Del Rosario, Ma. Veronica M.

BSMT II

Direct Fecal Smear

Objectives:
 Explain the principle of Direct Fecal Smear using different solutions
 Recognize the importance of Direct Fecal Smear
 Carry out properly the procedure
 Differentiate Ascaris lumbricoides from Trichuris trichiura

Questions:
 What are the factors affecting the ova of Ascaris lumbricoides?
The factors affecting the ova of A. lumbricoides are effect of heat, lack of hygiene and sanitation, use
of feces as fertilizer, expose to fecal matter with infective larva of A. lumbricoides.

 What is the infective stage of Ascaris lumbricoides?

The infective stage of A. lumbricoides is infective larvae / embryonated ova.
 What are the different cell stages of hookworm ova?
The different cell stages of hookworm ova are egg, 4 larval stage and adult of hookworm ova.
 Differentiate hookworm ova from Ascaris based color observed and shell?
Hookworm has thin shelled, oval and filariform (infective stage), clear color while A. lumbricoides has
egg is round/ova, tan colored/ golden brown.
 Give the disadvantage of Iodine solution in the study or examination of protozoa?
The disadvantage of Iodine solution in examining of protozoa is there a dirty background. Therefore,
it is difficult to see the morphology of the parasite.
 Is concentration technique a routine method in the laboratory? Why?
It is not a routine method in the laboratory because it is time consuming in the process of such
request.
 What is the disadvantage of Direct Fecal Smear compared to Concentration Techniques?
The disadvantage of direct fecal smear must be processed within 1 hour compared to concentration
technique.
Drawing:
Del Rosario, Ma. Veronica M.
BSMT II

Concentration Technique

Objectives:
 Recognize the advantages of concentration technique
 Perform the procedure with accuracy
 Identify ova and cysts
 Compare Direct Fecal Smear from Concentration Technique

Questions:
 What is the purpose of Concentration Technique?
Concentration procedure separate parasites from fecal debris and increase the chances of
detecting parasitic organisms when these are in small numbers. They are divided into flotation
techniques and sedimentation techniques.
 Compare Concentration Technique from Direct Fecal Smear
Concentration procedure separate parasites from fecal debris and increase the chances of
detecting parasitic organisms when these are in small numbers. While, Direct Fecal Smear
technique is the simplest and easiest technique to facilitate detection of intestinal parasites that
infected subjects pass in their feces.
 Give the importance of Concentration Technique
The use of a concentration method is essential for the examination of feces for parasitic diseases
as it increases the likelihood of finding ova, cysts and larvae, particularly in those specimens
where they are present in numbers too low to be seen by direct microscopy.
 Disadvantages of Concentration Technique
It has the disadvantage of destroying trophozoites stages and distorting cellular exudates.
 Advantage of Concentration Technique from Direct Fecal Smear
The concentration technique has the additional advantages over the thick smear of detecting
other intestinal parasites and allowing for transportation and storage after feces are preserved in
formalin.
Del Rosario, Ma. Veronica M.
BSMT II
Drawing:

Kato-Katz Technique

Objectives:
 Recognize the advantages and disadvantages of Kato-Katz Technique
 Carry out properly the procedure
 Recognize the importance of Kato-Katz Technique
 Identify ova and cysts
 Compare Kato-Katz Technique from Concentration Technique and Direct Fecal Smear

Questions:
 What is the importance of Kato-Katz Technique?
The Kato-Katz technique is used for qualitative and semiquantitative diagnosis of intestinal
helminthic infections. It is performed using a small spatula and slide template that allows a
standardized amount of feces to be examined under a microscope and the eggs to be counted.
 Advantages and Disadvantages of Kato-Katz Technique
The advantages of Kato-Katz are its low cost, short sample preparation time, simple handling and
the need of only basic equipment. However, the method has a low sensitivity for low STH infection
intensities, hookworm eggs disappear after one hour and samples and slides for hookworm cannot
be stored.
 Purpose of Kato-Katz Technique
The Kato-Katz technique facilitates the detection and quantification of helminth eggs that infected
subjects pass in their feces. A thick smear is prepared on a microscopic slide and helminth eggs are
enumerated under a light microscope and recorded for each helminth species separately.
 Compare Kato-Katz Technique from C.T and D.F.S
Kato technique (also called the Kato–Katz technique) is a laboratory method for preparing human
stool samples prior to searching for parasite eggs. Concentration procedure separate parasites
from fecal debris and increase the chances of detecting parasitic organisms when these are in small
Del Rosario, Ma. Veronica M.
BSMT II
numbers. While, Direct Fecal Smear technique is the simplest and easiest technique to facilitate
detection of intestinal parasites that infected subjects pass in their feces.

Drawing:

Scotch Tape Swab Technique

Objectives:
 Recognize the advantages and disadvantages of Scotch Tape Swab technique
 Recognize the importance of Scotch Tape Swab Technique
 Identify ova and cysts
 Compare Scotch Tape Swab Technique from Kato-Katz Technique, Concentration Technique and
Direct Fecal Smear

Questions:
 What is the importance of Scotch Tape Swab Technique
As the eggs are mostly deposited on the perianal area scotch tape preparation is used to isolate and
identify the eggs of pinworm when suspected of pinworm infections. To increase the chance of finding
pinworm eggs, the scotch tape preparation method should be done on three consecutive mornings.
 Compare Scotch Tape Swab Technique from Kato-Katz Technique, Concentration Technique and
Direct Fecal Smear
The most common means of diagnosing pinworm infection is via the “Scotch tape” test, where a clear
adhesive cellulose tape is applied to the anal area early in the morning before bathing or defecation. This
is then observed under a microscope for the presence of pinworm eggs. Kato technique (also called the
Kato–Katz technique) is a laboratory method for preparing human stool samples prior to searching for
parasite eggs. Concentration procedure separate parasites from fecal debris and increase the chances of
detecting parasitic organisms when these are in small numbers. While, Direct Fecal Smear technique is the
simplest and easiest technique to facilitate detection of intestinal parasites that infected subjects pass in
their feces.
 Purpose of Scotch Tape Swab Technique
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BSMT II
A transparent adhesive (cellophane) tape test (sometimes called a "Scotch tape" test) refers to the
collection and examination of a sample from the skin around the anus. The doctor presses the sticky side
of the tape to a microscope slide and uses a microscope to look for pinworms and/or pinworm eggs.

Drawing:

Phylum: Nemathelminthes
Typical Round Worms (Nematodes)

Ascaris lumbricoides

Overview:
Ascaris lumbricoides, commonly called the large intestinal roundworm, parasitizes the gastrointestinal
tract of humans. It is often referred to as a helminth, a term which encompasses a large number of nematode and
platyhelminth parasites. A. lumbricoides is also a soil-transmitted helminth (STH), a group of human
gastrointestinal nematodes transmitted via direct contact with eggs or larvae in soil. Intestinal nematode infections
affect one fourth to one third of the world's population. Of these, the intestinal roundworm Ascaris lumbricoides is
the most common. While the vast majority of these cases are asymptomatic, infected persons may present with
pulmonary or potentially severe gastrointestinal complaints. Ascariasis predominates in areas of poor sanitation
and is associated with malnutrition, iron-deficiency anemia, and impairments of growth and cognition.

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Egg/Ova Adult
 Del Rosario, Ma. Veronica M.
BSMT II

Pathology: Larvae Migration

 Sensitivity of the host
 Nutritional status of the host
 Number of the migrating larva
Adult Worm
 Mechanical Action – cause obstruction of the intestinal tract
 Sporiative Action – affect nutritional status of the host
 Allergic Reaction – metabolites of the living or the dead adult are toxic and immunogenic
Diagnosis:  DFS  Serodiagnosis
 Kato Tech. or Cellophane thick smear  Commonly used
 Kato-Katz Tech.  Indirect Hemagglutination
 Concentration Tech.  Immunofluorescent Ab
Prevention:  Sanitary disposal of human excreta
 Use of sanitary facilities
 Personal Hygiene
 Avoiding the use of fresh human feces for fertilizer
 Health Education
Treatment:  Albendazole
 Mebendazole

Phylum: Nemathelminthes
Typical Round Worms (Nematodes)

Trichuris trichiura

Overview:
Trichuris trichiura (Trichuriasis), also known as whipworm, colonizes the cecum and ascending colon and
may cause anemia, abdominal discomfort, bloody diarrhea, stunted growth, and, in overt cases, may lead to rectal
prolapse. It is referred to as the whipworm because it looks like a whip with wide handles at the posterior end. The
whipworm has a narrow anterior esophagus and a thick posterior anus. The worms are usually pink and attach to
the host via the slender anterior end. The size of these worms varies from 3 to 5 cm. The female usually larger than
the male.

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 Del Rosario, Ma. Veronica M.
BSMT II

Egg/Ova Adult

Pathology:  Light infection: asymptomatic and w/o clinical significance

 Chronic impairment: diarrhea, hypoalbuminemia and IDA
 Heavy infection: rectal prolapse
 It may also invade the appendix causing acute appendicitis
Diagnosis:  DFS
 Kato Tech.
 Kato-Katz Tech.
 Concentration Tech.
Prevention:  Sanitary disposal of human excreta
 Use of sanitary facilities
 Personal Hygiene
 Avoiding the use of fresh human feces for fertilizer
 Health Education
Treatment:  Albendazole
 Mebendazole
 Pyrantel Pamoate
Phylum: Nemathelminthes
Nematodes

Hookworms
Overview:
Hookworm, any of several parasitic worms of the genera Necator and Ancylostoma belonging to the class
Nematoda (phylum Aschelminthes) that infest the intestines of humans, dogs, and cats. Hookworm infection is
contracted from contact with soil contaminated by hookworm, by walking barefoot or accidentally swallowing
contaminated soil. An intestinal parasite that usually causes diarrhea or cramps. Heavy infestation with hookworm
can be serious for newborns, children, pregnant women, and persons who are malnourished. Hookworm infections
occur mainly in tropical and subtropical climates and affect about 1 billion people -- about one-fifth of the world's
population.

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 Del Rosario, Ma. Veronica M.
BSMT II

Egg/Ova Adult

Pathology: Larval Stage Adult worms

 Ground itch or Coolie itch  Hookworm anemia
 Pulmonary lesion or Wakana Disease  Hypoalbuminemia
 Creeping eruption or Cutaneous larva
migrans
Diagnosis:  DFS  Formalin-Ether Concentration Tech.
 Kato-Katz Tech. Differentiated from Strongyloides
 Concentration Tech.  Harada-Mori (Culture Method)
 Brine Floatation Tech.  (12 to 24 hrs.)
Prevention:  Sanitary disposal of human feces  Treatment of infected individuals
 Wearing of shoes, slippers or boots  Mass chemotherapy
 Health education on personal, family, and  Use of sanitary facilities
community hygiene
Treatment:  Albendazole  Oxantel or oxantel/ pyrantel
 Mebendazole Iron Therapy
 Pyrantel Pamoate  Ferrous Sulfate
Phylum: Nemathelminthes
Typical Round Worms (Nematodes)
Strongyloides stercoralis

Overview:
Strongyloides stercoralis is a nematode (roundworm). Most infections are asymptomatic, but clinically
significant infection in humans can include larval skin invasion, tissue migration, intestinal invasion with abdominal
pain and GI symptoms, and a Loeffler-like syndrome due to migration to the lungs. Strongyloidiasis which is an
infection caused by Strongyloides stercoralis, has a cosmopolitan distribution in tropical and subtropical regions;
whereas, it is sporadic in TurkeyThe infection is usually asymptomatic, however, eosinophilia may be the only sign.
S. stercoralis have the ability to persist and replicate within the host for decades and it may lead to infections with
high mortality especially in immunocompromised host. Humans are generally infected transcutaneously with
filariform larvae. Infections with S. stercoralis usually lead to cutaneous, gastrointestinal, or pulmonary symptoms.
Definitive diagnosis of strongyloidiasis is made on the basis of detection of larvae in the stool, sputum or duodenal
fluid.
 Del Rosario, Ma. Veronica M.
BSMT II
Drawing with Label:

Egg/Ova Adult

Pathology: Types of Disease 3 types of Infection

 Cutaneous Infection  Invasion of the skin by Filariform Larvae
 Pulmonary Infection  Migration of larvae through the body
 Intestinal Infection  Penetration of the intestinal mucosa by adult
Fatal female worm
 Swollen Baby or Belly Syndrome
Diagnosis:  Stool Microscopy Serodiagnosis
 Stool Culture  ELISA
1. Harada-Mori  IHA
2. Baermann Funnel Method using Charcoal  IFA
3. Agar Plate Method
Prevention:  Sanitary disposal of human feces  Treatment of infected individuals
 Wearing of shoes, slippers or boots  Mass chemotherapy
 Health education on personal, family, and  Use of sanitary facilities
community hygiene
Treatment:  Albendazole
 Thiabendazole
Phylum: Platyhelminthes
Tapeworms (Cestodes)
Order: Pseudophyllidea (false tapeworm)

Diphyllobothrium latum

Overview:
Diphyllobothriasis represents an intestinal parasitic zoonotic infection caused by the cestode
Diphyllobothrium. Diphyllobothrium latum (D. latum), which is the most common cause of diphyllobothriasis, also
called the “fish tapeworm” or the “broad tapeworm,” is transmitted to humans by the ingestion of fish which
harbor infectious larvae of the genus Diphyllobothrium causing a wide-ranging spectrum of disease and severity.
Freshwater fish serve as the primary epidemiological reservoir for D. latum, while other Diphyllobothrium species
originate from marine fishes.Thus, the fundamental risk factor is the consumption of raw freshwater or marine fish
with human disease occurring after maturation of larval stages of the tapeworm in the hosts’ intestine.
 Del Rosario, Ma. Veronica M.
BSMT II

Drawing with Label:

Egg/Ova Adult

Pathology:  Infected persons may experience abdominal pain, vomiting, diarrhea, and weight loss.
 In some infections there may be a severe Vitamin B12 deficiency and anemia caused by obstruction
of Vitamin B12 absorption coupled with high absorption rates by the tapeworm.
Diagnosis:  Microscopic examination of feces for the characteristics operculated eggs
 Examination of fecal sample for eggs and proglottids is the quickest way to diagnose
Diphyllobothriasis
Prevention:  Adequate cooking of fish
 Proper disposal of human waste
Treatment:  The best method is a diatrizoic acid injection into the duodenal wall
 Praziquantel
 Niclosamide
 Additionally, Vitamin B12 may be needed to correct a deficiency caused by infection

Phylum: Platyhelminthes
Tapeworms (Cestodes)
Order: Cyclophyllidea (true tapeworm)

Dipylidium caninum

Overview:
Dipylidium caninum (dog tapeworm or double-pored tapeworm) is a common intestinal cestode of
domestic dogs and cats that can infect children who ingest fleas. The scolex of the adult worm has four suckers and
is armed with up to seven rows of hooklets. The 15- to 70-cm tapeworm chain (i.e., strobila) consists of about 150
proglottids. The proglottids, which are highly mobile, are passed whole in feces and easily observed in stool; they
later disintegrate in soil to release their eggs. The eggs develop into cysticercoid larvae only if they are consumed
by the larval stage fleas. Dipylidium caninum is a common tapeworm of dogs and cats. Dogs are infected by
ingestion of fleas, which carry the cysticercoid form in their body cavities. The tapeworms can also develop in
children who have ingested the fleas. It is widespread worldwide, but human infections are unusual.
 Del Rosario, Ma. Veronica M.
BSMT II
Drawing with Label:

Egg/Ova Adult

Pathology:  Most infections are asymptomatic but mild gastrointestinal disturbances may occur
 Most striking feature in animals and children consists of the passage of proglottids, found in the
perianal region, in feces, on diapers and occasionally on floor coverings and furniture
 Pets may exhibit behavior to relieve anal pruritis, such as scraping anal region across grass or
carpeting
Diagnosis:  Based on finding characteristic eggs, egg packets or proglottids in feces
 Spherical eggs contain a six hooked embryo, measure from 24 - 40 μm in diameter and occur singly
or in packets
 Scolex (head) is somewhat elongated with four suckers and a small retractable rostellum
 Proglottids are barrel shaped and possess two genital pores, one on each lateral margin, which give
rise to the common name double pored tapeworm
Prevention:  Control fleas on your pet, and in their indoor and outdoor environments.
 Have your veterinarian treat your pets promptly if they have tapeworms.
 Do not allow children to play in areas that are soiled with pet- or other animal feces.
 Teach children to always wash their hands after playing with dogs and cats, and after playing
outdoors.
Treatment:  Praziquantel (5-10 mg/kg) body weight single dose
 Niclosamide
Phylum: Platyhelminthes
Tapeworms (Cestodes)
Order: Cyclophyllidea (true tapeworm)

Echinococcus granulosus
Overview:
Echinococcus granulosus, also called the hydatid worm, hyper tape-worm or dog tapeworm, is a
cyclophyllid cestode that dwells in the small intestine of canids as an adult, but which has important intermediate
hosts such as livestock and humans, where it causes cystic echinococcosis, also known as hydatid disease.
Echinococcus granulosus, which causes cystic echinococcosis, is a cestode whose life cycle involves dogs and other
canids as definitive hosts for the intestinal tapeworm and domestic and wild ungulates as intermediate hosts for
the tissue-invading metacestode, which is the larval stage of the tapeworm.

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 Del Rosario, Ma. Veronica M.
BSMT II

Egg/Ova Adult
Pathology:  Echinococcus' main method of harming the host comes from the cysts formed by the larvae form,
not by the pathogen itself.
 The cysts, if developed enough, will swell and put pressure on the surrounding tissues, causing
eventual blood vessel obstruction and necrosis of the tissue.
 Additional harm may be inflicted upon rupture of the cysts can cause an allergic reaction and
possible anaphylactic shock if the fluid from the cysts spreads via the blood stream to other parts of
the body.
 These ruptures are normally caused by trauma or medical treatment
Diagnosis:  Radiographic findings 2. IFA
 Immunodiagnosis 3. EIA
 Antibody detection Antigen detection
1. IHA
Prevention:  Proper hand washing
 Treatment of pet dogs regularly
 Prevent eating infected or contaminated meat
Treatment:  Surgical Removal
 Mebendazole, Albendazole, Praziquantel, Habitate
 PAIR Technique
Phylum: Platyhelminthes
Flatworms (Trematodes)
Lung Fluke

Paragonimus westermani
Overview:
Paragonimiasis is a food-borne parasitic infection caused by the lung fluke. It may cause a sub-acute to
chronic inflammatory disease of the lung. It is one of the most familiar lung flukes with the widest geographical
range. Paragonimus westermani also known as the oriental lung fluke. Disease: Paragonimiasis. More than 30
species of trematodes (flukes) of the genus Paragonimus have been reported to infect animals and humans.
Among them, more than 10 species are reported to infect humans, the most common is P. westermani. Eating raw,
undercooked or pickled crustaceans such as crab or crayfish, spitting, a habit in asian countries, Cultures that eat
raw crustaceans, drunken crab in China, raw crab or crayfish and alcohol in The Philippines, Gye Muchim in Korea.
 Del Rosario, Ma. Veronica M.
BSMT II
Drawing with Label:

Egg/Ova Adult

Pathology:  Causes Paragonimiasis, pulmonary  Hemoptysis is noted feature; eosinophilia is

distomiasis and endemic hemoptysis common
 Patients, complain cough and  Lung abscess or pleural effusion (present in
hemoptysis manifestations w/ chronic infection)
pulmonary tuberculosis (misdiagnosed  Mimics PTB
w/ PTB)  Extra-pulmonary Paragonimiasis
 Pulmonary Paragonimiasis  More severe clinical manifestation
 Low grade fever, cough (rusty or golden  Abdominal, cerebral, subcutaneous and
brown sputum), night sweat, pleurisy miscellaneous (liver, spleen, kidney, testes,
pain, bacterial pneumonia mesenteric lymph nodes)
Diagnosis:  Detection of eggs in feces, ELISA test, immunoblot for IgG antibody detection,CSF tests
Prevention:  Cook crustaceans thoroughly and no raw boar meat
Treatment:  Praziquantel
 Bithionol
 Triclabenazole
Phylum: Platyhelminthes
Flatworms (Trematodes)
Liver Fluke

Fasciola hepatica
Overview:
Fasciola hepatica, also known as the common liver fluke or sheep liver fluke, is a parasitic trematode
(fluke or flatworm, a type of helminth) of the class Trematoda, phylum Platyhelminthes. It infects the livers of
various mammals, including humans. The disease caused by the fluke is called fascioliasis (also known as
fasciolosis). F. hepatica is distributed worldwide, and causes great economic losses in sheep and cattle. It has been
known as an important parasite of sheep and cattle for hundreds of years.

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 Del Rosario, Ma. Veronica M.
BSMT II

Egg/Ova Adult

Pathology:  Acute or Invasive phase (penetrate in intestinal wall and migration to liver)
 Chronic or Latent phase (reached to the bile ducts; obstruction in vessel and inflammation in biliary
epithelium)
 Parasite may wander or be carried out by blood to ectopic site (lungs, subcutaneous tissues or brain)
 Traumatic acute inflammation when adult feeds on tissue
 Obstruction of bile ducts
 Halzuon-pharyngeal fasciolasis
Diagnosis:  Stool Samples
 Duodenal or Biliary Aspirate
 Antibiotic Test (can detect 2 weeks after infection)
 Ultrasound (visualize adults in bile ducts)
 CT Scan (reveals burrows in liver)
Prevention:  Periodic examinantion/treatment of liverstock
 Control of the snail vectors
 Health Education
 People must be aware of how infection might occur
Treatment:  Bithionol
 Triclabendazole
 Surgery
Phylum: Platyhelminthes
Flatworms (Trematodes)
Liver Fluke

Clonorchis sinensis

Overview:
Clonorchis Sinensis is also known as the Chinese liver fluke. These are most commonly found in Eastern
Asia but are also commonly found in Russia. These liver flukes are common parasites of fish-eating mammals. The
trematode Clonorchis sinensis (Chinese or oriental liver fluke) is an important foodborne pathogen and cause of
liver disease in Asia. This appears to be the only species in the genus involved in human infection. It was discovered
by a British physician James McConnell at the Medical College Hospital in Calcutta (Kolkata) in 1874. The first
description was given by Thomas Spencer Cobbold, who named it Distoma sinense. The fluke passes its life cycle in
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BSMT II
three different hosts, namely freshwater snail as first intermediate hosts, freshwater fish as second intermediate
host, and mammals as definitive hosts.

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Egg/Ova Adult

Pathology:  Intrahepatic bile ducts expansion, hepatomegaly, necrosis of liver tissue

 Continuous severe infection may cause liver cirrhosis
 Persistent Cholestasis cause biliary liver cirrhosis
 Associate with cholangiocarcinoma and hepatic carcinoma
Diagnosis:  Epidemiologic date: living in or come from the endemic area The history of eating raw or
inadequately cooked freshwater fish and shrimp
 Clinical date: gastrointestinal symptoms, hepatomegaly, neurasthenia, cholangoitis, cholecystitis, etc.
 Laboratory findings: Discovery of characteristic eggs in feces or by duodenal aspiration come to
accurate diagnosis Eosinophilia and positive immunologic test support the diagnosis
Prevention:  Avoid eating inadequately cooked freshwater fish and shrimp
 Sanitary disposal of the excreta
 Avoid of drinking contaminated water
 Control of snails
Treatment:  Praziquantel
 Triclabendazole
Phylum: Platyhelminthes
Flatworms (Trematodes)
Intestinal Fluke

Fasciolopsis buski
Overview:
Fasciolopsis buski is commonly called the giant intestinal fluke, because it is an exceptionally large
parasitic fluke, and the largest known to parasitise humans. Its size is variable and a mature specimen might be as
little as 2 cm long, but the body may grow to a length of 7.5 cm and a width of 2.5 cm. Fasciolopsis buski is a
relatively large intestinal fluke that is acquired in the Far East from ingestion of parasite cysts attached to aquatic
plants, such as water chestnuts, contaminated by feces from infected mammals (pigs, humans). Human infection is
acquired by eating aquatic plants (eg, water chestnuts) that bear infectious metacercariae (encysted stage). Adult
worms attach to and ulcerate the mucosa of the proximal small bowel. They grow to about 20 to 75 mm by 8 to 20
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BSMT II
mm. Adult worms have a life span of about 1 year. Most infections are light and asymptomatic, but heavy
infections may cause diarrhea, abdominal pain, fever, and signs of malabsorption or intestinal obstruction.

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Egg/Ova Adult

Pathology:  Traumatic, Obstructive and toxic

 Inflammation and ulceration (site of worm attachment; increase in mucus secretion and minimal
bleeding)
 In heavy infection, intestinal obstruction
 Intoxication results from absorption by the host of the worm metabolites
Diagnosis: Stool Examination:
 Direct fecal smear
 Water Sedimentation Method
Prevention:  Periodic examinantion/treatment of liverstock
 Control of the snail vectors
 Health Education
 People must be aware of how infection might occur
Treatment:  Praziquantel

Phylum: Platyhelminthes
Flatworms (Trematodes)
Intestinal Fluke

Echinostoma ilocanum
Overview:
Echinostoma is a genus of trematodes, which can infect both humans and other animals. These intestinal
flukes have a three-host life cycle with snails or aquatic organisms as intermediate hosts, and a variety of animals,
including humans, as their definitive hosts. Echinostoma infect the gastrointestinal tract of humans, and can cause
a disease known as echinostomiasis. The parasites are spread when humans or animals eat infected raw or
undercooked food, such as bivalve molluscs or fish.

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 Del Rosario, Ma. Veronica M.
BSMT II

Egg/Ova Adult

Pathology:  Echinostoma are not highly pathogenic.

 Symptoms of greater severity tend to be seen in an echinostomiasis infection where there is a higher
number of flukes.
 The flukes cause damage to the intestinal mucosa, which leads to ulceration and inflammation.
Diagnosis:  An Echinostoma infection can be diagnosed by observing the parasite eggs in the feces of an infected
individual, under a microscope. Methods such as the Kato-Katz procedure can be used to do this.
 The eggs typically have a yellow-brown appearance, and are ellipsoid in shape.
 To confirm which species is causing the infection adult worms must be recovered from the infected
individual, such as with anthelmintic treatment.
Prevention:  Echinostomiasis can be controlled at the same time as other food-borne parasite infections, using
existing control programmes.
 Interrupting the parasite's lifecycle by efficient diagnosis and subsequent treatment of infected
individuals, and preventing reinfection, may help to control this disease.
 As echinostomiasis is acquired through the consumption of raw or undercooked infected food,
cooking food thoroughly will prevent infection.
Treatment:  Praziquantel
Phylum: Platyhelminthes
Flatworms (Trematodes)
Blood Fluke

Schistosoma japonicum
Overview:
Schistosoma japonicum is an important parasite and one of the major infectious agents of
schistosomiasis.This parasite has a very wide host range, infecting at least 31 species of wild mammals, including 9
carnivores, 16 rodents, one primate (Human), two insectivores and three artiodactyls and therefore it can be
considered a true zoonosis. Travelers should be well-aware of where this parasite might be a problem and how to
prevent the infection. S. japonicum occurs in the Far East, such as China, the Philippines, Indonesia and Southeast
Asia.
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BSMT II
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Egg/Ova Adult

Pathology:  As a chronic disease, S. japonicum can lead to Katayama fever, liver fibrosis, liver cirrhosis, liver portal
hypertension, splenomegaly, and ascites. Some eggs may pass the liver and enter lungs, nervous system
and other organs where they can adversely affect the health of the infected individual.
Diagnosis:  Microscopic identification of eggs in stool or urine is the most practical method for diagnosis. Stool
examination should be performed when infection with S. mansoni or S. japonicum is suspected, and urine
examination should be performed if S. haematobium is suspected.
 Since the eggs of S. japonicum are small, concentration techniques may be required. Biopsies are mostly
performed to test for chronic schistomiasis with no eggs. An ELISA test can be performed to test for
antibodies specific to schistosomes.
Prevention:  Human waste should be hygienically disposed of. Human waste in water with the Oncomelania snail
intermediate host is a major cause to the perpetuation of schistosomiasis. To prevent this from occurring,
human waste should never be used for nightsoiling (fertilization of crops with human waste) and
unsanitary conditions should be improved. To avoid infection, individuals should avoid contact with water
(including swimming and walking through water) that is contaminated by human or animal waste,
especially water sources that are endemic to Oncomelania snails.
Treatment:  Praziquantel
Phylum: Platyhelminthes
Flatworms (Trematodes)
Blood Fluke
Schistosoma mansoni
Overview:
S. mansoni is locomotive in primarily two stages of its life cycle: as cercariae swimming freely through a
body of freshwater to locate the epidermis of their human hosts, and as developing and fully-fledged adults,
migrating throughout their primary host upon infection. Schistosoma mansoni is a water-borne parasite of
humans, and belongs to the group of blood flukes (Schistosoma). The adult lives in the blood vessels (mesenteric
veins) near the human intestine. It causes intestinal schistosomiasis (similar to S. japonicum, S. mekongi, S.
guineensis, and S. intercalatum). Clinical symptoms are caused by the eggs. As the leading cause of schistosomiasis
in the world, it is the most prevalent parasite in humans. It is classified as a neglected tropical disease.
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Egg/Ova Adult
Pathology:  Schistosomiasis includes various hepatic complications from inflammation and granulomatous reactions,
and occasional embolic egg granulomas in brain or spinal cord.
Diagnosis:  The presence of S. mansoni is detected by microscopic examination of parasite eggs in stool. A staining
method called Kato-Katz technique is used for stool examination. It involves methylene blue-stained
cellophane soaked in glycerine or glass slides. A bit costlier technique called formalin-ether
concentration technique (FECT) is often used in combination with the direct fecal smear for higher
accuracy. Serological and immunological tests are also available. Antibodies and antigens can be
detected in the blood using ELISA to identify infection. Adult worm antigens can be detected by indirect
haemagglutination assays (IHAs). Polymerase chain reaction (PCR) is also used for detecting the parasite
DNA. Circulating cathodic antigen (CCA) in urine can be tested with lateral flow immune-
chromatographic reagent strip and point-of-care (POC) tests.
Prevention:  Avoid swimming or wading in freshwater when you are in countries in which schistosomiasis occurs.
Swimming in the ocean and in chlorinated swimming pools is safe.
Treatment:  Praziquantel and Oxamniquine 
Protozoa
Rhizopoda/Sarcodina
Entamoeba histolytica
Overview:
Entamoeba histolytica is an anaerobic parasitic protozoan that infects the digestive tract of predominantly
humans and other primates. ... Transmission of the parasite occurs when a person ingests food/water that has
been contaminated with infected feces. The infection E. histolytica is called Amebiasis (or Amoebiasis). Entamoeba
histolytica is a protozoan parasite that accounts for an estimated 100,000 annual deaths globally. Infection ranges
from asymptomatic colonization of the large bowel to invasive intestinal and extra-intestinal disease, particularly
liver abscess. Fedor Losch is first credited with identifying motile amebae in the stool of a patient with dysentery in
1875; however, an association between dysentery and liver disease goes back to Hippocrates. Diagnosis
conventionally involves microscopic demonstration of the parasite; however, this is neither sensitive nor specific.
Treatment is effective with metronidazole or tinidazole.
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Trophozoite and Cyst

Pathology:  Asymptomatic amoebiasis – patient as  Hepatic amoebiasis – anchovy-sauce fluid
carrier  Pulmonary amoebiasis
 Acute symptomatic amoebiasis  Cerebral amoebiasis
 Amoebic diarrhea – 3-6x/day  Cutaneous amoebiasis
 Acute amoebic dysentery – 6-8x/day  Genital amoebiasis
 Chronic amoebic dysentery
 Extra-intestinal amoebiasis
Diagnosis:  Serological – ELISA, IHA, IFA, CIE
 Aspirates – liver/pulmonary – wet/stained smear
 PCR (Polymerase chain reaction) – differentiate E. histolytica from E. dispar
 Stained smear – Iron hematoxylin, Trichrome, PAS, Chlorazol Black E
Prevention:  Improved sanitation will help to reduce the liklihood of transmission. Travelers to endemic areas can
reduce the risk of infection by drinking bottled water, not using ice cubes in drinks, and washing fruits
and vegetables with clean water (or by peeling them yourself).
Treatment:  Metronidazole
 Tinidazole
Protozoa
Rhizopoda/Sarcodina
Entamoeba coli
Overview:
Entamoeba coli is the only Entamoeba species found in humans that has more than four nuclei in the cyst
stage. The nuclei may be seen in unstained as well as stained specimens. Karyosomes may be compact or diffuse
and are usually eccentrically located. Entamoeba coli is a non-pathogenic amoeba with worldwide distribution. Its
life cycle is similar to that of E. histolytica but it does not have an invasive stage and do not ingest red blood cells.
Laboratory diagnosis is made by finding the characteristic cysts in an iodine stained, formol-ether concentration
method or by detecting the characteristic trophozoites in a wet preparation or a permanent stained preparation.

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Trophozoite and Cyst

Pathology:  E. coli are mostly harmless parasites, and do not cause harm to the host. However, there have been cases
of internal bleeding. Usually, the cytoplasm of the E. coli "does not contain red blood cells, except in the
rare case of patients with intestinal hemorrhage" that leads to blood in the stools of these patients. This
may lead to intestinal lesions. Other problems that E. coli causes are usually result from having too many
in the large intestine. For example, large populations of E. coli may lead to "dyspepsia, hyperacidity,
gastritis, and indigestion"; these are common problems of most intestinal parasites.
Diagnosis:  DFS  Culture
 Quensel’s solution – best for trophozoite  LES – Locke’s Egg Serum
 Methylene blue  Boeck’s and Drbohlav’s
 Lugol’s iodine – for cyst  RES – Rice Egg Saline
 Di Antonis – for cyst  Nutrient Agar Saline
 Concentration Technique
Prevention:  Washing fruits and vegetables thoroughly.  Do not defrosting meat on the counter.
 Avoiding cross-contamination by using clean  Always defrosting meat in the refrigerator or
utensils, pans, and serving platters. microwave.
 Keeping raw meats away from other foods and
away from other clean items.
Treatment:  Nitroimidazole  Chloroquine
 Erythromycin  Paramomycin
Protozoa
Rhizopoda/Sarcodina
Free Living Amoeba
Acanthamoeba

Overview:
Acanthamoebae are free-living protozoa ubiquitous in fresh water, well water, brackish water, and soil.
These protozoa have been increasingly recognized as a worldwide cause of painful keratitis, resistant to many
forms of treatment, and ultimately responsible for loss of vision or even loss of the eye. Acanthamoeba is a genus
of amoebae that are commonly recovered from soil, fresh water, and other habitats. Acanthamoeba has two
evolutive forms, the metabolically active trophozoite and a dormant, stress-resistant cyst. Trophozoites are small,
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usually 15 to 25 μm in length and amoeboid in shape. In nature, Acanthamoeba species are free-living
bacterivores, but in certain situations, they can cause infections (acanthamebiasis) in humans and other animals.

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Trophozoite and Cyst

Pathology:  Acanthamoeba is ubiquitous. Corneal trauma, followed by exposure to the parasite (often through a
water supply or contact lens solution) in a patient with low tear levels of anti-Acanthamoeba IgA
leads to infection. Acanthamoeba exist in two forms: trophozoites and cysts.
Diagnosis:  Can be cultured using PYGC (proteose-peptone, yeast extract, glucose and cysteine)
Prevention:  Contact lens wearers should be educated regarding the proper care of contact lenses and the contact
lens cases. It is important that contact lenses not be worn when swimming, performing water sport
activities, or when enjoying a hot tub or Jacuzzi.
Treatment:  Itraconazole
 Ketoconazole
 Miconazole
 Rifampin
 Sulfamethazine
Protozoa
Mastigopora
Atrial or Lumen Flagellates
Giardia lambia
Overview:
iardiasis is a major diarrheal disease found throughout the world. The flagellate protozoan Giardia
intestinalis (previously known as G lamblia or G duodenalis), its causative agent, is the most commonly identified
intestinal parasite in the United States and the most common protozoal intestinal parasite isolated worldwide.
Infection is more common in children than in adults. Giardia lamblia is a common cause of diarrhea in humans and
other mammals throughout the world. It can be distinguished from other Giardia species by light or electron
microscopy. The two major genotypes of G. lamblia that infect humans are so different genetically and biologically
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that they may warrant separate species or subspecies designations. Trophozoites have nuclei and a well-developed
cytoskeleton but lack mitochondria, peroxisomes, and the components of oxidative phosphorylation. They have an
endomembrane system with at least some characteristics of the Golgi complex and encoplasmic reticulum, which
becomes more extensive in encysting organisms.

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Trophozoite and Cyst

Pathology:  Intense inflammation – attachment of parasite in the intestinal mucosa
 Steatorrhea (presence of fat in stool)
 Passage of foul smelling and bulky stools
Diagnosis:  The best single test for diagnosing giardiasis is antigen testing of the stool. For antigen testing, a
small sample of stool is tested for the presence of Giardial proteins. The antigen test will identify
more than 90% of people infected with Giardia.
Prevention:  Ingestion of fecally contaminated food or water is the main mode of transmission. Thus, reducing this
contamination is the best method of prevention. Filtering or purifying drinking water (iodine or
boiling) in endemic areas is important as is the washing of fruits and vegetables that may have been
contaminated.
Treatment:  Metronidazole
Protozoa
Mastigopora
Trichomonas Species
Trichomonas vaginalis
Overview:
Trichomoniasis is a sexually transmitted infection (STI) caused by a tiny parasite called Trichomonas
vaginalis (TV). Symptoms of trichomoniasis usually develop within a month of infection, although up to half of all
infected men and women have no symptoms. Trichomonas vaginalis is the causative agent of trichomoniasis, a
common cause of vaginitis. In men, it may cause urethritis but is more commonly asymptomatic. Despite being a
readily diagnosed and treatable sexually transmitted disease (STD), trichomoniasis is not a reportable infection and
control of the infection has received relatively little emphasis from public health STD control programs. More
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recently, however, recognition of the high rates of disease and of associations of trichomoniasis in women with
adverse outcomes of pregnancy and increased risk for HIV infection suggest a need for increased control efforts.
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Trophozoite
Pathology:  Vaginal walls are inflamed
 Vaginal secretion is greenish yellow
 Intense itching of the vagina and burning sensation
Diagnosis:  Unstained wet preparation
 Stained smear - Giemsa, Pap’s Romanowsky, Acridine Orange
 Culture – diamond’s modified medium, Feinberg and Whittington culture media
Prevention:  Use condoms (male or female) every time you have vaginal or anal sex. If you have oral sex, cover the
penis with a condom or the female genitals with a latex or polyurethane square (a dam) if you're a
woman and rub your vulva against your female partner's vulva, one of you should cover your genitals
with a dam.
Treatment:  Metronidazole (Flagyl)
 Tinidazole (Tindamax)
Protozoa
Mastigopora
Blood and Tissue Flagellates (Hemoflagellates)

Trypanosomes
Overview:
Human African trypanosomiasis, also known as sleeping sickness, is a vector-borne parasitic disease. They
are transmitted to humans by tsetse fly (Glossina genus) bites which have acquired their infection from human
beings or from animals harbouring human pathogenic parasites. Trypanosomes have been around for more than
300 million years. They are microscopic unicellular protozoa that are ubiqitous parasites of insects, plants, birds,
bats, fish, amphibians and mammals. Because they have been around for so long, they and their natural hosts have
evolved together to ensure their mutual survival. Fortunately, few species of trypanosomes are pathogenic.
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Trypanosomes, and other parasites, mainly cause disease when they spread to new hosts, like humans and their
domestic animals, especially recent imports into endemic areas of species that diverged since continents
separated.

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Trophozoite
Pathology:  The trypanosomes give rise to two distinct clinical entities, Gambian trypanosomiasis (chronic
infection) and Rhodesian trypanosomiasis (acute infection). The uneven distribution of African
trypanosomiasis is related to the habitats of tsetse flies.
Diagnosis:  T. brucei: based on the presence of trypanosomes in stained blood preparation, lymph
aspirates, CSF and buffy coat – Trypomastigotes are recovered
 CATT – Card Agglutination Test for Trypanosomiasis (Ag detection test)
 T. cruzi: thick blood smear for the presence of trypanosomes
 Xenodiagnosis: bugs are examined, these bugs are allowed to feed on patient’s blood and
later examined for the presence of T. cruzi – Metacyclic Trypanosoma
 Culture: Weinman’s medium
Prevention:  Infection by Trypanosoma species is acquired from the bite of an infected tsetse fly. Thus, preventing
flies from biting through the use of repellants or insect nets will reduce the transmission of the
parasite.
Treatment:  Pentamidine  Eflornithine
 Suramin  Nifurtimox
 Melarsoprol
Protozoa
Mastigopora
Blood and Tissue Flagellates (Hemoflagellates)

Leishmania
Overview:
Leishmania is an organism related to the trypanosomes. The inflammatory disease caused by the organism
that may involve skin and mucous membranes, as well as internal organs. The organism's lifecycle contains a flagellate
phase (promastigote) while living within the vector, and a phase when the flagellum is retracted (amastigote) which is
the stage seen in human infection and visualized in tissue sections or smear preparations.

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Trophozoite
Pathology: Cutaneous: usually restricted to face, scalp, arms or other exposed areas
 Localized, disseminated (if immune system doesnt respond to invading parasites), recurrent
(recidivans cutaneous) or post-kala azar (rare, years after visceral disease)
Mucocutaneous: usually New World disease of rural and jungle regions
 Occurs when primary infection with L. braziliensis becomes disseminated to upper respiratory tract,
produces lesions of oral, pharyngeal or nasal mucosa with ulceration, mutilation or sometimes death
Visceral: also called kala azar; parasites throughout reticuloendothelial system, causing fever, malaise,
hepatosplenomegaly, anorexia, pancytopenia, hypergammaglobulinemia
Diagnosis:  Smear of lesion stained with Wright’s or Giemsa – Amastigote seen
 Culture using NNN (Nicole, Novy, McNeal)
 Serological test: CFT, FAT, CIEP
 Screening test: FORMOL-GEL TEST - .1ml of serum + 1 drop formalin = gel formation (+ )
Prevention:  No vaccines or drugs to prevent infection are available. The best way for travelers to prevent
infection is to protect themselves from sand fly bites. To decrease the risk of being bitten, follow
these preventive measures:
 Avoid outdoor activities, especially from dusk to dawn, when sand flies generally are the most active.
Treatment:  Intravenous liposomal amphotericin B (L-AmB) for VL
 Oral miltefosine for CL, ML, and VL caused by particular species
Protozoa
Ciliata
Balantidium coli

Overview:
Balantidium coli is a protozoan parasite responsible for the disease Balantidiasis. Balantidium coli is the
largest protozoan and the only ciliate known to parasitize humans. Balantidium coli most commonly infects
humans, other primates, and pigs, which are reservoirs of the parasite. Balantidium coli, the largest and least
common of the human protozoan pathogens, is capable of causing an infection resembling amebic colitis. It is
particularly prevalent among people living in close association with pigs in South America, Iran, Papua New Guinea
and the Philippines. Up to 80% of persons carrying the organism are asymptomatic carriers. Acute diarrhea with
blood and mucus begins abruptly and is associated with nausea, abdominal discomfort and marked weight loss.
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There can be inflammatory changes and ulceration in the proctosigmoid region. Peritonitis and colonic perforation
can progress rapidly to death. A chronic infection occurs with intermittent diarrhea and infrequent bloody stools.

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Trophozoite and Cyst

Pathology:  Balantidium coli causes a disease called Balantidiasis. Balantidiasis is an uncommon infection.
Balantidiasis is caused through contamination and transmitted through fecal-oral route. Balantidium
coli primarily is found in the lumen of the large intestines
Diagnosis:  Diagnosis is based on detection of trophozoites in stool samples from symptomatic patients
or in tissue collected during endoscopy. Cysts are less frequently encountered, and are most
likely to be recovered from formed stool. Balantidium coli is passed intermittently and once
outside the colon is rapidly destroyed.
Prevention:  Balantidium coli infection can be prevented when traveling by following good hygiene practices.
Wash your hands with soap and warm water after using the toilet, changing diapers, and before
handling food. Teach children the importance of washing hands to prevent infection.
Treatment:  Tetracycline
 Metronidazole
 Iodoquinol
Protozoa
Sporozoa
Toxoplasma gondii
Overview:
Toxoplasma gondii is an intestinal coccidium that parasitizes members of the cat family as definitive hosts
and has a wide range of intermediate hosts. Infection is common in many warm-blooded animals, including
humans. Toxoplasmosis is caused by the protozoan parasite Toxoplasma gondii. In the United States it is estimated
that 11% of the population 6 years and older have been infected with Toxoplasma. In various places throughout
the world, it has been shown that more than 60% of some populations have been infected with Toxoplasma.
Infection is often highest in areas of the world that have hot, humid climates and lower altitudes, because the
oocysts survive better in these types of environments.
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Trophozoite
Pathology:  Infection with Toxoplasma gondii is usually asymptomatic in healthy individuals.
 About 10-20% of those with an acute infection will have enlarged lymph nodes in the cervical and
inguinal region as well as flu-like symptoms (fever, headache, muscle pain). The infection is generally
self-limited and the symptoms usually resolve in a few months.
 Immunocomprimised persons often show involvement of the central nervous system but may also
have heart and lung complications. In persons with AIDS, toxoplasmic encephalitis and brain lesions
may occur.
 Congenital infection occurs if the mother is infected during pregnancy. Toxoxplasma gondii
tachyzoites are thought to cross the placenta to the fetus which may lead to stillbirths or severe birth
defects. Early diagnosis and treatment of the mother may reduce the probability of congenital
infection.
 Chronic infections may also lead to blindness over time as sarcocysts in the eye develop and rupture
the infected cells.
Diagnosis:  Biopsy
 Serological tests – IHA, ELISA, LAT, IFA, Sabin-Feldman
 DNA determination by PCR
Prevention:  Wear gloves when you garden or handle soil. Wear gloves whenever you work outdoors and wash
your hands thoroughly with soap and water afterward. Don't eat raw or undercooked meat.
Treatment:  Corticosteroid
 Trimethoprim - sulfamethoxazole
Protozoa
Sporozoa
Isospora belli
Overview:
Cystoisospora belli, previously known as Isospora belli, is a parasite that causes an intestinal disease
known as cystoisosporiasis. This protozoan parasite is opportunistic in immune suppressed human hosts. It
primarily exists in the epithelial cells of the small intestine, and develops in the cell cytoplasm. The distribution of
this coccidian parasite is cosmopolitan, but is mainly found in tropical and subtropical areas of the world such as
the Caribbean, Central and S. America, India, Africa, and S.E. Asia. In the U.S., it is usually associated with HIV
infection and institutional living.

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Trophozoite
Pathology:  Immune competent individuals are usually asymptomatic to this parasite's infection. But clinical
symptoms such as mild diarrhea, abdominal discomfort, and low grade fever for approximately one
week has been observed in some individuals.
 Other symptoms of cystoisosporiasis include abdominal pain, cramps, loss of appetite, nausea,
vomiting, and fever that can last from weeks to months.
Diagnosis:  The oocyst that is diagnosed in the stool sample is unsporulated, and contains only one sporoblast.
For stool diagnosis, direct smear, concentration smear, microscopic wet mount, or iodine stains of
fecal smears are adequate. But for easy screening, acid-fast stains is recommended. If stool test is
negative, and biopsies of the small intestine is performed, different stages of schizogony and
sporogony should exist in the epithelial cells, but the alteration of the villi is not necessarily present.
Eosinophilia may also be seen unlike in the case of other protozoal infections.
Prevention:  The method of transmission is ingesting food or water that has been contaminated with feces from
someone who is infected. Washing your hands with soap and warm water after using the toilet,
changing diapers, and before handling food is vital. Also, educating children the importance of hand-
washing and good hygiene practice is important.
Treatment:  This infection is easily treated with antibiotics. The most common antibiotic that is prescribed is co-
trimoxazole (trimethoprimsulfamethoxazole), more commonly known as Bactrim, Septra, or Cotrim.
 In AIDS patients, treatments can result in the disappearance of the symptoms, but recurrence of
symptoms is common. In order prevent the recurrence, medication is continued in AIDS patients and
other immunosuppressed patients.
Plasmodium
Malaria
Plasmodium falciparum
Overview:
Plasmodium falciparum is a unicellular protozoan parasite of humans, and the deadliest species of
Plasmodium that causes malaria in humans. The parasite is transmitted through the bite of a female Anopheles
mosquito and causes the disease's most dangerous form, falciparum malaria. It is responsible for around 50% of all
malaria cases. P. falciparum is therefore regarded as the deadliest parasite in humans, causing 405,000 deaths in
2018. It is also associated with the development of blood cancer (Burkitt's lymphoma) and is classified as Group 2A
carcinogen.
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Stages
Pathology:  Infection with Plasmodium falciparum is often the most severe and involves infection in the brain
(cerebral malaria), kidney failure, and severe anemia that may lead to death.
Diagnosis:  Malaria parasites can be identified by examining under the microscope a drop of the patient's blood,
spread out as a “blood smear” on a microscope slide. Prior to examination, the specimen is stained (most
often with the Giemsa stain) to give the parasites a distinctive appearance
Prevention:  Awareness of risk – find out whether you're at risk of getting malaria.
 Bite prevention – avoid mosquito bites by using insect repellent, covering your arms and legs, and using a
mosquito net.
 Check whether you need to take malaria prevention tablets – if you do, make sure you take the right
antimalarial tablets at the right dose, and finish the course.
 Diagnosis – seek immediate medical advice if you have malaria symptoms, including up to a year after you
return from travelling.
Treatment:  Individuals should take 200 mg of Proguanil daily together with chloroquine 5 mg/kg per week as
prophylaxis.
 Pregnant women and individuals with underlying disease such as sickle cell making them susceptible to
severe or complicated malaria, however, should take just 200 mg Proguanil daily.
 In hard-core multi-drug resistance areas, mefloquine 250 mg once weekly together with chloroquine 300
mg weekly is recommended as prophylaxis.
 Chloroquine in total dose 25 mg/Kg over three days is the first choice treatment of uncomplicated malaria
in 4-aminoquinoline sensitive areas.
 Amodiaquine 25 mg/Kg over three days is the second line treatment, while pyrimethamine/sulphonamide
combinations are useful in areas where there is resistance to 4-aminoquinalines.
 Quinine 10 mg/kg every eight hours for seven days is the treatment of choice for severe and complicated
malaria.
Plasmodium
Malaria
Entamoeba histolytica

Plasmodium vivax
Overview:
Plasmodium vivax is a protozoal parasite and a human pathogen. This parasite is the most frequent and
widely distributed cause of recurring malaria. Although it is less virulent than Plasmodium falciparum, the deadliest
of the five human malaria parasites, P. vivax malaria infections can lead to severe disease and death, often due to
splenomegaly (a pathologically enlarged spleen). P. vivax is carried by the female Anopheles mosquito; the males
do not bite.
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Stages
Pathology:  Long considered a benign infection, Plasmodium vivax is now recognized as a cause of severe and fatal
malaria, despite its low parasite biomass, the increased deformability of vivax-infected red blood cells and
an apparent paucity of parasite sequestration.
Diagnosis:  The accurate diagnosis of vivax malaria in an acutely ill patient seeking routine care requires microscopy
examination of a Giemsa-stained blood smear (microscopy), or use of an immunochromatographic
cassette containing monoclonal antibodies to a P. vivax antigen (rapid diagnostic test [RDT]).
Prevention:  Awareness of risk – find out whether you're at risk of getting malaria.
 Bite prevention – avoid mosquito bites by using insect repellent, covering your arms and legs, and using a
mosquito net.
 Check whether you need to take malaria prevention tablets – if you do, make sure you take the right
antimalarial tablets at the right dose, and finish the course.
 Diagnosis – seek immediate medical advice if you have malaria symptoms, including up to a year after you
return from travelling.
Treatment:  Individuals should take 200 mg of Proguanil daily together with chloroquine 5 mg/kg per week as
prophylaxis.
 Pregnant women and individuals with underlying disease such as sickle cell making them susceptible to
severe or complicated malaria, however, should take just 200 mg Proguanil daily.
 In hard-core multi-drug resistance areas, mefloquine 250 mg once weekly together with chloroquine 300
mg weekly is recommended as prophylaxis.
 Chloroquine in total dose 25 mg/Kg over three days is the first choice treatment of uncomplicated malaria
in 4-aminoquinoline sensitive areas.
 Amodiaquine 25 mg/Kg over three days is the second line treatment, while pyrimethamine/sulphonamide
combinations are useful in areas where there is resistance to 4-aminoquinalines.
 Quinine 10 mg/kg every eight hours for seven days is the treatment of choice for severe and complicated
malaria.