I.

Introduction:
A. Definition of Terms :
Parasitology : a branch of biology that deals with the study of living organisms that take up their abode on or within another
living organism. (parasite and host)
Host : any living organism harboring any parasite.
Parasite:
1. Endoparasite : parasites found or living within the body of the host. “Infection”
2. Ectoparasite : parasites found on the surface of the body of the host. “Infestation”
Erratic: Parasite found in an organ w/c is not its usual habitat

Two states of PARASITOSIS:

INFESTATIONS INFECTION
Organism involved Ectoparasites Endoparasites
Characteristics Lodgement of the parasite on the surface of the Invasion/ Modification of the parasite within
host the host’s body
Sarcopies scabie (scabies)- caused by a small mite
that burrows into the skin.
Dog and cat hookworm
Pediculus humanus capitis(head lice), corporis

B. Host – Parasite Relationship

Types of symbiotic relationships:
Symbiosis: association of two species. “living together”, unlike organisms

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RELATIONSHIP DEFINITION TERMS OF
ORGANISM
Mutualism Specialized type of commensalism, wherein the relationship is Mutualists
beneficial to both organism
Ex. Termites and the flagellates inside their digestive system
From the latin for “ eating at the same table” denotes association that Commensals
Commensalism
is beneficial to 1 partner and the other is neither benefited nor harmed.
2 species live together
One species benefits from the relationship w/o harming or
benefiting the other
Ex. Entamoeba coli
Parasitism A relationship wherein the organism is benefited and the host is Parasite
harmed.
1 organism lives in or on another for its survival at the expense of
the host
Ex. Entamoeba histolytica
Living organisms are not physiologically dependent on each other. Phoront
Phoresis
Phoronts are traveling together (for transport/ transit)

Two types of Parasitic Life Cycle:

Direct life cycle: Parasite utilizes one host only in the entire life cycle. Ex. Ascaris lumbricoides
Indirect life cycle: utilizes two or more hosts in the life cycle. Ex. Malarial parasites

Types of Hosts
a. Reservoir
• Can be animate or inanimate objects in which the parasite is found normally living
• Allows the parasite’s life cycle to continue and become additional sources of infection
• Animate: normal hosts of parasites (ex. Human, animals)
• Inanimate: normal habitat (ex. Soil, water,)
B. Definitive/final host
• Harbors adult stage of parasite
• Harbors, sexual stage
• (ex: malarial parasites: mosquito- definitive host)
c. Intermediate host
• Harbors larval stage or asexual stage
d. Paratenic host ( phoretic host/ transport host)
- Harbors the parasite that does not undergo any development - Phoretic relationship (ex. Fasciola hepatica )
- Parasite remains alive and is able to infect another host

Classification of Parasites:
I. According to Pathogenecity:
1. Pathogenic
2. Non-pathogenic

II. According to need for host:

1. Obligate parasite – the parasite is totally dependent on the host. The organism cannot survive in any other manner. Need
a host to complete their development
2. Facultative parasite – the parasite can have a parasitic existence or free living. May exist in a free-living state
May become parasitic when the need arises
3. Accidental/ incidental parasite- attaches to the body of a host that is not considered a normal host (ex. Dipylidium
caninum), Parasite that established itself in a host where it does not ordinarily live. Ex. Echinococcus granulosus

III. According to number of host required in the life cycle:

1. Monoxenous – requires one host
2. Heteroxenous - requires 2 or more hosts
3. Autoheteroxenous – harbored by a definitive host that shall become the intermediate host of the next generation.
• Spurious parasite: organism that parasitizes other hosts that pass through the human intestine and are detected in the
stool after ingestion. Also called caprozoic parasites.

IV. According to Habitat

1. Endoparasite : parasites found or living within the body of the host.
2. Ectoparasite : parasites found on the surface of the body of the host.
GIT Enterozoic
Blood Hemazoic
Tissues Histozoic
Cells Cytozoic
Body Cavity Coelozoic

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Source of Parasitic infections:
1. Soil / water
Soil – “ soil transmitted parasite”
Water – “water-borne parasite
2. Food/ drinks
“ food-borne parasites ”
- Contaminated from the soil/water

Mode of transmission:
a. Ingestion of infective stage
b. Skin penetration
Nb. Contamination is due to lack of sanitary practice; practice of night soil (use of excrete for fertilizers- human excrete)
Pork Trichenella spiralis & Taenia solium
Beef Taenia saginata
Fish Diphyllobothrium latum & Capillaria philippinensis
Vegetation Fasciola hepatica
Crabs Paragonimus westermani
Snail Echinostoma ilocanum

3. Vectors
- Invertebrates, arthropods / mollusks - “vector-borne parasites”
Biological vectors – required in the life cycle Mechanical vectors – for transport. Referred to as “ harborage vector”
4. Animals
- Either be domestic/ wild
- Zoonosis ( infection acquired from an animal)
• TRANSMITTED BY ANIMALS (ANIMAL-BORNE INFECTIONS) A DISEASE OF WILD OR DOMESTIC
ANIMALS THAT ALSO OCCURS IN HUMANS
5. Other person – referred to as “”contact-borne parasites”
6. Oneself
- Infection is referred to as “autoinfection”
Anus ---- fingers ---- mouth Ex. Enterobius vermicularis
Ex. Strongloides stercolaris
7. Fomites
- Inanimate objects w/c becomes contaminated and causes infection

Portals of Entry:
• Any channel or the way through which the parasites gain access to the body of the host.
• Mouth (ingestion of infective stage
• Skin(direct penetration of larva stage)
• Respiratory tract, GUT, conjunctiva, other mucus membrane

Portals of Exit:
• Channel through which parasites leave the body of the host. Usually the same as the portal of entry.
• Nb. Importance: gives as the idea what specimen to collect from the specified site.

SOURCE PARASITE
Malarial parasites Filarial parasites Trypanosomes (Trypanosoma brucei gambiense, trypanosome cruzi)
Blood
Tissue Nematodes, Babesia, Schistosomes
Liver and Lung trematodes (Fasciola hepatica, Clonorchis sinensis, Paragonimus spp.)
Stool Intestinal Trematodes (fasciolopsis buski, Heterophyes heterophyes)
Blood trematodes (Schistosoma mansoni, Schistosoma haematobium, Schistosoma japonicum)
Intestinal (cryptosporidium spp. , Cyclospora cayetenensis) Liver and lung trematodes (Paragonimus spp. ) E
Sputum
gingivalis, T tenax, ASH, E histolyticca trophozoite
Skin O volvolus,
Tissue T spiralis, T solium, Spirometra, Renal biopsy= S japonicum, Naegleria, Acanthamoeba (eye scrapings),
biopsy Leishmania
Tissue Protozoa (Toxoplasma gondii)
CSF Free living amoebae (Naegleriafloweri, Acanthamoeba spp. )
Trypanosomes ( Trypanosoma cruzi, Trypanosoma brucei gambiense)
Blood trematodes ( Schistosoma mansori, Schistosoma Haematobium)
Urogenital Flagellates
Urine
(Trichomonas vaginalis) – vaginal/ urethral
W bancrofti

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Pathophysiology of Parasitic infection:
• Parasite factor – leads to disease / non-infection. Depends on the pathogenicity of the parasite
• Host – depends on the host defense mechanism

a. Factors of pathogenicity:
1. Parasite burden - Refers to the number of parasites in the host ( > in # of parasite = > damage in the host)
2. Tissue tropism
- Affinity of the parasite to a particular tissue or cell in the host
- Damage depends on the locality of parasite
3. Pathogenesis
- Mechanisms by which damage or injury is produced
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
- Ex. Hookworm- has buccal 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
Immune suppression – E histolytica
Antigenic variation- T gambiense
Host mimicry- E granulosum: blood group antigen
Intracellular sequestration- T gondii- Macrophages

Modes Of Transmission:
1. Contact Transmission
- E vermicularis, T vaginalis, S scabei, P capitis
- 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
5. Food/ animal:
- T spiralis, T solium, C philippinensis, P westermanni
6. Water
- G lamblia, E histo
7. Congenital
- T gondii
8. Soil
- A lumbricoides, T trichiura, A duodenale, N americanus, S stercoralis
9. Arthropod
- Plasmodium, Trypanosma, Wuchereria
10. Snail
- Schistosoma, Echinostoma

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 )

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Nonspecific Defenses Specific Defenses
Offer protection to any foreign agent; present at birth already Offers protection to a 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
NB. There is acquired immunity for parasitic infection (acquired immunity is at low levels)
- Not long lasting ( immunity confers resistance in the host, only when the parasite is within the host)
- Acquired immunity only confers resistance from hyper infection; does not protect the individual from reinfection
- Not absolute
Diagnosis of Parasitic infection
2 approaches:
1. Clinical approach
2. Laboratory approach

I. Clinical diagnosis
- Done by physicians
- Dependent on:
a. Gathering of information based on signs and symptoms of the disease, during physical examination
b. History taking

II. Laboratory diagnosis

- Done by medical technologists, & pathologists Methods :
1. Direct method
- Definitive identification
- Requires isolation and identification of parasite from a clinical specimen
- Isolate through : a) direct microscopy b) culture

2. Indirect method
- Presumptive identification
- No need for isolation/ identify/ detect
- Based on Ag- Ab reaction
- Referred to as “immune-diagnosis” (Ag/Ab identification) - Specimen: blood (serum)

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SPECIMEN COLLECTION:
Considered as STAT specimens in parasitology: Blood and CSF
CNS specimens for examination of free-Iiving amoebae, (2) blood films in a potentlal malaria case.
a. Container: clean, dry free from urine, tight fitting lids
b. Size: about 150 g ; thumb size (semi formed) ; half a teaspoon (watery)
c. Label: should contain date and time of collection
• Liquid- 5-5 tsp; 30 minutes- Trophozoites, helminth eggs, larvae
• soft stools- 1hour : best examined w/ an hour of the time of passage- Trophozoites, cysts, helminth eggs, larvae
• formed: 20-40g 1 hour; if cannot be processed,refrigerate for up to 2 days- Cysts, helminth eggs, larvae

ROUTINE STOOL EXAMINATION

Macroscopic / Physical examination :
1. Color (light to dark brown; variations: bright red, black/tarry, pale yellow, white, gray, clay/putty, green)
2. Consistency (formed, semi formed, soft, watery)
- Examine for the presence of mucus and blood.
Microscopic examination:
- 2 mg stool + 1 drop NSS / Iodine
1. Direct fecal smear – detection of trophic forms of amebae and flagellates. Allowing the observation of motility of the
organisms, all types of parasites
Saline wet mount Iodine wet mount
Mainly o stain glycogen and the nuclei of the
Initial microscopic examination of fecal specimen
cysts
Employed to demonstrate egg, larvae, protozoan trophozoites and cysts; can Reveals details that cannot be seen on saline
also reveal presence of RBCs and WBCs. wet mounts.
2. Kato thick smear (KTS)
- 50-60 mg/ 2 mongo beans
- Efficient means f diagnosis of intestinal schistosomiasis and intestinal helminthes.
- Not suitable for examining larvae, cysts or eggs from certain intestinal parasites.
- Uses a Cellophane presoaked with glycerine: clearing solution-malachite green- create contrast easy detection minimum
brightness solution for at least 24h
Chemical examination :
1. Occult Blood determination : Hema-Screen Guaiac Slide test
- Hema screen developer contains <6% H2O2 and denatured alcohol.
- (+) blue coloration on the test pad
- Occult blood may be a result of intestinal bleeding caused
by parasitic organism, but not indicative of such infection.
o Reporting :
Species, stage, average # per LPF (quantity)
Do not freeze unpreserved at RT: couple of hours
Beyond 1 hour, stool samples must be refrigerated
PRESERVATIVES= ratio 1:3
Preservative Advantages Disadvantages
Polyvinyl alcohol (PVA) For the detection of trophozoites in Contains mercuric chloride and w/
Less widely used but highly recommended for diarrheic and mushy stools that consequent disposal problems
surveys and as a routine procedure in the lab. would escape detection in other

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FIXAȚIVE OF CHOICE FOR STOOL
PCR/DNA Techniques techniques.
Comprised of plastic powder (adhesive for With Schaudinn use CUSO4
stool) Can be used for permanent stained Protozoan cyst
smear. Long shelf life Trophozoite= permanent stain

Schaudinn’s Solution
Provides optimum fixation and
A constituent of PVA and can be both a Contains mercuric chloride and w/
preservation of structural detail
fixative and preservative consequent disposal problems Not
specially for the diagnosis of
Mercury chloride suitable for concentration techniques
protozoans
preparation: staining
5% protozoan cyst
10% Formalin solution
Gives satisfactory result compared to 10% helminth eggs and larvae
Widely used for helminthic infection surveys
MIF and schaudinn’s Buffered with NaPO4
Preservative in direct fecal smear

Merthiolate iodine formaldehyde (MIF) a.k.a
thimerosal iodine formaldehyde (TIF) :
stored in brown glass bottles
SAF fixative solution Preservation of material
w/c can be concentrated by the tormol-ether
acetate technique/ made into permanent
stained smear
Retains good stain for some months; Concentration techniques - Not
useful for field collections; well reliable for specimens that have been
preserved specimen for a year stored more than a few days
Less adherence to the slide, although
For con’c and permanent stained
improved if the slide is coated with
smears
albumin

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 mount examination is negative despite the clinical symptoms indicating parasitic infection of a patient.
Helminth eggs and 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.
• SPECIFIC GRAVITY OF ORGANISM IS HIGHER THAN THE SOLUTION
SEDIMENTATION TECHNIQUES
SEDIMENTATION TECHNIQUES ADVANTAGES DISADVANTAGES
ACID- ETHER SEDIMENTATION
Sediments eggs and protozoan cysts after
clearing the fecal detritus and mucus with Useful in the detection of
Unsatisfactory for the diagnosis of
the acid and dissolving fatty constituents schistosomes and other trematode
protozoa
in ether eggs, Trichiuris, capillaria, cat stools
40% HCl: dissolves albuminous material
Ether: dissolves neutral fats
FORMALIN ETHER
SEDIMENTATION TECHNIQUE Useful for cleaning steatorrhea or
(FORMALIN-ETHYL ACETATE) other diarrheic feces . Efficient in The preparation contains some debris.
Ethyl acetate: substitute recovering all parasite forms. Results Flammability of ether and irritation from
Formalin fixes the eggs, larvae, oocyts in high sensitivity and economy effort formalin. Hymenolepis nana & Fasciola
and spores and preserves their Ether (ethyl acetate- remove fats and hepatica don’t concentrate well.
morphology. oils)de> Debris> formalin > Sediment
10% formalin, ether
SIMPLE GRAVITY
SEDIMENTATION Readily applicable for field work
Intended to collect parasite eggs too Cleans some debris and water soluble
dense to recover with common flotation pigments in the process of decanting
media.
BAERMANN SEDIMENTATION
Best for the recovery of Trichenella Less sensitive than centrifugal flotation
Uses simple gravity sedimentation to
spiralis larvae technique.
recover nematode larvae

FLOATATION TECHNIQUES
Superior to sedimentation
SPECIFIC GRAVITY OF SOLUTION IS HIGHER THAN ORGANISM
FLOATATION TECHNIQUES
SHEATHER’S SUCROSE
(SG: 1.275 other references)
A sucrose solution with a SG of 1.18 can
be used to concentrate protozoan oocysts
and cysts
Preserved with Phenol
ADVANTAGE DISADVANTAGE
For the recovery of
Cryptosporidium oocysts; SG=
Fluke eggs and tape eggs ; almost all
1.25-1.27
nematode eggs do not demonstrated well
5 times more efficient for detecting
Giardia spp. cysts are distorted and may be
infections w/ Trichuris compared to
destroyed by sheather’s sugar sol’n
Zinc sulfate

ZINC SULFATE Zinc sulfate sol’n SG
1.18 (fresh), used preferentially to
identify potential infections w/ parasitic
protozoan spp. Like giardia.
33% ZnSo4
A floatation medium for detecting
Giardia lamblia infections is nearly
2 ties more reliable than sheather’s
sucrose,
Procedure will not float some trematode and
some tapeworm ova. Unsuitable for fatty
stool samples Expensive and requires a
hydrometer.
Not detected because it is the heaviest:

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1.2 (unpreserved)
CENTRIFUGATION FECAL
FLOTATION
SATURATED SALT SOLUTION
TECHNIQUE
Brine solution
PASSIVE FECAL FLOTATION
STOOL CULTURE METHOD
1. Copro
2. Harada mori/ test tube culture
method
EGG COUNTING PROCEDURES
1. kato katz/ cellophane covered thick
smear
2. Stoll egg count
Perianal swab
Staining of stool
PERMANENT STAINS
STAINS
MODIFIED GOMORI’S TRICHROME
Demonstrates the mitochondrial myopathies and
so called range –red fiber. Positive structures are
the same as H&E stain
IRON HEMATOXYLIN STAIN
POLYCHROME IV STAIN Primarily used to
stain permanent smears prepared from MIF –
preserved fecal specimens
CHLORAZOL BLACK E STAIN
Can be used to detect fungal filaments in stool;
identify the presence of protozoa w/c is not
readily detected or difficult to detect in wet prep.
MODIFIED ACID FAST STAINS
MODIFIED IRON – HEMATOXYLIN STAIN
The internal elements that distinguish among
cysts and trophozhoites can best be visualized
with a stain that enhances the morphologic
features.
TRICHROME STAIN Background debris-
green Protozoa- blue-green to purple cytoplasm
Nuclei & inclusions- red or purple red and sharply
delineared from background
Ascaris lumbricoides:
Recovers significantly more eggs Requires use of centrifuge, either swinging
and oocytst and has fewer false- or fixed- head rotor. Overfilling the test
negative results than passive tubes with sugar in the solution can leave a
floatation system. sticky residue in the centrifuge
Cheap preparation using simple
apparatus Concentrates nematode Doesn’t concentrate cysts
ova well Shrink: hookworm, schistosoma eggs
Centrifugation not needed
Easy to conduct using commercial Less efficient than centrifugation techniques;
device. Often less expensive than recovers fewer eggs and yields more false-
centrifugation techniques negative results.
- positive stool samples + moisten Baermann technique = funnel
soil + granulated charcoal
filter paper
Strongyloides- Filariform larvae that move upwards in the Harada-Mori culture
technique
Hookworm- Filariform larvae that move downwards in the Harada-Mori culture
technique
- 50 -60 mg Monitor treatment
- reflects intensity: Infection
Diluent: 0.1 N sodium hydroxide Stool displacement flask: Calibrated at 56
and 60 ml
= amount of to examined x #eggs
cellulose tape scotch tape method enterobius vermicularis
Taenia
iron hematoxylin trichrome kinyoun Quantitative buffy coat- malaria acridine
acid fast chlorazol Black E orange
ADVANTAGE DISADVANTAGE
Less detail
Less time consumed Oocysts of Cryptosporidium, cyclospora
Convenient in identifying of nd isospora are difficult to recognize
intestinal protozoa
Results generally are superior
(enhanced definition of key
Watery specimens cannot be used;
nuclear and cytoplasmic
difficult to perform Oocysts of
characteristics)
Cryptosporidium, cyclospora and
excellent morphology of
isospora are difficult to recognize
intestinal protozoa but difficult
to perform
Can be used in place of
Cannot be used in specimen preserved
trichrome stain by the MIF,
with formalin.
PVA or SAF fixative method
Both fixation and staining Not recommended for materials fixed
occur in a single solution with PVA.
Sensitive and cost effective for
Lack specificity ; use of positive control
detection of these protozoa,
is mandatory; destruction of trophozoite
Cryptosporidium, Cyclospora,
stage of parasite
isospora
Save both time and personnel Not recommended for Schauddin’s
use fixative – preserved or PVA-preserved
Especially recommended for
Entamoeba, Giardia, Balantidium,
identifying features of amoebic
dicrofilaria
cysts and trophozoites
8/35
PAS entamoeba: Giardia, granules of toxoplasma bradyzoites, trichomonas, toxocara
Giemsa Giardia toxoplasma malaria
Trichrome entamoeba, giardia balantidium dicrofilaria
Acid fast cryptosporidium cyclospora, isospora
GMS Toxoplasma, microsporidia
Gram Trichomonas, microsporidia
Reticulum Leishmania
Luxol fast blue Microsporidia
India ink Cryptococcus neoformans, demonstrate uterine branches of Taenia spp. proglottid

CLINICAL PARASITOLOGY
Epidemiology: branch of science w/c deals with factors of distribution of disease.
-Endemic - Sporadic - Epidemic - Pandemic
-Cosmopolitan – found worldwide w/ or w/o sudden increase of parasitic infection / incidence

Factors that determine the occurrence of a disease:

1. Human factors
a. Age - > / extreme age = more susceptible to infection
b. Gender
c. Nutritional status
d. Habits of individual/ customs/ rites
e. Hereditary
2. Environmental factors
Factors that favor the survival and maintenance of the parasite outside the host
a. Physical factors/ climatic factors
b. Socioeconomic (poverty favors infection) c. Occupation
Prevention and control:
-Different strategies for prevention and control
1. Treatment of the host
- Refers to the administration of drugs - Reasons for use:
a. Reduce morbidity
b. Prevent mortality
c. Reduce transmission of parasites
2. Control the animal host
- Treatment with anti-parasitic drugs
- Destruction of the animal
- Reason: Reduce chance of transmission from the animal host

3. Control the vector host

- Killing the vectors
- Elimination of breeding grounds

4. Reduction of vehicle contamination

- Proper sanitation:
a. Proper waste disposal
b. Treatment of waste (chemically) - Purification of water
- Proper food storage and preparation

5. Interruption of transmission
- Referred to as “barrier protection”
- Use of physical barriers to separate host from the source of infection (parasite)
- A.k.a “spatial protection” 6. Education
- Information dissemination: Through different media

7. Immunization of susceptible individuals

- Acquired by vaccine
- Not for parasite infection

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PROTOZOANS
- Group of eukaryotic organisms
- One-celled organisms (unicellular)
- Has 7 phyla, but 3 are medically important
Phylum sarcomastigophora Subphylum sarcodina
Subphylum mastihophora
Phylum ciliophora

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 Phylum apicomplexa Class sporozoea
General morphology:
Two regions of protozoan cell
1. Cytoplasm
- Divisible into 2 portions
a. Ectoplasm
- on the outer part; peripheral region
- less granular; more homogenous than endoplasm

Functions :
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
e. Apical Complex
- invasion, penetration: coccidians
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.)
b. Endoplasm
- found in the inner region that directly surrounds the nucleus
– dense/ moderately dense granular

Functions:
i. Metabolism
ii. Site of food synthesis and storage
- stored in the form of glycogen mass/ vacuole or in the form of chromatoidal body / bar (represents protein storage; made-up
of crystalline RNA)

2. Nucleus
- Bounded by nuclear membrane
2 types of nucleus:
a. Vesicular type:
- Majority found in protozoans
- Characterized by irregular distribution of chromatin; appears that there are light areas or spaces in the
nucleoplasm
• Linin Network
- Chromatin materials in the nucleus - Spokeswheel arrangement
- Condensed / aggregates of chromatin granules in the nucleoplasm

• Karyosome
- 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
Trophozoite →Encystation →Cyst

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Cyst → Excystation → Trophozoite

ENCYSTATION :
- Transformation of trophozoite into a cyst stage
- Caused by adverse conditions in the environment
1. When there is nutritional deficiency
2. Changes in the increase toxicity
3. Desiccation
4. Decrease oxygen concentration
5. pH / temperature changes
6. Overcrowding/ overpopulation

EXCYSTATION :
- Cystic stage becomes trophozoite stage for reproduction - Both processes occurs within the host only

PHYLUM SARCOMASTIGOPHORA
SUBPHYLUM SARCODINA A.K.A “ Amoeba/ Amoebae”
a. Genus Entamoeba
- E. histolytica (real pathogen)
- E. coli
- E.gingivalis - E. dispar
- E. hartmani
b. Genus Endolimax - E. nana
c. Genus Iodamoeba - I. butschii

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.

MORPHOLOGY OF THE NUCLEUS

1. Genus Entamoeba
- Characterized by small karyosome (centrally located/ eccentrical)
- Has chromatin material (linin network)
- Has peripheral chromatin w/ either fine granules / course granules ot regular/ irregular distribution

2. Genus Endolimax
- Characterized by large karyosome and irregular shaped karyosome with fibrils radiating into periphery
- No peripheral chromatin

3. Genus Iodamoeba
- Characterized by large spherical karyosome surrounded by achromatic globules ( referred to as periendosome; may be
clustered at one side)
- Lacks peripheral chromatin

CRITERIA FOR IDENTIFICATION

1. Size – measured in μm
2. Shape and motility
3. Characteristics of the nucleus 4. Cytoplasm

TROPHOZOITE OF INTESTINAL AMOEBA

NUCLEUS CYTOPLASM
MOTILITY
SPECIES Peripheral Karyosomal
Pseudopod Number Appearance Inclusion
Chromatin Chromatin
Erythrocytes
Present, fine,
Fine granular, (not present in
uniform Small, discrete,
Active , progressive, ground glass E. dispar) may
granules, compact.
directional, hyaline One, not visible appearance, contain bacteria
Entamoeba evenly Usually
fingerlike or blade in unstained clean. If Differentiation
histolytica/ dispar distribute. centrally located
pseudopod , formed preparation present, : DNA & PCR
may be but occasionally
rapidly vacuoles are analysis
beaded eccentric
very small. - Detect
appearance
surface Ag
Present, fine,
uniform
Small, discrete,
Usually non One. Not granules,
Entamoeba compact often
progressive, but may visible in evenly Finely
hartmanni eccentrically Bacteria
be progressive unstained distributed. granular
AKA small race located but may
occasionally preparation May be
be central
beaded
appearance
Entamoeba coli Sluggish, non- One. Often Similar to E. Large, discrete, Coarse, often Abundant
(largest protozoan: progressive, blunt, visible in histolytica usually vacuolated bacteria, yeasts,
ameba) usually granular unstained Darker, solid eccentrically. and other
Dirty looking pseudopod. Formed preparation ring rather May be diffused materials

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 and darkly
cytoplasm slowly than beaded
stained
Moderately active ,
with multiple Present, fine
Small, well- Finely
Entamoeba pseudopods, vary granules, Epithelial cells
One defined, usually granular,
gingivalis from long , lobose to closely and leukocytes
centrally located vacuolated
short and blunt, packed.
often formed rapidly
Endolimax nana Sluggish, usually One,
Large, irregular
(smallest intestinal non progressive, occasionally
shaped, blot like, Granular,
protozoan) hyaline, blunt, visible in Usually none Bacteria
usually centrally vacuolated
Dwarf instetinal pseudopod, formed unstained
located
slug slowly. preparation
Large, usually
centrally located.
Surrounded by
Sluggish, usually retractile,
non progressive. One. Not achromatic Coarsely
Bacteria, yeast,
Iodamoeba Hyaline, blunt or usually visible granules. These granular,
Usually none or other
butschlii fingerlike in unstained granules are maybe heavily
materials
pseudopod. Formed preparation. often not distinct vacuolated
slowly. even in stained
slide.
Basket shaped
of flowers

CYSTS OF INTESTINAL AMOEBA

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

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 achromatic
granules on one
bodies as seen in
side of
Entamoeba iodine
karyosome.
species are not Glycogen mass
Indistinct in
present
iodine
preparations
NO CHROMATOIDAL BODY:
Endolimax nana
Iodamoeba butschlii

UNINUCLEATED CYST
Iodamoeba butschlii
Entamoeba powlecki
NO CYST
Entamoeba gingivalis

Entamoeba powlecki- swine amoeba

- uni nucleated: Pigs monkeys

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
Entamoeba histolytica- only pathogenic, erythrophagocytosis
AMOEBIASIS:
- Refers to any clinical condition resulting from infection with E. histolytica
- May occur at any area of invasion (usually intestinal)
IS: cyst
DS: Formed: cyst, Watery: trophozoite
MOT: Feall, oral, Sex (men – men)

Intestinal Amoebiasis:
- Either be asymptomatic or symptomatic
- Most common type (85-95% of cases are asymptomatic; 5-10% symptomatic )
- Passes formed stool

a. Acute amoebic colitis (nondysenteric)

- Includes abdominal pain / cramps
- Frequent dysentery (watery, bloody and mucoid) - Passes watery stool (trophozoite stage)
b. Chronic amoebic colitis (dysenteric)
- Intermittent diarrhea and constipation
- Either trophozoite / cystic stage is recovered

Pathogenic mechanism:
1. Cytoadherence
- Attachment of the parasite to the cells
- Has adhesins w/c enables attachment
2. Cytolysis
- Due to active motility or “amoeboid movement” – causes lysis of host cells
3. Proteolysis by E. histolytica
- Secretes “enzyme w/c lyse the tissue/ host cells

Lesions produced by intestinal amebiasis

a. Primary ulcer (start of lesion, found in the mucosa, usually small)
b. Then extends laterally into the mucosa
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 ulcer”

1. Amoeboma
- Granuloma that is formed in the intestinal wall resulting from the infection with E. histolytica
- Results into the thickening of intestinal wall and constriction of intestinal lumen
- It may resemble “colon-cancer
- The constriction is referred to as “napkin-ring”- affects bowel movement

2. Colonic perforation
- Results into peritonitis (inflammation) and hemorrhage
3. Secondary infection
- Caused by another agent in the area
4. Secondary invasion
- Cause by other agent
- Parasites gain access in blood circulation

EXTRA INTESTINAL AMOEBIASIS

SITE DESCRIPTION TERM
Liver Secondary to infection in colon Most common type of EA; characterized by : “ Hepatic
a. Amoebic hepatitis (char. By hepatomegaly) Amoebiasis”
b. Amoebic hepatic abscess (central part of abscess is pus- likened to be “anchovy-sauce”,

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 reddish brown in color
Results from direct extension of infection from the liver, usually affecting the right lung; may “Pulmonary
Lungs
occur via hematogenous origin; patient may cough- out “anchovy sauce like sputum” Amoebiasis”
Brain “Cerebral amoebiasis”
“Cutaneous
Skin Occurs in the perianal region; secondary to infection in the rectal portion
Amoebiasis”

Diagnosis: Culture media: IF, PCR

Gold standard: Concentration technique: Sigmoidoscopy and Boeck/ Drbohlav's
aspiration of mucosal lesions Locke egg
Shaffer Ryden frye
Balamuth's
Robinsons and Inoki
Stains: Lugol's iodine: Cyst
Quensel's methylene blue:
Trophozoite

FREE LIVING AMOEBAS

Naegleria folweri Acanthamoeba species
- Cyst, flagellate (non feeding temporary) Trophozoite No flagellate form
-Amoebastomes: Sucker like structures four phagocytosis in Motility: Sluggish polydirectional
culture forms Double-walled cyst with outer wrinkled wall & inner
lobose monopseudopodtum & very prominent nucleus with a polygonal wall
centrally located nucleolus Contact lens solution in tap water
IS and DS: Trophozoite IS and DS: Trophozoite
POE and MOT: Nasal olfactory nerve (brackish or POE and MOT:
freshwater) 1. Nasal olfactory nerve
2. eyes/ cornea
3. ulcerated or broken skin
Primary amoebic meningoencephalitis • Granulomatous amebic encephalitis
• Corneal ulcer keratitis
Culture media : Bacterial seeded agar with E coli
Non-nutrient agar plate_seeded with a lawn of heat-killed or PYRC: Proteus peptone yeast glucose cysteine
living Escherichia coliGiardia
Bacterial seeded agar: 0.2% NaCl + KCl - Naegleria folweri
inhibited
Diagnosis: Acridine orange
Lyophilization- 6 months- N gruberi viable

Blastocystis hominis often mistaken as cyst of amoeba

- former yeast - pseudopods
- no cell wall - binary fission
Formerly classified as yeast; now considered an ameba.
Fungal culture no growth Culture media:
Commensal: Multiplied: Diarrhea Boeck/ Drbohlav's
Nelson and jones (optimal growth: 37 C w/ bacteria)
1. Vacuolated- main cause of diarrhea 3. Granular- old culture
2. Ameba like intermediate ingest bacteria 4. Cyst

SUBPHYLUM MASTIGOPHORA
- A.k.a “Flagellates”
- Move by means of flagella- whip like
• Motor component: axonemes and flagella
• Neuromotor apparatus blephlaroplast, parabasal body
• Axostyle: cellular support
• Axoneme: intracellular flagellum
• Undulating membrane: finlike wavelike motion

a. Intestinal flagellates - Giardia lamblia

- Dientamoeba fragilis
- Chillomastix mesnii
- Pentatrichomonas hominis

b. Atrial flagellates
- Trichomonas spp.

c. Blood and tissue Flagellates - Leishmania spp.

- Trypanosoma spp.

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INTESTINAL AND ATRIAL FLAGELLATES
SPECIES L I F E C YC L E PATHOGENESIS DIAGNOSIS
1. Demonstration of parasite a.
Stool specimen
b. Duodenal aspirate
a. Acquired via ingestion of
- Gastrodoudenoscopy
mature cyst (water-borne),
- Nasogastric insertion
passed through the stomach
- Diagnostic stage: trophozoite
then reaches the duodenum – Giardiasis : Can cause
c. Enterotest (string test)
excystation occurs yielding 2 “Gay bowel syndrome”: Frothy
- Utilizes string device made up of
trophozoites stools, Steatorrhea, Leningrad's- St
gelatin capsule inside a spool of
Giardia lamblia/ b. Adheres to mucosa of Petersburg curse (travelers
nylon string and a weight
duodenalis, intestinal wall through diarrhea), backpackers diarrhea,
(collection of trophozoite- after 4
intestinalis/ Lamblia sucking disks beaver fever
hours) cysts are found in duodenal
intestinalis c. Multiplies , then
contents
encystation occurs in colon, Common in US
VSP: Variant specific surface
cysts passed in feces HYPERENDEMIC: transmission
protein- resistance to intestinal
(formed), and as trophozoite between homosexual males
proteases
(watery stool)
Cytoplasm - halo effect
Habitat: small intestine: Lives
2. Serological test- Ag detection
in Crypts of duodenum
Direct fluorescent antibody-
most specific and sensitive test

Associated with immunosuppressed

Chilomastix mesnili patients
General: non pathogenic
Other feature: Dientamoebiasis : often
1. Demonstration of parasite
“Shows explosive asymptomatic Transmitted through
Stool specimen (trophozoite
disintegration in fecal-oral route 25% diarrhea
Dientamoeba stage)
water” ,abdominal pain, flatulence,
fragilis a. Direct fecal
– tendency to be swollen in nonspecific gastrointestinal
Very delicate b. SCT
water granules to cytoplasm symptoms; Concomitant with
- inmates, colleges c. Permanent stains
will exhibit Brownian pinworm infection
students, military
movement then swings back (E. Vermicularis; anal pruritus)
recruits Common in US
to the normal size – referred MOT: via transmission of E. Flagella only present in Electron
to as “HAKANSON vermicularis eggs microscopy
phenomenon”
Pentatrichomonas
Commensals
hominis
Transmitted through direct contact:
sexual contact. Trichomoniasis –
clinical condition resulting from T.
vaginalis infection
Females: 50% asymptomatic & 50%
symptomatic Wet mount (jerky motility)
s/s : vaginitis/ cervicitis (vaginal Culture
discharge- yellowish in color/ Rapid Ag tests
Trichomonas greenish in color/ frothy); PCR
vaginalis pruritus;dysuria; Male carrier
dyspareunia(painful sexual contact); Media: Diamond’s medium
hyperemic vaginal mucosa Feinberg Whittington
Males: generally asymptomatic; Only flagellate in urogenital
occasionally appear in form of
urethritis & prostatitis
NB. Causes “Ping-Pong Infection”
–requires treatment of both sexual
partners
Trichomonas tenax Commensals

TROPHOZOITES OF INTESTINAL AND ATRIAL FLAGELLATES

NUMBER OF NUMBER OF
SPECIES SHAPE MOTILITY OTHER FEATURES
NUCLEI FLAGELLA
Sucking disk occupying 1⁄2
Pear- shaped
to 3⁄4 of ventral surface
Pyriform shape, 4 lateral (2
“Falling Leaf”, 2; not visible in “old man w/ eyeglasses”
Giardia lamblia tear-drop shape; ventral , 2
flip-flop unstained mounts “monkey face”
dorsoventrally dorsal)
Football shaped
flattened
Cytoplasm: halo effect
Chilomastix Pear- shaped Stiff, rotary, 1; not visible in 3 anterior, 1 in Prominent cytostome
mesnili Spiral, boring, unstained mounts cytostome extending 1/3 to 1⁄2 length

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 of body. Spiral groove
jerky across ventral surface
Shepherd’s crook
Karyosome usually in form
1 or 2. In
Ameboid, of cluster of 4-8 granules.
approximately
pseudopods are No peripheral chromatin.
40% organisms
Dientamoeba angular, serrated, or Cytoplasm is finely
Sluggish only 1 nucleus None
fragilis broad-lobed and granular, vacuolated, and
present. Nuclei
hyaline; almost may contain bacteria.
not visible in
transparent Organism formerly
unstained mounts
classified as amoeba.
Undulating membrane
Pentatrichomonas 1; not visible in 3-5 anterior, 1
Pear- shaped Rapid, jerking extending length body.
hominis unstained mounts posterior
Commensal
Undulating membrane 1/2
of body. No free posterior
Trichomonas 1; not visible in 3-5 anterior, 1 flagellum; does not live in
Pear- shaped Rapid, jerking
vaginalis unstained mounts posterior intestinal tract; seen in
vaginal smears & urethral
discharges
Undulating membrane (2/3
length of the costa ) extends
the length of body.
Trichomonas 1; not visible in 4 anterior, 1
Pear- shaped Rapid, jerking Flagellum extends 1⁄2 of
tenax unstained mounts posterior
body length. Axostyle
extends beyond posterior.
Commensal
CYSTS OF INTESTINAL AND ATRIAL FLAGELLATES
NUMBER OF
SPECIES SHAPE OTHER FEATURES
NUCLEI
Fibrils and flagella oriented longitudinally in
Usually 4 ; not cysts with other deep – staining fibrils lysing
distinct in unstained laterally or obliquely in lower part of cyst.
Giardia lamblia Oval or ellipsoidal
mount. Usually Cytoplasm often retracted from cyst wall. There
located at one end may also be a “halo” effect around outside of cyst
wall in stained smears.
Lemon-shaped, with anterior
hyaline knob or “nipple”
1; not visible in Cytostome with supporting fibrils. Usually visible
Chilomastix mesnili Protrusion at end
unstained mounts in stained preparation
Pear shaped
Lemon cyst

BLOOD AND TISSUE FLAGELLATES

Development AMASTIGOTE
PROMASTIGOTE EPIMASTIGOTE TRYPOMASTIGOTE
stages Leishman Donovan body
Other name Leishmania stage Leptomonas stage Crithidia stage Trypanosome stage
Fusiform; spiral shape
Generally ellipsoidal/
Fusiform in shape/ elongated
ovoidal or spherical/ Fusiform
Appearance spindle shape Posterior to nucleus
Leishman form Crithidial form
Anterior to nucleus trypanosomal form
found in humans
Form C shaped/U-shaped
Host’s blood and tissue
Insect vector
Multiplies within the cell Long & thin, with
Insect vector Long & thin, with
Contains a nucleus, a basal undulating membrane, &
Long & thin, found in undulating membrane
body Leishman- structure free flagellum with
insect vector (first stage UM:
Others (BLEPHAROPLAST) and VOLUTIN GRANULES
INFECTIVE STAGE appears)
small parabasal body. Found In ARTHROPOD
OF Leishmania Found in insect vector
Leishmania & T. cruzi in HOST
CULTURABLE STAGE of Trvpomastigote
humans INFECTIVE STAGE OF
TRYPANOSOMES
GENUS LEISHMANIA
Leishmania tropica/ L mexicana/ Leishmania donovani/ L infantum/ L
CRITERIA Leishmania braziliensis
L major chagasi
Phlebotomus Lutzomiya Lutzomiya Lutzomiya
Habitat/ source Macrophages of the skin, nearby Within macrophages, skin, Reticuloendothelial cells ,
lymph nodes, endothelial cells, mucous membranes of the macrophages of the liver, spleen, bone

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 marrow , intestinal mucosa and other
monocytes nose, and buccal cavity
body organs
Acquired from: Tissue juice Tissue juice Blood
Afghanistan; Brazil; Iran; Peru;
Epidemiology South and Central America Brazil; India; Nepal; and Sudan
Saudi Arabia and Syria
Cutaneous leishmaniasis
Also termed as “Old world
leishmaniasis”/ oriental sore/
tropical sore/ “Aleppo button/ Mucocutaneous leishmaniasis Visceral leishmaniasis - Affects
Jericho boil or Delhi boil or - Initial lesion is “Weeping visceral organs
Baghdad boil. ulcer” (fluid exudes from - Has lesions on the skin; manifested be
Disease - Starts w/ cellular infiltration, then ulcer) fever, hepatomegaly and splenomegaly;
necrosis and ulceration invites - Also termed in general leads to lymphadenopathy
secondary invasion, leading to “Spundia,” “Chichero ulcer,” A.k.a. “ Kala-azar”, “Dum-dum fever”
granuloma formation “Uta” , Bubas or “Death fever”
- Healing w/ scar (2-10 weeks)
Localized cutaneous infection
(macule > papule
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
Life cycle the proboscis
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”/ Leishman 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)
d. Serologic tests
Diagnosis
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
G E NU S TR Y P A N O SO M A
Trypanosoma brucei Trypanosoma brucei
Criteria Trypanosoma cruzi
rhodesiense gambiense
T. rhodesiense T. gambiense
OTHER South American trypanosomiasis Or “Chagas
NAME “ African trypanosomiasis ” or “ Old world disease”
trypanosomiasis ”
Disease Riverine South American trypanosomiasis or
Game attacking “ Chronic African “ Chagas disease ”
“Acute African trypanosomiasis trypanosomiasis ” - Initial lesion is in the skin , associated with
” or “ Sleeping sickness ”/ Or sleeping sickness/ “ the bite / any abrasion of the skin; produces
“East African trypanosomiasis” west African parasitized cells – “chagoma” small reddish
trypanosomiasis” painful nodules
3 Stages : (1st manifestation)
1st Stage : associated w/ the bite w/c produces lesion at the - Swelling of eyelid – bite /entry by the
site of bite; becomes a hard nodule (hard, itchy and painful) conjunctiva; referred to as
2nd Stage: associated w/ the entrance into the blood – “ Romaña’s sign ”
“parasitemia ” ; production of toxins (toxemia) ; w/c may result to regional lymphangitis &
enlargement of lymph nodes on the cervical area w/c is lymphadenopathy

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 referred as “winterbottom’s sign” ; hepatomegaly &
splenomegaly , lesions on the bone marrow
3rd Stage: associated with the involvement of CNS ;
neurologic infection; shows encephalitis and somnolence RES, cardiac muscle, CNS, C shaped
(excessive drowsiness) leads to coma and death Chronic stage: Heart and digestive tract
Involves Reduvid bugs belonging to the family
of Reduvidae; referred to as
“ Cone-nosed bug ” /
Involves “game attacking spp Involves “ The Kissing bug” / “Assassin bug” /
of genus Glossina” – primarily “Riverine spp of Triatomid bugs
bite animal/game animals Glossina” because they 1. Genus Panstrongylus megistus
Vector host
1. Glossina morsitans live along river banks 2. Genus Triatoma
2. Glossina pallidipes 1. Glossina palpalis ( Triatoma infestans )
3. Glossina swynnertoni 2. Glossina tachinoides 3. Genus Rhodnius
( Rhodnius prolixus )
Triatoma rubrofasciata
- vector in the philippines
Sporadic infection (due to game Limited to American continents : South and
Epidemiology Epidemic infection
animals) Central America

Two different host:

a. Man
b. Vector : “Tsetse flies” from
Genus Glossina - Has indirect
life cycle;
Vector host:
All Stages occur: a. Amastigote (found in RES)
1. Acquired through blood meal
b. Promastigote
acquiring
(found in human host – transitional stage)
trypomastigote ; carried into the
c. Epimatigote ( found in man as transitional stage; in midgut of the vector
midgut of the vector and
w/c multiplies) d. Trypomastigote
multiplies through binary
(“C shape”/ “S shape or U shape”; found in blood of man – extracellularly;
fission
found in hindgut of vector)
2. Returns to the anterior gut,
Vector host:
then transformed into
a. Infected during a blood meal:
epimastigote
trypomastigote (infective stage)- carried into the midgut then changes into
( at a certain time reverts back
epimastigote and multiplies longitudinally by binary fission b. Goes into
LIFE CYCLE into trypomastigote)
the hindgut (posterior gut)
3. Metacyclic trypomastigote
c. Becomes into metacyclic trypomastigotes then passed in feces of the
infects man through a blood
vector
meal.
Man:
Life cycle in man:
a. Associated w/ the bite of vector and
1. Acquired via bite of the tse-
defacates containing the metacyclic trypomastigote, rubbed onto the skin
tse flies, injecting metacyclic
(bite puncture/abrasion/mucosa of the eyes
trypomastigote
b. Trypomastigote enters and ingested by macrophages, then transforms
2. Multiplies through binary
into amastigote then multiplies causing rupture of macrophages –releases
fission, invades the bloodstream
amastigotes – infects other cells or may transform into promastigote –
3. From the blood stream enters
epimastigote – into trypomastigote then enter cells of other organs.
the lymph nodes and the
different organs of the body
(tissue spaces) NB. They do not
become intracellular
Localizes in the central nervous
system
Based on isolation and demonstration of parasite:
1. Demonstration of parasites
Specimen : blood and tissue aspirates
Specimen : blood, tissue
a. Direct microscopy
aspirate, and CSF
Blood: trypomastigote stage Tissue aspirate: amastigote stage
a. Direct microscopy
b. Tissue culture : Novi-Macneal-Nicolle medium - Trypomastigote
(diagnostic stage :
Diagnosis c. Xenodiagnoses
Trypomastigote stage)
– involves laboratory bred / reared bug (triatomid bug: a controlled bug,
- Wet mounts
free of infection ) allowed to feed/ take a blood meal on a patient suspected
- Fixed or stained smears b.
of having Chagas disease ; after 7-10 days, the bug is dissected and
Serologic tests
examined microscopy technique (trypomastigote / epimastigote can be
Increased serum IgM levels
isolated)
Stercorarian
Categorial Salavarian – undergoes anterior
- (feces) infective stage is passed in feces
Division station of development
- Undergoes posterior station of development
P H Y L U M C I LI O P H O R A
Species : Balantidium coli (largest intestinal protozoa)
Only significant ciliate
Largest parasitic protozoan
Motility Number of nuclei Other features Pathogenesis
Trophozoite Ciliates; rotary, 1 large, kidney – shaped Body covered with cilia, Balantidiasis
boring; may be rapid, macronucleus; 1 small round w/c tend to be longer - Causes ulceration;

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 micronucleus, which is characterized by wide
difficult to see even in stained near cytostome; mouth and rounded
rolling ball, thrown
smear; macronucleus may be cytoplasm may be base
ball
visible in unstained vacuolated Pathogenic mechanism:
preparations a. Motility : rotary
Macronucleus and motion enables invasion
contractile vacuole are of the host
visible in young cysts; in b. Production of enzyme
1 large macronucleus visible in hyaluronidase leads to
older cysts. Internal
Cyst unstained preparation; lectic necrosis
structure appears
micronucleus difficult to see
granular; cilia difficult NB. No extraintestinal
to see within the cyst infection. Confined in
wall the small intestine.
a. Acquired via ingestion of cystic stage
b. Enters the small intestine and undergoes excystation
Life cycle 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, vegetative
c. Cilia : locomotory apparatus; rotary motion
d. Contractile vacuoles: osmoregulators of the parasite
e. Food vacuole
f: cytostome: funnel shaped
g. cytopyge
NB. Other reservoirs: Hogs
- They are believed to cause infection w/ man. When man ingests the infected hogs

PHYLUM APICOMPLEXA
Class Sporozoa- obligate intracellular, no apparent locomotion: 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:
- 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 : fusion of macrogamete and microgamete b. Zygote – product of syngamy
c. Sporogony : development of sphorozoites/ formation of sphorozoites

Alternation of generation :
a. Monoxenous parasite:
- Alternation of generation happens/ occurs in the same host b. Heteroxenous parasite
- Alternation of generation occurs in different hosts

BLOOD COCCIDIA
Plasmodium species
- Plasmodium falciparum - Plasmodium vivax
- Plasmodium malariae
- Plasmodium ovale

Life cycle: indirect life cycle

Two hosts : man and vector ( mosquito belonging to the Genus Anopheles- only the female anopheles mosquito takes a blood
meal)

In man:
a. Acquired via bite of anopheles mosquito injecting sporozoite stage, along its salivary juice (containing sporozoite)

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b. Within 1 hour , it enters the liver cell (hepatocytes), and initiates the “preerythrocytic schizogony” (sporozoites become
schizonts)
c. Binary fission occurs --- merozoites – causes rupture of infected hepatocytes w/c releases the merozoites and invade the
RBCs
d. Initiation of erythrocytic schizogony – merozoites become “Ring forms”- earliest forms
NB. Hypnozoites – inactive sporozoites that can be reactive & produce preerythrocytic schizogony P. vivax & P. ovale can
have 2nd generation of preerythrocytic schizogony . development of hypnozoites

P. falciparum & P. malariae enters RBCs directly

e. Trophozoite (feeds on Hbg of RBCs and become larger in size)
f. Becomes a Schizont then merozoites
g. Merozoites can enter another RBC or transforms into a gametocyte
NB. P. falciparum – has affinity of RBCs of all ages

In vector host:
a. Acquired via blood meal; infected by gametocyte stage; then it matures
b. Exflagellation produces 5-8 microgametes ; fertilization occurs—produces zygote, then zygote becomes elongated and
motile termed as “ookinete/ travelling vermicule”
c. Penetrates intestinal wall of mosquito and forms a cyst wall w/c refers to “oocyst”
d. Oocyst undergoes nuclear and cytoplasmic division, producing sporozoites (sporogony)
e. Oocysts ruptures releasing sporozoites
f. Sporozoites migrate in the salivary glands of the vector ready for injection during a blood meal.
Man: intermediate host ; harbors asexual stage Mosquito: definitive host; harbors the sexual stage

INFECTIVE STAGE(S)
To MAN (host) Sporozoites
To Mosquito (vector) Gametocyte: required by mosquito during blood meal

Species Pathogenesis Geographic Distribution

Tertian malaria Acute malaria/ malignant malaria (black
water fever- intravascular hemolysis + hemoglobinuria) -
Common cause of malaria (Philippines)
Plasmodium falciparum Tropical regions
- >70% (fatal)
High mortality
medical emergency
Tertian Malaria Benign tertian malaria
Tropical , subtropics and some
Plasmodium vivax - most common cause (worldwide)
temperate areas
- <30%
Plasmodium malariae Quartan Malaria - <1% Tropics
Tertian Malaria West Africa, India and south
Plasmodium ovale
least common America
Quotidian malaria
Plasmodium knowlesi Palawan
Medical emergency

Malaria : derived from “mal” – bad ; “aria” –air

Signs and Symptoms:
I. Prodromal :
- Right after incubation; characterized by flu-like symptoms such as : fever, body malaise and headache
II. Stage of active invasion:
- Associated w/ presence of parasite in RBC
a. Anemia : rupture of infected RBCs and even autoimmune lysis

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b. Hepatosplenomegaly: associated to the activation & proliferation of macrophages
III. Febrile paroxysms
- Occurs 6-10 hours ; refers to fever attack - Characterized by 3 stages:
a. Cold stage – chills, 20 mins to 1 h
b. Hot stage –fever , 1-4 h
c. Sweating stage –profuse sweating, 2-3 h
- Synchronizes with the end of erythrocytic schizogony (when RBCs ruptures, releasing the merozoites)

Tertian malaria : characterized by length of asexual cycle of 48 hours; fever reoccurs every 3rd day
Quartan malaria: characterized by length of sexual cycle of 72 hours; fever reoccurs every 4th day

Primary attacks:
- Includes febrile paroxysms ; depends / vary from species to species
P. falciparum (2-3 weeks)
P. vivax (3-8+ weeks)
P.malariae (3-24 weeks)
P. ovale (2-3 weeks)
- Even w/o treatment the individual will enter a phase of asymptomatic; RBCs are cleared (does not constitute cure): may
lead to relapse/occurrence
2 Types of relapse : Relapse Recrudescence
Reappearance of symptoms after a period of w/c the
Renewed symptoms arising from increase number of
parasites have been absent in blood; associated w/ P. vivax
persisting blood stage forms to clinically detectable level;
and P. ovale (due to subsequent preerythrocytic schizogony /
blood has not been cleared of parasites; associated w/ P.
activation of hypnozoites- dormant stages, found in liver,
falciparum and probably P. malariae , P knowlesi
activated →release)
Pernicious Malaria
- Acute type of disease
- Acute malaria/malignant malaria; associated w/ P. falciparum
- Due to 4 factors:

1. Hyperparasitemia
- Due to infection to RBC of all ages (associated w/ black water fever –a syndrome of massive intravascular hemolysis w/c
results hemoglobinuria ( urine becomes dark color/brownish due to Hgb)
2. Cytoadherence
- Based of expression of parasite derived molecules on the surface of infected red blood cells

Molecules
- strain specific: infected by P. falciparum only
- Stage specific : expressed only when a parasite starts to divide (stage prior to division); causes the RBC to become sticky,
therefore causing agglutination: rbc will also adhere in the capillary endothelium – obstruction of capillaries—constriction of
capillary – obstruction of blood flow – hypoxia or anoxia – necrosis

LABORATORY :
• STAT in PARA: Thin and thick smears; DOH recommended to detect and identify malarial species
• Ideal time to collect: onset of fever
• Afebrile: ASAP
1. Microscopic examination:
Romanowsky- stained (thick and thin blood film by GIEMSA stain)

I. Preparation of blood films obtained by capillary or venous blood

- Capillary blood : most preferred sample; yields a # of parasite, especially for P. falciparum
- Thick & thin blood films are prepared directly

II. Venous blood:

- Use of anticoagulant
- NB: clotting may entrap the organisms
- Preferred anticoagulant is EDTA; prepared 1 h after collection, because it may cause morphological changes of the parasite
if prolonged.
Thick smear Thin smear
3 drops of blood; 1 cm away from thin smear ; 1 cm diameter-
1 large drop of blood
circular motion
Not fixed
(in order to cause cell lysis of RBC to undergo dehemoglobinized/ Fixed w/ methanol (prevent cell lysis)
dehemoglobination)
Examined first at the center ; no RBC, WBC & plates & parasites Examined at the feathery edge/tail;
are seen RBC,WBC,platelets and parasites are seen
Must have examined 100 OIF Must have examined 200-300 OIF
For Rapid detection For species identification

2 Methods of staining:
a. Rapid staining : making use of GIEMSA at 10% concentration – (5-15 mins)
b. Regular staining : makes use of 3% GIEMSA – (30-45 mins)

3 major considerations/ criteria to examine for malarial parasites:

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 a. Appearance of infected rbc
- Size of parasitized cell
- Shape (P. ovale – jagged/fimbriated ) - Stipplings
- Plasmodium falciparum : Maurer’s dots (wedge shape) - Plasmodium vivax : shuffner’s stipplings (small
granules)
- Plasmodium malariae: Zieman’s stipplings
- Plasmodium ovale: Jame’s stipplings b. Appearance of the parasite stage
-P. falciparum: only ring forms & gametocyte seen c. Parasite stages found in the peripheral blood
Fluorescence staining
- Makes use of fluorochromes( acridine orange, benzothiocarboxypurine)
- Excited w/ UV light , w/c will give of fluorescence

QBC microhematocrit centrifugation method (quantitative buffy coat)

- Commercially available ; not exclusive for malarial parasite
- Test kits:
1. Capillary tubes – coated w/ acridine orange (filled up w/ blood)
2. Caps – used as closures of capillary tube
3. Plastic floats – for insertion into the capillary tube w/ 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)

2. Non – Microscopic tests

I. Immunodiagnosis
- Detection of presence of antigen & antibody for malarial parasite
- Sample: serum

Rapid diagnostic tests (RDT) for malaria - Based on detection of antigen

- Immunochromatographic test ; relies on immunochromatography ( on the migration of a fluid on the surface of a
nitrocellulose membrane ); makes use of adsorbent pad made up of nitrocellulose.
- Principle: based on capture of parasite antigen w/ labeled monoclonal antibodies.

Malarial Antigens:
a. HRP-2 (histidine – rich protein 2)
- Water-soluble protein, that is formed only by P. falciparum, only by asexual stage including gametocytes

b. PLDH (parasite lactate dehydrogenase)

- Enzyme in the glycolytic pathway
- Produced by all malarial parasite

c. Plasmodium aldolase
- Enzyme in the glycolytic pathway
- Produced by all the malarial parasite ; also referred to as PMA (pan specific malarial antigen)

1. Parasight F test
- Detects only the presence of HRP -2
(+) P. falciparum
- Disadvantage: does not detect other malarial parasite
2. OptiMAL test
- Uses a dipstick ; detects HRP-2 & pLDH
- Adv. Detects infection w/ P. vivax
- (+) 2 lines – P. vivax; 3 lines –P. falciparum; does not distinguisd mix infection w/ other species
3. ICT malaria P.f/P.v
- Uses a card format or a cassette format - Based on immunochromatography
- Detects HRP-2, Plasmodium aldolase
(+) 3 lines
1st : control
2nd: detects HRP-2
3rd: detects Plasmodium aldolase
4. ICT malarial P.f

II. Molecular diagnosis

- Includes gene amplification through the method polymerase chain reaction(PCR)
Mosquito vectors: found in the Philippines - Night biters (6 pm – 6am)

Primary : Anopheles flavirostris

Secondary:
- A. litoralis
- A. maculatus
- A. mangyanus - A. balabacencis

Other modes of transmission :

1. Transfusion malaria : transfusion of contaminated blood
2. Using contaminated needles and syringe

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3. Congenital malaria : passed from mother to the baby; it is believe that the malarial infection is only passed when the
placenta is damaged.
Criteria Acquired from bite of mosquito Transfusion acquired
Infective stage Sporozoite Any of the sexual stage
Length of incubation Longer Shorter
Occurrence of true relapse Present Absent

Resistance to Malaria:
- Resistance to P.vivax : in Fy(a-b-) west African and American blacks are resistant (bec. 90% duffy antigen negative w/c
serve as attachment sites for the parasite)
- P. falciparum : a. found in sickle cell trait and sickle cell anemia; eb. found in G-6PD deficiency
(presence of large percentage of Hgb)
Plasmodium Plasmodium Plasmodium Plasmodium
Criteria Plasmodium vivax
falciparum malariae ovale knowlesi
All stages Young Old: senescent Young All
Persistence of
erythrocytic No Yes No Yes
cycle
Possible, but
No, but long-term
No long-term relapses Yes usually
Relapses recrudescence are Recrudescence
Recrudescence true relapse spontaneous
recognized
recovery
36-48 hours 44-48 hours 72 hours 48 hours
Time of cycle Quotidian
Tertian Benign tertian Quartan Tertian
1 1⁄2 larger than 60% of cells
normal; oval to larger than
Appearance of
normal; maybe Normal shape, size normal and oval;
parasitized
Both normal normal size until ring may be normal or 20% have
RBCs; size and
fills 1⁄2 of the cell slightly smaller irregular,
shape
Small reddish dots in frayed/ragged
RBC edges
Shuffner’s stipplings :
James’
usually present in all Stinton and
Inclusions Maurer’s dots : wedges Zieman’s stipplings stipplings/
cells except early ring Mulligans
Shuffner’s
forms
Color of Normal; bluish tinge at
Decolorized, pale Normal Decolorized, pale
cytoplasm times
Multiple
Common Occasional Rare Occasional
rings/cells
Ring forms few , as
All developing Young ring forms and
ring stage brief;
stages present no older stages; few All stages
All stages present mostly growing and
in peripheral gametocytes; rare present
mature trophozoites
blood mature schizonts
and schizonts
Delicate, small ring w/
small chromatin Ring often smaller
Ring is larger
dot(frequently 2); scanty than in P. vivax,
Young Ring is 1/3 diameter and more
cytoplasm around small occupying 1/8 of cell;
trophozoite of cell; cytoplasmic ameboid than P.
vacuoles; sometimes at heavy chromatin dot,
(early ring circle around vacuole; vivax, otherwise
edge of RBC (applique vacuole at times
forms) heavy chromatin dot similar in P.
form) or filamentous “filled in”, pigment
vivax
slender form; may have forms early
multiple rings in cell
Multishaped, irregular
ameboid parasite; Ring shape
Non-ameboid
streamers of maintained until
rounded/ band-shaped
cytoplasm close to late in
Growing Heavy ring forms; fine solid forms;
large chromatin dot; development;
trophozoite pigment grains chromatin may be
vacuole retained until non-ameboid
hidden by coarse, dark
close to maturity; compared to
brown pigment
increasing amounts of P.vivax
brown pigment
Vacuoles disappear
early; cytoplasm
Not seen in peripheral Irregular ameboid Compact;
compact, oval, band
blood(except in severe mass; 1/more small vacuoles
shaped, or nearly
Mature infection); development vacuoles retained disappear;
round almost filling
trophozoite of all phases following until schizont stage; pigment dark
cell; chromatin may
ring form occurs in fills almost entire cell; brown, less than
be hidden by
capillaries of viscera fine, brown pigment in P. vivax
peripheral coarse,
dark brown pigment

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 Progressive chromatin Similar to P.vivax
division; cytoplasmic except smaller; Smaller and
Schizont Not seen in peripheral
bands containing darker, larger pigment more compact
(presegmenter) blood
clumps of brown granules peripheral or than P. vivax
pigment central
Merozoites, 16 (12- 3⁄4 of cells
8(6-12) merozoites in
Not seen in peripheral 24) each w/ chromatin occupied by 8 (8-
Mature rosettes or irregular
blood; in rare cases may & cytoplasm, filling 12) merozoites in
schizont clusters filling normal
be seen entire RBC, w/c can rosette or
sized cells
hardly be seen irregular clusters
Sex differentiation
Rounded / oval
difficult, “cresent or
homogeneous
sausage” shapes Similar to P. vivax,
cytoplasm; diffuse,
Microgametocy characteristic; may but fewer in number, Smaller than P.
delicate, light brown
te appear in “showers”; pigment darker and vivax
pigment throughout
black pigment near more coarse
parasite; eccentric
chromatin dot, w/c is
compact chromatin
often central
Large pink to purple
Similar to P. vivax,
chromatin mass
Microgametocy Same as but fewer in number, Smaller than P.
surrounds by pale or
te macrogametocyte pigment darker and vivax
colorless halo; evenly
more coarse
distributed pigment
Large, pale red blood
Development following
cells; trophozoite RBC normal in size RBC enlarged,
ring stage takes place in
irregular; pigment and color; oval w/
blood vessels of internal
usually present ; trophozoutes compact, fimbriated edges;
organs; delicate ring
shuffner’s dots not stain usually intense, Shuffner’s dots
forms and cresent-
Main criteria always present; band forms not always seen in all stages,
shaped gametocytes are
several phases of seen; coarse pigment, gametocytes
only forms normally
growth seen in one no stippling of RBC; appear after 4
seen in peripheral blood;
smear; gametocytes gametocytes appear days or as late as
gametocytes appear
appear as early as after few weeks 18 days
after 7- 10 days
third day

BLOOD COCCIDIA: Babesia species

Babesiosis- tick-borne disease esulting in a febrile illness. Infection with Babesia is most commonly observed in: Patients
without spleen
Babesia microti
- resembles P falciparum ring forms
- no malarial pigments
- most infections in US
- erythrocytic intracellular parasites
- maltese cross formation
- no growing trophozoite
Definite host: Ixodid ticks MOT: Blood transfusion, transplacental
Intermediate host: Man Pathogenesis : Babesiosis
Headache + fever
Hemolytic anemia + hemoglobinuria

Babesia bigemia - redwater fever - cattles

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

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Mode of transmission : ingestion of infective stage
(All are intracellular in the enterocytes – intestinal epithelial cells ) Diagnostic stage: “Oocyst stage”
Species Shape and size
Ellipsoidal oocyst, range 20-30 μm in length, 10-19 μm width; sporocysts rarely seen broken out of
Isospora belli
oocysts, but measure 9-11 μm
Cryptosporidium
Oocysts generally round,4-6 μm, each mature oocyst containing 4 sporozoites
parvum
Oocysts generally round, 8-10μm, oocysts are not mature , no visible intestinal structure; oocyts may
appear wrinkled
Cyclospora
Autofluorescence
cayetanensis
Originally called: cyanobacterium like body
ingestion of GUATEMALAN RASPBERRIES
Sarcocystis hominis Oocyst thin-walled and contains 2 mature sporocysts, each containing 4 sporozoites, frequently, thin
Sarcosytis suihominis oocyst wall ruptures; ovoidal sporocysts each measure 10-16 μm in length & 7.5-12 μm in width
Sarcocystis
Vary considerably
lindemanni
Spores closely related: zygomycetes
Chromotrope/ calcoflour white
Microsporidia Obligate intracellular
Opportunistic- AIDS px- prolonged bacteria
Molecular studies- related to fungi
Enterocytozoan Most common microsporidia
bieneusi cause enteritis in AIDS patients

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
3. Enters enterocytes &
initiates the process of
schizogony—merogony –
leads to rupture of cell
4. Merozoites are
released w/c can either
become gametocytes or
enter another cell and
repeat the process
5. Gametocytes may
continue t syngamy –
forms a zygote – forms a
wall, referred to as oocyst
—passed out in feces
6. Immature oocyst is
passed out
Sarcocystis
Cryptosporidium Cyclospora hominis / Sarcocystis
parvum cayetanensis Sarcocystis lindemanni
suihominis
Heteroxenou
Monoxenous Monoxenous Heteroxenous
s
1. Acquired via ingestion 1. Acquired via M a n:
of mature oocyst ingestion of mature 1. Acquired via ingestion of the
2. Oocyst undergo oocyst sarcocyst
excystation in the 2. Encystation occurs present in contaminated beef or
intestine – releasing 3. Release sporozoite pork
sporozoites – sporozoites and enter into NB: sarcocyst – a tissue cyst ;
enter enterocytes enterocytes contain bradyzoites – one of the
(extracytoplasmic- just 4. Schizogony two forms of trophozoites;
beneath the cell happens; followed by slowly dividing trophozoites,
membrane of the cell) merogony – incased in a wall
3. undergoes gametogony 2. On ingestion the sarcocysts
schizogony : produces 5. Maturation into ruptures releasing bradizoites
merozoites gametes 3. Bradizoites become
4. merozoites can 6. Syngamy— intracellular – enterocytes
transform into produces zygote then 4. Undergo gametogony
gametocytes – forms a wall 5. Maturation then followed by
maturation – syngamy – 7. Zygote turns into syngamy 6. Produces a zygote
produces zygote—then oocyst ; immature w/c is enclosed w/ a wall
forms a wall –oocyst or oocyst passed in feces 7. Immature oocyst w/ 1
can enter another cell 8. Develop 2 sporoblast – divides into 2
5. Oocyst : Thick – sporoblast; develops sporoblast – forms a wall 8. 2
walled oocyst (80% of further to become 2 sporocysts results – undergoes
oocyst); thin-walled sporocysts sporogony—producing 4
oocyst (20% of the 9. Sporocysts sporozoites w/in 1 sporocysts—
oocyst) undergo sporogony 8 sporozoites
6. Followed by outside the host 9. Mature oocysts passed out in
sporogony 10. Mature oocyst: 2 feces
7. 20% (thin walled) can sporoblast; 2 I n ter m ed I a te hos t
rupture its oocyst while sperozoites/ 1. Acquired via ingestion of
still w/in the host then sporocysts—ingested sporolated oocysts (mature
releases sporozoites – results to infection oocyst)
(autoinfection) 2. Enters intestine and ruptures
8. The 80% thick-walled 3. Sporozoites released
are passed out in the penetrating the intestinal
feces – mature oocysts mucosa and enter the blood 4.

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 Carried into the endothelium –
sporozoites transform into
schizonts
5. Schizonts undergo
schizogony ; then merogony—
producing merozoites: released
from the endothelium
6. Can either become
bradizoites – form a wall and
become encysted—sarcocysts or
can enter cells and repeat the
cycle.
Diagnostic Mature Sarcocysts – dead-
Immature oocysts Mature oocysts Immature oocysts
stage oocysts end infection
1. Examination of the
feces - Unsporolated
oocysts 2. Fluorescent
microscopy - 1. Demonstration of parasite
Autofluorescence 1. Demonstration of a. Direct fecal smear – mature
(Characteristic of the parasite- immature oocyst b. SCT
1. Direct fecal
parasite; no making use oocyst c. Fluorescence microscopy
demonstration
of dyes; emit a bright 2. Fluorescent - Autofluorescence
2. Modified Kinyoun
blue –green color) microscopy - d. Modified acid fast staining :
Laboratory 3. Sheather’s sugar
Enterotest; floatation Autofluorescence kinyoun’s method
Diagnosis 3. Auramine / rhodamine/ 3. Modified acid fast Zoite: simplest form (banana
Modified kinyoun’s form)
method - Appears: pink to
red color
- Background: green
Methods of identification:
1. DFS (wet mounts)
2. SCT
3. Permanent staining
Diarrhea
Water-borne parasite; “Cyclosporiasis / Watery, frothy, A non human
causes “Gay bowel cyclosporidiosis” chronic, self sarcocystis,
syndrome” ; “Pulmonary - Once referred to as limited
“Isosporiasis” causing
sporidiosis” “cyanbacterium like diarrhea
Aculculous cholecystitis incidental
Human x2: daycare body”
infection - Dead
Watery, frothy, chronic, Chronic intermittent
Pathogenesis end infection
self limited diarrhea watery diarrhea

Diarrhea in
Diarrhea in immunocompromised person
Causes diarrhea in both immnunocompromised
immunocompromised Gastroenteritis with diarrhea
and immunocompetent individuals
person eosinophilic enteritis
Myalgia

TISSUE COCCIDIA
Toxoplasma gondii
-Either monoxenous/ heteroxenous
-Monoxenous in its natural habitat
(Natural host : cats of Family Felidae )
Life Cycle :
In animal host
a. Passed out in feces of cats, as immature oocyst (ovoidal in shape; 10-12 μm in diameter; contains a single sporoblast w/c
divides into 2 sporoblast)
b. Forms a wall produsing 2 sporocysts ; then develops 4 sporozoites on each
c. Mature oocysts contains 8 sporozoites (sporulated oocyst- infective stage)
d. Undergoes schizogony – merogony – gametogony then syngamy
e. Zygote becomes an oocyst then passed out in feces

In man
a. Heteroxenous : intermediate in other animals and in man • ; definitive for cats
b. Acquired via ingestion of mature oocyst w/c is shed in
cat feces •
c. Oocyst wall ruptures releasing sporozoites;
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

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Pathogenesis :
“Toxoplasmosis ”
- Contact with feline feces in cat litter is a primary source
- 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:
- oocysts= cold blooded animals
- 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)

Congenital Toxoplasmosis:
- manifestations: associated w/ still birth or birth defects w/c
include
1. Retinochoroiditis
2. Cerebral calcification
3. Hydrocephalus or microencephali

Laboratory Diagnosis:
1. Demonstration of parasite
- tissue aspirate : tachyzoites
- biopsy samples : zoitocyst
2. Serological test
- detection of Antibodies - Sabin- Feldman Dye test
- most common method
- Patient with cerebral calcification
• Based on detection of Ab from Pt. serum by reacting it w/ live toxoplasma org. in a presence of dye (methylene blue)
Based on the refractoriness of toxoplasma org. to the methylene blue dye in the presence of specific antibodies
(+) no stain
(--) stained in blue color
3.
HELMINTHS
General Life Cycle: Egg stage > Larval stage > Adult stage
1. Egg
- Undergoes embryonation
2. Larva
- Goes through 4 stages of development
Stages Symbol Other name
1st stage L1s Rhabditiform
2nd stage L2s Filariform
3rd stage L3s Filariform
4th stage L4s Filariform
-  In between stages, “Molting occurs”
-  Molting – shedding of the outermost covering of body
wall (cuticle)
3. Adult

Helminthology – study of worms

a. Phylum Nematoda “Round worms”
• Class Secernencia (phasmidia) : w/ caudal chemoreceptors
hookworm
S. stercoralis
W. bancrofti
B. malayi
• Class Adenophorea (aphasmidia): Lacks phasmids or caudal chemoreceptors “TCT”: Trichuris-
Capillaria-Trichinella
b. Phylum Platyhelminthes “Flat worms”
• Class Cestoda
• Class Trematoda
Amphid- Cephalic chemoreceptors

Phylum Nematoda
- Termed as “round worms” / “nematodes”
- Possess stiff cuticle; sexes are separate (males are generally smaller than females); well-developed digestive system.
- Unsegmented
- Reproduction: oviparous & larviparous
- Infection by :
• Ingestion of eggs

28/35
 • Penetration of larvae through surfaces Arthropod vectors
• Ingestion of encysted larvae

General morphology:
- Elongate, cylindrical worms, frequently attenuated at both ends.
- Possess mouth, esophagus and anus (important in further diagnosis)

Cuticle
- Non nucleated; generally smooth;
- May have: sensory papillae; bosses; spines or tubercle.

Mouth
- Subcuticular muscle
- With somatic muscular bands in four groups

Alimentary system
Mouth: lips; papillae, buccal capsule with teeth or cutting plates
Esophagus: Cellular or muscular: bulbous posteriorly
Alimentary canal; a simple tube
Anus (female); cloaca (male)

Excretory system
Central excretory pore
Excretory canals in thickenings of subcutaneous tissues

Nervous system
Ring of genitalia
Nerve of trunks (6) with transverse commissures

Reproductive system
Male Female
•Testes
•Seminal vesicle •Uterus becomes coiled, full ova/ larvae filling body cavity
• Spicule •Seminal receptacle
•Papillae: pre-anal and post- • Oviduct
anal,sometimes present (basis for species identification) •Ovary (usually paired) •Vulva and vagina ;
Nb. May have copulatory bursa

Class Adenophorea - Aphasmidia

- Trichuris trichiura
- Capillaria philippinensis
- Capillaria hepatica
- Trichinella spiralis

Class Secernencia – Phasmidia

- Ascaris lumbricoides
- Enterobius vermicularis
- Hookworm species :
• Necator americanus
• Ancylostoma duodenale
• Ancylostoma caninum
• Ancylostoma braziliense
- Strongyloides stercoralis
- Toxocara species:
• Toxocara canis
• Toxocara cati
- Filaria species:
• Wuchereria bancrofti
• Brugia malayi
• Onchocerca volvulus
• Loa loa
• Mansonella perstans
• Mansonella streptocerca
• Mansonella ozzardi
• Dracunculus medinensis

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Class
Adenopho
rea
Trichuris trichiura
CRITERI
A
Other
“Whip-worms”
name
Oviparous Cosmopolitan
Descriptio
(common in the tropics &
n
subtropics)
Anterior 3/5 : attenuated
whip-like 3/5 traversed by a
narrow esophagus resembling
string of beads.
Posterior: more robust , 2/5
containing the intestine and a Dheathed spicule
Adult single set of reproductive
schistocyte
stage organs.
(chitinitized)
Male – coiled posterior
Female – bluntly rounded end
String of beads: stichocyte
Slender or attenuated in the
anterior Resembles a whip
“Lemon-shaped”/“Barrel-
shaped”/ Japanese lantern” ;
Egg
with hyaline plugs / pluglike
stage /
translucent polar prominence;
larva
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
Capillaria
Capillaria hepatica Trichinella spiralis
philippinensis
“Pudoc worm” “Capillary liver worm” “Trichina worm”
Typical female:
oviparous
Atypical female:
larviparous Common Larviparous
in : Parasite of animals such as
Philippines , Thailand , rats, other rodents, and dogs larviparous
Korea, Japan, Taiwan, “Autoheteroxenous
Iran, Egypt, Italy and parasite”
Spain
Anterior end: slender, w/ a
small orbicular
nonpapillated mouth
Resembles Trichuris Posterior end: bluntly
trichiura rounded in the female and
ventrally curved w/ two
lobular caudal appendages
in male.
“Peanut- shaped” w/
flattened bipolar plugs;
“Lemon-shaped” ; outer
moderately thick-
shells are pitted like a golf Spear like tip
shelled; has striations;
ball w/ minute pores
shows straw color,
guitar, penut
a. Parasites of fish Life cycle in animals Maintained in nature
eating birds – a. Acquired via ingestion of among animals: swine, rats
transmitted (fish-bird embryonated egg and other rodents
cycle) b. Hatches in small a. Acquired via ingestion of
b. Acquired via intestines, releasing larva encysted larva in pork, bear
ingestion of larva in c. Larva enters the portal meat, walrus meat
fish circulation to the liver; b. Larva is released; then
c. Larva reaches the matures inside the liver d. developed into adult
30/35

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”
Eggs require
developmental period in
warm soil before infective.
IS: embryonated egg
DS: unembryonated egg
“Trichuriasis”
Trichocephaliasis
Light infections: generally
asymptomatic: eosinophilia
Heavy infections:
gastrointestinal symptoms,
bloody diarrhea etc.
Pathogene NB: 1 adult trichuria may
sis cause blood loss of
0.005mm/day – microcytic
type of anemia
– extrusion of rectal mucosa
(loss of muscle tone of
rectum
MOT: ingestion
1. Demonstration of
parasite a. DFS
1. Demonstration of parasite b. Concentration
a. DFS techniques c. KTS
b. Concentration techniques
Diagnosis c. KTS
d. Kato Katz – utilizes
premeasured volume of
sample (quantitative)
Coinfection: Ascaris
Soil (moist shaded suitable/
Autoinfection
ambient temperature humid)
transmitted
female/male
c. Copulation follows
NB. Male dies after
copulation
small intestine
d. Female penetrated into
d. Matures, populate ;
intestinal mucosa and
female lays
produce larva
unembryonated eggs- Lays eggs- unembryonated
e. Larva enters Blood
passed in feces ; egg (ingested by another
circulation or lymph
embryonated eggs host)
f. Localizes in skeletal
hatches and infects e. Passes through the
muscles g. Causes dead-end
man stomach, and passed out in
infection
feces w/o morphological
changes causing spurious
infection
Encysted larva
Life cycle in man a.
Storage at-15°C for 20 days
Acquired via ingestion of
or -30°C for 6 days= T
embryonated eggs
spiralis: not detected by
b. Enters small intestine ,
stool only: muscle biopsy:
IH: Hypsolotris, hatches, releasing larva
KILLS ENCYSTED
Bipartite, Birot, c. Larva enters the hepatic
LARVAE
Bagsang, Bagtu circulation to the liver –
Examination of stool
IS: Larva matures
specimens would not be
DS: Unembryonated d. Causes dead-end infection
effective
egg
Increase eosinophil
When undercooked meat is
digested in stomach, larvae
are resistant to gastric pH
and pass to intestine, where
they invade mucosa
“Pudoc disease” or “Trichinellasis” /
“Mystery disease” “Trichinosis” /
Instinal capillariasis “trichiniasis”
- Severe protein losing “ Hepatic capillariasis” - 3 stages:
enteropathy Develops acute hepatitis 1st : intestinal invasion –
s/s gastrointestinal - Eosinophilia gastrointestinal symptoms
symptoms 2nd : larval migration
- Borborygmus 3rd: stage of convalescence
(gurgling of stomach) – fibrosis , degeneration
- Intestinal and calcification
malabsorption
- LBM alternating
w/ constipation
MOT: Ingestion of
freshwater fishes
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) (+)
1. Demonstration of parasite
blanched wheal 5mm or >
a. liver biopsy
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
Dead end Dead end
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C L A S S S E C E R N E N TE A
Toxocara
CRITERIA Ascaris lumbricoides Enterobius vermicularis Toxocara canis
cati
“Pin worm” / “seatworm” Old “Cat
“Giant intestinal round worm” “Dog ascaria” /
name: “Oxyuris vermicularis”/ ascaria” / “
“Lumbricoides teres” “ dog round
Social or Society worm cat round
- Said to be “largest intestinal roundworm” worm”
Common in US: children worm”
resembles common earthworm
Other Name
Second most common nematode infection in Autoinfection: Same host
US (EV, SS) “ Visceral larva migrans” /
Most common helminth in the world “Ocular larva migrans ”
Largest nematode External autoinfection

Distinctive feature:
Smooth cuticle, unstriated , nonsegmented. Similar to Ascaris
- Cephalic alae
- Trilobite lips lumbricoides in appearance but
- Esophageal bulb
Adult Buccal cavity: Triangular, trilobate only a quarter to half its size.
w/ lateral wings or cephalic
lips NB. Toxocara : body is bent
alae
ventrally

a. Fertilized : Broadly ovoid; golden brown Superficially

in color; unembryonated at oviposition. pitted
Thick-shelled

Size: 50-60 x20-30 μm

- Thick-walled ; colorless
shell; - shell flattened on one
Egg side Resemble those of Ascaris, but
- coiled larva developing in are larger, less elongate and
Inner: non-permeable , lipoidal vitelline have thinner shell and
membrane egg - “D-shape”
- embryonated albuminoid outer covering.
Middle: thick, transparent, glycogen
membrane
Outer: coarsely mammilated, albuminous
layer

b. Unfertilized : 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
Cockroach (Periplaneta americana)- carrier
of eggs
MOT: ingestion
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
MOT: embryonated egg
Gravid female: migrate (night) embryonated egg
→eggs
Sporadic infection : several
consecutive collections
MOT: ingestion
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
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 “visceral
larva migrans”
d. can infect eyes – “ocular
larva migrans”

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 “Enterobiasis” / “Oxyuriasis”
due to female adult
- migration of the gravid
females from the cecum to the
“Ascariasis” Light infections: asymptomatic anus, causes intense itching in
Manifestations may be due to : the anal region referred to as
1. Migrating larvae “Pruritus ani”
- causes pneumonitis - insomnia
- eosinophilia associated w/ Loeffler’s - scratching of anal area
syndrome (transient eosinophilic infiltration Due to wandering female adult
of the lungs) - to peritoneum causing “ Visceral larva migrans” –
2. Development of adult worms peritonitis - to appendix infection of visceral organs
Pathogenesis
Gastrointestinal symptoms; decreased causing appendicitis - may “Ocular larva migrans” – eye
growth rate; “sand box infection/ worm ball/ cause vaginitis infection
Potbelly bolus” intestinal obstruction (can be- endometritis, salphingitis
entangled forming ascaris bolus blocking (infects uterus, ovaries etc)
intestinal bowel); downstream wandering Most common urine
( can enter appendix causing appendicitis) or contaminant
can cause upstream wandering
Often seen with trichiura Mother’s complex:
-Pruritus ani
-Lack of sleep
-Extraintestinal enterobiasis

Demonstration of parasite
1. DFS (unembryonated)
Demonstration of parasite:
2. Stool con’c techniques 3. KTS
1. perianal swab : Graham’s
4. Kato-katz
scotch tape method (eggs)/ - eosinophilia
5. Sputum sample : larvae x-ray examination
pinworm paddle - concentration techniques
Diagnosis ( bolus)
2. beneath the nail bed swabs - serology: Ab detection –
Egss collected: late in evening/ ELISA on serum
before defacation/ bathing:
morning

Dioctophyma renale: Giant Kidney Worm

Blood red bell shaped bursa with spicule
Pitted golf ball appearance
IH: Earthworms Paratenic host: Fish and frogs Incidental host: man
Pathogenesis: Destruction of kidney Specimen: Urine

HOOKWORM SPECIES
Necator americanus Ancylostoma Ancylostoma Ancylostoma
Criteria
duodenale caninum braziliense
Agent of laziness in poor white population and tropical anemia in Puerto Rico

“Morula ball” : egg

“New world hookworm”
Other name American hookworm “Old world hookworm” “Dog hookworm” “Cat hookworm”
American murderer
Resembles ancylostoma but smaller; head is
sharply bent in relation to the rest of the Adult worm: grayish white / pinkish; head is slightly bent
Adult
body, forming a definite hook shape at the Female: somewhat longer and stouter
anterior end
Unsegmented; 4-8 egg stage
Somewhat smaller compared to
Egg Shell is thin and colorless Regularly oval Identical to Necator
Necator eggs
Morula ball
A pair of semilunar cutting plates Two ventral pairs of
Buccal Three ventral pairs Two ventral pairs
Median teeth fused teeth
capsule of teeth of unfused teeth
S shpaed C shaped
Short and broad Dorsal
Longer than broad Dorsal rays- deep cleft rays – shallow cleft and Large, flame-
Copulatory As broad as long
and tips bipartite tips tripartite shaped Rays – long
bursa Rays – stunted
Two spicules – fused and barbed Two spicules – unfused and slender
and not barbed
Pathogenesis “Necatoriasis” Includes : Forms spergininous tunnels through
a. Larval penetration – filariform Nausea and vomiting the tissues—erythematous “Creeping

33/35
 Produces dermatitis lesion on the skin; also
referred to as “ ground itch”/ “dew itch” /
“coolie itch” Mazzamora/ water sore :
Severe itching/allergic reaction at the
site of skin penetration
b. Larval migration Pharyngeal irritation
Results to pneumonitis; transient Cough
eruptions” thus, referred to as
eosinophilia – Loeffler’s syndrome Dyspnea
“Cutaneous larva migrans”
c. Adult worms Hoarseness of voice
- Nonhuman hookworm infections
Generally asymptomatic; usually “Wakana syndrome”
Dead end infection; ectoparasite
coincidental – from ingestion of
(heavy infxn: anemia (IDA)– microcytic larva
hypochromic type N. americanus causes
blood loss about 0.03ml (0.15-0.25 ml/day
(0.2 ml)
Hypoalbuminemia
Live: 2-14 years
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
Life Cycle 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

Demonstration of parasite: a. DFS

b. SCT
c. KTS
d. Kato-katz method: egg counting
Diagnosis
e. Caproculture: culture of feces (harada-mori technique – larvae; filter paper test tube method)
Larva- feces: left at room temperature
Entero test: beale’s string test
Specimen: Stool urine sputum

Strongyloides stercoralis/ Threadworm

- Smallest nematode
- Facultative parasite
- Host specific
- Infectious to laboratorians
Parasitic existence : Small intestine Free-living existence: soil
Only female adult ; no male Parthenogenic female: able to
Both male and female
produce a row of offspring w/o the fertilization of the male.

3 Types of Life Cycle: ingest filariform

Indirect life cycle /
Direct life cycle / Homogonic life cycle Autoinfection
Heterogenic life cycle
a. Similar to hookworm spp.
a. Free living existence found
b. Acquired via skin penetration of filariform larva
in the soil
c. Enters the blood circulation
b. Rhabditiform larva
d. To the heart – the lungs—L3s undergoes molting to a. Occurs in the intestines
develops as adult
L4s b. Rhabditiforrm becomes filariform
c. Copulation occurs --- then
e. Ascends to the bronchial tree—to the esophagus— larva
production of eggs
then to the small intestine c. Filariform larva on the perianal
d. 2-4 egg cell stages;
f. Penetration in the mucosa—deposits eggs in the region; develops into FL and
embryonates to form
intestinal mucosa (happens about 2-4 weeks); releases penetrates the skin
rhabditiform larva
L1s or rhabditiform larva d. Cycle repeats
e. Cycle repeats
g. Migrates back to the intestinal lumen and passed out
Infective stage: 5-7 days
of feces—as rhabditiform larva.
Lifespan: undertermined
h. Reaches the soil and and become filariform
Pathogenesis:
“ Strongyloidosis”/ “Strongyloidiasis”/ “Strongyliasis”
Can be transfered thru organ transplantation
MOT: skin penetartion
Signs and Symptoms
1. Larval penetration:
Skin: dermatitis – “Ground itch”/ “Dew itch”/ “Cooley itch”
2. Larval migration
- May produce pneumonitis - Eosinophilia
- Loeffler’s syndrome
3. Development of adult worm
a. Light infection : generally asymptomatic
b. Heavy infection: mucoid diarrhea
“ Cochin-china diarrhea, diarrhea larva curens

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 c. hyperinfection- lead to death from tissue damage
NB. - In immunocompromised individuals: results in hyperinfection (disseminated strongyloidiasis)

Laboratory Diagnosis:
DS: Rhabditiform
IS: Filariform
1. Demonstration of parasite - Stool sample ( DFS ) 2 Morphologic larva
- Short buccal cavity (as long as wide)
- Genital primordium (cluster stage) : described as conspicuous, large/long

b. Isolated by SCT
c. Caproculture technique
- Baermann Technique: a culture technique, w/c uses a funnel apparatus/method
- A fresh stool is placed in a wire mesh, then wrapped w/ cloth (several layer of the gauze / cloth)
- Placed in a container w/ water w/ the funnel, the rhabditiform will pass through the wire gauze
- From gastroendoscopy
- Enterotest, beales string test for diagnosis: eosinophilia
- Sputum or urine
Strongyloides stercoralis (SHOBU LAGE HOOKWORM
LONGES NOTA)
Rhabditiform Short buccal Long buccal
Large genital primordium small genital primordium
Filariform Long esophagus Short esophagus
Notched tail pointed tail
FILARIA SPECIES :
- Belongs to class Secernentea
- Thread-like nematodes
- Blood and tissue nematodes
- Long nematodes
PATHOGENIC Common Name Normal habitat Vector hosts
Mosquitoes of diff. Genera:
Wuchereria
Bancroft’s filaria Lymphatics 1 Anopheles 2 Culex
bancrofti
3 Aedes
Brugian filaria Mosquitoes of diff. species of
Brugia malayi Lymphatics
Malayan filaria Genus Mansonia
Flies: Simulium
Onchocerca Convoluted filaria Subcutaneous tissues (dev’t in fixed
damnosum w/c referred to as the
volvulus Blinding worm nodules) Does not enter blood circulation
“Black-fly” or “Buffalo gnat”
Eye worm African Flies of “Chrysops” referred to as
Loa loa Subcutaneous tissues
eyeworm “Mango fly” or “deer fly”
LESS PATHOGENIC
Mansonella
None Mesenteries
perstans
Culicoides referred to as the
Mansonella Old name: Streptocerca Dermis, subcutaneous (does not enter
“Biting midges”
streptocerca streptocerca blood stream)
Mansonella ozzardi None Subcutaneous

LIFE CYCLE:
1. Acquired through bite of vector; after blood meal microfilariae inside vector transforms from L1s to L2s into the thoracic
cavity
2. L2s develops into L3s w/c migrates into the vector head and proboscis of the vector
3. During blood meal, the filariform will be injected into the host
4. Microfilaria enters the blood stream ready to be peaked up by a vector from a blood meal
5. Filariform enters the preferred habitat; then matures to become an adult worm (diff. sexes) – female lays microfilaria

35/35
FILARIA SPECIES
Wuchereria Brugia Onchocerca Mansonella Mansonella Mansonella
CRITERIA Loa loa
bancrofti malayi volvolus perstans ozzardi streptocerca
Subcutaneous
tissues Subcutaneous
Subcutaneous (develop in Subcutaneous tissues( does
Habitat Lymphatic Lymphatic Mesenteries
tissues fixed nodules ) tissues not enter blood
– does not enter stream)
blood stream
Size
(width
Thick filariae Thick filariae Thick filariae Thick filariae Thin filariae Thin filariae Thin filariae
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 Slightly longer
long short short
space as broad) than broad) as broad) than broad
Start in the
Discrete; Compact;
anterior as
regularly overlapping, Moderately
Nuclei compact compact Compact single row of
spaced in 2-3 irregularly compact
10- 20/more
rows spaced
nuclei
Tapered and Bluntly,
Tapered w/ Tapered w/ 2 coiled w/in the Tapered Bluntly rounded , bent
Long and
single row of conspicuous sheath; nuclei typically rounded; in shepherd’s
Tail slender; devoid
nuclei; no terminal are irregularly flexed, free nuclei extend crook shape;
of nuclei
nuclei in tip nuclei spaced to the from nuclei to the tip nuclei almost to
tip tip
Southeast South and
Africa, South Africa, South
Tropics and Asia, Indian West & Central Central West and
Distribution & Central and Central
subtropics subcontinent America America, Central Africa
America America
s Caribbean
Camarines
Sur,
Camarines
Norte, Albay,
Sorsogon,
Masbate,
Palawan,Mt. Palawan,
Province, Eastern
Philippines none none none none none
Quezon , Samar ,
Mindoro, Agusan, Sulu
Romblon,
Marinduque,
Bohol, Samar,
Leyte,
Mindanao
Province
Nocturnally Nocturnally
Rhythmical periodic (mf is periodic Aperiodic Aperiodic ( no
appearance/ found in PB 10pm – 2am Diurnally ( no rhythm rhythm or
occurrence either at day Nocturnally periodic (found None or pattern in pattern in None
on peripheral time/ the night subperiodic at day time) blood; found blood; found
blood time) (peak con’c anytime) anytime)
10pm- 2 am is at night)

FILARIA SPECIES
CRITERIA Wuchereria Brugia Loa loa Onchocerca Mansonella Mansonella Mansonella

36/35
 bancrofti malayi volvolus perstans ozzardi streptocerca
“Loaiasis”
“calabar
swelling” –
“Onchocercomata”
erythemato Asymptomatic
– a lesion on the
us swelling Calabar-like infection: but
Bancrofts/ skin; nodular and
in the skin swellings, inguinal Characterized
bancroftian erythematous lesion
Malayan/ about 5- pruritus, adenopathy, by pruritic
filariasis on the skin w/c is
Brugian 10cm in hives, fever pruritic and dermatitis w/
(lower 1-5 cm in diameter.
Pathogenesis filariasis diameter and maculopapular hypopigmented
extremities) “Ocular
(upper (also known headache; skin lesions , macules and
Chyluria involvement”-
extremities) as Fugitive “kampala or arthritis , fever inguinal
(milky associated w/
swelling) Uganda eye and eosinophilia adenopathy
urine) blindness –
Migrates to worm” has been
“blinding filariasis”
the eyes – reported.
or river blindness
“Eyeworm”
/ African
eyeworm

LABORATORY DIAGNOSIS:
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 3⁄4 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)
B. Microscopic examination of venous blood (provides larger volume of blood)
I. Knott’s concentration method : very low load
- 10 ml of 2% formalin placed in a centrifuge tube + 1ml of citrated blood
- Mix ; stand for 5 minutes; centrifuge then decant supernatant
- Examine sediment on a slide w/ cover slip
II. Membrane filtration technique
- Also termed “Millipore membrane technique or nucleopore membrane technique
- Set-up:
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)

2. DEMONSTRATION OF MICROFILARIAE IN “SKIN NIPS”

- Associated w/ O.volvolus and M. Streptocerca
- Materials: sterile needle & scalpel / razor blade
- (+): O.volvolus

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 (diethylcarbamazine), w/c generally provokes intense pruritus w/in few
hours due to dying of the microfilariae
- (+) O. volvulus

Dracunculus medinensis
- Longest nematode
- thick cuticle and a large uterus that fills the body cavity and contains rhabditoid larvae
- Commonly called :
“Guinea worm”/
“Serpent worm”/
“Dragon worm”/
“Medina worm” /
“Fiery serpent of Israelites”
Size Description
Adult male 12-29 x 0.4 mm “catgut thread”
Adult female 500-1200x 0.9 -1.7 mm Viviparous
Larva 500-700 x 15-25 μm Coiled; rounded anterior end; tapering & pointed tail
IS: Larva

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DS: Adult worm or larva
MOT: ingestion
IH: cyclops (copepods), water fleas
Pathogenesis: Mesenteric tissues > Pseudo peritoneal syndrome + allergic
MOT: Skin penetratration, ingestion: copepods

Life Cycle:
a. Arthropod- borne ; 2 host: man and a non-blood sucking but aquatic arthropod referred to as the “Copepods” of genus
Cyclops (small crustaceans)
b. Acquired via ingestion of water containing copepods infected w/ L3s (filariform)
c. Larva penetrates the intestinal wall, migrate into the abdominal cavity and retroperitoneal cavity ; about a year of onset-
development into adulthood occurs
d. Copulation takes place ; male dies soon after copulation
e. Adult female migrates to subcutaneous (causes irritation)
f. Migration results to blister formation ( filled w/ fluid then, can rupture and part of the female adult worm will be exposed.
Parasite is released in the water – taken up by another copepod

Pathogenesis:
“ Dracunculiasis / Dracunculosis / Dracontiasis ”

Clinical manifestation:
1. Toxic and allergic manifestations(lower extremities)
2. Blister on the skin

Laboratory Diagnosis:
1. Demonstration of the parasite
- From the skin ulcer/blister (adult female worm)
- Larvae in fluid from ulcer
2. X-ray examination

Epidemiology
- Geographic distribution : NWC America,SW Asia, NE America, W India

Factors that favor the infection:

- Distribution of the vectors
- Drinking from the step wells

Gnasthostoma spinigerium - phasmid

Cephalic bulb, 4 rows of hooks
MOT: Ingestion : Larva : fish bird Snakes
Gnasthomiasis- visceral and cutaneous larva migrans, CNS (eosinophilic myeloencephalitis)
Dicrofilaria immitis - dog heartworm
Pathogenesis: Peripheral nodule: lung ( coin lesion)
Angiostrongylus cantonensis/ Panstronglylus cantonensis - rat lung worm
Barber's pole appearance DH: rat
MOT : ingestive larva L3s snail prawns
Disease: eye and (eosinophilic myeloencephalitis) : Causes human eosinophilic meningoencephalitis
Resembles appendicitis: A. Castaricensis

Anisakis - Herring's worm

MOT: Ingestion raw fish ( larva) DH: Whales dolphin
Pathogenesis : Granulomatous abscess 3 IH: 1. copepods 2. Small fishes 3. Bigger fishes
PHYLUM PLATYHELMINTHES
Class Cestoda / Tapeworms
• hermaphroditic no separate sexes
• Integument: nutrition
• W/ microtriches: microvilli
- Diphyllobothrium latum
- Taenia solium
- Taenia saginata
- Hymenolepis nana
- Hymenolepis diminuta
- Dipylidium caninum
- Echinococcus granulosus

Class Trematoda/ Flukes

All except blood flukes

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 • unsegmented
• leaf like
• incomplete digestive tract
• No circulatory system
• egg operculated
• MOT: ingestion
• IS: metacercaria
• IH: 2nd IH
1. Liver flukes
- Fasciola hepatica
- Clonorchis sinensis
- Opistorchis felineus
- Dicrocoelium dendriticum

2. Intestinal flukes
- Fasciolopsis buski
- Echinostoma ilocanum
- Heterophyes heterophyes - Metagonimus yokogawai

3. Lung flukes
- Paragonimus westermani

4. Blood flukes
• Elongated & cylindrical
• Separate sexes
• eggs non operculated
• MOT: skin penetration
• IS: cercaria: fork tailed
• IH: 1H (snail)
- Schistosoma japonicum
- Schistosoma mansoni
- Schistosoma haematobium

GENERAL CHARACTERISTICS:
- Bilaterally symmetrical
- Compressed dorso-ventrally (flat)
- Collectively termed as “flat worms”
- They are Acoelomate (lack body cavity)
- Organs are embedded in the parenchyma

CLASS CESTODA :
- Termed as “ Tapeworms”
- Gross morphology: elongated ; ribbon-like, segmented ; monoecious –no separate sexes
• Order Pseudophyllidea - Diphyllobothrium latum
• Order Cyclophyllidea - Taenia solium
- Taenia saginata
- Hymenolepis nana
- Hymenolepis diminuta
- Dipylidium caninum
- Echinococcus granulosus

DIVISIONS:
a. Scolex : anterior end of the body; a muscular organ which is described as the “hold fast” or the attachment organ.
• Tapeworms anchor themselves to the inside of the intestine of their host
• Proof of therapy efficacy. Preserved stool, entire stool specimen (5-10% formalin)
• Rostellum- crown of scolex (head) , may be smooth or armed with hooks
2 types:
Bothriate
- Spindle shape or spatulate or spoon- shaped
- Has sucking grooves w/c is referred to as “Bothria/ bothrium”
- One on the mid ventral and one on the middorsal
- Ex: members of Order Pseudophyllidea Acetabulate

Acetabulate
- Quadrate scolex
- Has muscular suckers termed as“Acetabula”
- Ex: members of Order Cyclophyllidea
- Rostellum : a projection at the apex of the scolex; it may bear hooks or spine

b. Neck
- Found behind the scolex
- Unsegmented ; narrowest part; region of growth
- NB: the strobili proliferates from the neck
- Strobilation begings: growth
- new proglottid production

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c. Strobila
- Consists of series/ string of segments (referred to as proglottids)
- Body of cestodes

d. proglottid
- Body of the worm
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

Apolytic Anapolytic
Detaches the main body of the worm to release eggs Refers to the proglottids that detach the body of worm only after
(apolysis) exhausting the eggs
Detach → release Release → detach
Characteristic of Cyclophyllidea Characteristic of Pseudophyllidea

Other characteristic:
TWO TYPES OF PROGLOTTIDS
- No digestive system : obtains nutrition through the integument
- Integument : counterpart of cuticle; w/ microvilli referred to as “Microtriches”
- No vascular system
- Nervous and excretory system present

- Reproductive system:
Male: lies posterior in the dorsal region of each segment
Female: anteriorly on the ventral region of each segment
Genital pore: where the female and male reproductive system meets; also used as an identification marker for adult worms

Order
Pseudophylli Order Cyclophyllidea
dea
CRITERIA
Diphyllobotriu
m Taenia Taenia Hymenolepis Hymenolepis Dipylidium Echinococcus
saginata solium nana diminuta caninum granulosus
latum
Hydatid
tapeworm
Shortest
Dwarf tapeworm
Fish tapeworm Dog
tapeworm (only 3
Common / broad tapeworm
Beef Pork True tapeworm Rat tapeworm segments:
name/ other tapeworm / Doubled
tapeworm tapeworm of man (norway rats)
name broad fish pored immature,
Poor sanitation
tapeworm Flea TW mature,
and children
ripe/gravid)

Anti-P1

One; various One; various

Common Two; One; various
arthropods arthropods
intermediate copepods and One; cattle One; pig arthropods One; sheep
(beetles, fleas) (fleas, dog
host fish (beetles, fleas)
or none lice)
Definitive Cats & dogs
Man Man Man Man Man Man
host (man)
Ingestion of
cysticercoid in
Ingestion of
Ingestion of infected Ingestion of
plerocercoid Ingestion of Ingestion of
Mode of cysticercus arthropod or by cysticercoid in Ingestion of
(sparganum) cysticercus in cysticercoid
transmission in infected direct ingestion infected eggs
in flesh of infected beef in fleas, lice
Pork of egg; arthropod
infected fish
autoinfection
may occur

40/35
 Perhaps many
Normal life Up to 25 Usually < 1 Usually <
Up to 25 years Up to 25 years years as a result 10 or > years
span years year year
of autoinfection
Operculated
(immature/une
m bryonated) :
with
operculum; a
Egg stage Non – operculated (mature/ embryonated)
lid like
opening
through w/c
the larva
escapes
Oncosphere
(L1s w/in the
egg; contain 6 Ciliated Non ciliated
hook embryo;
“Hexecanth”
Cystic
latvae :
cysticercoid;
not fully
Hydatid cysts :
developed
fluid filled w/
invaginated
Cystic larvae brood capsule
Cystic larvae : Cystic latvae : scolex
Metacestode : cysticercus; Cystic latvae : that contain
Solid larvae cysticercus; cysticercoid; Mature &
(encysted filled w/ cysticercoid; not protoscolices;
(procercoid: filled w/ fluid ; not fully gravid
larva in fluid ; has fully developed uniocular
elongated, w/ has single developed proglottids:
extraintestin single invaginated /multiocular
free scolex) invaginated invaginated
al sites) invaginated scolex melon Hydatid cyst:
scolex scolex
scolex seed/pumpk scolicidal
in seed/rice agent : 10 %
formalin
grain-
shaped

d caninum:

e granulosus:

RE PR OD U CT I V E ORG A N S
Order
Order Cyclophyllidea
Pseudophyllidea
CRITERIA
Diphyllobotrium Taenia Hymenolepis Hymenolepis Dipylidium Echinococcus
Taenia solium
latum saginata nana diminuta caninum granulosus
Bilateral;
Central / Lateral w/ Lateral w/
Genital double- pored;
midventral part irregular regular Unilateral Lateral
pore one on each
of each segment alternation alternation
side
15-30 lateral
4-17 lateral Reticular filled
Central; uterine 12-15 lateral
Uterus branches Sacculate w/ egg
coiled/rosette branches branches
fingerlike capsules
tree like
Uterine
Present Absent
pore
Gravid Broader than Longer than
Longer than broad Broader than long V- shaped
proglottid long broad
Type of
Anapolytic Apolytic
proglottid
Scolex Knoblike but
Spatulate not usually Knoblike but Globular but
(Almond Quadrate seen not usually not usually
shaped) Diamond seen seen
shpaed
2 slit-like 4 suckers
sucking grooves
(bothria)

41/35
 Short,
Conical
invaginated
No rostellum Rostellum w/ refractile Rostellum with
No rostellum & rostellum Rudimentary
or hooks double crown rostellum w/ 1- double crown
hooks with single w/o rostellum
4 suckers of 25-30 hooks 7 circlets of of 30-36 hooks
row of 20-30
hooks
hooks
7 more circular
nearly
shape
spheroidal,
ovoid, yellow- yellowish,
pale, outer 25-40 μm,
brown, contains outer
membrane spherical
abundant yolk membrane
forms thin hyaline and
granules, spheroidal, forms
shell and thin-shelled,
moderately yellow-brown, moderately
Indistinguisha rigid inner contains Similar to
thick-shelled w/ thick radially thick shell and
Ova ble from those membrane hexacanth those of taenia
inconspicuous striated shell, inner
of T. solium has 2 polar embryo; 8-15 ova
operculum and and contains membrane has
thickening eggs enclosed
usually a small hexacanth 2 polar
but 4-8 in a
knob at embryo thickenings but
filaments, membranous
aboperculum no filaments,
encloses a capsule
end encloses a
hexacanth
hexacanth
embryo
embryo
Eggs are
identical to
those of
Taenia solium,
ordinarily can
distinguish
Eggs are
between
identical to Sometimes
species only
those of T. confused w/ Gravid
by
saginata; one is eggs of proglottid
Eggs are examination
less likely to Hymenolepis Should not be resemble rice
sometimes of gravid
find eggs in diminuta; confused w/ H. grains(dry) or Cyst shows a
confused w/ proglottids;
feces than with rodents serve nana since cucumber sharp outline,
Diagnostic eggs of eggs can be
T. saginata as reservoir eggs lack polar seeds (moist); and fluid levels
problems/ Paragonimus; confused w/
(handle all host filaments; dogs &cats can sometimes
notes eggs are pollen grains
proglottids w/ Most rodents serve serve as be detected
unembryonated eradicated by
extreme care common as reservoir reservoir hosts w/in it.
when passed in ingestion of
since T. solium tapeworm in host egg:
feces alcohol
eggs are US Resembles
ROUND
infective) only no IH: Taenia solium
SUNBURST
Extraintestinal children
APPEARANC
Autoinfection
E DUE TO
OUTER
STRIATED
LAYER
(SLICED
KIWI)

3rd Taenia: T asiatica- New species of Taenia discovered in Taiwan

DH: domestic pigs
Pork tapeworm but morphologically resemble T saginata

L A B O RA T OR Y D I A G NOS I S
Order
Order Cyclophyllidea
Pseudophyllidea
Diphyllobotrium Taenia Hymenolepis Hymenolepis Dipylidium Echinococcus
Taenia saginata
latum solium nana diminuta caninum granulosus
Demonstration of a. Taeniasis : Demonstration Demonstration of
eggs in feces • -  Eggs in feces of Embryonated proglottids or, more
(sputum), • -  Gravid eggs in stool rarely, egg packets in
proglottids and proglottids Demonstration stool
scolex in feces b. Cysticercosis : of proglottids or, Demonstration CT, ultrasonography ,
PCR : performed • -  Tissue biopsy more rarely, egg of Embryonated and radionucleotide
Demonstration
on samples of • -  X-ray packets in stool eggs in stool scans
of proglottids or,
purified egg examination Radiographic Demonstration Casoni’s intradermal
more rarely, egg
• -  serology specific of proglottids or, test: immediate
packets in stool
Largest tapeworm Caproantigen demonstration of more rarely, egg hypersensitivity test;
of man detection: the calcified cyst packets in stool uses antigen from
immunological a. biopsy hydatid fluid, injected
(ELISA) b. endoscopic intradermally on 1 arm
detection of examination & equal volume of
parasite material c. computer saline as a control on the

42/35
 in the feces of the
host; uses tomography
other arm. (+) large
polyclonal (brain cyst)
wheal; about 5 cm in
antibodies from
diameter w/ multiple
rabbits Smallest
pseudopodial projections
hyperimmunized intestinal
w/in 20-30 min & fades
w/ adult worm cestode
after 1 hr. Exploration
products while
puncture of the cyst:
others used both Ingest cystercoid
yields hydatid fluid &
rabbit polyclonal (rat flea:
demons. of solices in
and murine Xenopsylla
hydatid sand.
monoclonal cheopsis)
antibodies
PA T H OG E N E S I S
Order Pseudophyllidea Order Cyclophyllidea
Taenia Taenia Hymenolepis Dipylidium Echinococcus
Diphyllobotrium latum Hymenolepis nana
saginata solium diminuta caninum granulosus
Taeniasis
:infection due to
adult stage
Obstruction is due
to T. saginata and
Ulcers are caused
by T.solium; w/c
results to
inflammation
T. saginata gravid
Light infections are
are actively motile
asymptomatic:
leading to
Abdominal pain,
discomfort for the
Diphyllobothriasis: diarrhea, headache,
patients and can Infection seen in
nonspecific dizziness, anorexia
crawl out of the “Sheep raising
gastrointestinal and various
anus. Bile duct Mostly Light infections areas of the
symptoms; intestinal nonspecific
obstruction is also asymptomatic but are world.”
obstruction – 1 adult symptoms
due to this occasionally asymptomatic; Depends on the
only; causes macrocytic Cysticercosis:
species, including patients present abdominal pain, location of the
or megaloblastic anemia: due to larval stage;
the pancreatic mild diarrhea, and cyst; expanding
vit. B12 caused by T. solium
duct and gastrointestinal anal pruritus hydatid cyst causes
only; due to ingestion
appendix. complaints may occur pressure necrosis
of egg w/c leads to
deficiency similar of surrounding
Sparganosis: drink H20 cysticercus cellulose
to pernicious tissues
infected copepods in muscles or
anemia
subcutaneous;
T solium more
common to have
dangerous:
autoinfection
ingestion of egg
causing
Cystercosis
T solium infect
eyes
T saginata less
dangerous
because: Larva
invasion does not
occur

43/35
Spirometra mansoni
Old name: Diphyllobothrium mansoni
Resembles Diphyllobothrium latum adult
1st IH: copepods 2nd IH: Frog snakes
Incidental host : Man Definitely host: Dogs and cats
MOT: Ingestion Procercoid (copepods) Ingestion plerocercoid ( frogs and snakes )
Ingestion infected flesh: wild pigs (paratenic host)
Pathogenesis: Sparganosis, blindncockroachess extraIntestinal infection: eyes
Echinococcus multicularis Multiceps spp
MOT:egg Coenurus- fluid filled cyst - multiple scolices arising from
Most dangerous/lethal helminth disease of man germinal layer
Causes Alveolar Hydatid Disease
IH: Rodents/rat AH: man
DH: Fox, wolf occasionally of cats and dogs
AH: man

CLASS TREMATODA
- Known as “ Flukes ”
- Subclass Digenea
- Characterized by alternation of generation

1. Liver flukes
- Fasciola hepatica
- Opistorchis felineus
- Chlonorhcis sinensis
- Dicrocoelium dendriticum

2. Intestinal flukes
- Fasciolopsis buski
- Heterophyes heterophyes
- Echinostoma ilocanum
- Metagonimus yokogawai

3. Lung flukes
- Paragonimus westermani

4. Blood flukes
- Schistosoma japonicum
- Schistosoma haematobium
- Schistosoma mansoni

Groups based on reproductive system:

1. Monoecious
- One body w/ both sexual organs
- Includes intestinal & liver; lung flukes
2. Dioecious
- Include the blood flukes

General characteristics:
Monoecious Flukes
Gross morphology
- Flat, Leaf-shaped; unsegmented - Trematoda : body with holes
- Anterior end:
• Oral sucker : for attachment; termed as “Acetabula” ; surrounds the oral end of adult worm
• Ventral sucker: acetabellum for attachment
• Genital sucker: referred to as the “ gonotyl” ; common with the “heterophyids”
Ex: Metagonimus yokogawai : separate
• Heterophyes heterophyes: w/ genital sucker fused w/ the ventral sucker
- Attachment: 2 suckers: oral and ventral (acetabulum)
• Heterophyes: 3 suckers: gonotyle
- Digestive system :
Characterized by the oral cavity surrounded by the oral sucker --- pharynx---esophagus ( bifurcated: divided into two)---
intestine(does not open exteriorly ); incomplete digestive system; inverted “Y” shape

- Reproductive system
Female:
• Ovary – only 1 for each fluke shapes:
a. Round/subglobose

44/35
 b. Lobe/ lobate
c. Branched or dendritic (highly branched)

Male: has testes, vas deferens, ejaculatory ducts, etc.

• Testes – has 2 testes; clue for identification Shapes:
a. Ovoid testes
b. Lobed
c. Branched/dendritic
• Appearance:
a. Tandem: one behind the other
b. Side by side
c. Oblique or diagonal: usually posterior to the ovary, except for Dicrocoelium dendriticum
• Vitellaria –a yolk gland; located on the lateral margins

Morphology:
a. Can be branched or dendritic
b. Can be granular or aggregates c. Follicular

G E NE R A L LI F E C Y C L E
STAGES D E S C R I PT I O N
All are operculated
Immature
EGG STAGE Mature
Fasciola hepatica Fasciolopsis buski
Clonorchis sinensis Opistorchis felineus Heterophyes
Echinostoma ilocanum Paragonimus
heterophyes Metagonimus yokogawai
westermani
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
goes out of snail to go to water
infective stage of schistomes to humans
Characterized by elliptical body and with tail 2 types:
CERCARIA 1. Lophocercus
a. Simple b. Keel – tailed
2. Microcercus
a. Knob-like tail (w/ hooks)
METACERCARIA
ADULT Lays operculated eggs

1ST IH: Snail

2ND IH: fish, crab, plant/ vegetation/ snail
FISH:
• Schistosoma
• H hetrophyes
• O filineus
• C sinensis
• O vivirrini
Crab: Westermanni
Plant or vegetation;
• F hepatica
• F gigantica
• F buski
Snail: E ilocanum

MONOECIOUS FLUKES
Lung
Liver Flukes Intestinal Flukes
Fluke
Dicrocoeliu Heterophye
Echinosto Metagonim Paragonim
Fasciola Clonorchis Opistorchis m Fasciolopsi s
Criteria ma us us
hepatica sinensis felineus dendriticu s buski heterophye
ilocanum yokogawai westermani
m s
Appeara Leaf – Pointed Resembles Lancet- Elongate- Attenuated Narrow Resembles Active:

45/35
 anterior ;
rounded
posterior ;
“Bottle spoon-
neck shaped;
appearance preserved
” anterior, state: oval,
ovoidal in at both rounded H. flattened,
nce shaped C. sinensis shaped
OPERCUL shape ends posterior heteropyes “Coffee-
ATED; “Pyriform” bean-
PROMINE shaped”
NT Chinese
OPERCUL vased
AR
SHOULDE
RS
Scales vary
Scales are
in size,
narrow and
pattern & Resembles
Integu With spines closely set, Scale-like
distribution Aspinose Spinose H.
-ment and scales numerous spines
, but heteropyes
in the
posterior is
anterior
aspinose
Small and
Small and Small, oval
subglobose Round/
Ovary Branched slightly and slightly Branched Subglobose Subglobose Lobed
, posterior lobed
lobed lobed
to the testes
Coiled in
Short and Loosely the
Uterus Coiled
convoluted coiled posterior
2/3
Lobed,
Deeply
Highly Lobed, oblique to
lobed or Highly Deeply Ovoid,
dendritic; oblique to Slightly Ovoid, side each other
branched in dendritic, lobed, in obliquely
in tandem each other lobed, by side in or nearly
Testes tandem in in tandem tandem in side by side
in the 2nd in the oblique to posterior side by side
the in posterior posterior in posterior
& 3rd posterior each other 5th at the
posterior 1⁄2 1⁄2 5th
fourths 4th posterior
3rd
third
Numerous,
Granular,
Highly transversel Highly Medium- Large, Large,
aggregates Branched,
branched in y Follicular branched in sized polygonal polygonal
extending lateral for
the lateral compressed in middle the lateral follicles in follicles in follicles in
Vitellaria through the entire
and in the lateral and posterior each lateral each lateral
middle 3rd length of
posterior middle 3rd fields posterior 3⁄4 lateral posterior posterior
lateral the body
portions lateral portions fields third third
fields
fields
Broadly
ovoid, “Old
fashioned
electric
bulb”, light
Elongate-
yellow
ovoid;
brown,
narrower Yellowish-
convex
than C. brown to
operculum “Hen’s egg
Ovoid, sinensis dark
One of shaped;
“Hen’s ova; light Asymmetri golden
smallest identical to Similar to
egg- yellowish- cally brown,
passed in F. hepatica; Straw- H.
shaped; brown, ovoidal Ovoid, shape
man thin, colored heterophye
light operculum dark brown distinct varies
Ova One of transparent ,ovoid, s Similar to
yellowish- fits into a in color, opercular greatly,
most shell, small H.
brown;” thickened broad shoulder some
freqent small, operculum heterophye
small, flat rim of convex asymmetric
infections slightly s
operculum shell, operculum al ; thick
Seen in convex
at one end minute shell w/
asian operculum
thickening flattened
refugees
at the operculum
COMMA-
aboperculu
SHAPED
m
APPENDA
GE AT
ABOPERC
ULAR
END

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MONOECIOUS FLUKES
Liver Flukes Intestinal Flukes Lung Fluke
Dicrocoeliu Metagonim
Fasciola Clonorchis Opistorchis Fasciolopsis Echinostoma Heterophyes
Criteria m us
hepatica sinensis felineus buski ilocanum heterophyes
dendriticum yokogawai
“Oriental
liver fluke
“Sheep liver or chinese
“Giant “Von Seibold
Common fluke” liver fluke” “ Cat liver “Lancet “ Garrison’s “Yokogawa
intestinal fluke or dwarf
Name Temperate Most fluke” liver fluke” fluke” i fluke”
fluke” intestinal fluke”
fluke important
liver fluke
of man
Pyriform in
Pyriform in shape
shape; smallest WITH
Largest Largest
Other Bottle- neck but the deadliest opercular
fluke ; has fluke of man Relatively
descrip in WITHOUT shoulders
conical Largest small
-tion appearance opercular Resembles
projections nematode
shoulders Diphyllobo
thrium
latum ova.
Operculated Operculated , immature
Egg stage Operculated , mature Operculated , mature
, immature
Meta Lophocercus
Lophocercus, keel tailed
-cercaria , simple Lophocercus, keel tailed Lophocercus, simple tailed
stage tailed
Other Cattles;
Definitive herbivores; Man; dogs; water Dogs; pigs; Dogs; rats; Animals ;
Cats; man Animals ; man
host cattles,sheep cats buffalos ; man man man
, goats; man man
Snail from
Genus Snails from
Snail of Snail from
Parafossanu Snail from Genus Snail from the
Genus Genus
1st inter Snails from l us, Snail from Genus Gyraulus, Genus Pironella
Zebrina, Thiara, and
-mediate Genus Bulinus; Genus Segmentina, Convexiuscul (egyot) and
Helicella Gemilsulco
host Lymnea Alocinma; Bithynia Hippeutid , us, Hippeutis( Genus Cerithidea
and pira
Semisul Gyraulus H. (japan)
Cionella libertine
cospira; umbilicalis)
Melanoides
Aquatic
plants From
Aquatic
Trapa spp. Snail from
plants
(water Genus Pila,
Ipomea Fish Fish From
Fish caltrop), (kuhol – Pila
2nd inter obscura belonging Ants Odontobuti
belonging to Eliocharis luzonica ; Fish from Genus
-mediate (kangkong) to the “Formica s obscurus;
the Family tuberosa Genus Acanthogobi us
host & Family fusca” Salmo
Cyprinidae (water Vivipara
Nasturtium Cyprinidae perryi
chestnut), (suso - V.
officinate
Zizania angularis )
(water cress)
(water
bamboo)
Ingestion
Accidental of meta
Ingestion of
Ingestion of ingestion of 2nd IH Ingestion of -cercarian
Mode of Ingestion of fish
metacercari ants ingested encysted Ingestion of meta stage
trans- encysted carrying
a from 2nd carrying carrying metacercaria -cercarian stage Agent:
mission metacercaria metacercari
host metacercari metacercaria from 2nd IH CRABS,
a
a CRAYFIS
H

47/35
MONOECIOUS FLUKES
Liver Flukes Intestinal Flukes Lung Fluke
Dicrocoeliu Heterophye
Echinosto Metagoni Paragonimu
Fasciola Clonorchis Opistorchis m Fasciolopsi s
Criteria ma mus s
hepatica sinensis felineus dendriticu s buski heterophye
ilocanum yokogawai westermani
m s
Clinical Facioliasis Clonorchia Opistorchia Dicrocoelia Fasciolopsi Echinosto Similar to other Paragonimia
features Acute sis sis sis asis miasis intestinal fluke sis
stage: Adult stage Similar to Manifested Inflammati Similar to infection; does not Manifestatio
Associated found in Clonorchis by: on due to Fasciolopsi cause obstruction ns: Similar
w/ the sinensis Traumatic attachment asis Does Can become ectopic to P. TB
migration intrahepatic damage; ; not cause due to its size: Cellular
of adult bile ducts hyperplasis ulceration; obstruction Heart: myocarditis infiltration
stage resulting to of biliary obstruction due to its leading to heart failure accompanie
leading to “trauma epithelium; of small size to death d by
traumatic damage”; Inflammati intestinal CNS: to the brain granuloma
damage;tox hyperplasia on of bile lumen;toxi leading to neurologic leading to
ic irritation of biliary duct; c and manifestations fibrosis
causing epithelia; Fibrosis allergic s/s:
necrosis of inflammati symptoms cough
liver , on of bile chest pain
referred to ducts dyspnea
as “sheep referred as hemoptysis-
liver rot” “cholangiti endemic
Chronic s”; can NB: usually
stage: enter misdiagnos
associated gallbladder eas
w/ the causing pulmonary
maturation “cholecysti tuberculosi
of worms tis”; s
in the fibrosis
hepatic bile referred to sputum may
ducts as be viscous,
leading to “cholelithia streaked
biliary sis” – with blood,
obstruction formation and tinged
; of with
inflammati gallbladder brownish
on to stones ; flecks which
“fibrosis” toxic are clusters
Halzuon – irritation of eggs
pharyngeal causing "iron
fascioliasis “cholangio- fillings"
; temporary carcinoma
lodgement found in Was
of bile investigated
immature in a known
worm; Cancer: endemic
manisfeste Cholangitis municipality
d by Cholecystitis of
dysphagia Cholangiosarcoma Sorsogon,
&dyspnea Philipplnes

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 Demonstrat Demonstrat Demonstrati
Demonstrat
i on of eggs i on of eggs on of eggs
i on of egg
in feces; in feces; in sputum-
in feces ;
differential differential Demonstrat Demonstration of eggs reddish
Lab. Demonstrati on of egg differential
diagnosis diagnosis ion of egg in feces; differential brown
diagnosis in feces diagnosis
between between in feces identification needed flecks
w/ eggs of
spurious spurious resembling
Fasciola
and true and true iron fillings)
hepatica
infection infection or in feces

DIOECOUS FLUKES: Most romantic parasite of man

- Cancer
- Most important trematode in man: severity of infection
- MOT: skin penetration
- Acute infection: Katayama’s disease
- 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)
• Schistosomule: cercaria without tail

Criteria Schistosoma japonicum Schistosoma mansoni Schistosoma haematobium

Oriental blood fluke Manson’s blood fluke
only schistosome w/ separate Profile of a man Vesical blood fluke
Common name
sexes Smallest of the blood flukes Bladder fluke
most pathogenic and virulent
Definitive host Man Man man
Snails
Snails Snails
Intermediate From Genus Biophalaria
Oncomelania hupensis From Genus Bulinus
host Genus Australorbis
quadrasi Genus Planorbis
Tropicorbis
Superior mesenteric venules
Preferred habitat Inferior mesenteric venules (veins that Vesical plexus (venules that drain
(veins that drain in the small
in man drain into the large intestine) into the urinary venules)
intestine)
Non operculated mature:
Egg stage small knob like recurved Non operculated mature Non operculated mature
hook
Smallest; ovoidal in shape; Largest of the 3; eggs are elongated with Elongated with a rounded
characterized by rudimentary pointed anterior, posterior end is anterior, and the posterior is
Ova lateral knob rounded with a prominent lateral spine tapering into a terminal spine
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
Intestinal schistosomiasis Intestinal schistosomiasis Urinary schistosomiasis
Clinical features
Also referred to as “ Bilharziasis or Bilharz disease ”
Associated w/ skin penetration of the cercaria resulting into “ schistosome dermatitis”; characterized by
a. Early stage
reddish rash & 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” ; commonly observed with Schistosoma japonicum ; rarely for S.
b. Acute stage
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
Characterized by granuloma formation
c. Chronic stage
(ectopic eggs are carried by Blood in other sites of the body)

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 Microscopic examination of egg
with terminal spine,
Stool Microscopic Specimen: 24hr preserved urine;
Laboratory examination of egg with Stool Microscopic examination of egg 24-hr unpreserved urine SF,
diagnosis lateral knob, with lateral spine, antigens occasionally feces, more often in
antigens vesical or rectal biopsies
antigens
Far east : Japan
Geographic
(eradicated);China, Africa and South Africa Africa and Middle East
distribution
Philippines

Schistosoma mekongi Schistosoma intercalatum

Ova minute lateral spine or knob Elongate terminal spine
ova smaller than japonicum Ova> haematobium; FECES

Laboratory diagnosis:
1. Demonstration of parasite (ova/egg)
2. Serologic tests:
a. ELISA : uses monoclonal antibodies; demonstrate two glycoprotein antigens associated with the gut of adult
schistosomes (circulating, anodic “CAA” and cathodic “CCA” antigens); sensitive and specific
b. Skin tests : group specific
i. Intradermal 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/ Fairley’s test
(+)= Bleb or septate precipitates (>2 yrs to be negative)
MOC: definitive diagnosis of Schistomiasis in PH
- Globular or segmented precipitation around schistosome eggs incubated in positive sera
- “Cercarien-hullen” reaction : development of pericercarial membranes around cercaria incubated in positive sera
3. Ultrasonography
4. Demonstration of biopsy samples
- Rectal valve
- Urinary bladder
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)

Diagnosis:
1. Direct microscopy
2. Alkalaine phophatase immunoassay

ARTHROPODS
Malaria Plasmodium Mosquito Anopheles
Filariasis Wuchereria, Brugia Anopheles, ades, culex,
mansonia
Dengue/ DHF Dengue virus Aedes
Japanese encephalitis JE Virus aedes, culex, mansonia
Scrub typhus Rickettsia chigger mite Thrombicullidae
Babesiosis Babesia Tick Ixodes
Paragonimiasis Paragonimus crab Sundathelphusa
Diphyllobothriasis Diphyllobothrium Copepod Cyclops
Dracunculiasis Dracunculus Copepod Cyclops
Hymenolepiasis hymenolepis Rice and flour beetles Tenebrio
Diphylidiasis dypylidium Flea Ctneocephalides, Pulex
irritans
raillietinasis raillietina flour beetles Tribolium confusum

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amoebiasis Entamoeba flies and cockroaches Flies Musca domestica
Sarcophaga, calliphora
Diarrheal disease Enteric pathogen
Cockroaches: Periplaneta
Miscellaneous intestinal Ascaris, trichuris Americana, blatella
parasitoses germanica, Blatta orientalis

Intake of drugs (antidiarrheal antacids bismuth barium collect after 1 week

laxatives) : crystalline residue
Antibiotic intake decrease protozoans recovery
Amount of stool Formed: pea/thumb size, watery -5-6 tbs
Toilet water urine and soil contamination Destroy trophozoites; may contain free-living
Age of stool 30 mins - 1 hr (die trophozoites)
Storage Refrigerator (3-5C)
Never freeze incubate
If there is delay Preservatives

QUALITY ASSURANCE

Microscope
- most important instrument
Heat and humidity: Fungal growth damage lenses
Calibrated: Ocular and stage micrometer

Microscopic exam
- gold standard diagnostic procedure

Cross Checking
- assure reliable results

Controls In parasitology
- Preparation slides and photographs
LOEFFLER’S HEART LUNG MIGRATION (ASH) GAY BOWEL SYNDROME (ECG)
Ascaris E. histo
Strongyloides C. parvum
Hookworm G lamblia
UNHOLY TREE (HAT) ENTEROTEST IGLASS
Hookworm Isospora
Ascaris G lamblia
Trichuris S stercoralis
AUTOINFECTION (CHEST) MALE DIES AFTER COPULATION (TED)
Capillaria philippinensis Trichinella spiralis
Hymenolepis nana Enterobius
Enterobius Dracunculus medinensis
Strongyloides
Taenia solium
ANEMIA DUE TO BLOOD LOSS ANEMIA: DUE TO INCREASED DESTRUCTION
Hookworm Trypanosoma
Schistosoma Malaria

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Trichuris Lesihmania
Fasciola
ANEMIA: DECREASED PRODUCTION NONE BILE STAINED EGGS
(NUTRITIONAL DEFICIENCY)
Giardia Necator americanus
Entamoeba E vermicularis
Diphyllobothrium H nana
Strongyloides A duodenale
EGGS IN SATURATE SALT SOLUTION ( STUF sinks MALABSOROPTION
and FEATHer floats)
S stercoralis Adults and children :
Taenia E histolytica
Unfertilized egg of Ascaris G lamblia
F hepatica H nana
Fertilized eggs of Ascaris
E vermicularis Adults
A duodenale Strongyloides
T trichura Cyclospora
H nana
NON EOSINOPHILIA MEET TTeD Pfiestera piscicda
M yokogawai Recent Recognizd organism
E vermi secrete potent toxinss- fisk kills disease in humans
Echinostoma
T trichiuris
T saginata
T solium
D latum
SOIL TRASNMITTED CESTODES ARMED
Ascaris lumbricoides, Trichuris trichuria and Strongyloides Taenia solium
stercoralis. Hymenolepis nana
Echinococcus granulosus
PSEUDOPARASITES Parasites that cause anemia
a. Eggs of arthropods, plant nematodes, and other spurious Microcytic anemia S. mansoni & Schistosoma japonicum
parasites may be mistaken as human parasites anemia" by Hookworms, Trichiuris trich
b.Fungal spores coming from Candide spp., yeast and yeast-
like fungi may also be mistaken for parasites Megaloblastic anemia D. latum Fish tapeworm: Vit B12 deF
c. Elements of plant origin that resemble some parasites
Include: plant cells/fibers, pollen grans, starch granules
and vegetable spirals.
d. Plant and animal hairs ma look like helminth larvae

Arthropods
Copepods (Cyclops) IH of D. latum, D. medinensis and Gnathostoma spinigerum
Pthirus pubis Crab louse Agent of “crabs”
Myiasis Invasion of mammalian tissues by dipterous larvae (diptera/flies)
Cantharidin Volatile vessicating substance produced by the blisters of beetles of the family Meloidae
American cockroach
Periplaneta americana
Lays about 50 egg capsules (ootheca), each containing about 15 eggs
Blatella germanica German cockroach
Blatta orientalis Oriental cockroach
Tiger mosquito
Aedes aegypti
Vector of urban dengue
Aedes albopictus w/ silvery stripe on the mesonotum Vector of rural dengue
Culex Vectors of Japanese encephalitis
Anopheles flavirostris Primary vector of malaria
Aedes poecilus Mosquito associated w/ Bancroftian filariasis
Mansonia bonneae Vector of the Brugian type of filariasis
Musca domestica Common housefly
Sarcophaga “Chess-board appearance”
Calliphora Bluish fly covered w/ yellow hairs
Lucilia Greenish fly w/ white genae
Phaenicia Bronze-bottle fly
Muscina Slightly larger and more robust than the housefly
Laboratory Methods
Examination of Blood

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Detect agents of Malaria Babesiosis Trypanosomiasis Leishmaniasis Filariasis
Thick blood films Screening (malaria)
Thin blood films
Identification of malarial species

1. Preparation of buffy coat smears: -L. donovani

-Trypanosomes
-Microfilaria
Concentration techniques
2. Knott’s concentration membrane filtration
-Detection of microfilaria
3. Fluorochrome acridine orange in microhematocrit centrifuge format -QBC blood parasite
detection method
Examination of Fecal Specimens
1. Formalin = all purpose fixative
= 5% conc.: protozoan cysts
= 10% conc.: helminth eggs and larvae
Stool fixatives 2. Schaudinn’s fluid = w/ HgCl2
3. Polyvinyl alcohol (PVA) = for Trichrome stain (w/ HgCl2)
4. Merthiolate-iodine-formalin (MIF) = a.k.a. Thimerosal
= Merthiolate and Iodine: staining components
= Formalin: preservative
5. Sodium-acetate-formalin (SAF)
= Advantage: does not contain HgCl2

Direct wet mount 1. Saline mount = 0.85% NSS- easy: trophozoite motility and helminth ova and larva seen
2. Iodine mount = protozoan cysts (not trophozoites)- detect larva and ova
1. Wheatley’s trichrome stain/ Gomori/ trichrome- most common used stain in fecal parasite
2. Iron hematoxylin stain- enhance detail needed
Permanent stains 3. Modified acid fast stains (Cryptosporidium, Isospora, Cyclospora)
Modified trichrome: Microsporidia
- con’c, time ↑
Weber green- pink Ryan blue pink
Concentration Methods for Protozoan Cysts and Helminth Eggs and Larva
Best for eggs of:
-Schistosoma
-Operculated egg
-Trematodes
Sedimentation -Cestodes
-T. trichiura
-C. philippinensis
1. Acid-ether concentration
= Ether: dissolves fats and CHO
2. Formalin-ether concentration
= Formalin: preserves the eggs
1. Brine Flotation = NaCl
2. Zinc Sulfate centrifugal flotation technique
= SG (ZnSO4): 1.18
Flotation = for Protozoan cysts
= for Nematode eggs except T. trichiura and C. philippinensis (sedimentation)
= NOT for Schistosomal (mansoni) and operculated eggs; Ascaris: infertile ova (sedimentation)
Used most frequently and is preferable to sugar, sodium chloride or brine

Cultural Methods for Protozoa

Culture media for 1. Boeck and Dorbohlav’s diphasic medium (Modified by Dobell and Laidlaw) 2. Cleveland
intestinal amoeba Collier’s medium
NNN (Novy-McNeal-
Medium for Trypanosoma and Leishmania
Nicolle)
Additional Techniques for Examination of Enteric Parasites
Cellulose tape technique For pinworms- E. Vermicularis= perianal area
1. Direct smear method of Beaver
2. Stoll dilution egg count
Egg studies
3. Kato thick smear = qualitative (Cellophane paper, glycerine, malachite green) 4. Kato Katz
smear (Cellophane fecal thick smear) = quantitative
Nematode culture and 1. Harada-Mori paper strip culture
recovery techniques 2. Baermann funnel techniques (Strongyloides)
Examination of Other Specimens
Specimens:
Detection of T. vaginalis -Vaginal and urethral discharge -Prostatic secretions
-Urine
Sputum Recovery of protozoal and helminthic parasites

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 Ascaris lumbricoides
Early morning: most concentrated
1. Skin biopsy = Onchocerca, Mansonella
Biopsy
2. Muscle biopsy = Trichinella spiralis
Urine Early morning or first void
Genitalia Saline wet swab
Blood Fresh blood from fingerstick ( best not sued EDTA
Tissue and skin biopsy Sterile container
95% parasite – clean dry with secure lid
Do not accept contaminated with urine (destroy motile organism), water (may contain free living
Feces org), oil/barium enemas (intestinal protozoa undetectable 5-10 days, antibiotic (tetracyclines)-
modify intetsinal flora, prevent recovery for 2 weeks after drug cessation
Urea, acidic pH inhibit some parasites
Miscellaneous tests
Hidden blood
early detect: colorectal cancer
Occult blood pseudoperoxidase activity of hemoglobin release oxygen from hydorgen peroxidase to oxidize
guiac reagent
Blue: gastrointestinal bleeding
Fecal fat A. steatorrhea- fat excretion > 6 mg/ dl
B. Stain: Sudan III, Sudan IV, Oil red o
C. orange red staining
Diagnostic tests
1. Direct fluorescent Ab G lamblia, Cryptosporidium, T vaginalis
2. Direct agglutination Leishmanianiasis, Chagas disease
3. ELISA G lamblia, Cryptosporidium, T gondii
4. DNA probes & PCR Dx infections

SCIENTIFIC AND COMMON NAMES OF PARASITES

NEMATODES/ROUNDWORMS
Ascaris lumbricoides Giant intestinal roundworm, Lumbricus teres
Enterobius vermicularis Pinworm, Oxyuris vermicularis, Seatworm, Social or Society w.
Trichuris trichiura Whipworm
Capillaria philippinensis Pudoc worm
Necator americanus American hookworm, American murderer, New world hookw.
Ancylastoma duodenale Old world hookworm
Ancylastoma braziliense Cat hookworm
Ancylostoma caninum Dog hookworm
Strongyloides stercoralis Threadworm
Trichinella spiralis Muscle worm, Garbage worm
Wuchereria bancrofti Bancroft's filarial worm
Brugia malayi Malayan filarial worm
Loa loa Eye worm
Onchocerca volvulus Blinding worm
Dicrofilaria immitis Dog/canine heart worm
Dracunculus medinensis Fiery serpent of the Israelites, Medina w., Guinea w. Dragon w.
Anisakis Fish and Marine mammal roundworm, Herring's worm
Toxocara canis Dog ascarid
Toxocara cati Cat ascarid
TREMATODES/FLUKES
Fasciola hepatica Sheep liver fluke, Temperate liver fluke
Fasciola gigantica Giant liver fluke, Tropical liver fluke
Clonorchis sinensis Oriental liver fluke, Chinese liver fluke
Opisthorchis felineus Cat liver fluke
Opisthorchis viverrini Southeast Asian liver fluke
Fasciolopsis buski Giant intestinal fluke
Echinostoma ilocanum Garrison's fluke
Heterophyes heterophyes Von Siebold's fluke

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Paragonimus westermaní
Schistosoma japonicum
Schistosoma mansoni
Schistasoma haematobium Bladder fluke
CESTODES/TAPEWORMS
Taenia saginata
Taenia solium
Hymenolepis nana
Hymenolepis díminuta
Dipylidium caninum
Diphyllobothrium latum
Echinococcus granulosus
Oriental lung fluke
Oriental blood fluke
Manson's blood fluke, Profile of a man
Beef tapeworm
Pork tapeworm
Dwarf tapeworm
Rat tapeworm (Norway rats
Dog tapeworm, Double-pored tapeWorm, Flea tapeworm
Broadfish tapeworm
Hydatid worm

INFECTIVE STAGES
Cyst Protozoan (Amoeba)
Trophozoite T vaginalis
Sporozites Plasmodium
Trypomasigote Trypanosoma
Pormastigote Leishmania
Embryonated egg HATE
H nana
A lumbricoides
T trichiura
E vermicularis
Larva T spiralis
C philippinensis
Filariform Larva Hookworm
S stercoralis
3rd stage Larva (filariform) W bancrofti
B malayi
A cantonensis
L loa
O volvolus
Mansonella
Cercaria S japonicum
S mansoni
S haematobium
Metacercaria F hepatica
F buski
C sinensis
O felineus
P westermani
E ilocanum
Heterophyids
Cysticercus bovis T saginata
Cysticercus cellulosae T solium
Plerocercoid larva D latum
Hyadatid cyts E granulosus
Cystercercoid larva H diminuta
D caninum

INFECTIVE STAGES OF METAZOAN

Embryonated egg Hymenolepis nana (direct) Ascaris, Trichuris, Enterobius
Larva Trichinella spiralis, Capillaria philippinensis
Filariform larva Hookworm, Strongyloides stercoralis
3rd stage larva (filiform] Filarial worms, Dirofilaria, Dracunculus, Angiastrongylus cantonensis, Anisakis
Metacercaria Fasciola, Fasciolopsis, Glonorchis, Opisthorchis, Paragonimus, Echinostoma, Heterophyids
Cercaria Schistosoma spp.
Cysticercus bovis Taenia saginata

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Cysticercus cellulosae Taenia solium
Plerocercoid larva Diphyllobothrium latum
Hydatid cyst Echinococcus granulosus
Cysticercoid larva Hymenolepis nana (indirect), Hymenolepis diminuta, Dipyidium canimum
INTERMEDIATE HOSTS OF TREMATODES (FLUKES)
NOTE ALL TREMATODES require 2 intermediate hosts except for Schistosoma spp.(1 IH only)
st
1 LH Snails
2nd LH Fish= Heterophyes heterophyes, Clonorchis sinensis, Opistorchis felineus
Crab Paragonimus westermani, Cray Fish Fresh water)
Plant/Vegetation = Fasciola hepatica, Fasciola gigantica, Fascialopsis buski
Snail = Echinostoma ilocanum

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