PARASITOLOGY

BASIC PARASITOLOGY
Classification of C. Accdng. To mode of
living
Parasites
a. obligate
A. Accdng. to Habitat
b. facultative
a. endoparasite
c. incidental
b. ectoparasite
d. temporary
B. Accdng. to its effect to
e. permanent
the host
a. pathogenic f. intermittent
b. non-pathogenic g. transitory
 BASIC PARASITOLOGY
Mechanism of Disease Production by
Parasites
A. Traumatic damage
B. Lytic necrosis
C. Stimulation of host tissue reaction
D. Toxic and allergic phenomena
 BASIC PARASITOLOGY
PARASITES

PROTOZOA HELMINTHS

SARCODINA SPOROZOA MASTOGOPHORA CILIATA

(Amoebas) (Sporozoans) (Flagellates) (Ciliates)

PLATYHELMINTHES NEMATHELMINTHES
(Flatworms) (Roundworms)

TREMATODES CESTODES
(Flukes) (Tapeworms)
 BASIC PARASITOLOGY
PROTOZOA Nutritional Adaptation
(“first animals”)
Characteristics:  Mostly aerobic heterotrophs;
 Unicellular, eukaryotic and others are capable of anaerobic
chemoheterotrophic organisms. growth.
 Inhabit the soil and water.  Live in areas with a large supply
of water.
Life Cycle:  Transport food across plasma
Method of Reproduction membrane.
 Ciliates take in food by moving
a. Asexually –binary fission,
budding or schizogony their cilia toward a mouth-like
opening called CYTOSTOME.
b. Sexually – conjugation
 Amoebas engulf food through
phagocytosis.
Encystment  In all protozoans, digestion takes
 Protozoa produces a protective
place in their VACUOLES.
capsule called a CYST.
 BASIC PARASITOLOGY
HELMINTHS
Characteristics:
 Multicellular, eukaryotic animals that generally possess
digestive, circulatory, nervous, excretory and
reproductive systems.
Life Cycle:
a. Dioecious – male reproductive organs are in one animal
and female reproductive organs are in another
b. Monoeocious or Hermaphroditic – one animal has both
male and female reproductive organs
 CLINICAL
PARASITOLOGY
INTESTINAL PROTOZOA TREMATODES
1. Entamoeba histolytica 1. Schistosoma sp.
2. Giardia lamblia 2. Clonorchis sinensis
3. Cryptosporidium parvum 3. Paragonimus westermani

UROGENITAL PROTOZOA NEMATODES

1. Trichomonas vaginalis INTESTINAL
1. Enterobius vermicularis
BLOOD AND TISSUE PROTOZOA 2. Trichuris trichiura
1. Plasmodium sp. 3. Ascaris lumbricoides
2. Toxoplasma gondii 4. Ancylostoma duodenale
3. Trypanosoma sp. 5. Necator americanus
4. Leishmania sp. 6. Strogyloides stercoralis
7. Trichinella spiralis
CESTODES TISSUE
1. Taenia solium 1. Wuchureria bancrofti
2. Taenia saginata 2. Onchocerca volvulus
3. Diphyllobothrium latum 3. Loa loa
4. Echinococcus granulosus 4. Dracunculus medinensis
 Intestinal Protozoa
Entamoeba histolytica
D: amoebic dysentery (amoebiasis) and liver
abscess
T: fecal-oral transmission of cyst,
oral-anal transmission among homosexuals
P and C/F:
1. They multiply in the epithelial cells of the
wall of large intestine.
2. A severe dysentery results and the feces
contain blood and mucus.
3. Intestinal perforation leading to LIVER
ABSCESS
Tx: Metronidazole plus iodoquinol
P: Avoid fecal contamination of food and water.
Proper disposal of human waste.
Adequate cooking of food and boiling of
water.
 Intestinal Protozoa
Giardia lamblia
D: Giardiasis
T: fecal-oral transmission of cyst
P and C/F:
1. The cyst attach to the duodenum and
cause inflammation.
2. They occupy so much of the intestinal
wall that they interfere with food
absorption.
3. Non-bloody, foul-smelling diarrhea
accompanied by nausea, anorexia,
flatulence and abdominal cramps
persisiting for weeks or months.
4. There is no fever.
Tx: Metronidazole plus Quinacrine
hydrochloride
P: Boiling and filtration of water (Not
affected by chlorination)
 Intestinal Protozoa
Cyrptosporidium parvum
D: cryptosporidiosis (cholera-like
diarrhea for 10-14 days)
T: fecal-oral transmission of cyst
P and C/F:
1. The cyst attaches to the
jejunum but do not invade.
2. Produces watery, non-bloody
diarrhea causing large fluid
loss.
Tx: No effective drug therapy
Oral rehydration
P: Chlorination and filtration are
ineffective.
No means of prevention.
 Urogenital Protozoa
Trichomonas vaginalis
D: Trichomoniasis
T: sexual contact
P and C/F:
1. The cyst attaches to the wall of
vagina in women and urethra in
men and cause inflammation.
2. In women, a watery, foul-
smelling greenish discharge
accompanied by itching and
burning occurs.
3. Infection in men is usually
asymptomatic but 10% of
infected men have urethritis.
Tx: Metronidazole for both sexual
partners
P: Condoms limit transmission.
 Blood and Tissue
Protozoa
Plasmodium sp.
(P. vivax, P. ovale, P. malariae, P. falciparum)
D: Malaria
T: bite of female Anopheles mosquito
P:
1. The mosquito carries the sporozoite form of Plasmodia in
its saliva.
2. Sporozoites enter the bloodstream and enter the liver cells.
3. In the liver, the sporozoite undergo schizogony to produce
many merozoites
4. Release of merozoites in the blood to infect other RBCs.
C/F:
1. Abrupt onset of fever and chills (41C) accompanied by
headache, myalgias after 2 weeks of mosquito bite.
2. The fever is accompanied by nausea, vomiting and
abdominal cramps and drenching sweats.
Tx: Chloroquine, mefloquine, sulfadoxine, pyrethamine,
primaquine
P: Chemoprophylaxis and mosquito control
 Blood and Tissue
Protozoa
Toxoplasma gondii
D: Toxoplasmosis
T:
1. Ingestion of cyst in undercooked
meat
2. Direct contact with cat feces
3. Transplacental transmission
P: Trophozoites infect many organs esp.
brain, eyes and liver. Cyst persist in
tissue.
C/F:
1. Most initial infections are
asymptomatic
2. Congenital infections include
abortion, stillbirth, encephalitis,
mental retardation and visual
problems.
Tx: Sulfonamide and pyrethamine for
congenital and disseminated disease
P: Meat should be cooked. Pregnant
women should not handle cats
 Blood and Tissue
Protozoa
Trypanosoma cruzi
D: Chaga’s disease (American trypanosomiasis)
T: bite of reduviid bug
P:
1. The organism attacks cardiac muscles and cause inflammation
leading to cardiac arrythmias.
2. They also damage the nerves controlling the peristaltic action of
the esophagus and colon causing MEGACOLON AND
MEGAESOPHAGUs
C/F:
1. The acute phase is consist of facial edema and a nodule
(chagoma) near the site of bite
2. There is fever, lymphadenopathy, hepatosplenomegaly.
3. Most individials remain asymptomatic but some progress to the
chronic form (MEGACOLON AND MEGAESOPHAGUS)
4. Death is due to cardiac failure.
Tx: Nifurtimox
P: Protection from bite. Insect control
 Blood and Tissue
Protozoa
Trypanosoma gambiense & Trypanosoma
rhodesiense
D: Sleeping sickness (African trypanosomiasis)
T: bite of tsetse fly
P:
1. The organism spread from skin to the lymph nodes
and eventually to brain causing encephalitis.
C/F:
1. In the acute form, a cyclical fever spike occurs
(every 2 weeks)
2. The initial lesion is an undulated skin ulcer
(trypanosomal chancre).
3. Encephalitis occurs characterized by insomina and
mood changes followed by muscle tremors, slurred
speech that progress to somnolence and coma.
4. Untreated disease is usually fatal as a result of
pneumonia.
Tx: Suramin in early disease. Suramin plus melarsoprol
if CNS symptoms occur.
P: Protection from bite
 Blood and Tissue
Protozoa
Leishmania donovani
D: Kala-azar (visceral leishmaniasis) or dum
dum fever
T: bite of sandfly (Phlebotomus or Lutzomyia)
P: Amastigotes kill reticulo-endothelial cells esp.
liver, spleen and bone marrow
C/F:
1. Symptoms begin with intermittent fever,
weakness and weight loss.
2. Massive enlargement of spleen.
3. Gastro-intestinal bleeding.
Tx: sodium stibogluconate
P: Protection from bite

L. tropica & L. mexicana (cutaneous

leishmaniasis)
L. brasiliensis (muco-cutaneous leishmaniasis)
 CESTODES
Taenia solium
(pork tapeworm)
D: Taeniasis and cysticercosis
T: Eating raw or undercooked pork containing the
larvae
P:
1. The larvae attaches to the wall of intestine
and takes about 3 months to grow into adult
worms measuring up to 5 meters but they
cause little damage to the intestine.
2. The eggs can enter the blood and spread to
many organs especially the brain.
C/F:
1. Most patients with adult tapeworms are
asymptomatic but anorexia and diarrhea can
occur.
2. Cysticercosis in the brain causes headache
vomiting and seizures.
3. Cyticercosis in the eyes can appear as retinitis
or the larvae can be visualized as floating in
the vitreous humor.
Tx: Niclosamide for intestinal worms and
praziquantel for cerebral cysticercosis
P: Adequate cooking of pork
 CESTODES
Taenia saginata
(beef tapeworm)
D: Taeniasis
T: Eating raw or undercooked beef containing the
larvae
P:
1. The larvae attaches to the wall of intestine
and takes about 3 months to grow measuring
up to 6 meters (18feet). They can live in the
human intestine for 25 years with little
damage.
2. Do not cause cysticercosis in humans.
C/F: Most patients are asymptomatic except for
vague abdominal discomfort
Tx: Niclosamide
P: Adequate cooking of beef. Proper disposal of
human waste
 CESTODES
Diphyllobothrium latum
(fish tapeworm)
D: Diphyllobothriasis
T: Eating raw or undercooked freshwater fish
containing the larvae
P:
1. The larvae attaches to the wall of intestine and
develop into an adult worm measuring up to 13
meters (longest of all tapeworms) but causes
little damage in the intestine.
2. In some patients, megaloblastic anemia occurs
as a result of vit B12 deficiency
C/F:
1. Most patients are asymptomatic but
abdominal discomfort and diarrhea can occur.
Tx: Niclosamide
P: Adequate cooking of fish. Proper disposal of
human waste
 CESTODES
Echinococcus granulosus
(dog tapeworm)
D: Hydatid cyst disease
T: Ingestion of eggs in food contaminated with dog feces
P:
1. The eggs migrate to various organs especially the liver,
lungs and the brain.
2. Once placed, the eggs develop into a hydatid cyst (space-
occupying lesion).
3. If the cyst ruptures, anaphylaxis results
C/F:
1. Many patients with hydatid cyst are asymptomatic.
2. Liver hydatid cyst may cause hepatic dysfunction.
3. Cyst in the lungs can erode the bronchus causing bloody
sputum.
4. Cyst in the brain causes headache and focal neurological
signs.
Tx: Surgical removal of cyst. Mebendazole can be given in
inoperable cases.
 TREMATODES
Schistosoma spp.
(S. mansoni, S. japonicum, S. hematobium)
(blood fluke)
D: Schistosomiasis
T: Penetration of skin by free swimming eggs/larvae
P:
1. After skin penetration, they enter the blood and carried
to the liver where they mature as an adult flukes.
2. S. mansoni damages the walls of the distal colon
3. S. japonicum damages the walls of both the small and
large intestines.
4. S. hematobium induces granulomas and fibrosis in the
bladder wall which can lead to carcinoma of the
bladder.
C/F:
1. After skin penetration, there is itching and dermatitis.
2. Aftre 2-3 weeks, fever, chills, diarrhea and
hepatosplenomegaly occurs.
3. In chronic stage, there is GIT bleeding.
Tx: Praziquantel
P: Proper disposal of human waste. Swimming in endemic
areas should be avoided.
 TREMATODES
Chlonorchis sinensis
(liver fluke)
D: Chlonorchiasis
T: Eating raw or undercooked freshwater fish containing
the larvae
P:
1. After ingestion, they invade the duodenum and
enter the biliary ducts where they mature as adults.
2. Inflammatory response can cause hyperplasia and
fibrosis of the biliary tract but often there are no
lesions.
C/F:
1. Most infections are asymptomatic.
2. In patients with heavy worm burden, upper
abdominal pain, anorexia and hepatomegaly occur.
Tx: Praziquantel
P: Adequate cooking of fish. Proper waste disposal
 TREMATODES
Paragonimus westermani
(lung fluke)
D: Paragonimiasis
T: Eating raw or undercooked crab meat
containing the larvae
P:
1. Immature flukes penetrate the intestinal
wall through the diaphragm into the lungs.
2. They differentiate into adult eggs and
enter the bronchioles and are coughed up
and swallowed.
C/F:
1. The main symptom is chronic cough with
bloody sputum. It resembles tuberculosis.
2. Dyspnea, chest pain and recurrent attacks
of bacterial pneumonia.
Tx: Praziquantel
P: Adequate cooking of crabs
INTESTINAL NEMATODES
Enterobius vermicularis
D: Pinworm infection
T: Ingestion of eggs
P:
1. The adult male and female worms live in the colon where mating occurs.
2. At night, female migrates from the anus and releases thousands of
fertilized eggs and into the environment.
3. Within 6 hours, the eggs develop into larvae and become infectious.
4. Reinfection can occur if they are carried to the mouth by fingers after
scratching the itching skin. The ingested eggs hatch in the small
intestine where the larvae differentiate into adults and migrate to the
colon.
C/F:
1. Perianal pruritus is the most prominent symptom.
2. Scratching predisposes to secondary bacterial infection.
Tx: Mebendazole or pyrantel pamoate
P: No means of prevention.
INTESTINAL NEMATODES
Trichuris trichiura
D: Whipworm infection
T: Transmitted by food or water contaminated with
soil containing eggs
P:
1. The eggs hatch in the small intestine where the
larvae differentiates into immature worms.
2. They migrate to the colon where they mature,
mate and produce thousands of fertilized eggs
daily which are passed in feces.
3. Eggs are deposited in warm, moist soil and form
embryos.
C/F:
1. Most infections are asymptomatic.
Tx: Mebendazole
P: Proper disposal of human waste
INTESTINAL NEMATODES
Ascaris lumbricoides
D. Ascariasis
T: Transmitted by food contaminated by soil containing eggs
P:
1. The eggs hatch in the small intestine, and larvae migrate to
the bloodstream and the lungs.
2. They enter the alveoli, pass up the bronchi and trachea and
are swallowed.
3. Within the small intestine, they mature as adult worms and
get nutrition from partially digested food.
4. The adults are the largest intestinal nematodes often
growing up to 30cm (1 foot) or more.
5. Thousands of eggs are laid daily, passed in feces and form
embryos in warm, moist soil.
C/F:
1. In the lungs, tiny larvae cause some pulmonary symptoms
(ascaris pneumonia)
2. Malnutrition
3. Migration of worms (mouth, ears, nose)
Tx: mebendazole or pyrantel pamoate
P: Proper disposal of human waste
INTESTINAL NEMATODES
Ancylostoma duodenale &
Necator americanus
D: Hookworm infection
T: larvae in soil penetrate skin of feet and legs
P:
1. After skin penetration, they are carried by the
blood to the lungs, migrate to the alveoli and up to
the trachea and are swallowed.
2. They mature as adults in the small intestine and
attaches to its wall.
3. Feeds on blood and tissue of the intestinal villi.
4. Thousands of eggs are laid per day and are passed
in feces.
C/F:
1. Loss of blood at the site of attachment (0.1 – 0.3 ml
of blood per worm)
2. Weakness and pallor
Tx: Mebendazole or pyrantel pamoate
P: Use of footwear. Proper disposal of human waste
INTESTINAL NEMATODES
Strongyloides stercoralis
D: Strogyloidiasis
T: larvae in soil penetrate skin of feet and legs
P:
1. After penetration, larvae enter the blood and
migrate to the lungs. They move into the alveoli
and up to the trachea and are swallowed.
2. They become adults in the colon and are passed
in feces.
C/F:
1. Little effects in healthy individuals.
2. In immuno-compromised persons, massive
super-infection can occur accompanied by
secondary bacterial infection.
Tx: Thiabendazole
P: Proper disposal of human waste. Use of footwear.
INTESTINAL NEMATODES
Trichinella spiralis
D: Trichinosis
T: Eating raw or undercooked meat (pork)
P:
1. The larvae mature into adults within the mucosa of
the small intestine.
2. Eggs hatch within the adult females and larvae are
released via the bloodstream to many organs.
C/F:
1. Few days after eating infected pork, the patient
experiences gastroenteritis.
2. 1-2 weeks later, there is fever, muscle pain and peri-
orbital edema.
3. Signs of cardiac and CNS diseases are frequent
because the larvae can migrate in these areas.
4. Death, which is rare, is due to CHF and resoiratory
paralysis.
Tx: Thiabendazole or Mebendazole to kill adult worms.
Corticosterids to reduce inflammation
P: Adequate cooking of pork
 TISSUE NEMATODES
Wuchureria bancrofti
D: Filariasis (elephantiasis)
T: bite of female Anopheles and Culex
mosquitoes
P:
1. The larvae penetrate the skin, enter the
lymph nodes and after a year mature as
adults that produce microfilariae.
2. Microfilariae circulate in the blood, chiefly
at night and are ingested by biting
mosquito.
3. Within the mosquito, microfilariae produce
infective larvae that are transferred with the
next bite.
C/F:
1. Adult worms in the lymph nodes cause
inflammation that eventually obstruct
lymphatic vessels.
2. Fever, lymphangitis and cellulitis develop.
3. Gradually, the obstruction leads to edema of
the legs and genitals.
Tx: Diethylcarbamazine for microfilariae. No
drug therapy for adult worms
P: mosquito control
 TISSUE NEMATODES
Onchocerca volvulus
D: Onchocerciasis (river blindness)
T: bite of female black flies
P:
1. Blackfly deposits infective larvae while biting.
2. The larvae enter the wound and migrate into the
subcutaneous tissue where they mature as adults.
3. The female produces microfilariae that are ingested by
another blackfly.
4. Within the mosquito, the microfilariae develops into
infective larvae.
C/F:
1. Inflammation occurs in subcutaneous tissue and pruritic
papules and nodules form.
2. Microfilariae migrate in the eyes leading to blindness.
Tx: Ivermectin is effective for microfilariae but not adult worms.
Suramin in eye infection. Skin nodules can be surgically
removed.
P: Black fly control
 TISSUE NEMATODES
Loa loa
D: Loiasis
T: bite of deer fly
P:
1. Deer fly deposits infective larvae on the skin.
2. The larvae enter the bite wound, wnader in the body
and develop as adult worms.
3. The females release microfilariae, enter the blood
particularly during the day.
4. The microfilariae are taken up by another deerfly
during ablood meal and differentiate into infective
larvae.
C/F:
1. No inflammatory response to microfilariae but
hypersensitivity reaction causes transient, localized,
non-erythematous, subcutaneous edema (Calabar
swelling)
2. Adult worms crawling across conjunctiva of the eyes.
Tx: Diethylcarbamazine. Worms in the eyes may require
surgical excision.
P: Deer fly control
 TISSUE NEMATODES
Dracunculus medinensis
D: Dracunculiasis
T: ingestion of crustaceans containing infective larvae in
drinking water
P:
1. After ingestion, larvae are released in the small
intestine and migrate in the body where they
become adults.
2. Meter-long females cause the skin to ulcerate and
then release motile larvae into fresh water.
3. Crustaceans eat these larvae and form infective
larvae.
C/F:
1. Inflammation, blistering and ulceration of the skin
esp. the lower extremities.
2. The inflamed papule burns and itches and the ulcer
can become secondarily infected.
Tx: Niridazole and worm extraction.
P: Purification of drinking water