INTESTINAL PARASITES INFESTASION

Departeman Parasitology
FK USU
Specific Learning Objective:
 Intestinal Nematodes;
 Describing the life cycle of Enterobius vermicularis
 Explaining the pathogenesis and patophysiology of enterobiasis
 Explaining the parasitologic examination and prevention of
enterobiasis
Specific Learning Objective:
 Intestinal Cestodes;
 Describing the life cycle of Taenia saginata, Taenia solium, and
Hymenolepis nana
 Explaining and comparing the pathogenesis and pathophysiology
taeniasis saginata, taeniasis solium, and hymenolepiasis nana.
 Explaining the parasitologic examinations and preventions of
the infestations of intestinal cestodes
Specific Learning Objective:
 Intestinal Protozoas;
 Describing the mechanical vectors of amoebiasis
 Describing the life cycle of Entamoeba histolytica, Giardia lamblia,
and Balantidium coli.
 Explaining the pathogenesis and pathophysiology of amoebiasis,
giardiasis, and balantidiasis.
 Explaining the parasitologic examinations and preventions of
amoebiasis, giardiasis, and balantidiasis
 Enterobiasis

 Etiology:
Enterobius vermicularis
(Oxyuris vermicularis / pin worm/ thread worm/
seatworm).

 Habitat:
Large intestine (caecum and appendix).
Sometimes in ascending colon and ileum.
 Route of infection:

1. Ingestion infectious egg

2. Direct transfer/Autoinfection
3. Retroinfection
4. Inhalation : contaminated and airbone
transmission
Life cycle
 Pathofisiology

 The adults are mainly located in the caecal

region and female deposits her eggs on the
anus and perianal skin usually at night.

 The sticky, gelatinous substance in which the

ova are deposited and the movements of the
female worm cause perianal pruritus.
 Pathofisiology

 Adult worms undergo ectopic migration and

may enter the female genital tract. Inside the
uterus or fallopian tube they may become
encapsulated and produce symptoms of
salpingitis.

 The parasite may also become lodged in the

lumen of the appendix leading to appendicitis.
 Diagnosis

1. Anal swab ( N.I.H swab )

2. Suspected in children with perianal itching and
scratching, sleeplessness and restlessness..
3. Typical egg shape in feces, nail clipings, bedlinen
 Prevention

 Treat all family members.

 Personal grooming – clean and short fingernails.
 Personal hygiene – wash hands before eating and
after defecation.
 Frequent washing of bedlines and clothes with soap
and water.
 Taeniasis

 Ethiology : T. saginata and T solium

 Habitat : small intestine, yeyunum

Taenia saginata
 Mode of transmision

 Ingestion of raw or insufficiently cooked

meat harboring cysticercus
cellulosae/cysticercus bovis.
Life cycle
 Pathofisiology
 Ingestion of egg : cysticercosis

 Ingestion of larvae : taeniasis

 Taeniasis solium : autoinfection

 Clinical manifestation : heavy

 On human : taeniasis solium

 Diagnosis

 QDP (Questionaire Demonstration

Proglottid)
 Motile proglottid in feces
 Anal swab
 Prevention

 Personal hygiene
 Avoid consuming raw or unproperly cooked
meat
 Treatment of infected person
Hymenolepis sp.
 Hymenolepis nana
 Hymenolepis diminuta

•Called dwarf tapeworms or

•Rat tapeworms
•Distributed in warm climates.
Hymenolepis nana
Hymenolepis nana
• Cysticercoid has hooks in the anterior part
• Maturation in 2-4 weeks
• Length depends on parasitemia, mostly only 1-3 cm
• Scolex has 4 suckers and a short rostellum with 20-30 retractable
hooks
• Mature proglottid has three testes and a uterus
• Gravid proglottid is occupied by the uterus filled w/ 100-200 eggs
• The eggs are spherical with diameter 60-80 mm
• The nodes and filamentous substance are not usually seen
• Contains hexacanth embryo
Hymenolepis diminuta
• Adults are 10-60 cm long
• The scolex has four suckers but no hooks
• The structure of proglottids closely resembles that of H.nana
• The larva is called H. diminuta cysticercoid, differ from that of H.
nana in that this has no hooks
• The eggs are spherical w/ diameter 60-80 mm
• The nodes and filamentous substance are not usually seen
• Contains hexacanth embryo
Hymenolepis nana
Life cycle
Hymenolepis diminuta
Life cycle
Nature of the disease
 Hymenolepis is generally found in the feces of rats which is
consumed by its secondary hosts: beetles.
 The worms mature into a life form referred to as a "cysticercoid"
in the insect; in H. nana, the insect is always a beetle.
 Humans and other animals become infected when they
intentionally or unintentionally eat material contaminated by
insects.
 In an infected person, it is possible for the worm's entire life-cycle
to be completed in the bowel, so infection can persist for years if
left untreated.
Nature of the disease
 Hymenolepis nana infections are much more common than
Hymenolepis diminuta infections in humans because, in addition
to being spread by insects, the disease can be spread directly
from person to person by eggs in feces.
 When this happens, H. nana oncosphere larvae encyst in the
intestinal wall and develop into cysticercoids and then adults.
Clinical Manifestation
 It is not clear that hymenolepiasis necessarily have any symptoms.
 The symptoms of hymenolepiasis are traditionally described as
abdominal pain, loss of appetite (anorexia), itching around the
anus, irritability, and diarrhea.
 Examination of the stool for eggs and parasites confirms the
diagnosis. The eggs and proglottids of H. nana are smaller than H.
diminuta.
 Identifying the parasites to the species level is often unnecessary
from a medical perspective, as the treatment is the same for both.
Preventive action
 Good hygiene
 Public health and sanitation programs
 Elimination of rats help prevent the spread of
hymenolepiasis.
 Amoebiasis Coli
 Caused by Entamoeba histolytica
 Humans are infected by ingesting cysts, most
often via food or water contaminated with
human fecal material
 Trophozoites live in the host large intestine
 Cysts survive outside the host in water and
soils and on foods
 E. histolytica is potentially the most
pathogenic protozoa in human intestine
 Clinical incubation period 1-14 wks

29
Life Cycle of
E. Histolytica

Relatively simple
and direct being
transmitted
from one host to
the next via a
free-living
resistant stage -
the cyst
 Amoebiasis Coli
Epidemiology
 Widely distributed,mostly in poor hygiene
areas
 High frequency in high population places
 Carrier persons play role as main source of
infection
 Flies, cockroaches, and carrier food-handlers
are considered to be vectors
 Contaminated water is known as mediator of
infection
 It is also frequently diagnosed among
homosexual men
33
 Amoebiasis Coli
Nature of Disease

 Infection may be accompanied by:

1. No symptoms
2. Vague gastrointestinal distress
3. Dysentery (w/ blood and mucus)
 Complications include:
1. Ulcerative and abscess pain
2. Intestinal blockage (rare)
3. Trophozoites infect other organs (mostly
liver)  amoebic liver abscess

34
 Amoebiasis Coli
Pathology

 Intestinal invasion: ulcerous flask shaped

lesions, may lead to perforation
 Extra intestinal amoebiasis: various organs,
mostly liver (typical abscess)
 Colon ulceration can spread to other sites by
such ways:
1. Percontinuitatum (to secondary sites)
2. Hematogen (to distant organs)

35
 Amoebiasis Coli
Diagnosis
 Based on clinical symptoms
 Beware of carrier person!
 Stool examination: normal saline, lugol,
trichrom, and hematoxiline stains, or
concentration method
 Serologis test, especially for extra
intestinal amoebiasis patients
 The parasite must be distinguished from
other parasitic (but non-pathogenic)
protozoa

36
 Amoebiasis Coli
Preventive Treatment

 Treat the patients and carriers

 Health education
 Proper meal preparation and storage
 The use of proper toilets, drinking water
facilities, and garbage cans

37
 Giardiasis Intestinalis

 Caused by Giardia lamblia, a flagellate

 Regarded as the most common flagellate in
the human digestive tract and is highly
contagious
 Found throughout the world
 Traveler’s diarrhea
 Trophozoites live in the small intestine of the
host

38
Life Cycle of
G. lamblia
 Cyst are taken
in orally,
usually via
contaminated
drinking water
 The
trophozoites
may divide by
binary fission
 Trophozoites
can encyst and
pass out with
the feces
 Giardiasis Intestinalis
Nature of Disease

 G. lamblia does not invade the tissues of the

small intestine
 Patients harboring this protozoan can be
asymptomatic carriers
 Or exhibit all or some of the following
symptoms: diarrhea, dehydration, abdominal
pain and weight loss

42
 Giardiasis Intestinalis
Nature of Disease
 Type of diarrhea:
1. no blood loss
2. fatty consistency as a result of fat
malabsorption
3. occurs in heavy infections where attached
trophozoites can cover much of the
intestinal epithelial surface
 The symptoms may be associated w/ the
strain of variable virulence and host
immune response

43
 Giardiasis Intestinalis
Diagnosis

 Stool examination: visualizing both troph.

or cyst in stained/unstained preparation
 Concentrated method: floatation or
sedimentation
 ELISA

44
 Giardiasis Intestinalis
Preventive Treatment

Similar to those w/ other intestinal protozoa:

 The most important is to avoid using
contaminated drinking water or food
 Treat the patients and carrier persons
properly
 Health education

45
 Balantidiasis Coli

 Caused by Balantidium coli, a ciliate protozoa

 The parasite live in large intestine
 Occurs in humans, swine, rodents, and in many
other mammals, and can be transmitted readily
among these species

46
Life Cycle of B. coli
 Direct life
cycle
 Balantidiasis
is often
occurs in
swine, and
rare in human
 Swine is
considered as
a potential
reservoir
host for
human
 Balantidiasis Coli
Nature of Disease
 It can give various features, from
asymptomatic, mild to severe, according to
the virulence o/t parasite
 Mild illness include gastrointestinal
discomfort or mild diarrhea
 Trophozoites attack intestinal epithelial
tissue, causing flask-shaped ulcers (similar
to amebic ulcers) and secondary bacterial
infection
 Ectopic infection can also occur

49
 Balantidiasis Coli
Diagnosis

 Clinical features
 Stool examination
 Biopsy occasionally needed in ulcer cases or
ectopic infections

50
 Balantidiasis Coli
Treatment

 Drug of choice: metronidazole

 Preventive treatment is far more important
to prevent the disease

51