I. Introduction: d.

Paratenic host ( phoretic host/ transport host)

A. Definition of Terms : - Harbors the parasite that does not undergo any development
Parasitology : a branch of biology that deals with the study of living - Phoretic relationship (ex. Fasciola hepatica )
organisms that take up their abode on or within another living
organism. (parasite and host) Classification of Parasites:
Host : any living organism harboring any parasite. I. According to Pathogenecity:
1. Pathogenic
Parasite:
2. Non-pathogenic
1. Endoparasite : parasites found or living within the body of the host.
II. According to need for host:
2. Ectoparasite : parasites found on the surface of the body of the host.
1. Obligate parasite – the parasite is totally dependent on the
Two states of PARASITOSIS: host. The organism cannot survive in any other manner
INFESTATIONS INFECTIONS 2. Facultative parasite – the parasite can have a parasitic
exixtence or free living.
Org. involved Ectoparasites Endoparasites
3. Accidental/ incidental parasite- attaches to the body of a
Lodgement of the Invasion/ modification host that is not considered a normal host (ex. Dipylidium
Characteristic parasite on the surface of the parasite within
of the host. the host’s body caninum)
III. According to number of host required in the life cycle:
B. Host – Parasite Relationship 1. Monoxenous – requires one host
Types of symbiotic relationships: 2. Heteroxenous - requires 2 or more hosts
Symbiosis: association of two species. “living together” 3. Autoheteroxenous – harbored by a definitive host that shall
become the intermediate host of the next generation.
TERMS OF
RELATIONSHIP DEFINITION
ORGANISM Spurious parasite: organism that parasitizes other hosts that
Specialized type of commensalism, pass through the human intestine and are detected in the
Mutualism wherein the relationship is beneficial to Mutualists stool after ingestion. Also called caprozoic parasites.
both organism
IV. According to Habitat
From the latin for “ eating at the same 1. Endoparasite : parasites found or living within the body of the
table” denotes association that is
Commensalism
beneficial to 1 partner and the other is
Commensals host.
neither benefited nor harmed. 2. Ectoparasite : parasites found on the surface of the body of the
host.
A relationship wherein the organism is
Parasitism Parasite
benefited and the host is harmed.
GIT Enterozoic
Living organisms are not physiologically
dependent on each other. Blood Hemazoic
Phoresis Phoront
Phoronts are travelling together (for
transport/ transit)
Tissues Histozoic
Cells Cytozoic
Two types of Parasitic Life Cycle: Body Cavity Coelozoic
1. Direct life cycle: Parasite utilizes one host only in the entire life cycle.
Ex. Ascaris lumbricoides
2. Indirect life cycle: utilizes two or more hosts in the life cycle. Source of Parasitic infections:
Ex. Malarial parasites 1. Soil / water
Soil – “ soil transmitted parasite”
Types of hosts: Water – “water-borne parasite
a. Reservoir 2. Food/ drinks
“ food-borne parasites ”
-Can be animate or inanimate objects in which the parasite is - Contaminated from the soil/water
found normally living
-Animate: normal hosts of parasites (ex. Human, animals) Mode of transmission:
-Inanimate: normal habitat (ex. Soil, water,) a. Ingestion of infective stage
b. Definitive hosts b. Skin penetration
-Harbors the adult stage of the parasite Nb. Contamination is due to lack of sanitary practice; practice of
-Harbors the sexual stage nightsoil( use of excrete for fertilizers- human excrete )
(ex. Malarial parasites: mosquito-definitive host)
c. Intermediate host:
- Harbors the larval stage of the parasite, or the asexual stage
(malaria: Human – intermediate host)

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 SOURCE PARASITE
Pork Trichenella spiralis & Taenia solium
Malarial parasites
Beef Taenia saginata Filarial parasites
Trypanosomes (Trypanosoma
Blood
Diphyllobothrium latum & Capillaria brucei gambiense, trypanosome
Fish cruzi)
philippinensis
Tissue Nematodes
Vegetation Fasciola hepatica Liver and Lung trematodes
(Fasciola hepatica, Clonorchis
Crabs Paragonimus westermani sinensis, Paragonimus spp.)
Snail Echinostoma ilocanum Intestinal Trematodes
(fasciolopsis buski, Heterophyes
Stool
heterophyes)
3. Vectors
- Invertebrates, arthropods / mollusks Blood trematodes
(Schistosoma mansoni,
- “vector-borne parasites” Schistosoma haematobium,
Biological vectors – required in the life cycle Schistosoma japonicum)
Mechanical vectors – for transport. Referred to as Intestinal
“ harborage vector” (cryptosporidium spp. ,
4. Animals Sputum Cyclospora cayetenensis)
- Either be domestic/ wild Liver and lung trematodes
- Zoonosis ( infection acquired from an animal) (Paragonimus spp. )
Tissue Protozoa
5. Other person – referred to as “”contact-borne parasites” (Toxoplasma gondii)
Free living amoebae
(Naegleriafloweri, Acanthamoeba
6. Oneself CSF spp. )
- Infection is referred to as “autoinfection”
Trypanosomes ( Trypanosoma
cruzi, Trypanosoma brucei
Anus ---- fingers ---- mouth gambiense)
Ex. Enterobius vermicularis
Blood trematodes ( Schistosoma
Ex. Strongloides stercolaris mansori, Schistosoma
Urine Haematobium)
7. Fomites Urogenital Flagellates
( Trichomonas vaginalis)
- Inanimate objects w/c becomes contaminated and causes
infection
Pathophysiology of Parasitic infection:
Portals of Entry: Parasite factor – leads to disease / non-infection. Depends on the
Any channel or the way through which the parasites gain access to the pathogenicity of the parasite
body of the host. Host – depends on the host defense mechanism
Mouth (ingestion of infective stage) a. Factors of pathogenicity:
Skin(direct penetration of larva stage) 1. Parasite burden - Refers to the number of parasites in the host
Respiratory tract, GUT, conjunctiva, other mucusmembrane ( > in # of parasite = > damage in the host)
2. Tissue tropism
Portals of Exit: - Affinity of the parasite to a particular tissue or cell in the
Channel through which parasites leave the body of the host. Usually the host
same as the portal of entry. - Damage depends on the locality of parasite
3. Pathogenesis
Nb. Importance: gives as the idea what specimen to collect from the - Mechanisms by which damage or injury is produced
specified site. i. Spoliative action
- Competing with the host’s essential nutrients --- depletion
in the host
- ex. Dipyllobothrium latum – feeds on vit. B12 leading to vit.
B12 deficiency (megaloblastic anemia)
ii. Trauma/ physical damage
- Attachment of parasite, migration of parasites in the body

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 - Ex. Hookworm- has bucal cavity & teeth/ cutting plates, used
for attachment to host tissues. found in the intestinal mucous,
causes ulceration to the intestinal worm
Malaria parasites – inhabit RBC
Ascaris – largest parasite of man , forms “ascaris bolus”
(entangled ascaris blocks the GIT)
iii. Lytic Necrosis
- Brought upon by enzyme system of parasite; secrete enzymes
that have enzymatic activity that can breakdown the tissue
Ex. Entamoeba histolytica – cysteine proteinase
iv. Toxic and allergic manifestations/ phenomenon
- Metabolic products of parasites which are toxic to the host
considered “foreign” ---- allergy
v. Stimulation of the host tissue reaction
- Undergo:
Phagocytosis
Inflammation
Granuloma – single cell surrounded by the parasite;
called tubercle; offers production to the host; protective
mechanism
vi. Secondary invasion
- Parasites produce pathways for other pathogens to enter the
host
Modes Of Transmission:
1. Contact Transmission
- Requires the coming together of the host and the infection
and the next generation host
Via direct contact transmission
- Contact of portal of entry of the next host and portal of exit
of the original host
- Through sexual activities – horizontal transmission
- Through vertical transmission (trans placental, mother to
baby after & during birth, trans mammary)
Via indirect contact transmission
- Fomites are transmitted to host to host via intermediate
objects.
2. Air-borne transmission
- Inhalation of parasites
(ex. Enterobius vermicularis – infective about 4-6 h)
3. Common vehicle transmission
- Refers to non-living reservoir
- Inanimate reservoir
Ex. Through water, soil etc.
4. Vector- borne transmission
- Transmission through the aid of vectors
Host Defenses
3 lines of host defenses:
1st line: includes skin, mucous membranes; protection at the
portal of entry
2nd line : accumulation of phagocyte, cellular and chemical
response
3rd line : immune responses ; Ab - Ag reactions
(Ab production – shows specificity )
Nonspecific Defenses Specific Defenses
Offer protection to any foreign Offers protection to a
agent; present at birth already particular foreign agent only
“Natural / native “ “Acquired” by contact with Ag
Eosinophilia :
- Increased in eosinophil #
- Acts in parasitic infection, > in asthma/ allergic reactions
Eosinophils
- Granulocyte; does not engulf, undergoes degranulation
- Releases the granules in the env’t which contains lytic factors
causing holes in the integument of the parasite--- killing of
parasite (extracellular killing)
- Inflammatory factors produces granuloma to protect the host
2 types of immune response:
1. Humoral immune response
- Mediated by B- lymphocytes , differentiated into a) memory
B-cells---anamnestic response; b) plasma cells – actively
producing cells
2. Cellular immune response
- Mediated by the T-lymphocytes
- Known as CMI
- Requires the activation of macrophages—APC
(antigen presenting cells)
Mechanism of Elimination of Antigen for Humoral IR
1. Agglutination
- Reaction between Ab and a particulate Ag
- Agglutinin (Ab) ; Agglutinogen (Ag)
Precipitation
- Reaction between Ab and a soluble Ag
- Precipitin (Ab) ; Precipitinogen (Ag)
2. Neutralization of toxins / or toxic neutralization
- Ab are referred to as “antitoxin” (neutralizes toxins, before
they can attach to tissues and infect the host.
3. Steric hindrance
4. Opsonization
- Coating of microorganism
- Impt. For encapsulated bacteria / organism
- “Opsonins” – Antibodies (process of coating microorganisms
by the Ab and recognized by phagocytes to be readily
phagocytized)
5. Activation of compliment pathway
Complement: activatd when/ by Ag- Ab complex
C5b6789
– impt for killing of Ag; referred to as MAC (membrane attact
complex); a cytolysin
- Inserts itself to cell membrane of the target cell, producing
pores transmembrane channels results to leakage/ spillage of
cell content (cellular killing)
6. ADCC
“ antibody dependent cellular cytotoxicity”
- Ab form a bridge / acts as a bringing mechanism between Ag
and effector cell

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 NB. There is acquired immunity for parasitic infection (acquired Saline wet mount Iodine wet mount
immunity is at low levels)
- Not long lasting ( immunity confers resistance in the host, Initial microscopic examination Mainly o stain glycogen and the
only when the parasite is within the host) of fecal specimen nuclei of the cysts
- Acquired immunity only confers resistance from hyper Employed to demonstrate egg,
infection; does not protect the individual from reinfection larvae, protozoan trophozoites Reveals details that cannot be
- Not absolute and cysts; can also reveal seen on saline wet mounts.
presence of RBCs and WBCs.
Diagnosis of Parasitic infection
2 approaches: 2. Kato thick smear (KTS)
1. Clinical approach - Efficient means f diagnosis of intestinal schistosomiasis and
2. Laboratory approach intestinal helminthes.
- Not suitable for examining larvae, cysts or eggs from certain
I. Clinical diagnosis intestinal parasites.
- Done by physicians - Uses a Cellophane presoaked with glycerine-malachite green
- Dependent on: solution for atleast 24h
a. Gathering of information based on signs and symptoms of the o Chemical examination :
disease, during physical examination 1. Occult Blood determination : Hema-Screen Guaiac Slide test
b. History taking - Hema screen developer contains <6% H2O2 and denatured
alcohol.
II. Laboratory diagnosis - (+) blue coloration on the test pad
- Done by medical technologists, & pathologists - Occult blood may be a result of intestinal bleeding caused
Methods : by parasitic organism, but not indicative of such infection.
1. Direct method o Reporting :
- Definitive identification Species, stage, average # per LPF (quantity)
- Requires isolation and identification of parasite from a clinical PRESERVATIVES
specimen
Preservative Advantages Disadvantages
- Isolate through :
a) direct microscopy Polyvinyl alcohol (PVA) For the detection of
trophozoites in Contains mercuric
b) culture Less widely used but diarrheic and mushy chloride and w/
highly recommended for stools that would consequent
2. Indirect method surveys and as a routine escape detection in disposal problems
- Presumptive identification procedure in the lab. other techniques.
- No need for isolation/ identify/ detect Contains mercuric
- Based on Ag- Ab reaction Provides optimum
Schaudinn’s Solution chloride and w/
fixation and
- Referred to as “immune-diagnosis” (Ag/Ab identification) consequent
A constituent of PVA and preservation of
- Specimen: blood (serum) disposal problems
can be both a fixative and structural detail
Not suitable for
preservative specially for the
concentration
SPECIMEN COLLECTION: diagnosis of protozoans
techniques
a. Container: clean, dry free from urine, tight fitting lids
10% Formalin solution Gives satisfactory result
b. Size: about 150 g ; thumb size (semi formed) ; half a teaspoon Widely used for
(watery) compared to MIF and
helminthic infection
c. Label: should contain date and time of collection schaudinn’s
surveys
NB. Liquid / soft stools : best examined w/ an hour of the time of Merthiolate iodine Concentration
passage formaldehyde (MIF) Retains good stain for techniques - Not
a.k.a thimerosal iodine some months; useful reliable for
ROUTINE STOOL EXAMINATION formaldehyde (TIF) : for field collections; specimens that
well preserved have been stored
o Macroscopic / Physical examination : stored in brown glass specimen for a year more than a few
1. Color (light to dark brown; variations: bright red, black/tarry, bottles days
pale yellow, white, gray, clay/putty, green)
SAF fixative solution
2. Consistency (formed, semi formed, soft, watery)
Preservation of material
- Examine for the presence of mucus and blood. Less adherence to the
w/c can be concentrated
o Microscopic examination: slide, although
by the tormol-ether
improved if the slide is
1. Direct fecal smear – detection of trophic forms of amebae acetate technique/ made
coated with albumin
and flagellates. Allowing the observation of motility of the into permanent stained
organisms smear

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 STOOL CONCENTRATION TECHNIQUES

Allows detection of small parasites that may be missed by

using only a direct fecal smear. It is indicated when direct wet FLOATATION TECHNIQUES
mount examination is negative despite the clinical symptoms FLOATATION
indicating parasitic infection of a patient. Helminth eggs and ADVANTAGE DISADVANTAGE
TECHNIQUES
larvae, and protozoan cysts may be recovered by concentration
but protozoan trophozoites will not be seen as they are
usually destroyed during the concentration procedure. SHEATHER’S
Fluke eggs and tape
SUCROSE
For the recovery of eggs ; almost all
Cryptosporidium nematode eggs do
(SG: 1.275 other
SEDIMENTATION TECHNIQUES oocysts not demonstrated
references)
5 times more efficient well
SEDIMENTATION A sucrose solution
ADVANTAGES DISADVATAGES for detecting Giardia spp. cysts
TECHNIQUES with a SG of 1.18
infections w/ Trichuris are distorted and
can be used to
ACID- ETHER compared to Zinc may be destroyed by
concentrate
SEDIMENTATION sulfate sheather’s sugar
protozoan oocysts
sol’n
and cysts
Sediments eggs and
Useful in the
protozoan cysts Unsatisfactory for
detection of
after clearing the the diagnosis of
schistosomes and Procedure will not
fecal detritus and protozoa ZINC SULFATE
other trematode eggs float some
mucus with the acid Zinc sulfate sol’n SG A floatation medium
and dissolving fatty trematode and some
1.18, used for detecting Giardia
constituents in ether tapeworm ova.
preferentially to lamblia infections is
Unsuitable for fatty
identify potential nearly 2 ties more
stool samples
FORMALIN ETHER infections w/ reliable than
Expensive and
SEDIMENTATION The preparation parasitic protozoan sheather’s sucrose,
requires a
TECHNIQUE Useful for cleaning contains some spp. Like giardia.
hydrometer.
(FORMALIN-ETHYL steatorrhea or other debris. Flammability
ACETATE) diarrheic feces . of ether and
Efficient in recovering irritation from
Formalin fixes the all parasite forms. formalin. Requires use of
eggs, larvae,oocyts Results in high Hymenolepis nana & centrifuge, either
and spores and sensitivity and Fasciola hepatica Recovers significantly swinging or fixed-
preserves their economy effort don’t concentrate more eggs and oocytst head rotor.
morphology. well. CENTRIFUGATION and has fewer false- Overfilling the test
FECAL FLOTATION negative results than tubes with sugar in
passive floatation the solution can
SIMPLE GRAVITY system. leave a sticky
SEDIMENTATION Readily applicable for residue in the
field work centrifuge
Intended to collect
Cleans some debris
parasite eggs too
and water soluble
dense to recover
pigments in the Cheap preparation
with common
process of decanting SATURATED SALT using simple
flotation media. Doesn’t concentrate
SOLUTION apparatus
cysts
TECHNIQUE Concentrates
BAERMANN nematode ova well
SEDIMENTATION
Best for the recovery Less sensitive than
Uses simple gravity
of Trichenella spiralis centrifugal flotation Less efficient than
sedimentation to Easy to conduct using
larvae technique. centrifugation
recover nematode commercial device.
larvae PASSIVE FECAL Often less expensive
techniques; recovers
FLOTATION fewer eggs and
than centrifugation
yields more false-
techniques
negative results.

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 PERMANENT STAINS CLINICAL PARASITOLOGY
Epidemiology: branch of science w/c deals with factors of distribution
STAINS ADVANTAGE DISADVANTAGE of disease.
MODIFIED GOMORI’S -Endemic - Sporadic - Epidemic - Pandemic
TRICHROME Less detail
Oocysts of -Cosmopolitan – found worldwide w/ or w/o sudden increase of
Demonstrates the Cryptosporidium, parasitic infection / incidence
Less time consumed
mitochondrial cyclospora nd o Factors that determine the occurrence of a disease:
Convenient in
myopathies and so called isospora are
identifying of 1. Human factors
range –red fiber. Positive difficult to
intestinal protozoa
structures are the same recognize a. Age - > / extreme age = more susceptible to infection
as H&E stain
b. Gender
Watery specimens
c. Nutritional status
cannot be used;
Results generally are difficult to d. Habits of individual/ customs/ rites
superior (enhanced perform e. Hereditary
IRON HEMATOXYLIN definition of key Oocysts of
STAIN nuclear and Cryptosporidium, 2. Environmental factors
cytoplasmic cyclospora and Factors that favor the survival and maintenance of the parasite
characteristics) isospora are outside the host
difficult to a. Physical factors/ climatic factors
recognize
b. Socioeconomic (poverty favors infection)
POLYCHROME IV
STAIN c. Occupation
Can be used in place Cannot be used
Primarily used to stain o Prevention and control:
of trichrome stain by in specimen
permanent smears -Different strategies for prevention and control
the MIF, PVA or SAF preserved with
prepared from MIF –
fixative method formalin. 1. Treatment of the host
preserved fecal
specimens - Refers to the administration of drugs
CHLORAZOL BLACK E - Reasons for use:
STAIN a. Reduce morbidity
Can be used to detect
Not b. Prevent mortality
fungal filaments in stool; Both fixation and
recommended for
identify the presence of staining occur in a c. Reduce transmission of parasites
materials fixed
protozoa w/c is not single solution
with PVA. 2. Control the animal host
readily detected or
difficult to detect in wet - Treatment with anti-parasitic drugs
prep. - Destruction of the animal
Lack specificity ; - Reason: Reduce chance of transmission from the animal host
use of positive
Sensitive and cost 3. Control the vector host
control is
MODIFIED ACID FAST effective for
mandatory; - Killing the vectors
STAINS detection of these
destruction of - Elimination of breeding grounds
protozoa
trophozoite stage
of parasite 4. Reduction of vehicle contamination
MODIFIED IRON – - Proper sanitation:
HEMATOXYLIN STAIN a. Proper waste disposal
Not
The internal elements b. Treatment of waste (chemically)
recommended for
that distinguish among
Save both time and Schauddin’s - Purification of water
cysts and trophozhoites
personnel use fixative –
can best be visualized - Proper food storage and preparation
preserved or
with a stain that
PVA-preserved 5. Interruption of transmission
enhances the
morphologic features. - Referred to as “barrier protection”
- Use of physical barriers to separate host from the source of
TRICHROME STAIN infection (parasite)
Background debris- green Especially
Protozoa- blue-green to recommended for - A.k.a “spatial protection”
purple cytoplasm identifying features 6. Education
Nuclei & inclusions- red or
purple red and sharply of amoebic cysts and - Information dissemination: Through different media
delineared from trophozoites 7. Immunization of susceptible individuals
background - Acquired by vaccine
- Not for parasite infection

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 PROTOZOANS Functions:
i. Metabolism
- Group of eukaryotic organisms ii. Site of food synthesis and storage
- One-celled organisms (unicellular) - stored in the form of glycogen mass/ vacuole or in the
- Has 7 phyla, but 3 are medically important form of chromatoidal body / bar (represents protein
storage; made-up of crystalline RNA)
Subphylum sarcodina
Phylum sarcomastigophora
Subphylum mastihophora 2. Nucleus
Phylum ciliophora - Bounded by nuclear membrane
Phylum apicomplexa Class sporozoea 2 types of nucleus:
a. Vesicular type:
General morphology: - Majority found in protozoans
Two regions of protozoan cell
- Characterized by irregular distribution of chromatin;
1. Cytoplasm appears that there are light areas or spaces in the
- Divisible into 2 portions nucleoplasm
a. Ectoplasm
- on the outer part; peripheral region
- less granular; more homogenous than endoplasm - Chromatin materials in the nucleus
Functions : - Spokeswheel arrangement

i. Site of locomotory apparatus

a. flagella: thread-like , long whip-like structure arising from
the surface of the cell ( flagellates – org with flagella)
- spp. From Mastigophora
b. cilia : shorter , needle-like/ hair-like structures; found all
throughout the cell (ciliates – org. with cilia)
- spp. From Ciliophora
c. pseudopods/ pseudopodia: false-feet ; temporary
cytoplasmic extentions (amoeba – with pseudopods)
- spp. From Sarcodina
d. undulating membrane
- addition to flagella
- Flexible sheet of material that joins the flagella
to the surface of the cell . ex. Trichomonas vaginalis
ii. Use for procurement of food
- obtain food , through formation of pseudopodia
(extends and surrounds the food forming a cytoplasmic
vesicle -endocyosis)
- through a specialized cell mouth called “cytostome”
iii. Important in the discharge of metabolic waste
- discharge through “ exocytosis”
- through specialized cell anus at the oral end , referred to
as “Cytopyge”
iv. Protection
-Able to secrete a thick / resistant material referred to as
the “cyst wall” (formed during cystic stage; contains
“contractile vacuoles”- protects the cell from osmotic lysis;
enables protozoans to survive in water, collects the water
in the cell and pumps the water outside the cell ; acts as
osmoregulator.)
- Condensed / aggregates of chromatin granules in the
nucleoplasm
- Counterpart of nucleolus
- Chromatin granules lining the innerside of nuclear
membrane
b. Compact type
- No clear materials in light microscopy
- Chromatin is compact causing dark visual of the
nuclei
- Ex. Characteristics of phylum Ciliophora –
Balantidium coli
GENERAL CYCLE OF PROTOZOA
Two developmental stages:
1. Trophozoite Stage
- Motile stage of the protozoa
- “Active stage” ; Non-resistant stage
- Responsible for the pathogenicity or “Pathogenic stage”
- Aka “Vegetative stage” / “Reproductive stage”
(actively multiplies through binary fission)
2. Cystic Stage
- The non-motile stage ; “Inactive stage” or aka “Resistant
stage” (protected by a cysts wall secreted by the ectoplasm
- Responsible for the transfer of infection thus, “transfer stage”
or “ infective stage”
- Non-vegetative; does not reproduce / undergo binary fission

NB:
b. Endoplasm Encystation
- found in the inner region that directly surrounds the Trohozoite transform Cyst
nucleus Excystation
– dense/ moderately dense granular

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 ENCYSTATION : NB. All are intestinal amoeba except for E. gingivalis found in
the mouth usually at the cavities, teeth and gums. They are
differentiated by the morphology of the nucleus.
- Transformation of trophozoite into a cyst stage
- Caused by adverse conditions in the environment
1. When there is nutritional deficiency MORPHOLOGY OF THE NUCLEUS
2. Changes in the increase toxicity
1. Genus Entamoeba
3. Desiccation
- Characterized by small karyosome (centrally located/
4. Decrease oxygen concentration eccentrical)
5. pH / temperature changes - Has chromatin material (linin network)
6. Overcrowding/ overpopulation
- Has peripheral chromatin w/ either fine granules / course
granules ot regular/ irregular distribution
EXCYSTATION :
2. Genus Endolimax
- Cystic stage becomes trophozoite stage for reproduction
- Characterized by large karyosome and irregular shaped
- Both processes occurs within the host only karyosome with fibrils radiating into periphery
- No peripheral chromatin
PHYLUM SARCOMASTIGOPHORA
SUBPHYLUM SARCODINA A.K.A “ Amoeba/ Amoebae” 3. Genus Iodamoeba
- Characterized by large spherical karyosome surrounded
a. Genus Entamoeba by achromatic globules ( referred to as periendosome; may
- E. histolytica (real pathogen) be clustered at one side)
- E. coli - Lacks peripheral chromatin
- E.gingivalis
- E. dispar CRITERIA FOR IDENTIFICATION
- E. hartmani
b. Genus Endolimax 1. Size – measured in μm
- E. nana 2. Shape and motility
c. Genus Iodamoeba 3. Characteristics of the nucleus
- I. butschii 4. Cytoplasm

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 TROPHOZOITE OF INTESTINAL AMOEBA

NUCLEUS CYTOPLASM
SIZE MOTILITY
SPECIES Peripheral Karyosomal
(Usual Range) Pseudopod Number Appearance Inclusion
Chromatin Chromatin
Active ,
Present, fine, Fine granular,
10-60 μm progressive, Small, discrete,
uniform ground glass Erythrocytes (
Entamoeba (15-20 μm directional, One, not visible
granules, evenly
compact. Usually
appearance, not present in E.
histolytica/ – E. dispar ) hyaline fingerlike in unstained
distribute. may
centrally located
clean. If present, dispar) may
dispar (over 20 μm – or blade preparation
be beaded
but occasionally
vacuoles are contain bacteria
E. histolytica) pseudopod , eccentric
appearance very small.
formed rapidly
Present, fine,
Usually non Small, discrete,
uniform
progressive, but One. Not visible compact often
Entamoeba 5-12 μm
may be in unstained
granules, evenly
eccentrically Finely granular Bacteria
hartmanni (8-10 μm ) distributed. May
progressive preparation located but may
be beaded
occasionally be central
appearance
Sluggish, non- Large, discrete,
Similar to E.
progressive, One. Often usually Abundant
Entamoeba 15- 50 μm blunt , usually visible in
histolytica
eccentrically. Coarse, often bacteria, yeasts,
coli (largest ( 20-25 μm) granular unstained
Darker, solid
May be diffused vacuolated and other
protozoan) pseudopod. preparation
ring rather than
and darkly materials
beaded
Formed slowly stained
Moderately
active , with
multiple
Present, fine Small, well-
Entamoeba 5-20 μm pseudopods, vary
One granules, closely defined, usually
Finely granular, Epithelial cells
gingivalis (10-15 μm) from long ,
packed. centrally located
vacuolated and leukocytes
lobose to short
and blunt, often
formed rapidly
Sluggish, usually One,
Endolimax Large, irregular
non progressive, occasionally
nana (smallest 6-12 μm shaped, blot like, Granular,
hyaline, blunt, visible in Usually none Bacteria
intestinal (8-10 μm )
pseudopod, unstained
usually centrally vacuolated
protozoan) formed slowly. preparation
located

Large, usually
centrally located.
Sluggish, usually Surrounded by
non progressive. One. Not usually retractile, Coarsely
Bacteria, yeast,
Iodamoeba 8-20 μm Hyaline, blunt or visible in achromatic granular, maybe
Usually none or other
butschlii (12-15 μm) fingerlike unstained granules. These heavily
materials
pseudopod. preparation. granules are vacuolated
Formed slowly. often not
distinct even in
stained slide.

Compiled by: Frances Lictag Edited By: Saintclaus_eso 2114175 PARASITOLOGY NOTES 2015 Page 9
 CYSTS OF INTESTINAL AMOEBA

NUCLEUS CYTOPLASM
SIZE MOTILITY Peripheral
SPECIES Karyosomal Chromatoidal
(Usual range) Pseudopod Number chromatin/ linin Glycogen
chromatin bodies
network
Usually diffuse.
Present. Concentrated
1-4 in mature
Present. Fine , Elongated bars mass seen
Entamoeba cyst Small, discrete.
10-20 μm uniform in size with bluntly occasionally in
histolytica/ Usually spherical 1-2 occasionally Usually centrally
(12-15 μm) and evenly rounded ends young cyst.
dispar seen in located
distributed (cigars/ sausage/ Stains reddish
immature cyst
rod-like) brown with
iodine
Present.
1-4 in mature
Elongated bars
cyst
Entamoeba 5-10 μm Similar to E. Similar to E. with bluntly Similar to E.
Usually spherical 1-2 occasionally
hartmanni (6-8 μm) histolytica histolytica rounded ends histolytica
seen in
(bar-like or rice
immature cyst
grain)
1-8 in mature Present. Less
Present. Course Usually diffuse.
cyst. Super frequently seen
Usually granules But occasionally
nucleated cyst Large, discrete, than in similar
spherical. irregular in size well-defined
Entamoeba coli with 16 or more usually E. histolytica.
10-35 μm Occasionally & distribution, mass in
(largest seen. eccentrically but Usually splinter-
(15-25 μm) oval, triangular, but often immature cyst.
protozoan) or of another
2 or more
appear more
occasionally like with
Stains reddish
occasionally centrally located pointed ends
shape uniform than in brown with
seen in (broom stick,
trophozoite iodine
immature cysts jagged)
Occasionally,
granules or Usually diffuse.
small oval Concentrated
Endolimax nana 1-4 in mature
Large (blotlike),
masses seen, but mass seen
(smallest 5-10 μm Spherical, ovoid cysts. Less than bodies as seen occasionally in
None usually centrally
intestinal (6-8 μm) or ellipsoidal 4 rarely seen in in Entamoeba young cyst.
located
protozoan) immature cyst species are not Stains reddish
seen (comma, brown with
coccoid, short iodine
curved rods)
Large, usually
eccentrically
Granules
located.
occasionally
Retractile, Compact, well-
Ovoid, present, but
achromatic defined mass.
Iodamoeba 5-20 μm ellipsoidal, chromatoidal
1 in mature cyst None granules on one Stains dark
butschlii (10-12 μm ) triangular, or of bodies as seen
side of brown with
another shape in Entamoeba
karyosome. iodine
species are not
Indistinct in
present
iodine
preparations

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 P A T H O G E N E C I T Y AND P A T H O G E N E S I S
2. Colonic perforation
AMOEBIASIS:
- Refers to any clinical condition resulting from infection with - Results into peritonitis (inflammation) and
E. histolytica hemorrhage
- May occur at any area of invasion (usually intestinal) 3. Secondary infection
- Caused by another agent in the area
Intestinal Amoebiasis: 4. Secondary invasion
- Either be asymptomatic or symptomatic - Cause by other agent
- Most common type (85-95% of cases are asymptomatic; - Parasites gain access in blood circulation
5-10% symptomatic )
- Passes formed stool
EXTRAINTESTINAL AMOEBIASIS
a. Acute amoebic colitis (nondysenteric) SITE DESCRIPTION TERM
- Includes abdominal pain / cramps
Secondary to infection in colon
- Frequent dysentery (watery, bloody and mucoid) Most common type of EA;
- Passes watery stool (trophozoite stage) characterized by :
a. Amoebic hepatitis (char. By
b. Chronic amoebic colitis (dysenteric hepatomegaly) “ Hepatic
Liver
b. Amoebic hepatic abcess Amoebiasis”
- Intermittent diarrhea and constipation (central part of abcess is pus-
- Either trophozoite / cystic stage is recovered likened to be “anchovy-sauce”,
reddish brown in color

1. Cytoadherence Results from direct extension

- Attachment of the parasite to the cells of infection from the liver,
usually affecting the right lung; “Pulmonary
- Has adhesins w/c enables attachment Lungs
may occur via hematogenous Amoebiasis”
2. Cytolysis origin; patient may cough- out
- Due to active motility or “amoeboid movement” – “anchovy sauce like sputum”
causes lysis of host cells Brain “Cerebral amoebiasis”
3. Proteolysis by E. histolytica
Occurs in the perianal region;
- Secretes “enzyme w/c lyse the tissue/ host cells “Cutaneous
Skin secondary to infection in the
Amoebiasis”
rectal portion
a. Primary ulcer (start of lesion, found in the SUBPHYLUM MASTIGOPHORA
mucosa, usually small)
- A.k.a “Flagellates”
b. Then extends laterally into the mucosa
- Move by means of flagella
c. Deep necrosis of submucosa, muscularis layer and
sub serosa( causing lesion of large and round base)
- Described as a “flask- shape ulcer” or “tear-drop a. Intestinal flagellates
ulcer” - Giardia lamblia
- Dientamoeba fragilis
- Chillomastix mesnii
1. Amoeboma - Pentatrichomonas hominis
- Granuloma that is formed in the intestinal wall
resulting from the infection with E. histolytica
b. Atrial flagellates
- Results into the thickening of intestinal wall and
constriction of intestinal lumen - Trichomonas spp.
- It may resemble “colon-cancer
- The constriction is referred to as “napkin-ring”- c. Blood and tissue Flagellates
affects bowel movement - Leishmania spp.
- Trypanosoma spp.

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 I N T E ST I N A L A N D A T R I A L F L A G E L L A T E S
SPECIES LIFE CYCLE
a. Acquired via ingestion of mature
cyst (water-borne), passed through the
stomach then reaches the duodenum –
excystation occurs yielding 2
trophozoites
Giardiasis :
Giardia lamblia b. Adheres to mucosa of intestinal wall
through sucking disks
c. Multiplies , then encystation occurs
in colon, cysts passed in feces
(formed), and as trophozoite (watery
stool)
Chilomastix mesnili
Other feature:
“Shows explosive disintegration in
water”
– tendency to be swollen in water
Dientamoeba fragilis granules to cytoplasm will exhibit
Brownian movement then swings back
to the normal size – referred to as
“HAKANSON phenomenon”
Pentatrichomonas hominis
Trichomonas vaginalis
Trichomonas tenax
Compiled by: Frances Lictag Edited By: Saintclaus_eso 2114175
PATHOGENESIS DIAGNOSIS
1. Demonstration of parasite
a. Stool specimen
b. Duodenal aspirate
- Gastrodoudenoscopy
- Nasogastric insertion
- Diagnostic stage: trophozoite
Can cause c. Enterotest (string test)
“Gay bowel syndrome” - Utilizes string device made
up of gelatin capsule inside a
spool of nylon string and a
weight (collection of
trophozoite)
2. Serological test
Dientamoebiasis : often
asymptomatic Transmitted 1. Demonstration of parasite
through fecal-oral route
25% diarrhea ,abdominal pain, Stool specimen
flatulence, nonspecific (trophozoite stage)
gastrointestinal syptoms; a. Direct fecal
Concomitant with pinworm b. SCT
infection c. Permanent stains
(E. vermicularis)
Commensals
Transmitted through direct
contact: sexual contact.
Trichomoniasis – clinical
condition resulting from T.
vaginalis infection
Females: 50% asymptomatic &
50% symptomatic
s/s : vaginitis/ cervicitis (vaginal
discharge- yellowish in color/
greenish in color/ frothy);
pruritus;dysuria;
dyspareunia(painful sexual
contact); hyperemic vaginal
mucosa
Males: generally asymptomatic;
occasionally appear in form of
urethritis & prostatitis
NB. Causes “Ping-Pong Infection”
–requires treatment of both
sexual partners
Commensals
PARASITOLOGY NOTES 2015 Page 12
 TROPHOZOITES OF INTESTINAL AND ATRIAL FLAGELLATES

NUMBER OF NUMBER OF
SPECIES LENGTH SHAPE MOTILITY OTHER FEATURES
NUCLEI FLAGELLA

Pear- shaped
Sucking disk occupying ½ to ¾ of
Pyriform shape, 2; not visible in 4 lateral (2
Giardia 10-20μm “Falling Leaf”, ventral surface
tear-drop shape; unstained ventral , 2
lamblia (12-15 μm) flip-flop “old man w/ eyeglasses”
dorsoventrally mounts dorsal)
“monkey face”
flattened

1; not visible in Prominent cytostome extending

Chilomastix 6-24 μm 3 anterior, 1 in
Pear- shaped Stiff, rotary unstained 1/3 to ½ length of body. Spiral
mesnili (10-15 μm) cytostome
mounts groove across ventral surface

1 or 2. In
Ameboid,
approximately Karyosome usually in form of
pseudopods are
40% organisms cluster of 4-8 granules. No
angular,
Dientamoeba 5-15 um only 1 nucleus peripheral chromatin. Cytoplasm
serrated, or Sluggish None
fragilis (9-15 μm) present. Nuclei is finely granular, vacuolated, and
broad-lobed and
not visible in may contain bacteria. Organism
hyaline; almost
unstained formerly classified as amoeba.
transparent
mounts

1; not visible in
Pentatrichom 8-20 μm 3-5 anterior, Undulating membrane extending
Pear- shaped Rapid, jerking unstained
onas hominis (11-12 μm) 1 posterior length body. Commensal
mounts

Undulating membrane extends

1; not visible in length of body. No free posterior
Trichomonas 7-23 μm 3-5 anterior,
Pear- shaped Rapid, jerking unstained flagellum; does not live in
vaginalis (11-15μm)
mounts
1 posterior
intestinal tract; seen in vaginal
smears & urethral discharges

Undulating membrane (2/3 length

1; not visible in of the costa ) extends the length
Trichomonas 5-12 μm Pear- shaped Rapid, jerking unstained
4 anterior,
of body. Flagellum extends ½ of
tenax mounts
1 posterior
body length. Axostyle extends
beyond posterior. Commensal

CYSTS OF INTESTINAL AND ATRIAL FLAGELLATES

SPECIES LENGTH SHAPE NUMBEROF NUCLEI OTHER FEATURES

Fibrils and flagella

oriented longitudinally in
cysts with other deep –
staining fibrils lysing
Usually 4 ; not distinct in laterally or obliquely in
8-19 μm
Giardia lamblia Oval or ellipsoidal unstained mount. Usually lower part of cyst.
(11-14 μm)
located at one end Cytoplasm often retracted
from cyst wall. There may
also be a “halo” effect
around outside of cyst
wall in stained smears.

Cytostome with
Lemon-shaped, with
6-10 μm 1; not visible in unstained supporting fibrils. Usually
Chilomastix mesnili (7-9 μm)
anterior hyaline knob or
mounts visible in stained
“nipple”
preparation

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 BLOOD AND TISSUE FLAGELLATES
Development stages AMASTIGOTE PROMASTIGOTE EPIMASTIGOTE TRYPOMASTIGOTE
Other name Leishmania stage Leptomonas stage Crithidia stage Trypanosome stage
Appearance Generally ellipsoidal/ ovoidal Fusiform in shape/ spindle Fusiform; spiral shape
Fusiform
or spherical shape elongated
Size 3-4 x 2 μm (very small) 14-20 μm in length
Location Insect vector Insect vector Host’s blood and tissue

GENUS LEISHMANIA
CRITERIA Leishmania tropica Leishmania braziliensis Leishmania donovani

Reticuloendothelial cells ,
Within macrophages, skin, mucous
Macrophages of the skin, nearby lymph macrophages of the liver, spleen,
Habitat/ source membranes of the nose, and buccal
nodes bone marrow , intestinal mucosa and
cavity
other body organs

Acquired from: Tissue juice Tissue juice Blood

Afghanistan; Brazil; Iran; Peru; Saudi

Epidemiology South and Central America Brazil; India; Nepal; and Sudan
Arabia and Syria

Cutaneous leishmaniasis
Visceral leishmaniasis
Also termed as “Old world
- Affects visceral organs
leishmaniasis”/ oriental sore/ tropical Mucocutaneous leishmaniasis
- Has lesions on the skin; manifested
sore/ “Aleppo button/ Jericho boil or - Initial lesion is “Weeping ulcer”
be fever, hepatomegaly and
Delhi boil or Baghdad boil. (fluid exudes from ulcer)
Disease splenomegaly; in general leads to
- Starts w/ cellular infiltration, then - Also termed
lymphadenopathy
necrosis and ulceration invites secondary
invasion, leading to granuloma “Epundia,” “Chichero ulcer,” “Uta”
A.k.a. “ Kala-azar”, “Dum-dum fever”
formation
or “Death fever”
- Healing w/ scar (2-10 weeks)

Two hosts
a. Man
b. Vector host: sand flies ( Genus phlebotomus- vector host of the old world or Genus Lutzomyia – vector host of the new world)
NB. Acquired via bite of sand flies; two stages involved in life cycle the amastigote and promastigote
a. Leishmania species occur as amatigote stage ( tissue juices and macrophages) in blood ; vector takes a blood meal acquiring the amastigote
b. Amastigote proceeds to the midgut of the vector; changes into promastigote
c. Promastigote multiplies by binary fission; migrates back to the anterior gut then, promastigote blocks the proboscis
Life cycle d. During blood meal, promastigote (infective stage) is injected into the skin.
Life cycle in man:
a. Acquired via bite of vector; promastigote is injected
b. Promastigotes are ingested by the macrophages then transforms into amastigote stage
c. Multiplies w/in the macrophages by binary fission causing rupture of parasitized cell, releasing amastigotes
d. Infects other cells; then form core of parasitized cells (L. tropica: remain localized in the skin & acquired from tissue juices; L. braziliensis: acquired
from tissue juices; L. donovanni: acquired from blood)

a. Direct microscopy : diagnostic stage – amastigote stage

b. Culture : Novy – Macneal-Nicolle medium (made up of nonnutrient agar – sodium chloride, water and rabbit blood) –
Promastigote (expected specimen.)
c. Skin test : “Montenegro skin test”
- Involves intradermal injection of suspension of killed promastigote
(+) induration after 12 hours at the site of injection (reddening – wheal appearance)
- Highly positive in cases of cutaneous leishmaniasis; 95% positive for mucocutaneous leishmaniasis ; negative for visceral
leishmaniasis during active stages (positive only 2 months after)
Diagnosis d. Serologic tests
e. Other non-specific tests:
1. Increased serum gamma globulins (about 10-70%)
2. Aldehyde test of Napier (formol Gel Test)
- 1-2 ml of Pt serum + 1-2 drops of 40% formalin
- (+) jellification
- Positive for visceral leishmaniasis at least 3 months duration ; negative for others
3. Antimony test of Chopra
- Utilizes 4% urea stibamine + Pt. serum
- (+) profuse flocculence

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 GENUS TRYPANOSOMA

Criteria Trypanosoma brucei rhodesiense Trypanosoma brucei gambiense Trypanosoma cruzi

T. rhodesiense T. gambiense
South American trypanosomiasis
OTHER NAME
Or “Chagas disease”
“ African trypanosomiasis ” or “ Old world trypanosomiasis ”

“ Chronic African trypanosomiasis

“Acute African trypanosomiasis ” or “
”
Sleeping sickness ”/ “East African South American trypanosomiasis
Or sleeping sickness/ “ west
trypanosomiasis” or
African trypanosomiasis”
“ Chagas disease ”
- Initial lesion is in the skin ,
associated with the bite / any
3 Stages : abrasion of the skin; produces
parasitized cells – “chagoma” small
Disease 1st Stage : associated w/ the bite w/c produces lesion at the site of bite; reddish painful nodules
becomes a hard nodule (hard, itchy and painful) (1st manifestation)
- Swelling of eyelid – bite /entry by
2nd Stage: associated w/ the entrance into the blood – “parasitemia ” ; the conjunctiva; referred to as
production of toxins (toxemia) ; enlargement of lymph nodes on the “ Romaña’s sign ”
cervical area w/c is referred as “winterbottom’s sign” ; hepatomegaly & w/c may result to regional
splenomegaly , lesions on the bone marrow lymphangitis & lymphadenopathy

3rd Stage: associated with the involvement of CNS ; neurologic infection;

shows encephalitis and somnolence (excessive drowsiness) leads to coma
and death

Involves Reduvid bugs belonging to

Involves “game attacking spp of
genus Glossina” – primarily bite
animal/game animals
because they live along river banks
Vector host
1. Glossina morsitans
2. Glossina pallidipes
3. Glossina swynnertoni
the family of Reduvidae; referred
to as
Involves
“ Cone-nosed bug ” /
“Riverine spp of Glossina”
“ The Kissing bug” / “Assassin bug”
1. Glossina palpalis
1. Genus Panstrongylus megistus
2. Glossina tachinoides
2. Genus Triatoma
( Triatoma infestans )
3. Genus Rhodnius
( Rhodnius prolixus )

Sporadic infection Limited to American continents :

Epidemiology Epidemic infection
(due to game animals) South and Central America

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 LIFE CYCLE Two different host: All Stages occur:
a. Man a. Amastigote (found in RES)
b. Vector : “Tsetse flies” from Genus Glossina - Has indirect life b. Promastigote
cycle; (found in human host – transitional stage)
c. Epimatigote ( found in man as transitional
Vector host: stage; in midgut of the vector w/c multiplies)
1. Acquired through blood meal acquiring d. Trypomastigote
trypomastigote ; carried into the midgut of the vector and (“C shape”/ “S shape or U shape”; found in
multiplies through binary fission blood of man – extracellularly; found in
hindgut of vector)
2. Returns to the anterior gut, then transformed into
epimastigote Vector host:
( at a certain time reverts back into trypomastigote) a. Infected during a blood meal:
trypomastigote (infective stage)- carried into
3. Metacyclic trypomastigote infects man through a the midgut then changes into epimastigote
blood meal. and multiplies longitudinally by binary fission
b. Goes into the hindgut (posterior gut)
Life cycle in man: c. Becomes into metacyclic trypomastigotes
1. Acquired via bite of the tse-tse flies, injecting metacyclic then passed in feces of the vector
trypomastigote
Man:
2. Multiplies through binary fission, invades the bloodstream a. Associated w/ the bite of vector and
defacates containing the metacyclic
3. From the blood stream enters the lymph nodes and the trypomastigote, rubbed onto the skin (bite
different organs of the body (tissue spaces) NB. They do not puncture/abrasion/mucosa of the eyes
become intracellular
Localizes in the central nervous system b. Trypomastigote enters and ingested by
macrophages, then transforms into amastigote
then multiplies causing rupture of
macrophages –releases amastigotes – infects
other cells or may transform into
promastigote – epimastigote – into
trypomastigote then enter cells of other
organs.

Diagnosis 1. Demonstration of parasites Based on isolation and demonstration of

Specimen : blood, tissue aspirate, and CSF parasite:
Specimen : blood and tissue aspirates
a. Direct microscopy (diagnostic stage : Trypomastigote a. Direct microscopy
stage) Blood: trypomastigote stage
- Wet mounts Tissue aspirate: amastigote stage
- Fixed or stained smears b. Tissue culture :
b. Serologic tests Novi-Macneal-Nicolle medium
Increased serum IgM levels - Trypomastigote
c. Xenodiagnoses
– involves laboratory bred / reared bug
(triatomid bug: a controlled bug, free of
infection ) allowed to feed/ take a blood
meal on a patient suspected of having
Chagas disease ; after 7-10 days, the
bug is dissected and examined
microscopy technique (trypomastigote /
epimastigote can be isolated)

Categorial Salavarian – undergoes anterior station of development Stercorarian

Division - (feces) infective stage is passed in
feces
- Undergoes posterior station of
development

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 PHYLUM CILIOPHORA
Species :
Balantidium coli Shape and
Motility Number of nuclei Other features Pathogenesis
(largest intestinal size
protozoa)

Trophozoite Ovoid w/ 1 large, kidney – Balantidiasis

tapering shaped macronucleus; - Causes ulceration;
anterior end ; 1 small round characterized by wide
Ciliates;
50-100 μm in micronucleus, which mouth and rounded base
rotary, Body covered with cilia, w/c tend
length; 40-70 is difficult to see
boring; to be longer near cytostome;
μm in width; even in stained Pathogenic mechanism:
may be cytoplasm may be vacuolated
usual range smear; macronucleus a. Motility : rotary motion
rapid
40-50μm may be visible in enables invasion of the
unstained host
preparations b. Production of enzyme
hyaluronidase leads to
Cyst Spherical or 1 large macronucleus Macronucleus and contractile lectic necrosis
oval ; visible in unstained vacuole are visible in young cysts; NB. No extraintestinal
50-70 μm; preparation; in older cysts. Internal structure infection. Confined in the
usual range micronucleus difficult appears granular; cilia difficult to small intestine.
50-55 μm to see see within the cyst wall

Life cycle a. Acquired via ingestion of cystic stage

b. Enters the small intestine and undergoes excystation
c. Enters into trophozoite stage, then starts to feed and multiply in the cecum
d. Distal part of the large intestine , encystation takes place
e. Cyst can be passed in feces in formed stool or in watery stool if no encystation takes place

Diagnosis 1. Demonstration of the parasite

a. Watery stool: trophozoite stage
b. Formed stool : cyst stage

Epidemiology Cosmopolitan; prevalence rate : sporadic (<1%)

Parts of Balantidium coli :

a. Micronucleus : spherical ; functions for reproduction
b. Macronucleus : kidney-shaped; responsible for phenotypic characteristics of the parasite
c. Cilia : locomotory apparatus; rotary motion
d. Contractile vacuoles: osmoregulators of the parasite
e. Food vacuole
NB. Other reservoirs: Hogs
- They are believed to cause infection w/ man. When man ingests the infected hogs

PHYLUM APICOMPLEXA
Class Sporozoa : Subclass Coccidia
A. Blood coccidia
- Plasmodium falciparum
- Plasmodium vivax
- Plasmodium malariae
- Plasmodium ovale
- Plasmodium knowlesi (newly discovered)
B. Intestinal coccidia
- Isospora belli
- Cryptosporidium parvum
- Cyclospora cayetanensis
- Sarcocystis hominis
C. Tissue Coccidia
- Toxoplasma gondii
General characteristics:
Compiled by: Frances Lictag
- Has complex life cycle with “alternating sexual and asexual
generations.
1. Asexual stages:
a. Schizont
(actively dividing forms of parasite by multiple fission)
b. Merozoites (daughter cells of schizonts)
c. Formation of Schizont/ merozoites is termed Schizogony /
merogony respectively.
d. Gametogony : formation of gametocytes, following
shizogony/ merogony.
e. Gametocytes : sexually differentiated
i. Microgametocytes – male
ii. Macrogametocytes- females
2. Sexual stages
a. Syngamy : fussion of macrogamete and microgamete
b. Zygote – product of syngamy
c. Sporogony : development of sphoozoites/ formation of
sphorozoites
Edited By: Saintclaus_eso 2114175 PARASITOLOGY NOTES 2015 Page 17
 Geographic
Alternation of generation : Species Pathogenesis
Distribution
a. Monoxenous parasite:
- Alternation of generation happens/ occurs in the same host Tertian malaria
Acute malaria/
b. Heteroxenous parasite malignant malaria
- Alternation of generation occurs in different hosts Plasmodium falciparum (black water fever) Tropical regions
- Common cause of
BLOOD COCCIDIA malaria
Plasmodium species - >70%
- Plasmodium falciparum Tertian Malaria
- Plasmodium vivax Benign tertian
Tropical ,
malaria
- Plasmodium malariae subtropics and
Plasmodium vivax - 2nd most common
some temperate
- Plasmodium ovale cause
areas
- <30%
Life cycle: indirect life cycle
Quartan Malaria
Two hosts : man and vector ( mosquito belonging to the Genus Plasmodium malariae - <1% Tropics
Anopheles- only the female anopheles mosquito takes a blood meal)

In man: West Africa, India

Plasmodium ovale Tertian Malaria
a. Acquired via bite of anopheles mosquito injecting sporozoite and south America
stage, along its salivary juice (containing sporozoite)
b. Within 1 hour , it enters the liver cell (hepatocytes), and Malaria : derived from “mal” – bad ; “aria” –air
initiates the “preerythrocytic schizogony” (sporozoites become Signs and Symptoms:
schizonts) I. Prodromal :
c. Binary fission occurs --- merozoites – causes rupture of - Right after incubation; characterized by flu-like symptoms
infected hepatocytes w/c releases the merozoites and invade the such as : fever, body malaise and headache
RBCs
d. Initiation of erythrocytic schizogony – merozoites become II. Stage of active invasion:
“Ring forms”- earliest forms - Associated w/ presence of parasite in RBC
NB. Hypnozoites – inactive sporozoites that can be reactive & a. Anemia : rupture of infected RBCs and even autoimmune
produce preerythrocytic schizogony P. vivax & P. ovale can have lysis
2nd generation of preerythrocytic schizogony . development of b. Hepatosplenomegaly: associated to the activation &
hypnozoites proliferation of macrophages
P. falciparum & P. malariae enters RBCs directly III. Febrile paroxysms
e. Trophozoite (feeds on Hbg of RBCs and become larger in size) - Occurs 6-10 hours ; refers to fever attack
f. Becomes a Schizont then merozoites - Characterized by 3 stages:
g. Merozoites can enter another RBC or transforms into a a. Cold stage – chills, 20 mins to 1 h
gametocyte b. Hot stage –fever , 1-4 h
c. Sweating stage –profuse sweating, 2-3 h
NB. P. falciparum – has affinity of RBCs of all ages
- Synchronizes with the end of erythrocytic schizogony
(when RBCs ruptures, releasing the merozoites)
In vector host:
a. Acquired via blood meal; infected by gametocyte stage; then it Tertian malaria : characterized by length of asexual cycle of 48
maturea hours; fever reoccurs every 3rd day
b. Exflagellation produces 5-8 microgametes ; fertilization Quartan malaria: characterized by length of sexual cycle of 72
occurs—produces zygote, then zygote becomes elongated and hours; fever reoccurs every 4th day
motile termed as “ookinete/ travelling vermicule”\
c. Penetrates intestinal wall of mosquito and forms a cyst wall Primary attacks :
w/c refers to “oocyst” - Includes febrile paroxysms ; depends / vary from species to species
d. Oocyst undergoes nuclear and cytoplasmic division, producing P. falciparum (2-3 weeks)
sporozoites (sporogony) P. vivax (3-8+ weeks)
e. Oocysts ruptures releasing sporozoites P.malariae (3-24 weeks)
P. ovale (2-3 weeks)
f. Sporozoites migrate in the salivary glands of the vector ready
for injection during a blood meal. - Even w/o treatment the individual will enter a phase of
asymptomatic; RBCs are cleared (does not constitute cure ): may
Man: intermediate host ; harbors asexual stage lead to relapse/ occurence
Mosquito: definitive host; harbors the sexual stage

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 Thick smear Thin smear
2 Types of relapse : Relapse Recrudescence
3 drops of blood; 1 cm away
Reappearance of symptoms from thin smear ; 1 cm 1 large drop of blood
Renewed symptoms arising from diameter- circular motion
after a period of w/c the
increase number of persisting
parasites have been absent Not fixed
blood stage forms to clinically
in blood; associated w/ P. (inorder to cause cell lysis of
detectable level; blood has not Fixed w/ methanol
vivax and P. ovale ( due to RBC to undergo
been cleared of parasites; (prevent cell lysis)
subsequent preerythrocytic dehemoglobinized/
associated w/ P. falciparum and
schizogony / activation of dehemoglobination)
probably P. malariae
hypnozoites)
Examined first at the center ; no Examined at the feathery
RBC, WBC & plates & parasites edge/tail; RBC,WBC,platelets and
Pernicious Malaria are seen parasites are seen
- Acute type of disease Must have examined 200-300
- Acute malaria/malignant malaria; associated w/ P. falciparum Must have examined 100 OIF
OIF
- Due to 4 factors: For Rapid detection For species identification
1. Hyperparasitemia
- Due to infection to RBC of all ages (associated w/ black water 2 Methods of staining:
fever –a syndrome of massive intravascular hemolysis w/c results a. Rapid staining : making use of GIEMSA at 10% concentration
hemoglobinuria ( urine becomes dark color/brownish due to Hgb) – (5-15 mins)
2. Cytoadherence b. Regular staining : makes use of 3% GIEMSA – (30-45 mins)
- Based of expression of parasite derived molecules on the surface
of infected red blood cells 3 major considerations/ criteria to examine for malarial parasites:
a. Appearance of infected rbc
Molecules - Size of parasitized cell
- strain specific: infected by P. falciparum only - Shape (P. ovale – jagged/fimbriated )
- Stage specific : expressed only when a parasite starts to divide - Stipplings
(stage prior to division); causes the RBC to become sticky, therefore - Plasmodium falciparum : Maurer’s dots (wedge shape)
causing agglutination: rbc will also adhere in the capillary - Plasmodium vivax : shuffner’s stipplings (small
endothelium – obstruction of capillaries—constriction of capillary – granules)
obstruction of blood flow – hypoxia or anoxia – necrosis - Plasmodium malariae: Zieman’s stipplings
- Plasmodium ovale: Jame’s stipplings
LABORATORY : b. Appearance of the parasite stage
-P. falciparum: only ring forms & gametocyte seen
1. Microscopic examination: c. Parasite stages found in the peripheral blood
Romanowsky- stained (thick and thin blood film by GIEMSA
stain) Fluorescence staining
- Makes use of fluorochromes( acridine orange,
I. Preparation of blood films obtained by capillary or venous benzothiocarboxypurine)
blood - Excited w/ UV light , w/c will give of fluorescence
- Capillary blood : most preferred sample; yields a # of
parasite, especially for P. falciparum
QBC microhematocrit centrifugation method
- Thick & thin blood films are prepared directly (quantitative buffy coat)
- Commercially available ; not exclusive for malarial parasite
II. Venous blood: - Test kits:
- Use of anticoagulant 1. Capillary tubes – coated w/ acridine orange
- NB: clotting may entrap the organisms (filled up w/ blood)
- Preferred anticoagulant is EDTA; prepared 1 h after 2. Caps – used as closures of capillary tube
collection, because it may cause morphological changes of 3. Plastic floats – for insertion into the capillary tube w/
the parasite if prolonged. blood.
- Acridine orange: stains the DNA of the nucleus
- Bright apple green-yellow color
- RNA cytoplasm will be stained yellow or orange in
color
- Provides rapid detection (not for identification)

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 (+) 3 lines
1st : control
2. Non – Microscopic tests
2nd: detects HRP-2
I. Immunodiagnosis 3rd: detects Plasmodium aldolase
- Detection of presence of antigen & antibody for
malarial parasite 4. ICT malarial P.f
Sample: serum
II. Molecular diagnosis
Rapid diagnostic tests (RDT) for malaria
- Based on detection of antigen - Includes gene amplification through the method
polymerase chain reaction(PCR)
- Immunochromatographic test ; releies on
immunochromatography ( on the migration of a fluid Mosquito vectors: found in the Philippines
on the surface of a nitrocellulose membrane ); makes - Night biters (6 pm – 6am)
use of adsorbent pad made up of nitrocellulose.
Primary : Anopheles flavirostris
Principle: based on capture of parasite antigen w/ labeled
monoclonal antibodies. Secondary:
- A. litoralis
Malarial Antigens:
- A. maculatus
a. HRP-2 (histidine – rich protein 2)
- A. mangyanus
- Water-soluble protein, that is formed only by P.
falciparum, only by asexual stage including gametocytes - A. balabacencis

Other modes of transmission :

b. PLDH (parasite lactate dehydrogenase) 1. Transfusion malaria : transfusion of contaminated blood
- Enzyme in the glycolytic pathway 2. Using contaminated needles and syringe
- Produced by all malarial parasite 3. Congenital malaria : passed from mother to the baby; it is
believe that the malarial infection is only passed when the
c. Plasmodium aldolase placenta is damaged.
- Enzyme in the glycolytic pathway
- Produced by all the malarial parasite ; also referred to Acquired from bite of Transfusion
as PMA (pan specific malarial antigen) Criteria
mosquito acquired
1. Parasight F test Any of the sexual
Infective stage Sporozoite
- Detects only the presence of HRP -2 stage
(+) P. falciparum Length of
- Disadvantage: does not detect other malarial parasite Longer Shorter
incubation
2. OptiMAL test
Occurrence of true
- Uses a dipstick ; detects HRP-2 & pLDH Present Absent
relapse
- Adv. Detects infection w/ P. vivax
- (+) 2 lines – P. vivax; 3 lines –P. falciparum; does not
distinguisd mix infection w/ other species Resistance to Malaria:
3. ICT malaria P.f/P.v - Resistance to P.vivax : in Fy(a-b-) west African and
- Uses a card format or a cassette format American blacks are resistant( bec. 90% duffy antigen
negative w/c serve as attachment sites for the parasite)
- Based on immunochromatography
- P. falciparum : a. found in sickle cell trait and sickle cell
- Detects HRP-2, Plasmodium aldolase anemia; eb. found in G-6PD deficiency
(presence of large percentage of Hgb)

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 Criteria Plasmodium falciparum Plasmodium vivax Plasmodium malariae Plasmodium ovale

Persistence of
erythrocytic No Yes No Yes
cycle

No, but long-term

Possible, but usually
Relapses No long-term relapses Yes recrudescence are
spontaneous recovery
recognized

Time of cycle 36-48 hours 44-48 hours 72 hours 48 hours

Appearance of 1 ½ larger than normal; oval 60% of cells larger than

parasitized to normal; maybe normal Normal shape, size may be normal and oval; 20%
Both normal
RBCs; size and size until ring fills ½ of the normal or slightly smaller have irregular,
shape cell frayed/ragged edges

Shuffner’s stipplings :
Inclusions Maurer’s dots : wedges usually present in all cells Zieman’s stipplings James’ stipplings
except early ring forms

Color of Normal; bluish tinge at

Decolorized, pale Normal Decolorized, pale
cytoplasm times

Multiple
Common Occasional Rare Occasional
rings/cells

Young ring forms and no Ring forms few , as ring

All developing
older stages; few stage brief; mostly growing
stages present in All stages present All stages present
gametocytes; rare mature and mature trophozoites
peripheral blood
schizonts and schizonts

Delicate, small ring w/

small chromatin
dot(frequently 2); scanty
Young
cytoplasm around small
trophozoite
vacuoles; sometimes at edge
(early ring
of RBC (applique form) or
forms)
filamentous slender form;
may have multiple rings in
cell
Ring often smaller than in P.
Ring is 1/3 diameter of cell; Ring is larger and more
vivax, occupying 1/8 of cell;
cytoplasmic circle around ameboid than P. vivax,
heavy chromatin dot,
vacuole; heavy chromatin otherwise similar in P.
vacuole at times “filled in”,
dot vivax
pigment forms early

Multishaped, irregular
ameboid parasite; streamers
Non-ameboid rounded/ Ring shape maintained
of cytoplasm close to large
Growing Heavy ring forms; fine band-shaped solid forms; until late in development;
chromatin dot; vacuole
trophozoite pigment grains chromatin may be hidden by non-ameboid compared to
retained until close to
coarse, dark brown pigment P.vivax
maturity; increasing
amounts of brown pigment

Vacuoles disappear early;

Not seen in peripheral
Mature blood(except in severe
infection); development of all
trophozoite
phases following ring form
occurs in capillaries of viscera
Irregular ameboid mass;
cytoplasm compact, oval, band
1/more small vacuoles retained Compact; vacuoles disappear;
shaped, or nearly round almost
until schizont stage; fills pigment dark brown, less
filling cell; chromatin may be
almost entire cell; fine, brown than in P. vivax
hidden by peripheral coarse,
pigment
dark brown pigment

Progressive chromatin division; Similar to P.vivax except

Schizont Not seen in peripheral blood cytoplasmic bands containing smaller; darker, larger pigment
Smaller and more compact
(presegmenter) than P. vivax
clumps of brown pigment granules peripheral or central

Merozoites, 16 (12-24) each w/

Not seen in peripheral blood;
Mature schizont in rare cases may be seen
8(6-12) merozoites in rosettes ¾ of cells occupied by 8 (8-
chromatin & cytoplasm, filling
entire RBC, w/c can hardly be
or irregular clusters filling 12) merozoites in rosette or
normal sized cells irregular clusters
seen

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 Criteria Plasmodium falciparum
Sex differentiation difficult,
“cresent or sausage” shapes
characteristic; may appear
Microgametocyte
in “showers”; black pigment
near chromatin dot, w/c is
often central
Microgametocyte Same as macrogametocyte
Development following ring
stage takes place in blood
vessels of internal organs;
delicate ring forms and
Main criteria cresent-shaped gametocytes
are only forms normally
seen in peripheral blood;
gametocytes appear after 7-
10 days
INTESTINAL COCCIDIA AND TISSUE COCCIDIA:
INTESTINAL COCCIDIA
• Isospora belli
• Cryptosporidium parvum
• Cyclospora cayetanensis
• Sarcocystis species
-Sarcocystis lindemanni
-Sarcocystic hominis
-Sarcocystis suihominis
General characteristics:
• Characterized by alternation of generation
• Can occur in either both on the same host / separate
• Monoxenous
-Isospora belii
-Cryptosporidium parvum
-Cyclospora cayetanensis
• Heteroxenous
SARCOSYTIC species
Mode of transmission : ingestion of infective stage
( All are intracellular in the enterocytes – intestinal epithelial cells )
Diagnostic stage: “Oocyst stage”
Compiled by: Frances Lictag Edited By: Saintclaus_eso 2114175
Plasmodium vivax Plasmodium malariae Plasmodium ovale
Rounded / oval
homogeneous cytoplasm;
Similar to P. vivax, but fewer
diffuse, delicate, light
in number, pigment darker Smaller than P. vivax
brown pigment throughout
and more coarse
parasite; eccentric compact
chromatin
Large pink to purple
Similar to P. vivax, but fewer
chromatin mass surrounds
in number, pigment darker Smaller than P. vivax
by pale or colorless halo;
and more coarse
evenly distributed pigment
Large, pale red blood cells;
RBC normal in size and
trophozoite irregular; RBC enlarged, oval w/
color; trophozoutes compact,
pigment usually present ; fimbriated edges;
stain usually intense, band
shuffner’s dots not always Shuffner’s dots seen in all
forms not always seen;
present; several phases of stages, gametocytes appear
coarse pigment, no stippling
growth seen in one smear; after 4 days or as late as
of RBC; gametocytes appear
gametocytes appear as early 18 days
after few weeks
as third day
Species Shape and size
Ellipsoidal oocyst, range 20-30 μm in
length, 10-19 μm width; sporocysts
Isospora belli rarely seen broken out of oocysts,
but measure 9-11 μm
Oocysts generally roud,4-6 μm, each
Cryptosporidium parvum mature oocyst containing 4
sporozoites
Oocysts generally round, 8-10μm,
oocysts are not mature , no visible
Cyclospora cayetanensis
intestinal structure; oocyts may
appear wrinkled
Sarcocystis hominis Oocyst thin-walled and contains 2
mature sporocysts, each containing 4
sporozoites, frequently, thin oocyst
wall ruptures; ovoidal sporocysts
each measure 10-16 μm in length &
Sarcosytis suihominis 7.5-12 μm in width
Sarcocystis lindemanni Vary considerably
PARASITOLOGY NOTES 2015 Page 22
 Intestinal coccidia
Isospora belli
Criteria
Classification Monoxenous
Life cycle 1. Acquired via ingestion of
mature oocyst
2. Mature oocyst referred to as
sporolated ; when reaching the
small intestine undergoes
excystation- release sporozoites sporozoites – sporozoites
3. Enters enterocytes &
initiates the process of
schizogony—merogony – leads membrane of the cell)
to rupture of cell
3. undergoes schizogony :
4. Merozoites are released w/c
can either become gametocytes
or enter another cell and
repeat the process
gametocytes – maturation
5. Gametocytes may continue t – syngamy – produces
syngamy – forms a zygote –
forms a wall, referred to as wall –oocyst or can enter
oocyst—passed out in feces
6. Immature oocyst is passed
out
Diagnostic stage
Immature oocysts
Laboratory 1. Examination of the feces
Diagnosis - Unsporolated oocysts
2. Fluorescent microscopy
- Autofluorescence
(Characteristic of the parasite;
no making use of dyes; emit a
bright blue –green color)
3. Modified kinyoun’s method
- Appears: pink to red color
- Background: green
Methods of identification:
1. DFS (wet mounts)
2. SCT
3. Permanent staining
“Isosporiasis”
Pathogenesis
Diarrhea in
immunocompromised person
Compiled by: Frances Lictag Edited By: Saintclaus_eso 2114175
Cryptosporidium Sarcocystis hominis / Sarcocystis
Cyclospora cayetanensis
parvum Sarcocystis suihominis lindemanni
Monoxenous Monoxenous Heteroxenous Heteroxenous
1. Acquired via ingestion 1. Aquired via ingestion of M a n:
of mature oocyst mature oocyst 1. Acquired via ingestion of the sarcocyst
present in contaminated beef or pork
2. Oocyst undergo 2. Encystation occurs NB: sarcocyst – a tissue cyst ; contain
excystation in the bradyzoites – one of the two forms of
intestine – releasing 3. Release sporozoite and trophozoites; slowly dividing trophozoites,
enter into enterocytes incased in a wall
enter enterocytes 2. On ingestion the sarcocysts ruptures
(extracytoplasmic- just 4. Schizogony happens; releasing bradizoites
beneath the cell followed by merogony – 3. Bradizoites become intracellular –
gametogony enterocytes
4. Undergo gametogony
5. Maturation into gametes 5. Maturation then followed by syngamy
produces merozoites 6. Produces a zygote w/c is enclosed w/ a
6. Syngamy—produces wall
4. merozoites can zygote then forms a wall 7. Immature oocyst w/ 1 sporoblast –
transform into divides into 2 sporoblast – forms a wall
7. Zygote turns into oocyst ; 8. 2 sporocysts results – undergoes
immature oocyst passed in sporogony—producing 4 sporozoites w/in
zygote—then forms a feces 1 sporocysts—8 sporozoites
9. Mature oocysts passed out in feces
another cell 8. Develop 2 sporoblast;
5. Oocyst : Thick –walled develops further to become IntermedIa te host
oocyst (80% of oocyst); 2 sporocysts 1. Acquired via ingestion of sporolated
thin-walled oocyst oocysts (mature oocyst)
(20% of the oocyst) 9. Sporocysts undergo 2. Enters intestine and ruptures
sporogony outside the host 3. Sporozoites released penetrating the
6. Followed by sporogony intestinal mucosa and enter the blood
7. 20% (thin walled) can 10. Mature oocyst: 2 4. Carried into the endothelium –
rupture its oocyst while sporoblast; 2 sperozoites/ sporozoites transform into schizonts
still w/in the host then sporocysts—ingested – 5. Schizonts undergo schizogony ; then
releases sporozoites results to infection merogony—producing merozoites:
(autoinfection) released from the endothelium
6. Can either become bradizoites – form a
8. The 80% thick-walled wall and become encysted—sarcocysts or
are passed out in the can enter cells and repeat the cycle.
feces – mature oocysts
Sarcocysts –
Mature oocysts Immature oocysts Mature oocysts dead-end
infection
1. Demonstration of parasite-
1. Demonstration of parasite
immature oocyst
a. Direct fecal smear – mature oocyst
1. Direct fecal b. SCT
2. Fluorescent microscopy
demonstration c. Fluorescence microscopy
- Autofluorescence
- Autofluorescence
d. Modified acid fast staining : kinyoun’s
3. Modified acid fast
method
Water-borne parasite; “Cyclosporiasis / A non human
causes “Gay bowel cyclosporidiosis” sarcocystis, causing
Diarrhea incidental infection
syndrome” ; - Once referred to as - Dead end
“Pulmonary sporidiosis” “cyanbacterium like body” infectiom
Causes diarrhea in both immnunocompromised and
Diarrhea in immunocompromised person
immunocompetent individuals
PARASITOLOGY NOTES 2015 Page 23
 TISSUE COCCIDIA
Toxoplasma gondii
Congenital Toxoplasmosis:
-Either monoxenous/ heteroxenous
- manifestations: associated w/ still birth or birth defects w/c
-Monoxenous in its natural habitat include
( Natural host : cats of Family Felidae ) 1. Retinochoroiditis
Life Cycle : 2. Cerebral calcification
In animal host 3. Hydrocephalus or microencephali
a. Passed out in feces of cats, as immature oocyst (ovoidal in
shape; 10-12 μm in diameter; contains a single sporoblast w/c Laboratory Diagnosis:
divides into 2 sporoblast) 1. Demonstration of parasite
b. Forms a wall produsing 2 sporocysts ; then develops 4 - tissue aspirate : tachyzoites
sporozoites on each - biopsy samples : zoitocyst
c. Mature oocysts contains 8 sporozoites (sporulated oocyst- 2. Serological test
infective stage) - detection of Antibodies
d. Undergoes schizogony – merogony – gametogony then - Sabin- Feldman Dye test
syngamy
e. Zygote becomes an oocyst then passed out in feces • Based on detection of Ab from Pt. serum by reacting it
w/ live toxoplasma org. in a presence of dye (methylene
In man blue)
a. Heteroxenous : intermediate in other animals and in man • Based on the refractoriness of toxoplasma org. to the
; definitive for cats methylene blue dye in the presence of specific
b. Acquired via ingestion of mature oocyst w/c is shed in antibodies
cat feces • (+) no stain
c. Oocyst wall ruptures releasing sporozoites; • (--) stained in blue color
d. Sporozoites penetrate intestinal mucosa to reach blood
circulation; then carried into different tissues and organs
e. Sporozoites transform into “tachyzoites”(fast dividing: 4-
8 x2-3 μm; cresent shape; one end tapered and rounded at
one end w/ a single nucleus; seen in the early stages of the
disease)
f. Multiplies by binary fission w/c is “endodyogeny”- cell
membrane is formed first before nuclear division
g. Overtime tachyzoites transform into bradyzoites (seen on
the latter stages of the disease)
h. Bradyzoites forms a wall becoming a “zoitocyst”(found in
skeletal muscles, myocardium and also in the brain, eyes
particularly in the retina of the eye)—causes dead-end
infection

Pathogenesis :
“Toxoplasmosis ”
- In man :majority 90% asymptomatic, especially in
immunocompetent
- s/s in immunocompromised person:
starts with non-specific flu-like (fever, myalgia,
lymphadenopathy, pneumonia, encephalomyelitis,
myocarditis, and retinochoroiditis – leads to
blindness

Other Modes of Transmission:

- ingestion of tissue cysts in meat of other animals (zoitocyst)
- Person- to- person :
a. Blood transfusion : tachyzoites
b. Organ transplantation: zoitocyst
c. From mother to fetus: acute stage – tachyzoites
(congenital toxoplasmosis)

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 HELMINTHS Alimentary system
General Life Cycle:
1. Egg
- Undergoes embryonation
2. Larva
- Goes through 4 stages of development
Excretory system
Stages Symbol Other name
hickenings of subcutaneous tissues
1st stage L1s Rhabditiform
Nervous system
2nd stage L2s Filariform

3rd stage L3s Filariform

4th stage L4s Filariform Reproductive system

Male Female
- In between stages, “Molting occurs” • Testes • Uterus becomes coiled, full
- Molting – shedding of the outermost covering of body • Seminal vesicle ova/ larvae filling body
wall (cuticle) • Spicule cavity
• Papillae: pre-anal and post- • Seminal receptacle
3. Adult
anal,sometimes present • Oviduct
Helminthology – study of worms (basis for species • Ovary (usually paired)
Two phyla : identification) • Vulva and vagina ;
a. Phylum Nematoda “Round worms”
Nb. May have copulatory bursa
Class Secernencia (phasmidia)
b. Phylum Platyhelminthes “Flat worms”
Class Adenophorea - Aphasmidia
- Trichuris trichiura
- Capillaria philippinensis
Phylum Nematoda - Capillaria hepatica
- Termed as “round worms” / “nematodes” - Trichinella spiralis
- Possess stiff cuticle; sexes are separate (males are generally smaller Class Secernencia – Phasmidia
than females); well-developed digestive system. - Ascaris lumbricoides
- Unsegmented - Enterobius vermicularis
- Reproduction: oviparous & larviparous - Hookworm species :
- Infection by : Necator americanus
Ingestion of eggs Ancylostoma duodenale
Penetration of larvae through surfaces Ancylostoma caninum
Arthropod vectors Ancylostoma braziliense
Ingestion of encysted larvae - Strongyloides stercoralis
- Toxocara species:
General morphology:
- Elongate, cylindrical worms, frequently attenuated at both ends. Toxocara canis
- Possess mouth, esophagus and anus (important in further Toxocara cati
diagnosis) - Filaria species:
Cuticle Wuchereria bancrofti
- Non nucleated; generally smooth;
Brugia malayi
- May have: sensory papillae; bosses; spines or tubercle.
Onchocerca volvulus
Mouth
- Subcuticular muscle Loa loa
- With somatic muscular bands in four groups Mansonella perstans
Mansonella streptocerca
Mansonella ozzardi
Dracunculus medinensis

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 Class
Adenophorea Trichuris trichiura
CRITERIA
Other name “Whip-worms”
Description
Oviparous
Cosmopolitan
(common in the tropics & subtropics)
Adult stage Male : 30-45 mm
Female: 35-50 mm
Anterior 3/5 : attenuated whip-like 3/5
traversed by a narrow esophagus resembling Male : 1.5-3.9mm x 23-28 μm
string of beads.
Posterior: more robust , 2/5 containing the Female :2.3-5.3mm x 29-47μm
intestine and a single set of reproductive ( 2- 5 mm in length)
organs.
Male – coiled posterior
Female – bluntly rounded end
Egg stage / Size: 50-54 μ x 23 μ
larva “Lemon-shaped”/“Barrel-shaped”/
Japanese lantern” ; with hyaline plugs /
pluglike translucent polar prominence;
yellowish outer shell and translucent
inner shell.
Life cycle a. Acquired through ingestion of
embryonated egg (l1s) ,w/c contains
larva (l1s- rhabditiform)
b. Enters intestines, egg hatches ,
releasing the larva, then penetrates an
intestinal villi- undergoes molting
c. Stays in the villi 3-10 days, then
returns back to the lumen and migrate
into the cecum (maturation to
adulthood)
d. Adult becomes embedded in the
intestinal mucosa – copulation – sheds
eggs
e. Unembryonated eggs shed in feces-
causes ”soil-transmitted helminthiasis”
Pathogenesis “Trichuriasis”
Light infections: generally
asymptomatic
Heavy infections: gastrointestinal
symptoms, diarrhea etc.
NB: 1 adult trichuria may cause blood
loss of 0.005mm/day – microcytic type
of anemia
– extrusion of rectal
mucosa (loss of muscle tone of rectum
Diagnosis 1. Demonstration of parasite
a. DFS
b. Concentration techniques
c. KTS
d. Kato Katz – utilizes premeasured
volume of sample (quantitative)
Compiled by: Frances Lictag Edited By: Saintclaus_eso 2114175
Capillaria philippinensis
“Pudoc worm”
Typical female: oviparous (1 row of
eggs : 8-10 eggs)
Atypical female: larviparous(2-3 rows
of eggs: 40-45 eggs)
Common in :
Philippines , Thailand , Korea, Japan,
Taiwan, Iran, Egypt, Italy and Spain
Size: 20 x 40 μ
“Peanut- shaped” w/ flattened bipolar
plugs; moderately thick-shelled; has
striations; shows straw color.
a. Parasites of fish eating birds –
transmitted (fish-bird cycle)
b. Acquired via ingestion of larva in
fish
c. Larva reaches the small intestine
d. Matures, populate ; female lays
unembryonated eggs- passed in feces ;
embryonated eggs hatches and infects
man
“Pudoc disease” or “Mystery disease”
s/s gastrointestinal symptoms
- Borborygmus (gurgling of stomach)
- Intestinal malabsorption
1. Demonstration of parasite
a. DFS
b. Concentration techniques
c. KTS
Capillaria hepatica
“Capillary liver worm”
Larviparous
Parasite of animals such as rats, other
rodents, and dogs
Resembles Trichuris trichiura
Size: 51-68 μ x 30-35 μ
“Lemon-shaped” ; outer shells are
pitted like a golf ball w/ minute pores
Life cycle in animals
a. Acquired via ingestion of
embryonated egg
b. Hatches in small intestines,
releasing larva
c. Larva enters the portal circulation
to the liver; matures inside the liver
d. Lays eggs- unembryonated egg
(ingested by another host)
e. Passes through the stomach, and
passed out in feces w/o morphological
changes causing spurious infection
Life cycle in man
a. Acquired via ingestion of
embryonated eggs
b. Enters small intestine , hatches,
releasing larva
c. Larva enters the hepatic circulation
to the liver –matures
d. Causes dead-end infection
“ Hepatic capillariasis”
- Develops acute hepatitis
- Eosinophilia
1. Demonstration of parasite
a. liver biopsy
PARASITOLOGY NOTES 2015
Trichinella spiralis
“Trichina worm”
larviparous
“Autoheteroxenous parasite”
Male: 1.5x 0.04 mm
Female : 3.5 mm x 0.06 mm
Anterior end: slender, w/ a small
orbicular nonpapillated mouth
Posterior end: bluntly rounded in the
female and ventrally curved w/ two
lobular caudal appendages in male.
Larva :
Size:
90 x 100 μ
Maintained in nature among animals:
swine, rats and other rodents
a. Acquired via ingestion of encysted
larva in pork
b. Larva is released; then developed
into adult female/male
c. Copulation follows
NB. Male dies after copulation
d. Female penetrated into intestinal
mucosa and produce larva
e. Larva enters Blood circulation or
lymph
f. Localizes in skeletal muscles
g. Causes dead-end infection
“Trichinellasis” / “Trichinosis” /
“trichiniasis”
3 stages:
1st : intestinal invasion –
gastrointestinal symptoms
2nd : larval migration
3rd: stage of convalescence – fibrosis ,
degeneration and calcification
1. demonstration of parasite
a. muscle biopsy (encysted larvae)
b. xenodiagnoses (using albino rats fed
w/ infected muscles obtained from
patient w/ infection
2. Bachman intradermal test (a skin
test; Ag is prepared from the larva)
(+) blanched wheal 5mm or >
diameter surrounded by an area of
erythema
3. serological test:
a. bentonite flocculation
b. latex agglutination
other laboratory findings:
- Increased CPK and LDH
- Increased myokinase
- Related through the destruction of
muscles
Page 26

CRITERIA Ascaris lumbricoides
Other Name
“Giant intestinal round worm”
- Said to be “largest intestinal nematode”
Adult Male: 150-200 x 2-4 mm
Female: 200-350 x 4-6 mm
Smooth cuticle, unstriated ,
nonsegmented.
- Trilobite lips
Egg a. Fertilized : 60x 45 μm
Broadly ovoid; golden brown in color;
unembryonated at oviposition.
Thick-shelled
Inner: non-permeable , lipoidal vitelline
membrane
Middle: thick, transparent, glycogen
membrane
Outer: coarsely mammilated, albuminous
layer
b. Unfertilized : 88-94 x 39-44 μm
Longer and narrower than fertilized egg;
completely filled with disorganized, highly
retractile granules
Thinner shell and irregular mammilated,
albuminous layer
Epidemiology Cosmopolitan
Life cycle a. acquired via ingestion of embryonated
egg (L2s)
b. enters small intestine and hatches,
releasing larva (L2s- filaria form)
c. penetrates intestinal mucosa – enters
portal circulation- liver
d. from liver to the heart; then enters the
lungs (undergoes molting : L3s-L4s)
e. ascends to the alveolar tree
f. esophagus to small intestine (development
to adult stage)
MT: 2 months
LS: 10-12 months
g. lays eggs and then passed into the feces
as unembryonated egg
h. into the soil – becomes embryonated
after 1-2 weeks
i. causes soil-transmitted parasite
Pathogenesis “Ascariasis”
Light infections: asymptomatic
Manifestations may be due to :
1. Migrating larvae
- causes pneumonitis
- eosinophilia associated w/ Loeffler’s
syndrome (transient eosinophilic
infiltration of the lungs)
2. Development of adult worms
Gastrointestinal symptoms; decreased growth - to appendix causing appendicitis
rate; intestinal obstruction (can be entangled - may cause vaginitis
forming ascaris bolus blocking intestinal
bowel); downstream wandering ( can enter uterus, ovaries etc)
appendix causing appendicitis) or can cause
upstream wandering
Diagnosis Demonstration of parasite
1. DFS
2. Stool con’c techniques
3. KTS
4. Kato-katz
5. Sputum sample : larvae
x-ray examination ( bolus)
Compiled by: Frances Lictag Edited By: Saintclaus_eso 2114175
CLASS SECERNENTEA
Enterobius vermicularis
“Pin worm” / “seatworm”
Old name: “Oxyuris vermicularis”
Male: 2-5 x 0.1 mm
Female : 8-13 x 0.3- 0.5 mm
Distinctive feature:
- Cephalic alae
- Esophageal bulb
Size: 50-60 x20-30 μm
- Thick-walled ; colorless shell;
- shell flattened on one side
- coiled larva developing in egg
- “D-shape”
- embryonated
Cosmopolitan
a. acquired via ingestion of
embryonated egg
b. egg hatches and releases larva in
small intestine
c. matures into adult in the cecum
(MT: 3-4 weeks; LS: 1-2 months)
d. copulation occurs; female crawls
out through the anus (night time)
e. eggs embryonate (4-6 hours)
immediately after release
f. autoinfection
“Enterobiasis” / “Oxyuriasis”
due to female adult
- migration of the gravid females from
the cecum to the anus, causes intense
itching in the anal region referred to as
“Pruritus ani”
- insomnia
- scratching of anal area
Due to wandering female adult
- to peritoneum causing peritonitis
- endometritis, salphingitis (infects
Demonstration of parasite:
1. perianal swab : Graham’s scotch
tape method (adult female)
2. beneath the nail bed swabs
PARASITOLOGY NOTES 2015
Toxocara canis Toxocara cati
“Dog ascaria” / “ dog “Cat ascaria” / “ cat round
round worm” worm”
“ Visceral larva migrans” / “Ocular larva migrans ”
Similar to Ascaris lumbricoides in appearance but
only a quarter to half its size.
NB. Toxocara : body is bent ventrally
Size: 85 x75 μ Size: 65-70 μ in
Superficially pitted diameter
Resemble those of Ascaris, but are larger, less
elongate and have thinner shell and albuminoid
outer covering.
Same as Ascaris lumbricoides
Animal:
a. ingestion of embryonated egg
b. egg hatches in the small intestine; then larva
released penetrates the heart and lungs--- esophagus
– maturation occurs in the intestine
c. unembryonated egg is then passed out
d. embryonization occurs in the soil
Man:
a. ingestion of embryonated egg
b. egg hatches releasing larva, enters the blood
circulation
c. larva is then carried into the visceral organs of the
body, wherein they remain as larva stage, thus termed
“visveral larva migrans”
d. can infect eyes – “ocular larva migrans”
“ Visceral larva migrans” – infection of visceral
organs
“Ocular larva migrans” – eye infection
- eosinophilia
- concentration techniques
- serology: Ab detection – ELISA on serum
Page 27
 HOOKWORM SPECIES
Criteria Necator americanus Ancylostoma duodenale Ancylostoma caninum Ancylostoma braziliense
Other
“New world hookworm” “Old world hookworm” “Dog hookworm” “Cat hookworm”
name
Adult Resembles ancylostoma but
smaller; head is sharply bent
in relation to the rest of the Adult worm: grayish white / pinkish; head is slightly bent
body, forming a definite hook Male : 1 cm x 0.5mm
shape at the anterior end Female: somewhat longer and stouter
Male: 5-9 mm long
Female: 1cm long
Egg Size: 64-76 μm x 36-40 μm
Unsegmented; 4-8 egg stage
Identical to Necator Somewhat smaller compared to Necator eggs
Shell is thin and colorless
Regularly oval
Buccal A pair of semilunar cutting
Two ventral pairs of fused Two ventral pairs of unfused
capsule plates Three ventral pairs of teeth
teeth teeth
Median teeth
Copulatory Longer than broad Short and broad Large, flame-shaped As broad as long
bursa Dorsal rays- deep cleft and Dorsal rays – shallow cleft Rays – long and slender Rays – stunted
tips bipartite and tips tripartite
Two spicules – fused and Two spicules – unfused and
barbed not barbed
Pathogenesis “Necatoriasis”
a. Larval penetration

Produces dermatitis lesion on

the skin; also referred to as “
ground itch”/ “dew itch” /
“coolie itch”
Includes :
b. Larval migration
Nausea and vomiting Forms spergininous tunnels through the tissues—erythematous
Pharyngeal irritation “Creeping eruptions” thus, referred to as “Cutaneous larva
Results to pneumonitis;
Cough migrans”
transient eosinophilia –
Dyspnea
Loeffler’s syndrome
Hoarseness of voice - Nonhuman hookworm infections
c. Adult worms
“Wakana syndrome” – from
ingestion of larva
Generally asymptomatic;
usually coincidental
(heavy infxn: anemia –
microcytic hypochromic type
N. americanus causes blood
loss about 0.03ml (0.15-0.25
ml/day
Hypoalbuminemia
Life Cycle a. Acquired via skin penetration of filariform larva (L3s)
b. Larva enters the blood circulation, then the other parts of the body
c. To the heart; undergoes molting, then proceeds to the alveolar spaces, ascending to the upper respiratory tract
d. To the esophagus – to the pharynx (maturation 6-8 weeks ; LS: 4 years; Ancylostoma duodenale: 1 year)
e. Adult lays eggs (unembryonated)--- passed out in feces – soil ---embryonization (7-8 days)
f. Cycle begins again
Diagnosis Demonstration of parasite:
a. DFS
b. SCT
c. KTS
d. Kato-katz method
e. Caproculture: culture of feces (harada-mori technique – larvae; filter paper test tube method)

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 Strongyloides stercoralis b. Isolated by SCT
- Host specific - Facultative parasite c. Caproculture technique
- Baermann Technique: a culture technique, w/c uses a funnel
Parasitic existence Free-living existence apparatus/method
- A fresh stool is placed in a wire mesh, then wrapped w/ cloth (several
Only female adult ; no male layer of the gauze / cloth)
Parthenogenic female: able to
Both male and female - Placed in a container w/ water w/ the funnel, the rhabditiform will
produce a row of offspring w/o pass through the wire gauze
the fertilization of the male.
- From gastroendoscopy
3 Types of Life Cycle: - Enterotest

Direct life cycle / Indirect life cycle / Autoinfection FILARIA SPECIES :

Homogonic life cycle Heterogenic life cycle
- Belongs to class Secernentea - Blood and tissue nematodes
a. Similar to hookworm a. Free living a. Occurs in the - Thread-like nematodes - Long nematodes
spp. existence found in intestines Species include :
b. Acquired via skin the soil b. Rhabditiforrm - Wuchereria bancrofti - Brugia malayi
penetration of filariform b. Rhabditiform larva becomes filariform - Onchocerca volvulus - Loa loa
larva develops as adult larva - Mansonella perstans - Mansonella streptocerca
c. Enters the blood c. Copulation occurs c. Filariform larva
circulation --- then production on the perianal - Mansonella ozzardi
d. To the heart – the of eggs region; develops
lungs—L3s undergoes d. 2-4 egg cell stages; into FL and PPATHOGENIC Common Name Normal habitat Vector hosts
molting to L4s embryonates to form penetrates the Wuchereria Mosquitoes of diff.
e. Ascends to the rhabditiform larva skin bancrofti Genera:
bronchial tree—to the e. Cycle repeats d. Cycle repeats Bancroft’s filaria Lymphatics 1 Anopheles
esophagus—then to the 2 Culex
small intestine Infective stage: 3 Aedes
f. Penetration in the 5-7 days
mucosa—deposits eggs in Lifespan: Brugia malayi Brugian filaria
Mosquitoes of diff.
the intestinal mucosa undertermined Lymphatics species of Genus
Malayan filaria
(happens about 2-4 Mansonia
weeks); releases L1s or Onchocerca Subcutaneous Flies: Simulium
rhabditiform larva volvulus tissues (dev’t in damnosum w/c
g. Migrates back to the Convoluted filaria
fixed nodules) referred to as the
intestinal lumen and Blinding worm
Does not enter “Black-fly” or
passed out of feces—as blood circulation “Buffalo gnat”
rhabditiform larva.
h. Reaches the soil and Loa loa Flies of
and become filariform “Chrysops”
Eye worm Subcutaneous
referred to as
Pathogenesis: African eyeworm tissues
“Mango fly” or
“ Strongyloidosis”/ “Strongyloidiasis”/ “Strongyliasis” “deer fly”
Signs and Symptoms
1. Larval penetration: LESS PATHOGENIC
Skin: dermatitis – “Ground itch”/ “Dew itch”/ “Cooley itch” Mansonella
2. Larval migration None Mesenteries
perstans
- May produce pneumonitis
Dermis,
- Eosinophilia Old name: Culicoides
Mansonella subcutaneous
streptocerca Streptocerca (does not enter
referred to as the
- Loeffler’s syndrome streptocerca “Biting midges”
blood stream)
3. Development of adult worm
a. Light infection : generally asymptomatic Mansonella None Subcutaneous
ozzardi
b. Heavy infection: mucoid diarrhea
“ Cochin-china diarrhea LIFE CYCLE:
NB. - In immunocompromised individuals: results in hyperinfection 1. Acquired through bite of vector; after blood meal microfilariae inside
(deminated strongyloidiasis) vector transforms from L1s to L2s into the thoracic cavity
Laboratory Diagnosis: 2. L2s develops into L3s w/c migrates into the vector head and proboscis
of the vector
1. Demonstration of parasite - Stool sample ( DFS )
3. During blood meal, the filariform will be injected into the host
2 Morphologic larva 4. Microfilaria enters the blood stream ready to be peaked up by a
- Short buccal cavity (as long as wide) vector from a blood meal
- Genital primordium (cluster stage) : described as 5. Filariform enters the preferred habitat; then matures to become an
conspicuous, large/long adult worm (diff. sexes) – female lays microfilaria

Compiled by: Frances Lictag Edited By: Saintclaus_eso 2114175 PARASITOLOGY NOTES 2015 Page 29
 FILARIA SPECIES
Wuchereria Onchocerca Mansonella Mansonella Mansonella
CRITERIA
bancrofti Brugia malayi Loa loa volvolus perstans ozzardi streptocerca
Habitat Lymphatic Lymphatic Subcutaneous Subcutaneous Mesenteries Subcutaneous Subcutaneous
tissues tissues (develop tissues tissues( does not
in fixed nodules enter blood
) – does not stream)
enter blood
stream
Size Thick filariae Thick filariae Thick filariae Thick filariae Thin filariae Thin filariae Thin filariae
(width
compared to
rbc)
Sheath Yes Yes Yes none none none none
Giemsa stain Unstained Stained Unstained none none none none
Hematoxylin Stained unstained Stained none none none none
Cephalic Short (as long Long(longer Short(as long as long short Slightly longer short
space as broad) than broad) broad) than broad
Nuclei Discrete; Compact; compact Moderately compact Compact Start in the
regularly spaced overlapping, compact anterior as
in 2-3 rows irregularly single row of 10-
spaced 20/more nuclei
Tail Tapered w/ Tapered w/ 2 Tapered and Tapered Bluntly rounded; Long and Bluntly, rounded
single row of conspicuous coiled w/in the typically flexed, nuclei extend to slender; devoid , bent in
nuclei; no nuclei terminal nuclei sheath; nuclei free from nuclei the tip of nuclei shepherd’s crook
in tip are irregularly shape; nuclei
spaced to the tip almost to tip
Distribution Tropics and Southeast Asia, West & Central Africa, South & Africa, South South and West and
subtropics Indian America Central America and Central Central America, Central Africa
subcontinents America Caribbean
Philippines Camarines Sur, Palawan, Eastern none none none none none
Camarines Samar , Agusan,
Norte, Albay, Sulu
Sorsogon,
Masbate,
Palawan,Mt.
Province,
Quezon ,
Mindoro,
Romblon,
Marinduque,
Bohol, Samar,
Leyte, Mindanao
Province
Rhythmical Nocturnally Nocturnally Diurnally None Aperiodic ( no Aperiodic ( no None
appearance/ periodic periodic periodic rhythm or rhythm or
occurrence (mf is found in 10pm – 2am (found at day pattern in blood; pattern in blood;
on PB either at day Nocturnally time) found anytime) found anytime)
peripheral time/ the night subperiodic
blood time) (peak con’c is at
night)

Compiled by: Frances Lictag Edited By: Saintclaus_eso 2114175 PARASITOLOGY NOTES 2015 Page 30
 FILARIA SPECIES

CRITERIA
Wuchereria Brugia malayi Loa loa Onchocerca Mansonella Mansonella Mansonella
bancrofti volvolus perstans ozzardi streptocerca
Pathogenesis Bancrofts/ Malayan/ “Loaiasis” “Onchocercomata” Calabar-like Asymptomatic Characterized by
bancroftian Brugian filariasis “calabar – a lesion on the swellings, infection: but pruritic
filariasis (upper swelling” – skin; nodular and pruritus, hives, inguinal dermatitis w/
(lower extremities) erythematous erythematous fever and adenopathy, hypopigmented
extremities) swelling in the lesion on the skin headache; pruritic and macules and
Chyluria (milky skin about 5- w/c is 1-5 cm in “kampala or maculopapular inguinal
urine) 10cm in diameter. Uganda eye skin lesions , adenopathy
diameter (also “Ocular worm” arthritis , fever
known as involvement”- and eosinophilia
Fugitive associated w/ has been
swelling) blindness – reported.
Migrates to the “blinding
eyes – filariasis” or river
“Eyeworm”/ blindness
African
eyeworm

LABORATORY DIAGNOSIS: 2. Demonstration of Microfilariae in “skin nips”

1. DEMONSTRATION OF MICROFILARIAE
A. Microscopic examination of capillary blood
I. Wet blood film :
Easy to perform (a drop/2 on a slide + 3%
HAC); a temporary mount
NB: 3% HAC is a diluent and lyses the RBC
II. Microhematocrit tube method
- Capillet filled ¾ of blood then centrifuge;
placed on a slide – secured at both ends
- Examine under LPO of microscope (buffy
coat: parasite that is motile is emerging
from the buffy coat going into the plasma)
III. Stained thick blood film
IV. QBC method (quantitative buffy coat)
- Associated w/ O.volvolus and M. streptocerca
- Materials: sterile needle & scalpel / razor blade
3 Sites of Collection:
a. buttock area
b. calf of legs
c. back shoulder/ shoulder blades
3. Mazzoti test
- A presumptive test done if no skin snips reveal no
microfilariae
- Oral administration of a single dose of 50 mg
DEC, w/c generally provokes intense pruritus w/in
few hours due to dying of the microfilariae
- (+) O. volvulus

B. Microscopic examination of venous blood - Commonly called :

(provides larger volume of blood) “Guinea worm”/
I. Knott’s concentration method “Serpent worm”/
“Dragon worm”/
- 10 ml of 2% formalin placed in a “Medina worm” /
centrifuge tube + 1ml of citrated blood “Fiery serpent of Israelites”
- Mix ; stand for 5 minutes; centrifuge then
decant supernatant
Size Description
- Examine sediment on a slide w/ cover slip
Adult male 12-29 x 0.4 mm “catgut thread”
II. Membrane filtration technique Adult female 500-1200x 0.9 -1.7 mm Viviparous
- Also termed “Millipore membrane technique or Coiled; rounded
nucleopore membrane technique Larva 500-700 x 15-25 μm anterior end; tapering
- Set-up: & pointed tail
Membrane filter ( 25mm in diameter; 3-5 μm
porosity-dimension of the porosity)
Membrane filter holder ( swinnex type)
Syringe (attached to the membrane filter
holder; 20ml capacity)

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 Life Cycle : PHYLUM PLATYHELMINTHES

a. Arthropod- borne ; 2 host: man and a non-blood Class Cestoda

sucking but aquatic arthropod referred to as the
“Copepods” of genus Cyclops (small crustaceans) - Diphyllobothrium latum

b. Acquired via ingestion of water containing copepods

infected w/ L3s (filariform)
- Taenia solium
- Taenia saginata
c. Larva penetrates the intestinal wall, migrate into the
- Hymenolepis nana
abdominal cavity and retroperitoneal cavity ; about a year
of onset- development into adulthood occurs - Hymenolepis diminuta
- Dipylidium caninum
d. Copulation takes place ; male dies soon after - Echinococcus granulosus
copulation
Class Trematoda
e. Adult female migrates to subcutaneous 1. Liver flukes
(causes irritation) - Fasciola hepatica
- Clonorchis sinensis
f. Migration results to blister formation ( filled w/ fluid - Opistorchis felineus
then, can rupture and part of the female adult worm will - Dicrocoelium dendriticum
be exposed. Parasite is released in the water – taken up 2. Intestinal flukes
by another copepod - Fasciolopsis buski
Pathogenesis: - Echinostoma ilocanum
- Heterophyes heterophyes
“ Dracunculiasis / Dracunculosis / Dracontiasis ” - Metagonimus yokogawai
3. Lung flukes
Clinical manifestation:
- Paragonimus westermani
1. Toxic and allergic manifestations(lower extremities) 4. Blood flukes
2. Blister on the skin - Schistosoma japonicum
- Schistosoma mansoni
Laboratory Diagnosis: - Schistosoma haematobium
1. Demonstration of the parasite
- From the skin ulcer/blister (adult female worm) GENERAL CHARACTERISTICS:
- Larvae in fluid from ulcer
- Bilaterally symmetrical
2. X-ray examination
- Compressed dorso-ventrally (flat)
Epidemiology - Collectively termed as “flat worms”
- They are Acoelomate (lack body cavity)
- Geographic distribution : NWC America,SW Asia, NE America, - Organs are embedded in the parenchyma
W India
CLASS CESTODA :
Factors that favor the infection:
- Termed as “ Tapeworms”
- Distribution of the vectors - Gross morphology: elongated ; ribbon-like, segmented ;
- Drinking from the step wells monoecious –no separate sexes

• Order Pseudophyllidea
- Diphyllobothrium latum

• Order Cyclophyllidea
- Taenia solium
- Taenia saginata
- Hymenolepis nana
- Hymenolepis diminuta
- Dipylidium caninum
- Echinococcus granulosus

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 DIVISIONS: TWO TYPES OF PROGLOTTIDS
a. Scolex : anterior end of the body; a muscular organ which is
described as the “hold fast” or the attachment organ. Apolytic Anapolytic
2 types Detaches the main body of the Refers to the proglottids that
Bothriate worm to release eggs (apolysis) detach the body of worm only
- Spindle shape or spatulate or spoon- after exhausting the eggs
shaped Characteristic of Cyclophyllidea Characteristic of
- Has sucking grooves w/c is referred to as Pseudophyllidea
“Bothria/ bothrium”
- One on the mid ventral and one on the
middorsal Other characteristic:
- Ex: members of Order Pseudophyllidea - No digestive system : obtains nutrition through the
Acetabulate integument
- Quadrate scolex - Integument : counterpart of cuticle; w/ microvilli referred
to as “Microtriches”
- Has muscular suckers termed
as“Acetabula” - No vascular system
- Ex: members of Order Cyclophyllidea - Nervous and excretory system present
- Rostellum : a projection at the apex of the
scolex; it may bear hooks or spine - Reproductive system:
Male: lies posterior in the dorsal region of each
b. Neck segment
- Found behind the scolex Female: anteriorly on the ventral region of each
- Unsegmented ; narrowest part; region of segment
growth Genital pore: where the female and male
- NB: the strobili proliferates from the neck reproductive system meets; also used as an
identification marker for adult worms
c. Strobila
- Consists of series of segments
(referred to as proglottids)

Regions of strobila Description

Immature Follows the neck region; reproductive
organs are not fully developed
Mature Each mature segment has at least 1
set of reproductive system. (D. latum
: 2 sets)
Gravid Filled w/ eggs and other reproductive
organs have atrophied; uterus still
remain

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 Order Order Cyclophyllidea
Pseudophyllidea
CRITERIA
Diphyllobotrium Taenia saginata Taenia solium Hymenolepis Hymenolepis Dipylidium Echinococcus
latum nana diminuta caninum granulosus
Common Fish tapeworm /
name/ other broad tapeworm Hydatid
Beef tapeworm Pork tapeworm Dwarf tapeworm Rat tapeworm Dog tapeworm
name / broad fish tapeworm
tapeworm
Common One; various
One; various One; various
intermediate Two; copepods arthropods
One; cattle One; pig arthropods arthropods One; sheep
host and fish (beetles, fleas)
(beetles, fleas) (fleas, dog lice)
or none
Definitive Cats & dogs
Man Man Man Man Man Man
host (man)
Mode of Ingestion of
transmission cysticercoid in
Ingestion of
Ingestion of infected Ingestion of
plerocercoid Ingestion of Ingestion of
cysticercus in arthropod or by cysticercoid in
(sparganum) in cysticercus in cysticercoid in Ingestion of eggs
infected direct ingestion infected
flesh of infected infected beef fleas, lice
Pork of egg; arthropod
fish
autoinfection
may occur
Prepatent
3-5 weeks 10-12 weeks 5-12 weeks 2-3 weeks -3 weeks 3-4 weeks 5 months or so
period
Normal life Perhaps many
span Up to 25 years Up to 25 years Up to 25 years years as a result Usually < 1 year Usually < year 10 or > years
of autoinfection
Egg stage Operculated
(immature/unem
bryonated) : Non – Non – Non – Non – Non – Non –
with operculum; operculated operculated operculated operculated operculated operculated
a lid like (mature/ (mature/ (mature/ (mature/ (mature/ (mature/
opening through embryonated) embryonated) embryonated) embryonated) embryonated) embryonated)
w/c the larva
escapes
Oncosphere
(L1s w/in the
egg; contain
Ciliated Non-ciliated Non-ciliated Non-ciliated Non-ciliated Non-ciliated Non-ciliated
6 hook
embryo;
“Hexecanth”
Metacestode Hydatid cysts :
Cystic larvae : Cystic larvae :
Cystic latvae : Cystic latvae : Cystic latvae : fluid filled w/
Solid larvae cysticercus; filled cysticercus; filled
(encysted cysticercoid; not cysticercoid; not cysticercoid; not brood capsule
(procercoid: w/ fluid ; has w/ fluid ; has
larva in fully developed fully developed fully developed that contain
elongated, w/ single single
extraintestin invaginated invaginated invaginated protoscolices;
free scolex) invaginated invaginated
al sites) scolex scolex scolex uniocular
scolex scolex
/multiocular
Adult stage
4-10 m 4-12 m 1.5-8 m 2.5-4.0 cm 20-60 cm 10-70 cm
(length)

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 REPRODUCTIVE ORGANS
Order Order Cyclophyllidea
Pseudophyllidea
CRITERIA
Diphyllobotrium Taenia saginata Taenia solium Hymenolepis Hymenolepis Dipylidium Echinococcus
latum nana diminuta caninum granulosus
Genital pore Central / Lateral w/ Lateral w/ Bilateral; double-
midventral part regular irregular Unilateral Unilateral pored; one on Lateral
of each segment alternation alternation each side
Uterus Central; 4-17 lateral 15-30 lateral Reticular filled 12-15 lateral
Sacculate Sacculate
coiled/rosette branches uterine branches w/ egg capsules branches
Uterine pore Present Absent Absent Absent Absent Absent Absent
Gravid Broader than Longer than Longer than
Broader than Broader than Longer than
proglottid long broad broad V- shaped
long long broad
(3x11 mm) (11x5 mm) (19 x 17mm )
Type of
Anapolytic Apolytic Apolytic Apolytic Apolytic Apolytic Apolytic
proglottid
Scolex Spatulate Quadrate Quadrate Knoblike but not Knoblike but not 0.2-0.5mm in Globular but not
(3x1mm) (1mm in diam) (1-2mm in diam) usually seen usually seen diam usually seen
2 slit-like
sucking grooves 4 suckers 4 suckers 4 suckers 4 suckers 4 suckers 4 suckers
(bothria)
Short,
Rostellum w/ invaginated Conical refractile Rostellum with
No rostellum & No rostellum or Rudimentary
double crown of rostellum with rostellum w/ 1-7 double crown of
hooks hooks w/o rostellum
25-30 hooks single row of circlets of hooks 30-36 hooks
20-30 hooks
Ova 70-60 μm; more
70x45 μm,
44x35 μm nearly circular shape
ovoid, yellow-
spheroidal, pale, yellowish, outer
brown, contains 25-40 μm,
31 x 43μm, outer membrane membrane
abundant yolk spherical hyaline
spheroidal, forms thin shell forms
granules, and thin-shelled,
yellow-brown, and rigid inner moderately thick
moderately Indistinguishable contains
thick radially membrane has 2 shell and inner Similar to those
thick-shelled w/ from those of T. hexacanth
striated shell, polar thickening membrane has 2 of taenia ova
inconspicuous solium embryo; 8-15
and contains but 4-8 polar
operculum and eggs enclosed in
hexacanth filaments, thickenings but
usually a small a membranous
embryo encloses a no filaments,
knob at capsule
hexacanth encloses a
aboperculum
embryo hexacanth
end
embryo
Diagnostic Eggs are
Eggs are
problems/ identical to
identical to
notes those of T.
Eggs are those of Taenia
saginata; one is Gravid
sometimes solium, Sometimes Should not be
less likely to find proglottid Cyst shows a
confused w/ ordinarily can confused w/ confused w/ H.
eggs in feces resemble rice sharp outline,
eggs of distinguish eggs of nana since eggs
than with T. grains(dry) or and fluid levels
Paragonimus; between species Hymenolepis lack polar
saginata cucumber seeds can sometimes
eggs are only by diminuta; filaments;
(handle all (moist); dogs be detected w/in
unembryonated examination of rodents serve as rodents serve as
proglottids w/ &cats serve as it.
when passed in gravid reservoir host reservoir host
extreme care reservoir hosts
feces proglottids; eggs
since T. solium
can be confused
eggs are
w/ pollen grains
infective)

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 LABORATORY DIAGNOSIS
Order Pseudophyllidea Order Cyclophyllidea
Diphyllobotrium Taenia Taenia Dipylidium
latum saginata solium Hymenolepis nana Hymenolepis diminuta caninum Echinococcus granulosus

a. Taeniasis : Demonstration of
- Eggs in feces proglottids or, more rarely,
- Gravid proglottids Demonstration of egg packets in stool
Embryonated eggs
b. Cysticercosis : in stool CT, ultrasonography , and
- Tissue biopsy radionucleotide scans
- X-ray examination Demonstration of
Demonstration of - serology proglottids or, more Casoni’s intradermal test:
eggs in feces rarely, egg packets Demonstration of immediate hypersensitivity
(sputum), Caproantigen detection: in stool Embryonated eggs in Demonstration test; uses antigen from
proglottids and immunological (ELISA) stool of proglottids hydatid fluid, injected
scolex in feces detection of parasite Radiographic or, more rarely, intradermally on 1 arm &
material in the feces of specific Demonstration of egg packets in equal volume of saline as a
PCR : performed on the host; uses polyclonal demonstration of proglottids or, more stool control on the other arm.
samples of purified antibodies from rabbits the calcified cyst rarely, egg packets in (+) large wheal; about 5 cm
egg hyperimmunized w/ adult a. biopsy stool in diameter w/ multiple
worm products while b. endoscopic pseudopodial projections
others used both rabbit examination w/in 20-30 min & fades
polyclonal and murine c. computer after 1 hr.
monoclonal antibodies tomography Exploration puncture of the
(brain cyst) cyst: yields hydatid fluid &
demons. of solices in
hydatid sand.

PATHOGENESIS
Order Pseudophyllidea Order Cyclophyllidea
Diphyllobotrium Taenia Taenia Hymenolepis nana Hymenolepis diminuta Dipylidium Echinococcus granulosus
latum saginata solium caninum

Light infections are

Taeniasis :infection due to
adult stage
Obstruction is due to T.
saginata and Ulcers are
Diphyllobothriasis: caused by T.solium; w/c
nonspecific results to inflammation
gastrointestinal
symptoms; intestinal T. saginata gravid are
obstruction – 1 actively motile leading to
adult only; causes discomfort for the
macrocytic or patients and can crawl out
megaloblastic of the anus. Bile duct
anemia: vit. B12 obstruction is also due to
this species, including the
pancreatic duct and
appendix. deficiency
similar to pernicious
anemia
asymptomatic:
Abdominal pain,
diarrhea, headache,
dizziness, anorexia
and various Light Infection seen in
nonspecific infections are “Sheep raising areas of the
symptoms Mostly asymptomatic asymptomatic; world.”
but occasionally
Cysticercosis: patients present mild abdominal Depends on the location of
gastrointestinal pain, diarrhea, the cyst; expanding hydatid
due to larval stage; complaints and anal cyst causes pressure
caused by T. solium pruritus may necrosis of surrounding
only; due to occur tissues
ingestion of egg w/c
leads to cysticercus
cellulose in muscles
or subcutaneous;
common to have
autoinfection

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 CLASS TREMATODA • Heterophyes heterophyes: w/ genital sucker fused w/ the
- Known as “ Flukes ” ventral sucker
- Subclass Digenea
- Digestive system :
- Characterized by alternation of generation
1. Liver flukes Characterized by the oral cavity surrounded by the oral
- Fasciola hepatica - Clonorchis sinensis sucker --- pharynx---esophagus ( bifurcated: divided into
- Opistorchis felineus - Dicrocoelium dendriticum two)--- intestine(does not open exteriorly ); incomplete
2. Intestinal flukes digestive system; inverted “Y” shape
- Fasciolopsis buski - Echinostoma ilocanum
- Heterophyes heterophyes - Metagonimus yokogawai - Reproductive system
3. Lung flukes
- Paragonimus westermani Ovary – only 1 for each fluke shapes:
4. Blood flukes a. Round/subglobose
- Schistosoma japonicum - Schistosoma mansoni
- Schistosoma haematobium b. Lobe/ lobate
c. Branched or dendritic (highly branched)
Groups based on reproductive system: ferens, ejaculatory ducts, etc.
1. Monoecious
- One body w/ both sexual organs Testes – has 2 testes; clue for identification
- Includes intestinal & liver; lung flukes Shapes:
a. Ovoid testes
2. Dioecious
b. Lobed
- Include the blood flukes
c. Branched/dendritic
General characteristics: Appearance:
Monoecious Flukes a. Tandem: one behind the other
Gross morphology b. Side by side
- Flat, Leaf-shaped; unsegmented c. Oblique or diagonal: usually posterior to the
ovary, except for Dicrocoelium dendriticum
- Trematoda : body with holes
- Anterior end: Vitellaria –a yolk gland; located on the lateral
margins
• Oral sucker : for attachment; termed as “Acetabula” ;
surrounds the oral end of adult worm Morphology:
• Ventral sucker: acetabellum for attachment a. Can be branched or dendritic
• Genital sucker: referred to as the “ gonotyl” ; common b. Can be granular or aggregates
with the “heterophyids” c. Follicular
Ex: Metagonimus yokogawai : separate

GENERAL LIFE CYCLE

STAGES D E S C R I PT I O N
All are operculated
Immature Mature
EGG STAGE Fasciola hepatica Clonorchis sinensis
Fasciolopsis buski Opistorchis felineus
Echinostoma ilocanum Heterophyes heterophyes
Paragonimus westermani Metagonimus yokogawai
MIRACIDIUM Hatched egg; pyriform in shape; ciliated
SPOROCYSTS Irregular in shape, sac-like; A broad chamber for the next larval stage, “Redia”
REDIA Undergoes asexual reproduction to become metacercaria
CERCARIA Characterized by elliptical body and with tail
2 types:
1. Lophocercus
a. Simple b. Keel – tailed
2. Microcercus
a. Knob-like tail (w/ hooks)
METACERCARIA
ADULT Lays operculated eggs

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 MONOECIOUS FLUKES
Liver Flukes Intestinal Flukes Lung Fluke
Criteria Fasciola Clonorchis Opistorchis Dicrocoelium Fasciolopsis Echinostoma Heterophyes Metagonimus Paragonimus
hepatica sinensis felineus dendriticum buski ilocanum heterophyes yokogawai westermani
Adult 10-25 x3- 7-12 x 2-3 5-14 x 1.5-2.5 20-75 x 8-20 2.5-6.5 x 1- 1.0-1.7 x 0.3- 8-15 x 4-8
30 x13 mm 2 x 0.5 mm
size 5mm mm mm mm 1.35 mm 0.4 mm mm
Appeara Active:
nce Pointed spoon-
Narrow
anterior ; shaped;
Elongate- anterior,
Leaf – rounded Resembles C. Lancet- Attenuated Resembles H. preserved
ovoidal in rounded
shaped posterior ; sinensis shaped at both ends heteropyes state: oval,
shape posterior
“Bottle neck flattened,
“Pyriform”
appearance” “Coffee-
bean-shaped”
Integu Scales vary
Scales are
-ment in size,
narrow and
pattern & With spines Resembles H. Scale-like
Aspinose Aspinose Aspinose Spinose closely set,
distribution, and scales heteropyes spines
numerous in
but posterior
the anterior
is aspinose
Ovary Small and
Small, oval
Small and subglobose, Round/
Branched and slightly Branched Subglobose Subglobose Lobed
slightly lobed posterior to lobed
lobed
the testes
Uterus Short and Loosely Coiled in the Coiled Coiled Coiled Coiled Coiled
convoluted coiled posterior 2/3
Testes Highly Deeply lobed Lobed, Slightly Highly Deeply Ovoid, side Ovoid, Lobed,
dendritic; in or branched oblique to lobed, dendritic, in lobed, in by side in obliquely oblique to
tandem in in tandem in each other in oblique to tandem in tandem in posterior 5th side by side each other
the 2nd & the posterior the posterior each other posterior ½ posterior ½ in posterior or nearly
3rd fourths 3rd 4th 5th side by side
at the
posterior
third
Vitella Highly Granular, Numerous, Follicular in Highly Medium- Large, Large, Branched,
-ria branched in aggregates transversely middle branched in sized follicles polygonal polygonal lateral for
the lateral extending compressed lateral fields the lateral in posterior follicles in follicles in the entire
and through in the and ¾ lateral each lateral each lateral length of the
posterior middle 3rd middle 3rd posterior fields posterior posterior body
portions lateral fields lateral fields portions third third
Ova 130-150 x 63 28-35 x 12-19 30 x 11 μm 38-45 x 22- 130-140 x 80- 83 x 58-69 28-30 x 15-17 Similar to H. 70 -100 x 50-
-90 μm μm Elongate- 30 μm 85 μm μm μm heterophyes 60 μm
Ovoid, Broadly ovoid; Asymmetrica “Hen’s egg Straw- Ovoid, Similar to H. Yellowish-
“Hen’s egg- ovoid, narrower lly ovoidal shaped; colored distinct heterophyes brown to
shaped; light “Old than C. dark brown identical to ,ovoid, small opercular dark golden
yellowish- fashioned sinensis ova; in color, F. hepatica; operculum shoulder brown, shape
brown;” electric light broad convex thin, varies
small, flat bulb”, light yellowish- operculum transparent greatly, some
operculum at yellow brown, shell, small, asymmetrical
one end brown, operculum slightly ; thick shell
convex fits into a convex w/ flattened
operculum thickened operculum operculum
rim of shell,
minute
thickening at
the
aboperculum

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 MONOECIOUS FLUKES
Liver Flukes Intestinal Flukes Lung Fluke
Criteria
Fasciola Clonorchis Opistorchis Dicrocoelium Fasciolopsis Echinostoma Heterophyes Metagonimus Paragonimus
hepatica sinensis felineus dendriticum buski ilocanum heterophyes yokogawai westermani
“Von Seibold
“Oriental
“Giant fluke or
Common “Sheep liver liver fluke or “ Cat liver “Lancet liver “ Garrison’s “Yokogawai “Oriental
Name fluke” chinese liver fluke” fluke” intestinal fluke” dwarf fluke” lung fluke”
fluke” fluke” intestinal
fluke”
Largest Pyriform in
Other Bottle- neck
fluke ; has Largest fluke Relatively shape; Pyriform in
descrip in
-tion conical of man small smallest but shape
appearance
projections the deadliest

Egg stage
Operculated Operculated Operculated Operculated Operculated Operculated Operculated Operculated Operculated
, immature , mature , mature , mature , immature , immature , mature , mature , immature
Meta Lophocercus
Lophocercus, Lophocercus, Lophocercus Lophocercus Lophocercus, Lophocercus, Microcercus,
-cercaria , simple
stage keel tailed keel tailed , simpletailed , simpletailed keel tailed keel tailed knoblike tail
tailed
Other Cattles;
Definitive herbivores; Man; dogs; water Dogs; pigs; Dogs; rats; Animals ; Animals ; Animals ;
host Cats; man
cattles, cats buffalos ; man man man man man
goats; man man
Snail from Snails from
Snail from
Genus Genus
Snail of Snail from the Genus Snail from Snail
Parafossanul Gyraulus,
1st inter Snails from
us, Bulinus; Snail from Genus Genus Convexiuscul Pironella Genus Antemelania
-mediate Genus Alocinma; Genus Zebrina, Segmentina, us, (egyot) and Thiara, and asperata
host Lymnea Bithynia Helicella and Hippeutid , Hippeutis( Genus Gemilsulcopi (Brotia
Semisul
cospira; Cionella Gyraulus H. Cerithidea ra libertine asperata)
(japan)
Melanoides umbilicalis)
Aquatic
Aquatic plants
plants From Trapa Snail from
Crustaceans
Ipomea spp.(water Genus FishSundathelph
obscura Fish Fish
Ants
caltrop), Pila,(kuhol – Fish from
From usa
2nd inter
-mediate
(kangkong) belonging to belonging to “Formica
Eliocharis Pila luzonica Genus Odontobutis philippina
host & the Family the Family
fusca”
tuberosa ; Genus Acanthogobi obscurus; (Parathelphu
Nasturtium Cyprinidae Cyprinidae (water Vivipara us
officinate chestnut), (suso - V.
Salmo perryi sa
(water Zizania angularis ) grapsoides )
cress) (water
bamboo)
Ingestion of Accidental 2nd IH Ingestion of Ingestion of Ingestion of Ingestion of
Mode of Ingestion of Ingestion of
metacercaria ingestion of ingested encysted meta meta cercaria
trans- encysted fish carrying
mission from 2nd ants carrying carrying metacercaria -cercarian -cercarian from the 2nd
metacercaria metacercaria
host metacercaria metacercaria from 2nd IH stage stage IH

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 MONOECIOUS FLUKES
Liver Flukes Intestinal Flukes Lung Fluke
Criteria
Fasciola Clonorchis Opistorchis Dicrocoelium Fasciolopsis Echinostoma Heterophyes Metagonimu Paragonimus
hepatica sinensis felineus dendriticum buski ilocanum heterophyes s yokogawai westermani
Facioliasis Clonorchiasis Opistorchiasis Dicrocoeliasis Fasciolopsiasis Echinostomiasis Paragonimiasis

Acute stage: Adult stage Similar to Manifested by: Inflammation Similar to Similar to other intestinal Manifestations:
Associated w/ found in the Clonorchis Traumatic due to Fasciolopsiasis fluke infection; does not Similar to P. TB
migration of intrahepatic sinensis damage; attachment ; Does not cause cause obstruction Cellular
adult stage bile ducts hyperplasis of ulceration; obstruction due Can become ectopic due infiltration
leading to resulting to biliary obstruction of to its small size to its size: accompanied by
traumatic “trauma epithelium; intestinal Heart: myocarditis granuloma
damage;toxic damage”; Inflammation lumen;toxic leading to heart failure to leading to
irritation hyperplasia of of bile duct; and allergic death fibrosis
causing biliary Fibrosis symptoms CNS: to the brain leading s/s:
necrosis of epithelia; to neurologic cough
liver , inflammation manifestations chest pain
referred to as of bile ducts dyspnea
“liver rot” referred as hemoptysis
Chronic “cholangitis”; NB: usually
stage: can enter misdiagnosed as
Clinical associated w/ gallbladder pulmonary
the causing tuberculosis
features maturation of “cholecystitis”;
worms in the fibrosis
hepatic bile referred to as
ducts leading “cholelithiasis”
to biliary –formation of
obstruction; gallbladder
inflammation stones ; toxic
to “fibrosis” irritation
Halzuon – causing
pharyngeal “cholangio-
fascioliasis ; carcinoma
temporary
lodgement of
immature
worm;
manisfested
by dysphagia
&dyspnea
Demonstrati Demonstrati Demonstrati Demonstrati Demonstrati Demonstration Demonstration of eggs Demonstration
on of eggs on of egg in on of egg in on of eggs in on of egg in of egg in feces in feces; differential of eggs in
in feces; feces feces feces; feces ; identification needed sputum or in
differential differential differential feces
Lab.
diagnosis diagnosis diagnosis w/
diagnosis
between between eggs of
spurius and spurius and Fasciola
true true hepatica
infection infection

DIOECOUS FLUKES
- Referred to as Blood flukes
- Belonging to the Genus Schistosoma
- Gross morphology: 2 points of differentiation
• Different sexes
• Shape : elongated & narrower; compressed dorsoventrally
- Oral & ventral sucker : present in both female(longer and slender) and male (shorter and more robust)

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 Criteria Schistosoma japonicum Schistosoma mansoni Schistosoma haematobium
Common Oriental blood fluke Manson’s blood fluke Vesical blood fluke
name
Definitive host Man Man man
Snails Snails Snails
Intermediate
Oncomelania hupensis quadrasi From Genus Biophalaria and Genus From Genus
host
Australorbis Bulinus and Genus Planorbis
Preferred Superior mesenteric venules (veins that Inferior mesenteric venules (veins that Vesical plexus (venules that drain into
habitat in man drain in the small intestine) drain into the large intestine) the urinary venules)
Egg stage Non operculated mature Non operculated mature Non operculated mature
Smallest; ovoidal in shape; characterized Largest of the 3; eggs are elongated with Elongated with a rounded anterior, and
by rudimentary lateral knob pointed anterior, posterior end is the posterior is tapering into a terminal
rounded with a prominent lateral spine spine
Ova
Lateral knob ; 70-105 x 50-80 μm 140-180 x 45-70 μm 112-170 x 40- 70 μm
50-100 ova in uterus 1-4 ova in uterus 20-30 ova in uterus
Ovary Central Anterior half Posterior half
Tegument Smooth Coarsely tuberculated Slightly tuberculated
(male)
Testes 6-8 testes 8-9 testes in a row 4-5 testes
Clinical Intestinal schistosomiasis Intestinal schistosomiasis Urinary schistosomiasis
features Also referred to as “ Bilharziasis or Bilharz disease ”
Associated w/ skin penetration of the cercaria resulting into “ schistosome dermatitis”; characterized by reddish rash &
a. Early stage
pruritus referred to as “swimmer’s itch or water itch or clamp digger’s itch”
a. Characterized by toxic and allergic manifestation associated w/ the presence of parasite in the blood circulation;
manifested by fever, hepatomegaly coughing and lymphadenopathy collectively termed as “katayama disease or syndrome” ;
b. Acute stage commonly observed with Schistosoma japonicum ; rarely for S. haematobium and less for S. mansoni
b. Intestinal signs and symptoms include abdominal pain and diarrhea
c. Urinary signs and symptoms include dysuria and hematuria
c. Chronic Characterized by granuloma formation
stage (ectopic eggs are carried by Blood in other sites of the body)

Stool Microscopic examination of egg Stool Microscopic examination of egg Microscopic examination of egg with
with lateral knob, with lateral spine, terminal spine,
o Specimen: urine; SF, occasionally feces,
Laboratory
antigens antigens more often in vesical or rectal biopsies
diagnosis
antigens

Geographic Far east : Japan (eradicated);China, Africa and South Africa Africa and M iddle East
distribution Philippines

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 Laboratory diagnosis:
1. Demonstration of parasite (ova/egg)
2. Serologic tests:
a. ELISA : uses monoclonal antibodies; demonstrate two glycoprotein antigens assicuated with the gut
of adult schistosomes (circulating, anodic “CAA” and cathodic “CCA” antigens); sensitive and specific
b. Skin tests : group specific
i. Intradermall allergic test (Fairley’s test)
- Uses antigen from infected snails, from cercaria, eggs and adult schistosomes
c. Other serologic tests: not very useful ; complete fixation, bentonite flocculation, indirect
hemagglutination, immunofluorescence, gel diffusion
d. Special tests : 2 circumoval precipitation
- Globular or segmented precipitation around schistosome eggs incubated in positive sera
- “Cercarien-hullen” reaction : development of pericercarial mmbranes around cercaria
incubated in positive sera
3. Ultrasonography
4. Demonstration of biopsy samples
- Rectal valve
- Urinary bladdler
5. Viability tests : eggs
a. Flame cell activity
- In each egg 4 flame cells (part excretory system;one on each corner) examined under HPO
- (+) motile flame cell - viable
- (–) not motile - nonviable
b. Miracidial hatching test
- Specimen is mixed w/ distilled water, placed in a flask w/ a side arm, covered w/ a foil or
dark paper except for the side arm
- Allowed to stand in a presence of a desk lamp
(+) eggs will hatch releasing miracidia – viable
(–) no hatching – nonviable
- Miracidia: prototrophic ; swims toward the light (side arm of the flask)

COVERAGES PAGE DATE

QUIZ 1 INTRODUCTION TO PROTOZOA 1 to 24
QUIZ 2 NEMATODA 25 to 32
QUIZ 3 PLATYHELMINTHS 32 to 42
PRACTICALS
SHIFTING EXAM

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