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Parasitology 2019
Lecture notes
Prepared by: Ariane T. Laranang, RMT, MT(ASCPi), MSMT

Topic outline:
1st Part
• Introduction to Parasitology
• Specimen Collection
• Amoebas
• Flagellates
• Blood and Tissue flagellates/ Hemoflagellates
• Sporozoans: Plasmodium and Babesia
• Miscellaneous Protozoans

2nd Part
• Nematodes
• Filarial worms
• Cestodes
• Trematodes

I. Introduction to Parasitology

Parasitology- is a science that deals with the study of 2 organisms namely: HOST and PARASITE
Host:
Parasite:

This type of relationship is a classification of a Symbiotic relationship, specifically: _________.

Types of symbiotic relationship:
1. Mutualism
2. Commensalism
3. Parasitism

Classification of Host:
• Definitive
• Intermediate
• Reservoir
• Accidental
• Transport
• Carriers
Classification of Parasites:
According to habitat:
Endoparasite
Ectoparasite
According to the effect to the host:
Pathogenic
Non-pathogenic
According to the mode of living:
Obligate
Facultative

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Parasitic infection-
Parasitic Disease-
Infection-
Infestation-

Disease Distribution: Epidemiology

Endemic- when a disease in human population maintains a relatively steady, moderate level.
Epidemic- there is a sharp rise in the incidence or an out-break of disease.
Hyperendemic- if the prevalence of a disease in a community is high.
Sporadic- if the disease appears only occasionally in one or few members of the society.
Pandemic- when the disease covers extensive area of infection.

Portal of entry/ Mode of Transmission (MOT):

• Mouth- Ingestion/ Fecal Oral Route, Kissing, Mouth to Mouth
• Skin- Skin penetration, Needle prick/ Sharing of infected needles
• Genitals- Sexual Transmission
• Nose- Intranasal
• Transplacental- Vertical transmission
• Bite of an Arthropod Vector
• Blood Transfusion

PHASES IN THE COURSE OF PARASITIC INFECTION:

Exposure – an individual in a state of risk acquiring the parasite
Inoculation – the introduction of the parasite to the host via a portal of entry
Biologic incubation period – time from the entry of the organism until they may be recovered in body fluids,
tissues, or excreta without any manifestation
Clinical incubation period – the time of entry of a disease causing organism into the body of the host until the
earliest sign and/or symptom of the infection appear.

Usual symptoms of an intestinal parasitic infection- DApAc J

Diarrhea
Abdominal pain
Abdominal cramping

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Life cycle: (e.g Hookworm)

Infective stage
Diagnostic stage
Mode of Transmission
Habitat
Developmental stages
Hosts- Intermediate and Final/ Definitive host
Vector- Mechanical and Biologic
Specimen of choice
Prevention and Control

II. Specimen Collection, Transport and Preservation

Stool should be collected in a clean cardboard or PAN.

Container: clean, dry, sterile, wide-mouthed container with a tight-fitting lid (screw capped lid) with sufficient moisture before submitting
to the lab.
Ideally: 2-5 grams= Thumb sized/ Pea sized/ Walnut sized stool
Should not be contaminated with Urine or Water.

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Specimen properly labelled: Complete name, Date and Time of Collection, Test to perform (This should be submitted together with a
laboratory request)

. Fresh stool samples should be delivered and processed into the laboratory. (MOTILITY of Trophozoites)
} Liquid stool: within 30 minutes
} Semisolid stool: within one hour
} Formed stool: within one hour
*If there will be a delay in processing, samples should be placed in a ___________.

Typical stool collection protocol: Atleast 3 specimens/ stool submitted within 10 days (one every other day)
Amoebiasis: Total of 6 specimens collected within 14 days (acceptable) Reference: Zeibig

Therapy or medication:
Stool should be collected before therapy!
• antibiotics or antimalarial medications- Collection should be delayed for 2 weeks following therapy à FALSE NEGATIVE
• Barium, Bismuth, Kaolin, Mineral oil- Wait for 5-7 days to resume collection

Fixatives:
} Preserves the morphology
} Ratio of fixative to stool: 3:1 (commercial kits are available).
} The specimen must be fixed in the preservative for at least 30 minutes before processing begins.

1. Formalin/ Formaldehyde

Advantage Disadvantage

• All purpose fixative • Not suitable for some permanent smears

• Easy to prepare stained with trichrome
• Long shelf life • Trophozoites usually cannot be recovered and
• Good preservation of morphology of helminth morphologic details of cysts and eggs may fade
eggs, larvae, protozoan cysts, and coccidia with time
• Suitable for concentration procedures and UV • Can interfere with PCR (extended fixation time)
fluorescence microscopy
• Suitable for acid-fast, safranin, and
chromotrope stains
• Compatible with immunoassay kits and UV
fluorescence microscopy

5% formalin-
10% formalin-

2. Merthiolate-Iodine-Formaldehyde (MIF)
Advantages Disadvantages

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• Components both fix and stain • Not suitable for some permanent smears stained with
• Easy to prepare trichrome
• Long shelf life • Inadequate preservation of morphology of protozoan
• Useful for field survey trophozoites
• Suitable for concentration procedures • Iodine interferes with other stains and fluorescence
• Iodine may cause distortion of protozoa

3. Low Viscosity PVA (Polyvinyl Alcohol)

PVA- is often combined with ___________ which may contain Zinc sulfate, Copper sulfate and Mercuric chloride as a base.
Advantages Disadvantages

• Good preservation of morphology of protozoan • Inadequate preservation of morphology of helminth

trophozoites, cysts and most helminth eggs eggs, larvae, coccidia and microsporidia
• Easy preparation of a permanent stained smear • Contains mercuric chloride
• long shelf life when stored at room temperature • Difficult and expensive to dispose
• Difficult to prepare in the lab
• Not suitable for concentration procedures
• Not for immunoassay kits
• Not suitable for acid-fast, safranin, and chromotrope
stains

4. Sodium acetate formalin (SAF)

Advantages Disadvantages

• Easy to prepare • Requires additive for adhesion of specimens to

• Long shelf life slides (ALBUMIN)
• Suitable for concentration procedures and preparation • Permanent stains not as good as PVA or Schaudinn’s
of permanent stained smears fixative
• Suitable for acid-fast, safranin, and chromotrope stains
• Compatible with immunoassay kits

5. Schaudinn’s fixative
Advantages Disadvantages

• Good preservation of trophozoites and cysts • Less suitable for concentration procedures
• Easy preparation of permanent stained smear • Contains mercuric chloride
• Inadequate preservation of morphology of helminth
eggs and larvae, coccidia and microsporidia
• Poor adhesion of liquid or mucoid specimens to slides

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6. Modified PVA
Advantages Disadvantages

• Permanent smears can be made and stained with • Staining is not consistent
trichrome • Organism morphology of cysts and trophozoites is poor
• Zinc is preferred over copper • Copper-morphology of cysts and trophozoites
• No mercuric chloride • Zinc- better morphology but not comparable to LV-PVA

7. One vial fixative (Single system)

Advantages Disadvantages

• Free of formalin and mercury • do not provide the same quality of preservation as
• Used in both concentration techniques and permanent mercury-based fixatives
stained smears • organism identification will be more difficult from
• Used in performing fecal immunoassays permanent stained slides
• Sometimes more expensive than formalin and LV-PVA

Page 18. Reference: Zeibig, Clinical Parasitology, A practical approach

O and P Technique- Stool Examination

Ova and Parasites Technique

Procedures:
1. Wet mount- 0.85% NSS, Iodine (Lugol’s or D’ Antoni’s)

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2. Concentration Technique- Sedimentation: Formalin- Ethyl Acetate Concentration Technique (FECT)

Flotation: Zinc Sulfate Flotation Technique (ZSFT)

Specific gravity of Zinc sulfate:

Sheather’s sugar flotation technique

3. Permanent stain- Trichrome stain (Wheatley’s)- Rapid, reagents have long shelf life, easy to perform
Iron Hematoxylin- Time consuming
(+)=Dientamoeba fragilis trophozoite

Other methods: 4. Cellophane covered thick smear- Kato katz/ Kato thick

Analysis of Stool:
• Macroscopic- C
C
G
• Microscopic- WBCs, RBCs, Parasites seen

Formed stool- cysts

Loose/ Diarrheic/ Watery- Trophozoites
Bright red blood streaks present in stool- Lower GIT bleeding
Mucus- WBCs

Other special stains:

Modified Acid fast stain- Coccidians

Other specimens aside from Stool:

1. Blood- Capillary, Venous whole blood (EDTA), Serum, Malarial smears
2. Buffy coat
3. Knott technique
4. Urine
5. Sputum
6. Skin snips
7. Oral swab/ Mouth Scrapings
8. Corneal Scrapings
9. CSF, Body fluids
10. Bone Marrow
11. Tissue biopsy
12. Genital secretions
13. Eye specimens
14. Aspirates/ Abscess for Culture
15. Animal inoculation/ Xenodiagnosis
16. Nasal swab
17. Scotch tape swab- 3 consecutive morning right after patient wakes up or before washing

III. Amebas/ Amoebas

Cystic stage Trophozoite

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Locomotion: Pseudopodia (false feet)

Cytoplasm: Endoplasm and Ectoplasm
Stages: Trophozoite- Feeding, Motile (Pseudopodia), Vegetative
Cyst- Non feeding, Non motile, Infective
Replication: Binary fission

INTESTINAL EXTRAINTESTINAL
• Entamoeba histolytica • Entamoeba gingivalis
• Entamoeba moshkovskii** • Naegleria fowlerii
• Entamoeba dispar • Acanthamoeba
• Entamoeba hartmanni
• Entamoeba coli
• Entamoeba polecki
• Endolimax nana
• Iodamoeba butschlii

**Entamoeba moshkovskii- has been isolated from sewage plants in many parts of the world and in one study was shown to infect a
substantial minority of children in Bangladesh.

Developmental stage Entamoeba histolytica Entamoeba coli

Trophozoite Hyaline pseudopodia Blunt pseudopodia

Rapid, unidirectional progressive motility Sluggish, Non progressive motility

Small centrally located karyosome Large, irregularly-shaped Eccentric

karyosome

Peripheral chromatin fine and evenly distributed Unevenly distributed peripheral chromatin

Fine granular cytoplasm “Clean looking cytoplasm”, Coarsely granular cytoplasm. “dirty
“ground glass appearance of cytoplasm” looking cytoplasm”

Ingested RBCs- Diagnostic feature J

NO Ingested RBCs, Ingested bacteria,
debris maybe seen
Cyst 1-4 nuclei 1-8 nuclei

Infective: Quadrinucleated cyst

Sausage shaped/ rounded ends- chromatoidal Thin with pointed to splintered ends
bars “broom-stick” appearance
of chromatoidal bars
Pathogenic- Amoebiasis Non-Pathogenic
Asymptomatic Carrier State Considered to be a commensal
Symptomatic Intestinal Amoebiasis
Symptomatic Extraintestinal Amoebiasis

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Entamoeba histolytica: Amebic killing of Target cells (Markell and Vogues)
• Receptor-mediated adherence to target cell- Gal/Gal NAc lectin
• Amebic cytolysis of target cells- Caspase 3
• Amebic phagocytosis

Belizario: Gal/ GalNAc lectin, Amebapores, Cysteine proteinases

Diagnostic procedures: DFS, Sigmoidoscopy, Hepatic Abscess, Serological Tests

Stool culture = (TYI-S-33)

Life cycle: E. histolytica

Ingestionà Excystation (small intestine) à 1 cyst= 8 trophozoites à Trophozoites replicate in the Large intestine via binary fission and
feed on host cells à ExtraIntestinal migrates in the Liver (abscess formation), Lungs, Brain

Encystation in the intestinal lumen à Infective cysts passed out into the environment (may survive up to 1 month)
Trophozoites may also be seen in the stool.

IS:
DS:
Habitat:
Specimen:

Entamoeba hartmanni- sub specie of E. histolytica, small-race E.histolytica

Entamoeba polecki- Non descript oval or round Inclusion mass is seen in approximately 50% of cysts studied.
Parasite of PIGS and MONKEYS. = Papua New Guinea
Endolimax nana- Trophozoite: “Blot-like appearance of karyosome”, no peripheral chromatin
Cyst: “Cross-eyed cyst” (4 nuclei)
Iodamoeba butschlii- Glycogen mass in cysts picks up IODINE stain= Iodamoeba means “Iodine-loving”
Trichrome: Glycogen mass _____________
Iodamoeba cyst nucleus: “basket of flowers”
Entamoeba gingivalis- NO CYSTIC STAGE!
The only amoeba that ingests WBC, Epithelial cells, bacteria
First amoeba recovered from a human specimen

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MOT: ____________________
Specimen:

Naegleria fowleri- PAM

Three known morphologic forms:
Culture: NNA
(+)Kernig’s sign= patient is unable to fully straighten his or her leg when the hip is flexed
at 90 degrees because of hamstring stiffness (Meningitis)
Specimen: __________ , _____________
MOT:

Acanthamoeba sp- GAE: _____________________________ and Acanthamoeba keratitis

“Spineplike or Thorn-like pseudopods” known as _________________
CYST has Double cell wall
Specimen:
MOT: Reference CDC: __________, ____________, ____________
10 species of Acanthamoeba known to infect humans: Acanthamoeba castellanii, A. culbertsoni, A.
rhysodes (CNS and Eye)
Stain for Acanthamoeba keratitis: CFW: __________________ (Bright Greenish White/ Apple green)

IV. Flagellates

Phylum: Sarcomastigophora
Subphylum: Mastigophora
Class: Zoomastigophora
Locomotor organelle: Flagella (Flagella +axonemes)
Intestinal Extraintestinal
Giardia intestinalis Trichomonas tenax
Chilomastix mesnili Trichomonas vaginalis
Dientamoeba fragilis
Trichomonas hominis
Enteromonas hominis
Retortamonas intestinalis

Giardia intestinalis
Aka. Giardia lamblia, Cercomonas intestinalis, Giardia duodenale
Disease: Giardiasis, Traveller’s Diarrhea, Backpacker’s diarrhea
Fatty, Frothy stools- Steatorrhea
Associated with Malabsorption syndrome
Bilaterally symmetrical parasite
Trophozoite: Old Man’s face with eyeglasses, Monkey face, Old man’s face with whiskers
Giardia intestinalis
Trophozoite
Shape:
Motility:
Cyst:
Specimen:
Habitat:
IS:
DS:
Lab methods:
Treatment: MTN
CYST TROPHOZOITE NOTE: Pathogenic intestinal flagellate J


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Flagellate Trophozoite Cyst

Chilomastix mesnili Cytostome, Spiral groove Lemon shaped cyst/ Nipple shaped
Shape: Anterior hyaline knob / protuberance
Motility:
“Shepherd’s crook appearance 1 nucleus=1 cytostome
Retotomonas intestinalis Cytostome “Bird’s beak appearance”
2 anterior flagella
Enteromonas hominis Simplest: 4 nuclei
Oval shape
Dientamoeba fragilis Trophozoite only NO CYSTIC STAGE!
Amoebaà Amoeboflagellate à
Flagellate (Centrodesmus)
** Similarity to the flagellate Histomonas
and antigenic similarity to the trichomonad
group

Binucleated with 4-8 chromatin granules

With Hyaline Pseudopodia

EM- Flagellate characteristic
MOT:
Lab diagnosis:

Trichomonas sp.
FEATURES Trichomonas hominis Trichomonas tenax Trichomonas vaginalis

Habitat

Size

Nucleus

Undulating membrane

Inclusion bodies

Specimen for Diagnosis

Female: burning sensation,

“strawberry cervix”
Male: Asymptomatic; urethra,
prostate, epididymis

Motility:
COSTA- Connects the undulating membrane to the trophozoite body
Undulating membrane- Tumbling Jerky motility
Treatment:


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V. Sporozoans: Plasmodium and Babesia

Phylum: ______________

Plasmodium Babesia
Plasmodium vivax Babesia microti
Plasmodium ovale Babesia divergens
Plasmodium malariae
Plasmodium falciparum
Plasmodium knowlesi

Plasmodium: Morphological stages

Ring forms (Early Trophozoites)
Developing Trophozoites
Immature Schizonts
Mature Schizonts
Microgametocytes
Macrogametocytes

Vector: ___________

Life cycle: Malarial Parasite

MOT:
IS TO MAN:
Exo- erythrocytic cycle happens in the ___________.
Hypnozoites: ______________ and _____________
Erythrocytic cycle happens in ___________.
Asexual cycle is also known as ___________.
IS to Mosquito:
Sexual cycle is also known as __________


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Specimen of choice:
Best time to collect specimen:

Features P. vivax P. ovale P. malariae P. falciparum

Disease
Trophozoite BAND Circle
Headphones
Accole
Applique
Multiple forms
Merozoites (Schizont) 12-24 (16) 8 (Rosette) 6-12 with brown-green 8-36 (24)
pigment at the center
Microgametocyte Round to Oval Crescent
Sausage
Banana

Macrogametocyte Round to Oval

RBCs infected Young (Enlarged) Young Aged, Mature All types
Paroxysm
Cytoplasmic granules

Treatment: Quinine, Chloroquine

Resistance:

Plasmodium knowlesi- Malaysia (Borneo)

Parasite of Old world monkeys
Sinton and Mulligan’s stippling
5th human malaria
“Quotidian”

Babesia sp.
u Texas Cattle Fever
u Red Water Fever

Babesia microti Babesia divergens

Vector: Tick Ixodes dammini Ixodes ricinus
IH White footed mouse (Peromyscus rabbits, cattles
leucopus)

Man: Accidental Host (Zoonotic)

Maltese-Cross appearance of trophozoite (Diagnostic)
IS to Man/ Animal:
IS to Tick:
MOT:

VI. Miscellaneous Protozoans

1. Balantidium coli- Ciliate (meaning Cilia is the organelle for movement/locomotion)

Disease: Balantidiasis/ Balantidiasis dysentery
“Little bag” or Sac-like body
These parasite is the largest intestinal protozoan and the only pathogenic ciliate.
Symptoms of Balantidiasis is similar to having amoebic dysentery. The parasite has a cytolytic enzyme hyaluronidase for tissue invasion.


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Two developmental stages: Trophozoite and cyst
Trophozoite- motile, feeding stage
Cyst- non-motile and infective stage
Diagnostic stage: Trophozoite or cyst found in STOOL

TROPHOZOITE CYST

The parasite has the following parts:

Trophozoite has a cytostome and a cytopyge.
Cytostome- rudimentary/ primitive mouth of parasite
Cytopyge- Excretory pore

The trophozoite and cyst both have a macronucleus, micronucleus and contractile vacuoles.
Macronucleus- Kidney/ Bean-shaped nucleus and is the vegetative portion
Micronucleus- small spherical nucleus located in the concavity of the micronucleus and is the reproductive portion

LIFE CYCLE: Balantidium coli

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MOT: Ingestion of contaminated food and water with infective cysts
Excystation happens in the small intestines. (CYST becomes Trophozoites). Then Trophozoites replicate via transverse binary fission.
They inhabit the large intestines. Encystation also happens. (Trophozoites to cysts).
Diagnostic stage: Trophozoite or cyst
Specimen: Stool
Method: Direct fecal smear/ DFS/ Stool examination
Treatment: Oxytetracycline or Iodoquinol
Reservoir host: Pigs
Final host/ Definitive Host: Man
No intermediate host.

2. Isospora belli
Classified also in a group known as Coccidians
Infective stage: Mature OOCYST
Disease: Isosporiasis

Ova: Double layered cell wall with 2 sporoblasts (Immature oocyst)

2 sporocysts with 4 sausage shaped sporozoites (Mature oocyst)
Specimen of choice: Stool, duodenal contents
Concentration or Flotation method used: Sheather’s sugar flotation technique
Stains for detection: Iodine Wet Preparation
Auramine Rhodamine Permanent stain
Confirmatory stain: Modified Acid Fast Stain

Lifecycle: Cyst à Sporozoites à Merozoites à Gametocytes (Macro and Micro)àImmature oocyst (Shed in Stool) à Mature Oocyst
(Environment)

Eosinophilia- Charcot leyden crystals seen in stools

Eosinophilia means an increase in Eosinophils in the blood
Charcot Leyden crystals- are disintegrated eosinophils seen in stool
Eosinophils- Are White blood cells which are increased during parasitic infection, allergies, asthma
Treatment: Sulfamethoxazole, Trimethoprim, Sulfadiazine
Chemotherapy at a lower dosage for a longer period may be necessary for AIDS patients infected with Isospora belli.

3. Sarcocystis
Also a Coccidian
Sarcocystis species:
Sarcocystis hovihominis- IH: Cattle
Sarcocystis suihominis- IH: Pig
Sarcocystis lindemanii- Infects MAN
IH- means Intermediate Host
Specimen of choice: STOOL
In the stool you will see Ruptured sporocysts which are most often seen singly or in pairs cemented together.
Intermediate Host= Pig/ Cattle with infective SARCOCYSTS
Definitive Host= Man
MOT: Ingestion of uncooked meat with sarcocyst

SARCOCYST may be present in HUMAN Samples if Man accidentally ingests the OOCYST(Ova).
Ingestion of oocysts à sarcocysts in muscle of Man (It’s a Dead end cycle: Because no one eats improperly cooked meat of Man unless
you are a cannibal or a zombie! Hehe. J)
Treatment: SXT Sulfadiazine; No chemotherapy

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Sarcocystis sp. needs an intermediate host to proceed to infection in Man unlike Isospora that could readily infect Man via ingestion of
oocyst/ova.

4. Cryptosporidium parvum
Disease: Cryptosporidiosis
4-6um often confused as YEAST
Ova: No sporocysts; 4 sporozoites with thick cell wall. Contains 1-6 dark granules
Schizonts with 4-8 merozoites
Gametocytes (microgametocyte and microgametocyte)

Specimen of choice:
Stool: to see OVA
Intestinal biopsies: to see schizonts and gametocytes

Methods of Detection:
Stool: Iodine, Modified Acid Fast Stain, Formalin fixed smears, Giemsa stained smears may also yield desired oocysts
Enterotest, ELISA, IIF
Zinc sulfate and Sheather’s sugar flotation

This parasite is capable of AUTOINFECTION and leading cause of diarrhea in AIDS patients.
Treatment: Spiramycin
Prevention: Wear gown and gloves in handling poultry and cattle. Proper handwashing, use of full strength commercial bleach, or 5 to
10% household ammonia.

5. Cyclospora cayetanensis
Also a coccidian
Ova: 2 sporocyst each containing 2 sporozoites
Formalin fixed smears is NOT used for detection.
Ova Sporulate best at room temperature.
Detection: 5% Potassium dichromate- visible
Modified Acid Fast Stain


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Specimen: Stool

Life cycle: OOCYSTà SPOROZOITEà merozoite/ gametocytes à OOCYST

Symptoms are the same with cryptosporidiosis but the diarrhea is longer in Cyclosporiasis than cryptosporidiosis.
In cyclospora infection, There is no known connection with immunocompromised patients.

6. Toxoplasma gondii
Also a coccidian
Disease: Toxoplasmosis, Congenital Toxoplasmosis, Cerebral Toxoplasmosis
Stages of development: OOCYST, TACHYZOITES, BRADYZOITES

Bradyzoites- slow growing, dormant stage surrounded by a wall often found in IH like mouse brain/ rodents
Tachyzoites- Fast growing, fast moving, motile, has the ability to migrate
Oocyst- Infective stage

Life cycle: Toxoplasma gondii

IH: Rodents, Mice, Mouse, Other animals even Pigs

Final Host: Cats

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Accidental host: Man
MOT to Man: Ingestion of sporulated Oocyst, Transplacental, Ingestion of improperly cooked pork with cysts in tissues
How does cat acquire Toxoplasma? If the rat ingests the oocyst, it becomes tachyzoites in the rat and migrates to the brain and settle
there as bradyzoites. Tha cat eats the rat/ mouse with bradyzoites and that’s the time the cat become infected. Inside the cat, the parasite
matures and the cat eventually sheds unsporulated oocysts in the stool.

Treatment: Trisulfapyrimidines, pyrimethamine (Daraprim),

Spiramycin (for pregnant women)

Please read about the disease, signs and symptoms of toxoplasmosis in Zeibig. J
Specimen of choice in Cats: Stool
In Man: CSF for cerebral toxoplasmosis, Blood sample/ Serum
Serologic assays are used to detect toxoplasmosis in humans: IgM (double-sandwich ELISA), IgG and IgM (IFA) Indirect Fluorescent
Antibody, IgG- Indirect Hemagglutination and ELISA, Inoculation of Laboratory Animals

7. Blastocystis hominis
Most frequently isolated is the Vacuolated form of the organism. Large central vacuole is present and 2-4 nuclei are found in the periphery
of the organism.
Iodine wet mount of STOOL: Nuclei- light yellow Vacuole- does not stain
Treatment: Iodoquinol, Metronidazole
Often seen with Entamoeba histolytica infections and Giardia intestinalis infections
Classification: ALGAEà YEASTà PARASITEà STRAMENOPILES
First it was classified as an algae then a yeast then a parasite and now stramenopiles which is a eukaryote.

8. Microsporidia
PROTOZOA à FUNGI (First it was a protozoan then now it is classified as a fungi)
3 out of 5 (AIDS)- 3 out of 5 are associated with AIDS patients
Enterocytozoon bieneusi (agent of enteritis), Encephulitozoon and Pleistophora (severe tissue infections)
Microsporidium, Nosema –Corneal infections
Detection Methods: Trichrome, Acid fast, PAS (Periodic Acid Schiff stain)
TEM (Transmission Electron Microscopy)- use to identify Microsporidia species
Infective stage: Spores with extruding polar filaments which inject SPOROPLASM into a host cell.
Treatment: Albendazole/ Fumagillin

9. Pneumocystis jiroveci
Also known as Pneumocystis carinii
From parasite, now its classified as FUNGUS
Disease: Pneumocystosis, Atypical Interstitial plasma cell pneumonia
Developmental stages: TROPHOZOITE, CYST
Trophozoite- one nucleus, ovoid, ameboid
Cyst- 4 to 8 nuclei (intracystic bodies) arranged in a rosette or unorganized fashion
Mode of detection: Giemsa, Iron hematoxylin stain
Histologic stain for detection: Gomori’s methamine silver nitrate stain –BEST
Specimen of choice: Sputum, bronchoalveolar lavage, tracheal aspirates, lung tissue, bronchial brushings
Habitat of parasite: alveolar spaces in lungs
It is the Leading cause of death in AIDS. And patients with Pneumocystis also has Kaposis sarcoma (skin disorder)
MOT: Droplet infection, person to person contact

VII. Blood and Tissue Flagellates/ Hemoflagellates

Genera: Leishmania & Trypanosoma

4 Morphological forms:

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1. Amastigote- 5x3 um, Round to Oval with One nucleus usually off center, Contains Kinetoplast = blepharoplast + parabasal body,
without flagella. This form is found intracellular in mononuclear phagocytes.

2. Promastigote- 9-15 um long, Long and slender, with One nucleus in or near center. It has a Kinetoplast positioned in the anterior end
with a single flagellum. No undulating membrane.

3. Epimastigote- 9-15 um long, long and slightly wider than the promastigote. The nucleus is found posterior the kinetoplast. The
Kinetoplast is anterior to nucleus with an Undulating membrane which is half of body length with a Flagellum.

4. Trypomastigote- 12-35 um long, 2-4 um wide, Shape: C,S or U in blood films, long and slender with One nucleus anterior to kinetoplast.
Other features:
• Kinetoplast – posterior end (below the nucleus)
• Undulating membrane – full body length
• Flagellum – anterior end
NOTE: Please refer to the illustrations in the book pages 107-108 (Zeibig)

Transmission: Bite of arthropod vector (specific vector depends on the genus)

Diagnostic form: (Morphologic forms which are isolated in Man)
¡ Leishmania – amastigote
¡ Trypanosama – trypomastigote
T. cruzi – amastigote may also be found together with trypomastigotes

Leishmania complexes classification:

1. Leishmania braziliensis
2. Leishmania donovani
3. Leishmania mexicana
4. Leishmania tropica

Trypanosoma classification:
1. Trypanosoma brucei gambiense
2. Trypanosoma brucei rhodesiense
3. Trypanosoma cruzi
4. Trypanosoma rangeli

Leishmania complex L. braziliensis L. donovani complex L. mexicana complex L. tropica complex

complex
Vector: Lutzomyia, Lutzomyia, Lutzomyia Phlebotomus
Psychodopygus Phlebotomus
Sandflies sandflies

Disease: Mucocutaneous Visceral Leishmaniasis New world cutaneous Old world cutaneous
Leishmaniasis Leishmaniasis Leishmaniasis
Reservoir host Dogs and forest rodents L. donovani chagasi- Forest rodents L. aethiopica- Rock
dogs, cats, foxes hyrax

L. donovani infantum- L. major- Gerbils,

dogs, foxes, jackals, rodents
porcupines
L. tropica- Dogs
(possibly)

 21

Please refer to Table 5-5 page 111 of Zeibig for the conditions and diseases associated with Leishmaniasis. J

Leishmania braziliensis complex

Lab diagnosis:
Specimen: biopsy of infected ulcer
Procedures:
Giemsa-stained preparation – showing amastigotes
Promastigotes – is seen only if sample is collected immediately after infection
Culture – will reveal promastigotes
Serological, enzyme analysis & molecular techniques
Under research: schizodeme & zymodeme analysis
Clinical symptoms
Mucocutaneous leishmaniasis
Ulcers in oral or nasal mucosa – initial invasion
Edema & secondary bacterial infections , and mucosal lesions = disfigurement of face
Death – bacterial infection
Treatment:
Antimony compounds (Pentosam)- drug of choice
Liposomal amphotericin B
Oral antifungal –fluconazole, ketoconazole, itraconazole

Leishmania donovani complex

Lab diagnosis:
Montenegro Skin Test – screening test for population at risk (Montenegro skin test is similar to tuberculin skin
test. It is not good in detecting active disease.)
Demostration of amastigotes: Giemsa-stained specimens of blood, bone marrow, lymph node aspirates &
biopsies
Culture – promastigotes
Serlogic – IFA, ELISA, DAT

Clinical symptoms:
Visceral Leishmaniasis/ dum dum fever/ kala-azar
Internal organs affected
Abdominal illness & hepatomegaly
Fever and chills
2-18 months incubation
Diarrhea, weight loss, anemia, emaciation
Advance stages: kidney damage granulomatous areas of skin, darkening of skin (kala-azar)
Death: chronic – 1-2 yrs, acute – weeks
Treatment:
Liposomal amphotecirin B (Ambisome) – drug of choice
Gamma interferon + petravalent antimony
Allopurinol – AIDS patients
New drugs: paramomycin and miltefosine

Notes of interests:
Person to person transmission via blood transfusion is possible
Galactosyl-alpha(1,3) galactose antibodies – high levels of this marker may indicate parasite remnants

Leishmania mexicana complex

Lab diagnosis:
Giemsa-stained preparations – lesion biopsy materials (will show Amastigotes)

 22

Culture – NNN medium (Novy McNeal Nicolle Medium) will reveal promastigotes
Serologic and monoclonal antibodies techniques

Clinical symptoms:
New World Cutaneous Leishmaniasis
Aka chiclero ulcer/ bay sore
Characterized by single pus-containing ulcer
40% cause ear infections
Initial symptoms: small red papule , pruritis
Anergic patients – no spontaneous healing of ulcers

Treatment:
Pentosam – drug of choice
Antimony + pentoxifylline - 3x a day for 30 days
Amphotericin B & liposomal Amphotericin B

Leishmania tropica complex

Lab diagnosis:
Giemsa-stained preparation of fluid aspirates under ulcer bed (showing amastigotes)
Culture, Serologic (IFA)

Clinical symptoms:
Old World Cutaneous Leishmaniasis
One or more ulcers containing-pus
Thick plaques of skin, along w/ multiple lesions or nodules
Treatment:
Pentosam
Steroids, heat application to lesions, Glucantime, pentamidine, oral ketoconazole & paromomycin ointment

Cutaneous Tapir nose/ Espundia/ Mucocutaneous Visceral/ Kala-azar

Life cycle: Leishmania

Vector: Sandfly with promastigotes infects man via a blood meal/biteà promastigotes become amastigotes in Man à
amastigotes invade the macrophages or phagocytes intracellularlyà A sandfly bites an infected Manà amastigotes become
promastigotes inside Vectorà Ready to infect another Man to repeat the cycle

INFECTIVE STAGE to MAN: Promastigote

Diagnostic stage: Amastigote
Infective stage to Sandfly: Amastigote


 23

Trypanosoma: Trypanosomes

Trypanosoma brucei gambiense

Lab diagnosis:
Giemsa stained slide : blood & lymph nodes aspirates
CSF: microscopic exam of sediments, ↑IgM & protein detections
Serum IgM

Clinical symptoms:
West african (Gambian) Sleeping sickness/ Gambian trypanosomiasis
¢ Chancre- painful ulcer, with white halo surrounding the bite site
¢ Winterbottom’s sign- Cervical lymphnode enlargement
¢ Grandular phase: erythymatous rash, edema, Kerandel’s sign (delayed sensation to pain)
¢ CNS involvement: somnolence/ excessive sleepiness

VECTOR: TSETSE FLY (Glossina palpalis and Glossina tachinoides)

There are NO known animal reservoir hosts.

Trypanosoma brucei rhodesiense

Lab diagnosis:
Giemsa- stained slides – blood slides
CSF Sediment microscopic exam & IgM increase
Clinical Symptoms:
East African (Rhodesian) Sleeping Sickness, Rhodesian trypanosomiasis
¢ Fever, myalgia, rigors
Early CNS involvement : mental disturbance, lethargy, anorexia
Death : kidney damage & myocarditis
Lymphadenopathy is absent.
Vector: Tsetse fly (Glossina morsitans and Glossina pallidipes)

Life cycle: T. b. gambiense and T. b. rhodesiense

Tsetse fly with infective Trypomastigotes gains entry to Man via insect biteà Trypomastigotes in the blood and lymphatic
systemà Trypomastigotes transferred back to tsetse flies via insect biteà Trypomastigotes become epimastigotes in the
tsetse flyà In the salivary glands, the epimastigotes transforms back into infective trypomastigotes.

Infective stage to Man- Trypomastigotes

Diagnostic stage- Trypomastigotes

NOTE: Rhodesiense is much more virulent organism than Tb gambiense. J

 24

Trypanosoma cruzi
Lab diagnosis:
Giemsa-stained slides of blood – trypomastigotes
Amastigotes : Giemsa-stained slides, Blood Culture
¡ Serologic: CF, DAT, IIF
¡ PCR, ELISA (blood screening for donation)
Epimastigotes- are found in the arthropod vector
Xenodiagnosis- noninfected reduviid bug is allowed to feed on a person suspected of Chagas’ disease. Feces of the bug
is examined for presence of trypomastigotes.

Clinical Symptoms:
Chagas’ disease (Discovered by: Carlos Chagas)/ American trypanosomiasis
Can be: Asymptomatic, chronic, acute
Chagoma – erythematous nodule
Romana’s sign – conjunctivitis & edema of eyelids
Chronic - years after asymptomatic
¢ Megacolon, megaesophagus, cardiomegaly, brain damage
Acute Chagas disease – fever, chills, fatigue, myalgia and malaise

T. cruzi Vector: Reduviid bud/ Triatomine bug/ Kissing bug/ Conenose bug/ Triatomid bug/ Panstrongylus megistus
Infective stage to Man- Trypomastigote
Diagnostic stage- Trypomastigote and Amastigote
Infective stage to vector- Trypomastigote

MOT: Bite of vector. The reduviid bug defecates infective trypomastigotes near the bite site. Itchiness will trigger Man to scratch the bite
site, therefore infective trypomastigotes will gain entry.

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Trypanosoma rangeli
Lab diagnosis:
Giemsa stained slide of blood- detection of trypomastigotes
Vector: Rhodius prolixus (reduviid bug)
It has the same lifecycle with T.cruzi
Reservoir hosts: monkeys, raccoons, dogs, cats, armadillos, rodents
Clinical symptoms: asymptomatic, benign infections
Treatment: Nifurtimox and Benzimidazole

PARASITOLOGY (PART II)

NEMATODES
Characteristics:
1. Adult nematode is elongated, cylindrical worm, primarily bilaterally symmetrical
2. Anterior end may be equipped with hooks, teeth, plates and papillae for purpose of abrasion , attachment
3. Supporting body wall consists of an outer hyaline noncellular cuticle, subcuticular epithelium and a layer of muscle cells.
4. Alimentary tract is simple tube extending from mouth to anus. There is no circulatory system.

Cestodes Trematodes Nematodes

Shape Tape-like Leaf-like unsegmented Elongated, cylindrical,
unsegmented
Head end Suckers present, some have Suckers are present but no Hooks and suckers absent.
attached hook hooks Well developed buccal
capsule with teeth or cutting
plates seen in some species.

Body Cavity Absent, but inside is filled Same as cestodes Present and known as
with spongy undifferentiated pseudocele. Viscera remains
mesenchymous cells in the suspended in the pseudocele
midst of which lie the viscera

Sex Not separate: Hermaphrodite Not separate, hermaphrodite Separate sexes (dioecious)
(monoecious) except Schistosoma
Life Cycle Requires 2 host except Requires 3 host except Requires 1 host except
Hymenolepis (1 host) and schistosomes (2 host) Filarial worms (2 host) and
Diphyllobothrium (3 host) Drancunculus (2 host)
D. latum
D.H. – Man
1st I.H. – cyclops
2nd I.H. -fish

5. Life cycle: Egg stage> larval stage >adult stage

6. With two separate sexes
7. Provided with chemoreceptor – Cephalic Chemoreceptor (AMPHID) and Caudal Chemoreceptor (PHASMID)
a. Oviparous –lays egg unsegmented stage (unembryonated) ; parasite that lays eggs which hatch after leaving the
body of the host .
b. Oviviparous – lays egg in segmented stage (embryonated) : parasite that lays eggs that hatch before leaving the
host


 26

c. Larviparous/Viviparous – larva only no egg stage ; parasite that bears living young instead of laying eggs.
d. Parthenogenic female

Classification:
I.According to presence of chemoreceptors
a. Aphasmids (lacks phasmids or caudal chemoreceptors)
b. Phasmids (w/caudal chemoreceptors)

II.According to their habitat

1. Intestinal Nematode
a. Small intestine
b. Large intestine

2. Extra -intestinal Nematode

________________________________________________________________________________________

Ascaris lumbricoides
- Romans “Lumbricus Teres” – resemble common earthworm
- Giant intestinal round worm
- Adult (in small intestine)
o White cream or pinkish yellow when fresh
o Head is provided with 3 lips and a triangular buccal cavity(trilobate lips)
Size Posterior
Female Larger Pointed
Male smaller Curved

- Egg
-Either fertilized or unfertilized
-Fertilized egg consists of 3 layers:
Inner vitelline membrane (not found in unfertilized egg)
Middle glycogen layer
Outermost mammillation (with mammillation –corticated / w/o – decorticated)
-Unfertilized egg (2 layers)
with lecithin granules
MOT: ingestion ; fecal-oral route
Infective Stage: Embryonated Egg

Life Cycle:
1. Adult lives in small intestines
2. Undeveloped eggs in feces , embryonated in warm moist soil
3. Embryonated egg ingested by man
4. Larva hatch in small intestine and begin larval migration (intetsinal wall –blood vessel –liver-blood
vessels –lung-alveoli –bronchioles-pharynx-small inestine) then mature into adult.
Signs /Symptoms and Pathology:
1. pneumonia, cough , fever, eosinophilia during larval migration (resembles “Loeffler’s syndrome” , tissue
invasion = increase eosinophils)
2. Vomiting and abdominal pain
3. Intestinal Perforation is possible
4. Heart to lung migration (ASH – Ascaris, S.stercoralis and Hookworm)

Laboratory Diagnosis
Diagnostic Stage: Egg


 27

Test: Stool exam
If stool is negative maybe: no infection, early infection or all male worm infection
Toxocara cati (Ascaris of cat) ; Toxocara canis (Ascaris of dog) VLM- Visceral Larva Migrans

Enterobius vermicularis
- Pin worm/ Seat worm/social worm
- Most common helminth infection in the world
- Male: curved tail , Female: pointed tail
- Anterior : Lateral wings/Cephalic alae
Disease: _____________________
Habitat: Large Intestine
MOT: ingestion /fecal-oral route
Infective stage: embryonated egg

Adult
- Small, whitish or brownish in color
- Anterior end with lateral wings or cephalic alae
Egg
-Elongated, flattened on one side, D-shaped (infective stage)
Life cycle:
1. Adult in colon
2. Gravid female migrates to perianal region to deposit eggs
3. Eggs ingested hatch in small intestine , releasing larvae and develop into adult worms

Pathology: “mother’s complex”

1. Pruritus ani (autoinfection – E.vermicularis (external; perianal region) , S. stercoralis (internal-larvae may penetrate
intestinal mucosa) )
2. Lack of sleep
3. Extraintestinal enterobiasis – vagina , fallopian tube , uterus etc.

Laboratory Diagnosis:
Diagnostic stage: egg
1. perianal swab
2. Scotch tape swab

Trichuris trichiura
- CN: Whip worm
- Diseases: Trichuriasis , trichocephaliasis, whip worm infection
- TRIAD OF INFECTION/UNHOLY 3 : 1. Hookworm, 2 . A.lumbricoides 3. T. trichiura

Adult: Flesh colored or pinkish gray worms , slender(resembling a whip) or attenuated in the anterior. Male- curved tail ,
Female – pointed tail

Egg: Barrel-shaped with bipolar mucus plug / foot ball shape / Japanese lantern
MOT: ingestion / fecal-oral route
Infective stage: embryonated ova (embryonate in soil)

Lifecycle: adult in colon – undeveloped eggs in feces , embryonate in warm moist soil –embryonated egg ingested by man –
larvae hatch in small intestine, penetrate and develop in villi , return to lumen and migrate to cecum - mature to adult.

 28

Signs/Symptom and Pathology:
1. Bloody or mucoid diarrhea
2. Weight loss , abdominal pain
3. Rectal Prolapse

Laboratory Diagnosis: Stool exam ZEIBIG: Lab method- _______________

Diagnostic Stage: Egg

Capillaria philippinensis
-Pudoc Worm /Pudoc disease or Mystery Disease
Adult: Delicate tiny worms,
Male with chitinized spicule/spicule sheath
Female usually have eggs in utero
Egg: With bipolar mucus plugs NOT PROMINENT (similar T. trichiura) striated and smaller than T. trichiura egg
-Guitar, peanut shaped
Intermediate host: Fresh Water Fishes – Ipon(Hypselotris bipartita) , birot, bagsang, bagtu

To differentiate it from T. trichiura egg:

1. smaller and striated
2. mucus plugs are not as protruded
MOT: Ingestion
Infective Stage: 2nd stage larvae
Intermediate Host: Fish

Pathology:
1. Malabsorption ( C. philippinensis and Giardia lamblia)
2. Borborygmi – peculiar abdominal gurgling sound
3. LBM alternating w/ constipation
Laboratory Methods: stool exam
Diagnostic Stage: Egg

Hookworms
- Necator americanus (American hookworm,American murderer or New World Hookworm) A=o
- Ancylostoma duodonale (Old World Hookworm) B =2 pr (2 pairs of ventral teeth)
- Ancylostoma braziiense (cat hookworm) C = 2 pr (1 pair true ventral and 1 pair inconspicuous)
- Ancylostoma caninum (Dog hookworm) D = 3 pr

Host :
Man – N. americanus , A . duodonale
Cat – A. braziliense
Dog – A. caninum
Agent of laziness in poor population & tropical anemia in Puerto Rico (Uncinariasis)
Adult – small intestine
N. americanus – S-shaped with cutting plates (semilunar ) – no teeth but have cutting plate
A. duodenale - C- shaped with 2 pairs of teeth
A. braziliense – 1 pair of True teeth, I pair inconspicuous
A. caninum - 3 pairs of teeth
Eggs: Ovoidal , thin-shelled and colorless - (look alike with Hookworm /Fasciola / Taenia) and (is a germ cell in fragmentation)
– “MORULA BALL”

MOT: skin penetration

Infective Stage: filariform larva (L3)


 29

Life Cycle:
Adults live in small intestine – eggs in feces, develops rapidly to rhabditiform larva(appears short and stout – 1st
stage larva – open mouth: feeding stage) and hatches in soil - After 2 molts , becomes filariform larva - Filariform larva
(appears long & slender , 2nd stage larva , closed mouth: “nonfeeding stage or infective stage “) penetrates skin of man
begins larval migration , (enters lymphatics and blood – lung –alveoli - bronchioles –pharynx –small intestine) matures to
adult.

Necator americanus (New world) Ancylostoma duodenale (Old world)

Cervical curvature / S shape C shape
Male with copulatory bursa Tripartite (3 digits)
Bipartite (2 digits) Simple and not barbed
Barbed / dec. Bristle like

Signs/Symptoms and Pathology:

1. Ground Itch – severe itching (allergic reaction – a.k.a watersore; mazza mora) at the site of larval penetration of skin
2. Pneumonia and alveolar hemorrhage , bloody sputum
3. Enteritis , pain. Microcytic hypochromic anemia (blood loss) , IDA
4. CREEPING ERUPTION /CLM or Cutaneous Larva Migrans (Animal hookworms acquired by Man)- lacks
COLLAGENASE

Animal Hookworm : A. brazilense and A. caninum

Laboratory Diagnosis:
1. Stool Exam
2. Harada-Mori Technique or Filter Paper Culture Technique (for Hookworm and Thread worm larvae)

Strongyloides stercoralis
- Threadworm
- Walang parasitic male puro parasitic female kaya capable of PARTHENOGENESIS (fertility w/o benefit of male / growth
and development of embryo without fertilization)
- Causative agent of Strongyloidiasis , Cochin-China Disease, Vietnam Diarrhea
o Honey –combed appearance of the intestinal mucosa
- Can be free-living(facultative nematode)- lives in oil/ parasitic – small intestine
- MOT: skin penetration
- Infective Stage: Filariform Larva

- Signs/Symptoms and Pathology:

§ Skin : allergic migration at site of larval penetration
§ Larval Migration (ASH-Ascaris, Strongyloides, Hookworm) – pneumonia, similar with the signs and
symptoms of bronchopneumonia
§ Intestines : Abdominal pain, diarrhea, vomiting ,eosinophilia
§ Rarely does not produce egg in the stool if there an egg it indicates heavy infection because only
rhabditiform larva is present in stool.
§ Adult resides in the small intestine

A. rhabditiform larva (1st stage) Hookworm Threadworm (S.stercoralis)

-buccal cavity
long short
-genital primordium Small inconspicous Prominent conspicous
B. Filariform Larva (2nd stage)


 30

- sheath (+) (-)
- tail pointed Notched/ forked

Laboratory Diagnosis
1. Stool exam (Diagnostic stage: Rhaditiform larva)
2. Harada –Mori Culture Techinique (filter-paper culture)
• Baermann Technique directly
• after concentration (formalin-ethyl acetate)
• after recovery of the larvae by the Baermann funnel technique
• after culture by the Harada-Mori filter paper technique
after culture in agar plates

Trichinella spiralis (Great imitator)

-muscle worm
-Adult in intestine (small intestine), larvae in muscles
- require 2 hosts ( propagated by black and brown rats)
-Man is the Definitive host and Intermediate host , at the same time (dead end host).
- FREEZING – destroys T. spiralis larvae
Male: w/ conical papillae
Female: w/ club-shaped uterus , viviparous /larviparous

Diseases : Trichinosis , trichiniasis , trichinelliasis

MOT : ingestion of meat with encysted larva
Infective stage: Encysted larva

Signs/Symptoms and Pathology: (great imitator – mimic other disease)

1. Intestine : edema and inflammation , nausea and vomiting, diarrhea – abdominal pain
2. Larval Migration : fever , facial edema , eosinophilia
3. Muscle: edema and pain at the site of encystations ,tongue(difficulty in swallowing) –difficulty in breathing
4. Local: eyelid edema , retinal hemorrhage , rash

Laboratory Diagnosis:
1. Muscle biopsy (D.S: encysted larva)
2. Immuno Test
a. Bentonite Flocculation test (T. spiralis and E.granulosis)
b. Bachman Intradermal Test
3. Xenodiagnostic Test (T. spiralis and Trypanosoma cruzi)
4. Beck’s Test - use albino rat/mice
5. Increase in muscle enzymes: ______, ______, ______

Additional:
Dracunculus medinensis
- Guinea worm, fiery serpent of Israelites
- Disease: Dracontiasis, dracunculosis
- Adult worm inhabits the cutaneous and subcutaneous tissue

Angiostrongylus cantonensis
-rat lungworm
-Disease: Eosinophilic meningoencephalitis
-Normally live in pulmonary mesenteric arterioles of rats, can cause human infections
-When infective larvae are ingested by a person, they migrate to the brain and spinal cord, producing eosinophilic
meningoencephalitis. DIAGNOSIS: presence of eosinophils in CSF.


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Blood and Tissue Nematodes
(Chapter 9: Filarial worms)

-vector borne nematodes

Definitive Host: Man Intermediate Host: Vector
Infective Stage: Filariform Larvae (3rd stage) Diagnostic stage: microfilaria
SPECIMEN: BLOOD except for Onchocerca volvulus

Filarial Worm Habitat (adult) Vector (intermediate Specimen Microfilaria Periodicity

host) (diagnostic (appearance in blood)
stage)
1. Wuchereria Lymphatics Aedes, Anopheles, Blood Sheathed, Nocturnal
bancrofti (Lower) Culex (Mosquito) nuclei absent (9pm -4am –peak of
-Bancroft’s filariasis *Elephantiasis in tail count)

2. Brugia Malayi Lympatics Aedes, Anopheles, Blood Sheathed, tail Subperiodic

-Malayan filariasis (Upper) Mansonia sp. with 2 separate Nocturnal
(Mosquito) nuclei
*Elephantiasis
3. Loa loa Subcutaneous Chrysops sp., Blood Sheathed, Diurnal (morning)
-eye worm Tissue Tabanid or mango fly nuclei (10:15am-2:15pm)
-calabar continuous up
swelling/fugitive to the tip of the
swelling tail

4. Onchocerca Subcutaneous Simulium sp. Skin snips or Unsheathed, Nonperiodic (nyt & day
volvulus tissue Black fly skin nuclei absent peak of count)
-blinding worm shavings in tail
-convoluted filaria
-river blindness

5. Mansonella ozzardi Body Cavities, Culicoides sp., Blood Unsheathed , Non-periodic

-New world filarial visceral fat, sucking midge, nuclei absent
mesenteries simulium black fly in tail

6. Dipetalonema Body Cavities, Culicoides sp. Blood Unsheathed, Non-periodic

perstans (Mansonella Pleural, Sucking midge nuclei up to the
perstans) peritoneal tip of the tail
-Perstan’s filarial mesentery

Mode of transmission: Bite of an infected vector containing the infective larva

Laboratory Diagnosis:
1. Knott’s Technique – isolation of microfilaria ; 1 ml of blood +9ml reagent ; 3-5 % formalin (2% formalin)
2. Stain with Giemsa

Treatment:
1. Wuchereria bancrofti- Diethylcarbamazine (DEC), Ivermectin + Albendazole= kills microfilaria
2. Brugia malayi- DEC
3. Loa loa- surgical removal of the adult
4. Onchocerca volvulus- Ivermectin


 32

Mansonella ozzardi and Mansonella perstans are NON-PATHOGENIC.

Symptomatic ozzardi infection- Ivermectin
Symptomatic perstans infection- DEC, Albendazole

Additional:

Dirofilaria immitis
- common filarial parasite of dogs , may infect humans
- Microfilaria are unsheathed and exhibit partial nocturnal periodicity
- Several species of mosquitoes can serve as vectors
- Human infection: solitary, peripheral nodules in the lungs (coin lesions) or as subcutaneous nodules.

CESTODES
- Living worms are white and yellowish in color , adult is flat and ribbon –like or dorsoventrally flattened and segmented
bodies.
- Lack alimentary system
- The head carries suckers and some with hooks
- Monoecious/ Hermaphroditic and body cavity is absent
- Oviparous/ Oviviparous
- Cestodes living in small intestines:
o D. latum
o T. solium
o T. saginata
o T. asiatica
o Hymenolepis nana
o
- Cestode body consist of:
a. Scolex – organ of attachment to the intestinal mucosa of the definitive host (nonrecovery
of scolex will mean unsuccessful deworming)
b. Neck – region of growth
c. Strobila (proglottids) or chain of segments (can be Immature, mature and ripe/gravid which
is filled with eggs)

Difference Pseudophyllidean (false tape worm) Cyclophyllidean (true tape worm)

Diphyllobothrium latum Taenia solium
Taenia saginata
Dipylidium caninum

*Both T. solium and T. saginata requires

Vertebrate I.H.
*D. caninum requires Invertebrate I.H.
* H. nana – may not require I.H.
Scolex Absence of suckers but possess spoon- Quadrate , with four cuplike suckers (rostellum
shaped with slit-like sucking grooves or with/armed or without/unarmed hooklets)
bothria (for attachment)
Strobila – Anapolytic (not shedding segments) Apolytic (sheding segments)
UTERINE PORE
Immature –nearest in the neck

 33

Mature- 2nd
Gravid (with eggs) - 3rd away
from the neck
Ova Ovoid in shape, Operculated , immature Spherical in shape, Non-operculated ,
when laid ,ciliated embryonated, mature when laid (hexacanth
Oncosphere –embryo inside the embryo), not ciliated
egg- human tapeworms
typically have 3 paris of
hooklets or 6 hooked embryos
or hexacanth.
rvalSes Stages: Coracidumàprocercoidàplerocercoid Cysticercus(Taenia)
Cysticercoid (Dipylidium, Hymenolepsis)
Hydatid (Echinococcus)
Intermediate Host 2 intermediate host 1 intermediate host ONLY
Adult worm in human intestine Diphyllobothrium latum- Fish tapeworm Taenia saginata – Beef tapeworm
Taenia solium – Prok Tapeworm
Hymenolepsis nana – Dwarf tapewrom
Hymenolepsis diminuta – Rat Tapeworm
Dipylidium caninum – Double-pored dog tapewo

Diphyllobothrium latum
-Broad or fish tape worm / largest and longest cestode infecting man.
-Scolex is spatulate/spoon-shaped/almond shaped with sucking organ called bothrium
-Eggs are operculated (immature with aboperculum)
-Larval stages: (1st stage larva - coracidium> 2nd stage larva - procercoid> 3rd stage larva plerocercoid(infective stage
to man)
- 1st I.H. : Copepods
-2nd I.H.: Fresh Water Fish
-D.H.: MAN
-Tapeworm anemia/ vitamin B12 deficiency anemia / megaloblastic anemia (hookworm- IDA or microcytic
hypochromic anemia)
SPARGANOSIS-

Life Cycle: D. latum

Laboratory Diagnosis: Ova and Proglottids in stool

Serological Test: Coproantigen

 34

Treatment: Praziquantel
Prevention and Control:
§ proper ccoking of fish
§ deep freezing (-10C for 24-48 hrs) if consumed raw
§ prevention of fecal pollution of natural waters
§ periodical deworming of dogs and cats
-
Difference Taenia saginata Taenia solium
Common name Beef Tapeworm Pork tapeworm
Intermediate host Cattle / Cow/ Buffalo Pig
Definitive host Man Man
Scolex No rostellum/ Unarmed scolex Armed Rostellum
Uterus Lateral branches 15-30 each side, thin and Lateral branches 5-10 on each side , thick and
dichotomous dendritic
Vagina Present Absent
Length Up to 25 meters Up to 7 meters
Number of proglottids 1000 – 2000 Below 1000
Gravid proglottid 15-20 lateral branches (dichotomous or tree-like) 7-13 lateral branches (dendritic or finger-like)
Eggs (hexacanth Eggs are spherical and striated , inside is an Infective to man ; same as for T. saginata
embryo) embryo or oncopshere with 6 hooklets

Not infective to man

Larva Cysticercus bovis -infective stage to humans Cysticercus cellulosae – infective stage

Present in cow not in human Present in pig and man

Infective Stage Cysticercus bovis Cysticercus cellulosae , Egg
Pathogenesis (adult tape Taeniasis saginata Taeniasis solium
work causes obstruction) Cysticercosis (more serious because it may
lodge in the brain & spinal cord)
Mode of infection Ingestion of undercooked (measly beef) Undercooked (measly pork) containing
containing cysticercus bovis ; eggs not infective cysticercus cellulosae, autoinfection and egg in
to man contaminated vegetable , food and water.
EGGS ARE INFECTIVE TO HUMAN.
Diagnosis Eggs or Proglottids in stool, serodiagnosis, Intestinal-egg or proglottids in stool,
molecular diagnosis Cysticercus-biopsy, X-ray , CT scan, MRI and
serology.
Treatment Praziquantel Praziquantel, Albendazole, Anti-epileptics in
neurocyticercosis

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Taenia Saginata Asiatica

- related to Taenia saginata and found mainly in Asia.
- Morphologically similar to T. saginata except:
§ Smaller than T. saginata
§ I.H. is pig not cow
§ Its cysticerci are located primarily in the liver of the pig (not muscle)
§ Clinical features , diagnosis and treatment are similar to T. saginata.
§ MOT:______________________

Difference Hymenolepis nana Hymenolepis diminuta

Common name Dwarf tape worm (smallest tape worm of man) Rat tapeworm/ norway rat
Scolex Armed rostellum Unarmed rostellum
Eggs Contain an oncosphere enclosed in an inner Contain an oncosphere , membrane
membrane with two polar thickenings ; each with 4 with two polar thickenings; without
to 8 polar filaments filaments (sunny side up egg)
Infective stage Eggs (direct) Cysticercoid larva
Cysticercoid larva (indrect)
Autoinfection
Intermediate host The only human tapeworm that does not require Insects
I.H. to complete its natural life cycle, however
insects may act as an intermediate host in some
occasions
Definitive host /Final host Man (natural final host) Norway rats

Dypylidium caninum
-Dog tapeworm or double-pored tapeworm
- Proglottids have double set of reproductive organs and genital pore on each side of the lateral margin (2 genital pores)
-Mature and gravid proglottids are typically shaped like melon seed/ pumpkin seed/ rice grains or granules.
-Infective stage: cysticercoid larva
-Accidental host: MAN
-Definitive host: Dogs/ Cat
- Diagnostic stage : Proglottid/ Egg packet (8-15 eggs)
Treatment of choice: Praziquantel
-Common tapeworm of the dog and cat; man is an accidental host (ingestion of fleas containing larva)
Ctenocephalides canis – dog flea
Ctenocephalides felis – cat flea
Pulex irritans – human flea

Echinococcus granulosus (formerly known as Taenia Granulosus)

- Also known as Dog tape worm, Hydatid worm
- Habitat is in the jejunum and duodenum of dogs and other canines ( wolf and fox)
- Larval stage (hydatid cyst ) is found in humans and herbivorous animals (sheep, goat, cattle and horse)
-Hydatid worm producing Hydatid Disease (Unilocular Hydatid cyst/ Unilocular Echinococcosis)
-Shortest tapeworm with only three segments (1 immature, 1 mature and 1 ripe/garvid) – 3-6 mm
- consist of: scolex (pyriform with 4 suckers and prominent rostellum), short neck and strobila
-Eggs cannot be differentiated from the eggs of Taenia (egg same as Taenia , spherical , embryonated /hexacanth
3 pairs or 6 hooklets)
- Infective stage: HYDATID CYST
-Final host: Dog


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-Accidental Intermediate Host: MAN Diagnostic stage in MAN: __________________
Treatment: Albendazole and Praziquantel

Diagnosis:
1. Exploratory cyst puncture
2. Roentgenogram (xray)
3. TEST OF CHOICE: Ultrasonography
4. Immunologic Test
a. Bentonite flocculation test (for T. spiralis and E. granulosus)
b. CASONI: intradermal test – immediate type 1 hypersensitivity ; positive result: large wheal > 5 cm in
diameter with multiple pseudopodia like projections (non specific)
Treatment: 1. Surgery
2. PAIR:

Echinococcus multilocularis
DH: Fox
IH: Rodents, mice
Accidental IH: MAN
Disease: Multiple Hydatid cyst, Multilocular hydatid disease

TREMATODES: FLUKES

Trematodes: Digenea/ Trematoda

Phylum: _____________
Generally are Hermaphroditic EXCEPT _________
Flukes: Leaf-like structure with 2 suckers: __________ and ________ EXCEPT:

Eggs are operculated EXCEPT________

MOT: Ingestion EXCEPT ________

Infective stage: METACERCARIA EXCEPT __________

Life cycle: Requires 2 I.H EXCEPT _________

Classification based on HABITAT:

1. LIVER- Fasciola hepatica, Fasciola gigantica, Clonorchis sinensis, Opistorchis felineus
2. INTESTINES- Fasciolopsis buski, Echinostoma ilocanum, Heterophydiae family,
3. LUNGS- Pragonimus westermani
4. PORTAL VEINS- Schistosomes (Schistosoma japonicum, Schistosoma mansoni, Schistosoma haematobium)

Classification based on EGGS/ OVA- operculated, non-operculated, embryonated, unembryonated

Embryonated ova= CHOS
Unembryonated= PEFF

LIFE CYCLE OF TREMATODES:

1. Eggs
2. Larval stageà Miracidium- Sporocyst- Redia- Cercaria- Metacercaria
3. Adult

1st IH: SNAIL

2ND IH: FISH, WATER VEGETATION/PLANT, CRAB, SNAIL

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LIVER FLUKES:
Fasciola hepatica
CN: Sheep liver fluke, Temperate liver fluke
Disease: ___________, Fascioliasis
Prominent CEPHALIC CONE
Small OS and VS
1ST IH: SNAIL ( Lymnae philippinensis, Lymnae swinhoe, and Lymnae truncatula)
2nd IH= Plant/ vegetation (water cress, grass, Ipomea obscura, Ipomea reptans)

Fasciola gigantica
CN: Giant liver fluke, Tropical liver fluke
Larger, more lanceolate, Less developed shoulders
Fasciola ova: HEN-EGG shape

Halzoun/ Pharygeal Fascioliasis- eating raw animal liver (sheep) containing the adult flukes
Life cycle: 1st IH: Snail, 2nd IH: Plant, FH: Herbivores, Man
Diagnostic stage: Egg/ ova in stool + Adult
Infective stage: Metacercaria
MOT: _____________

Clonorchis sinensis
CN: Chinese liver fluke/ Oriental liver fluke/ Distome of China
VS is smaller than OS
Ova: Old fashioned electric bulb (abopercular knob)
Associated in formation of gall stones
1st intermediate host- SNAIL (Parafossarulus manchoricus, fresh water snails )
2nd intermediate host – FISH (Ctenopharyngodon idellus, Caridina nilotica gracilipes )
“Parasite of Fish eating mammals and Man”

Opistorchis felineus
CN: Cat liver fuke
Lancet shaped
OS is smaller than VS
Two OBLIQUELY arranged testes
1st intermediate host: SNAIL ( bithynia leachi )
2nd intermediate host: FISH( Idus melanotus, Tinca tinca, Cyprinus carpio, Barbus barbus )

LUNG FLUKES:
Paragonimus westermani
CN: Oriental lung fluke
1st IH: SNAIL ( Antemelania Asperata/Brotia aspirata and Antemelania dactylus )
2nd IH: CRAB ( Sundathelpusa philippina/ Parathelpusa grapsoides )
Ova: Operculated, Thickened abopercular end

INTESTINAL FLUKES
Fasciolopsis buski
CN: Giant intestinal fluke/ Large intestinal fluke
NO Cephalic cone
1st IH: SNAIL ( Segmentina trocholdeus or Hippeutis umbilicalis )
2nd IH: PLANT ( Trapa bicornis ( water caltrop ), Ellocharis tuberosa ( water chestnut ), Ipomea aquatica ( water morning glory ), lotus
Ova: Hen’s egg appearance resembling _________
FH: usually Man, Pigs

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Fasciolopsiasis mimics _______________.

Echinostoma ilocanum
CN: Garrison’s fluke
OS with spines: ____________
Testes: Bilobe/ Tandem formation
1st IH: SNAIL ( Gyraulus convexlusculus or Hippeutis umbilicalis )
2nd IH: SNAIL Pila luzonica (kuhol), Vivipara angularis (susong pampang)

Heteropydiae:
Heterophyes heterophyes
CN: Von siebold’s fluke/ Heterophid fluke
Smallest fluke of man, Deadliest fluke
3rd sucker: Gonotyle

Metagonimus yokogawai
Haplorchis taichui
Haplorchis yokogawai

1st I.H. SNAIL

H. heterophyes- Pironela conica
M. yokogawai- Thiara and Hua
H. taichui- Thiara riquetti

2nd IH: FISH

H. heterophyes- Mugil, Acanthogobius
M. yokogawai- Salmo, Richarsonlum, Odontoburis
H. taichui- Ambassis burensis, Claris batrachus, Gerris kapas, Therapon plumbeus

Ova: same with Clonorchis but lacks the abopercular knob, less distinct shoulders than the Clonorchis.

Blood flukes: Schistosomes

*Schistosoma japonicum
*Schistosoma mansoni
*Schistosoma haematobium
Schistosoma mekongi
Schistosoma intercalatum- Slightly bent terminal spine, POSITIVE FOR _________________

Generally are Dioecious

Males: shorter, stouter with Gynecophoral canal
“Most romantic Parasites”
Ova: Non-operculated, Fully embryonated
I.S: Cercaria (bifid/ forktailed)
MOT: Skin penetration

S. japonicum S. mansoni S. haematobium

Common name Oriental blood fluke Manson’s blood fluke Bladder fluke, Vesical
blood fluke
Habitat Superior mesenteric veins Mesenteric vein of the Portal vein of the Urinary
of SI Large intestines bladder
Specimen Stool Stool Urine
Testes (Male) 6-7 in a single file 8-9 in a zigzag row 4-5 in groups


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Ovary (Female) Middle of the body Anterior to the middle of Behind the middle of the
with 50 or more eggs the body with 1-3 eggs body with 20-30 eggs
Egg Lateral knob Lateral spine Terminal spine
IH: Snail Oncomelania quadrasi Biomphalaria, Bulinus, Physopsis,
Australorbis, Tropicorbis Biomphalaria
DH Man, domestic animals Man Man
Disease Katayama’s disease, Schistosomiasis mansoni Bilharziasis/ Urinary
Schistosomiasis schistosomiasis
(intestinal/ Hepatic)
Distribution

Treatment: PRAZIQUANTEL, While Oxamniquine for S. mansoni.

Diagnosis: DFS, COPT, ELISA, Kato Katz, Concentration technique

PULMONARY INVOLVEMENT-
CEREBRAL MANIFESTATIONS-
SCHISTOSOMAL DERMATITIS-

“Put your heart, mind, and soul into even your smallest acts. This is the secret of success”. –S.Sivananda