FEU – DR.

NICANOR REYES MEDICAL FOUNDATION SCHOOL OF MEDICINE

Parasitic Amoeba:
MEDICAL PARASITOLOGY  Entamoeba histolytica
 Entamoeba coli
 Endolimax nana
PRELIMS  Iodamoeba buetschlii
o Parasites are organisms that depend on another living creature, referred to as the  Entamoeba gingivalis (Trophozoite form ONLY)
host, for survival  Entamoeba hartmanni
o 2 types of host:  Entamoeba disparr (same as E. histolytica)
1. Intermediate host: harbors the ASEXUAL cycle (larval stage) of
development
2. Definitive / Final host: harbors the SEXUAL stage (mature stage) of RECALL
the parasite  Infective stage: CYST
o Parasites can be divided into:  Pathogenic stage: TROPHOZOITE
o Protozoa (single-cell organisms)  Where does EXCYSTATION take place? SMALL INTESTINES
o Metazoa (multi-cellular organisms)  Where does ENCYSTATION take place? LARGE INTESTINES
 Trophozoites will only be found in the LARGE INTESTINES
 Intestinal Amoebiasis (E. histolytica)
PROTOZOA o Primary lesion: small and produces no signs and symptoms
CYST TROPHOZOITE o At the muscularis mucosa: Flask-shape lesion of amoebiasis (small
Non-motile Motile (w/ locomotive organs) opening and a long neck); “Pepsi cola” lesion
Non-feeding (due to tough Feeding (absorb nutrients via plasma o Tumor-like lesion: Amoebic granuloma or Amoeboma
cyst wall) membrane)  Extraintestinal Amoebiasis (E. histolytica)
Chromatoidal bodies o Liver
-  Single lesion  Amoebic Liver Abscess
(stored food)
Infective stage Pathogenic stage  Anchovy sauce-like material
 Hepatomegaly
Found in formed stool and
Found in soft/watery stool  RIGHT lobe of liver
water fecal specimen
 Common among males
Resistant (due to tough Easily destroyed (must be examined
 4th and 5th decade of life
cyst wall) within 30mins)
o Lungs
Preservative: 5-10%
Preservative: Polyvinyl Alcohol  Hematogenous route: BOTH LUNGS
Formalin
 Extension of amoebic liver abscess: RIGHT LUNG
Pseudopodia (finger-like)  DOC for E. histolytica: METRONIDAZOLE
Organs of locomotion: PCF
Cilia (thread-like)
Flagella (hair-like) E. histolytica is both pathogenic AND invasive.

PROTOZOA

I. RHIZOPODEA (commonly amoeba)

o w/ pseudopodia
o Found in the lumen of the large intestine: CECUM (EXCEPT E. gingivalis – Buccal
cavity)
o All are NON-PATHOGENIC except E. histolytica

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1. Entamoeba histolytica: o FREE-LIVING PATHOGENIC (OPPORTUNISTIC)

Cyst:  Naegleria fowlerii
o Dx feature: Cigar-shaped/rounded or spherical/rod-shaped chromatoidal bodies  Acanthamoeba cumbertsoni
o 1-4 nuclei  Acanthamoeba polyphaga
Trophozoite:  Acanthamoeba castellani
o Characteristic motility: Active, progressive, directional  Acanthamoeba astronyxis
o Dx feature: ingested RBCs, Bull’s eye karyosome
o ONE nucleus NAGLERIA FOWLERI ACANTHAMOEBA
Most common habitat: Cecum Primary Amoebic Meningoencephalitis
2nd most common habitat: Rectosigmoid Granulomatous Amoebic Encephalitis (GAE)
(PAM)
Trophozoite and Cyst forms Trophozoite and Cyst forms
2. Entamoeba coli
Acquires organisms through the eyes,
Cyst:
Trophozoite: Amoeboid or flagellate breaks in skin, respiratory tract, genito-
o Dx feature: PROMINENT multinucleated cyst
urinary tract
o 1-8 nuclei
Highly motile Eyes: “Black eye”
o Whisk-broom appearance of chromatoidal bodies
Preceded by trauma
Trophozoite:
Among those using soft lenses (contact
o Characteristic motility: Sluggish, non-progressive, non-directional Aquatic (found in water) lenses)
o ONE, large nucleus
Also known as Amoebic Keratitis
o Eccentric karyosome
Occurs in chronically ill, debilitated or
Occurs in healthy individuals
immunocompromised individuals
3. Endolimax nana
Cyst: ACUTE infection, similar to Fulminating CHRONIC infection, with granuloma
o Dx feature: Ground-glass appearance cytoplasm Bacterial Meningitis formation, similar to brain tumors
o Cross-eyed appearance of karyosome: “punched-out” nucleus Signs and sx of meningitis:
o 1-4 nuclei 1. Severe headache
Encephalitis
Trophozoite: 2. Projectile vomiting
o Characteristic motility: Sluggish 3. Nuchal rigidity / Stiff neck
o ONE nucleus DOC: Amphotericin B DOC: Sulfadiazine
Signs and Sx of encephalitis:
4. Iodamoeba buetschlii 1. Headache
Cyst: 2. Seizures
o Dx feature: Large glycogen vacuole (2/3 of organism) Tool for Diagnosis: Cerebrospinal Fluid (CSF)
o Glycogen vacuole: Iodine cyst of Wenyoun
o 1-2 nuclei, usually 1 II. CILIATEA
Trophozoite:  Balantidium coli ONLY
o Dx feature: Large glycogen vacuole (1/3 of organism)  Organ of locomotion: Cilia (arising from the basal granules)
o ONE nucleus  LARGEST intestinal protozoa to infect man
o Habitat: LARGE INTESTINE
5. Entamoeba gingivalis  Cyst and trophozoite forms
Trophozoite form only  2 nuclei (Macro- and micronucleus)
o ONE nucleus  Type of encystment: PROTECTIVE
o Central karyosome  Lesion:
o Habitat: Buccal cavity o “Coca-cola”: big opening and large rounded end
o Disease: Pyuria alveolaris o Big lesions
o Associated w/ Trichomonas tenax  DOC: Metronidazole
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 FEU – DR. NICANOR REYES MEDICAL FOUNDATION SCHOOL OF MEDICINE

III. ZOOMASTIGOPHOREA 2. Giardia lamblia

o Commonly called flagellates Cyst:
o Organ of locomotion: Flagella (arising from the kinetoplast, consisting of parabasal o Dx feature: Retracted cytoplasm, a pair of axoneme
bodies and blepharoplast) o 4 nuclei
Trophozoite:
A. Atrial Flagellates B. Blood & Tissue Flagellates o Characteristic motility: Falling leaf-like, gliding kite
(longitudinal binary fission) (Lorna Tolentino) o Tumbling motility
o 4 pairs of flagella
Inhabit luminal organs or Inhabit the blood and/or internal organs and are vector-
structures of the body transmitted
o Pathogenic
 Chilomastix mesnili Leishmania & Trypanosoma o Non-invasive
 Giardia lamblia (Alma o MOT: ingestion of cysts
tropica gambiense

L T
Moreno – “carpeting”) o Pathogenesis: Carpeting/Coating intestinal mucosa (Alma Moreno)
 Trichomonas tenax o Habitat: Small intestine (Duodenal crypts)
brasiliensis rhodisiense
(assc. w/ E. gingivalis) o Malabsorption
 Trichomonas hominis donovanii cruzi o Traveller’s diarrhea/Lenningrad’s curse
T. gambiense & rhodisiense: o Steatorrheic/gruelly stool
 Trichomonas vaginalis AFRICAN sleeping sickness o Lab dx: DFS, Entero test (String test)
(“Ping-pong” infection) Trypomastigote: BOTH o DOC: Metronidazole
LEISHMANIA:
pathogenic and infective stage
Pathogenic: Amastigote
T. cruzi: South American - 3. Dientamoeba fragilis
Infective: Promastigote
 Dientamoeba fragilis Chaga's dse. - Trophozoite only
Pathogenic: Amastigote o Dx feature: Tetracoccic kayosome (4 karyosomes)
Infective: Trypomastigote o 1-4 nuclei, usually 2
DOC: o MOT: ingestion of trophozoite with the eggs of E. vermicularis
o L. donovani: Pentavalent antimony sodium gluconate, amphotericin B, o Pathogenic
pentamidine isethionate o Non-invasive
o T. gambiense & T. rhodisiense: Pentamidine isethionate, Suramin sodium,
Melarsoprol, Tryparsamide 4. Trichomonas spp.
o T. cruzi: Primaquine, Benznidazole - Trophozoite only

1. Chilomastix mesnili Trichomonas tenax Trichomonas hominis Trichomonas vaginalis

Cyst: Jerking motility Tumbling motility Moving
o Dx feature: Lemon/nipple-shape protuberance Dx feature: Siderophil granules
o Hour-glass cytostome Rigid axostyle
present along the axostyle
o ONE nucleus Inconspicuous Post-trailing end of axostyle
Trophozoite: Inconspicuous cytostome
cytostome Conspicuous cytostome
o Characteristic motility: Corkscrew/Boring motion Buccal cavity: Along Vagina
o Pear-shaped due to spiral groove the tartar of teeth, Prostate gland
o Hour-glass cytostome gums and tonsil)
Large intestine (Cecum)
Urethra
Non-pathogenic
Ping-pong infx
Habitat: Cecum ONE nucleus at ONE nucleus with central
Creamy, frothy vaginal
Lab dx: DFS anterior part karyosome
discharge
Pyuria alveolaris (assc.
DOC: Metronidazole
with E. gingivalis)
Non-pathogenic Non-pathogenic Pathogenic
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RECALL Opportunistic coccidia:

 Pathogenic Amoeba:  Toxoplasma gondii – in any tissue
o E. histolytica  Cryptosporidium parvum - in the brush borders of the stomach and intestine
o B. coli  Pneumocystis jirovecii – in lungs
o G. lamblia Coccidia:
o T. vaginalis  Isospora belli
o T. homins  Sarcocystis hominis
o T. tenax  Sarcocystis lindemanii
o D. fragilis  Eimeria (spurious parasite: pass through the body without any changes or
 Organisms where the infective stage is TROPHOZOITE (no cyst forms): maturation)
o E. gingivalis
o T. vaginalis Isospora
Asexual and sexual stages occurring in ONE
o T. hominis Eimeria
host
o T. tenax Cryptosporidium
o D. fragilis Sarcocystis
 BOTH pathogenic and invasive Needs 2 hosts for life cycle
Toxoplasma
o E. histolytica
o B. coli Hemosporina:
 Organisms with cytostome  Plasmodium falciparum (#1 in Phils)
o B. coli (in trophozoite form only)  Plasmodium vivax
o C. mesnili (trophozoite and cyst) – “hour-glass” appearance cystostome  Plasmodium malariae (often in Phils)
o T. hominis (“conspicuous” cytostome)  Plasmodium ovale (#1 in Africa)
 Trophozoites w/ 2 nuclei:
o B. coli MALARIA
o G. lamblia Definitive host:
o D. fragilis o Insect vector (Anopheles Mosquito)
o Sexual stage
o Infective stage to DH: Gametocytes
MIDTERMS o Life cycle: Sporogony
o Will produce: Sporozoites
IV. SPOROZOA
o No specific organ of locomotion because they are intracellular parasites producing Intermediate host:
SPORES o Man
CLASS COCCIDIA HEMOSPORINA o Asexual stage
# of hosts 1 2 o Infective stage to IH: Sporozoite
Vector None Insect vectors o Life cycle: Schizogeny
Isospora o Will produce: Merozoites
Cryptosporidium
Genera Plasmodia Stipplings:
Toxoplasma
Sarcocystis o Francis Magalona -> P. falciparum – Maurer’s dots
o Vilma Santos -> P. vivax – Schuffner’s dots
o Manila Zoo -> P. malariae – Ziemann’s dots

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Plasmodium Plasmodium RECALL

Plasmodium vivax
malariae falciparum
Malignant tertian  Plasmodium ovale:
Disease Benign tertian Benign Quartan Subtertian o Oval shape RBC
Aestivo-Autumnal o NOT present in the Philippines
In temperate and o Present in Africa, S. America, Myanmar, Thailand
Predominant in the subtropical regions  Most severe to less severe:
Found in Common in Philippines o P. falciparum
world Occasionally in
Philippines o P. vivax
Reddish/pinkish o P. ovale
chromatin dot w/ Polymorphic/pleomorphic o P. malariae
ring of bluish
Single dot with bluish
Multiple infections  Malaria endemic regions in the Philippines:
YT ring of cytoplasm o Bicol
cytoplasm May have double
Signet ring o Palawan
Ring form: signet chromatin dots
ring appearance o Mindoro (Oriental and Occidental)
o Sulu Province (Sulu, Basilan, Tawi Tawi)
Increase in bluish Only YT and gametocytes
o Quezon City (Novaliches)
Enlarged RBC cytoplasm (compact) are seen in PBS.
GT o Rizal province (Montalban, Antipolo)
Amoeboid cytoplasm About 5% of GT is in Intermediate stages are
 Malarial pigment
band form seen in the capillaries
o Also known as Hematin pigment
MT Amoeboid cytoplasm Compact cytoplasm and internal organs.
o Hemoglobin  Heme (contains iron) + Globin (protein component)
If YT is present in PBS,
o Plasmodium consumes the globin part and heme becomes a waste
there is overwhelming
YS 2 chromatin dots 2 chromatin dots product
infx  warning sign of
o Heme becomes the malarial pigment seen in the cytoplasm of the
perinicious anemia
plasmodium
GS 3-11 chromatin dots 3-5 chromatin dots 3-7 chromatin dots
 2 types of Relapse (reappearance of Malaria):
Daisy/rosette/
Haphazard o Recurrence: P. vivax and P. ovale
margarette
MS arrangement of  Plasmodium w/ HYPNOZOITE stage
arrangement of
chromatin dots  May undergo Secondary Exo-erythrocytic cycle
chromatin dots
o Recrudescence: P. falciparum and P. malariae
ES cycle 48 hrs 72 hrs 36-48 hrs  No hypnozoite stage
# of  Only MEROZOITES can infect RED BLOOD CELLS
12-24 6-12 18-24-32
merozoites  Only SPOROZOITES can infect LIVER CELLS
Microgametocyte: Microgametocyte: Microgametocyte:  Febrile paroxysm:
scattered chromatin chromatin dot Banana-shaped, 1. Cold stage: Chills
Gameto- dot scattered at the center scattered chromatin dot 2. Hot stage: Fever
cytes Macrogametocyte: Macrogametocyte: Macrogametocyte: 3. West stage: Profuse sweating
enlarged chromatin enlarged chromatin crescent-shaped,  Best time to collect blood sample: BEFORE the height of the fever (Schizonts will be
dot at periphery dot at periphery compact chromatin dot observed)
Stipplings /  Thin blood smear: Specific diagnosis
Malarial  Thick blood smear (dehemoglobinated blood): Rapid diagnosis
Schuffner’s dots Ziemann’s dots Maurer’s dots
pigments  Primaquine: greatest ability to kill plasmodium in the INTRA-HEPATIC stage
(Hematin)
Mature, senescent, old Young and mature,
Affinity to Young RBC
RBC senescent, old RBC

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METAZOA RECALL

o Helminthes (worms)  Blood-lung phase: SANA

o 2 phyla: Nematodes and Platyhelminthes o Strongyloides stercoralis
o Ascaris lumbricoides
I. NEMATODES o Necator americanus
o Round worms o Ancylostoma duodenale
o Cylindrical, elongated and unsegmented bodies  Auto-infection: CHEST
o Development: egg  larva  adult o Capillaria philippinensis
o Sex is separated o Hymenolepis nana
o Complete digestive system: o Enterobius vermicularis
o Mouth o Strongyloides stercoralis
o Buccal / Oral / Pharyngeal Cavity o Taenia solium
o Gut  Anemia:
o Females: Anus o Hypochromic – T. trichiura
o Males: Cloaca – common opening for digestive and reproductive systems o IDA – Hookworm
o Phasmids – caudal chemoreceptors o Perinicious – P. falciparum
o NO Circulatory and Respiratory system  Diarrhea:
o P. falciparum
A. Adenophorea (Aphasmidea) o T. trichiura
o Trichuris trichiura o C. philippinensis
o Capillaria philippinensis o S. stercoralis (on and off)
o Trichinella spiralis  Charcot-Leyden crystals:
o T. trichiura (in colon exudates)
B. Secernentea (Phasmidea) o A. lumbricoides (in sputum)
o Ascaris lumbricoides (ascaris of humans)  Larviparous:
o Toxocara canis (ascaris of dogs) o C. philippinensis
o Toxocara cati (ascaris of cats) o T. spiralis
o Anisakis (ascaris of sea animals) o Microfilariae
o Human Hookworms: Necator americanus and Ancylostoma duodenale o A. lumbricoides **
o Animal hookworms: Ancylostoma braziliense and Ancylostoma caninum  Loeffler’s syndrome:
o Strongyloides stercoralis o A. lumbricoides
o Gnathostoma spinigerum o S. stercoralis
o Enterobius vermicularis  Unsegmented eggs (laid unembryonated)
o Angiostrongylus cantonensis o G. spinigerum
o A. cantonensis
C. Filarial worms (Infective stage: L3 Filiform Larva)  Segmented egg (laid embryonated):
o Wuchereria bancrofti o E. vermicularis
o Brugia malayi  VLM Triad (T. cati, T. canis, Strongyloides, Hookworm, Gnathostoma, Spirometra):
o Loa loa o Eosinophilia
o Onchocerca volvulus o Hepatomegaly
o Mansonella ozzardi o Hyperglobulinemia
o Mansonella perstans  Cephalic Alae: T. cati & T. canis
 Cephalic & Caudal Alae: E. vermicularis
 Greater blood loss: Ancylostoma (0.15mL/worm/day) > Necator (0.03mL/wormday)
 Uncinariasis: Necator americanus | Oxyuriasis: Enterobius vermicularis

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ADENOPHOREA SECERNENTEA
Parasite
T. trichiura T. spiralis C. philippinensis A. lumbricoides S. stercoralis E. vermicularis G. spinigerum
Common Society/Seat/Communit
Whipworm Trichina worm Pudok worm Giant intestinal roundworm Threadworm
name y/Pin worm
IH None (Direct infection) Man Fishes None (Direct infection) None None DH: Dog & Cat
DH Man Rats & Pigs Man Man Man Man Accidental host: Man
Infective stage
Embryonated egg Encysted Larva L3 Filariform larva Embryonated egg L3 Filariform larva Embryonated egg L3 Filariform larva
to DH
Ingestion of
MOT Ingestion improperly cooked Ingestion Ingestion Skin penetration Ingestion Ingestion
pork
Cecum, appendix, Duodenum,
Habitat Jejunum Ileum Small intestine Cecum Tissues/Organs
colon, lower ileum jejunum
Tail-end coiled 360deg Conspicuous conical Long, chitinous, Bulbous esophagous 4 pairs perianal
Tail-end tortuously coiled Bifid/notched tail
Male Worm Lancet-shaped spicule papillae copulatory spicule (Diagnostic) nipple-shaped
w/o sheath
Sacculate testes Single testes Overhanging sheath Cephalic alae papilla
Straight tail end Stichosomes in
Oviparous & Bulbous esophagous
Sacculate ovaries uterus Bihorned uterus Long vagina,
Female Worm larviparous Oviparous (Diagnostic)
(+) Stichocytes Single ovary Short vulva directed anteriorly
Vulva: pouting Cephalic alae
Oviparous Oviparous
o 3 layers:
o Albuminous: bile-stained Rhabditiform larva:
(absent in decorticated o Feeding
Calcified in Flattened, bipolar
Egg/Larva Football/barrel shaped egg) o Open-mouth Plano-convex Mucoid plug at one
glycogen-poor mucus plugs
Morphology Bipolar mucus plugs o Glycerol layer Filariform larva: Inverted “D” shape end
tissues Pitted shell
o Vitelline: protect the larva o Non-feeding
(absent in unfertilized o Closed-mouth
egg)
o Mild to moderate o Malabsorption
Stages:
infx: asymptomatic syndrome Blood-lung Phase o Nocturnal pruritus
o Invasion: Blood-lung Phase
o Heavy/massive infx: o Sprue-like stools o Internal autoinfx ani o Gnathostomiasis
abdominal pain o Loffler’s pneumonitis
chronic diarrhea, o Abdmonial pain o External autoinfx o Nervousness interna
o Larval Migration: o Pot-belly
diffuse colitis, o Electrolyte o Cutaneous: Larva o Convulsion o Gnathostomiasis
Manifestation fever, myalgia, o Intermittent colicky
dysentery, imbalance curens o Vaginitis Externa: larva
s edema abdominal cramps
abdominal cramps o Borborygmi o Lungs: Loeffler’s o Acute appendicitis migrans/creeping
o Encystation: o Intestinal obstruction
o Hypochromic o Diarrhea syndrome o Oxyuriasis: pruritus, eruption
Muscle pain, fever o Obstructive appendicitis
anemia o Muscle wasting o Intestinal: Honey- insomnia, stunted
o Tissue repair &
o Rectal prolapse o Hypoproteinemia comb lesion growth, irritability
recovery
o Dehydration
DFS DFS
Sputum: Eosinophil, (Rhabdi>Filari>Egg)
Biopsy Graham scotch tape ELISA
Lab dx DFS DFS Charcot-Leyden String test
Xenodiagnosis method Precipitin test
Barium swallow X-ray: Harada Mori
String sign technique
DOC Mebendazole

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Hookworm Necator americanus Ancylostoma duodenale A. cantonensis

Common Name New World Hookworm Old World Hookworm o Common name: Rodent Lung Worm
Uncinariasis o Infective stage: L3 Filariform Larva
Disease Ancylostomiasis o DH: Rats
Necatoriasis
Distribution Worldwide: Tropical > Worldwide: Temperate > o Man as accidental host
Habitat Duodenum & Jejunum Jejunum & Prox. Ileum o MOT to man: Ingestion of snails
Lifespan 15 yrs (usually 3-5 yrs) 1-6 yrs o Habitat: Tissue/organs
o Lab dx: CSF, ELISA
MOT Percutaneous > Oral Oral > Percutaneous
Eggs/worm/day 6,000 – 10,000 25,000 – 30, 000
Anisakis spp
Blood loss/worm/day 0.03mL 0.15mL
o Disease: Anisakiasis or Herring Worm disease
Cephalic part bent Cephalic part bent
o Ascaris of sea animals
Shape of adult worm DORSALLY VENTRALLY
o Lab dx: Serologic test, biopsy
S-shape C-shape
Semi-lunar cutting plates 2 pairs of teeth Filarial Worms:
Buccal capsule
(neCator) (DUOdenale; Duo=2) o Nocturnal:
Larger Broader & long o W. bancrofti
Copulatory bursa
Bipartite Tripartite o B. malayi
o Diurnal:
o Loa loa
Toxocara T. canis T. cati o Non-periodic:
Adult worm Long & narrow cervical alae Short & broad cervical alae o M. ozzardi
Thick, coarsely pitted egg o M. perstans
Thin, finely pitted egg shell
Egg shell o Sheathed:
Embryonates in soil o W. bancrofti
IH Man Man o B. malayi
DH Dog Cat o Loa loa
Infective stage Embryonated egg o Unsheathed:
Man: Tissues/organs o O. volvulus
Habitat o M. ozzardi
Dogs/cats: Intestines
DOC Mebendazole o M. perstans

Cutaenous Larva Migrans

o A. braziliense (most common)
o A. caninum
o A. ceylanicum
o Commonly affects: feet, legs, hands

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FINALS DIESCIOUS FLUKES S. hematobium S. mansoni S. japonicum

II. PLATYHELMINTHES Manson’s blood
Common name Vesical blood flukes Oriental blood fluke
o Trematodes (flukes) and Cestodes (tapeworm) fluke
o Schistosomiasis
A. Trematodes hematobia o Manson’s
o Schistosomiasis
o Flattened, dorso-ventrally o Schistosomal intestinal
jematobia
o Leaf-like hematobia schistosomiasis
Disease o Oriental
o Presence of oral and ventral suckers / acetabula o Vesical or Urinary o Manson’s
schistosomiasis
o Alimentary system looks like an inverted “Y” bilharziasis schistosomiasis
o Katayama disease
o Intestinal ceca: highly-branched (dendritic) or simple (straight) o Vesical o Bilharziasis
o Both sexes in one organism (except Schistosoma) schistosomiasis
 Both male and female reproductive organs found in the same Far East:
organism Africa, Middle East Africa, S. America, Philippines, Samar,
Location
 Hermaphrodites (Monoecious) Egypt Carribean Bicol, Leyte,
 Schistosoma parasites are DIESCIOUS (have separate sexes) Mindanao
o Position of testes: Oncomelania
IH Snail (Bulinus) Biomphalaria
 Side by side Quadrasi
 In tandem DH Man Man Man
 Obliquely placed Infective stage to
Cercaria
o Eggs are laid mature or immature DH
 All immature eggs develop in water MOT Skin penetration
o Romantic parasites: Schistosoma Vesical plexus Inferior mesenteric
 Always found in copula Superior mesenteric
Habitat Pelvic plexus plexus
 Females are found inside the gynocorporal of male plexus
Veins of rectum Vesical plexus
o Infective stage of most trematodes: Metacercaria (except Schistosoma) COARSE
o Infective stage of Schistosoma: Cercaria FINE tuberculation NO tuberculation of
Cuticle tuberculation of
o First Intermediate host: Snail of cuticle cuticle
cuticle
Esophagus SINGLE bulb SINGLE bulb DOUBLE bulb
o Liver Flukes:

}
Near posterior end Near anterior end
 Fasciola hepatica Intestinal Ceca VERY LATE union
LATE union EARLY union
 Clonorchis sinensis 6-8 in
 Opistorchis felineus 4-5 cluster
6-9 clusters/column
clusters/column
o Intestinal Flukes: Posterior and
MONOESCIOUS Testes Posterior/behind Posterior and
 Fasciolopsis buski the ventral sucker
behind the ventral
behind the ventral
 Echinostoma ilocanum sucker
sucker
 Heterophyds
Posterior to the Anterior to the Centrally located/at
o Lung Fluke: Position of Ovary
midpoint midpoint the midpoint
 Paragonimus westermani
Uterus Longest uterus Shortest uterus Second shortest
o Blood Flukes:

}
Shortest posterior
 Schistosoma hematobium Shortest posterior Longest posterior
ceca
 Schistosoma japonicum DIESCIOUS ceca or none at all ceca
50 eggs at a time
 Schistosoma mansoni Posterior Ceca 20-30eggs at a time 1-2 eggs at a time
1500-3000
20-290 100-300
eggs/female/day
eggs/female/day eggs/female/day
(most severe infx)

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LIVER FLUKES LUNG FLUKE INTESTINAL FLUKES

MONOECIOUS Heterophyds
Paragonimus Echinostoma Heterophyes heterophyes
FLUKES Fasciola hepatica Clonorchis sinensis Opistorchis felineus Fasciolopsis buski
westermani ilocanum Metagonimus yokogawai
Haplorchis yokogawai
Chinese Liver Fluke Giant Intestinal
COMMON NAME Sheep Liver Fluke Cat Liver Fluke Oriental Lung Fluke Garrison’s Fluke -
Oriental Liver Fluke Fluke
Paragonomiasis
DISEASE Facscioliasis
Clonorchiasis Opistorchiasis Pulmonary Distomiasis Fasciolopsiasis Echinostomiasis -
PRODUCED Sheep liver rot
Endemic Hemoptysis
Snail (Antemelania H.h: Snail (Pironella)
Snail (Lymnea Snail (Gyraulus
1ST IH Snail (Bulimus) Snail (Bulimus) aspera, Brotia Snail (Segmentina) M.y: Snail (Semisulcospira)
philippinensis) convexiculus)
asperata) H.y: Snail
INFECTIVE STAGE
Miracidium Embryonated egg Embryonated egg Miracidium Miracidium Miracidium Embryonated egg
to 1ST IH
MOT to 1ST IH SP Ingestion of egg Ingestion of egg SP SP SP Ingestion of egg
DEVELOPMENTAL H.h & H.y: S-R-C
S-R-R-C S-R-C S-S-R-C S-R-C S-R-R-C R-R-C
STAGE M.y: S-R-R-C
Fresh water crabs
(Sundathelphusa Water chestnut Snail (Pila luzonica,
2ND IH Water vegetation Fish Fish Fish
philippina) Water bamboo Pila conica)
Crayfish
INFECTIVE STAGE Simple-tail Simple-tail
Keeled-tail Cercaria Keeled-tail Cercaria Microcercus Cercaria Simple-tail Cercaria Keeled-tail Cercaria
to 2ND IH Cercaria Cercaria
MOT to 2ND IH Ingestion Ingestion Ingestion Ingestion Ingestion Ingestion Ingestion
Proximal biliary Distal biliary Distal biliary
HABITAT Pulmonary pockets Small intestine Small intestine Small intestine
passages passages passages
PATHOGENIC Mature/Young Mature/Young Adult
Adult Adult Adult Adult Adult
STAGE Adult Cluster of eggs
Stool Exam Stool Exam Stool Exam Stool Exam Stool Exam
Sputum Exam Stool Exam
LAB DX Entero Test (String Entero Test (String Entero Test (String Entero Test (String Entero Test (String
X-ray Entero Test (String test)
test) test) test) test) test)
H.h: oral, ventral genital
Cephalic cone
suckers, 2 equal testes
Attenuated end Large dendritic No cephalic cone Circumoral disc with
Transversely Coffee-bean shaped M.y: oral sucker. Ventral
FLUKE All dendritic testes, in tandem, Rounded end colorette around
compressed vitellaria Plump sucker tiled to the right, 2
CHARACTERISTIC except uterus and in posterior 3rd of Intestinal ceca: the oral sucker at
at the lateral side Zig-zag intestinal ceca unequal testes
oral&ventral fluke double indentation the anterior end
H.y: Oral and ventral sucker,
suckers
ONE large testes
Triangular
EGG Old fashioned Old fashioned Flattened operculum operculum Old fashioned electric light
Hen’s egg Hen’s egg
CHARACTERISTIC electric light bulb electric light bulb Thick abopercular end Prominent germ bulb
ball
Treatment: Praziquantel
*SP: Skin Penetration |Information obtained from MRA Trans (2013) and Pacis trans (2014), with few modifications

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B. Cestodes (Tapeworms) I. Pseudophyllidea

o Scolex: Organ of attachment
o Neck: Zone of growth 1. Diphyllobothrium latum
o Strobula: 3 parts – o Common name: Broad/Fish tapeworm
1. Immature proglottid: near the neck o Disease: Diphyllobothriasis, Bothriocephalus anemia
2. Mature proglottid o 1st IH: Crustaceans (Diaptomus vulgaris)
3. Gravid proglottid o 2nd IH: Fresh water fishes
o DH: Man
CESTODES PSEUDOPHYLLIDEA CYCLOPHYLLIDEA o Infective Stage: Plerocercoid larva / Sparganum
Taenia solium o MOT: Ingestion of larva in improperly cooked fish
Taenia saginata o Egg: mistaken for F. hepatica or F. buski; distinct separation between operculum
Diphyllobothrium latum Taenia multiceps and body of egg
Parasites Spirometra mansoni Hymenolepis nana o Lab Dx: DFS (eggs or proglottids)
Spirometra mansonoides Hymenolepis diminuta
Dipylidium caninum 2. Spirometra
Echinococcus granulosus o S. mansoni – most common in Asia
Spatula shape o Disease: Sparganosis, Visceral Larval migrans
Almond shape o Man as accidental host
Quadrate o Infective stage: Plerocercoid larva
Scolex Spoon shape
With 4 cup-like structures
w/ sectorial groove
(bothria) II. Cyclophyllidea
Common at atrium at the Common atrium at the
median and ventral surface lateral margins, which may TAENIA T. solium T. saginata
Mature segment Uterus: rosette, piled, be on the same sides or Common name Pork tapeworm Beef tapeworm
coiled alternating Disease Taeniasis solium Taeniasis saginata
Testes: scattered Uterus: tubular IH Pigs Cattle
Filled with eggs Uterus with lateral DH Man Man
Gravid segment
branches, filled with eggs Infective stage Cysticercus cellulosae larva Cysticercus bovis larva
Ovoid, operculate, MOT Ingestion Ingestion
Egg Spherical, non-operculate
immature when laid Habitat Jejunum Small intestine
Occurs after ingestion by Armed Unarmed (no hooks)
Hatching Occurs in water
appropriate host Scolex Circle of hooklets 4 hemispherical suckers
Called coracidium Non-ciliated embryophore 4 cup-like suckers
Embryo
With cilia Oncosphere Mature segment Longer than broad Broader than long
IH 2 1 Gravid proglottid 7-13 uterine branches 15-20 uterine branches
Larval stage solid Vesicular Thick eggshell
Egg Oncosphere with 3 pairs of hooklets
Truncated prism appearance
Adult forms in small intestine (ileum) Adult worm: vague
Larval forms in man
of man abdominal pain, chronic No larva infx in humans
D. latum S. mansoni Manifestations indigestion, diarrhea, Single worm infx only
T solium S. mansonoides appetite loss
T. saginata T. solium Larva: Occular and cerebral
H. nana T. multiceps Lab Dx DFS: Egg; X-ray, CT, MRI, ELISA (Larva)
H. diminuta E. granulosus DOC Praziquantel

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 FEU – DR. NICANOR REYES MEDICAL FOUNDATION SCHOOL OF MEDICINE

Taenia solium Dipylidium caninum

o Sol  Soul  Soul food = Pork o Common name: Double pored dog tapeworm
o Soul Sister – Cysticer-(sounds like sister) cosis o Disease: dipylidiasis
o Sister is armed – armed rostellum o Tapeworm of dogs and cats
o IH: Insects (fleas)
Taenia saginata: o DH: Man / Dog/ Cat
o Saginata  many letters  many uterine branches (15-20 branches) o Habitat: Small intestine
o Mature segment: Broader than long, pumpkin seed shape, double pored
HYMENOLEPIS H. nana H. diminuta o Scolex: 1-7 circles of spikes/hooklets
Common name Dwarf tapeworm Rat tapeworm o Egg: Thin shell, 8-15 mother pockets
Disease Hymenolepsiasis nana Hymenolepsiasis diminuta o Lab dx: DFS
Dog flea o DOC: Praziquantel
The only tapeworm that
IH Cat flea
does not need IH Echinococcus granulosus
Human flea
DH Man Man / Rat o Common name: Hydatid worm
Infective stage Embryonated egg Cysticercoid larva o Disease: Unilocular echinococcus, Hydatid disease
o IH: Sheep, goat, camel, ox, hog, cattle (Man as accidental host)
Person-person contact
MOT Ingestion o DH: dog
Hand-mouth transfer
o Infective stage: Hydatid Larva
Habitat Small intestine Small intestine
o No adult worm infection; only larva
Adult Small (Nana = dwarf/small) Larger than H. nana
o Scolex: Armed
3 rounded testes 3 ovoid testes
Mature segment o Egg: Same as Taenia spp.
Saccular uterus,
o DOC: Albendazole
Armed w/ hooklets (20-40 Small, club-shaped
Scolex
spines) Unarmed scolex
Thin eggshell
Hexacanth embryo with 2 2 polar thickenings
Egg polar thickening NO polar filaments
Diagnostic: 4-8 polar 6 lanceolate hooklets
filaments
Headache
Asymptomatic
Dizziness
Headache
Anorexia
Manifestations Abdominal pain
Pruritus of nose and anus
Nausea
Diarrhea
Anorexia
Loss of appetite
Lab dx DFS (Eggs) DFS (Eggs)
DOC Praziquantel

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FEU – DR. NICANOR REYES MEDICAL FOUNDATION SCHOOL OF MEDICINE

RECALL  Oriental BLOOD fluke: Schistosoma japonicum

 Larval Development inside the 1st IH  Oriental LIVER fluke: Clonorchis sinensis
o After Miracidium…  Oriental LUNG fluke: Paragonimus westermani
1. S-S-C: Schistosoma  Swimmer’s itch or clam digger’s itch iin Schistosomiasis: CERCARIA
2. S-R-C: CPHH  Schistosomiasis causing portal hypertension: EGG
 Clonorchis sinensis  Circumoval precipitin test: EGG of Schistosoma
 Paragonimus westermani  Cercarian Huellen Reaction: CERCARIA of Schistosoma
 Heterophes heterophyes
 Haplorchis yokogawai  For attachment and orientation of the strobila: Scolex
3. S-R-R-C: FFM  Needs 2 intermediate hosts to complete its life cycle: PSEUDOPHYLLIDEA
 Fasciola hepatica  Eggs are matured when laid: CYCLOPHYLLIDEA
 Fasciolopsis buski  D. latum egg:
 Metagonimus yokogawai o Immature when laid
4. S-S-R-C: Opistorchis felineus o With bubble-like germ ball
5. R-R-C: Echinostoma ilocanum  Infective stage of D. latum: Plerocercoid/Sparganum
 Immature eggs: PEFF  No larval infection in man: T. saginata
o Paragonimus westermani
o Echinostoma ilocanum
o Fasciola hepatica
o Fasciolopsis buski
 Immature eggs will be laid in water and will mature in water. Miracidium will come
out of the egg and enter 1st IH.
 Eggs that are laid in water and ingested by the 1st IH (snail) and, therefore, will
mature inside the 1st IH: CHHOM
o Clonorchis sinensis
o Heterphyes heterophyes
o Haplorchis yokogawai
o Opistorchis felineus
o Metagonimus yokogawai
o Characteristic appearance of these eggs: Old fashioned electric bulb
 Mature eggs: SHHM
o Schistosoma spp
o Heterphyes heterophyes
o Haplorchis yokogawai
o Metagonimus yokogawai

 Type of Cercaria:
o Fork-tail cercaria: All Schistosoma spp.
o Simple-tail cercaria:
 Faschiola hepatica
 Fasciolopsis buski
o Keeled-tail cercaria:
 Clonorchis sinensis “Therefore I tell you, whatever you ask for in prayer, believe that you have received it and
 Heterophyds it will be yours.” Mark 11:24
 Opistorchis felineus Good luck and God Bless!
o Mircocercus: Paragonimus westermani #RoadToVNeck

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