CLINICAL PARASITOLOGY

INTRODUCTION
Parasitology – the area of biology concerned with the phenomenon of dependence of one living organism on another
Definition of Terms:
▪ Commensalism – association between two organisms in which one derives benefit without reciprocating nor
injuring the other
▪ Mutualism – association between two organisms in which both members benefit from each other but life
without the other is still possible
▪ Parasitism – association between two organisms in which one member lives at the expense of the other and at
the same time causes it harm
▪ Host – organism that supports or harbors the parasite
▪ Vector – responsible for transmitting the parasite from one host to another
o Biological vector – essential in the life cycle of the parasite
o Mechanical/Phoretic vector – not essential, but simply transports the parasite
▪ Incidence – number of new cases of infection in a population in a given period of time
▪ Superinfection – when an individual harboring a parasite is reinfected with the same species of parasite
▪ Autoinfection – when the infected person is his own source of re-exposure
▪ Hematozoic – parasite living inside the red blood cells (e.g., plasmodium spp.)
▪ Cytozoic – parasite living inside the cells of tissues (e.g., Isospora)
▪ Enterozoic – parasite living inside the lumen of the intestines
▪ Coelozoic – parasite living inside the body cavaties (e.g., Manzonella ozzardi)
▪ Obligate parasite – a parasite that cannot exist without a host (e.g., Leishmania spp.)
▪ Facultative parasite – capable of a parasitic or free-living existence (e.g., S. stercoralis)
▪ Incidental parasite – a parasite which occurs occasionally in an unusual host (e.g., A. caninum)
▪ Erratic parasite – parasite which invades or becomes fixed in an organ or habitat which is not its usual habitat
(e.g., A. lumbricoides)
▪ Spurious parasite (Coprozoic) – some free-living organisms that parasitize other hosts, having merely passes
through the intestines, and are recovered in a living or dead state from human feces
▪ Definitive host – one that harbors the sexually mature stage of the parasite
▪ Intermediate host – harbors the larval/immature or the asexual stage of the parasite
o 1st IH – harbors the early larval stage of the parasite
o 2nd IH – harbors the infective stage
▪ Reservoir host – host that harbors a parasite that is also parasitic to humans, and from which humans may
become infected
▪ Carrier – a person or animal that harbors a specific parasite without manifesting any symptom and serves as a
potential source or reservoir of infection for man and animals
▪ Oviparous – lays eggs which hatch after leaving the body of the host
▪ Oviviparous – lays eggs which hatch before leaving the host
▪ Viviparous – bears living young instead of laying eggs (e.g., Trichinella)
▪ Parthenogenetic – the ability of a female parasite to produce eggs without being fertilized by the male (e.g., S.
stercoralis)
LABORATORY METHODS
Importance of Fecal Examination:
1. Detects the presence of parasite
2. Detects evidence of malfunction of some parts of the GIT, liver, or pancreas
3. Detects GIT bleeding
4. To investigate steatorrhea
Collection of Fecal Sample
▪ Container – clear, sterile, disposable, wide mouth with tight fitting lid and transparent
▪ Amount – pea-sized (2-5 grams)
▪ Avoid contamination with urine and water
▪ Processing:
o Liquid stool – examine within 30 minutes
o Semi-formed/soft – examine within 1 hour
o Formed – may be held within 24 hours (must be stored at refrigerator)
Preservation methods
A. Physical
 Refrigeration

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 B. Chemical
Preservative Advantage
Formalin  For protozoan cysts and
helminths
 Suitable for concentration
procedures and DFS
 Can be used for antigen
tests
 Preserve the specimen for
years (long shelf-life)
Schaudinn’s fluid  Suitable for permanent
staining
 Preserved fresh materials
and those recovered from
intestinal linings
Polyvinyl alcohol  Suitable for permanent
staining (Wheatly
trichrome or Iron
hematoxylin staining)
 Long shelf life
Merthiolate-Iodine formalin  Suitable for concentration
techniques and DFS
Sodium acetate-formalin  Suitable for concentration
techniques, DFS, and
permanent staining
 Can be used for antigen
tests
 Does not contain mercury
Disadvantage
 Not suitable for permanent
staining
 Trophozoites are not
usually recovered,
morphologic details of cysts
may fade with time
 Hazardous
 Not suitable for
concentration techniques
and DFS
 Contains mercury
 Can be used but not
suitable for concentration
techniques, DFS, and
antigen test
 Most often combined with
Schaudinn’s fluid
 Not suitable for permanent
staining
 Less adhesive property
 Protozoan morphology in
stained smears is not that
clear

Macroscopic Examination
✓ Consistency of the stool – formed to soft
✓ Color – light brown to dark brown
✓ Odor – foul to offensive
Variations in the Rice water stool Cholera
Consistency Pea soup stool Typhoid fever
Flattened/Ribbon-like Spastic colitis, cancer, ulcer, tumors
Bulky/Frothy Bile duct obstruction, pancreatic disorders
Butter-like Cystic fibrosis
Hard and scybalous Constipation
Variations in the Yellow Bilirubin, santonin & senna, antibiotic therapy
Color Red Lower GIT bleeding, food coloring, rifampin
Black/Tarry Upper GIT bleeding, iron, bismuth, charcoal
Dark red/chocolate brown Upper GIT bleeding, increased intake of coffee
Green Biliverdin, increased vegetable diet, calomel
Gray or putty Bile duct obstruction, BaSO4 meals
Blood-streaked mucus Dysentery, colitis, malignancies, constipation
Variations in the Sour/Rancid Infant stool (fatty acids from milk)
Odor Adult stool: steatorrhea
CHO fermentation
Putrid/Extremely foul Ulcerate and malignant tumor of the lower
bowel, alkaline stools, putrefaction of
undigested protein

Chemical Examination
▪ Fecal Occult Blood Test – indicates hemorrhage in the GIT and may be seen in malignant tumor, benign peptic
ulcer, esophageal, stomach, and duodenal bleeding, hemorrhoids, liver cirrhosis, and GIT carcinoma
o Principle: Pseudoperoxidase activity of hemoglobin
o Patient preparation: abstinence from red meat, horseradish, melons, raw broccoli, cauliflower, radish,
turnips, and vitamin C in 3 days

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 o Methods:
1. Benzidine test
2. Guaiac’s test
3. Hematest tablet
4. Hemoquant – fluorometric test for Hb and porphyrin
5. IFOBT – Hemoccult Immunochemical test
Microscopic Examination
A. Direct Fecal Examination (Direct Wet Mount)
a. NSS mount (0.85% NaCl)
− observation of protozoan trophozoite motility
− cyst appear as glistening and refractile
− doesn’t demonstrate glycogen vacuole and nuclei
b. Iodine mount (D’ antoni’s/Lugol’s)
− glycogen vacuole becomes prominent
− chromatoidal bars are fully seen
− enhances the details of protozoan cyst
c. KTS (Kato Thich Smear)
− Reagents: distilled water, glycerin, and malachite green
− For large scale examination
− satisfactory for all common types of helminth eggs
− unsuitable for diarrheic stools
− cannot demonstrate protozoan cysts and trophozoites
B. Concentration Techniques
a. Sedimentation Method - more efficient and easier to perform
 Formalin Ether Concentration Technique
− Uses fresh or PVA preserved material
− Disadvantage: more fecal debris are left
 Acid Ether Sedimentation Technique
− Uses formed stool
− Applicable for helminth eggs and larvae
− NOT applicable for protozoan cysts
 Others:
o Merthiolate-Iodine Formalin Concentration Technique
o Acid-Sodium Sulfate Tritan
b. Floatation Method
 Allows the separation of helminth eggs and larvae, and protozoan cyst using liquid of higher
specific gravity
 Parasitic elements are recovered on the surface and some parasites and fecal debris at the
bottom
 Sugar Floatation Technique
 Willie brine
 Lane’s Direct Centrifugal Floatation technique
 Magnesium sulfate technique
 ZnSO4 centrifugal floatation technique
− ZnSO4 solution has specific gravity of 1.18-1.20
− Microscopic examination should be done within 5-30 minutes
− Removes more fecal debris
Staining Methods
A. Temporary Staining
a. D’ antonis
b. 1% Isotonic Eosin solution and 2% Brilliant Cresyl Blue
c. Fosin in saline
d. Buffered methylene blue (e.g., Nairs Methylene Blue)
B. Permanent Staining
a. Wheatly (modification of Trichrome stain)
b. Iron Hematoxylin stain (Tompkins-Miller method)
c. Modified AFS – for oocyst (coccidians) and microsporidia, Isospora, and Cyclospora
d. Modified Iron Hematoxylin stain (added with carbol fuchsin)
e. Chlorazol black E
f. Modified Kohn’s

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 NOTE
Permanent Staining:
 Confirms the morphology of protozoan cysts and trophozoites
 NOT suitable for helminth eggs and larvae
 Fixatives used: PVA or SAF

Special Recovery Methods

A. Cellulose Tape Preparation – for recovery of E. vermicularis and Taenia eggs
B. Egg count technique – estimates worm burden or degree of infection (e.g., Ascaris, Hookworm, and Trichuris)
C. Egg Hatching – for Schistosomes
D. Harada-Mori (Test tube culture method)
E. Baermann Funnel technique
F. Membrane Filtration
G. Culture media:
▪ Balamuth’s Monophasic Medium (for E. histolytica and B. coli)
▪ Boeck and Drbohlav’s Diphasic medium – E histolytica
▪ Trussel and Johnson’s medium – T. vaginalis
▪ Novy, McNeal and Nichol’s – Leishmania and Trypanosomes
▪ Hockmeyer’s – Leishmania
▪ Weinman’s medium – T. gambiense
▪ Tobies medium – Trypanosomes
Specimens for Examination
Habitat Parasites Recovered Specimen
Intestinal tract E. histolytica Fresh stool
E. coli Preserved stool
E. hartmanni Sigmoidoscopy material
E. nana Duodenal contents
I. butschlii Anal impression smear
G. lamblia Adult worm segments
C. mesnili
T. hominis
Cryptosporidium spp.
I. belli
A. lumbricoides
E. vermicularis
Hookworms
S. stercoralis
T. trichiura
H. nana
T. saginata
D. latum
C. sinensis
Schistosomes
Blood Plasmodium spp. Anticoagulated blood
L. donovani Thick and thin smears
T. gondii Wet smears
Trypanosomes
Microfilariae
Lungs P. carinii Sputum
P. westermani Lavage
Transbronchial aspirate
Tracheobronchial aspirate
Brush biopsy
Open lung biopsy
Bone marrow L. donovani BM aspirate
CNS T. solium CSF
Echinococcus spp.
N. fowleri
Acanthamoeba spp.
Hartmanella spp.
T. gondii
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 Trypanosomes
Cutaneous ulcers Leishmania spp. Biopsy
Eyes Acanthamoeba spp. Corneal scrapings
Loa loa Corneal biopsy
Liver, spleen Echinococcus spp. Aspirates
E. histolytica Biopsy
L. donovani
Muscle T. spiralis Muscle biopsy
T. solium
Onchocerca volvulus
Skin Leishmania spp. Scrapings
Microfilariae Skin snips
Biopsy
Urogenital T. vaginalis Vaginal discharge
S. haematobium Urine
Urethral discharge
Prostatic secretions

NEMATODES
A. Ascaris lumbricoides
 Most common intestinal roundworm of man
 Common name: Giant intestinal roundworm
 Infective stage: Embryonated ova
 Definitive host: Man (no IH needed)
 Main habitat: small intestine
 Mechanical vector: cockroach
 Life span: 12-17 months
 Developmental stages:
o Ova
▪ Unfertilized
− longer and narrower
− filled w/ amorphous mass and lacks the crescentic clear shaped; often distorted
▪ Fertilized
− 3 layers:
o Albuminous layer: outermost mamillated layer with a tanning action
o Chorionic/true shell: chitinous layer; secretory product of the egg
o Vitelline layer: fertilization membrane; protects the inner embryo
NOTE:
▪ Embryonated ova – same as fertilized ova but contains the larva of the embryo
▪ Decorticated ova – lacks the albuminous mamillated shell; usually seen in old specimens

o Adult
▪ white, creamy, or pinkish yellow when freshly expelled and resembles earthworm
▪ head is provided with three conspicuous lips which are finely denticulated
 Life cycle
 Disease: Ascariasis, Dooryard or Backyard infection
o Larval migration:
▪ Ascaris pneumonitis
o Adult worms:
▪ Due to its erratic behavior, it may cause vomiting, suffocation, intestinal obstruction,
appendicitis, acute pancreatitis, peritonitis
 Laboratory detection: DFS, KTS, concentration technique, ELISA
NOTE:
Stool examination may give negative results due to the following:
✓ Infection is still early (worms are still immature)
✓ During larval migration through the bloodstream
✓ Male worms are the only present in the intestine

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B. Hookworms
Human Hookworms N. americanus (American murderer/American hookworm/New World
Hookworm)
A. duodenale (Old World Hookworm)
A. ceylanicum
Animal Hookworms A. braziliense (cat hookworm)
(Causes larval migrans in man) A. caninum (dog hookworm)
 Developmental stages
OVA
▪ Ovoidal
▪ Colorless/hyaline
▪ Thin-shelled
▪ 4-8 cell stage when passes in the feces (surrounded by a clear zone)

RHABDITIFORM LARVA FILARIFORM LARVA

▪ feeding stage ▪ Non-feeding stage
▪ short and stout ▪ infective stage
▪ has a long narrow buccal cavity ▪ mouth is closed with a protecting sheath
▪ flask-shaped esophagus ▪ longer and slender with a pointed
▪ very small genital primordium posterior end
ADULT
▪ Small, cylindrical, fusiform, grayish white
▪ Relatively stout with a cervical curvature which appeared like a hook
▪ With a well-developed buccal capsule
Hookworm species Buccal Cavity Copulatory bursa
Necator americanus 1 pair of semilunar cutting plates Fused spicules; deep cleft
Bipartite dorsal rays

Ancylostoma duodenale 2 pairs of fused ventral teeth Unfused spicules; shallow cleft
Tripartite dorsal rays

Ancylostoma caninum 3 pairs of ventral teeth Burse is supported by long, slender

rays

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 Ancylostoma braziliense 1 pair of larger outer teeth and 1 Bursa is supported by short stubby
pair of very inconspicuous median rays
teeth

 Infective stage: Filariform larva

 Mode of Transmission: through skin penetration
 Life cycle
 Disease: Necatoriasis (N. americanus), Ancylostomiasis (Ancylostoma spp.)
o Pathology
1. Due to larval stage:
a. Ground itch (aka Coolie itch or Dew itch)
− Intense itching, edema and erythema and later papulovesicular eruption
b. Creeping eruption
− aka Cutaneous Larva Migrans/Plumber’s itch/Duck hunter’s itch
− “Serpiginous tunnel” in the stratum germinativum of the skin
c. Wakana disease
− causes pulmonary lesions
2. Due to adult worms:
a. Hookworm anemia
− Chronic blood loss due to continuous mechanical suction of blood from
the intestinal mucosa and the presence of bleeding areas left by the
adult as they transfer to new areas
− causes microcytic hypochromic anemia
b. Hypoalbuminemia
 Diagnosis
o Recovery of eggs using DFS, KTS, Brine floatation technique and FECT
o Harada-Mori culture technique
 Treatment
o Mebendazole, Pyrantel Pamoate, Oxantel
o Severe anemia – iron therapy
C. Strongyloides stercoralis
 Common name: Threadworm
 Definitive host: Man
 Habitat: Small intestines (duodenum)
 Developmental stages:
o Ova
▪ ovoidal, thin-shelled and transparent
▪ resembles Chinese lantern
▪ contains fully developed embryo
▪ NOT found in feces EXCEPT in diarrhea and hyperperistalsis
o Larvae
▪ Rhabditiform larvae
− flask-shaped and stout esophagus
− short buccal cavity
− conspicuous genital primordium
▪ Filariform larvae
− non-feeding stage with a long and delicate esophagus
− forked or notched tail
o Adult – with well-developed buccal capsule (no teeth nor cutting plates); bears a crown of
chitinous, leaf-like process
 Phases of Development
o Parasitic
o Free-living

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  Mode of Transmission: penetration of filariform larva; autoinfection
 Life cycle
 Disease: Cochin-China diarrhea, Strongyloidosis
o Asymptomatic in light infection
o May cause death among immunocompromised hosts (due to heavy autoinfection)
 Diagnosis
o DFS
o Stool culture (Harada-Mori filter paper technique), Baermann Funnel technique
o Enterotest
o ELISA
 Treatment
o Difficult to treat (autoinfection may persist for years)
o Thiabendazole
Distinguishing Features Hookworm Strongyloides
RHABDITIFORM LARVA

Buccal cavity LONG SHORT

Genital primordium SMALL LARGE
FILARIFORM LARVA

Esophagus SHORT LONG

Tail POINTED NOTCHED

D. Enterobius vermicularis
 Synonym: Oxyuris vermicularis
 Common name: Pin worm, society worm, seat worm
 Main habitat: large intestine (cecum and appendix)
 Definitive host: Man
 Reservoir host: dogs and cats
 Infective stage: embryonated eggs
 Developmental stages:
o Ova
▪ Double-lined chorionic shell, transparent and colorless

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 ▪ Elongated and ovoidal w/ one side flattened
▪ Embryonated when laid at the perianal area
▪ Remain viable up to 13 days
▪ Rarely seen in stool
o Adult
▪ small, spindle-shaped, relatively stout with dorsoventral bladder-like expansions of
cuticle called the “Cephalic alae” or lateral wings
▪ have an oral end and three lips; hour-glass shaped esophagus
 Mode of transmission:
1. Fecal-oral via contaminated fingers and fomites
2. Via contaminated food and drinks especially if the food handler is a carrier
3. Via inhalation (ova can float in the air)
4. Retro-infection: gravid female after laying eggs in the perianal area → goes back
through the anus to the large intestine
 Life cycle
 Disease: Enterobiasis, Oxyuriasis
o Cardinal feature: hypersensitivity and nocturnal perianal itching
 Diagnosis:
o Graham Scotch Tape method/Cellulose Acetate Technique - demonstration of eggs
 Prevention and Control
o Home and community sanitation
o Personal hygiene
E. Toxocara spp.
 Species:
o T. canis (dog ascarid)
o T. cati (cat ascarid)
 Can infect humans and cause damage of the visceral organs
 Cycle and transmission: eggs from feces of infected animals → eggs embryonate in the environment →
embryonated eggs are swallowed by man and hatch in the intestine → larvae penetrate the mucosa →
enter the circulation→ liver, lungs, eyes, and other organs causing inflammatory necrosis
 Disease: Visceral Larva Migrans (invasion of human visceral organs by nematode larvae)
 Diagnosis:
o Clinical S/S: triad of marked eosinophilia, hepatomegaly, hyperglobulinemia
o ELISA, EIA
 Treatment: Mebendazole
F. Trichinella spiralis
 Common name: Trichina worm, Pork roundworm
 Infective stage: encysted larva
 Final hosts: Hogs, rats, man
 Intermediate host: hogs, rats
 Developmental stages:
o Larva – has spear-like burrowing tip at its tapering anterior end
o Adults
− rarely seen in stool or any material
− Female: posterior end is bluntly rounded with single vulva at the anterior 5 th;
LARVIPAROUS
− Male: posterior end has ventrally curved with two lobular caudal appendages
 Life span: 4-16 weeks
 Mode of transmission: ingestion of encysted larva
o NOTE: human infection is a dead-end infection
 Life cycle
 Disease: Trichinosis, Trichiniasis, Trichinelliasis
o Intestinal invasion: inflammation of duodenal and jejunal mucose, malaise, nausea, diarrhea,
and abdominal cramps
o Muscle invasion: fever, facial edema (particularly the eyes), pain, swelling and weakness of the
involved muscle
o Convalescence: begins at about the end of the 3rd week → cyst wall subsides → the larva itself
will calcify
 Diagnosis:
o Muscle biopsy

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 − usually involving the gastrocnemius and biceps (demonstration of encysted larva
through digestion of pepsin-HCl)
o Bachmann Intradermal Test
− uses antigen prepared from Trichinella larva
− (+) result: small white swelling around injected site
o Beck’s Xenodiagnosis
− uses albino rats
o Bentonite Flocculation test
o CBC – marked eosinophilia
 Treatment: self-limiting
G. Capillaria philippinensis
 Common name: Pudoc worm
 Infective stage: 3rd larva stage
 Intermediate host: glassfish, “bagsit”, “bagsang”, “ipon”
 Definitive host: Man, and Birds
 Habitat: small intestine
 Distribution: Philippines and Thailand
 Developmental stages:
o Ova – pale yellow with moderately thick striated shell, and with
flattened bipolar plugs; resembles “peanut-shaped” appearance
o Adult
▪ Female – 2-4 mm in length
• Typical Female Adult: the 8-10 eggs in utero are arranged in the single row
(Oviparous)
• Atypical Female Adult – the 40-45 eggs in utero are arranged in 2-3 rows
(Larviparous); causes autoinfection
▪ Male – 2-3 mm in length; characterized by the presence of a chitinized spicule and a
long spicule sheath extending beyond the length of the worm
 Mode of Transmission: through eating of infected fish
 Life Cycle
 Disease: Capillariasis or Mystery Disease
o Malabsorption syndrome
o Gurgling stomach (Borborygmus)
o Abdominal pain, diarrhea, pneumonia, heart failure, cerebral edema
o NOTE: death may occur 2 weeks to 2 months after the onset of these symptoms
 Laboratory Diagnosis
o DFS and concentration techniques
 Treatment
o Albendazole (drug of choice)
H. Capillaria hepatica
 Common name: Capillary liver worm
 Infective stage: Embryonated ova
 Hosts: rats, dogs, cats, monkeys, rare in humans
 Habitat: liver
 Developmental stages:
o Ova – outer shell is pitted like golf ball; resembles “lemon-shaped”
o Adult - males are half as long as the female with slightly chitinized spicule
 Life cycle
 Diagnosis – Liver biopsy (reveals eggs and mature worm)
I. Trichuris trichiura
 Other name: Trichocephalus trichiurus; Trichocephalus dispar
 Common name: Whipworm
 Infective stage: embryonated ova
 Principal host: Man
 Other hosts: has been found in hogs, monkeys, cattle, dogs, and mice
 Habitat: Large intestine (cecum and appendix)
 Life span: 5-10 years
 Developmental stages:
o Ova
▪ Barrel-shaped/Japanese lantern-shaped/Football-shaped
▪ w/ bipolar mucus plugs

Felix, JD P a g e 10 | 27
 ▪ w/ vitelline membrane and triple shell
▪ outermost shell is yellow-brown
o Adult
▪ Female – 3.5-5 cm in length with straight posterior end
▪ Male – 3-4.5 cm in length with coiled posterior end (360°)
 Mode of Transmission: ingestion of embryonated ova
 Life Cycle
 Disease: Trichuriasis, Whipworm infection
o Asymptomatic for light infections
o Heavy infection: surface colon is matted with worms
▪ Diarrhea (bloody mucoid), hypoalbuminemia, iron deficiency anemia
▪ Rectal prolapse
▪ Obstruction and inflammation of the appendix
 Diagnosis: demonstration of eggs using DFS, KTS, concentration techniques
 Treatment: Albendazole, Mebendazole, Oxantel-Pyrantel
J. Dioctophyma renale
 Other name: Eustrongylus gigas
 Common name: Giant Kidney worm
 Infective stage: 3rd stage larva
 Habitat: Kidney (typically the right kidney)
 Definitive host: fish-eating mammals
 Life span: 5 years
 Developmental stages:
o Ova – ellipsoidal and brownish-yellow; deeply sculptured depressions except at the pole
o Adult – adults are blood red in color
▪ Male – 14-20 cm in length; with bell-shaped copulatory bursa not supported by rays
▪ Female – up to 60 cm in length; w/ midventral vulva near the anterior end
 Diagnosis: demonstration of eggs in urine
 Treatment: surgical excision
K. Angiostrongylus cantonensis
 Synonym: Pulmonema cantonensis
 Common name: Rat Lungworm
 Definitive host: Rats
 Habitat: Lungs
 Infective stage: 3rd stage larva
 Developmental stages:
o Ova – elongated, ovoidal with a delicate hyaline shell
o 1st stage larva – has a distinct dorsal minute notch near the tip of the tail
o 3rd stage larva – w/ 2 well developed chitinous rods with expanded knob-
like tips at the anterior end
o Adult
▪ Female – the milky white uterine tubules are spiral around the blood-filled intestine and
can be seen through transparent cuticle as a “barber’s pole” pattern
▪ Male – has a well-developed caudal bursa which is kidney-shaped and single lobed
 Mode of transmission:
1. Ingestion of raw mollusks containing the 3rd stage larva
2. Ingestion of raw leafy vegetables contaminated with mucus secretions of the mollusks
containing the 3rd stage larva
3. Drinking water contaminated with the infective larva
4. Ingestion of paratenic hosts such as fresh water prawns and crab containing the infective larva
 Life cycle
 Disease: Human Angiostrongylosis
o Pathology and Symptomatology: confusion, incoherence, disorientation and impairment of
memory or profound coma
 Diagnosis
o Brain dyscrasia – moderate to marked eosinophilic count in the spinal fluid
o History of the patient as to ingestion of snails, seafoods, or leafy vegetables
L. Anisakis spp.
 Causes Anisakiasis or Herring Disease
 Common gastrointestinal parasites of marine mammals
 Infective stage: 3rd stage larva
 Mode of Transmission: ingestion of 3rd stage larva from raw, freshly salted or smoked marine fish
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  Diagnosis: confirmed by the recovery of intact worm through endoscopy or by the presence of
eosinophilic granuloma containing an identifiable nematode in a surgical specimen
 Prevention: freezing the fish at -20°C for 24 hours
M. Dracunculus medinensis
 Common name: Medina worm, Guinea worm, Dragon worm, serpent worm, Fiery serpent of Israelites
 Distribution: Nile valley, Middle east, India, Iran, Afghanistan, Pakistan, and Africa
 Habitat: cutaneous and subcutaneous tissue
 Life span: 12-18 months
 Infective stage: 3rd stage larva
 Mode of transmission: ingestion of copepods from contaminated water
 Morphology of the adult worm:
o Female – 50-120 cm in length
o Male – 12-29 cm in length
 Disease: Dracunculosis, Dracunculiasis, Dracontiasis
o If the worm fails to reach the skin, it dies and either disintegrates or calcifies
o Mesenteric tissues – it causes pseudoperitoneal syndromes and allergic manifestations
o Superficial tissues – the worm liberates a toxic substance that produces local inflammatory
reactions → blister appears at any location → rupture of blisters favors the escape of the larvae
o Contamination of ruptured blister causes secondary bacterial infection such as abscesses,
cellulitis, extensive ulceration and necrosis
 Diagnosis:
o Visual observation of blisters – outline of worm under the skin is revealed by reflected light
o Larvae release may be induced when cold water is applied
o Calcified worm may be located by x-ray
 Treatment
o Mebendazole, Niridazole, Thiabendazole
o Surgical removal of the worm or slow withdrawal from blister by gentle traction and rolling the
protruded portion on a stick
 Prevention and Control: refrain drinking from suspected water source

SUMMARY:
 Parasitizes the small intestine:
✓ T. spiralis
✓ C. philippinensis
✓ A. lumbricoides
✓ N. americanus
✓ A. duodenale
✓ A. ceylanicum
✓ S. stercoralis
 Parasitizes the large intestine:
✓ T. trichiura
✓ E. vermicularis
 Parasitizes the tissues:
✓ W. bancrofti
✓ B. malayi
✓ L. loa
✓ D. medinensis

BLOOD AND TISSUE NEMATODES

Filarial Worms
 Mode of Transmission: arthropod-transmitted (mosquito-borne parasites)
 Infective stage to man: filariform/filiform/3rd stage microfilariae
 Infective stage to vector: microfilariae
 Diagnostic stages:
o Microfilariae – blood
o Adult larva – lymphatics
 Morphology
▪ Microfilaria – embryos produced by filarial worms, highly motile and threadlike; usually found in
peripheral blood and lymph spaces of the skin
▪ Larval stage – snake-like with a column of cells in the anterior to the posterior portion
Felix, JD P a g e 12 | 27
 ▪ Adult – threadlike, creamy, white, varies in length
 Sheath – a thin, translucent egg shell remnant covering the body of the microfilaria and past the
head and tail
 Life cycle
 SHEATHED FILARIA WORMS
Wuchereria bancrofti Brugia malayi Loa loa
Common Name Bancroft’s filarial worm Malayan filarial worm Eye worm
Loa worm
Disease/s caused Bancroftian filariasis Malayan filariasis Loasis
Wuchereriasis

Elephantiasis of the lower Elephantiasis of the Fugitive swelling

extremities, lymphatics of upper extremities Calabar swelling
scrotum
Habitat Lower lymphatics Upper lymphatics Subcutaneous and
muscular tissues
Specimen of choice Blood Blood Blood
Vector Culex pipiens Mansonia spp. Chrysops fly
Anopheles spp. (Deer fly/mango fly)
Differential Characteristics of Sheathed Microfilariae
Body curves Regularly smoothly Irregular and twisted Irregular and twisted
curved, graceful Stiff w/ secondary kinks
sweeping
Body nuclei Coarse, well separated Coarse, tend to overlap Coarse, tend to overlap
Tail end No nuclei on the tip 2 widely spaced nuclei Nuclei present
Blunt tip Rounded tip

Periodicity Nocturnal Nocturnal Diurnal

 UNSHEATHED FILARIAL WORMS

Onchocerca volvulus Mansonella perstans Mansonella streptocerca Mansonella ozzardi
Common Name Blinding worm Ozzard’s filaria
New World filaria
Disease/s caused River blindness Dipetalonemiasis Streptocerciasis Ozzard’s filariasis
Habitat Subcutaneous Inside the body Inside the body Inside the body
tissue cavities cavities cavities
Specimen of choice Skin snips Blood Blood Blood
Vector Simulium spp. Culicoides spp. Culicoides spp. Culicoides spp.
Black fly (Night biting)
Buffalo fly
Differential Characteristics of Sheathed Microfilariae
Body curves Regular Regular Tail usually curved Regular
Slightly twisted Often form loops Slightly twisted
Body nuclei Coarse Tend to overlap Fine Fine
Mostly separated Mostly separated Mostly separated
Tail end No nuclei Nuclei present Nuclei present No nuclei
Pointed tip Rounded tip Curved tip Pointed tip

Periodicity Non-periodic Non-periodic Non-periodic Non-periodic

Felix, JD P a g e 13 | 27
  Laboratory Diagnosis
▪ Wet smears and thick smears
 For the demonstration of microfilariae
 Stain: Wright’s, Giemsa, Delafield Hematoxylin
NOTE:
✓ a negative result may be due to low intensity of
infection, dead worms, or due to obstructed lymphatics
✓ Diethylcarbamazine – stimulates the microfilariae to
come out to the peripheral circulation

▪ Knott’s method
 1 ml WB + 2% formalin
 Centrifuge at 500 g for 10 minutes
 sediment → thick and thin smear
▪ Buffy coat smear
▪ Immunoassay: antigen detection and PCR
 Treatment:
▪ DEC/Hatrazan
▪ Ivermectin
 Prevention
▪ For abaca workers – wear long sleeve shirts

CESTODES
Order Pseudophyllidean:
A. Diphyllobothrium latum
 Common name: Fish tapeworm, Broad tapeworm
 1st IH: Copepods (Cyclops and Diaptomus)
 2nd IH: Fresh water fish (salmon, trout, and white fish)
 Reservoir host: Dogs and cats
 Definitive host: Man
 Infective stage to man: Plerocercoid larvae
 Developmental stages:
o Ova – single-shelled, broadly ovoidal with the posterior part thickened
and with operculum at one end; immature when passed in the feces
o Coracidium – ciliated, swims freely in the water
o Procercoid larvae – 2nd larval stage, w/ 3 pairs of hooklets
o Plerocercoid larvae (sparganum) – 3rd larval stage, unsegmented and has
an invaginated anterior end, but no scolex
o Adult
▪ Scolex – almond shaped, unarmed
and has 2 deep dorsoventral
suctorial grooves
▪ Proglottids – mature segment,
broader than long
 Mode of Transmission: ingestion of infected fish
 Life cycle
 Disease: Diphyllobothriasis (Fish or Broad Tapeworm infection)
o Systemic toxemia
o Pernicious anemia (Vitamin B12 deficiency)
o Human Sparganosis
 Laboratory Diagnosis
o Examination of eggs and proglottids in feces
o KTS preparation
o Concentration technique
 Treatment
o Niclosamide
o Quinacrine HCl
o 40% ethyl alcohol with Procaine is injected into the lesion to kill the plerocercoid larva
Additional Notes: Sparganosis
 Sparganosis refers to the larval infection caused by Spirometra
 Humans may be infected through drinking water containing Cyclops or copepods
infected with procercoid larvae, eating infected 2nd IH like frogs, toads, or snakes

Felix, JD P a g e 14 | 27
Order Cyclophillidean
B. Taenia solium
 Common name: Pork tapeworm
 Intermediate host: Pig, man
 Definitive host: Man
 Infective stage: cysticercus larvae
 Developmental stages:
o Ova – brown, spherical, with 2 radially striated shells
o Adult
▪ Scolex – globular with 4 suckers and armed with
rostellum (circular row of hooks)
▪ Proglottid – w/ 800-1000 proglottids
▪ Gravid Proglottid – contains 30,000-50,000 eggs; uterus
exhibit 7-12 lateral branching
 Mode of Transmission: ingestion of raw meat
 Life cycle
 Disease
1. Taeniasis solium
2. Neurocysticercosis
 Diagnosis
o DFS (ova and proglottids)
o Scotch tape method
 Treatment: Praziquantel, Bithionol, Panomomycin
C. Taenia saginata
 Common name: Beef Tapeworm
 Intermediate host: Cow
 Definitive host: Man
 Infective stage: Cysticercus bovis
 Developmental stages:
o Ova – same with T. solium
o Adult
▪ Proglottid – each proglottid contains 80,000 eggs
 Disease: Taeniasis saginata
 Mode of Transmission: ingestion of raw beef
 Life cycle: same with T. solium except for the IH
 Diagnosis
o Stool examination – DFS, KTS, concentration technique
o Scotch tape method
Distinguishing Features of Taenia spp.
Taenia solium Taenia saginata
Scolex Globular in shape with 4 cup-shaped Pyriform in shape with 4 muscular suckers
suckers No hooklets
Rostellum and double rows of hooklets

Mature proglottids Irregularly alternate genital pore Irregularly alternate lateral genital pore
Segments 800-1000 1000-2000
Testes 150-200 300-400

Felix, JD P a g e 15 | 27
Uterine branches 7-12 15-30

D. Hymenolepis nana
 Common name: Dwarf tapeworm
 Intermediate host: fleas (rice and flour beetles)
 Definitive host: man, rats
 Infective stage: embryonated ova and cysticercoid larva
 Developmental stages:
o Ova – w/ 4-8 polar filaments; oncosphere has six hooks (seen as dark line at 8 o’clock)
o Larva (cysticercoid) – tailed structure w/ invaginated scolex
o Adults
▪ Scolex – retractable rostellum w/ 20-30 Y-shaped hooklets
▪ Segments – wider than long
▪ Genital pore – located on the same side
 Life cycle
 Disease: Dwarf Tapeworm infection
o Generalized toxemia – due to the absorption of metabolic wastes of the parasite
o Pruritus ani
o Periodic diarrhea
 Diagnosis: DFS
 Treatment: Praziquantel, Niclosamide
E. Hymenolepis diminuta
 Common name: Rat tapeworm
 Intermediate host: cockroach, beetles, rat fleas
 Developmental stages:
o Ova
o Adult
▪ Scolex – club-shaped w/ 4 suckers and unarmed rostellum
▪ Proglottid – broader than long; 3 ovoid testes and 1 ovary; sac-like uterus
 Lab Diagnosis: DFS, concentration technique (for light infections)
 Treatment – Praziquantel
Distinguishing Features of Hymenolepis spp.
Hymenolepis nana Hymenolepis diminuta
Scolex Globular Club-shaped
Bears a short refractile rostellum w/ a Has rudimentary unarmed rostellum
single row of 20-30 small hooks

No. of segments 200 800-1000

Mature proglottid Trapezoidal Same with H. nana
Broader than long w/ single genital pore
on its left side and 3 round testes and
bilobed ovary
Uterus Sacculate Same with H. nana

Felix, JD P a g e 16 | 27
Ova (w/ 6 hooklets) Has 4-8 polar No polar filament
filaments

Habitat Upper 2/3 of the ileum SI of rats and mice

Infective stage Embryonated ova Cysticercoid larvae

F. Dipylidium caninum
 Common name: Double-pored dog tapeworm
 Habitat: Small intestine of dogs
 Infective stage: cysticercoid larvae
 Intermediate host: Cat fleas, dog fleas, human flea (Pulex irritans)
 Definitive host: Dogs
 Developmental stages:
o Ova – hyaline w/ thick transparent albuminous covering with
membranes; each egg contains an oncosphere (w/ 3 pairs of
delicate hooklet)
o Adult
▪ Scolex – rhomboidal-shaped, w/ a club-shaped rostellum and thorn-shaped hooks
▪ Proglottids – pumpkin seed-shaped
 Disease: Dipylidiasis
 Pathology: intestinal disturbances
 Lab Diagnosis: DFS, KTS, Concentration technique
 Treatment: Quinacrine, Niclosamide, Bithionol
G. Multiceps multiceps
 Common name: Gid worm
 Intermediate host: Herbivores
 Definitive host: dogs, wolves, and fox
 Infective stage: embryonated eggs
 Morphology (Adult): scolex is pyriform w/ double circles of rostellar hook
 Disease: cerebral and ocular coenurosis
 Treatment: Praziquantel
H. Echinococcus granulosus
 Common name: Hydatid worm
 Infective stage: embryonated ova
 Intermediate host: sheep, cattle, horses
 Definitive host: dogs and other canines
NOTE:
Man is parasitized only by the larva
(hydatid cyst) of the tapeworm. The
canines/dog is the only definitive host.

 Disease: Unilocular echinococcosis, Hydatid Disease

 Developmental stages:
o Ova – cannot be differentiated from the eggs of Taenia
o Adult
▪ Scolex – pyriform w/ four suckers and armed rostellum (double
crown of 20-36 hooklets)
▪ Proglottids (gravid segment)
• uterus resembles a loosely twisted coil
• uterus has 12-15 branches distended w/ around 500 eggs
o Hydatid cyst (larva)
Types of Hydatid cyst:
✓ Unilocular – consists of laminar and germinal layers; most prevalent
human type of hydatid cyst; may grow 5-20 years before it is
diagnosed
✓ Alveolar – lacks the laminar layer which is the mother cyst
✓ Osseus – lacks the laminar layer; found in the bones

o Life cycle
Felix, JD P a g e 17 | 27
  Pathogenesis
o Damage produced by the larval forms are mechanical and toxic
o Young cysts may lodge in vital organs causing dangerous obstruction
o In the bone, they cause erosion leading to fracture
o In the abdomen, they grow into tremendous size and eventually burst, followed by anaphylactic
reactions caused by toxins released by the hydatid cyst
o Causes brain damage (Jacksonian epilepsy)
 Diagnostic stage: demonstration of the larval stage
o X-ray
o Hydatid thrill – vibrations felt which is a special diagnostic sign in unilocular hydatid cyst of the
abdomen
o CBC – marked eosinophilia
o Immunologic tests:
▪ Bentonite flocculation test
▪ Casoni’s intradermal test
▪ ELISA, IE
 Treatment
o Surgical removal of the cyst; replacement of the cyst fluid with 10% formalin or 2% AgNO3
o Albendazole
o High dose of Mebendazole
TREMATODES
Dioecious Flukes
 Most important digenetic parasites of man inhabiting the veins of their hosts
 Morphology
o Male:
▪ Larger than females
▪ w/ a gynecophoral canal
o Female – threadlike
NOTE: adult male and female live typically in pairs

Infective stage: CERCARIA

Human Infection: Schistosomiasis/Bilharziasis
o Vesicular schistosomiasis
o Oriental schistosomiasis (Katayama disease)
o Rectal or intestinal schistosomiasis
 Life cycle:
1. Adult male and female in copula in portal veins
2. Female deposits eggs in terminal branches or venules in the walls of
intestines (10-12x a day)
3. Eggs liberate miracidia
4. Miracidia penetrate the snail host
5. Miracidia in snail develops into primary sporocyst → secondary sporocyst → cercaria
6. Cercaria escapes into the water (1-3 days) → penetrates the skin of a host
7. Cercaria in DH develops into schistosomula and migrates into the portal veins and matures in 24
days
 Lab Diagnosis
o S. haematobium – demonstration of eggs in urine (dysuria and hematuria); bladder biopsy
o S. mansoni and S. japonicum – eggs in feces; rectal biopsy
o Circumoval precipitin test
 Treatment: Praziquantel, Oxamiquine, Niridazole
S. japonicum S. haematobium S. mansoni
Common name Oriental blood fluke Vesical blood fluke Manson’s blood fluke
Visceral blood fluke Bladder fluke
Habitat Superior mesenteric veins Veins of the urinary bladder Inferior mesenteric veins
Ova Oval to sub-spherical w/ Ellipsoidal w/ prominent Ellipsoidal w/ prominent
minute lateral spines/knob terminal spine lateral spine

Felix, JD P a g e 18 | 27
 Intermediate host (snails) Oncomelania quadrasi Biomphalaria spp. Tropicorbis
Oncomelania nocophora Bulimus spp. Australorbis
Oncomelania formosana Biomphalaria
Disease Katayama disease Vesical/Urinary Intestinal Bilharziasis
Visceral or Oriental Schistosomiasis Schistosomal dysentery
Schistosomiasis

Monoecious Flukes
A. Paragonimus westermani
 Common name: Lung fluke, Oriental Lung Fluke
 Habitat: lung pockets
 Infective stage: METACERCARIA
 1st IH: snail of genus Hua
 2nd IH: fresh water crabs
 Developmental stages:
o Ova
▪ Operculated and ovoidal
▪ Golden brown in color
▪ Immature when laid
o Adult
▪ Tegument covered with single spaced spines
▪ Active state: spoon-shaped
▪ Preserved state: coffee bean-shaped
 Life cycle
 Disease: Paragonimiasis (resembles TB)
 Lab Diagnosis:
o Demonstration of eggs in sputum and feces
o X-ray
o Ab detection
B. Clonorchis sinensis
 Common name: Chinese Liver Fluke, Oriental Liver Fluke
 Habitat: bile ducts
 Infective stage: METACERCARIA
 1st IH: operculated snails
 2nd IH: Fresh water fish
 Developmental stages:
o Ova
▪ Yellowish brown w/ distinct convex operculum
▪ Resembles an “old fashion” electric bulb
▪ Fully embryonated when laid
o Adult
▪ Flat, transparent, elongated, rounded posteriorly and
attenuated anteriorly
 Disease: Clonorchiasis
o Acute infection: hepatomegaly, diarrhea, eosinophilia
o Chronic infection: cholangitis, cholelithiasis, pancreatitis and cholangiocarcinoma
 Lab Diagnosis:
o Eggs in biliary drainage (most practical diagnostic method)
o Surgery – recovery of adult flukes
 Treatment: Praziquantel and chloroquine phosphate
C. Opistorchis felineus
 Common name: Cat Liver Fluke
 Infective stage: METACERCARIA
 Habitat: bile ducts, occasionally pancreatic duct
 1st IH: Bithynia snail
 2nd IH: Fish
 Morphology: resembles C. sinensis
 Disease: Opistorchiasis (same symptomatology w/ C. sinensis)
D. Dicrocoelium dendriticum
 Common name: Lancet Fluke
 Morphology:
o Ova – relatively small, thick shelled w/ distinct operculum; fully embryonated when laid
Felix, JD P a g e 19 | 27
 o Adult – slender, lancet-shaped, flat
 Infective stage: METACERCARIA
 1st IH: Land snails
 2nd IH: Ants
 Disease: chronic constipation and hepatomegaly
E. Fasciola hepatica
 Common name: Sheep Liver Fluke
 Morphology
o Ova – large and ellipsoidal; thin-shelled w/ distinct operculum;
unsegmented stage in the feces
o Adult – large, broad, and flat body
 Infective stage: METACERCARIA
 1st IH: Water snail
 2nd IH: water cress
 Disease: Liver rot disease, Fascioliasis
 Lab Diagnosis: DFS, concentration and sedimentation technique, demonstration of adult fluke through
duodenal or biliary drainage
F. Fasciola gigantica
 Common name: Giant Liver Fluke
 Morphology: same with F. hepatica, except:
o greater in length
o shorter cephalic cone
o larger ventral sucker
o reproductive organs are located on the anterior portion of the worm
o ovum is bigger
 Infective stage: METACERCARIA
 1st IH: snail
 2nd IH: water cress
 Disease: Fascioliasis
 Lab Diagnosis: same with F. hepatica
G. Fasciolopsis buski
 Common name: Large Intestinal Fluke
 Morphology:
o Ova – resembles hen’s egg
o Adult:
▪ Testes – dendritic or highly branched and in tandem position
▪ Ovary – branched and located at the middle of the body
 Habitat: small intestine, occasionally in the LI and stomach
 Infective stage: METACERCARIA
 1st IH: Planorbid snails (Segmentina, Hippeutic, Gyraulus)
 2nd IH: water plants (Trapa bicornis), water caltrop (Thiara), water bamboo
 Disease: Fasciolopsiasis
 Lab Diagnosis: DFS and vomitous examination (NOTE: eggs are indistinguishable from those of Fasciola)
H. Echinostoma ilocanum
 Common name: Garrison’s intestinal fluke
 Distribution: Ilocos, Philippines
 Morphology
o Adult – w/ horse-shoe shaped collar of spines surrounding the dorsal and lateral sides of oral
sucker
 Habitat: small intestine
 Infective stage: METACERCARIA
 1st IH: water snail
 2nd IH: fresh water mollusks (Pila conica)
 Lab Diagnosis: DFS
I. Heterophyes heterophyes
 Common name: Dwarf Intestinal Fluke, Von Seibold Fluke
 Morphology:
o Ova – contains fully developed miracidium at oviposition
o Adult – cuticle is covered w/ minute scale-like spine
 Habitat: small intestine
 Infective stage: METACERCARIA
 1st IH: blackish water snails
Felix, JD P a g e 20 | 27
  2nd IH: Mugil or Mullet
 Disease: main symptoms are diarrhea and colicky abdominal pain
 Lab Diagnosis: DFS
J. Metagonimus yokogawai – smallest human fluke
PROTOZOA: SARCODINA (AMOEBA)
A. Entamoeba histolytica
✓ Most pathogenic amoeba in man
✓ The only amoeba that has the potential of tissue invasion
o Habitat: Large intestines
o Infective stage: CYST
o Stages of Development:
▪ Trophozoite
▪ Cyst
Trophozoites Cyst

Pseudopodia Finger-like and extruded Absent

Motility Active, progressive, and directional Non-motile

Wet mount Motile Nuclei not visible

Nucleus not visible Chromatoid bar – refractile
Ingested RBCs are visible
Iodine stained Nucleus visible Nucleus visible (w/ 4 nuclei)

Chromatoid bar Absent Rods w/ rounded ends (cigar/sausage-

shaped)

o Pathogenesis
1. Primary Amoebiasis
→ trophozoites penetrate the cecal mucosa and epithelia by lytic digestion aided by
amoeboid movement
→ trophozoites burrow deeper with tendency to spread laterally by continuous lysis of cells
until they reach the submucosa to form flask-shaped ulcers
2. Extra-intestinal amoebiasis (hepatic abscess, pulmonary abscess, cerebral amoebiasis, splenic
abscess, cutaneous abscess)
o Lab Diagnosis
1. DFS
NOTE:
✓ Cysts – found in formed or semi-formed stools
✓ Trophozoites – diarrheic stools/dysenteric stools

2. Permanently stained preparations (Trichrome stain)

3. Saline purge
4. Sigmoidoscopy material
5. Stool culture method – Balamuth’s medium, rice egg saline, Locke egg serum, Robinson’s and
Inoki medium
6. Serological Methods
NOTE:
✓ Antibody detection is most useful in patients with
extraintestinal amoebiasis
✓ Differentiation of E. histolytica and E. dispar is not
possible by microscopy; this can only be done by
ELISA, PCR, and isoenzyme analysis

Felix, JD P a g e 21 | 27
 o Treatment: Metronidazole (Flagyl), Iodoquinol, Emetine HCl (for extraintestinal amoebiasis), Tinidazole
(for amebic dysentery)
AMOEBIASIS
Bacillary Dysentery Amebic Dysentery
Acute onset Gradual onset
Prodromal fever is common No prodromal features
Vomiting common No vomiting
Watery, bloody diarrhea Bloody diarrhea
Odorless stool Fishy odor stool
Microscopy: Microscopy:
Numerous bacilli, pus cells, red cells, no Charcot- Few bacilli, red cells, trophozoites with ingested
Leyden crystals RBCs, Charcot-Leyden crystals

B. Entamoeba hartmanni
 Common name: small race E. histolytica
 Morphology: same with E. histolytica except in size; resembles E. nana in size
C. Entamoeba coli
 Habitat: LI of human
 Distinct features: no ingested RBC
DIFFERENCES BETWEEN E. histolytica and E. coli
Features E. histolytica E. coli
Size Large Larger
Number of nuclei 1-4 1-8
CYST

Chromatoidal bodies Sausage-shaped Splinter/Broomstick

appearance
Pseudopodia Finger-like Blunt and broader
Motility Progressive and Sluggish, non-progressive,
TROPHOZOITE

directional non-directional
Nucleus Bull’s eye nucleus Eccentric
Cytoplasm Clean-looking w/ Dirty looking
ingested RBC Heavily vacuolated due to
ingested bacteria and food
particles

D. Endolimax nana
 Smallest intestinal protozoan of man
 Synonym: Endolimax intestinalis, Entamoeba nana
 Common name: Cross-eyed cyst
 Morphology:
o Cyst – w/ 1-4 nucleus, chromatoidal bodies are comma-
shaped
o Troph – movement is sluggish, blot-like karyosome
 Habitat: cecum
E. Iodamoeba butschlii
 Also known as Endolimax williamsi
 Habitat: LI of man and swine
 Morphology:
o Cyst – contains only one nucleus with large glycogen vacuole
o Troph – small, with fairly active progressive movement (sometimes
non-progressive)
F. Entamoeba gingivalis
 Habitat: tartar of the teeth and gingival pockets
 MOT: use of contaminated drinking utensil, dental utensil, kissing, droplet spray
 Trophozoite stage only; NO CYST STAGE
 Troph – w/ multiple pseudopodia; moderate progressive motility
 Prevention: oral hygiene
FREE LIVING PATHOGENIC AMOEBA
 Habitat: stagnant water, brackish and ocean sediments, thermal pools, swimming pools, polluted soil, sewage
disposal system
A. Naegleria fowleri
 Morphology
Felix, JD P a g e 22 | 27
 o Trophozoite
▪ Amoeboid – blunt pseudopodia and vesicular nucleus
with large karyosome
▪ Flagellate – elongate and bear two equal, anteriorly
located flagella
o Cyst
▪ Round, cyst wall is smooth and double walled, with the
outer wall perforated by 3-8 pores (ostioles)
▪ Single nucleus and spherical chromatoid bodies
 Life Cycle
1. The parasite enters the host through nasal passages while swimming or diving in contaminated
bodies of water
2. From nasal passages, the trophozoites migrate along the olfactory nerves through the cribriform
plates and into the meninges and cerebral hemispheres of the brain
NOTE: When inside the host, the Naegleria trophozoites
do not exhibit the flagellate stage, and cysts are not also
formed.

 Pathogenesis
o “Brain-eating” amoeba
o Primary Amebic Meningoencephalitis (PAM)
B. Acanthamoeba spp.
 Morphology
o Trophozoites – has a single vesicular nucleus and a large
karyosome; pseudopods are present
o Cyst – Uninucleate and double-walled
o NOTE: NO flagellate form
 Disease: Granulomatous Amebic Encephalitis (GAE)
 Treatment: Amphotericin B
PROTOZOA: MASTIGOPHORA (FLAGELLATES)
A. Giardia lamblia – the only pathogenic intestinal flagellate found only in man
 Synonyms: G. intestinalis, G. duodenalis, Cercomonas intestinalis
 Disease: Giardiasis, Flagellate diarrhea
o Duodenitis
o Cholangitis
 Habitat: duodenal area of small intestine, gall bladder
 Troph – invasive stage
 Cyst – infective stage
 Morphology
o Cyst
▪ Ovoidal/ellipsoidal
▪ Double walled
▪ Axostyle and fibrillar remnants of
locomotory apparatus present
o Troph
▪ Pyriform
▪ Bilaterally symmetrical
▪ “Old man in glasses”, “tennis racket”
▪ Motility: jerky falling leaf, kite-like, spinning, flip flop
 Life Cycle:
1. Ingestion of viable cysts from contaminated food and water
2. Excystation in duodenum → trophozoites
3. Trophozoites inhabit the duodenum → reproduce via binary fission
4. Encystation occurs in the LI with water reabsorption
 Diagnosis:
o DFS, ZnSO4 floatation technique
o Entero test (duodenal aspiration)
 Treatment: Metronidazole (drug of choice)
B. Chilomastix mesnili
 Considered as commensals
 Habitat: cecum of the LI

Felix, JD P a g e 23 | 27
  Morphology:
o Cyst – pear or lemon-shaped, w/ knob-like
protuberance projection
o Trophozoite
▪ Asymmetrically pear-shaped tapering toward
the posterior end
▪ Cytostome resembles a “shepherd’s crook”
and is the most prominent of several
supporting cytostomal fibrils
▪ Motility: boring or spiral forward movement (corkscrew, clockwise, twisting motility)
C. Dientamoeba fragilis
 Causes co-infection with E. vermicularis
 Originally described as amoeba, but is actually a flagellate with only the
trophozoite stage known.
 It is now classified among the Trichomonads because of the following:
✓ Binucleated trophozoite
✓ Absence of the cyst stage
✓ Evidence of rudiments
✓ Resembles Trichomonads antigenically and ultrastructural
ATRIAL FLAGELLATES GENERAL FEATURES:
✓ Multiplication is through longitudinal binary fission
✓ NO Cyst stage
✓ Morphology:
o Axostyle – rod-like structures; for anchorage
o Cytostome (cell mouth) – located on one side of the anterior end
o Blepharoplast – located between the nucleus and the anterior margin of the organism
o there are 4 free flagella and 1 which runs along the undulating membrane
o Nucleus – single, spherical in the mid-line near the anterior pole
o Motility: Fast jerky tumbling motility
Trichomonas species
Differences T. tenax T. hominis T. vaginalis
Habitat Buccal cavity Cecum Vagina
Tartar of the teeth Prostate gland
Size Smallest Medium Largest
Undulating membrane 2/3 of the body As long the body Less than ½ of the body
Inclusion bodies Siderophil bodies in the
NONE
cytoplasm
Flagella 4 anterior, 1 posterior
Cytostome Inconspicuous Highly conspicuous Not visible
Disease/s caused Vaginitis, prostatitis, urethritis
NON-PATHOGENIC Strawberry cervix

Mode of Transmission Droplet spray, kissing, Ingestion of Sexual contact

contaminated utensils contaminated food and
drink
Specimen Oral scraping Stool Urine, vaginal swab, urethral
discharge

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 PROTOZOA: MASTIGOPHORA (HEMOFLAGELLATES)
Blood and Tissue Flagellates
✓ May infect the blood, lymph nodes, muscles, and the RES
✓ Multiply in the blood and tissue of humans
Four Stages of Morphologic Development:
1. Amastigote (Leishman-Donovan body/Leishmanial form) – with reduced or absent flagellum, off-center nucleus,
L-donovan bodies in macrophages
2. Promastigote (Leptomonal form) – with a flagellum that arise anteriorly, nucleus is near-center, NO undulating
membrane
3. Epimastigote (Crithidia) – with a flagellum anterior of nucleus, and a short undulating membrane
4. Trypomastigote (Trypanosomal form) – with a flagellum posterior of nucleus, and a long undulating membrane
Stage Common Name Found in
Amastigote Leishmanial form L. donovani
L. tropica
L. braziliensis
T. cruzi
Promastigote Leptomonad form Sand fly (Leishmania vector)
T. cruzi (transitional phase)
Epimastigote Crithidial form Tse tse fly
Reduvid bug (Trypanosome vector)
Trypomastigote Trypanosomal form T. brucei rhodesiense
T. brucei gambiense
T. cruzi

Genus Leishmania
 General Life cycle
 Lab Diagnosis:
o Culture methods: NNN diphasic medium
o In vivo skin test: Montenegro test
Features L. tropica L. braziliensis L. donovani
Clinical Disease Old World cutaneous American mucocutaneous Visceral leishmaniasis
leishmaniasis leishmaniasis Kala-azar fever
Oriental sore Espundia Dum-dum fever
Aleppo button Bubas
Baghdad or Jericho boil
Habitat Skin Mucous membrane, skin, RES
nose, pharynx
Vector Phlebotomus spp.
Mode of Transmission Bite of sand fly
Infective stage Promastigotes
Diagnostic stage Demonstration of amastigotes in the macrophage (Giemsa-stained smears)
Pathology Localized cutaneous Primary lesions is similar to Splenomegaly associated
infection which gives rise that of L. tropica except the w/ severe anemia
to a macule then a papule, ulcer produced is a
a raised lesion w/ weeping lesion w/o a
depressed ulcerated center granular base
Clinical manifestations Presence of lesions Ulceration of naso-oral Monocytosis and
Chronic ulceration of the region neutropenia with
exposed skin areas Eroding ulcer which granulocytopenia
destroys the cartilages of Undulant fever
the septum of the nose, Hepatosplenomegaly
thus the tip is depressed Infection of the bone
marrow
Black fever
Lab Diagnosis Blood smear Skin scrapings Puncture of the ulcerated
Lymph node aspirate part

Genus Trypanosoma
 General Life cycle
 Lab Diagnosis: demonstration of trypomastigotes in thick and thin smears prepared from blood or CSF (C-shaped
trypomastigotes)
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 Features T. brucei rhodesiense T. brucei gambiense T. cruzi
Clinical Disease East African sleeping West African sleeping American trypanosomiasis
sickness sickness Chaga’s disease
Habitat During febrile periods: in the blood and lymph nodes RES, cardiac muscle, and
During sleeping periods: in the cerebrospinal fluid CNS
Vector Triatoma infestans
Glossina morsitans Glossina palpalis
(triatomid bugs, reduviid
bugs, kissing bugs)
Mode of Transmission Bug bite and defecates on
Insect bite (Tse tse fly) Insect bite (Tse tse fly) the wound;
Vertical and transfusion
Infective stage Trypomastigote
Diagnostic stage Trypomastigote
Pathology
Clinical manifestations Romona’s sign (edema of
Winterbottom’s sign
the eyelids)
Kerandel’s sign (invasion of lymph nodes)
Chagoma (initial lesion)
Lab Diagnosis Demonstration of Trypomastigote from Giemsa-stained smears

PROTOZOA: PLASMODIUM SPECIES

Plasmodium species:
 Obligate intracellular parasites of blood and tissues
 Exhibit alternation of sexual and asexual development and alternation of hosts
 Species:
o P. vivax – causes Benign Tertian Malaria
o P. ovale – causes Ovale Tertian Malaria
o P. malariae – causes Quartan Malaria
o P. falciparum – causes Malignant Tertian Malaria
 General Life cycle

 Lab Diagnosis: Microscopy (Gold standard), ICT, IFA, ELISA

 Treatment: Chloroquine (drug of choice)

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 P. falciparum P. malariae P. ovale P. vivax
Disease caused Malignant malaria Quartan malaria Ovale malaria Tertian malaria
Paroxysm cycle 36-48 hours 72 hours 48 hours 44-48 hours
Infected RBCs Not enlarged Not enlarged Enlarged Enlarged
Number of 6-32 6-12 6-14 12-24
merozoites
Inclusion Maurer’s dots Ziemann’s dots James dots Schuffner’s dots
Cytoplasm Young rings are Rounded, compact Rounded, compact Irregular; has
small, delicate, often trophozoites with trophozoites; “spread-out”
with double dense cytoplasm; occasionally slightly appearance
chromatin dots band-form ameboid; growing
trophozoites trophozoites have
occasionally seen large chromatin mass
Trophozoite Accole or Applique Band Red cell containing Amoeboid
forms trophozoite may
May have multiple have fimbriated
rings edges
Gametocyte Sausage-shaped Round Round Round
Crescent-shaped
Stages seen in Rings (gametocytes) All stages All stages All stages
peripheral blood
Severity High mortality Rarely fatal Rarely fatal Rarely fatal
May cause relapse May cause relapse

Most common
worldwide

PROTOZOA: COCCIDIANS
A. Toxoplasma gondii
 Infective stage: oocyst and tissue cyst
 Disease caused: Toxoplasmosis
 Morphology: a delicate pyriform or crescentic body, with one or both extremities pointed or round
 MOT: ingestion of uncooked meat, food contaminated with cat litter, nasal route, transplacental
transmission
 Habitat: Intracellular obligate parasite of endothelial cells, mononuclear WBCs, body fluids and tissues of
the host
 Vectors: cats
 Tissue stages in man (both causes infection):
o Bradyzoites: slow proliferation, chronic phase
o Tachyzoites: fast rapid multiplication, acute phase; pyriform in shape
 Lab Diagnosis: Serologic tests
B. Isospora belli
 Infective stage: Sporulated oocyst
 Morphology: elongated oocyst w/ tapering end
 Pathogenesis: associated with watery diarrhea and abdominal pain among AIDS patients
 Lab Diagnosis: DFS, AFS, Sheather’s sugar Floatation technique
C. Cryptosporidium parvum
 Infective stage: Sporulated oocyst
 Morphology: oocysts are ovoid or spherical, thick-walled organisms containing 4 naked sporozoites
 Pathogenesis: common infection among Immunocompromised hosts
 Lab Diagnosis: Kinyoun’s AFS
D. Cyclospora cayetanensis
 Infective stage: oocyst
 Diagnosis: DFS, Mod. Ziehl-Neelsen

REFERENCES
V. Belizario - Medical Parasitology
E. Zeibig – Clinical Parasitology
P. Beaver – Clinical Parasitology

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