. 1st intermediate host is ingested by 2nd Intermediate host, acquiring the
4. Crustaceans or copepods are ingested by fish, procercoid larva develops procercoid larva, which develops into Plerocercoid larva
Life cycle
into plerocercoid larva 5. Definitive host ingests plerocercoid larva
5. Humans ingest fish carrying plerocercoid larva 6. Plerocercoid larva matures into adults in the Small Intestine
6. Plerocercoid larva develop into immature adults & migrate to small 7. Female lays eggs
intestines
7. Adults mature into male & female & reproduce
8. Adult female release gravid proglottids/ immature eggs into feces
- ivory-colored
Adult morphology
- largest tape worm
Adult size 3 -10 m long; 10 – 20 mm wide
Scolex (head; Spoon-shaped/spatulae (almond-shaped)
attachment organ) 2 – 3 mm X 1 mm
2 slit-like, longitudinal, prominent
Bothria (sucking
located dorsally & ventrally
grooves)
no suckers/grooves
- longer than the head
Neck (region of
- thin & unsegmented
growth)
- followed by immature proglottids
PARASITOLOGY
- Anapolytic (proglottids can’t detach) - Anapolytic (proglottids can’t detach)
Strobila (chain of
- 3,000 - 4,000 proglottids - Wrinkled, whitish ribbon-like
proglottids)
- immature, mature, gravid (front to back)
Vitellaria (yolk glands) - Diffused w/ many follicles
- centrally located
- 2 – 4 mm X 10 – 12 mm
- 1 set of reproductive organs each
Mature
- testis: dorsolateral part
- ovary: bilobed, present at posterior 3rd above Mehlis’ gl&
Proglottid
- openings: vas deferens, vagina, uterus (front to back)
- located at 4/5th
- Broad w/ rosette-shaped uterus
Gravid Spiral uterus
- appx. 1,000,000 ova/day
- wider than long
Present
Uterine pore
Median lateral surface
- Oval, operculated (lid structure), smooth, yellowish brown, moderately - indistinguishable w/ D. latum but shorter
thick shell - floats on sugar or zinc sol
- Unembryonated when released - narrower at the anterior end
Ova/Egg morphology - Opposite of operculum: small knob-like thickening
- oncosphere: embryo w/ 6 hooklets inside the egg; Hexacanth embryo;
surrounded by yolk granules
- does not float in saturated salt sol.; bile stained
Ova/Egg size 65 um X 45 um
1st larva - Coracidium: ciliated embryo; motile
2nd larva - Procercoid: 550 um; retains 3 hooklets; globular
Larva morphology
3rd larva - Plerocercoid (sparganum): 20mm; glistening; opaque; white;
unsegmented vermicule w/ wrinkled surface; often coiled
Demonstration of eggs: FECT, Kato-Katz, DFS
Demonstration of proglottids
Laboratory diagnosis Travel history (Baltic, Switzerland, Romania, Danube, Russia, Turkistan, Demonstration of the worm
Israel, Northern Manchuria, Japan, Chile, Argentina, Canada) & diet
Serodiagnosis: coproantigen detection test
Symptoms (due to toxins, by-products of degenerating of proglottids, Sparagnosis: caused by sparganum (plerocercoid larva)
mucosal irritation) - ectopic infection; becomes encysted & develops into spargana

PARASITOLOGY
- Nervous disturbances, digestive disorders, abdominal discomfort, weight - found in various subcutaneous parts of the body; peritoneum, brain,
loss, weakness, anemia abdominal viscera, eyes
Diphyllobothriasis (Fish tapeworm inf., Broad fish tapeworm inf.):
- hyperchromic, megaloblastic anemia w/ thrombocytopenia & leukopenia
- based on the mass of the worm
- a type pernicious anemia (due to Vit.B12 def.) called bothriocephalus
anemia can be observed
Taenioid
Male reproductive
system of a typical
cestode
Dipylidean
Pseudophyllidean Female reproductive
system of a typical
cestode

PARASITOLOGY
Cestodes (Tapeworm)
Cyclophyllidea (True Tapeworms)
Species Taenia saginata Taenia solium Taenia asiatica
Common name Beef tapeworm; “Unarmed tapeworm” Pork tapeworm Taiwan/Asian tapeworm
Intermediate host Cattle Pig, Humans (case of Cysticercosis) Wild pigs, cattle, goats, wild boars, monkeys
Cysticercus cellulosae
Infective stage Cysticercus bovis Cysticercus viscerotropica
Embryonated egg (for Cysticercosis)
Ingestion of raw/ undercooked/ contaminated
Ingestion of raw/ undercooked/ contaminated pork containing cysticercus larva
Mode of transmission
beef containing cysticercus larva Fecal-oral route
Autoinfection
Habitat Small intestine (Upper Jejunum) Small intestine (upper) Small intestine, liver
1. Man ingests undercooked meat containing 1. Man ingests undercooked meat containing 1. Man ingests undercooked meat containing
cysticercus bovis cysticercus cellulosae cysticercus cellulosae
2. Larva is released & the protoscolex attaches 2. Larva is released & the protoscolex attached 2. Larva is released & the protoscolex attached
to the lining of the S.I to the lining of the S.I to the lining of the S.I
3. Tapeworm matures & proglottids & eggs are 3. Tapeworm matures & proglottids & eggs are 3. Tapeworm matures & proglottids & eggs are
released in feces released in feces released in feces
Life cycle
4. Cattle are infected by ingesting vegetation 4. Pigs are infected by ingesting vegetation 4. Pigs are infected by ingesting vegetation
contaminated with proglottids & eggs contaminated with proglottids & eggs contaminated with proglottids & eggs
Cysticercosis- occurs when man accidentally
ingests eggs from eating contaminated
vegetables/ food/ water. The larva can be lodged
in tissues even in the brain
- opalescent white in color
Adult morphology - ribbon-like Shorter Same as T. saginata
- dorsoventrally flattened, segmented
Adult size 4 – 10 m – 25 m 2–5m–8m 4 – 10 m
- Cuboidal - globular & small (1 mm) - cuboidal
- Unarmed (no hooks, no rostellum) - 1- 2 mm (diameter) - no hooks
Scolex (head; - 1 – 2 mm (diameter): large - 4 suckers (acetabula) but smaller (0.5 mm), - 4 suckers
attachment organ) - 4 hemispherical suckers (acetabula) situated in more spherical
4 angles (sole organ for attachment) - suckers not pigmented
- may be pigmented

PARASITOLOGY
- armed - sunken rostellum
- 20 – 50 - 2 rows in wart-like formation
Rostellum (knob-like
None - alternating large & small
protrusion)
- dagger-shaped hooklets
- cusion-likle double crown of hooks
Neck (region of
Short Short & half as thick as the head Same as T. saginata
growth)
Strobila (chain of - Apolytic (proglottids detach) - Apolytic (proglottids detach) - Apolytic (proglottids detach)
proglottids) - 1,000 – 4,000 proglottids - 8,000 – 10,000 proglottids - 300 – 1,000 proglottids
- follicular testis: 300 – 400 (scattered - follicular testis: 150 – 200 - vaginal sphincter present
throughout the proglottid) - presence of accessory ovarian lobe
- square
Mature - 2 large lobes of ovaries
- uterus: median club-shaped, thin &
dichotomous
- rectangular - square - longer than wide

Proglottid
- longer than wide (16 – 20 mm X 5 – 7 mm) - wider than tall (12 mm X 6 mm) - thin, tree-like, lateral uterine branches (11 –
- thin, tree-like, lateral uterine branches (15 – - thick, tree-like, lateral uterine branches (5 - 13) 32)
30) - no vaginal sphincter
Gravid - has vagina sphincter - non-motile
- motile - contains appx 30,000 – 50,000 ova
- contains 97,000 – 124,000 ova (may pass - expelled in short chains (5 or 6)
594,000,000 ova/yr.)
- expelled singly
SAME FOR ALL TAENIA SPP.
Outer membrane: thick, striated
Inner membrane: thin
Ova/Egg morphology Oncosphere: 6 hooklets (3 pairs); Hexacanth
yellowish-brown
T. saginata ova: not infective to man
T. solium: infective to man
Ova/Egg size 24 – 40 um X 18 – 30 um
Cysticercus bovis: “bladder worm”, ovoidal; Cysticercus cellulosae: “bladder worm”; ovoid,
Larva morphology milky white; 10 mm (diameter); single scolex opalescent, milky-white, 5 mm X 8 – 10 mm Cysticercus viscerotropica
invaginated into fluid-filled bladder (found in
PARASITOLOGY
muscle mastication, cardiac muscle & tongue of
cattle)
- Eggs: Stool examination (DFS, Kato-Katz, FECT)
- Proglottids: number of uterine branches
- Scolex: after treatment
- Perianal swab: recovery of eggs & proglottids
- Double slide compression Technique (use of India Ink/ Carmine to visualize)
- Coproantigen Detection: ELISA
- Molecular methods
- For Cysticercosis: Surgery, X-Ray, CT-scan, MRI, Serology
Intestinal Taeniasis saginata Intestinal Taeniasis solium Taeniasis
- symptoms: epigastric pain, vague discomfort, - mild, non-specific abdominal complaints - symptoms: epigastric pain, vague discomfort,
hunger pangs, weakness, weight loss, loss of Cysticercosis hunger pangs, weakness, weight loss, loss of
appetite, pruritus ani - cysticerci are multiple & may develop in any appetite, pruritus ani
- intestinal obstruction (bile, pancreatic ducts) organ or tissue (most common striated muscle,
brain, subcutaneous tissue of eye, heart, lung, &
peritoneum; eventually calcified
- most serious manifestation is
neurocysticercosis (NCC); 2 forms:
parenchymal & extra-parenchymal

PARASITOLOGY
Cestodes (Tapeworm)
Species Hymenolepis nana Hymenolepis diminuta Dipylidium caninum
Double-pored tapeworm
Dog tapeworm
Cat tapeworm
Common name Dwarf tapeworm Rat tapeworm
Cucumber tapeworm
Pumpkin seed tapeworm
Flea tapeworm
Final/Definitive host Man Man (accidental host), Rodents Dogs, Cats
Ctenocephalides canis (Dog flea)
Ctenocephalides canis (Dog flea)
Pulex irritans (Human flea)
Arthropods Ctenocephalides felis (Cat flea)
Intermediate host Xenopsylla cheopsis (Human/ Rat flea)
(cockroaches, rat flea, flour moths, flour beetles) Pulex irritans (Human flea)
Tenebria (Rice flea)
Humans are accidental hosts
Tribolium (Flour flea)
Cysticercoid larva (Indirect life cycle w/ I.H.)
Infective stage Cysticercoid larva
Embryonated egg (Direct life cycle no I.H.)
Mode of transmission Ingestion of embryonated egg or infective larva
Habitat Small intestine (Ileum) Small intestine
Immature: 1. Eggs are passed into feces & in the 1. Gravid proglottids are passed in feces or from
1. Infective when passed into feces (can’t environment to embryonate perianal region of host
survive for more than 10days in the 2. Eggs are ingested by intermediate host. 2. In the environment, proglottid disintegrate &
environment) Oncospheres are released & penetrate intestinal releases egg packets
2. Eggs are ingested by arthropod Intermediate walls of host, developing into cysticercoid larva 3. Eggs ingested by intermediate host
host, where they develop into cysticercoid larva 3. Cysticercoid larva is ingested by humans or oncosphere is released & penetrates intestinal
3. Cysticercoid larva is ingested by humans or rodents, where they mature into adults wall, developing into infective cysticercoid larva
mice, where they mature into adults 4. Adult female lays eggs & are released in the 4. Definitive hosts ingest flea with cysticercoid
Life cycle 4. Adult female lays eggs & are released in the small intestine from gravid proglottids that larva, penetrating S.I
small intestine from gravid proglottids that disintegrate after breaking off from the adult 5. Cysticercoid larva matures into adult worms
disintegrate after breaking off from the adult worms. 6. Gravid proglottids detach or adult lay eggs
worms. 5. The eggs are expelled to the environment in that are released into feces
5. The eggs are expelled to the environment in the mammalian host’s feces
the mammalian host’s feces
Direct:
1. Host ingest eggs
2. Hatch in duodenum
PARASITOLOGY
3. Embryos penetrate & develop in mucosal villi
& develop into infective cysticercoid larvae
4. Larvae break out of the villi & attach into
adults
- smallest tapeworm infecting humans
Adult morphology - only tapeworm to complete its entire life cycle
in a single host
Adult size 5 – 45 mm (length) X 1 mm (width) 10 - 60 cm (length) 10 – 70 cm (length)
- Subglobular or rhomboidal - Knob-shaped - Conical (small & globular)
Scolex (head;
- 4 cup-shaped suckers - Pear-shaped - 4 suckers
attachment organ)
- 4 suckers
- small, retractable - small, unarmed rostellum - retractable & armed
Rostellum (knob-like
- single row of hooks (20 – 30 Y-shaped - located at the anterior end - 1 – 7 rows (circlets)
protrusion)
hooklets) - rose thorn-shaped/clubbed-shaped spines
Neck (region of - long & slender
growth) - broader than long
- Apolytic (proglottids detach) - Apolytic (proglottids detach)
Strobila (chain of - delicate - disintegrates after release & the eggs hatch Apolytic (proglottids detach)
proglottids) - 25 – 45 mm (length) X 1 mm (width)
- 175 – 220 segments
- short - same as H. nana but much larger (0.75 mm - bilateral genital pore
- rectangular (length) X 3.5 mm width) - narrow
Mature - 1 X 2 mm - 2 sets of testes & ovaries
- ovoid testes: 3
Proglottid
- ovary: 1
- broader than long - same like H. nana - pumpkin seed shape (8 -15 enclosed eggs)
Gravid - no testes or ovary & uterus hollows out (sack- - longer than wide
like)
Genital pore Same side of segments (straight pattern) Unilateral
- Spherical/sub-spherical - Circular - colorless
- Colorless or clay-colored - Larger - thin-shelled
- Thin outer membrane - Thick striated outer membrane (distinct polar - egg packets (clusters)
Ova/Egg morphology - Thick inner membrane: 4 – 8 polar thickenings thickenings) - oncosphere: six-hooked
- Conspicuous bipolar thickenings - Thin inner membrane (smooth, slightly - membrane enclosed packets (each contains 5 –
- Oncosphere: 6 hooklets (3 pairs) granular space between membranes) 30 eggs)
- non-bile strained - bile-stained
PARASITOLOGY
- Oncosphere: fan-like arranged hooklets (3
pairs of hooks)
Ova/Egg size 30 - 40 um 55 X 85 um 30 – 60 um
Stool examination: eggs & proglottids Stool examination: eggs morphology
Laboratory diagnosis Stool examination: eggs morphology
morphology
- Usually asymptomatic - Usually asymptomatic - usually asymptomatic
- Hymenolopiasis (Light infection): headache, - Hymenolopiasis w/ H. diminuta (symptoms): - Symptoms: abdominal pain, anal pruritus ani
dizziness, anorexia, pruritus of nose & anus, diarrhea, nausea, abdominal pain, anorexia - Common in school children
diarrhea, vomiting, abdominal pain, pallor,
Disease manifestation weight loss
- Hymenolopiasis (Heavy infection): enteritis
(due to necrosis & desquamation of the
intestinal epithelial cells)
- Most common cestode infection

PARASITOLOGY
Cestodes (Tapeworm)
Species Echinococcus granulosus Echinococcus multilocularis Taenia multiceps/Taenia serialis Raillietina garrisoni
Common name Hydatid worm Alveolar hydatid worm Coenurus tapeworm Madagascar tapeworm
Dogs & other canines (T. Tribolium confusum (flour
Final/Definitive host Dogs & other canines multiceps) beetle) or any arthropods (usually
Dogs, Foxes (T. serialis) ants, beetles, cockroaches)
Sheep, goat, swine, cattle, horses, Sheep, Rabbits, Rats, Pigs, Cattle,
Intermediate host Rodents Rats, Birds
camel Camel, Horse
Embryonated egg (Intermediate
host)
Hydatid cyst (Definitive host)
Infective stage Cysticercoid larva (Definitive host) Cysticercoid larva
Embryonated egg (Intermediate host)
Coenurus cerebralis (Infective larva
of T. multiceps)
Ingestion of infective intermediate Ingestion of infective
host/embryonated egg/ cysticercoid intermediate host/ Ingestion of
Mode of transmission Ingestion of infective cysts larva/ cysticercoid larva
Coenurus - infected tissue *Humans are accidental hosts
*Humans are accidental hosts
Habitat Small intestines of canines
1. Gravid proglottids release eggs that are passed in the feces 1. Eggs & gravid proglottids are 1. Mature eggs are released from
2. Eggs are ingested by I.H., that hatch in the bowels & release oncopsheres shed into feces & in the avian or rodent host through
that penetrate intestinal wall & migrate to various organs of the host, environment feces by detaching the last gravid
especially the liver 2. Eggs are ingested by proglottid
3. Oncosphere develops into a hydatid cyst at organ site intermediate host, hatches in 2. Eggs develop into larval forms
4. Cyst enlarges, producing protoscolices & daughter cysts, filling the interior intestine, releasing oncospheres that (oncospheres), are ingested by
5. Cysts are ingested by definitive host. Protoscolices evaginate, producing circulate in blood until they lodge intermediate hosts & migrates to
protoscolices in suitable organs abdominal cavity to develop into
Life cycle
6. Scolex attach to intestine & develop into adults 3. Oncospheres develop into mature cysticercoids
7. Adult lay eggs & proglottids that are released into feces coenuri 3. Development of juvenile stage
4. Coenurus or Coenuri - infected in I.H compromises of (1)
tissue is ingested by definitive Oncosphere stage, (2) Lacuna
host stage, (3) Cystic cavity stage, (4)
5. Coenurus develops & resides in Scolex formation & (5)
the small intestine of D.H Cysticercoid stage
*Humans become infected after
PARASITOLOGY
accidentally ingesting eggs on 4. When arthropods are ingested
fomites, contaminated food & by definitive host, cysticercoid is
water released & Rostellar hooks attach
to intestinal wall
5. Larva matures into adults
6. Adult lay eggs & proglottids
that are released into feces
Adult morphology Small Smaller than E. granulosus
Adult size 3 – 6 mm 60 cm
Small
Scolex (head; Pyriform
Pyriform Subglobular
attachment organ) 4 acetabula (suckers)
4 suckers
Armed rostellum
2 rows of hammer-shaped (90 -
Rostellum (knob-like Armed Armed
140) hooklets
protrusion) Double crown of hooks (30 – 36 hooks) Large & small hooks
Several rows of spines surrounds
the rostellum
Neck (region of Short neck
growth) 3 mm X 6 mm
Strobila (chain of Apolytic (proglottids detach) Apolytic (proglottids detach)
Apolytic (proglottids detach)
proglottids) 3 proglottids (immature, mature, gravid)
Ovary: bilobed
Mature Testes: Rice grain appearance
(36 – 50 ovoid testes)
- 2 mm
- 200 – 400 egg capsules
Proglottid Median uterus w/ lateral evaginations (filled w/ eggs which resembles other
- 1 – 4 spindle-shaped eggs
taeniid worms
Gravid Contains tens of thousands of eggs - oncosphere: enclosed in 2 thin
Uterine branch: 12 – 15 branches (filled w/ 500 eggs)
membranes (outer elongated
Widest & longest in the strobila
membrane & inner spherical
membrane)
Ovoid in shape
Thin-shelled (brown) Enclosed in an egg capsule
Ova/Egg morphology
Hexacanth embryo (3 pairs of hooklets) (spindle-shaped)
Resembles taenia spp. eggs
Ova/Egg size
PARASITOLOGY
- called “unilocular” cyst - called “alveolar” cyst Coenurus
- slowly growing - roughly spherical or ovoid
2 layers: bladderworm
- outer: laminated hyaline layer - multiple invaginated
- inner: nucleated germinal layer protoscolices
Inside:
Hydatid cyst
- Brood capsule: contains protoscolex
(Larval stage)
(may rupture & release it); ave. 2 mil;
lacks a protective cyst wall & lamina
- daughter cells: replicas of mother
cyst
- hydatid s&: protoscolices & brood
capsules that are free
Hydatid cyst size 1 – 7 mm (diameter) 3 cm
Radiographic findings &/or ultrasonography (X-Ray, Ultrasound, CT scan)
Stool examination
Laboratory diagnosis Serologic test: indirect hemagglutination (IHA), indirect fluorescent antibody
(IFA), enzyme immunoassays (EIA) (screening tests); Xasoni Intradermal test
Cystioc Echinococcus: Alveolar or multilocular hydatid Coenuri of T. multiceps are usually Usually asymptomatic; children
- most common & important site of disease found are usually affected
involvement is liver (75%), right lobe - liver is the most commonly affected in the eyes & brain: Coenurosis
(85%); lungs (20 – 30 %); brain organ (GID): an often fatal CNS parasitic
(10%) Destruction of organs (liver) disease
Hepatic echinococcal cyst Necrosis or metastasis of cyst Coenuri of T. serialis are found in
Type CL: unilocular cystic lesions w/ subcutaneous tissues
uniform anechoic content w/o
pathognominic signs
Disease manifestation Type CE1: unilocular cyst w/
uniform anechoic content & w/
pathognomonic signs (includes
visible cyst wall & snow flake sign)
Type CE2: Multivesicular,
multiseptated cyst
Type CE3: Anechoic content w/
detachment of laminated membrane
from the cyst wall (visible as floating
membrane, ‘water-lily’ sign)

PARASITOLOGY
Type CE4: Heterogeneous
hypoechoic or hyperechoic
degenerative contents (no daughter
cyst present)
Type CE5: Cyst characterized by
thick calcified wall which is arch-
shaped, producing a cone-shaped
shadow (degree may calcification
may vary from partial to complete)

PARASITOLOGY
Diphyllobothrium latum

PARASITOLOGY
Spirometra spp.

PARASITOLOGY
Taenia saginata

PARASITOLOGY
Taenia solium

PARASITOLOGY
Taenia spp. egg
Embryonated egg

PARASITOLOGY
Taenia asiatica

PARASITOLOGY
Hymenolepis nana

PARASITOLOGY
Hymenolepis diminuta

PARASITOLOGY
Dipylidium caninum

PARASITOLOGY
Echinococcus granulosus

PARASITOLOGY
Taenia multiceps/Taenia serialis
T. serialis

PARASITOLOGY
Raillietina garrisoni

PARASITOLOGY
Trematodes
Blood Flukes
Species Schistosoma japonicum Schistosoma mansoni Schistosoma haematobium
Vesical Blood fluke
Manson’s Blood fluke
Common name Oriental Blood fluke Urinary Schistososme
Intestinal Mansoni
Bladder fluke
Man (mainly)
Domestic mammals (dogs, pigs, cats, carabaos,
Definitive host Man
cows, man): reservoir host
Sylvan reservoirs (rodents & monkeys)
Oncomelania hupensis quadrasi (amphibian
Intermediate host Biomphalaria (fresh water snails) Bulinus (fresh water snails)
snails)
Mode of transmission Skin penetration
Infective stage Cercaria larva
Vesical, prostatic, uterine, plexus (venous
Habitat Superior mesenteric vein (small intestine) Inferior mesenteric vein (colon)
circulation)
1. Embryonated eggs from the stool of the D.H. comes into contact with water and hatch (miracidia: free-living)
2. Miracidia seeks out & infect I.H.
3. Miracidia develops into 1st & 2nd generation sporocysts (able to reproduce asexually)
4. Sporocysts give rise to cercariae
Life cycle
5. Cercariae penetrates the skin of the D.H. (when in contact with infested fresh water)
6. Cercaria lose their tail and transforms into schistosomula which enters the superficial lymphatic vessels or subcutaneous veins and reach the lungs
7. Either the schistosomules migrate through intravascular or through pleural cavity to reach liver (portal vein) where they mature
8. Eggs deposited in mucosal or sub-mucosal terminal veins or capillaries escape through ulcerations into the intestinal lumen & are released in feces
- shorter but sturdier - Largest - 2 muscular suckers - Smallest - 2 muscular suckers - same as other
- Its body is split - Tapered & round - oral sucker: small - Studded integuments - oral sucker: small schistosomes
longitudinally to - Dioecious (separate - ventral sucker: w/ prominent coarse - ventral sucker: - distribution: Africa,
produce the canal sexes) large & prominent tubercles large & prominent near east, miggle east,
- Gynecophoral canal - Suckers (aid in - gynecophoric canal: - distribution: Africa - gynecophoric canal: India
Adult (lateral boarders are movement): large at begins after the ventral & south amenira begins after the ventral
Male
morphology rolled ventrally into a anterior; ventral end sucker up to the caudal sucker up to the caudal
cylindrical shape - Incomplete digestive end end
producing a long system
grove or trough): - Excretory system:
where the female is made up of flame cells
held
PARASITOLOGY
- 2 muscular suckers - Has a protease
- oral sucker: small (hemoglobinase):
- ventral sucker: breaks down globulin
large & prominent & hgb; they ingest
- gynecophoric canal: RBCs
begins after the ventral - distribution: China,
sucker up to the caudal japan, far east
end (oriental)
- Longer & slender - uterus: 1 – 3 eggs - longer & slender
- 1 pyramidal ovary - cuticular tubercles
Female (located at midline) (confined at 2 ends)
- uterus: 50 or more - uterus: 20 – 30 eggs
eggs
Male 12 – 20 mm X 0.4 – 0.5 mm 10 – 15 mm X 1 mm
Adult size
Female 15 – 26 mm X 0.3 mm 20 mm X 0.25 mm
Location of ovary Middle Anterior ½ Posterior ½
Egg production 500 - 2000 immature eggs/day 190 – 300 eggs/day 300 eggs/day
Integumentary
None Prominent; Grossly Fine
Tuberculations
Testes 6 – 7 in a single file 8 – 9 in a zigzag row 4 – 5 in groups
- Smallest - Elliptical. Oblong - Elliptical
- Oval, round, pear-shaped - Non-operculated - Non-operculated
- Yellow - Brownish yellow transparent shell - Brownish yellow transparent shell
Egg morphology
- Thin shell: residual tissue or RBCs adhere - Large lateral spine - Large terminal spine
- Recurved hook or knob or spine: located near - eggs passed into lumen of the urinary bladder
one polar ends (mall terminal spine) - eggs passed during midday
Egg size 50 – 85 um X 38 – 60 um 112 – 182 um X 40 – 75 um 1500 um X 50 um
- Apical papilla
- Epidermal plates covered w/ cilia (disappears
once the it penetrates the I.H.)
- Primitive gut
Miracidia - Pair of cephalic unicellular penetration glands
opening by a duct of the apical papilla
- 2 pair of flame cells
- Germinal cells
- Free-swimming
PARASITOLOGY
- Forked tail (50 – 70 um)
- Tail trunk (140 – 150 um X 20 – 35 um)
- 100 – 500 um X 40 – 60 um
- Anterior end: oral sucker
Cercariae
- Small ventral sucker
- Nocturnal (evening to midnight) release from
I.H.
- Free-swimming
Cephalic glands (in Oxyphilic: 2 Oxyphilic: 2 pairs Oxyphilic: 5
cercariae) Basophilic: 3 Basophilic: 4 pairs Basophilic none
Stool examination: DFS, FECT, Kato-Katz Stool examination: DFS, FECT, Kato-Katz
Faust-Meleney’s Egg Hatching Technique Detection of eggs in urine
Rectal or Liver Biopsy - Best to collect urine from 12nn-3pm
Immunodiagnosis - Concentration techniques- Nuecleopore
- IHAT Filtration technique
- ELISA Faust-Meleney’s Egg Hatching Technique
- COPT (Circumoval Precipitin Test): serum (Confirmatory test in the Philippines: (+) Blep Rectal or Liver Biopsy
Laboratory Diagnosis
precipitates Immunodiagnosis
Intradermal Tests using adult worm extracts - IHAT
- ELISA
- COPT (Circumoval Precipitin Test): serum
(Confirmatory test in the Philippines: (+) Blep
precipitates
Intradermal Tests using adult worm extracts
Oriental Schistosomiasis Intestinal Biharziasis Urinary Biharziasis
Snail fever/Katayama fever/Katayama Egyptian Hematuria
syndrome: Bladder cancer
- easily fatigability, respiratory symptoms,
athralgias (joint pains), myalgias (muscle pain),
malaise (discomfort), eosinophilia, fever,
abdominal pain
- Hepatosplenomegaly may lead to severe
hepatic dysfunction & death
Schistosomiasis japonica:
- granulomatous hypersensitivity reaction
around single egg or cluster (this develops in

PARASITOLOGY
organ where cercariae resides: liver, brain,
lungs, CNS – less frequent)
Cerebral schistosomiasis:
- Aberrant migration (occludes circulation of the
brain & spinal cord)
- Seizures, paresthesias (‘pins & needles’
feeling), transient ischemic attacks, stokes
Cercarial penetration:
- dermatitis and pruritus (swimmer’s itch)
Schistosomiasis = Biharziasis

PARASITOLOGY
Trematodes
Type Lung Flukes Intestinal Flukes
Heterophyes heterophyes
(Heterophyid flukes)
Echinostoma ilocanum
Species Paragonimus westermani Fasciolopsis buski Metagonimus yokogawai
Artyfechinostomum malayanum
Haplorchis taichui
Haplorchis yokogawai
Garrison’s fluke
Common name Oriental lung fluke Giant intestinal fluke Von Siebod’s fluke
Echinostomids
Man, Cats, Dogs, Foxes, other fish
Definitive host Man, Mammals Man, Pigs Man, Dogs, Cats, Pigs
eating mammals
Antemalania asperata Segmentina Gyraulus convexiusculus Certhideopsilla cingulate
1st Intermediate
Antemalania dactylus (Brotia Hipppeutis Hippeutis umbilicalis (freshwater, Brackish water or
host
asperata) - Snail (Snail) (Snails) marine spp.)
E. ilocanum A. malayanum
Pila luzonica Lymnaea (syn.
Water caltrop (Trapa bicornis)
(Kuhol) Bullastra)
Water chestnut (Eliocharis tuberosa)
Vivipara cumingiana
2st Intermediate Sundathelpusa philippina Water morning glory (Ipomea Freshwater, Brackish & Saltwater
angularis (birabid)
host (crustacean/mountain crab/cray fish) obscura) fish (Tilapia)
(Susong Ampullarius
Nymphaea lotus
pampang) canaliculatus
(water plants)
(golden apple
snail)
Habitat Lungs (in pairs in cystic) Small intestine (duodenum) Small intestine Small intestine
Infective stage Metacercariae
Diagnostic stage Presences of eggs in stool Eggs in stool Eggs in stool Eggs in stool
Mode of Eating undercooked crab or crayfish Ingestion of encysted metacercariae Ingestion of encysted metacercariae
Ingestion of encysted metacercariae
transmission containing metacercariae from aquatic plants in snails
1. Eggs passed in feces of definitive
1. Adult worms live in the host, releasing miracidia (free-
respiratory tract of the D.H. swimming)
2. Unembryonated eggs escape into 2. Miracidia penetrates 1st I.H. and
Life cycle
the bronchi & are cough up and undergoes development into
voided in sputum or swallowed & sporocysts (1st & 2nd generation
passed in feces rediae & cercariae)
3. Cercariae escape from snail
PARASITOLOGY
3. Eggs mature & hatch to release 4. Encyst on roots of lotus, bulb of
free-swimming miracidia infecting water chestnut, on other aquatic
the 1st I.H. vegetation
4. Cercariae are then released from 5. D.H. ingests the metacercariae
the snails which are microcercus excyst in the duodenum & become
(having short stumpy tail) attached to the mucosa & develop
5. Cercariae swims on the streams into adults
are drawn into the gill chambers of
2nd I.H.
6. They encyst in the gills or muscles
as metacercariae
7. D.H. are infected when they eat
2nd I.H. raw or inadequately cooked
8. The metacercariae excyst in the
duodenum & the adolescence
penetrate the gut wall, reaching the
abdominal cavity
9. They migrate up through the
diaphragm into the pleural cavity &
lungs reaching the bronchi (where
they develop into adult worms)
- Coffee bean shaped (reddish brown - Elongated (oval in shape) E. ilocanum A. malayanum
in color) - No cephalic cone - Circumoral - Spines: 43 – 45
- Anterior: round (sucker present) - Small oral sucker disk w/ spines (rounded
- Posterior: tapered (sucker present) - Intestinal ceca are unbranched surrounding the posterior end)
- Tegument: w/ spines reaching to posterior end oral sucker - Testes: 6 – 9 - Tegument: Fine scale like spines
- Vitellaria: Branching - Dendritic testes arranged in tandem - Spines: 49 – 51 (lobed) - Gonotyl (genital sucker): a 3rd
- Uterus: Coiled in rosette (in posterior half of the body) (tapered sucker
Adult
- Testes: lobed & opposite to each - Ovary: branched lies in the right of posterior end) - Testes: variously arranged
morphology
other the midline - Testes: bilobed - Ovary: globularly or slightly lobed
- Found in pairs or three’s in fibrotic - Vitelline follicles: situated (in tandem) - Grayish
capsules of the lung throughout the lateral margin of the - Reddish-gray - smallest trematode parasite of man
- hermaphroditic body
- migrating larva lose their way & - 25,000 per day
reach ectopic sites (mesentery, groin, - Largest intestinal fluke of humans
brain) & pigs

PARASITOLOGY
7 – 12 mm (length) X 4 – 6 mm 2.5 – 6.6 mm X 5 - 12 mm X 2 – H. heterophyes M. yokogawai
Adult size 5 cm X 1.5 cm
(width) X 3.5 – 5 mm (thick) 1 – 1.35 mm 3 mm 1.0 X 0.5 mm 1.5 X 0.5 mm
- Oval - Operculated - Operculated
- Light brown
- Yellowish-brown or golden brown - Straw-colored - Brown-colored
- Large - Ovoid/Elongated/Pyriform
- Thin-shelled - Larger
- Operculated - Operculated
- Undeveloped Miracidium
- Undeveloped miracidium - Embryonated
Egg morphology surrounded by a thin smooth shell
- Indistinguishable to F. hepatica & - Shell thickness: Heterophyes
- Flattened but prominent operculum
F. gigantica (thick); Metagonimus (thin)
w/ shoulders
- Similar to C. sinensis
- Terminal shell: thickening
(abopercular thickening)
83 – 116 um X 120 – 130 um X
Egg size 78 – 120 um X 45 – 60 um 128 – 140 um X 78 – 85 um 30 um X 15 um
58 – 69 um 80- 90 um
- covered w/ spines
- ellipsoidal body
Cercaria - small tail
- stylet is present at the dorsal side of
the oral sucker
- 381 – 457 um
Metacercaria
- round
Detection of eggs:
- Stool: FECT, Kato-Katz
- Sputum: 3% NaOH (can lyse
mucus/mucolytic agent)
Detection of eggs:
X-Ray: non-specific Detection of eggs: Stool: FECT, Kato-Katz (more
Laboratory - Stool: DFS, FECT, Kato-Katz
CT scan: “grape-like appearance - Stool: DFS, FECT efficient)
Diagnosis Patient history
(Cerebral paragonimiasis) - Eggs resemble F. buski but smaller Adult: autopsy
Clinical impression
MRI: “soap-bubble calcifications”
Serology: Complement fixation,
Intradermal Test, ELISA,
Immunoblot
Echinostomiasis Local inflammation at the site
Lung fluke disease
Fasciolopsiasis - Inflammation at the site of of attachment
Disease - provokes a granulomatous reaction
- inflammation of intestinal lining, attachment Peptic ulcer diseases
manifestation (gives rise to development of fibrotic
obstruction, toxic worm metabolites -Heavy infections Deposition of eggs in vital
cyst which contains a blood-tinged
-Bloody diarrhea organs
PARASITOLOGY
purulent material, adult worms, -Abdominal pain
eggs) -Intoxication: metabolites
- chronic cough, hemoptysis, chest
pain, dyspnea, low-grade fever,
fatigue, myalgia
Pulmonary Distomiasis
Endemic Hemoptysis or Parasitic
Hemoptysis
- may mimic signs & symptoms of
TB
E. ilocanum A. malayanum

PARASITOLOGY
Trematodes
Type Liver Flukes
Species Fasciola hepatica Fasciola gigantica Clonorchis sinensis Opisthorchis felineus Dicrocoelium dendriticum
Temperate liver fluke
Tropical liver fluke Lanceolate fluke
Common name Sheep liver fluke Chinese liver fluke Cat liver fluke
Giant liver fluke Lancet fluke
Common liver fluke
Sheep, Cattles, other
Definitive host herbivores, Man Man (Definitive host), Cats, Dogs, Pigs & other mammals (Reservoir host) Herbivores, Man
(occasionally infected)
1st
Intermediate Lymnaea philippinensis Parafossarulus bulinus (snail) Bithynia Cionella lubrica (snail)
host
2st Ipomea obscura (KangKong)
Intermediate Nasturtium officinale (Water cress) Cyprinoid fresh water fish Formica fusca (ants)
host (Aquatic plants)
Habitat Biliary passages of Liver
Infective stage Metacercariae
Diagnostic
Presence of eggs
stage
Mode of
Ingestion of metacercariae Accidental ingestion
transmission
1. Adult worms lives in the biliary passage of D.H., lay eggs 1. Eggs are embryonated but does not hatch in water. Instead
which is passed in feces it hatches inside the 1st I.H. when ingested
2. Embryo matures in water & miracidium escapes 2. Miracidium develops into sporocysts and redia stages
3. Miracidium penetrates the tissue of 1st I.H. becoming lophocercus cercaria (has large fluted tail)
4. In 1st I.H., miracidium becomes sporocysts & the 1st & 2nd 3. The cercariae escape from the snail & swim in water. It
generation redia becomes cercariae attaches to the 2nd I.H.
Life cycle
5. cercariae escapes in water and encyst on aquatic vegetation 4. Cercariae shed their tails & encyst under the scales or flash
to become metacercariae becoming metacercariae
6. D.H. ingest vegetation containing the metacercariae 5. D.H. gets infected when they eat undercooked or raw 2nd
7. Metacercariae excyst in the duodenum, pierce the gut to I.H.
enter the peritoneal cavity, traveling to the liver parenchyma
& reach the biliary passages where they mature
- Large - Longer but narrower - Reddish-brown - Blade-like, lancet-like
Adult - Bigger oral sucker
- Broad, flat body - Shorter cephalic cone - Testes: lobate arranged in - Aspinous (spiny)
morphology - Deeply branched
- Suckers: small - Less developed shoulders tandem - Testes: anterior
PARASITOLOGY
- Cephalic cone - Intestinal ceca: more - Testes: arranged in tandem, - Leaf-like in shape
- Prominent shoulders branched large, highly branched - Tegument: transparent
- Testes: highly branched - Ovary: more branched - Intestinal ceca: simple
- Ovary: dendritic (longer & numerous) - Leaf-like in shape
- Intestinal ceca: long & - Tegument: transparent
highly branched
Adult size 18 – 51 mm X 4 – 13 mm 25 – 75 mm X 3 – 12 mm 10 – 25 mm X 3 – 5 mm 8 – 12 mm – 1.5 – 3 mm
- Large - Old-fashioned bulb or pitcher
- Ovoidal - Distinct convex operculum
- Yellowish to Brownish - Thick rim eggshell - Dark-brown
Egg - Operculated - Small protuberance at the abopercular end - Thick shelled
- Bigger than F. hepatica
morphology - Immature when released - Miracidium: well-developed - Large operculum
(contains unsegmented mass - Yellowish-brown (bile-stained) - Embryonated
of vitelline cells) - indistinguishable from other spp.
- bile-stained - Mature when passed
Egg size 128 – 150 um X 60 – 90 um 160 – 190 um X 70 – 90 um 16 – 30 um X 15 – 17 um
Detection of eggs:
- Stool (FECT, Kato-Katz, Stoll’s
Laboratory Detection of eggs dilution) Detection of eggs:
Diagnosis - Stool: FECT, Kato-Katz Duodenal aspirates, Entero-test - Stool
Serology: ELISA
Molecular: PCR
Fascioliasis
Clonorchiasis & Opistorchiasis - Usually asymptomatic
• Clinical stages:
Chronic infection - Heavy infections:
- Fever, jaundice, pain, anorexia, hepatomegaly
Disease Cirrhosis and portal hypertension enlargement of bile ducts and
- Chronic stage:
manifestation Perforation of the gall bladder hyperplasia of the
persistence of adults in biliary ducts
Enhanced susceptibility to: epithelium; may lead to
-Obstruction & inflammation leading to fibrosis
Cholangiocarcinoma (Liver cancer) cirrhosis
- Halzuon: temporary lodgment of the fluke in the pharynx

PARASITOLOGY
Schistosoma japonicum
Male Female

PARASITOLOGY
Schistosoma mansoni

PARASITOLOGY
Schistosoma haematobium

PARASITOLOGY
Paragonimus westermani

PARASITOLOGY
Fasciolopsis buski

PARASITOLOGY
Heterophyes heterophyes

PARASITOLOGY
Fasciola hepatica
F. hepatica
(british sheep)
F. hepatica (British ox)

PARASITOLOGY
Fasciola gigantica F. gigantica
F. gigantica (Burnese ox)
(African ox)

PARASITOLOGY
Clonorchis sinensis

PARASITOLOGY
Opisthorchis felineus

PARASITOLOGY
Dicrocoelium dendriticum

PARASITOLOGY
Protozoans
Intestinal Amoeba
Species Entamoeba histolytica Entamoeba coli
Definitive host Man
Mode of Ingestion of cyst via contaminated food/water
transmission (Fecal-oral)
Diagnostic stage Presence of cyst & trophozoite in stool
Infective stage Mature quadronucleated cyst Mature cyst
Habitat Large intestine
1. Cyst pass through the stomach undamaged & enter the small intestine
2. Excystation: cyst reaches caecum or lower part of ileum (due to alkaline medium) the cyst wall is damaged which leads to excystation
3. Cytoplasm gets detached from the cell wall and amoeboid movements appear causing tear which quadronucleated amoeba is formed (this stage is called
metacyst)
Life cycle
4. Nuclei in the metacyst undergoes binary division to form 8 nuclei which gets surrounded by its own cytoplasm becoming 8 small amoebulae or metacystic
trophozoite
5. Some develop into precystic forms which is passed on to the feces to the environment
6. D.H. then ingest
- Vegetative stage, feeding stage, pathogenic - Vegetative stage, feeding stage, commensal
- Motility: Progressive, unidirectional, rapid; crawling or gliding - Motility: Sluggish, non-progressive
- Pseudopodia: Finger-like, single - Pseudopodia: broad & blunt
Trophozoite - Peripheral chromatin: smooth, fine, evenly distributed - Peripheral chromatin: Coarse, dirty, unevenly distributed
morphology - Karyosome: Central (found in nucleus (1): spherical; 4 – 6 um) - Karyosome: Eccentric
- Cytoplasm: Clean-looking w/ ingested RBCs (pale, greenish, refractile); - Cytoplasm: Dirty-looking w/ ingested bacteria, yeast & other debris;
granular ‘ground glass appearance’ (coarse & granular)
- Stain: Quensel’s stain, Buffered methylene blue - Stain: Quensel’s stain, Buffered methylene blue
Trophozoite
12 – 60 um (diameter) 25 – 50 um
size
- Resistant, non-motile - Resistant, non-motile
- Nuclei (mature): 1 - 4 - Nuclei (mature): 8
- Karyosome: central - Karyosome: Eccentric
Cyst
- Chromatoidal bars: Sausage/cigar shaped - Chromatoidal bars: Splintered/broomstick appearance
morphology
- Stain: Lugol’s iodine, Anthony stain - Stain: Lugol’s iodine, Anthony stain
- Refractile hyaline wall
- spherical to round
Cyst size 10 – 20 um 10 – 30 um

PARASITOLOGY
Intestinal amoebiasis (amoebic dysentery)
- lumen dwelling: asymptomatic (90 %)
- if they invade intestinal tissue: 10 %
- Amoebic ulcer: typical lesion; flask-shaped; multiple; appear in mucosa as raised nodules w/ pouting edges; breaks down discharging brownish necrotic
material containing large numbers of trophozoites
- Stool: large, foul-smelling, brownish-black, blood streaked mucus intermingle w/ feces; the RBCs are clumped & reddish-brown; cellular exudate:
scanty; Charcot-leyden is present
Extraintestinal amoebiasis
- Hepatic amoebiasis: most common extraintestinal amoebiasis; Amoebic hepatitis: px develop w/ enlarged tender liver w/out detectable impairment of liver
Disease function; liver abscesses (thick chocolate brown pus ‘anchovy sauce pus’)
manifestation - Pulmonary amoebiasis: rare; usually occur in the lower part of the right lung; hepatobronchial fistula: expectoration of chocolate brown sputum (pleuritic
chest pain, dyspnea, on-productive cough)
Metastatic amoebiasis
- distant organs by hematogenous spread &lymphatics; Abscesses in kidney, brain, spleen, adrenals
Cutaneous amoebiasis
- direct extension in anus, colostomy site, discharging sinus; extensive gangrenous destruction of the skin (lesion may be mistaken for condyloma or
epithelioma)
Genitourinary amoebiasis
- Penile amoebiasis: prepuce & galns are affected (acquired through anal intercourse); same lesions may occur in females (vulva, vagina, cervix); lesions
resemble carcinoma
Stool examination:
- DFS: Concentration technique (FECT) - to detect cyst (formed stool) & trophozoite (watery stool) within 30mins
▪ Lugol’s Iodine - Chromatoidal bar (colorless), Glycogen (brown)
- Permanent stained smears (Iron hematoxylin or Trichome stain)- confirmatory test
Laboratory ▪ Glycogen (colorless), RBC (black), Chromatoidal bar (bright-darkened)
diagnosis ▪ Presence of charcot-leyden crystals
Culture: Boeck’s, Rice egg saline, Diamond, Balamuth’s egg yolk infusion
Serology; Molecular methods
Rectal biopsy
Liver aspirates: Amoebic Liver abscess “anchovy sauce” appearance

PARASITOLOGY
Protozoans
Commensal Amoeba (Intestinal)
Species Entamoeba hartmanni Entamoeba polecki Iodamoeba butschlii Endolimax nana Entamoeba gingivalis
Definitive host Man Man (rare), Pigs, Monkeys Man Man Man
Direct transmission via
Mode of
Ingestion of cyst via contaminated food/water kissing, droplet spray, utensil
transmission
sharing
Mouth (surface of gum,
Habitat Large intestine teeth, gum pockets, tonsillar
crypts)
Diagnostic stage Presence in stool Throat swab
Infective stage Mature cyst Trophozoite
- Vegetative stage, feeding - Vegetative stage, feeding - Vegetative stage, feeding - Vegetative stage, feeding - Vegetative stage, feeding
stage; commensal stage; commensal stage; commensal stage; commensal stage; commensal
- Pseudopodia: finger- - Motility: sluggish, non- - Motility: Sluggish, - Motility: Sluggish, non- - Motility: active
shaped, rapidly extruded progressive (normal stools); progressive (usually) progressive - Pseudopodia: varying
- Motility: Sluggish, non- progressive, unidirectional - Peripheral chromatin: none - Pseudopodia: blunt, hyaline appearance, numerous
progressive, less vigorous (diarrheal stool) - Karyosome: Central, Bull’s - Peripheral chromatin: none - Karyosome: Central
- - Karyosome: small, - Peripheral chromatin: eye appearance (surrounded - Karyosome: Blot-like - Peripheral chromatin: fine,
eccentric evenly distributed, fine by achromatic granules) (large, irregular) evenly distributed
- Stain: Quensel’s stain, - Karyosome: Central, small - Cytoplasm: Coarsely, - Nucleus: 1 - Nucleus: 1
Buffered methylene blue - Nucleus: 1 granular, vacuolated - Stain: Quensel’s stain, - Stain: Quensel’s stain,
- small race of E. histolytica - Stain: Quensel’s stain, (contains bacteria, yeast Buffered methylene blue Buffered methylene blue
Trophozoite - ingested bacteria may be Buffered methylene blue cells, other debris) - Cytoplasm: contains food - Cytoplasm: finely granular,
morphology present - Nuclei: 1 - Nucleus: 1, large, vesicular vacuoles (contains bacteria) may contain food vacuoles
- Ingested bacteria, other - Stain: Quensel’s stain, (contains cellular debris
food particles Buffered methylene blue mostly leukocytes, epithelial
cells, bacteria, RBCs)
- May ingest bacteria, debris,
WBCs
- Non-pathogenic: may be
seen in px w/ pyorrhea
alveolaris (gum inf)
- may also be found in the
genital tract (vaginal &
cervical areas)
PARASITOLOGY
Trophozoite
4 – 12 um 8 - 25 um 6 – 12 um 5 – 12 um 10 – 20 um
size
- Resistant, non-motile - Resistant, non-motile - Resistant, non-motile - Resistant, non-motile
- Nuclei (mature): 1 - 4 - Nuclei (mature): 1 - Nuclei (mature): 4 - Nuclei (mature): 4
- Karyosome: central - Karyosome: central, small - Karyosome: eccentric, large - Karyosome: blot-like,
- Chromatoidal bars: - Peripheral chromatin: (surrounded by achromatic eccentric (cross-eyed cyst)
Sausage/cigar shaped Evenly distributed, fine granules) - Peripheral chromatin: none
- Stain: Lugol’s iodine, - Chromatoidal bars: - Peripheral chromatin: none - Nucleus: 2 - 4
Anthony stain Angular/pointed ends (‘basket of flowers’ - Stain: Lugol’s iodine,
- Refractile hyaline wall - Nucleus: 1 appearance) Anthony stain
- spherical to round - spherical to round - Nucleus: 1 - Oval, spherical, ellipsoid,
- Similar to E. histolytica - Cytoplasm: granular - Stain: Lugol’s iodine, small
Cyst - does not ingest RBCs - Stain: Lugol’s iodine, Anthony stain
No cyst stage
morphology Anthony stain - vary in shape: ovoid,
- presence of glycogen mass ellipsoid, triangular, or other
shapes
- Cytoplasm: coarsely
granular & vacuolated
- Cytoplasmic inclusions:
well-defined glycogen mass
‘iodophilic body’ (granules
may be present)
- large glycogen vacuole
(dark brown w/ iodine)
Cyst size 5 – 10 um 10 – 20 um 5 - 22 um 7 – 10 um N/A
Disease
Nonpathogenic
manifestation
Laboratory Stool examination: Mouth scraping
diagnosis - DFS: Concentration technique (FECT) - to detect cyst (formed stool) & trophozoite (watery stool) within 30mins

PARASITOLOGY
Protozoans
Opportunistic Amoeba (Free-living)
Species Naegleria fowleri Acanthamoeba spp Balamuthia mandrillaris
Definitive host Man
Mode of Entry to olfactory epithelium, respiratory tract,
Entry through nose, eyes, or break in the skin
transmission skin & sinuses
Diagnostic
Presence of trophozoite Trophozoite & cyst
stage
Infective stage Amoeboid trophozoite Trophozoite & Cyst
Habitat CSF & tissue (trophozoites); CSF (flagellate) CSF & tissue (trophozoites)
- Motility: slug-like, directional - Pseudopodia: prominent “thorn-like” appendages - irregular in shape
- Cytoplasm: granular, many vacuoles (acanthopodia): for locomotion - Motility: active
(amoebostomes) - Motility: sluggish - Pseudopodia: broad
- Nucleus: 1 - Nucleus: central, large densely granulated (large
- Karyosome: large, dense, center endosome)
Trophozoite - Pseudopodia: blunt, lobose (rounded) - Cytoplasm: fine, granulated, large contractile
morphology - Peripheral chromatin: none vacuole
- Anterior: broad - Nuclei: 1
- Posterior: tapered - Karyosome: large
- thermophilic (thrives best in hot springs & other - Peripheral chromatin: Absent
warm aquatic environments) - Cytoplasm: granular & vacuolated
- replicates by promitotis
Trophozoite
10 – 35 um 12 - 45 um 12 – 60 um
size
Flagellate - Biflagellate
(swimming - Pear-shaped N/A N/A
form) - jerky movements or spinning
Flagellate size 7 – 15 um N/A N/A
- Smooth double wall - resistant - spherical
- Resting or dormant form - roundish w/ ragged edges - 3 layered cyst wall
- round - double-walled cyst - Outer: irregular ectocyst
Cyst
- thick cell walls - Outer wall: wrinkled, jagged - Middle: mesocyst
morphology
- Inner wall: polygonal, smooth - Inner: endocyst, round
- Nuclei: 1
- Karyosome: large & central

PARASITOLOGY
- Cytoplasm: disorganized, granular (sometime
vacuolated)
Cyst size 7 – 10 um 8 – 25 um 6 – 20 um
Primary amebic meningoencephalitis (PAM) Acanthamoeba keratitis (AK) Granulomatous amebic encephalitis (GAE)
- fatal - use of improperly disinfected soft contact lenses - usually occurs in immunocompromised hosts
- fever, nausea, vomiting, headache, nuchal (rinsed w/ tap water or contaminated lens solution) - destruction of brain tissue & associated
rigidity, mental status changes, rapid progression - severe ocular pain & blurring of vision, corneal meningeal irritation
to coma & death ulceration w/ progressive corneal infiltration - systemic manifestations (early): fever, malaise,
- primary amebic infection or secondary bacterial anorexia
infection may lead to hypopyon (accumulation of - neurology symptoms: inc. sleeping time, severe
WBCs that form a whitish layer in the lower headache, mental status changes, epilepsy, coma
Disease portion of the eye) formation
manifestation - progression leads to scleritis & iritis, vision loss
Granulomatous amebic encephalitis (GAE)
- usually occurs in immunocompromised hosts
- destruction of brain tissue & associated
meningeal irritation
- systemic manifestations (early): fever, malaise,
anorexia
- neurology symptoms: inc. sleeping time, severe
headache, mental status changes, epilepsy, coma
CSF examination for trophozoites AK: Epithelial biopsy (corneal scrapings) GAE: demonstration of trophozoites & cyst in
Laboratory
GAE: demonstration of trophozoites & cyst in brain biopsy (CSF)
diagnosis
brain biopsy (CSF)

PARASITOLOGY
Protozoans
Flagellates
Intestinal & Urogenital Flagellates
Species Giardia lamblia Dientamoeba fragilis Chilomastix mesnili
Giardia duodenalis
Common name
Giardia intestinalis
Definitive/Final
Man
host
Reservoir host Beaver, other mammals
Habitat Small intestine (duodenum, jejunum, upper ileum) Mucosal crypts of appendix, cecum, upper colon Large intestine (Cecal)
Mode of Ingestion of mature cyst via contaminated Ingestion of trophozoite via contaminated Ingestion of mature cyst via contaminated
transmission food/water food/water food/water
Infective stage Mature cyst Trophozoite Mature cyst
Diagnostic
Presence of cyst & trophozoite in stool Presence of trophozoite in stool Presence of cyst & trophozoite in stool
stage
- Vegetative form - Irregular & roundish - Commensal
- Pear-shaped pyriform, tear-dropped shape, tennis - Nucleus: Rosette-like; 1 or 2 (rarely 3 or 4) - Asymmetric, pear-shaped, pyriform
racket, heart-shaped - Pseudopodia: transparent, broad, leaf-like, - Twisted jaw appearance
- Anterior: rounded serrated margins - Nuclei: 1
- Posterior: pointed - Karyosome: 4 – 8 discrete granules (nuclear - Karyosome: central or eccentric
- Dorsal: convex chromatin) - Flagella: 4 (3 from anterior; 1 from posterior)
- Ventral: Concave, sucking disk - Motility: progressive
Trophozoite - Presence of spiral groove (extending through the
- Motility: Falling-leaf, erratic tumbling - Stain: iron hematoxylin
morphology middle half of the body)
- Nuclei: 2 (1 pair) - Cytoplasm: bacteria-filled vacuoles
- Cystosomal fibril: Shepherd’s crook
- Karyosome: large (Old man w/ glasses - no flagellum
- Motility: Boring, Corkscrew, spiral forward, stiff,
appearance) - coinfection w/ E. vermicularis
directional
- Flagella: 8 (4 pairs)
- Parabasal body (median body); 2 hammer
shaped, sausage-shaped
- Bilaterally symmetrical
Trophozoite
9 – 12 um X 5 – 15 um X 4 um 7 – 12 um 5 - 25 um X 5 – 10 um
size
- Oval, round - Nucleus: 1
Cyst - Nuclei: 4 (quadronucleated) - Nipple, American lemon-shaped (broadly
None
morphology - Karyosome: center rounded at one end, somewhat bluntly conical at
- Hyaline cyst wall the other end which has a knob-like protuberance)
PARASITOLOGY
Cyst size 8 – 17 um X 6 – 10 um None 5 – 10 um X 4 – 5 um
Giardiasis (traveler’s diarrhea) Acute infection:
Beaver fever - loss of appetite, colicky abdominal pain,
Gray-bowel syndrome (light-colored stool) intermittent diarrhea w/ excess mucus, abdominal
Disease Manifestations: explosive watery diarrhea; tenderness, bloating sensation, flatulence, anal
Asymptomatic
manifestation chronic: steatorrhea, weight loss, malaise, foul- pruritus
smelling stools Chronic infection:
Pathogenic determinant: ventral sucking disk - mimic the symptoms of irritable bowel syndrome
(IBS)
Stool exam: DFS, Concentration techniques,
Stained smear; contains mucus but no blood
Laboratory
Duodenal aspirates Stool examination Stool examination
diagnosis
Entero-test (Beale’s string test)
Serology: ELISA, Molecular diagnostic, Biopsy

PARASITOLOGY
Protozoans
Subphylum Mastigophora: Flagellates
Intestinal & Urogenital Flagellates
Pentatrichomonas hominis Trichomonas tenax
Species Trichomonas vaginalis
(formerly T. hominis) Trichomonas buccalis
Definitive/Final
Man
host
Female: vagina, cervix, Bartholin’s glands,
Habitat urethra, urinary bladder Large intestine: Colon Mouth (Tartar or teeth)
Male: anterior urethra, prostate, preputial sac
Mode of Sexual intercourse Ingestion of trophozoite via contaminated Direct contact, droplet spray from mouth, kissing,
transmission food/water use of contaminated dishes & drinking glass
Infective stage Trophozoite
Diagnostic Trophozoites in vaginal discharge, urine
Presence of trophozoite in stool
stage sediments, prostatic secretions
- Nucleus: 1, Ovoidal - Nucleus: Rounded (no peripheral chromatin) - Nucleus: Ovoidal
- Undulating membrane: Covers ½ of the body - Undulating membrane: Full-body length - Undulating membrane: covers 2/3 of the body
- Inclusion bodies: Siderophil granules (contains - Inclusion bodies: none - Inclusion bodies: none
iron) - Motility: Jerky, nervous - Motility: Jerky motility
- Motility: Jerky, tumbling, twitching - Commensal - Nuclei: 1 (filled w/ chromatin granules)
- Pyriform shape (pear-shape or ovoid) - Pyriform (pear shaped) - Flagella: 5 (4 extend anterior, 1 extend posterior)
Trophozoite
- Flagella: 5 (4 free anterior that arise from a - Flagella: 3 - 5 anterior - Commensal
morphology
simple stalk; 1 embedded in undulating membrane) - Motile - Axostyle: thick curves around nucleus
- Axostyle: median, prominent - Nuclei: 1 (w/ a small central karyosome) - Smaller, slender, pear-shaped
- Axostyle: extends beyond the posterior end of the
body
- Conical cytosome cleft in anterior region
ventrally opposite the undulating membrane
Trophozoite
10 – 30 um X 5 – 10 um 7 – 13 um 5 – 12 um
size
Trichomoniasis:
Disease - Females: Vaginal pruritus, strawberry cervix,
manifestation frothy/greenish/yellowish discharge
Nonpathogenic
- Males: asymptomatic
Laboratory Wet mounts of urethral and vaginal discharge
diagnosis DFS
PARASITOLOGY
Stained smears
Culture:
- Diamond modified medium
- Feinberg Whittington
- Cysteine peptone liver maltose
Serology: Antigen detection
Molecular methods

PARASITOLOGY
Protozoans
Hemoflagellates
Species Trypanosoma cruzi Trypanosoma brucei rhodesiense Trypanosoma brucei gambiense
Definitive/Final
Man
host
Vector Triatomid/ Reduviid bug (Kissing bug) Glossina pallidipes, Glossina morsitans (tsetse fly) Glossina palpalis (Tsetse fly)
Habitat Reticulo-Endothelial system, cardiac muscle, CNS Blood, Lymph, CNS
Direct contact with feces of vector entering bite
wound
Mode of
Blood transfusion Bite of infected vector
transmission
Organ transplantation
Transplacental
Infective stage Metacyclic trypomastigote
Diagnostic
Trypomastigote & Amastigote Trypomastigote
stage
- found in the bloodstream
- Long & slender: 16 – 20 um
- Short & stumpy: 15 um
- Posterior end: usually pointed, wedge-shaped
- Nucleus: 1 (anterior to the kinetoplast)
Trypomastigote
- Kinetoplast: located at posterior end
- Undulating membrane: narrow w/ 2 -3 undulations, extending entire body length
- Flagellum: single, thread-like near the kinetoplast (extending from anterior end)
- C-shaped, U-shaped, S-shaped (when stained)
Present Present Present
- Long, slightly wider than promastigote
- Nucleus: 1 (posterior end)
- Kinetoplast: anterior to the nucleus
Epimastigote
- Undulating membrane: extending half of body length
(Crithidia)
- Flagellum: free (extending from anterior end)
Present
Present Present
Found in the vector
- long & slender
Promastigote
- Nucleus: 1 (near center)
(Leptomonas)
- Kinetoplast: located at the anterior end
PARASITOLOGY
- Flagellum: 1 (extending from anterior end)
- 9 – 15 um long
Present
Not present Not present
Found in the vector
- found in tissue cells (muscle, nerve, reticulo-endothelial system) as small groups of cyst-like
- Nucleus: 1 (off center)
- Kinetoplast: present, consisting of dot-like blepharoplast (which emerges small axoneme)
Amastigote - Parabasal body: located adjacent to the blepharoplast
(Donovan - round or ovoid in shape
Leishmania) - non-motile
- Intracellular
- 5 - 3 um long
Present Not present Not present
American Trypanosomiasis or Chagas disease Rhodesian or East African Sleeping Sickness Gambian or West African Sleeping Sickness
- Chagoma: Ulceration/ Lesion/ Nodule (Human African trypanosomiasis [HAT]) (Human African trypanosomiasis [HAT])
- Romaña’s sign: Periorbital swelling (Unilateral) - Acute, rapid onset CNS stage takes place early - Chronic progression: Trypanosomal chancre
Chronic stage: (less than 9months) Winterbottom’s sign: enlargement of cervical
Disease - Enlargement of vital organs (10-20 years) lymph nodes
manifestation - Megacolon: Megaesophagus, Cardiomegaly, Kerandel’s sign
Cardiac arrhythmia
Other causes of American Trypanosomiasis
- Trypanosoma rangeli- asymptomatic; no
amastigote
Giemsa staining of CSF, Blood, Lymph Trypomastigotes in blood, CSF, lymph node aspirate
Xenodiagnosis Concentration of buffy coat
Laboratory
Culture: NNN (Noovy MacNeal Nicolle) Serology: IHAT, ELISA, Rapid tests
diagnosis
Serology and Molecular tests Molecular methods
Animal inoculation and culture

PARASITOLOGY
Protozoans
Hemoflagellates
Species Leishmania tropica Leishmania braziliensis Leishmania donovani
Definitive/Final
Man
host
Phlebotomus papatasii Phlebotomus peruensi
Vector Phlebotomus sergenti Phlebotomus verrucarum Phlebotomus argentipe (sandfly)
(sandfly) (sandfly)
Endothelial cells of skin capillaries; phagocytic Mucocutaneous junctions (nasal septum, mouth,
Habitat Endothelial cells of the RES
monocytes pharynx)
Mode of
Bite of vector
transmission
Infective stage Promastigote
Diagnostic
Promastigote
stage
- found in the bloodstream
- Long & slender: 16 – 20 um
- Short & stumpy: 15 um
- Posterior end: usually pointed, wedge-shaped
- Nucleus: 1 (anterior to the kinetoplast)
Trypomastigote
- Kinetoplast: located at posterior end
- Undulating membrane: narrow w/ 2 -3 undulations, extending entire body length
- Flagellum: single, thread-like near the kinetoplast (extending from anterior end)
- C-shaped, U-shaped, S-shaped (when stained)
Not present Not present Not present
- Long, slightly wider than promastigote
- Nucleus: 1 (posterior end)
Epimastigote - Kinetoplast: anterior to the nucleus
(Crithidia) - Undulating membrane: extending half of body length
- Flagellum: free (extending from anterior end)
Not present Not present Not present
- long & slender (9 – 15 um long)
Promastigote - Nucleus: 1 (near center)
(Leptomonas) - Kinetoplast: located at the anterior end
- Flagellum: 1 (extending from anterior end)
PARASITOLOGY
Present
Seen in the hindgut, midgut, proboscis of the Present Present
vector
- found in tissue cells (muscle, nerve, reticulo-endothelial system) as small groups of cyst-like
- Nucleus: 1 (off center)
- Kinetoplast: present, consisting of dot-like blepharoplast (which emerges small axoneme)
Amastigote - Parabasal body: located adjacent to the blepharoplast
(Donovan - round or ovoid in shape
Leishmania) - non-motile
- Intracellular
- 5 - 3 um long
Present Present Present
Cutaneous Leishmaniasis Mucocutaneous Leishmaniasis Visceral Leishmaniasis (Kala-azar, Black fever,
Old World Leishmaniasis American/ New world Leishmaniasis Dumdum fever)
Disease Aleppo button - Cause espundia tapir nose and chiclero ulcer in
manifestation Dehli Boil ears
Baghdad boil
Jericho boil
Diagnostic stage: Intracellular amastigotes
Demonstration of lesions
Tissue biopsies
Skin biopsies
Examination of Bone marrow, spleen, lymph node
Laboratory
Montenegro Skin test: Leishmanian skin test
diagnosis
Formol gel test: detection of hypergammaglobulinemia in patients with kala-azar
(+) opacity and jelly consistency after adding 1 drop of formalin
Serology: IFAT
Culture: NNN
Molecular methods

PARASITOLOGY
Protozoans
Phylum Ciliophora: Ciliates
Species Balantidium coli Blastocystis hominis
Definitive/Final
Man
host
Reservoir host Man, Pig
Habitat Colon (Cecum), Large intestine Large intestine
Mode of
Ingestion of mature cyst via contaminated food/ water
transmission
Infective stage Mature cyst
Diagnostic
Demonstration of cyst & trophozoite in stool Demonstration of cyst in stool
stage
- Ovoid
- Tapered anterior end (cytostome located)
- rounded posterior end (cytopyge located)
- Cytostome: oral apparatus, funnel-shaped, small
- Cytopyge: where it excretes waste (anus)
- Nuclei: 2
Trophozoite - Macronucleus: bean-shaped
morphology - Micronucleus: round-shaped, for reproduction
- Motility: Thrown-ball/rotary motility
- Vacuoles: 1 or 2 visible contractile vacuoles
- Cytoplasm: may contain food vacuoles &/or bacteria
- covered w/ cilia arranged in longitudinal pattern (extending from oral to
caudal region)
- largest protozoan
Trophozoite
20 - 152 um X 22 – 123 um
size
- Double-walled 5 forms:
- Cilia: surrounds the parasite; used for locomotion (can be found in between - Classical vacuolated form (Central body form): most predominant forms in
layers) fecal specimen; large central vacuole; cytoplasm: peripheral; nuclei: 4,
Cyst - Nuclei: 2 peripheral
morphology - Macronucleus: large nucleus; kidney-shape - Granular form: multinucleated & observed in old cultures
- Micronucleus: small nucleus; round-shaped; for reproduction (may not - Ameboid form: amoeba-like, active extension & retraction of pseudopodia,
be observable) peripheral clumping
- Cytosome: mouth of parasite (funnel-shaped) - Multivacuolar form
PARASITOLOGY
- Cytopyge: anus of the parasite - Avacuolar form: (not sure: acc. to a study it is the trophozoite from w/ 2
small nuclei & appx. 5 um size)
- Classical vacuolated form (Central body form): 5 – 10 um
- Granular form: 10 – 60 um
Cyst size 44 – 66 um - Ameboid form: 2.5 – 8 um
- Multivacuolar form
- Avacuolar form
Balantidiasis: Blastocystis:
- Bloody diarrhea - diarrhea, fever, vomiting, nausea, abdominal pain & cramping
Disease
- Flask-shaped ulcers (wide neck & rounded base ulcers) - the symptoms may be due to other infections like E. histolytica, G.
manifestation
- Extraintestinal spread may occur intestinalis so it is not clear if B. hominis is pathogenic
- Virulence factor: Hyaluronidase
Laboratory Stool Exam
Stool examination
diagnosis Biopsy

PARASITOLOGY
Protozoans
Phylum Apicomplexa: Malariae
Species Plasmodium falciparum Plasmodium vivax Plasmodium ovale Plasmodium malariae
Definitive/Final
Mosquito
host
Intermediate host Man
Vector Female Anopheles minumus flavirostris (night biter)
Habitat Liver, RBCs
Infective stage
Sporozoites
from vector to I.H.
Infective stage
Gametocytes
from I.H. to vector
Mode of
Mosquito bite, Blood transfusion, Congenital
transmission
Asexual stage:
1. Female Anopheles mosquito bites humans & injects sporozoites
2. Sporozoites reach liver to become merozoites & reproduce
- Some merozoites infect other liver cells & reproduce asexually
- Some become hypnozoites and remain dormant inside liver cells (Hypnozoites are seen in P. vivax and P. ovale and cause relapse/recrudescence)
- Some merozoites enter the blood circulation & infect RBCs
3. Merozoites enter the blood circulation to invade RBC’s to become ring forms (early trophozoites)
4. Ring forms mature to become mature trophozoites
Life cycle
5. Trophozoites become schizont (containing merozoites)
6. RBC’s burst & merozoites are released to infect other healthy RBC’s
7. After many erythrocytic cycles, gametocytes are produced (Macrogametocytes: Females; Microgametocytes: Males)
Sexual stage:
1. Gametocytes are ingested by female anopheles
2. Gametocytes transform into gametes in the mosquito midgut & unite to form a zygote
3. Zygotes become an ookinete
4. Ookinete’s mature to oocyst which releases sporozoites that migrate to salivary glands of mosquito ready to infect a susceptible human
Paroxysmal cycle 36 – 48 hrs 44 – 48 hrs 48 hrs 72 hrs
RBC infected All forms Young Young Old (senescent RBCs)
- Oval (some may be larger than
Size of parasitized normal)
Normal Enlarged (macrocytic) Normal
RBC - Presence of fimbriated or serrated
edges
PARASITOLOGY
Maurer’s dot Schüffner’s dot
Stippling James dot & Schüffner’s dot Ziemann’s dot
(comma-like red dots) (more commonly seen)
Presence of RBC Ring forms Few rings (mostly trophozoites &
All stages All stages
stages Gametocytes schizonts)
- Ring: small. delicate - Ring: 1/3 diameter of RBC - Ring: Larger - Ring: small, 1/8 of cell
- Chromatid dots: 2 - Chromatin dot: Heavy - similar to P. vivax - Chromatin dot: Heavy (Bird’s eye
Ring forms - Common multiple rings in an - Signet ring appearance appearance)
RBCS
- Accole/applique forms
- Ring-shaped - Band-shaped
Most common in the Philippines; Most common worldwide; most
Trophozoite - Non-ameboid - Basket forms may be seen
most virulent prevalent
- similar to P. vivax
- Same as P. vivax but w/ small - Signet-ring form - small, darker in color (more solid - Same as P. vivax but w/ blue
thread-like blue cytoplasmic circle - cytoplasmic ring: red & blue; than P. falciparum) cytoplasmic circle (smaller, thicker,
Small - Chromatin dots: 1 or 2, small, red heavy - Schüffner’s dot: regularly present heavier)
- double chromatin: common in 100% of cells
- marginal forms: common
- remains in ring form - Signet-ring still present - closely resembles same stage of P. - Chromatin: rounded or elongated
- usually oldest asexual stage seen in - Cytoplasmic ring: red & blue; malariae but larger - Cytoplasm: compact or in narrow
PBS heavy - Pigment: lighter & less band across cell
Growing - increased cytoplasm w/ small, conspicuous - Dark brown granules may have
Types
yellowish-brown pigment granules peripheral arrangement
- Amoeboid (bizarre-looking,
irregular shaped) activity
- Chromatin: large mass - Chromatin: often elongate,
- Cytoplasm: loose, irregular, or clos indefinite in outline
compact - Cytoplasm: dense, compact, in
Large Seldom present Seldom present
- Increasing amount of fine brown round oblong or band forms
pigment - Pigment granules: larger, darker
than P. vivax (parasite fills the cells)
- Chromatin: divided - Oval shape (about 25 % of infected Same as P. vivax except:
- Cytoplasm: varying degrees of cells) - parasite is smaller
Schizont separation into strands & particles - round parasite in the center of oval - shows less chromatin division
Not present
(presegmenting) - Pigment: present cell - more delayed clumping of pigment
- many cells w/ indefinite fringed
outlines
PARASITOLOGY
- Pigment: lighter & less coarse than
P. malariae
Merozoites: 8 – 36 (rarely seen) Merozoites: 12 – 24 Merozoites: 8 Merozoites: 6 – 12
Schizont
- smaller than other spp. - pigment in 1 or 2 clumps - arranged around a central block of Rosette or fruit pie appearance
(mature)
- parasite almost fills the cell pigment (Daisy head)
- Sausage/Banana-shaped - Round
Microgametocyte - Diffused chromatin - Large-pink to purple chromatin Smaller than P. vivax
mass surrounded by pale halo
- Crescent-shaped - Round
Macrogametocyte Smaller than P. vivax
- Compact chromatin - Eccentric chromatin mass
Specimen used: Capillary blood (more preferred)
Collection: Collect blood at height of fever or every 6-8 hours
- Without anticoagulants are preferred but in case, EDTA tube is used
1. Microscopy (Gold standard):
Preparation of Thick & Thin blood smear (Stain used: Giemsa stain)
- Thick smear: perform malarial count; screening for presence of parasites
- Thin smear: identification of the species; RBCs still intact (cannot identify without RBCs)
2. Quantitative Buggy coat (QBC):
Laboratory Capillary tube with acridine orange stain
diagnosis (+) Bright green & yellow fluorescence under microscope
3. Rapid Diagnostic Tests (Immunochromatographic methods)
Antigen detection
- HRP-II (Histidine-rich protein): antigen produced by P. falciparum trophozoite & gametocytes; Paracheck PF; ParaHIT f, Malaquick
- pLDH (parasite LDH): produced by viable parasites; can distinguish P. falciparum from non-P. falciparum
- Other panmalarial Antigen (Aldolase)
4. Serology: ELISA, HAT, IFAT
5. Molecular: PCR for low parasitemia & mixed infection
6. Culture: RPMI1640
Malignant Tertian malaria
Subtertian malaria
Disease Benign Tertian malaria
Estivoautumnal malaria Ovale Tertian malaria Quartan malaria
manifestation Vivax malaria
Falciparum malaria
Black water fever

PARASITOLOGY
Protozoans
Phylum Apicomplexa: Coccidians Partially Acid Fast Intestinal Coccidians
Babesia microti
Sarcocystis spp.
(rodent strain)
Cryptosporidium Cyclospora S. hominis (cattle)
Species Babesia divergens & Toxoplasma gondii Cystoisospora belli
hominis cayetanensis S. suihominis (pig)
Babesia bovis (cattle
S. lindenmanni
strain)
Intracellular parasites
Cryptosporidium Cyanobacterium-like Either a protozoa or
Also known as that cause malaria-like Tissue coccidians Isospora belli
parvum body fungi
infections
Ticks (Ixodes Members of the felidae
Definitive host Man
scapularis) family (cats)
Cow (S. hominis)
White-footed mouse, Only coccidian that
Intermediate host Birds, rodents, pigs Pig (S. suihominis)
deer, livestock, cattle does not have I.H.
Man ( S. lindemanni)
Accidental host Humans Humans
Habitat RBCs Small intestine
Infective stage Oocyst & tissue cyst Oocyst
Ingestion of infected
undercooked meat,
Ingestion of
consumption of food/ Infection by ingestion Ingestion of food &
Bite of an infected deer raw/undercooked beef
Mode of water contaminated Ingestion of oocysts of food & water water
tick, blood transfusion, (S. hominis) or pig (S.
transmission with cat feces, blood Autoinfection contaminated w/ feces contaminated w/
vertical transmission suihominis)
transfusion or organ containing oocysts sporulated oocyst
transplantation, vertical
transmission
- Trophozoite:
pleomorphic 2 – 5 um
- Merozoite: Maltese-
cross pattern
- Schizont: none
Morphology N/A N/A N/A N/A N/A
- Gametocyte: none
- Ring form: may be
mistaken as Bunny-ears
arrangement

PARASITOLOGY
- rapidly multiply
- infect cells of I.H. &
non-intestinal epithelial
cells of cats
Tachyzoites N/A N/A N/A N/A N/A
- crescent shape
- size: 3 – 7 um X 2 – 4
um
- Nucleus: 1, center
- multiply slow
- develops mostly in
neural & muscular
tissue (sometimes in
visceral organs)
Bradyzoites N/A - smaller than N/A N/A N/A N/A
trophozoites
- hundreds to thousands
enclose themselves to
form a cyst (12 –100
um in diameter)
- Size: 10 – 15 um X 8 - Size: 4 – 6 um - Size: 8 – 10 um - ellipsoid/spindle - Size: 15 – 20 um
– 12 um - Sporozoites: 4 - Sporocysts: 2 shaped - sporocysts: 2
- Sporocyst: 2 (crescent-shaped) - Sporozoites: 4 (2 - sporocysts: 2 - sporozoites: 4
- Sporozoite: 8 (4 each) - infective once each) - sporozoite: 8 (4 each); - refractile residual
Oocyst N/A
- Round to slightly oval released - unsporulated or crescent-shaped body
- transparent immature when - unsporulated or
- Cell wall: clear, released immature when
colorless, 2-layered released
Microscopy: Sabin-Feldman test: Stool examination:
examination of uses methylene blue to - Concentration techniques: Sheather’s sugar floatation, FECT
Giemsa-stained smears detect presence of - Staining method: Modified Kinyoun method
Serology: IFAT antibodies in serum - Decolorizer used: 1% Sulfuric acid
Laboratory
Molecular methods ELISA, HAT, FAT
diagnosis
Travel history TORCH testing
Inoculation of animals Examination of tissue
(Gold hamster/ Gerbil) & CSF
Molecular methods

PARASITOLOGY
Babesiosis Usually asymptomatic - Outbreaks of diarrhea Diarrhea implicated Diarrhea Diarrhea
Texas cattle fever among - low infective dose after consumption of - least common (Invasive or Intestinal)
Red-water fever immunocompetent - severe diarrhea for contaminated fruits
Immunocompromised: AIDS patients (raspberries & basil)
Disease - encephalitis
manifestation - retinochoroiditis
- lymphadenopathy
- splenomegaly
Congenital defects to
newborn

PARASITOLOGY
Entamoeba histolytica

PARASITOLOGY
Entamoeba coli

PARASITOLOGY
Entamoeba hartmanni

PARASITOLOGY
Entamoeba polecki

PARASITOLOGY
Iodamoeba butschlii

PARASITOLOGY
Endolimax nana

PARASITOLOGY
Entamoeba gingivalis Naegleria fowleri

PARASITOLOGY
Acanthamoeba spp. Balamuthia mandrillaris

PARASITOLOGY
Giardia lamblia

PARASITOLOGY
Dientamoeba fragilis Chilomastix mesnili

PARASITOLOGY
Trichomonas vaginalis

PARASITOLOGY
Pentatrichomonas hominis Trichomonas tenax

PARASITOLOGY
Trypanosoma cruzi, Trypanosoma brucei rhodesiense, Trypanosoma brucei gambiense
T. cruzi C-shaped
T. cruzi trypomastigote trypomastigote

PARASITOLOGY
Leishmania tropica, Leishmania braziliensis, Leishmania donovani

PARASITOLOGY
Balantidium coli Blastocystis hominis

PARASITOLOGY
Plasmodium falciparum
Mature macrogametocyte
Ring form w/ double chromatin Ring form (a) schizont (b) stain precipitate
Immature schizont Developing gametocyte

PARASITOLOGY
Plasmodium vivax
Mature schizont
Ring form Ring form w/ Schüffner’s dots
Immature (a) mature (b) schizont Schizont w/ Schüffner’s dots

PARASITOLOGY
Plasmodium ovale Plasmodium malariae

PARASITOLOGY

PARASITOLOGY
Babesia microti Toxoplasma gondii

PARASITOLOGY
Cryptosporidium hominis Cyclospora cayetanensis

PARASITOLOGY
Cystoisospora belli Sarcocystis spp.

Parasitology Notes

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Parasitology Notes

Uploaded by

Copyright:

Available Formats

PARASITOLOGY

LARIOSA, K.A.M. RMT ni Lord 2024

LARIOSA, K.A.M. RMT ni Lord 2024

LARIOSA, K.A.M. RMT ni Lord 2024

LARIOSA, K.A.M. RMT ni Lord 2024

LARIOSA, K.A.M. RMT ni Lord 2024

LARIOSA, K.A.M. RMT ni Lord 2024

LARIOSA, K.A.M. RMT ni Lord 2024

LARIOSA, K.A.M. RMT ni Lord 2024

LARIOSA, K.A.M. RMT ni Lord 2024

LARIOSA, K.A.M. RMT ni Lord 2024

LARIOSA, K.A.M. RMT ni Lord 2024

LARIOSA, K.A.M. RMT ni Lord 2024

LARIOSA, K.A.M. RMT ni Lord 2024

LARIOSA, K.A.M. RMT ni Lord 2024

LARIOSA, K.A.M. RMT ni Lord 2024

LARIOSA, K.A.M. RMT ni Lord 2024

LARIOSA, K.A.M. RMT ni Lord 2024

LARIOSA, K.A.M. RMT ni Lord 2024

LARIOSA, K.A.M. RMT ni Lord 2024

LARIOSA, K.A.M. RMT ni Lord 2024

LARIOSA, K.A.M. RMT ni Lord 2024

LARIOSA, K.A.M. RMT ni Lord 2024

LARIOSA, K.A.M. RMT ni Lord 2024

LARIOSA, K.A.M. RMT ni Lord 2024

LARIOSA, K.A.M. RMT ni Lord 2024

LARIOSA, K.A.M. RMT ni Lord 2024

LARIOSA, K.A.M. RMT ni Lord 2024

- rectangular - square - longer than wide

LARIOSA, K.A.M. RMT ni Lord 2024

LARIOSA, K.A.M. RMT ni Lord 2024

LARIOSA, K.A.M. RMT ni Lord 2024

LARIOSA, K.A.M. RMT ni Lord 2024

LARIOSA, K.A.M. RMT ni Lord 2024

LARIOSA, K.A.M. RMT ni Lord 2024

LARIOSA, K.A.M. RMT ni Lord 2024

LARIOSA, K.A.M. RMT ni Lord 2024

LARIOSA, K.A.M. RMT ni Lord 2024

LARIOSA, K.A.M. RMT ni Lord 2024

LARIOSA, K.A.M. RMT ni Lord 2024

LARIOSA, K.A.M. RMT ni Lord 2024

LARIOSA, K.A.M. RMT ni Lord 2024

LARIOSA, K.A.M. RMT ni Lord 2024

LARIOSA, K.A.M. RMT ni Lord 2024

LARIOSA, K.A.M. RMT ni Lord 2024

LARIOSA, K.A.M. RMT ni Lord 2024

LARIOSA, K.A.M. RMT ni Lord 2024

LARIOSA, K.A.M. RMT ni Lord 2024

LARIOSA, K.A.M. RMT ni Lord 2024

LARIOSA, K.A.M. RMT ni Lord 2024

LARIOSA, K.A.M. RMT ni Lord 2024

LARIOSA, K.A.M. RMT ni Lord 2024

LARIOSA, K.A.M. RMT ni Lord 2024

LARIOSA, K.A.M. RMT ni Lord 2024

LARIOSA, K.A.M. RMT ni Lord 2024

LARIOSA, K.A.M. RMT ni Lord 2024

F. hepatica (British ox)

LARIOSA, K.A.M. RMT ni Lord 2024

LARIOSA, K.A.M. RMT ni Lord 2024

LARIOSA, K.A.M. RMT ni Lord 2024

LARIOSA, K.A.M. RMT ni Lord 2024

LARIOSA, K.A.M. RMT ni Lord 2024

LARIOSA, K.A.M. RMT ni Lord 2024

LARIOSA, K.A.M. RMT ni Lord 2024