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    ExpertMD Quick Parasitology 2023 STUDENT

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    ExpertMD 8 Biological Relationships Medicine Board Review QUICK REVIEW OF PARASITOLOCY FOR PLE 2923 PASAY Living together of unlike organisms May also involve protection or other advantages to one or both organisms ‘Symbiosis in which two species live together and one species benefits from the relationship without harming or benefiting the other (¢.g., Entamoeba coll) ‘Symbiosis in which two organisms mutually benefit from each other (e.g., termites and flagellates in their digestive system, which synthesize cellulase to aid in the breakdown of ingested wood) ‘Symbiosis in which the parasite depends on another organism for its survival, usually at the expense of the host (e.9., Entamoeba histolytica) Host = harbors the parasite, provides shelter, nourishment, and protection to the parasite Harbors the adult or sexual stage of the parasite Harbors the larval or asexual stage of the parasite Not required for the development or life cycle of the parasite Parasite does not develop further to later stage, remains alive and is able to infect another susceptible host a ‘Animals that are potential sources of a parasitic Infection for humans Allows the parasite's life cycle to continue and become additional sources of human infection Parasites - weaker, dependent on the host for survival Lives inside the body of the host Infection ~ presence of endoparasite in a host Lives outside the body of the host Infestation - presence of ectoparasite on a host ot Parasioe “antuman << {_ pwiceove sagt, * Parton emg) teammate fos 2) & * P penteone Ss pee Sep rae = bad . 4p Paras merge 7. Cae rey Gromer frre tegen ee tetra approptite PARASITES AT A GLANCE! Protozoa Metazoa Non-helminths Helminths ‘Amoeba Nematodes/Roundworms Flagellates Cestodes/Tapeworms Ciliate Trematodes/Flukes Sporozoa Microsporidia By Dra, Krizza-Almond S. Aguila-Salido, RMT, MT (ASCP) "#HappyRoadyMDniLord wn Arizzaaimond.com | www facebook convdoc kizza almond | wi. youtube, convazzik16 10f18 ExpertMD 2 QUICK REVIEW OF PARASITOLOCY FOR PLE 2023 PROTOZOA ‘Amoeba Motility: pseudopodia Reproduction: binary fission Stages: cyst and trophozoite (except Entamoeba gingivalis) Flagellates ‘Motility: one or more whip-like flagella With undulating membrane (e.g., trypanosomes) Reproduction: binary fission Stages: cyst and trophozoite (except Pentatrichomonas) Giliate ‘Motility: cilia distributed in rows or patches ‘Two kinds of nuclei (macro and micro) Stages: cyst and trophozoite Sporozoa Obligate intracellular parasites With sexual and asexual reproductive phases Microsporidia Now classified with the fungi Opportunistic pathogens AMOEBA Species Entamoeba histolytica - the only true pathogen Entamoeba coli Endolimax nana (smallest intestinal protozoa) lodamoeba butschlii (buetschlii) Entamoeba gingivalis Entamoeba bangladeshi Entamoeba hartmanni Entamoeba moshkovskii Entamoeba polecki Blastocystis spp. Effect All are non-pathogenic except E. histolytica (pathogenic ameba) Stages Cyst and trophozoite except E. gingivalis (no cyst) Infective stage Mode of transmission Habitat Developmental Stages (infective, diagnostic) Immotile form Motile form (with pseudopodia) Usually infective Usually non-infective Feeding/vegetative form Found in formed stool Found in liquid/watery stool ‘Stained by jodine ‘Stained by permanent stains (richrome, iron hematoxylin) Resistant to damage ‘Susceptible to damage {remains intact during centrifugation) (disintegrates during centrifugation) Distribution of protozoa in relation to ooT consistency except E. gingivalis (trophozoite) Ingestion of fecally-contaminated material (except E. gingivalis - oral contact) Others: fomites, oral/anal, flies and cockroaches (mechanical vectors contaminated fecal material) All are found in the colon except &. gingivalis (buccal cavity, gingival tissue) Specimen Cytoplasmic inclusion ‘Stool except for E. gingivalis (oral scrapings) Amoebic abscess, igmoidoscopy specimen (E. histolytica) All contain bactet is ‘and debris except E. histolytica and €. gingivalis By Dra, Krizza-Almond S. Aguila-Salido, RMT, MT (ASCP) "#HappyRoadyMDniLord wn Arizzaaimond.com | www facebook convdoc kizza almond | wi. youtube, convazzik16 20f18 ©)|ExpertMD ©) | medicine woard Review QUICK REVIEW OF PARASITOLOGY FOR PLE 2023 Entamoeba histolytica - tissue invading intestinal amoeba Stages Cyst - found in colon; form seen in formed stool ~ Quadrinucleated, with cigar-shaped chromatoidal body ‘Trophozoite - only form present in tissues; form seen in watery stool ‘Minute, compact, central, bull’s eye indistinct karyosome, progressive and unidirectional motility (long, fingerlike pseudopodia), may have INGESTED RBCs (pathognomonic) Disease/s 1) Asymptomatic/Carrier 2) Intestinal amebiasis: Amebic colitis/dysentery ** Gradual onset of abdominal pain and diarrhea with or without blood and mucus in stools + Site of colonization: COLON (cecum) o Early (pathognomonic histopathologic sign) + A smail point of entry, leading via a narrow neck through the mucosa into an expanded necrotic area in the submuc o Late - neutrophilic infiltrates ‘+ May be differentiated from bacillary dysentery (caused by Shigella dysenteriae) by the presence of needle-like crystals known as 3) Extraintestinal amebiasis ‘+ Hepatic amebiasis or amoebic liver abscess (ALA) or amebic hepatitis (most common form) Fever and RUQ pain = Ameboma - inflammatory or granulomatous tumorlike mass in the intestine ‘> Mass-like lesion with abdominal pain and a history of dysentery + Visceral amebiasis (lungs, spleen, brain) Diagnosis Stool exam (standard O&P exam) * Direct wet mount «Concentration methods ‘Permanent stained smear (trichrome or iron-hematoxylin) Fecal immunoassays - identifies E, histolytica/E. dispar Nucleic acid-based testing (PCR, multiplex assays) Treatment Lumenal amebidices - paromomycin, iodoquinol, or diloxanide furoate Tissue amebicides - metronidazole, tinidazole, or dehydroemetine ‘« Mild, moderate, severe intestinal disease: _ ‘+ Asymptomatic cyst passers: DILOXANIDE Fi , odoquinol or paromomycin + ALA: metronidazole, percutaneous drainage for prompt symptom relief Prevention/ Proper disposal of contaminated feces - most important preventive measure Control__No vaccine is currently available Species Identical to E. histolytica Non-pathogenic Does not ingest RBCs, non-invasive in humans Produces no intestinal symptoms Causes diarthea in school-age children and immunocompromise: Does not ingest RBCs Morphologically very similar to E. histolytica and E. dispar Has been recovered from feces of symptomatic and asymptomatic children Does not ingest RBCs Morphologically very similar to E. histolytica and E. dispar Non-pathogenic Previously regarded as “small-race histolytica” Non-pathogenic Zoonotic (parasite of pigs and monkeys) Also found as a human parasite ividuals Blastocystis spp. + Usually listed with the amebae, but classification is still under review + Placed within the stramenopiles based on molecular sequencing (of SSU rRNA gene) + Pathogenic or non-pathogenic By Dra, Krizza-Almond S. Aguila-Salido, RMT, MT (ASCP) "#HappyRoadyMDniLord wn Arizzaaimond.com | www facebook convdoc kizza almond | wi. youtube, convazzik16 30f18 ©)|ExpertMD ©) | medicine Board Review QUICK REVIEW OF PARASITOLOGY FOR PLE 2023 FACULTATIVE/FREE-LIVING AMOEBA. ‘Acanthamoeba spp. Disease/s 1) ‘opportunistic infection (vs PAM) = Altered mental state, headache, seizures, stiff neck 2) Acanthamoeba keratitis (AK) ‘= Eye trauma, contaminated contact lenses (contact lens fluid contamination) ‘+ Severe ocular pain, corneal ulceration, CNS abscess Laboratory Trophozoites in CSF diagnosis Trophozoites or cysts in brain tissue ‘Trophozoites of cysts in corneal scraping or biops\ Treatment Amphotericin Other agent of GAE: Balamuthia mandrillaris Naegleria fowleri_ Disease usually occurs in previously healthy adults with history of swimming acquired thru diving or swimming in stagnant water fever, nausea, vomiting, severe frontal headache, nuchal rigidity, and mental status changes = rapid progression to coma & death Laboratory Trophozoites in CSF diagnosis: Treatment Amphotericin 8 and Clotrimazole FLAGELLATES Species and thelr | Intestinal and Atrial Flagellates habit INTESTINAL/LUMINAL Trichomonas hominis: Giardia lamblia Chilomastix mesnilii Pentatrichomonas hominis Dientamoeba fragilis Retortomonas intestinalis Enteromonas hominis, EXTRAINTESTINAL/ATRIAL Trichomonas vaginal Trichomonas tenax Hemoflagellates Leishmania donovani Leishmania braziliense Leishmania tropica Trypanosoma brucei rhodesiense Trypanosoma brucei gambiense Trypanosoma cruzi Effect Pathogenic: T. vaginalis, G. lamblia, D. fragilis, Leishmania spp., Trypanosoma spp. Mode of transmission Giardia lamblia, Chilomastix mesnili, Pentatrichomonas hominis, Dientamoeba fragilis, Retortomonas intestinalis, Enteromonas hominis Trichomonas tenax ‘Trichomonas vaginalis Hemoflagellates (Leishmania, Trypanosoma) Stages Species | Stages Infective stage Trichomonas Trophozoite only Trophozoite Pentatrichomonas Dientamoeba Giardia ‘Cyst and trophozoite ‘Cyst and trophozoite Chilomastix Retortomonas Enteromonas Leishmania ‘Amastigote ‘Amastigote Promastigote Trypanosoma | Amastigote ‘Amastigote Promastigote (intracellular) or Epimastigote trypomastigote Trypomastigote By Dra, Krizza-Almond S. Aguila-Salido, RMT, MT (ASCP) "#HappyRoadyMDniLord wmnv.krizzaaimond com | www facebook com/doc.krizza.almond | www. youtube convazziki6 40f18 ® ExpertMD. | medicine board Review QUICK REVIEW OF PARASITOLOCY FOR PLE 2023 SPECIES Giardia lamblia aka Giardia duodenalis, Giardia intestinalis Habitat, ‘Small intestines (duodenum) Effect Pathogenic Disease Most common cause of intestinal infection worldwide Symptoms include mild diarrhea, flatulence, and vague abdominal pains, acute, severe diarthea Ingestion Cyst and trophozoite Infective | Cyst stage as Diagnostic | Cyst and trophozoite stage Specimen/s | Stool or sigmoidoscopy specimen Laboratory _| Stool exam (standard O&P exam) diagnosis ‘CYST ‘TROPHOZOITE (Ovoid, sub-spherical, ellipsoidal, football shape | Bilaterally symmetrical, pear/pyriform/teardrop 2 nuclei if immature, 4 if mature, central | Falling leaf, karyosomes 2 ovoid nucleus with large karyosome 4 pairs of flagella Ventral sucking disk Characteristic “old man with glasses” Described as “someone looking at you" Fecal immunoassays Entero test/String test In most cases, self-limiting Nitazoxanide (for drug-resistant cases), tinidazole, Handwashing ~ most effective practice for prevention Improved hygiene, adequate disposal of fecal waste, adequate washing of contaminated fruits and vegetables SPECIES Trichomonas vaginalis Habitat Genitourinary tract (vagina and prostate) Effect Pathogenic Disease Trichomoniasis| + Profuse frothy yellow or cream-colored vaginal discharge, vulval pruritus, burning sensation, local tenderness Most common curable sexually transmitted infection worldwit Mode of ‘Sexual contact transmission | Contaminated towels and underclothes (rare) Stages Trophozoite only + Four free flagella from a single stalk + Fifth flagellum (undulating membrane) { + Jerky motility in fresh specimens ‘infective | Trophozoite stage Diagnostic | Trophozoite stage Specimen/s | Urine, vaginal/urethral discharge, prostatic secretions (after prostate massage) Laboratory | Wet mount examination diagnosis | “Strawberry cervix” in speculum exam Rapid diagnostic tests Plastic envelope method (immediate examination and culture in one self-contained system) Treatment. or Tinidazole 2g (single dose) Simultaneous treatment of both sexual partners to prevent “ping-pong” or recurrent infections Prevention/ Control Others Treat asymptomatic males Promote awareness of sexual transmission Humans are the only natural host for T. vaginalis By Dra, Krizza-Almond S. Aguila-Salido, RMT, MT (ASCP) "#HappyRoadyMDniLord wn Arizzaaimond.com | www facebook convdoc kizza almond | wi. youtube, convazzik16 5 0f18 ©)|ExpertMD © | meatcine Board Review QUICK REVIEW OF PARASITOLOCY FOR PLE 2923 HEMOFLAGELLATES ‘SPECIES Leishmania braziliensis_ | Leishmania donovani Leishmania tropica complex complex complex Disease Mucocutaneous: i Visceral leishmaniasis (VL), | +L. tropica (dry or urban (MCL) dumdum fever, kala-azar fever, oriental sore) Nasal stuffiness, discharge, | death ever, tropical | « L. major (moist or rural epistaxis, and destruction of the | splenomegaly oriental sore) nasal septum (espundia) +L. mexicana (chiclero ulcer, MOST SEVERE TYPE usually affecting the ears) Ola World cutaneous leishmaniasis (CL), Baghdad boil, Delhi boil, Oriental sore, uta Mode of | Vector bite: _ transmission Others: congenital, blood transfusion, contamination of bite wounds, direct contact with contaminated specimens Stages Develops in vector Infective stage to man Develops in man | Diagnostic stage Specimen/s | L. donovani (aspirates) we LC tropica (skin biopsy) L. braziliense (tissue biopsy) Laboratory | Demonstration of Leishmania from lesion and tissue scrapings, aspirates, or Biopsy diagnosis __| Montenegro skin test can be used to identify exposure to the parasite Treatment | Sodium stibogluconate and n-methyl-glucamine (meglumine) Miltefosine - only oral drug currently given to VL patients Vector control, avoiding shared needles, checking blood supply, Trypanosoma | Trypanosoma Trypanosoma cruzi brucei gambiense | brucei rhodesiense Disease | West Africa sleeping | East African sleeping | Chagas disease Sickness sickness (South American trypanosomiasis or New Old World Old World World Trypanosomiasis) Teypanosomiasis —_| Trypanosomiadls (chronic form (atte form oval palnful,pravilc, erythemataus Chale at| Acute stage bite « Chagoma - subcutaneous inflammatory nodule Hemolymphatic stage ~ early stage ‘| _~ posterior cervical | * Romaiia’s sign - unilateral eyelid swelling imphadenapa : Meningoencephalitc stage - late stage Chronic stage may result to cardiomegaly, CHF, Messed | tromboemsolam ahythmios Mode of Vector bite: transmission T. brucei also transmitted by mechanical methods | T. cruzi also transmitted by blood transfusion, (accidental needle pricks, other blood sucking | vertical transmission insects), vertical transmission Stages | Amastigote - found in tissues Develops in vector Promastigote N Epimastigote Develops in man ‘Trypomastigote (C-, S U-shaped) - found in blood Infective | Metacyclic trypanosome Metacyclic trypanosome stage | Diagnostic | Trypomastigote ‘Amastigote (intracellular) or trypomastigote stage | Specimen/s | Blood, body fluids Blood, CSF Laboratory | Thick and thin blood smears (Giemsa) Thick and thin blood smears (Giemsa) ~ acute diagnosis. Serology, PCR - chronic Treatment | Early: Suramin sodium (WV), Pentamidine (IM) for | Nifurtimox and benznidazole Gambian form Late: Melarsoprol, nitrofurazone (in case of treatment failure with melarsopro)) «Jarisch-Herxheimer reaction - febrile episode ‘due to trypanosome lysis following melarsoprol treatment Vector control, avoiding shared needles, checking | Vector control, avoiding shared needles, checking blood suppl blood supp) By Dra, Krizza-Almond S. Aguila-Salido, RMT, MT (ASCP) "#HappyRoadyMDniLord wn Arizzaaimond.com | www facebook convdoc kizza almond | wi. youtube, convazzik16 6 0f18 ® ExpertMD. | medicine board Review QUICK REVIEW OF PARASITOLOCY FOR PLE 2023 CILIATE Neobalantidium coli (formerly Balantidium coli) - LARGEST PROTOZOA Disease Balantidiasis Mode ‘of Ingestion ‘transmission Stages Cyst and trophozoite Nuclei = reproduction; spherical ~ vegetation; kidney-shaped cyst Spherical or oval with thick wall Trophozoite | Exhibits directional tumbling motility Infective stage Cyst Laboratory ‘Stool exam (standard O&P exam) diagnosis Treatment Tetracycline (drug of choice) lodoquinol, metronidazole, nitazoxanide (alternative) Prevention/ Improved hygiene, adequate disposal of fecal waste, adequate washing of contaminated fruits and Control vegetables; prevention of human-pig contact, hygienic rearing of pigs SPOROZOA Species and habitat | Blood Plasmodium falciparum Plasmodium malariae Plasmodium vivax Plasmodium ovale Plasmodium knowlesi (Simian malaria) Babesia microti Tissue Toxoplasma gondii Intestinal Cryptosporidium Cyclospora Cytoisospora Plasmodium spp. Intraerythrocyic parasites Disease Malaria «Classical symptoms: Intermediate host Definitive host Mode of transmis: Vector bites or skin inoculation, blood transfusion, vertical transmission Vector Infective stage (from mosquitoes) Infective stage to mosquito: + Macrogametocyte ~ female + Microgametocyte - male _—~ Immature sex cells (from humans) Diagnostic stage Immature (ring) and mature trophozoites Schizonts Gametocytes Life cycle 2 phases: sexual and asexual ‘* SEXUAL ~ also known as sporogony, happens in MOSQUITOES (definitive host) + ASEXUAL - also known as schizogony, happens in HUMAN (intermediate host) EXO-ERYTHROCYTIC CYCLE - happens within liver cells ERYTHROCYTIC CYCLE ~ happens within RBCs By Dra, Krizza-Almond S. Aguila-Salido, RMT, MT (ASCP) "#HappyRoadyMDniLord wmnv.krizzaaimond com | www facebook com/doc.krizza.almond | www. youtube convazziki6 7 0f18 ExpertMD 2 ovale) ~ dormant stages that may persist within liver cells and responsible for cases of relapse (P. vivax and QUICK REVIEW OF PARASITOLOCY FOR PLE 2023 Diagnosis Endemic areas in the Philippines ‘Specimen: Blood « Best time to collect: __ + Gold standard for detection: THICK AND THIN BLOOD SMEAR - for rapid diagnosis, needs to be dehemoglobinized prior ‘Only four provinces remain endemic for malaria ~ Kudarat (as of 2019) for species Identification, to be fixed prior to staining Palawan, Sulu, Occidental Mindoro, and Sultan Other Names Malignant Tertian Malaria Quartan Malaria Estivo-Autumnal Malaria Black Water Fever ‘Affinity to RECS All ages Mature or older Effect on RBC size Normal size Smaller ‘Gytoplasmic inclusions Paroxysm. 48h Day 1 and 4 Stages seen in PES Ring, gametocyte All Trophozoite ‘Aplique or acole, double nuclear dots Band shape, single large compact ring (ring form) Gametocyte sscent_or sausage or banana shaped | Round to oval smaller than RBCS larger than RBCS. Ring forms ‘Single or double chromatin dots Single chromatin dot Multiple ring forms Common Rare owes lies pefcntage of parastia | Ronit meravalte/ daly formation Astocsed wih SPD deny Treatment Uttomteated“eoroqune Ghee no | CHoroqune wee no race fesstanco eters aremethet/ Jumefantrine i rant pn wot se = — se aa Maurers Red blood gametocyte ae tog vn one SER rom i en br) oe tg = spree soernet ond TET san ‘anger By Dra, Krizza-Almond S. Aguila-Salido, RMT, MT (ASCP) 80f18 2 ExpertMD. ine Board Review QUICK REVIEW OF PARASITOLOCY FOR PLE 2023 ‘Other Names Ovale Malaria Benign Tertian Malaria Affinity to RBCs Young or immature Young or immature Effect on REC size Enlarged (oval, fringed, fimbriated) Enlarged ‘Cytoplasmic inclusions Paroxysm ‘Alternate days ‘Aitemate days Stages seen in PBS All A Trophozoite Single compact ring Small hyaline ring that appears amoeboid (cing form) ‘Gametocyte Round to oval same size as RBC Round to ova, ils enlarged RBC Ring forms Single chromatin dot Single chromatin dot Multiple ring forms | Occasional Occasional ‘Others Relapse (hypnozoites) Relapse (hypnozoites) ‘Treatment Uncomplicated: chloroquine (where no’ | Uncomplicated: chloroquine plus primaquine resistance) (where no resistance), otherwise quinine plus doxycycline or tetracycline Primaquine for elapse Primaquine for relapse Perc ove ed ood Fimbated ‘ol ages schatinar oe shatnars ao Fated nee Late rophozote Cameroon Peso vex Red toed eal tog : pops cs senators Ev cunped mall Some Late toprozoite schizo wih 12-24 rare Other Protozoa Disease Babesiosis Mode of transmission Tick bites, blood transfusion Vector Ixodes dammini Gick) Infective stage ‘Sporozoites Diagnosis Thick and thin blood smears Tetrad forms (Maltese Cross’) inside RECs Treatment ‘Atovaquone plus azithromycin; clindamycin plus quinine Diseases Toxoplasmosis Congenital toxoplasmosis - stillbirths, chorioretinits, intracerebral calcifications, psychomotor disturbances, and hydrocephaly or microcephaly Intermediate host Man Definitive host Cat infective stage Sporulated oocyst Mode OF Ingestion of oocyst transmission Transplacental (TORCH) Ingestion of cyst from meat of infected animals Blood transfusion Diagnosis Serology 7 _ (serologic test) positive results loss of affinity to methylene blue Treatment Pyrimethamine plus sulfadiazine By Dra, Krizza-Almond S. Aguila-Salido, RMT, MT (ASCP) “#HappyReadyMDniLord _woinw.krizzealmond com | www facebook convdoc.krizza.almond | ww. youtube, com/azzirks6 9 of 18 ExpertMD Medicine Board Review QUICK REVIEW OF PARASITOLOCY FOR PLE 2923 8 Cryptosporidium parvum, Cyclospora cayatenensis, Cystoisospora belli - infect intestinal epithelial cells Diseases Watery diarrhea (mild and self-limited) in normal persons Severe, prolonged diarthea (in immunocompromised, or very young/old) Mode of transmission Ingestion of contaminated food and water Infective stage ‘Sporulated oocyst Diagnosis ‘Stool exam Modified Acid-Fast stain Sheather’s flotation increases chances of recovering Cryptosporidium oocyst = with autofluorescence ‘Treatment ‘Cryptosporidium ~ Nitazoxanide for immunocompetent Cyclospora - Trimethoprim- sulfamethoxazole Ctoisospora - Trimethoprim: sulfamethoxazole MICROSPORIDIA = now classified as fungi; opportunistic, obligate intracellular parasite NEMATODES OR ROUNDWORMS Characteristics | Round, unsegmented, elongated, bilaterally symmetrical Complete digestive tract (mouth to anus) Sexes are separate Larger and with straight tails : Shorter, smaller and with curved tails Species and * Intestinal their habitat © Small intestine: Ascaris lumbricoides, Capillaria philippinensis, Strongyloides stercoralis, Hookworms (Necator americanus, Ancylostoma duodenale), Trichinella spiralis (adult) © Large intestine: Trichuris trichiura, Enterobius vermicularis + Extraintestinal © Skeletal muscles: Trichinella spiralis (larva) © Subcutaneous tissues: Dracunculus medinensis © With lung migration (can cause pneumonitis): Ascaris, Strongyloides and hookworm Unholy three: Effect Pathogenic Stages Egg, Larva, Adult Mode of Species Infective Stage \gnostic Stage & Specimen transmission Ascaris Embryonated egg ‘Ova/eggs in stool Trichiuris: Ova/eggs in stool Enterobius ‘Ova/eggs in perianal swab Capillaria [tara ‘Ova/eggs in stool Dracunculus B larva ‘Adult worm in lesions Parastrongylus (3 larva ‘Adult female worm by histology Trichinella Encysted larva Encysted larva in muscle biops “Strongyloides Filariform larva (unsheathed) | Rhabditiform larva in stool Hookworms Filariform larva (sheathed) ‘Ova/eggs in stool | Filarial worms (3 larva Microfilariae in blood ay 4 (0. volvulus ~ skin snips) (Species [ characteristic Eag/Ova Outer mamilary coat/mammilation, enilized/unferlized eggs lestained ova Barrel shaped cugs, foctball, with protruded polar plugs japanese lantern ava Dishaped, tla on one side, with larva ‘Thickshelled, football shaped eggs with one sightl flattened side Peanuit-shaped, with flattened polar lugs ‘Oval with thin transparent shell containing 2 to 8 germ cells Resembles hookworm ova, but contains larva Chinese lantern ova By Dra, Krizza-Almond S. Aguila-Salido, RMT, MT (ASCP) "#HappyRoadyMDniLord wn Arizzaaimond.com | www facebook convdoc kizza almond | wi. youtube, convazzik16 10 of 18 2 ExpertMD. QUICK REVIEW OF PARASITOLOCY FOR PLE 2023 [ Species ‘Characteristic Adult Female: pencil lead thickness Male: prominent incurved tail Slender head, fleshy tail resembling a whip Pointed tail, resembles pinhead With cuticular alar expansion and well-defined esophageal bulb Male: prominent posterior copulatory bursa With buccal teeth, +1 pair: #2 pairs: #3 pairs: + Semilunar cutting plates: .. INTESTINAL ROUNDWORMS ‘Species Ascaris lumbricoides_|___ Trichuris trichiura Enterobius vermicularis Common —_| Giant Intestinal Roundworm | Human Whipworm Pinworm, Seatworm, Society name/s Largest intestinal nematode Worm Disease Ascariasis (most common Trichuriasis, Enterobiasis intestinal helminth infection) | Ulcerative colitis Intense pruritis ani (severe anal Rectal prolapse itching) when adult female Pheumonitis, Loeffler's migrates out of anus at night to syndrome, intestinal blockage deposit eggs Mode of | Ingestion Ingestion transmission | (Soil-Transmitted Soil-Transmitted ‘or inhalation Helminthiasis [STH) Helminthiasis [STH)) Non-STH Infective | Embryonated egg Embryonated egg Embryonated eg3 stage Diagnostic | Ova/eags Ova/egas Ova/egas (perianal swab) stage Specimen/s | Stool ‘Stool Scotch/cellophane tape preparation or perianal swab Laboratory | Stool exam (standard O&P exam) | Stool exam (standard O&P exam) | Scotch/cellophane tape diagnosis, preparation or perianal swab Adult worms may also be | « Zinc sulfate flotation method recovered in small intestine, gallbladder, liver, appendix, | stool, vomitus, external nares Ova Unfertilized/infertile - oval, | Barrel, football, Japanese lantern | D-shaped with thin shell (val, 1 side is flattened) 2 Layers: | Smooth, yellow brown (bile- 4) Mamillary coat | contact) with 2 prominent Double layered, colorless @) Glycogen layer hyaline polar plugs Fertilized/fertile - round, with thick shell 3 Layers: () Albuminoid mamillary coat (outen (2) Thick chorionic glycogen (middle) | {) Lipoidal vitelline membrane (inner) Treatment | Mebendazole, albendazole Mebendazole, albendazole ‘Albendazole, mebendazole, or pyrantel pamoate Prevention/ Improved hygiene, adequate Improved hygiene, adequate Improved hygiene, adequate Control disposal of fecal waste, adequate | disposal of fecal waste, adequate | disposal of fecal waste, adequate washing of contaminated fruits | washing of contaminated fruits | washing of hands and vegetables and vegetables Others With larval migration to the = Highly communicable lungs won bri Associated with retroinfection/autoinfection ‘Transmits D. fragilis By Dra, Krizza-Almond S. Aguila-Salido, RMT, MT (ASCP) "#HappyRoadyMDniLord almond. com | wiw facebook com/doc.krzza. almond | ww. youtube, com/szzirk 6 11 0f18 ® ExpertMD. | medicine board Review QUICK REVIEW OF PARASITOLOCY FOR PLE 2023 Species Necator Ancylostoma Strongyloides stercoralis americanus duodenale Common | New World hookworm | Old World hookworm | Threadworm name/s American murderer Disease Uncinariasis (Necator) /Ancylostomiasis Strongyloidiasis (hyperinfection syndrome, (Ancylostoma) internal autoinfection) "Ground itch” or “Dew itch” or “Coolie itch” Cochin China diarthea (heavy infection) Iron deficiency anemia (microcytic, hypochromic anemia) Wakana's disease, Mazza mora Mode of | Skin penetration, typically the foot ‘kin penetration, typically the foot, from transmission contaminated soil Stages ‘Adult worm Rhabditiform larva (RL) Filariform larva (FL) Ova/eggs RHARDITIFORM vs FILARIFORM LARVA Rhabditiform larva (RL) Filariform larva (FL) Feeding stage, with open mouth, shorer Non-feeding stage, with closed mouth, longer NONINFECTIVE INFECTIVE STAGE ~ 2 Rhabditiform | Long buceal cavity Short buccal cavity larva (RL) Thin sheath No sheath Small genital primordium Large genital primordium Tilariform | Short esophagus Tong esophagus farva (Ft). | Pointed tal Notched tall [ovayegas | Ovaid, with thin hyaline wansparent shell Similar to hookworm but smaller Chinese Lantern Ova” Tnfective | Farform ara Filariform larva stage Diagnostic | Ova/eaos Rhabavform larva stage Specimen/s | Siool Stool Laboratory Stool exam (standard O&P exam) Stool exam (Gtandard O8P exam) diagnosis Coproculture (light infections) * Zinc sulfate flotation method Coproculture (light infections) Treatment | Albendazole, mebendazole, pyrantel pamoate Ivermectin - recommended Albendazole, mebendazole — alternatives Prevention/ | Contaminated soil and beaches should be avoided. | Contaminated soil and beaches should be Control Appropriate footwear (enclosed shoes) should be | | avoided. Appropriate footwear (enclosed shoes) |worn in potentially contaminated areas. Should be worn in potentially contaminated areas Capillaria philippinensis ‘Anisakis simplex Pseudoterranova decipiens Common —_| Pudoc worm/Mystery worm Herringworm, codworm, sealworm name/s Disease Capilliariasis/Mystery disease Anisakiasis/anisakidosis or herring worm disease Gorborygmi/guraling stomach) “Tingling throat syndrome" - oropharynx visceral larva migrans (VLM) Mode of | ingestion of infected raw fish Ingestion of infected fish or squid transmission TISSUE ROUNDWORMS. t ‘Species Trichinella spiralis Common name/s ‘Trichina worm, Pork muscle roundworm Habitat ‘Adult: Small intestines Larva: Skeletal muscles (deltoids, gastrocnemius, biceps, gluteus) Disease Trichinosis, Trchinellosis Diarrhea (first 24 h), muscle pain, fever Mode of transmi Ingesting undercooked contaminated meat: pork, deer, bear, walrus Infective stage Encysted larva Laboratory diagno: Muscle biopsy for definitive diagnosis ‘Treatment ‘Albendazole (plus steroids for severe symptoms Prevention/ ‘Adequate cooking of meat, use of cooked rather than raw garbage for pigs Control By Dra, Krizza-Almond S. Aguila-Salido, RMT, MT (ASCP) "#HappyRoadyMDniLord wn Arizzaaimond.com | www facebook convdoc kizza almond | wi. youtube, convazzik16 12 of 18 2 ExpertMD. Je Board Review QUICK REVIEW OF PARASITOLOCY FOR PLE 2023 ‘Common | Guinea worm/Serpent worm/Dragon worm Rat lungworm name/s Disease Dracunculiasis/Guinea worm disease (WHO NTD) | Eosinophilic meningoencephalitis/neural Allergic reaction, skin ulcer angiostrongyliasis Mode of Ingestion of infected copepods (Cyclops water Ingestion of mollusk transmission | fleas) Laboratory | Recovery of larva after placing a drop of water to_| Histolog! identification of adult female worms diagnosis | open blisters (spiral, winding uterus with barber's pole appearance) Treatment _ | Slow removal of worm around stick; surgical ‘No drug is proven effective removal; wound treatment Analgesic and corticosteroids for symptomatic relief Self-limited course with complete recovery Non-human ascaris ‘= Toxocara canis ~ ascaris of dogs, acquired thru ingestion of embryonated eggs * Toxocara cati - ascaris of cats, acquired thru ingestion of embryonated eggs Non-human hookworms ~ « Ancylostoma caninum ~ dog hookworm, acquired thru skin penetration of filariform larva # Ancylostoma braziliense ~ cat hookworm, acquired thru skin penetration of filariform larva BLOOD AND TISSUE FILARIAL ROUNDWORMS Stages ‘Adult worms live in tissue or the Iymphatic system (rarely seen) ‘+ Usually appear creamy white and assume a threadlike appearance Larvae (called microfilariae) are usually detected in the blood Merlino stator host cont Sioa Commousrow — Necontnne, aaa! Mstepocca "mapas Seer Periodicity Nocturnal = occurring at night Diurnal occurring during the day Subperiodic ~ timing of occurrences not clear-cut Vectors Biting insects such as mosquitoes Diagnosis Microscopic examination of microfilariae in a Giemsa-stained smear of blood or a tissue scraping of an infected nodule ‘= Knott technique - uses centrifugation to concentrate the organisms onto a slide ‘+ Nucleopore filtration - blood is passed through a polycarbonate filter that contains a 2-~um pore ‘Common | Malayan filaria | Bancroft’s Eyeworm New World Perstans filaria | Blinding filaria, name/s filaria filaria river blindness Specimen | Blood Blood Blood Blood Blood ‘Skin snips Disease| Malayan Bancro®’s| Toiasis Non-pathagen | Nor-pathogen | Onchacerciasis| filariasis or —_| filariasis or River blindness elephantiasis | elephantiasis | Calabar Subcutaneous swellings fibrous nodules Treatment | Diethylcarbama | Diethylcarba- | Diethylcarba- | ivermectin Diethylearba- | Ivermectin zine (DEC) mazine (DEC) _| mazine (DEC) mazine (DEC) = dog heart worm, dog filaria im lodges in the right heart or branches of the pulmonary artery {The healed pulmonary infarct may appear as a‘coin lesion’ on chest radiography and can be mistaken for mallgnan By Dra, Krizza-Almond S. Aguila-Salido, RMT, MT (ASCP) “#HappyReadyMDniLord _woinw.krizzealmond com | www facebook convdoc.krizza.almond | ww. youtube, com/azzirks6 13 of 18 ©)|ExpertMD oO ber Board Review QUICK REVIEW OF PARASITOLOCY FOR PLE 2923 CESTODES OR TAPEWORMS Classes Pseudophyllidean/False tapeworm: Diphyllobothrium Tatum Cyclophyllidean/True tapeworms: Taenia solium, Taenla saginata, Taenia asiatica, Hymenolepis nana, Hymenolepis diminuta, Dipyllidium caninum, Echinococcus granulosus Habitat Intestinal cestodes: D. latum, T. solium, T. saginata, T. asiatica, H. nana, H. diminuta, D. caninum Tissue cestodes: T. soflum, E. granulosus, Spirometra mansonoides Features | Monoecious or hermaphrodites (combined sexes in one organism) Flat, ribbon-like and segmented bodies consisting of: + Scolex/Head - organ for attachment; specific for cestode © Spatulate/Spoon-shaped/Almond-shaped: Globular * With hooks: T: solium, H. nana, D. caninum, E. granulosus + Without hooks: T. saginata, H. diminuta ‘+ Neck - region of growth or budding zone (germinative tissues) + Segments/Proglottids ~ represents body (STROBILA - entire chain of segments/proglottids) immature - immediately next to the neck, sexually undeveloped ‘Mature ~ middle part, with full sets of maie and female reproductive organs, sexually developed + 3" ovary (accessory ovarian lobe): 7 +2 lateral genital pores: _ (Gouble pored tapeworm) © Gravid/ripe - terminal portion, contains egg filled uterus (shapes may vary) += Rosette-shaped: anamaam + Saccular: + With 7 to 13 lateral branches: * With 15 to 20 lateral branches. + Fragmented into packets /egg packets: Hosts & Requires two (2) hosts, except H. nana (requires only one host) and D. latum (requires 3 hosts) infective | + One (1) INTERMEDIATE HOST and one (1) DEFINITIVE HOST stage Species | Intermediate host/s Definitive Host D.latum Ist: Copepods (Cyclops or Diaptomus) Man 2nd: Freshwater fish T. solium Pigs/swine/hogs Man T. saginata__| Cows/cattles Man H. nana May or may not require IH (leas) Man, rodents Require only | host to complete its life cycle H. diminuta | Rat flea, cockroach, beetle Rats, rarely man D. caninum | Fleas Dogs, rarely man E. granulosus | Sheep, hoas Dogs, foxes, wolves (Man iS accidental IH) Stages Egg, larva, adult + Eggs: embryonated, non-operculated except for D. latum (unembryonated, operculated) Tnfective stage and Species | Infective stage Diagnostic stage diagnostic || D. latum —— Plerocercoi larva (common) Ova/eags stage Procercoid larva T. solium | Cysticercus cellulosae Ova/eaas Ova/eggs T. saginata | Cysticercus bovis ‘Ova/eags 1H. nana ‘Ova/eggs (direct) Ova/eggs Cysticercoid larva (indirect) Gysticercoid larva ‘Ova/eags ‘D. caninum | Cysticercoid larva ‘Ova/eags E. granulosus | Ova/eggs ‘Ova/eags Mode of __| Ingestion transmis Life span | 25 years: D. latum, Taenia

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