lOMoARcPSD|32262012

Parasite - Lecture notes 1

Parasitology (University of Santo Tomas–Legazpi)

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Stephany Mae S. Chi

PARASITOLOGY LECTURE
2 BS Medtech-1
Parasite Morphology Laboratory Diagnosis Life Cycle Notes Epidemiology Pathogenesis

TREMATODES: BLOOD FLUKES

Specie: Schistosoma Egg: ovoid, round or pear-shaped and pale yellow  Microscopic examination - Eggs take 10-12 days in order to In PH, Schistosomiasis is endemic Mode of Transmission: Cercar
japonicum in color; Longer diameter ranges 46-110 µm while to visualize parasite egg mature in: penetration of skin (results to swimme
shorter diameter ranges from 37-90 µm; with like stool examination and - Eggs require CLEAN FRESH - 12 regions itch)
Common name: small lateral spine difficult to detect even with rectal imprint WATER w/ sufficient oxygen - 28 provinces - Symptoms termed as “Katayam
Oriental blood fluke microscope  Rectal or liver biopsy to - Ideal temperature for the eggs is - 190 municipalities Fever”
obtain eggs 25-30 degrees Celsius - 15 cities - Hepatosplenomegaly
 MIFC- for moderate and - Viable eggs hatch w/in 2-4 hours, - 2,222 barangays - Main pathology and chron
heavy infections liberating a miracidium -National average prevalence is disease manifestation is due
 Kato-Katz- egg - Miracidium infects the first 2.5 % the host granulomatous reacti
quantification intermediate host (Oncomelania -6.8 million are at-risk population to eggs deposited in liver a
 Immunodiagnostic tests hupensis quadrasi) where they -5-12 y/0 has the highest other organs
develop into a sporocyst prevalence of infection - Colonic involvement
- Sporocyst reproduce asexually - Hepatosplenic disease (mo
and give rise to free-swimming serious consequence of chro
cercariae after 60-70 days schistosomiasis)
- Cercariae penetrate the skin of - Pulmonary involvement
Miracidium parts: the definitive host, loses their tail - Cerebral schistosomiasis
 Apical papilla and become a schistosomula.
 Epidermal plates with cilia - Schistosomules differentiate into
 Primitive gut male and female forms then pair
 Pair of cephalic unicellular penetration up.
glands - Female deposits 500-2,000
 2 pairs of flame cells immature eggs/day
 Germinal cells - Egg deposition starts 24th-27th day
after cercarial penetration
Cercaria
 Has a body and a forked tail
 Has an oral sucker and small ventral
sucker
 Main body: 100-500 µm in length and 40-
60 µm traversely
 Tail trunk: 140-150 µm by 20-35µm
 Fork: 50-70 µm long
TREMATODES: LUNG FLUKES
Paragonimus westermani - Adult Fluke: is reddish brown in color - detection of parasite eggs in - Immature egg embryonates in - focal distribution in limited - provoke granulomatous reactio
measures 7-12 mm in length 4-6 mm in width, Stool, sputum or less frequently water, moist soil or leached feces parts of Asia, Latin America (Peru - fibrotic cysts
Common Name: 3.5 to 5 mm in thickness and resembles a coffee in aspirated material from - Miracidium develops w/in 2-7 and Ecuador) and Africa (Nigeria - Most common symptom
Oriental Lung Fluke bean abscesses or pleural effusions weeks and Cameroon) chronic cough usually in the morning a
- Ovary is located anterior to the testes (thru MICROSCOPY) - Pair or group of worms migrates -20.7 M people infected; 292.8 M hemoptysis
and posterior to ventral suckers - Sputum sensitivity ranging into lung parenchyma to develop into at risk - Confused w/ TB
- Vitellaria (helps in reproduction) is 37-88 % adults in about 6 weeks -IN PH: endemic in Mindoro, - Infection usually asymptomatic
branched extensively - Best sensitivity for - Completion of development in Camarines, Sorsogon, Leyte, - Clinical symptoms less seve
- Cercaria is covered w/ spines and has sputum- sputum conc. w/ 3% definitive host takes 65 to 90 days Samar, Zamboanga del Norte, after 5-6 years
ellipsoidal body and a small tail sodium hydroxide w/ repeated - Adult worms known to persist in Davao Oriental, Basilan and - May cause ECTOPIC INFECTION
- Metacercaria is round and measures 381- sputum examinations up to three humans for 20 years or longer Cotabato; prevalence vary - Cerebral involvement is t
457 um times on different days - Cysteine proteases- play an -Infection rates in Sorsogon- 16- most serious complication- may cau
- Chest radiographs w/ high important role in development of young 25 % in 1997 congestion, vasculitis, capillary rupture
index of suspicion parasites -Zamboanga del Norte - Cerebral paragonimia
- Pulmonary Tuberculosis prevalence- 14.8 % in 2005 symptoms- headaches, meningism
should be ruled out DEVELOPMENT: -Food that may transmit fluke: seizures, hemiparesis, blurring of visio
- PERIPHERAL BLOOD Egg- miracidium- sporocyst- 2 rediae- kinagang, kinilaw, sinugba diplopia, homonymous hemianopsia, a
COUNT- eosinophilia (more cercariae-metacercariae aphasia
common in acute stage) with
elevated IgE Mode of Transmission: ingestion of
- Immunological tests/ encysted metacercariae from crabs
serodiagnosis
Egg: oval, yellowish brown, thick-shelled, - ELISA, IB, LAMP test (for 1st Intermediate Host:
measures 80-118 um by 48-60 um and has a epidemiological studies) Antemelania asperata and Antemelania
flattened but prominent operculum - Cerebral- CT scan MRI dactylus ( previously Brotia asperata)
scan

2nd Intermediate Host:

- Mountain crab Sundathelphusa
philippina (Parathelphusa grapsoides)

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Stephany Mae S. Chi

PARASITOLOGY LECTURE
2 BS Medtech-1

TREMATODES: Intestinal Flukes

Fasciolopsis buski detection of parasite eggs in Stool Habitat/Loc: Bowel Wall (duodenum and -found in China (including - Abdominal pain/ discomfort d
Parasite Biology: jejunum) Taiwan),Vietnam, and Thailand, to irritation at site of attachme
Common Name: - Adult fluke: 20 to 75 mm in length, and 8 and in parts of Indonesia, increased mucus secretion w/ minim
Large intestinal fluke to 20 mm in width Reservoir host: rabbits, pigs, and dogs Malaysia, and the Indian bleeding
- Does not have a cephalic cone subcontinent - inflammation and bleeding
Mode of Transmission: ingestion of In PH: the affected area
Egg: encysted metacercariae from aquatic - No locally acquired - jaundice
plants fascioliopsiasis in humans or pigs - diarrhea
F. buski egg measures 128 to 140 μm by 78 to 85 - May be acquired abroad - gastric discomfort
μm ; w/ oblong undeveloped miracidium; w/ Development Notes: - edema
operculum -Metacercaria develop w/in 3 mos. - Gland abscesses are occasiona
-Egg embryonates in WATER formed in the mucosa
-Becomes MIRACIDIUM in 3-7 weeks - heavy infections- worms m
cause intestinal obstruction
Development: - Intoxication results from t
egg- miracidium-sporocyst-mother absorption of worm metabolites
rediae-daughter rediae-cercariae- - generalized toxic and aller
METACERCARIAE (in second intermediate symptoms- edema of the fa
host, which is infective) abdominal wall, and lower limbs
- Profound intoxication – m
1st Intermediate Host: snail belonging to result to death of the host
genus Segmentina or Hippeutis

2nd Intermediate Host: seed pods, bulbs,

stems, or roots of various aquatic plants
such as Trapa bicornis (water caltrop),
Eliocharis tuberosa (water chestnut),
Ipomea obscura (morning glory
or kangkong), and Nymphaea lotus
(lotus)

Definitive Host: man and pigs

TREMATODES: Liver and Gallbladder Flukes
Clonorchis sinensis - Adult Fluke: leaf like in shape with - detection of parasite eggs Habitat/Loc: liver, bile ducts -C. sinensis- 35 million infected; CLINICAL PATHOGENESIS
transparent tegument in Stool; eggs may be - C. sinensis- maturation is in 601 million at risk - Clonorchiasis- local trauma a
Common Name: - C. sinensis adult- 10-25 mm long and 3-5 stained by potassium LIVER; Residence is in BILE DUCT irritation at site
Chinese Liver Fluke mm wide permanganate and - C. sinensis endemic in China, Has four phases:
observed under 400x to - Egg fully mature when released from Korea, Japan and Vietnam 1. Desquamation of epithelial cell
Egg: yellowish brown, ovoid, 26-30 um by 15-17 show morphology the worm 2. Hyperplasia and (1)
um, w/ distinct convex operculum, small - Miracidium hatches in 1st intermediate - Only 2 cases of clonorchiasis in 3. 1,2, and adenomatous tiss
protuberance at abopercular end host PH formation
4. Marked proliferation of t
Development: periductal connective tissue w
scattered abortive acini of epithelial ce
Egg-miracidia-sporocysts-two generations and fibrosis of the wall of the biliary du
of rediae-cercariea-metacercariae - C. sinensis
1. Light infections- ≤ 100 fluk
Mode of Transmission: ingestion of asymptomatic; or nonspecific symptom
encysted metacercariae on infected raw such as diarrhea and abdominal pain.
or undercooked fish; reported in salted, 2. Moderate- 101-1,000 flukes m
dried or pickled freshwater fish cause fever, diarrhea, loss of appeti
rash, edema, night blindness, swoll
1st Intermediate Host: abdomen, and hepatomegaly
C. sinensis- Parafossarulus (machouricus, 3. High- up to 25k flukes, acu
anomlaospiralis, stratulus), Bulinus pain in upper right quadrant; followed
striatulus, Semisulcospira, Alocinma chronic complications where liv
longicornis, Thiara granifera, Melanoides malfunction may occur; more severe la
tuberculatus complications are calculi, ASC, RP
cholecystitis, hepatitis, and pancreatitis
2nd Intermediate Host: 4. Increased risk of hepatocellu
Freshwater fish, family Cyprinidae carcinoma and cholangiocarcinoma
5. C. sinensis probable carcinoge
for C. sinensis 31 species in 7 families and group 2A
one specie of freshwater shrimp

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Stephany Mae S. Chi

PARASITOLOGY LECTURE
2 BS Medtech-1
PROTOZOA: Intestinal Amebae
Entamoeba histolytica - pseudopod forming non-flagellated
protozoan parasite
- The E. histolytica trophozoites are highly
motile and possess pseudopodia
- It is the most invasive of the Entamoeba
parasites
- E. histolytica is a eukaryotic organism
- lacks organelles that morphologically
resemble mitochondria
- no rough endoplasmic reticulum or Golgi
apparatus, although cell surface and
secreted proteins contain
sequences, and tunicamycin inhibits
protein glycosylation
TROPHOZOITE
Trophozoite size: 8-65 µm
Average size of trophozoite: 12-25 µm
- exhibits rapid, unidirectional progressive
movements
- contains single nucleus & karyosome;
surrounded by chromatin material
- May include ingested RBCS
CYSTS
- Cysts are usually spherical, and the size
may vary from 10 to 20 μm. They are
characterized by a highly refractile
hyaline cyst wall, one to four nuclei, and
rod-shaped (or cigar-shaped)
chromatoidal bars.
PROTOZOA: Commensal Ameba
Entamoeba gingivalis - Can be found in the mouth
TROPHOZOITE
- The trophozoite measures 10 to 20 μm.
- It moves quickly, and has numerous
blunt pseudopodia.
- Food vacuoles that contain cellular debris
Reservoir Host:
cats, dogs, pigs and 6 other species of
mammals
- Microscopic examination - The life cycle of E. histolytica
of fully passed stool consists of two stages: an
specimens reveals the infective cyst and an invasive
characteristic progressive trophozoite form
and directional movement - No host other than humans is
of trophozoites, with implicated in the life cycle
pseudopodia as - Mode of Transmission- ingesting
locomotory organelles cysts from fecally contaminated
- Special medium- TYI-S-33 material; venereal transmission
supports E. histolytica in - Excystation occurs in the small or
culture large bowel, where a cyst
signal - Antigen Tests- ELISA, IHA, undergoes nuclear followed by
GDP, IIF cytoplasmic division to form eight
- Detection of antibodies in trophozoites.
the serum is still the key in - Host: Humans
the diagnosis of ALA - Trophozoites multiply by binary
fission
- Swab between the gums Mode of Transmission: direct; through Prevalent in people with poor
and teeth examined for kissing or droplet spray or by sharing oral hygiene
trophozoites utensils - Cosmopolitan
- The trophozoite stage of E. - Common globally
gingivalis is morphologically
similar to that of E. histolytica.
CORRELATION OF OPISTHORCHIAS
AND CLONORCHIASIS WI
CHOLANGIOCARCINOMA
- Infects bile ducts of millions
individuals in the FAR EAST
- Have a role in carcinogenesis
- May cause cholangiocarcinoma
- 1956; primary liver cancers
Hongkong were due to C. sinensis
- Thailand study, 2,635 necrop
cases in THAILAND; 78%
cholangiocarcinoma were caused by liv
fluke
- Body reactions include nit
oxide formation and mucin production
- the true prevalence of - Majority of cases present
amebiasis is asymptomatic infections w
approximately 1 to 5% cysts being passed out in t
worldwide stools (cyst carrier state).
- 50 million E. histolytica - Amebic colitis is one of t
infection cases, and pathologies involved with
40,000 to 100,000 deaths histolytica
due to amebiasis in the - Ameboma occurs in less than 1
world per year of intestinal infections
- third most important - Amebic liver abscess (ALA) is t
parasitic disease, after most common extra-intestin
malaria and form of amebiasis
schistosomiasis - The onset of amebic colitis m
- second to malaria as the be sudden after an incubati
top cause of mortality period of 8 to 10 days, or afte
among parasitic long period of asymptomatic c
protozoans carrier state.
- Amebic infection is - ALA may have all acu
prevalent in the Indian presentation of less than
subcontinent, Africa, weeks duration or a chronic o
East Asia, and South and of more than 2 weeks duration
Central America - The most serious complicati
- of amebic colitis is perforati
and secondary bacter
peritonitis
- Colonic perforation occurs
60% of fulminant colitis cases
- In ALA, the most serio
complications are rupture in
the pericardium with a mortal
rate of 70%, rupture into t
pleura with mortality of 15
30%, and super infection
- Intraperitoneal rupture, wh
occurs in 2 to 7.5% of cases,
the second most comm
complication of ALA.
- differential diagnoses of A
include pyogenic liver absce
tuberculosis of the liver, a
hepatic carcinoma
- Acute amebic colitis should
differentiated from bacilla
dysentery of the followi
etiology: Shigella, Salmone
Campylobacter, Yersinia,
- Non-pathogenic

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Stephany Mae S. Chi

PARASITOLOGY LECTURE
2 BS Medtech-1
(mostly leukocytes, which is characteristic
of this species) and bacteria are
numerous.
- First ameba recovered from human
specimen

NO CYST STAGE

PROTOZOA: Free Living Pathogenic Ameba

Acanthamoeba spp. - active trophozoite stage with - CSF, brain tissue, corneal - Only two stages in its life cycle; - Acanthamoeba spp. have - Acanthamoeba Keratitis
characteristic prominent “thorn-like” scrapings as specimen of cysts and trophozoites a protean distribution Symptoms:
appendages (acanthopodia); and a choice - No flagellated stage exists as part - has been reported in the - severe ocular pain and blurring of visio
highly resilient cyst stage into which it - Epithelial biopsy of the life cycle. United States, Europe, - Corneal ulceration with progressi
transforms when environmental - Diagnosis of GAE is post- - The trophozoites replicate by South America, and Asia. corneal infiltration may occur.
conditions are not favorable mortem mitosis - The first case of AK was - Primary amebic infection or seconda
TROPHOZOITES - Indirect - The trophozoites are the recognized in the bacterial infection may lead to hypopy
- exhibit a characteristic single large Immunofluorescent infective stage, although both Philippines in the 1990s formation.
nucleus with a centrally-located, densely antibody staining- for cysts and trophozoites gain entry from a patient from the - Progression of infection may cau
staining nucleolus; a large endosome; speciating species into the body through various Philippine General scleritis and iritis, and may ultimate
finely granulated cytoplasm; and a large means. Hospital lead to vision loss.
contractile vacuole. - Mode of transmission: Entry can - Major differentials which need to
- Small, spiny filaments for locomotion occur through the eye, the nasal ruled out include fungal and herpe
known as acanthapodia are evident on passages to the lower respiratory keratitis
phase-contrast microscopy tract, or ulcerated or broken
CYSTS - The presence of naturally- - Granulomatous Amebic Encephalitis
- 8-25 µm in size occurring bacterial Symptoms:
- Round w/ ragged edges endosymbionts in Acanthamoeba - GAE usually occurs
- Large central karyosome spp. has been reported. immunocompromised hosts includ
- No peripheral chromatin the chronically ill and debilitated, a
- Cytoplasm is disorganized, granular and those on immunosuppressive agen
sometimes vacuolated such as chemotherapy and anti-rejecti
- Double cell wall for protection medications
- Signs and symptoms of GAE a
generally related to destruction of bra
tissue and the associated meninge
irritation
- Systemic manifestations early in t
course include fever, malaise, a
anorexia.
- Neurologic symptoms may inclu
increased sleeping time, seve
headache, mental status chang
epilepsy, and coma. Neurologic findin
depending on the of the lesions inclu
hemiparesis, blurring of vision, diplop
cranial nerve deficits, ataxia, a
increased intracranial pressure.

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PARASITOLOGY LECTURE
2 BS Medtech-1

PROTOZOA: Ciliates
Balantidium coli Trophozoite - microscopic - Pigs are the major hosts of - The distribution of B. coli - Balantidium coli trophozoites a
- Balantidium coli trophozoite measures 30 demonstration of balatidiasis is cosmopolitan capable of attacking t
to 150 μm long and 25 to 120 μm wide. trophozoites and cysts in - Mode of Transmission: ingestion - more prevalent in areas intestinal epithelium and creati
- Ciliated feces using direct of food and/or water with poor sanitation, a characteristic ulcer with
- Parts: examination or contaminated with B. coli cysts. close contact with pigs or rounded base and wide neck
Cytostome concentration - The incubation period is normally pig feces - Ulceration is caused by the ly
oral apparatus (sedimentation or from 4 to 5 days. - There is an estimated 1% enzyme hyaluronidase which
cytopyge flotation) techniques. - Ingested cysts excyst in the small worldwide prevalence of secreted by the trophozoite.
2 dissimilar nuclei - presence of trophozoites intestines and become human B. coli infection - Trophozoites also invade t
Bean-shaped macronucleus in biopsy specimens from trophozoites. - In a study done in two submucosa and the muscu
Round micronucleus lesions obtained through - Trophozoites inhabit the lumen, (northern and southern) coat, including blood vessels a
two contractile vacuoles sigmoidoscopy mucosa, and submucosa of the sites in the Philippines, lymphatics
- Bronchoalveolar washings large intestines, primarily the an examination of pigs - 3 forms of Balantidiasis:
Cysts may also contain B. coli cecal region. revealed 66.1% 1. Asymptomatic carriers
- spherical to slightly ovoid in shape trophozoites in the case of - Parasite reproduction occurs prevalence of B. coli 2. Fulminant balantidiasis,
- measures 40 to 60 μm in diameter pulmonary infection. asexually through asymmetric infection balantidial dysentery
- They are covered with thick cell walls binary fission, although sexual 3. Chronic form
(double-walled) reproduction through conjugation - B. coli can spread
has been reported. extraintestinal sites
- Cysts are formed principally as - Complications of balantidia
protection for survival outside include intestinal perforati
the host. and acute appendicitis
- The parasites encyst during -
intestinal transport or after
evacuation of semi-formed stools.
- Infective stage: Cysts are the
infective stage, and they may
remain viable for several weeks
PROTOZOA: Flagellates (vaginal)
Trichomonas vaginalis - Trichomonas vaginalis exists only in the - Saline preparation of - Mode of Transmission: sexual - Trichomonas infection - The acute inflammation caus
trophozoite stage. vaginal fluid is the intercourse occurs worldwide. characteristic liquid vagin
- It has a pyriform shape, measuring 7 to quickest and most - T. vaginalis cannot live without - It is estimated that there secretions, greenish or yellow
23 μm inexpensive way close association with the are 170 to 190 million color.
- four free anterior flagella that appear to - The accepted gold vaginal, urethral, or prostatic individuals with - The vaginal secretions are ve
arise from a simple stalk, and a fifth standard is culture which tissues. trichomoniasis. irritating and may cause inten
flagellum embedded in the undulating takes 2 to 5 days. - Four to 28 days after - Prevalence is higher itchiness and burning sensation
membrane introduction of viable T. vaginalis among women of child- - associated with an increas
- Undulating membrane extends to about into the vagina, proliferating bearing age incidence of postpartu
half the organism’s length. colonies of the flagellate cause endometritis
- The parasite has a median axostyle and a degeneration and desquamation - Complications in women inclu
single nucleus of the vaginal epithelium secondary bacterial infection
followed by leukocytic the urogenital tract
inflammation of the tissue layer - strawberry cervix: observed
- Infective Stage: trophozoite in only 2% of cases.
vagina or orifice of urethra - Trichomonas infection in ma
- Diagnostic stage: trophozoite in may be latent and essentia
secretions asymptomatic; or may cau
irritating persistent a
recurring urethritis.
- Prostatitis is the most comm
complication in men.
PROTOZOA: Non-Pathogenic (oral)
Trichomonas tenax - pyriform flagellate which has been - Diagnosis is made by - Mode of Transmission: Exposure - prevalence of oral - A harmless commensal
observed only in the trophozoite stage. swabbing the tartar results from droplet spray from protozoan infections was - Pulmonary trichomoniasis h
- It measures 5 to 12 μm, and is smaller between the teeth, the the mouth, kissing, or common found to be largely been reported among tho
and more slender than T. vaginalis. I gingival margin, or use of contaminated dishes and greater in patients with with underlying chro
- has four free equal flagella and a fifth tonsillar crypts drinking glasses. periodontal diseases pulmonary disease, entering t
one on the margin of an undulating - Trichomonas tenax is a harmless lungs most probably
membrane which does not reach the commensal of the human mouth, aspiration
posterior end of the body, and lacks a living in the tartar around the
free posterior extension. teeth, in cavities of carious teeth,
- has a single nucleus and a cytostome and in necrotic mucosal cells in
the gingival margins.
- It is quite resistant to changes in
temperature and will survive for
several hours in drinking water.

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Stephany Mae S. Chi

PARASITOLOGY LECTURE
2 BS Medtech-1

PROTOZOA: Flagellates (intestinal)

Giardia lamblia Trophozoites - Diagnosis is made by - Mode of Transmission: Cysts from - Giardia has a worldwide - Giardiasis
- The trophozoites measure 9 to 12 μm demonstration of G. animals or human feces are distribution. - able to cause alterations in t
long by 5 to l5 μm wide. duodenalis trophozoites transferred to the mouth via - In the Philippines, the villi such as villous flattening a
- pyriform or teardrop shaped, pointed and/or cysts in stool contaminated hands, food, or prevalence of giardiasis crypt hypertrophy. The
posteriorly, with a pair of ovoidal nuclei, specimen water. ranges from 1.6 to 22.0% alterations lead to decreas
one on each side of the midline - - Once mature cysts (infective depending on the electrolyte, glucose, and flu
- dorsal side of the organism is convex, stage) are ingested, they pass population group being absorption, and cau
while the ventral side is concave with a safely through the stomach and studied deficiencies in disaccharidases
large adhesive disc used for attachment excyst in the duodenum (in about - From ingestion of the cysts,
- bilaterally symmetrical, with a distinct 30 minutes) developing into takes about 1 to 4 wee
medial line called the axostyle trophozoites which rapidly (average of 9 days) for t
- parasite is propelled into an erratic multiply and attach to the disease to manifest
tumbling motion by four pairs of flagella intestinal villi causing pathologic - acute cases: patients experien
arising from superficial organelles in the changes. abdominal pain, described
ventral side of the body - The trophozoites may then be cramping, associated w
found in the jejunum. diarrhea ; excessive flatus w
Cysts - As the feces enters the colon and an odor of “rotten eggs” due
- Cysts are ovoid and measure 8 to 12 μm dehydrates, the parasite then hydrogen sulfide
long by 7 to 10 μm wide. encysts. - Diarrhea is the most comm
- The young cysts have two nuclei, while - After encystment, mature cysts symptom, occurring in 89%
the mature cysts have four. are passed out in the feces and cases.
- Cysts are characterized by flagella are infectious. - Spontaneous recovery occu
retracted into axonemes, the median or within 6 weeks in mild
parabasal body, and deeply stained moderate cases.
curved fibrils surrounded by a tough - Chronic infection is characteriz
hyaline cyst wall secreted from by steatorrhea, or the passage
condensed cytoplasm. greasy, frothy stools.

PROTOZOA: Coccidians
Cryptosporidium hominis
- The oocysts are round and measure 4 to - Sheather’s sugar flotation
5 μm in diameter. and the formalin
- Each oocyst contains four sporozoites, ether/ethyl acetate
which are present at the time of passage concentration technique
into the feces - Kinyoun’s modified acid
fast stain is routinely used
with the oocysts appearing
as red-pink doughnut-
shaped circular organisms
in a blue background.
- Intestinal biopsy material
may also be examined
under a light microscope
- Indirect fluorescent
antibody, enzyme
immunoassay, and DNA
probes specific for C.
hominis have been
developed.
- there is an alternation of sexual - Cryptosporidiosis - In the immunocompetent ho
and asexual multiplication. hominis has a universal the disease may present as a se
- typically characterized by three distribution with limiting diarrhea lasting for 2
sequential stages, namely: sexual infections reported 3 weeks
cycle or sporogony producing worldwide - In immunocompromis
oocysts, asexual cycle or - In developing countries, persons, the diarrhea becom
schizogony (merogony) producing prevalence ranged from 3 more severe, progressive, a
merozoites (meronts), and to 20%. may become life-threatening.
gametogony resulting in the - The prevalence in the - acute and gangreno
development of male (micro) and Philippines has been cholecystitis.
female (macro) gametocytes reported to be low at - Respiratory
(gamonts). 2.6%. - There may be varying degrees
malabsorption and excessi
fluid loss
immunocompromised patients.
- Death may occur in disseminat
infections

Blood and Tissue Flagellates (Hemoflagellates)

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2 BS Medtech-1
Trypanosoma cruzi
Leishmania spp.
Leishmania tropica (complex)
PARASITOLOGY LECTURE
AMASTIGOTES - A complete patient
- Amastigotes are round or ovoid in shape history is the primary tool
and measure from 1.5 to 4 μm in for diagnosing Chagas
diameter. They are usually found in small disease
groups of cyst-like collections in tissues. - The definitive diagnosis of
TRYPOMASTIGOTES Chagas disease during its
- The long slender trypomastigotes are 16 acute phase relies on
to 20 μm in length while the short, direct visualization of the
stumpy forms measure around 15 μm. parasites in thick and thin
The posterior end is usually pointed. The blood smears using
undulating membrane is narrow with two Giemsa stain.
to three undulations, and a single - Cerebrospinal fluid (CSF),
thread-like flagellum originating near tissue samples, or lymph
the kinetoplast provides the parasite can also be used for
with mobility. parasite visualization.
- In stained specimens, trypomastigotes - (microhematocrit)
are characteristically C-shaped. They have - blood culture,
also been described as U- or S-shaped - PCR test
with a prominent kinetoplast, - Xenodiagnosis
characteristic of the species. - serologic tests: enzyme-
linked immunosorbent
assay (ELISA), IHA, indirect
immunofluorescence, and
PCR.
- Amastigotes are ovoid or rounded - Diagnosis of active
bodies measuring 2 to 3 μm in length and leishmaniasis is based on
live intracellularly in monocytes, the microscopic
polymorphonuclear leukocytes, or demonstration of
endothelial cells. The nucleus is large, Leishmania from lesion
while an axoneme arises from the and tissue scrapings,
kinetoplast and extends to the anterior aspirates, or biopsy
tip.
- promastigotes in the hindgut
- Promastigotes have a single free
flagellum arising from the kinetoplast at
the anterior end. They measure 15 to 20
μm in length and 1.5 to 3.5 μm in width.
Vector: reduviid bugs, belonging to the - have infected more than - Chagas disease.
genera Triatoma, Panstrongylus, and 10 million people - The acute phase is characteriz
Rhodnius worldwide. by a focal or diffuse inflammati
- Most cases are reported mainly affecting the myocardiu
Mode of Transmission: insect bites in the Latin Americas, - Chagomas are furuncle-l
where more than 25 lesions associated w
Reservoir host: domestic animals, million people are at risk induration, central edema, a
armadillos, raccoons, rodents, marsupials, for the disease. regional lymphadenopathy.
and even some primates - Endemic regions include - If the parasite penetrat
most of Central America through the conjunctiva, eye
Development: and the southern cone swelling called Romaña’s si
- Inside its insect vector, the of South America may form
amastigote, epimastigote, and - countries such as USA, - Chronic phase is manifested
promastigote forms occur in the Canada, Spain, France, fibrotic reactions that cau
midgut, while the infective Switzerland, Japan, and injury to the myocardium, card
metacyclic trypomastigote Australia have seen a conduction network, and ente
appear in the hindgut number of cases, nervous system (decrease
- After their entry into the human primarily due to human nerve ganglia leading
host, the metacyclic migration patterns as megasyndromes). The heart
trypanosomes are engulfed by well as from blood the primary organ affect
macrophages of the transfusion, organ during this phase.
reticuloendothelial system and donation and vertical The majority of symptomatic, chron
multiply through binary fission as transmission patients manifest with the cardiac for
amastigotes. - Chagas disease is while the rest develop t
- Amastigotes develop into included in the WHO list gastrointestinal form.
trypomastigotes, and the cells of Neglected Tropical
lyse in 4 to 5 days. Diseases (NTDs)
- The released trypomastigotes - Leading cause of
enter the bloodstream, ready to parasite-related deaths in
replicate again once they enter Latin America.
another cell or are ingested by an - In 2003, it ranked 3rd as
insect vector. the leading cause of
- Upon ingestion of intermediate parasitic infection in the
host, the trypomastigotes pass world, behind malaria
through the posterior portion of and schistosomiasis
the insect’s midgut and become
epimastigotes, where they
multiply via longitudinal fission.
- Infective metacyclic
trypomastigotes appear in the
insect’s rectum 8 to 10 days after
infection, and are passed in the
bug’s feces.
- The metacyclic trypomastigotes
gain entry into the body through
broken skin, or through mucous
membranes that are rubbed with
fingers contaminated with the
bug’s feces.
- Vector: Sandfly, genera - Leishmaniasis is a global - Old World Cutaneo
Phlebotomus (for Old World) disease Leishmaniasis
- Mode of Transmission: Insect - distributed across 88 countries - Oriental sores
bites in four continents - Delhi boils
- Reservoir hosts: domestic dogs - It affects more than 12 million - Baghdad boils
- Leishmania spp. produce people worldwide, and more - Dry or Urban Cutaneo
amastigotes intracellularly in the than 350 million are at risk for Leishmaniasis
mammalian host, and the disease -
- Leishmaniasis is primarily a
(Viannia subgenus), midgut disease of poverty
(Viannia and Leishmania
subgenera), and proboscis
(Viannia and Leishmania
subgenera) of the insect vectors
- Has Sandfly and Human stages

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Stephany Mae S. Chi

PARASITOLOGY LECTURE
2 BS Medtech-1
HUMAN STAGES
- Promastigotes are phagocytized
by macrophages
- Promastigotes transform into
amastigotes inside the
macrophages (diagnostic stage)
- Amastigotes multiply in cells
(diagnostic stage)

SANDFLY STAGES
- Sandfly takes a blood meal
(ingests macrophages infected
with amastigotes)
- Ingestion of parasitized cell
- Amastigotes transfom into
promastigotes in midgut
- Divide in midgut and migrate to
proboscis
- Sandfly takes a blood meal
(injects promastigotes stage to
the skin)

Sporozoans: Plasmodium spp.

Plasmodium falciparum - Infected RBC cells: Normal: multiple - Microscopic identification
infection of RBC very common of the malarial parasites
- Small trophozoite: same as P. vivax but in thick and thin blood
with small threadlike blue cytoplasmic smears stained with
circle with one or two small red Giemsa or Wright’s stain is
chromatin dots; double chromatin still important in making
common; marginal forms common the definitive diagnosis
- Growing trophozoite: Remains in ring and remains as the gold
form but grows resembling small standard
trophozoite of P. vivax in size; usually the - Serologic tests (however it
oldest asexual stage seen in peripheral is unable to determine
blood past from active
- Large trophozoite: seldom present infections)
- Schizont (presegmenting): not present
- Schizont (mature): Rarely present; 8-24
- The asexual cycle in humans
consists of schizogony, which
leads to the formation of
merozoites, and gametogony,
which leads to the formation of
gametocytes.
- The sexual cycle in the mosquito
involves sporogony, which leads
to the formation of sporozoites
- Vector (in PH): Anopheles
minimus var. flavirostris
- Anopheles litoralis is associated
with malaria transmission in the
coastal areas of Mindanao,
particularly in Sulu
- world’s most important tropical
parasitic disease
- a public health problem today
in more than 90 countries
- 2.1 billion are at low risk
- 1.2 billion at high risk
- WHO cites a decreasing number
of malaria cases in a majority of
countries belonging to the
Western Pacific Region
- greater than 50% decrease in
cases were reported for China,
Philippines, Republic of Korea,
Solomon Islands, and Vietnam,
while
- The average pre-patent peri
for P. falciparum is 11 to 14 day
- The incubation period may ran
from 9 days to 3 years
- no absolute clinical features
malaria except for the regu
paroxysms of fever with t
associated asymptoma
intervals
- classical malaria paroxysms ha
three stages: the cold stage, t
hot stage, and the sweati
stage
- interval between attacks:
hours

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 lOMoARcPSD|32262012
Stephany Mae S. Chi
PARASITOLOGY LECTURE
2 BS Medtech-1
merozoites; smaller than other species - Anopheles maculatus coexists
- early trophozoite form is ring-shaped with A. flavirostris in the portion
with a red chromatin dot and a scant of streams exposed to sunlight
amount of blue cytoplasm when stained - Anopheles mangyanus has the
with Giemsa or Wright’s stain same breeding habitats and
- trophozoite form has a large chromatin seasonal prevalence as A.
mass and a prominent ameboid flavirostris but appears to prefer
cytoplasm, which is spread through the habitats located in forest fringe
erythrocyte - Mode of Transmission: blood
transfusion from infected donors,
insect bite, contaminated needles
and syringes, congenital
Development:
-involves two hosts
- During a blood meal, a malaria-infected
female Anopheles mosquito inoculates
sporozoites into the human host
- Sporozoites infect liver cells and mature
into schizonts which rupture and release
merozoites
- After this initial replication in the liver
(exo-erythrocytic schizogony), the
parasites undergo asexual multiplication
in the erythrocytes (erythrocytic
schizogony)
- Merozoites infect red blood cells
- The ring stage trophozoites mature into
schizonts, which rupture releasing
merozoites
- Some parasites differentiate into sexual
erythrocytic stages (gametocytes)
- The gametocytes, male
(microgametocytes) and female
(macrogametocytes), are ingested by an
Anopheles mosquito during a blood meal
- The parasites’ multiplication in the
mosquito is known as the sporogonic
cycle
- While in the mosquito’s stomach, the
microgametes penetrate the
macrogametes generating zygotes
- The zygotes in turn become motile and
elongated (ookinetes) which invade the
midgut wall of the mosquito where they
develop into oocysts
- The oocysts grow, rupture, and release
sporozoites, which make their way to the
mosquito’s salivary glands.
- Inoculation of the sporozoites into a new
human host perpetuates the malaria life
cycle
Sporozoans: Babesia spp.
Babesia microti - Intraerythrocytic protozoa - Babesia parasites are - does not undergo exo-
- measure 1-3 microns usually detectable in blood erythrocytic merogony
- organisms resemble Plasmodium smears only during the - 3 developmental phases
falciparum acute stage of the - (a) merogony in the RBC; and in
- vary more in shape and in size infection the tick vector,
- do not produce pigment - Definitive diagnosis - (b) stages of gamogony in the
requires direct gut and epithelium; and,
microscopic examination - (c) sporogony accompanied with
of Giemsa-stained multiple fission in various cells
peripheral blood smears and organs forming sporokinetes,
for the presence of and the development of infective
Babesia, showing its sporozoites.
established unique - intra-erythrocytic merozoites in
morphological features the gut of engorged ticks undergo
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- 25-50% decrease in the number
of cases were seen in Lao
People’s Democratic Republic,
Malaysia, and Vanuatu
- in PH: disease prevalence high
in Regions IV-B, Caraga, III, XII,
and II
- 59/80 provinces in country are
endemic for the disease
- 60.4% of the endemic
provinces located in Luzon
- 39.5% in Mindanao
- 0.1% in Visayas
- As of 2009, the provinces of
Cagayan, Isabela, Palawan, Sulu,
and Tawi-Tawi have the highest
number of malaria cases
reported
-
- Worldwide distribution
- Asian cases reported
have been few and
sporadic
- IN PH:
studies on animal
babesiosis have been
limited and mainly
concentrated on
hematological
parameters and clinical
manifestations in cattle
B. bigemina and B.
argentina (syn. B. bovis),
- merozoites of P. falciparu
invade the erythrocytes, t
cells reduce their deformabil
the degree of which is direc
proportional to parasite maturi
- . The soluble antigens of
falciparum are potent inducers
proinflammatory as well as an
inflammatory cytokines fro
monocytes and macrophages
- Severe malaria (symptoms)
- Falciparum malaria in a young
child is considered a medical
emergency for it can be rapidly
fatal
- most common complications of
severe malaria in children are
cerebral malaria, severe anem
respiratory distress, and
hypoglycemia
- hyperparasitemia: defined as a
peripheral count more than
250,000/μL or more than 5% o
the RBCs infected, and the
presence of mature or immatu
schizonts in a peripheral blood
smear
-
- low grade and chronic infection
asymptomatic
- Human cases of babesiosis a
generally associated w
splenectomized a
immunocompromised patien
cases acquired through blo
transfusion and org
transplantation
- Symptoms: Fatigue, malai
anorexia, and weight loss beg
to manifest approximately one
six weeks post-exposure follow
by non-periodic or intermitte
 lOMoARcPSD|32262012

Stephany Mae S. Chi

PARASITOLOGY LECTURE
2 BS Medtech-1
- Serological tests (e.g. IHA) morphologic, and B. canis fever (38-40°C), chills, a
- (PCR) is highly specific and physiologic/metabolic, and sweats accompanied w
is generally considered to antigenic changes; differentiate - headache, myalgia, arthralg
be the gold standard for into gametocytes that eventually nausea, vomiting, a
Babesia detection develop into gametes prostration
- Postfertilization: zygote begins to - May manifest emotional labil
infect the gut epithelial cells depression, and hyperesthesia.
where it undergoes multiple - severe cases: hemolytic anem
fission, and eventually forms and hemoglobinuria w
sporokinetes jaundice become apparent
- Once the sporokinetes are - pulmonary edema : mo
released, they continue to infect frequently observed complicati
and multiply in various organs, of the disease
including the ovaries of the - Severity of infection: w
replete tick, until death ensues. possible fatal outcome
- The transovarian route generally associated with t
represents one pattern of elderly, the splenectomized a
parasite transmission in the immunocompromised, a
vector, which terminates with the those manifesting evidence
death of the vector. Lyme disease
- With the passage of sporokinetes
to eggs (transovarian), similar
cycles of multiple fissions
continue to take place in the
embryo and in the organs of the
larva, nymphs, and adult ticks.
- With the stage-to-stage
(transstadial) transmission, each
of the developmental stages is
generally capable of parasite
transmission to mammals
- Vectors: (putative vectors)
Boophilus spp., Rhipicephalus
spp., Ixodes spp., Hyalomma spp.,
Haemaphysalis spp., and
Dermacentor spp.
- Biological hosts: Hard ticks
(family Ixodidae)
- Mode of Transmission: Tick bites,
cases acquired through blood
transfusion and organ
transplantation

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