Parasitology

❖ Features and Laboratory Diagnosis

A) Intestinal and Urogenital Protozoa:

1) Entamoeba histolytica:
Features:
• Cyst has 04 Nuclei
• Trophozoite has 01 Nucleus
• 01 Cyst produces 01 amoeba which divides to form 08 Trophozoites.
• Causes
1) Dysentery (Bloody Diarrhea)
2) Liver Abscess (Aspiration yields brownish-yellow pus with anchovy paste consistency)
3) Ameboma (Granulomatous lesion resembling adenocarcinoma of colon)

Laboratory Diagnosis:
1) Finding Trophozoites in diarrheal stools OR Cysts in formed stools.
2) Examination of Cysts:
a) Saline Wet Mount.
b) Iodine-Stained Wet Mount.
c) Trichome-Stained Preparation.
3) Indirect Hemagglutination Test (Positive in invasive amoebiasis)
4) Antigen test detects E. histolytica Antigen.
5) PCR detects E. histolytica’s Nucleic Acids

2) Giardia lamblia:
Features:
• Cyst with 04 Nuclei.
• Pear-Shaped Trophozoite has 02 Nuclei, 04 Pairs of Flagella and a Sucking Disk.
• 01 Cyst produces 02 Trophozoites.
• Predisposing Factor = IgA deficiency
• Causes:
1) Protein and Fat Malabsorption.
2) Watery, Foul-Smelling Diarrhea.
3) Steatorrhea
Laboratory Diagnosis:
1) Finding Trophozoites and/or Cysts in diarrheal stools OR Cysts in formed stools.
2) String Test.
3) ELISA detects Giardia Antigen in the stool.
4) PCR detects Giardia’s Nucleic Acids in the stool.

3) Trichomonas vaginalis:
Features:
• Only exists in Trophozoite form which are Pear-Shaped.
• Transmitted by Sexual contact.
• Watery, Foul-Smelling Greenish Vaginal Discharge

Laboratory Diagnosis:
1) Wet Mount of Vaginal Discharge reveals Pear-Shaped Trophozoites with Jerky Motion
2) NAATs (Highly sensitive and specific)

B) Blood and Tissue Protozoa:

1) Plasmodium:
Features:
• 05 Species
1) P. falciparum
▪ Causes most severe infection
▪ High Level of Parasitemia (Infects RBCs of all ages)
▪ Causes Tertian Malignant Malaria
▪ Causes Cerebral Malaria
▪ Causes Blackwater Fever (Renal Damage + Hemoglobinuria)
▪ Has Cresent Shaped Gametocytes.
▪ G6PD Deficient people are Protected
2) P. vivax
▪ Infects only Reticulocytes
▪ Causes Tertian Benign Malaria
▪ Most widely distributed.
▪ Forms Hypnozoites
▪ Duffy Antigen Negative individuals are Resistant.
3) P. ovale
▪ Causes Tertian Benign Malaria
 ▪ Forms Hypnozoites
4) P. malariae
▪ Causes Quartan Malaria
▪ Infects only Mature RBCs
5) P. knowlesi
• Most Pathologic findings are due to RBC Destruction.
• RBC Destruction Due to:
1) Release of Merozoites from RBCs
2) Action of Spleen to sequester and lyse infected RBCs (Reason for Splenomegaly)
• People with Sickle Cell Trait are protected from all kinds of malaria.
• Overall Clinical Findings include
1) Fever and Chills
2) Anemia
3) Splenomegaly
4) Cerebral Malaria
5) Blackwater Fever

Laboratory Diagnosis:
1) Microscopic Examination of Giemsa-Stained Smears.
a) Thick Smear = Presence of Organism.
b) Thin Smear = Species Identification.
2) Ring-Shaped Trophozoites in infected RBCs can be seen.
3) Detection of Hemozoin Pigment in infected RBCs
4) Schuffner’s Dots can be visualized using Romanowsky Stain
5) PCR for Plasmodium Nucleic Acid
6) ELISA for P. falciparum protein

2) Toxoplasma:
Features:
• Immunocompetent adults are asymptomatic (Some show signs of Infectious Mononucleosis)
• Congenital Toxoplasmosis results in triad of
1) Chorioretinitis
2) Encephalitis
3) Intracranial Calcifications
• Immunocompromised adults have Disseminated Disease (Encephalitis)
• Rim-Enhancing Lesion is seen in Brain Imaging

Laboratory Diagnosis:
1) For acute and congenital infections IgM is detected through immunofluorescence.
2) Giemsa-Stain shows Cresent-Shaped Trophozoites.
3) Mice Inoculation confirms the diagnosis.
3) Leishmania:
a. Leishmania donovani
Features:
• Targets Reticuloendothelial System which results in
1) Anemia
2) Thrombocytopenia
3) Leukopenia
• Splenomegaly occurs
• Hyperpigmentation of the skin (Kala-Azar)

Laboratory Diagnosis:
1) Detection of Amastigotes in the Bone Marrow.
2) Serology (Indirect Immunofluorescence)
3) Leishmanin Skin Test (Crude Homogenate of Promastigotes used as antigen)
a) Positive in Recovered Patients.
b) Negative in Patients with Active Disease.

b. L. tropica, L. mexicana and L. brazilensis

Features:
• Tropica and Mexicana cause Cutaneous Leishmaniasis.
1) Red Papule at the bite site.
2) Multiple Nodules Ulcerate.
3) Heals in Immunocompetent individuals.
• Brazilensis causes Mucocutaneous Leishmaniasis.
1) Papule at the bite site.
2) Metastatic Lesions Form.
3) Disfiguring Granulomatous Ulcerations destroy cartilage but leave bone.

C) Cestodes:

1) Taenia solium
Features:
• Pork Tapeworm.
• Scolex has 04 Suckers and Circle of Hooks.
• 5-10 Primary Uterine Branches.
 • Taeniasis doesn’t cause significant damage.
• Cysticercosis in Brain
1) Space Occupying Lesions
2) Vomiting and Headache
3) Seizures
• Cysticercosis in Eyes
1) Retinitis
2) Uveitis
• Cysticercosis in Skin
1) Subcutaneous Nodules

Laboratory Diagnosis:
1) Gravid Proglottids (5-10 uterine branches) in the Stools.
2) Diagnosis of Cysticercosis:
a. CT Scan
b. Serology detects antibodies to T. solium antigens (Serology negative in neurocysticercosis)

2) Taenia saginata
Features:
• Beef Tapeworm.
• Scolex has 04 Suckers and No Hooks.
• 15-25 Primary Uterine Branches.
• Taeniasis doesn’t cause significant damage.
• May cause Pruritis Ani

Laboratory Diagnosis:
1) Gravid Proglottids (15-25 uterine branches) in the Stools.

3) Diphyllobothrium latum
Features:
• Fish Tapeworm
• Longest Tapeworm
• 02 Sucking Grooves and No Hooks
• Eggs are Oval and have Lid-Like opening (operculum).
• Causes Vitamin B12 Deficiency resulting in Megaloblastic Anemia
• Diarrhea

Laboratory Diagnosis:
 1) Oval Yellow-Brown Operculated Eggs in the Stools.

4) Echinococcus granulosus
Features:
• Dog Tapeworm.
• Smallest Tapeworm
• Causes Unilocular Hydatid Cyst Disease
1) Liver Cysts cause Hepatic Dysfunction
2) Lung Cysts cause Bloody Sputum
3) Cerebral Cysts cause Headache and Focal Neurological Signs
• Rupture of Cyst causes Anaphylactic Shock

Laboratory Diagnosis:
1) Microscopic Examination reveals presence of Brood Capsules
2) Serology (Indirect Hemagglutination Test

D) Trematodes:

1) Schistosoma
Features:
• Blood Fluke.
• Only Trematode that is not Hermaphrodite.
• Pathology due to Presence of Eggs in the Liver, Spleen or Gut/Bladder Wall.
• Eggs in Liver Cause
1) Fibrosis
2) Hepatomegaly
3) Portal Hypertension which leads to Splenomegaly
• There are 03 Species of Schistosoma
1) S. haematobium
▪ Terminal Spine
▪ Resides in Veins Draining Bladder (UT related symptoms are because of this)
▪ Causes Bladder Carcinoma (After Granuloma formation and Fibrosis of Bladder)
▪ Hematuria
2) S. japonicum
▪ Small Lateral Spine
 ▪ Resides in Superior and Inferior Mesenteric Venules (Small and Large intestines
Effected)
▪ GI Hemorrhage, Hepatomegaly, and Splenomegaly
▪ Death by exsanguination from ruptured Esophageal Varices
3) S. mansoni
▪ Prominent Lateral Spine
▪ Resides in Inferior Mesenteric Venules (Distal Colon affected)
▪ GI Hemorrhage, Hepatomegaly, and Splenomegaly
▪ Death by exsanguination from ruptured Esophageal Varices

Laboratory Diagnosis:
1) Finding Characteristic Eggs in Stools or Urine

2) Clonorchis sinensis
Features:
• Liver Fluke.
• Causes Asian Liver Fluke Infection.
• Hyperplasia and Fibrosis of Biliary Tract.

Laboratory Diagnosis:
1) Finding Small, Brownish Operculated Eggs in the Stool.

3) Paragonimus westermani:
Features:
• Lung Fluke.
• Causes Chronic Cough and Bloody Sputum
• Disease resembles Tuberculosis

Laboratory Diagnosis:
1) Finding Operculated Eggs in the Sputum or Stool.

E) Intestinal Nematodes:

1) Enterobius vermicularis:
Features:
• Pinworm Infection
• Perianal Pruritis

Laboratory Diagnosis:
1) Scotch Tape Test
2) Adult worms can be found in stools (Eggs not found in stools)

2) Ascaris lumbricoides:
Features:
• Loeffler’s Syndrome (Eosinophilic Pneumonia) due to larva migrating through lungs.
• Malnutrition
• Intestinal Obstruction

Laboratory Diagnosis:
1) Eggs can be found in stools (Can sometimes even be seen with naked eye)

3) Ancylostoma and Necator:

Features:
• Hookworm infection
• Cause Microcytic Iron Deficiency Anemia (Due to heavy blood loss from the bite site in the
intestine as a result of anticoagulant production)
• Larvae of A. canium and some other cause Cutaneous Larva Migrans (Larva of Toxocara canis
causes Visceral Larva Migrans)

Laboratory Diagnosis:
1) Eggs can be found in stools.
2) Eosinophilia is Typical

4) Strongyloides stercoralis:
Features:
• Threadworm infection
• 2 Distinct Life Cycles
• Watery Diarrhea
• Cutaneous Larva Migrans
• Can result in Sepsis by Enteric Bacteria
Laboratory Diagnosis:
1) Finding Larvae in the Stools.
2) Striking Eosinophilia.
3) Enzyme Immunoassay detects Antibodies to Larval Antigens

5) Trichinella spiralis:
Features:
• Whipworm infection
• Periorbital Edema
• Muscle Pain
• Eosinophilia

Laboratory Diagnosis:
1) Muscle Biopsy reveals Larvae within Striated Muscle
2) Serology (Bentonite Flocculation Test)
a) Becomes Positive 3 weeks after infection.

F) Tissue Nematodes:

1) Wuchereria bancrofti
Features:
• Vector = Female Mosquito (Anopheles or Culex)
• Causes Filariasis:
1. Adult worms in the lymph nodes cause inflammation resulting in lymphatic obstruction
2. and severe Edema especially of the Legs (Elephantiasis) and Scrotum.
• Wolbachia (Bacteria that lives intracellularly in Wuchereria) releases endotoxin-like molecules that
plays role in pathogenesis of Wuchereria.
• Tropical Pulmonary Eosinophilia (TPE) is an Immediate Hypersensitivity Reaction.

Laboratory Diagnosis:
1) Thick Blood Smears at night reveal Microfilariae.

2) Onchocerca volvulus
Features:
 • Vector = Female Blackfly (Simulium)
• Causes River Blindness.
• Hanging Groin (Loss of Subcutaneous Elastic fibers in the Groin Region)
• Lizard Skin (Thick, Scaly and Dry Skin)

Laboratory Diagnosis:
1) Skin Biopsy reveals Microfilariae.

3) Loa loa
Features:
• Vector = Deerfly (Mango fly Crysops)
• Adult worm can be seen crawling in the Conjuctiva of the Eye.
• Causes Calabar Swellings
1) Transient, Localized, Subcutaneous Edema due to a Hypersensitivity reaction.

Laboratory Diagnosis:
1) Visualization of Microfilariae in the Blood Smear

4) Dracunculus medinensis
Features:
• Guinea Fire Worm
• Blistering, Inflammation and Ulceration of the Skin

Laboratory Diagnosis:
1) There is no Laboratory Diagnosis as diagnosis is made Clinically by finding worm in the Skin Ulcer