PMT 316: MEDICAL PARASITOLOGY LECTURER: DAVID KIPROP SANG, PHD DEFINITIONS Medical parasitology is the science which deals with human parasites, A parasite is an organism which has adapted itself to existence in or on another organism, the latter, which harbours the parasite, being termed the host .Parasites which live outside and attached to the body are known as ectoparasites, those which live inside the body are known as endoparasites. This study of human parasitology is restricted to those organisms which lives in or on humans and obtains nutrition and protection, while at the same time causes harm to the human host. Parasitism isa situation in which one organism (the parasite) lives in or on another organism (the host) obtains nutrition and shelter while at the same time causing harm to the host. Hence the parasite lives at the expense of the host. Other related phenomena are: Comensalism - an association of organisms of mutual benefit to both partners. Here the partners retain physiological independence. Mutualism (Symbiosis) - an association of organisms of mutual benefit to both partners. But partners are interdependent Within the scope of human parasitology is Medical Entomology — the study of invertebrate vectors of human diseases. Objectives of training Diagnosis of parasitic diseases, a key component in the management of cases by evidence base action (treatment and support). Parasitological diagnostic Techniques are the gold standard in the diagnosis of parasitic diseases Epidemiology as specified in the life cycle, vector biology, animal reservoirs and other risk factors associated with the sociological setting of the diseases, using appropriate sampling techniques. Control of parasitic diseases based on the epidemiology and transmission patterns, ‘The phenomenon of Neglected Tropical Diseases (NTDs) within the realm of neglected populations, and the use of such populations to reverse the trend of epidemiology The diversity of species, transmission and clinical outcome of disease. Nomeclature of Parasites In the classification of animal parasites very numerous subdivision of the main groups are necessary. The names applied follow certain laws, laid down in the International Rules of Zoological Nomerclature. It is.hree not necessary here to do more than indicate the general principles. Human parasites belOn8 f° ‘ phyla of the animal kingdom, namely Protozoa, Platyhelminthes and Nemathelminthes. The Sprirochaeteles are not included, as they are probably more akin to the bacteria than to the protozoa Most ectoparasites which include vectors of a section of endoparasites belong to the Phylum Arthropoda, and a few to Mollusca and Crustacea. A vector of a parasite is an organism (Arthropod, Mollusc or Crutacean) in which a parasite undergoes cyclical development before being transmitted to the next host. The cyclical development includes morphological and metabolic change essential for transmission from one host to another. Some parasites have animal reservoirs, which is ether an incidental host (or dead end host) or that which forms an essential component of the life cycle of the parasite. A definitive host is that in which the adult stage of the parasite occurs, while an intermediate host is that which harbours the immature stages or gametes of the parasite. Control and prevention requires knowledge of the life cycle of individual parasites and the ability to build interventions around it. Parasitism is one of the most common life styles on earth and practically every animal species harbours some type of parasite. Over 100 species of parasites are known to live in and/or on man. Others are shared with animals, wild and domestic. Division from Phylum to species Each phylum is divided into Classes, and these are in turn divided into Orders, Families, Genera and Species. Sometimes other subdivisions are included, e.g. Superfamily and Sub-family. in medical parasitology the most important of the names are those of the Genus and the species. System of classification in some of the taxa are subject to a variety of opinion, which may be apparent in the literature. Objectives of the course Goal: To acquire knowledge of medical parasitology and to eventually use it for diagnosis prevention and control of parasitic diseases specific objectives Understand the morphology, metabolic implications and adaptations of parasites to their hosts. Understand the functions of various stages of the parasite lfe cycle, and the preparation of specimens for diagnosis and treatment of infected individuals, d the pathogenicity of the parasite for the purpose of management of cases of parasitic Understani r matory diagnosis by microscopy diseases and the rationale behind the need for confinMEDICAL PARASITOLOGY DEFINITIONS Medical parasitology is the science which deals with human parasites. A parasite is an organism which has adapted itself to existence in or on another organism, the latter, which harbours the parasite, being termed the host .Parasites which live outside and attached to the body are known as ectoparasites, those which live inside the body are known as endoparasites. This study of human parasitology is restricted to those organisms which lives in or on humans and obtains nutrition and protection, while at the same time causes harm to the human host. Parasitism is a situation in which one organism (the parasite) lives in or on another organism (the host) obtains nutrition and shelter while at the same time causing harm to the host. Hence the parasite lives at the expense of the host. Other related phenomena are: Comensalism - an association of organisms of mutual benefit to both partners. Here the partners retain physiological independence. Mutualism (Symbiosis) - an association of organisms of mutual benefit to both partners. But partners are interdependent Within the scope of human parasitology is Medical Entomology ~ the study of invertebrate vectors of human diseases. ‘ Objectives of training Diagnosis of parasitic diseases, a key component in the management of cases by evidence base action (treatment and support). Parasitological diagnostic Techniques are the gold standard in the diagnosis of parasitic diseases. Epidemiology as specified in the life cycle, vector biology, animal reservoirs and other risk factors associated with the sociological setting of the diseases, using appropriate sampling techniques. Control of parasitic diseases based on the epidemiology and transmission patterns. The phenomenon of Neglected Tropical Diseases (NTDs) within the realm of neglected populations, and the use of such populations to reverse the trend of epidemiology The diversity of species, transmission and clinical outcome of disease. Nomeclature of Parasites In the classification of animal parasites very numerous subdivision of the main groups are necessary. The names applied follow certain laws, laid down in the International Rules of Zoological Nomerclature. It is not necessary here to do more than indicate the general principles. Human parasites belong to three phyla of the animal kingdom, namely Protozoa, Platyhelminthes and Nemathelminthes.i than to the ‘The Sprirochaeteles are not included, as they are probably more akin to the bacter!2 protozoa Most ectoparasites which include vectors ofa section of endoparasites belong to the Phylum Arthropoda, and a few to Mollusca and Crustacea. which a parasite undergoes A vector of a parasite is an organism (Arthropod, Mollusc or Crutacean) in opment includes cyclical development before being transmitted to the next host. The cyclical devel morphological and metabolic change essential for transmission from one host to another. ‘Some parasites have animal reservoirs, which is ether an incidental host (or dead end host) or that which forms an essential component of the life cycle of the parasite. A definitive host is that in which the adult stage of the parasite occurs, while an intermediate host is that which harbours the immature stages or gametes of the parasite. Control and prevention requires knowledge of the life cycle of individual parasites and the ability to build interventions around it. Parasitism is one of the most common life styles on earth and practically every animal species harbours some type of parasite. Over 100 species of parasites are known to live in and/or on man. Others are shared with animals, wild and domestic. Division from Phylum to species Each phylum is divided into Classes, and these are in turn divided into Orders, Families, Genera and Species. Sometimes other subdivisions are included, e.g. Superfamily and Sub-family. In medical parasitology the most important of the names are those of the Genus and the species. System of classification in some of the taxa are subject to a variety of opinion, which may be apparent in the literature. Objectives of the course Goal: To acquire knowledge of medical parasitology and to eventually use it for diagnosis prevention and control of parasitic diseases Specific objectives Understand the morphology, metabolic implications and adaptations of parasites to their hosts. Understand the functions of various stages of the parasite life cylcle, and the preparation of specimens for diagnosis and treatment of infected individuals Understand the pathogenicity of the parasite for the purpose of management of cases of parasitic diseases and the rationale behind the need for confirmatory diagnosis by microscopy Understand the epidemiology and recognize the geographical distribution and potential socio-economic impact on communities affected by parasitic diseases, and the role of parasitic diseases on human life and history.Understand the biology, transmission patterns and life cycle of parasites in order to eventually formulate methods of prevention and control in various defined habitats Lecturers of Medical Parasitology are usually those directly involved in the acquisition of knowledge through research. PROTOZOOLOGY: THE PHYLUM PROTOZOA General morphology: Unicellular, mostly microscopic Metabolism: Feeding , motility, encystment/excystment, reproduction Class Rhizopodea Entamoebza histolytica: Causative organism of Amoebiasis Geographical distribution is cosmopolitan, but important only in the tropics and subtropics Habitat: Unencysted in the large intestine of humans and monkeys, sometimes the liver where they give rise to amoebic absceses. Cyst are formed in the intestinal lumen and not outside. Morphological characters ~ cyst and trophozoite. Life history Formation of cysts in the large intestine, passed in faeces, ways of contamination of food and water, resistance to digestion by gastric juice, excystment in the intestine Invasion of the mucous membrane of the large intestine and multiplication, may enter the portal blood stream and be carried by the portal vein to the liver. Pathogenicity Acute stage: Diarrhea and ulceration of the large intestine with blood and mucous in stool with unencysted amoebae containing blood cells. Chronic amoebiasis mostly without symptoms with passage of encysted amobae Diagnosis, Detection of unencysted amobae in acute dysentery , characteristic cysts in chronic cases and in amebic hepatitis and liver abscess, Non-pathogenic species which may be present in samples include Entamoeba coli and related species Class Ciliateaflagella are shorter than This Class includes protozoan parasites which move by means of cilia, which ‘and usually cover the entire body. They beat in a synchronous rhythm Genus Balantidium: Contains a species pathogenic to man, 8. coli cyst and ide. Both Habitat: The intestine of man and pig. Cysts are formed in the intestine and not outs! trophozoite may pass out in faeces ciliate Morphology: Characteristic flagellate trohozoites and cysts Life history Unencysted forms die outside the body when passed out in faeces and even if accidentally ingested By man alive they would be destroyed by gastric juice. Cysts passed out by either man or pig are infective to man. Excystemt takes place in the intestine each cyst giving rise to one parasite, unlike E. histolytica which gives rise to four. Pathogenicity 8. coli may invade the intestinal mucosa and cause dysentery as in E, histolytica. In acute cases only trophozoites are found. Uleers with undermined edges result. In chronic cases cysts are found in stool. Both stages are found in sub-acute cases. The large intestine is the most commonly affected, but the lower part of the small intestine may be involved. Diagnosis By finding unencysted ciliates usually with blood and mucus in acute case of dysentery, and by finding cysts in chronic cases and both cysts and trophozoites in sub-acute cases. Prevention and control The practice of good environmental sanitation proper observance of hygienic practices, and the messages that go with these are essential in eliminating intestinal protozoa as a public health problem Class Zoomastigophorea General morphology of the Family Kineto platida (“haemoflagellates") have a flagellum which may be free or terminated at the anterior end of the organism; multiplication is by longitudinal fission Genus Trypanosoma Trypamastigotes in the blood of man (monomorphic in America Trypanosomiasis: caused by 7. cruzi and pleomorphic in Afican Trypanosomiasis caused by .gambiense and T. rhodesiense). Undergo cyclial development in insects in which epimastigotes and metacyclic forms are involved Trypanosoma gamiense and T. rhodessienseCausative organism for Gambian and Rhodesian sleeping sickness respectively Geographical distribution Tropical West Africa from Gambia to Uganda for Gambian and Southern Africa from f Western Kenya to Zinbabwe in Rhodesian sleeping sickness. Habitat Trypamastigotes occur in the blood, lymphatic system and cerebrospinal fluid of man, which is the essential host of T. gambiense. T. rhodesiense is essentially a parasite of wild game Morphology Trypansomes have characteristically located nucleus, kinetoplast and flagellum which may be free or restricted within the undulating membrane. Mmonomorphic in America Trypanosomiasis: T. cruzi and pleomorphic in African Trypanosomiasis caused by T.gambiense and T. rhodesiense Life cycle In man and animals metacylic trypanosomes injected through the mouthparts from the salivary gland of the tsetse fly vector, multiply locally at site of inoculation before spreading to lymphatics and blood. ‘symptoms will be produced within 10 days or more depending on the species of trypanosome In the tsetse fly trypastigotes taken in by the biting fly multiply in the midgut and within a few days begin their characteristic migration forward to the salivary glands. Here they develop into metacyclic forms ready for inoculation to the host in the next blood meal Pathogenicity The most severe stage, sleeping sickness may be acute in onset after only a few months after inoculation in 7. rhodesiense or chronic lasting as long as 20 years in T.gambiense infection. The symptoms vary with the acuteness of the disease in each parasite. ‘Aconstant pathological change in the central nervous system of cases is an infiltration of leucocytes, chiefly lymphocytes and plasma cells, around the blood vessels. Diagnosis By finding trypamastigotes in peripheral blood in fresh or stained preparations or by centrifugation. Material can also be obtained from enlarged glands for direct examination. Laboratory animal inoculation can be performed using all the types of material obtained from different tissues. Trypanosoma cruzi This is the causal organism for American trypanosomiasis or Chagas diseasesGeographical distribution South and Central America and southern North America Habitat and morphology , jin animals Trypamastigotes in the blood stream and amastigotes in the tissues ‘of man and of certai e-g.cats, puppies, armadillos, opossums and monkeys Life history the triatomine bug vector enter the tissue cells lose their falgellan me develop flagella and emerge in ation and enter cell by losing Meacyclic trypanosomes derived from and become rouded into amastigotes. The multiply and eventually so dirculation as trypamastigotes. Some trypanastigotes also leave circul flagella in a similarly repeated process. Both immature and mature triatomine bugs acquire infection through a blood meal By biting an infected person or animal. The parasites change from trypamastigote to amastigote staBe and multiply in the edgut, During multiplication and movement down the midgut some the amastigotes change to epimastigotes and eventually to metacycli forms which are infective. These pass out through the hind gut with the faeces during feeding by contaminating the wound made by the biting Insect. Infection is carried though the metamorphosis of the insect. Pathogenesis This depends on the organ and the damage by the parasite, e.g. heart, nervous system, kidneys, ‘common particularly in children Diagnosis Asin African trypanosomiasis and by feeding clean triatomine bugs on patients and examination of faeces of the bug for trypanosomes for three weeks. Genus Leishmania ‘The amastigote stage occurs inthe tissues of man and certain and animal reservoirs; the promastigote form infective to man occurs only in certain species of sandflies of the Genera Phlebotomus and Luzomyia in the Old and New World respectively. The promastigotre form also occurs in culture. Morphologically the flagellum is without an undulating memebrane cycle ‘The metacylci form from the foregut of sandflies injected into the skin of man assume the amastigote form and are taken up by macrophages in the subcutaneous tissue where they multiply. Subsequent events will depend on the species of parasite responsible for the various clinical forms of leishmaniasis. In sandilies amastigotes from a bloodmeal transform into promastigotes and multiply in the midgut. During the process a proportion transform into metacyclic froms which migrateforeword in large numbers and tend to block the foregut. During the next bloodmeal the fly will fd it difficult to feed, thus regurgitating some of the foregut contents which is injected with the i tiva and deposited in the skin of the host at the site of feeding, The salivary glands are not involved, Figure 1. Phlebotomine sandfly vector of leishmaniasis Pathogenicity Genus is responsible for a spectrum of diseases in man Leishmania donovani ‘This causes visceral leishmaniaisis (Kala-azar) Geographical distribution ‘amastigotes occur in the cells of the reticulo-endothelial system throughout the body, and are particularly abundant in the spleen, bone marrow and liver. No animal reservoirs have detected in the endemic areas in Africa, namely Sudan, Kenya and Ethiopia where man is the primary host. in the Mediterraneas, China and the New World the dog harbours the disease.st Pokot districs In Kenya the disease in endemic in Northern Rift valley from the Baringo and We: northwards, and the rest of northern Kenya in localized pockets. yn. The symproms The ment of the spleen are irregular fever, anaemia, weight loss, emaciation, dysentery, and liver. se is fatal in over 90% of untreated cases 8 months to 2 years after infectio hair loss and enlarge’ Diagnosis a Bot and By examining aspirates from the enlarged spleen, bone marrow and lymph glands using microscoPY culture (confirmatory) By serologic tests Cutaneous leishmaniasis, In the Old world this is due to 3 Leishmania species L. tropica, L. major and L. aethiopica presenting with characteristic symptoms. In the New World they are due to the Leishmania braziliensis and L. Mexicana group groups of parasites. Geographical distribution Far East, Middle East, North and East Africa, Mediterranean, Central and South America Habitat ‘Amastigotes occur in man, the dog , hyrax and certain rodents depending on the species, predominantly in the skin Life history As in Kala-aszar |, but may vary with the species of infecting parasite. They occur in a spectrum usually of clinical manifestation in the skin. Diagnosis By finding the parasite using smear and culture methods. Serology is not useful except in some disseminated forms. Espundia Geographical distribution - South America as an aberrant for of CL due to Leishmania brazliensis HabitatReticuloendothelial system of the mucous memebrane and of the mouth, nose and throat. The opossum ‘and certain rodents are reservoirs Life history ‘Asin cutaneous leishmaniasis and Kala-azar Pathogenicity Chronic ulceration of the mucous membrane with destruction of cartilage and bone of the affected sites Diagnosis ‘As in cutaneous leishmaniasis Other Flagellates Genital flagellates : non-encysted Genus Trichomonas: T. vaginalis Geographical distribution: cosmopolitan Habitat: Genital tract of both males and females, but particularly the latter Pathogenicity Mild symptoms of vaginitis and discharge Diagnosis: By finding actively motile organisms from fresh preparations from the genital tract, confirmed by morphology in fixed and stained films. Intestinal flagellates Giardia intestinalis Geographical distribution: Cosmopolitan Habitat: Upper part of the small intestine, trophozoites arefound in diarrhoeal faeces, rarely seen in normal stool samples except after a purgative Life history ‘The flagellates multiply in the intestine of man by the characteristic flagellate longitudinal fission. Cysts are formed in the intestine only and infection is by contamination of food, hands and water Pathogenicity: Mild if present Diagnosis: By finding characteristic cysts or, more rarely trophozoites usually very sluggish,lass Teleosporea sement such as flagel or cilia. This group of In this Class of Prorozoa there are no special organs of mov \d Sarcocystis. parasites consists of four Genera Plasmodium, Isospora , Toxoplasma an Genus Plasmodium 4 species may give rise to malaria: P. vivax, P. malariae, P. ovale and P. falciparum. Habitat fed blood cells and certain tissues. Sexual and asexual forms occur in the blood. Definitions ‘Trophozoite: The growing form in the blood of man including the ring form Schizont: A form inthe process of dividing asexually and"immature” at the beginning and “mature” when the division is complete and the parasitized cell is about to rupture. asexual reproduction by which the nucleus and cytoplasm divid into Schizogony: Process or cycle of ing called mersoite. many subsidiary parts simultaneously in the liver and red blood cells, each part b Sporogony: A process or cycle of sexual reproduction resulting in the production of sporozoites, which ‘occurs in the mosquito. Gametocyte: The stage of the parasite containing the gamete Gametes: The male gamete (microgamete) and female gamete (macrogamete) before fertilization Zygote: Fertilized macrogamete ) Ookinete: A zygote capable of moving Oocyst: an ookinete which has settled down, become rounded and covered with a membranous cyst wall. Geographical distribution Malaria parasites are found in the tropics, sub-tropics and parts of temperate regions. P. vivax is cosmopolitan, unlike other species is well adapted to temperate regions. P. malariae has a wide but patchy distribution in warm climates. P. ovale is the rarest, and appears to be confined to tropical Africa. P. falciparum is cosmopolitan, commoner in tropics and sub-tropics. This is responsible for over 90% of the cases in Kenya. Control and eradication has considerable affected the distribution in the world. HabitatIn the bodies of Anopheline mosquitoes during the sexual cycle. in the cells of the liver and in redblood cells of man during the asexual cycle. There is age specific invasion of red blood cells by different species ed bi of malaria parasites. Morphological characters Stained in Leishman and Giemsa stain their appear in the i 6 1e form of a ring consisting of a dot or rod shaped nucleus of chromatin, which is red, a peripheral ring of cytoplasm which stained blue, and a clear area, like a vacuole in the center which is not stained at all. Details of size and morphology vary with the species. The shape of the gametocytes are different in different species. Life history This consists of two cycles or phases of development: 2) Schizogony (asexual multiplication) in the tissues of man, which is succeeded by schizogony in the in the blood stream. b) Sporogony, the sexual cycle which occurs in the body of an anopheline mosquito vector Pathogenicity and symptoms All malaria parasites are pathogenic to man, causing fever rogours and anaemia, with enlargement of the spleen. id day, i.e, every 48 hrs is caused by P. vivax and P. ovale, Tertian cases of malaria with fever every thir .d, and the former more chronic with frequent relapses. the latter being milder and more easily cure InP. malariae there is fever every 4" day, i. every 72 hrs and relapse at long intervals. In P falciparum fever occurs every third day and is more serious, Le. malignant tertian ‘Aneamia shock and high fever occurs as the parasites congregate in the capillaries of internal organs and slowing or stoppage of blood flow usually leading to death of tissues, e.g. brain within 2 short time. Diagnosis ‘A blood film in the absence of an antimalaria drug in the blood within a week after taking drug. Thick ‘and thin blood films are made, air dried and thin film fixed in methanol and both stained in Giemsa. ‘After 10 min epending on the concentration of stain, is washed, air dried and examined under oil immersion. Control of malaria Case management MIP/IPT Vector control: ITNS AND IRS THE COCCIDIA¢ the intestine of the host, IIs of ¢ re found in J restricted to her host. some 2 The parasitic Coccidia have similar life cycle as malaria, b except for 8 period outside the body during passive transmission to anote Gecper organs and a few have unusual ite cycles involving intermediate Noss Genus Isospora Isospora belli Habitat: in epithelial cells of the villi of the small intestine Morphological characters * In the cocyst stage only: A transparent and colorless oval, pear-shaped or spindle shaped body with thick walls. Geographical distribution: In the tropics and sub-tropics Life history Mature oocyst transforms into two mature sporocysts each with four elongate and infective bodies, the sporozoites attached to a spherical residual body. All the stages can be detected in the faeces. The sporozoites are believed to enter the vill of the next host through, undergoes cyclical and morphological development similar to that or malaria resulting in the production of oocysts which escape from the host cell to the gut ready to be passed in faeces. Pathogenicity: Uncommon infection associated with diarrhea, abdominal discomfort. Complete recovery occurs in a few weeks. Diagnosis: By finding characteristic oocysts in the faeces. Toxoplasma gondii Geographical distribution: Probably cosmopolitan Habitat: In the viscera, musculature, lymphatic glands and central nervous system of man, a large number of domestic and wild mammals, and birds. Parasites are usually intracellular in the reticuloendothelial cells of various tissues and in mononuclear leucocytes. Morphological characters Crescent shaped, in dried blood films stained in Giemsa. Parasites occur in pseudocysts of leucocytes with distended cell membrane and nucleus pushed to the side. Life history ‘Asexual toxoplam stage in one or more intermediate hosts are ingested with the muscle by a cat develops like Isospora in the epithelial cells of the intestine asexually and themn sexually. Oocyts are passed in cat faeces, infective to man and other susceptible animals where they develop as toxoplams Pathogenicity‘Small inflammatory focus free or in macr¢ ir ‘ophages or psedocysts, partic particularly the centr a In some cases enlargement of lymph glands, fever. Grave congenital infection ee omea infected mothers, with high mortality and mental defects. a Diagnosis In ocrontages fs the blood or cerebrospinal fluid detected with some difficulty. Serology by CFT, intracranial inoculation of mice using autopsy or biopsy material producing peritoneasl exudates in mice Sarcocystis Many species have been described, with S. lindmani infecting man Geographical distribution: probably cosmopolitan Habitat: Muscle of domestic animals — sheep, pigs, cattle, horses, ducks and many wild animals, very rarely man. " Morphology: Some species may be visible, crescent shaped. Life cycle: Cannot be transmitted directly totother intermediate hosts. n susceptible carnivore parasite develops as in Isospora. Pathogenicity: Not very significant HELMINTHOLOGY |: PHYLUM PLATYHELMINTHES ‘These are dorso-ventrally flattened endoparasitic worms with solid bodies without a body cavity. There is no vascular or respiratory system, but have an elaborate bilaterally symmetrical excretory system. The Phylum contains two Classes of medical importance, Cestoidea or tape worms and Trematoda or flukes CLASS CESTOIDEA Habitat Adults are exlusively n the intestines of man and certain other mammals. Adults consist of a head (scolex) and sucking organs sometimes with hooks in ‘addition. The sucking organs are for attachment to the host intestine. The posterior part of the head is @ proliferating area continuously budding off younE segments (proglottides) forming 2 long chain known 2 ‘trobila or a colony of individual progiottides‘through which the Uterine pore if present is on the ventral surface. The cuticle contains fine pores parasite obtains nutrients. containing small Mature egg contains an embryo known as an onchospere, 2 ball of cells te Earth A EBHOs hooks. The onchosphere of a ‘tapeworm has six hooks, as SO iscalled a _ aD are and outermost egg shel usually enclosed in one or more envelopes an innermost ‘embryophor Order Pseudophyllidae The scolex has two slt lke sucking grooves (bothria) and is not armed with hooks. The genital pore Is iterine pore. rr ated on the flat surface of the segment and uterus opening by a separate J Diphyllobothrium latum This is the only member of the Pseudophyllidea parasitic to man. of most of the great Geographical distribution: Europe , America, China, Japan. Occurs in the vic lakes of the world Habitat ‘Ault occurs in the intestine of man,cat, dog, foxes, bears, seals etc. Intermediate stages in Cyclops or Diaptomus and fish of various species ‘Morphology Usually 3-4 meters long, sometimes 10 m or more, yellowish grey ‘and consisting of as many as 3,000 segments, and 1-2 cm broad. The segments are broader than Jong and the genital pore is on the flat surface, The eggs are yellowishor brownish and operculated and rnon-infective to man. Life history ‘the ovumn/egg develops into a hexacanth larva or onchspher in water in about 2 weeks enclosed! in a Wicate membranous embryophore, which eventually acquires a covering of cilia. The opeculum fs then pushed open and a mature coracidium escapes and swims freely If swallowed within 12 hrs by Cyclops oe Dlaptoms the clare shed and the larva migrates into the body cavity ofthe new host. After further Gevelepment tis called a pracercoid. A few weeks later after development itis infective to the second hast ofthe larva, when the Crustacean is swallowed by one of the smaller plankton feeding fish species I surrows though the intestine of the fish, develops and becomes a plercercoid, usually n the fat of the mesentery and muscles. These are eaten by man and larger species of fish e.g, salmon, pike, perch and gravling. Mature procercoi i only infective to man eaten in raw or insufficiently cooked fish and isthe read of the future worm. It attaches itsel to the intestine and gices rise to segments, becoming an adult in about 4 weeks. biagnosis: By finding characteristic operculated eggs i" faeces and segments which are broader than long.pathogenicity: Severe anaemia in about 1% of cases due to ab sorption it Patplood formation lassitude and abdominal disturbance HE ee a ae! 2 Order cyclophyllidae intapeworms of this Order the head bears four suckers, the genital pore on each segment is situated on the lateral margin. The uterus is closed sac without ‘communication to exterior, and therefore the eg& ‘an only escape when the segment Separates and! ruptures, in the genus Taenia the rostellum is well Geveloped, sometimes armed with a double circle of hooks, alternating large and small. The uterus consists of amedian longitudinal stem with lateral compound branches. The number of branches enables two medically important species to be distinguished, T. solium and T. saginata. Gravid proglottides are longer than broad, dlistinguishin them from those of D; latum. The eg8s POsses® thick radially striated embryophore which can survive on the ground for a few days to 4 months depending on humidity and temperature. Development does not occur ‘outside the body. When swallowed by 2 suitable host the hexacanth embryo hatches and migrates int the tissues where it develops into a ysticercus, which is infective after maturing in 2-3 months, after which it degenerates and dies. When meat containing infective cysticerci swallowed by a suitable host the meat and capsule |S digested, the head of the larval worm evaginates snd and attaches itself to the mucosa of the small intestine by the suckers, and hooks if present. Taenia saginata Geographical distribution: Cosmopolitan, common particularly in communities eating uncooked or undercooked beef, and occurs much more frequently than T. solium. Habitat: Adult in the small intestine of man only. Eges passed in human faeces individually or in gravid proglottides are infective only to cattle. Larvae are in the musculature and heart of cattle only. Morphological characters ers long and up to 1.4cm broad and differs from T, solium in that the head does not Measures 3-4 met pear hooks and is somewhat larger up t0 2 ¢™ road when gravid. Mature uterus bears 18-30 ‘compound branches on each side ‘compared to T. solium which has B12 Life cycle ges passed by man in faeces directly or In proglottides contaminate pasture of water in ponds or from ites of infection are muscles of the jaw, heart diaphragm, shoulder and oesophagus sewage. Common si Cysticercus dies within about nine months. ‘Man gets infected by eating ‘2 OF undercooked beef. Pathogenicity symptoms are usually mild, sometimes indigestion wit either diarrhoea or constipation, vorntngs loss of appetite and anaemia Diagnosisns after boiling to 1d up to the light ult to obtain. e or hand le! ‘ite when hel Proglettides with 18-30 lateral branches of uterus ‘examined head is diffic kill eggs and pressing them between 2 glass slides. They appe ‘The wags are indistinguishable from those of T. slium, and in both sPeck Taenia solium Geographical distribution: Cosmopolitan among those who eat pork inata. Larvae are Habitat; Adults in the small intestine of man only, much rarer than T. saginata. usually in the musculature and other organs ie it fe of man. rns ofthe pig, and also, accidentally in the subcutaneous tissue, brain, orbit and musculature Morphological characters The rostellum bears a double row of about 28 hooks, a fully developed uter' stem with 8-12 lateral branches on each side. us has a median longitudinal Figure 2. T. solium segment life history ‘Man gets infected by ingesting the cysticercus form in undercooked pork. Pig gets infected with larval for Cystricercus cellulosae through eggs which have been passed in human faeces, infective in about ten days and may survive for in pigs flesh for several years. Commonly found in tongue, forearm thigh and neck. Ccysticercus cellulosae is a colourless bladder the size of a pea with milky white spot, the scolex, the size of a pin head. When swallowed by man the bladder is digested, the scolex evaginates and attaches itself to the wall of the small intestine. This produces a chain of segments becoming a mature T. solium which produces eggs in about six weeks. i wy Man becomes infected with cysticercus by drinking water or eating undercooked food especially vegetables contaminated by himself or another person with the age stage. Sometimes owing to gastric disturbance gravid segments and eggs are regurgitated and hatch in the stomach — an equivalent of thousands of eggs being swallowed.Figure 3. E. granulosus adult worm Morphological characters ‘he adult worm is very small 2:9 mm long, 0.5mm broad, comprising a head and 3 segements, the last Dre gravid and longer and larger than the rest, The head has 28-40 hooks in a double crown, The larva oreyst grown slowly toa diameter of 1m in five months, eventually attaining the size of a child’s head snd full of fluid with a sediment called the “hydatid sand” of scoleces. Life history ges deposited on pasture by canine carnivores infect herbivores. Eggs are viable for about two weeks under dry warm conditions but for months in colder condition. Man becomes infected by ingesting wvater, vegetables contaminated with dog faeces containing eggs, or handling handling the coat of infected dogs causinmg accidental infections, Pathogenicity Frequently serious pathogenicity, depending on the location of the cyst: Liver (60%), lung, peritoneal cavity, Eventually there is tissue reaction and the cyst is surrounded by a stout host tissue, thus isolating the parasite in smaller cysts. Diagnosis bifficult to detect the small worm in dogs and canines. Diagnosis ofthe hydatid cyst is by ultrasound and an intradermal skin test called Casoni test, which is 50-100% accurate. Treatment is by surgical removal, or the use of anthelminthics in smaller cysts. CLASS TREMATODA and some are cylindrical in shape. They are hermaphroditic except for ate. The alimentary canal is a blind tube with a mouth. Adults ves by means of two suckers. Strictly parasitic trematodes igenea. they require one or more intermediate hosts to itic Monogenea, require one or more intermediate sexual (in the adult These are usually leaf —like, schistosomes in which the sexes are separ: are in or on vertebrates and attach themsel ‘are endoparasitic and belong to the sub-class complete the life cycle and, unlike the non-parasi hosts to complete their life cycle. The Digenea life cycle involves two generations a s stage) and an asexual (in the larval stages) . In Digenea the following laraval stages occur: Miracidium. A ciliated and first larval stage which develops in all trematode eggs, infect6ive only to mollusks, sporocyst. The next larval stage in mollusks, as a thin walled sac with a mass of proliferating cells. ‘Asexual reproduction in schistosomes occurs only at this stage.ie sie the larvae have been recorded “Te effect ofthe adut worm is asin Tsaginata. in eystercereus celulOsS" ue, brain, orbit and from practically every part of the human body, most commonly su st calcification of ital organs, tnuscles iis dangerous when this occurs in the brain, eye or other VEAL OTHE To of mental older cysts. It is a commonly identifiable cause of epilepsy and m: be ay disorder. Diagnosis x, in Cysticercus cellulosae if the cysts are superficial they can As in. saginata inthe adult stage, Howeve ae ag ss calcified cysts. be excised and examined. Otherwise diagnosis depends on X-ray in Echinococcus granulosus gions. Infection Geographical distribution: Cosmopolitan, but common only in sheep and cattle rearing rei of man shows a patchy distribution in many parts of the world Habitat ‘Adult worm net in man but in dog, jackal,wolve, etc., which are definitive hosts, attached to the mucous membrane of the small intestine, appearing as small whitish specks on the reddish mucous membrane. Eggs in faeces , indistinguishable from other Teania eggs from the host, are infective to man, and to domestic and wild herbivores. They may be found free in the faeces or in gravid proglottides, which subsequently ruprutes on the ground or on the coat of the animals host. The larva forms the hydatid cyst inmany species of herbivore animals, particularly sheep, cattle and horses, in practically every organ but mostly liver and lungs. Infections also occur in man, and high transmission and infection rates occur in the Turkana district of Kenya.Redia, This is the next larval stage occurring only in molluscs, with a mouth pharynx and a blind end gut. Asexual reproduction occurs at this stage, except in schistosomes where this stage does not occur, Cercaria, Ths is the final larval stage developing in mollusks, a miniature adult with a tails for swimming in water after leaving the snail. Depending on the species of organism this stage penetrates nto the final host, or into a second intermediate host e.g. fish or crustacean, or encysts on vegetation in water. Metacercaria, Cercaria which has shed its tail and has encysted on vegetation or inside tissues of @ second intermediate host after penetration before becoming adult. Trematode worms or flukes vary greatly in size from the most minute (1mm long) to several centimeters. Have an external cuticular layer with spicules and other preturberances. Suckers are present in all species. Those of medical importance have two: oral and ventral suckers. A third sucker: the genital sucker is present in the genus Heterophyes. Sub-class Digenea ‘A sub-class of Digenea with the mouth at the anterior end surrounded by an oral sucker. In species of medical importance multiplication is in an intermediate host from egg to adult, in the Families Schistosomatidae, Ophistorchiidae, Fasciolidae and Troglotrematidae. Family Schistosomatidae “The male is rather broad with lateral margin folded into a gynaecophoric canal in which the female lives. ‘The female is longer than the male and fliform. This genus measure up to 2 cm in length and about Trem in diameter and lve in the portal vein ands radicles, with greatest numbers ‘of mature worms venous plexus ofthe rectum and bladder in. mansoni ands. haematobium respectively ‘Schistosoma haematobium SE tin In var Cyprus, Southda Portugal, Mau Habitat . Adults in pofal vein and its radicles especially the vesical plexus of man, ocassionally in rodents and bakoons. Eggs in.urine, rarely in faces. Infective only to snail. All the larval stages occur in freshwater snails, €.g. Bulinus tuncatus and other species of the same genus in Africa. infective larvae escape from the mollusk and have a short free swimming life in water They penetrate unbroken skin of man and occasionally rodents and baboons. us parts of Africa and in Madagascar, and sporadically in Midcle East, ius and India, Morphologyga cylindrical senting read-like, ‘The male worm is colourless 1 em long lateral margin curved ventrally PITS’ rica, thy Sppearance, doral surface covered with small tubercles. The female wor ‘often redish black in colour and twice longer than the male. .e at on e pole. ‘The eggs are compact, elongate spindles, dilated in the middle with & terminal spin Life history ‘The eggs are passed in urine particularly in the first and last portion ofthe flow. When passed e685 contain ciated miracidium which hatches when urine is diluted in water and swims about in search of the laral host within about 36 hrs ofits Ifespan. ft penetrates the soft tissues ofthe snail losing its cilia, becomes a sporsocyst and migrates to the visceral mass where proliferation occurs forming numerous daughter sporscyts. 3 weeks later the next generation of sporocysts turn into cercariae, esape into water and within about two days life span will penetrate unbroken human skin liberating its tail. By means of lytic ferments of their penetration glands and active movement ‘eventually reaching the venous circulation, the lungs and the systemic circ! portal system where they become adult. it these penetrate the tissues .ylation and are carried to the Pathogenicity Paired worms migrate from the portal vein to the visceral plexus where eges are laid. Eggs pass through the tissues aided by lytic ferment from penetration glands of the miracidia and reach the mucosa of the bladder wall, Some pass through the bladder wall to the urine while others calcify form sandy patch appearance. The presence of the worm causes eosinophilia. Eggs ulcerate through and haemorrhage ‘occurs causing passage of blood and eggs in urine. Liver and spleen frequently enlarge, sometimes with pain in the bladder region and sometimes in the rectum with symptoms of dysentery. Diagnosis By finding terminally spined egg in urine, rarely in stool, and by examining recta tissue removed by biopsy. Schistosoma mansoni Geographical distribution. Africa especially Egypt and the wet tropical region, West Indies and east coast of tropical South America Habitat, Adults in haemorroidal plexus of man and certain species of rodents and babtons. Eggs are found in faeces and rarely in urine, infective only to freshwater snails.Figure 4, 5. mansoni egg The rest of the facts are generally as in 8. haematobium from urine (rarely in faeces) ‘japonicum is a parasite of man mainly in the Far East: Japan, China, Thailand, Vietnam and Philippines. itis also parasitic in other mammals e.. cattle, horses, buffaloes, pigs, rodents, dogs and cats. Eggs occur in faces and the life cycle is as in’S. haematobium. Several other species of schistosomes normally parasitic in other mammals have been recorded as human parasites,e.g. S. intercalatum, S, mathei, S. bovis and S. rodhaini. ther parasites of the Sub-class Digenea occur in Families Opisthorcidae which are maily human parasites ofthe Far East, e.g. genera Clonorchis and Heterphyes. Others are Family Fasciolidae which are parasites of man and herbivorous animals throughout the world in Genus Fasciola and restricted to Far East in Fasciiolopsis HELMINTHOLOGY II: PHYLUM NEMATODA These are elongate, cylindrical, and unsegmented worms with a body cavity but without appendages They include fliform worms. This Phylum constitute numerous species of true roundworms some of Which are free living and others parasitic. The eggs of parasitic nematodes are never opeculate, and in ‘ne genus plugs are present at the poles. Usualy the eggs rupture to release the larvae, while other oe odes are viviparous, the larvae hatching in the uterus giving birth to an active ara, During growthi and the moulting is necessary for sti larvae cast their skin because the cuticle is only slightly ela expansion. SUPERFAMILY ASCARIDOIDEA. itic to man. e species parasi a number of stout worms of large size. The genus Ascaris contains the type SP Ascaris lumbricoides Geographical distribution: cosmopolitan Habitat: Adult is in the intestine of man, usually the small intestine, but wander haut 4 es body and may be found in other locations. Eggs are found inhuman faeces, non in felis whe passed, but become infective later when larvae inside the egg develop in the soil, water green vegetables o Figure 5. A. lumbricoides ege Morphology Ti isthe largest ofthe human infecting nematodes. The male is slightly smaller than the female, being about 25 cm by 4mm breadth. The posterior extremity is pointed and curved ventrally in the form of « hook The female measures up to 35 cm by 5 mm breadth, posterior extremity conical but straight, nat curved. Life history The eggs are not infective until the larvae have developed and become segmented a few weeks after being passed. Man becomes infected by swallowing water, green vegetables and soil contaminated witheggs containing the infective larvae. Childi . Children are particularly i sratinges which contaminate the mouth osferngifecessiangustee ‘The eggs pass through the stomach and hatch in the small intestine, They burrow into the wall of th intestine and enter into the blood circulation. They are carredi to right side of the heart snd eventual to the lungs. They remain in the alveoli of the lungs for several days during which pe theyre ea moutt. They are then carried up the trachea, pass over the epiglttis and down the esophogus tothe stomach and intestine where they moult and become adult. The time taken from leaving the intestine until their return there is about 10 daj ys. They then grow from about 2mm to the maximum in about 2 months and thereafter live for about a year. peat Pathogenicity Asa rule the symptoms are mild, However, in the early stages of heavy infection the migration of the larvae through the lungs gives rise to haemorshages and to oedema and exudation, amd may produce symptoms similar to lobar pneumonia, This may cause death in young children Allergic man fest“ may result from the presence of these parasites. Migrating worms may be vornited or es¢3Pl- through body orifices. If numerous they may obstruct the lumen of the intestine, oF may penetrate the intestinal wall causing peritonitis. Diagnosis. Based on the identification of worms passed or on finding characteristic e885 stool samples. In children detection of infection in the mother or sputum of the infant for the larval stages of Ascaris may be necessary in cases presenting with symptoms of pneumonia. SUPERFAMILY OXYUROIDEA Have a globular enlargement of the posterior end of the oesophagus, and the posterior end of the female is long and tapering. Enterbius vermicularis Geographical distribution. Cosmopolitan Habitat. The worm is a common parasite of man especialy of children. The YON and mature worm Secure in the terminal ileum, but the gravid female lives inthe colon, especially the rectum. Eggs are deposited on perianal skin where infective larvae are found in eB8s on buttocks a few hours after being passed Morphology. The male worm measures about 4 mm by 150 um dlametel, the posterior extremity aero and charply truncated. The female s much larger, about 1cm by 400um diameter with long tapering tall straight tail. The eggs are asymmetrical with one side 2 litle flattened.Figure 6. €. vermicularis eggs Life history of eggs may be found on the buttocks. This causes lothing, bedding, which may be transferred to the ‘mouth or inhaled in dust.athoge be severe and it i i ay cause pruritis which may icity, Many subelinical infections, But some sf rene Farigue and loss of sleep. APPENEICIS Yay resuit from invasion of that orB® se of piagnosis. By demonstrating characteristic eggs on perianal skin BY means of a swab or the ‘adhesive tapes and microscoPY SUPERFAMILY RHABTIDOIDEA ave alternate free living and parasitic i ther free living oF hi a ‘of minute worms which are either 3 se medal Anumber vit muscular oesophagus. one Bens, ‘strongy/lol existence. Allhave a promine! importance. ‘strongyloides stercoralis Geographical distribution. Hurnid ‘tropical countries abitat. Probably only females occur buried deep in the mucosal glands of the duodenum and jejunum, petieved to reproduce parthenogeneticall. The ormal host is man, But certain domestic and wild eimals may act as temporary hosts. Larvae not eBBS3f° passed in human faeces. Infective larvae found in contaminated soil and water. Morphology. Parasitic form Parasitic females are 2.2mm long by SOum breadth, only detected post mortem by scraping the mucose ‘and examining under low power magnification. esophagus is one third the length of the Body and is cylindrical. in gravid worms the eggs numbering about 20 are conspicuous within the body, almost 95 tproad as the diameter of the parasite. They lie sntero-posteriorly in a single file joined by 2 fine sheath-like membrane. The eggs are transparent, thin aiid and contain larvae ready to hatch. They are laid and readily hatch in the mucosa and bore their vray into the lumen ofthe intestine and are passed out in faeces Free living form ‘ihe female measure about 1 mm long by SOum in breadth. The oesophagus is short and club shaped ith @ bulb atthe posterior end. When gravid the eggs about 40 in ‘number lie in a chain, in one file each ve almost the breadth of the body, and they extend over half the length of the worm. The male worm smaller about 700 um ong by 45 um with a tal very sharply flexed. Life history dt era iments sf the mucosal glands deposit eggs in strings joined 2 fine ensheathing fe nba pasar ibs hatch and migrate into the lumen of the intestine from where they ere eee (es 1 larvae may either give rise to a free living generation or those directly ‘man depending on ambient conditions. Those larvae which chang with long evlindrical oesophagus are infective to man. Je into filariform laravaebut ive hook worm larvae bling infect iform larava producing more ion, one pair of rhab Others moult and directly change into filariform rese! distinguishable, resulting in considerable multiplicati infective filariform larvae. form larvae becoming filariform and Ifthe free living phase is omitted there is no increase, each rhabti infective. iting the next host, usually by vveral weeks awaiting t! circulation into the heart and lungs where Each filariform larva can remain infective and viable for se .d develop into adult. Thereafter they penetration of unbroken skin, entering into blood and lymph they break into alveolus and bronchioles where they moult an‘ a migrate up the tachea through the oesophagus to the intestine. Fertilized tor most pean te parthenogenetic ) females burrow into the mucosa where they eventually produc a Be an Gr from penetration of filariform larvae to passage of rhabtidiform larvae in the faeces i weeks. Pathogenicity Penetration of the skin by larvae may cause dermatitis with pruritis and urticaria. Their migration commonly causes itchy wheals on the buttocks> If the infecting dose is large pulmonary symptoms may follow the migration through the lungs. The adult worm may cause diarrhea by burrowing in the mucosa. Diagnosis. The presence of larvae in freshly passed, or appropriatel preserved unconstipated stool is absolutely diagnostic. SUPERFAMILY TRICHUROIDEA, Worms with thin hair-like anterior and much stouter posterior. The oesophagus is non muscular, Consisting of a narrow channel running through a column of large cells arranged in a single file. This “ Superfamily contains two genera of medical importance, each with a single species, Trichuris trichura Worms morphologically similar to the human infecting species can be found in almost any animal, particularly in the caecum of sheep, pigs and cattle, in the faces of which the eggs can be obtained. Geographical distribution. Cosmopolitan, especially in warm moist regions. Habitat. Adult in the caecum of man, also appendix, ileum and colon. Eggs passed in human faces, but not infective. Infective larvae found in eggs in the soil, water and green vegetables. Morphological characters Resembles a whip, the adult worm being compost of a hair like anterior roughly three fifths the length of the body and a much stouter part comprising the remaining two thirds, The whole of the anterior hir —like part is buried in the mucosa of the intestine parallel to the digestive tract.. The male measures 4emin length by 2 mm at the poster Sm sc Dine cha posterior end, The f 28 are brown, barrel shaped wit vier conahetnalen’ ad oni \aped with a plug each pole. They contain a fertized aeemenel = Cr 4 * \ \ Figure 7. Trichuris trichura adult worm Life history Development of the egg is’ completed in damp soil, infective three or more weeks after being passed, viable for several weeks. infection takes place when eggs containing infective larvae are swallowed, possible as a result ‘of contamination of hands or by. pollution of drinking water or food, especially uncooked vegetables. The eggs after being swallowed move down to ‘the caecum where they hatch and grow directly to the adult. Pathogenicity. Usually moderate infections occur which may be of little importance. . However, diarrhea end mild gastric disturbance occur, including appendicitis if the ‘appendix is involved. Diagnosis. By finding characteristic eggs in stool. Trichinella spiralis Geographical distribution. Cosmopolitan among most pork eating acts Habitat, Essentially a disease of rats, both enzootic and epizootic. Among other animals the most susceptible is the pig and man. The adult worms live in the duodenvry ‘and jejunum. No eggs are seared into the intestine, and eggs ae laid by the female into the i”mph and blood stream, and encyst inthe muscles, Infective larvae are found encysted in the flesh of man, PIE and rat. Morphology. The male which is rarely found measures about 2.5 mm long and 40uum broad. The female which is viviparous is about 3mm by 6umFigure 8. T spiralis larval cysts in muscle Life history ‘B host are necessary, both of which are infected by both larval and adult stages. When rats eat a portion of another containing encysted larva the latter rapidly become adult male and female worms in the intestine. Following fertilization the female burrows into the villii and lymphatic duct and in 5 days begin to liberate larvae into the lymphatic and blood vessels for the next two weeks, They are carried to all parts of the body, and only those which reach striated muscles survive to become infective. Most active muscles such as tongue, diaphragm, throat, eye and thorax. They become infective during the third week as they coil up between the myscle fibres and encapsulate. They remain infective for several “years, but most die and calcify within a year. Pigs become infected by éating portions from other pigs in garbage; and man become infected by eating insufficiently cooked pork. Pathogenicity Most infections are small and symptomless. In clinical disease these are gastro-intestinal symptoms as the worm burrows into the mucosa and vill of the intestine, e.g. nausea and vomiting and diarrhea and heamorrhage. During the second week there is sever muscle pain, oedema of the orbit, fever and eosinophilia. Encystment of the larvae and repair of the muscles begin towards the end of the third week of infection. The individual may die or recover depending on the severity of infection. Diagnosiss Towards the end of the second week of infection by examining tissue preparations for larvae under low Power of the microscope. A biopsy of muscle is pressed between two microscope slides . Alternatively the tissue is digested using artificial gastric juice for several hours at blood temperature and the deposit examined for larvae.SUPERFAMILY STRONGYLOIDEA, This embraces all ne: matodes in wt hich the males posses bursa copulatrix, a membranous expansion of the posterior end su pported sapien tes wr A te bys of stouter tissue. The oesophagus is muscular and club shaped . The “americana, Both possess’ bat oosth of parasites of man, Ancylostoma duodenale and Necator den oped into cating af ‘ge mouth cavity(buccal cavity) lined with chitin, poprtions of which are ‘gans, teeth in A. duodenale and plates in N.americana. The anteri of the worm is bent, hence the name “hook worm” lor extremety Ancylostoma duodenale Geographi ibuti Ge graphical distribution. Endemic in any country without long freezing temperature and where the living standards of hygiene are low. This includes mu a ‘ch of the tropic among rural peasants, and also in Jemperate region in mines where temperarure and humidity are favourable Habitat. Adult worm lives in the jejunum and less often in the duodenum of man. Eggs passé in human faces are not infective to man. infective larvae are found free in the soil and water mostly by burrowing into unbroken skin. Morphology. Mature worms are cylindrical, plump, rigid and creamy white in colour. The anterior extremity is bent alittle dorsally. The buccal cavity is large and conspicuous. The male ‘worm measures 1 cm long and 500um diameter ‘The female about 1.2 em long and 600um broad. The eggs are oval and colourless. 1 Figure 9. A. duodenale buccal cavity Life historyJin the presence of sufficient belie The m ii +t. After testinal tract the length of the intestin : a babies unbroken skin, migrate to the eal qlee + they leave the circulation and enter the Sees through the stomach to the ually mature and may i warm s Alarva hatches out of the egg in 24-86 hrs naa newly hatched larva has rhabtidiform oesophagt moulting it becomes active and infective. nfacio he heart an and lymph vessels and are carried to the ee alveoli, pass up the trachea, over the epiglottis, down the oesork hoe a duodenum, After moulting and developing internal organs t! live for 1-5 years or more Pathogenicity i i is ground-itch. Penetration of infective larvae causes popular urticarial eruptions of the skin ke L a euncieny Depending on the worm load varying degrees of host resistance, nutritional statu: ecco infection, physical work or pregnancy there may be varying degrees of severity of anaemia. in lassitude, dyspnoea, palpitation of the heart and oedema of the feet and ankles. By finding characteristic eggs in the faeces. Diagnosis Necator Americana Figure 10. N. americana buccal cavity Similar to A. duodenaale in many respects. But: The species differs from A. duodenale in the following points; The anterior extremity is more strongly bent and the worm is slightly smaller, 't has plates rather than teeth present in A. duodenale, and takes much less blood ‘N.americana produces much smaller number of eggs than A. duodenale ‘SUPERFAMILY FILAROIDEAThe adult worm in the Superfamily is relativel cutan uutaneous or connective tissue, or of the | ly long and thread like. They are parasites of the sub- that is they give birth to lances mBbati sistem or serous cavities. They ae all vviparous require a second host to arcana oy ets. norder to complete the development the larvae rceptionaly Vong onc ee ance festive forms to man. In ths superfamily the genus Onchocereais recovered i i demonstration of the larval form from peripheral bond andskin a ae Anatomy of the laravae or microfilariae Preparati ne aoe ton dried films fixed and stained show certain diagnostic characters: \ce oF absence of a sheath ~ present in 3 species of microfilaria foun W.bancrofti, B. malayi W. and L. loa The arrangement of the column of nuclei representing the rudiments of the animals organs running=g from the rounded head to the pointed tail of the larva or stops short of this Source of material - from skin, blood, lymph etc. 1d in the blood only 2 3. Periodicity. Certain species of blood inhabiting microflariae appear in peripheral blood in greater vrumbers st about midnight and decrease to 2 minimum or zero at mid day, a phenomenon known 25 nocturnal periodicity (W bancrofti and B.malayi) owever, in some strains of these two parasites periodicity isnot marked, and these strains are said to bbe sub-periodic TnL loa microfilaria are diurnal periodic, being present in maximum numbers at midday and minimum numbers at mid night. Thus of Mansonella perstans show no such variation, occurring n more or less the same numbers throughout the day and night and are said to be aperiodic. The periodicity is related to the biting habits of the insect vector, which may be either, night or both in some cases. Wuchereria bancrofti Geographical distribution. Tropics and sub-tropics chiefly in Africa, Asia and America, but in coastal belts from the Mediterranean to the pacific between 40.N to 205 latitude Habitat, Adult worm found inextricably colled in lymphatic glands , in superficial absceses or lying in lymphatic vessels or wandering in retroperitoneal tissues of other sites. Microfilaria periodicity in the treed depends on the strain, Developmental forms of microflaia derived from peripheral blood are found in the gut and muscles of certain species of mosquitoes producing infective larvae Morphological characters ‘Adult males measure about 4 cm long by about 120 um broad. The posterior end is curved ventrally. The ‘adult female is about 8 cm long and 250um broad. Life history Mircrofilaria from blood depending on periodicity are taken up by culex, Aedes and Anopheles mosquito host during blood meal. In the gut the larva loses its shealth, passes through the gut wall and the haemocolele within 24 hrs and invades the muscles of the thorax. Here the actively motile larvae settlea down and become quiescent, assuming 2 sausage shape while development of rudimentary internal organs of the parasite takes place. After moulting and growth the larva becomes active again and moves from the thoracic muscles to the head region and proboscis ready for transmission. There is no multiplication. uring feeding of the mosquito the microfilariae permeates the broken skin and migrates to the lymphatic vessels and glands and within 8 months to a year become adult. Fertilization takes place in the lymphatics and the resultant microfialriae eventually reach the blood vessels via the thoracic and right lymphatic ducts. Pathogenicity F ‘The worm causes irregular fever, lymohangitis, enlargement of the lymph glands, hydrocoele, thickening of the skin and elephantiasis of the legs, scrotum and vulva, and less commonly of the arms and breast, and other symptoms. Diagnosis Examination of fresh finger prick blood under coverslip at low power and an appropriater time depending on the periodicity of the microfilariae species. Depending n the results or alternatively make a thin and thick film of the blood for appropriate staining and examination and determining the species of the infecting parasite. srigte maton Geographical distribution 4yietnam, Thailand, Malaysia, Indonesia, India and Sri Lanka. Habitat./Adults in dilated lymph vessels of man only. Sheathed microfilaria found in the blood ifetominanty at night ,except in certain strains of sup-periodic infections in Malaysia. Infective laravae jevelop cyclically in mosquitoes of the genera Anopheles and Mansonia breeding in rice fields, coastal swamps and fresh water swamp forests. , ‘Morphology. Both sexes are relatively smaller than W. bancrofti, and the microfilaria tend to be smaller and characteristic of this species. Life history. Development in the mosquito is similar to that of W.bancrofti Pathogenicity. Similar to W. bancrofti, except that scrotal involvement does not occur. Diagnosis. By finding characteristic microfilariae in peripheral blood at an appropriate time depending on the strain of 8. malayi. Loaloa Geographical distribution. The central forest belt of Africa. Habitat. Adult worm in the connective tissue under the skin, in the mesentery and parietal peritoneum. ‘They commonly migrate rapidly in the body and may be seen crossing the sub-conjunctival tissue of the eye or in thin skinned areas. Periodicity is diurnal, The microfilariae are sheathed. Cyclical developmentoccurs in the gut and muscles of certain biting flies of the genus Chrysops, and development occurs as for B. bancrofti in mosquitoes. Pathogenicity. Worm causes loiasis characterized by swellings in various parts of the body, known as Calabar swellings. These are transient (a few days to weeks) and may be painful if situated over joints. Diagnosis, As in W. bancrofti but the blood is taken near mid-day rather than at night Onchocerca volvulus Geographical distribution. Tropical Africa and Central and South America. Habitat. Adult worms are found in sub-cutaneous nodules and lymph spaces of man. Unsheathed miefilariae occur in nodules and in the skin. Cyclical development of larvae occur in the gut and muscles of blackflies of the genus Simulium in rivers and streams of Africa and America. Morphology. Adult male measures 3 cm by about 150 um and adult female 50 cm by about 400um. Life history. 0. volvuluis in Simulium follows the same cyclical developmental course as for B bancrofti in mosquitoes, However, larvae are obtained by Simulium from superficial layers of the skin not the blood, but laceration using mouthparts. Pathogenicity. This worm causes onchocerciasis in man characterized by irregular fever, lymphangitis and enlarged glands. Later slow growing and painless sub-cutaneous nodules in various parts of the body, particularly on bony protruberances e.g . iliac crest, great trochanter, ribs and limbs in Africa, according to the biting habits of the vector. In America vecor bit the head region and the nodules are almost exclusively restricted to the head and neck producing oedema of the face and severe eye lesions _ In heavily infected areas the incidence of blindness (River blindness) may be as high as 20%. Diagnosis. By demonstration of microfialriae in the skin from skin snips teased in saline and examined under coverslip at low power or air dried fixed and stained appropriately. ‘SUPERFAMILY DRACUNCULOIDEA Dracunculus medinensis Geographical distribution. In tropics and sub-tropics in Africa, Indian sub-continent, Arabi: and South America. It has been eradicated from Asia (Yemen, India and Pakistan). n peninsula Habitat, Adult worm found in the sub-cutaneaous tissues, chiefly of the legs, and inter-muscular connective tissue of man. Gravid female forms a blister though which it releases larvae into water once this ruptures. Cyclical development occurs once the larvae are taken up and ingested by water crustaceans of the genus Cyclops. Morphology. The male measure up to 3em in length and has a coiled tail. The female may be over 100 em long and about 1.5mm broad. Life historyA blister in the skin caused by a toxin from the anterior end of the worm ruptures When in cotanct with water. The anterior end then protrudes and a loop of uterus prolapses through the body wall, ruptures and releases numerous first stage larvae into water. These can survive for 2 to 3 day in water, during which they can be ingested by tiny water crustaceans of the genus Cyclos. When this occurs the larvae penetrate the gut wall of the intermediate host and enter the body cavity where it undergoes development for about two weeks before it becomes infective. Man becomes infected when he swallows water containing the infected Cyclops intermediated host containing the infective stage of larvae. The gastric juice digests the Cyclops but does not affect the larvae, which then burrow through the stomach wall and proceed to wander in the tissues until they reach adulthood. Fertilization occurs after which the male dies. The female migrates to the skin, usually in the lower parts of the body. A blister then forms on the anterior extremity of the worm containing a lytic irritant secreted by the worm. This produces a burning sensation causing the affected parts to be dipped into water by the infected individual over a period of two to three weeks before the larvae are evacuated. The period taken from drinking water containing infective inte4rmediate hosts to the emergence of the adult worm in the blister is approximately one year. Figure 11. Skin blister due to Guinea worm Pathogenicity The worm causes Dracunculiasis or Guine worm disease. The long period of migration of the larvae and Young adults is free of symptoms. Symptoms appear when the adult and gravid female is approaching the skin. These include allergic and toxic manifestations and a burning sensation when the blister forms. The rupture of the blister may result in secondary infection along the track of the worm, with severe inflammatory reactions and formation of large amounts of pus. This may be crippling in multiple infections. The rupture of the worm during extraction may cause a severe anaphylactic reaction Diagnosis This is usually possible only when the characteristic worm has ‘emerged from the skin surface, when larvae can also be demonst4rated in a drop of water from the affected area.