Parasitolog

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Done by Adham Alnakhlany

• SCIENTIFIC COMMITTEE_Batch 34

Supervisor
‫‪Parasitology‬‬ ‫‪SCIENTIFIC COMMITTE‬‬ ‫دفعة ‪ 34‬طب بشري‬ ‫اللجنة العلمٌة‬

‫إعـــــداد‪:‬‬
‫‪ ‬سلمى هائل‬

‫طباعة وتنسيق ‪ /‬كتابة‪:‬‬

‫‪ ‬سلمى هائل‬

‫فً حالة وجود أي خطأ علمً او مطبعً او أي إضافة ٌرجى متابعتنا على حساب التلٌجرام التالً‬
‫‪@lajna34‬‬
Parasitology SCIENTIFIC COMMITTE ‫ طب بشري‬34 ‫دفعة‬ ‫اللجنة العلمٌة‬

Second Cestoda
Name Taenia Saginata Taenia solium
Parasite disease Taeniasis saginata Taeniasis solium
Worldwide where beef eaten Cosmopolitan and common
Distribution
undercooked wherever pork is eaten raw
D.H & Habitat small intestine of man only small intestine of Man only
Diagnostic stage Immature eggs Immature eggs
I.H Cattle Pig {Man can act as I.H}
Infective stage & Cysticercus bovis through eating Cysticercus cellulose through
Mode of infection undercooked infected beef ingestion of infected pork
Gravid segment pass in fasces or become disintegrated in intestinal lumen
liberating egg ingested by I.H hatch duodenum liberating
onchosphere penetrate intestinal wall blood right side of heart lung
Life cycle
systemic circulation distributed in tongue ,heart and active striated
muscle develop into Cysticercus bovis\cellulose in intestine of Man
evaginates its Scolex attached to intestinal mucosa develop to adult
Pathogenesis Slight erosion of mucosa at the site of
attachment {I.P 3 month}
-no symptoms in the majority of
patient
-intestinal disturbance as hunger pain
Cysticercosis may occur with
,nausea
T. Solium not T. Saginata
-intestinal obstruction
Clinical picture (Described later )
-loss of weight
-segments may detached and enter the
appendix ,common bile duct or creep
out of the anus causing itching and
nervousness
- Finding eggs or segments in the stool -detection of eggs in stool and
- Specific diagnose made from the 15- differention by Ziehl Neelsen stain
30 lateral uterine branches in the -detection of gravid segments and
Diagnosis
gravid segments differention by number of uterine
- Perianal cellophane tape swab for lateral branches (7-13)
eggs or gravid segments
- Praziquantel: single oral dose -Atebrine 1gm drug of choice
10mg\kg -Avoid yomesan or Praziquantel for
- Niclosamide(yomesan):2mg(4tablet) fear of internal auto-infection
for adult and 1mg for children chewed which lead to cysticercosis due to
Treatment
in single dose on an empty stomach. dis integration of segment.
-if yomesan used a saline purge
must be given one hour after
treatment
-infection of man prevented by - treatment infected person
Prevention & thorough cooking or deep freezing of - healthy sanitation
control beef -inspection of pork
- infection of cattle prevented by - thorough cooking of pork
 Parasitology SCIENTIFIC COMMITTE ‫ طب بشري‬34 ‫دفعة‬ ‫اللجنة العلمٌة‬

avoiding defecation where cattle graze

- inspection of slaughtered cattle
-sanitary disposal of human stool for
prevention of cattle infection

Cestoda may classified according to Habitat:

Intestinal Somatic

-Man is D.H -Man is D.H & I.H

Cyclophyllidea Psudophyllidea Cyclophyllidea Psudophyllidea

**Cyclophyllidea and psudophyllidea previously mentioned

Parasitology SCIENTIFIC COMMITTE ‫ طب بشري‬34 ‫دفعة‬ ‫اللجنة العلمٌة‬

Name Hymenolepis Nana Hymenolepis diminuta

Parasite disease (hymenolepiasis nana ) ( hymenolepiasis diminuta)
Distribution Worm countries Egypt & Sudan Cosmopolitan
Man,
Adult lives in small intestine Adult live in S.I of rats , mice &
D.H & Habitat
larvae lives embedded in villi Occasionally of man
( see frequently in children )
I.H Man Insect (fleas ,four beetles, flour moth)
Diagnostic stag Egg Egg
Eggs or cysticercoid larva through
Infective stag& Egg or cysticercoid larva through
-contaminated food and drink
Mode of infection accidental ingestion of infective insect
-external auto –infection (hand to mouth
*Direct life cycle: egg pass mature with eggs ingested by insect hatch in
fasces and directly infective to man intestine liberating onchosphere
hatch S.I release onchosphere penetrate intestine to body cavity of
penetrate villi of upper S.I change to insect change cysticercoid larvae
Cysticercoid larva one week return to definitive host get infected by ingested
lumen attached itself to mucosa infective insect in S.I larva
develop to adult . evaginates its Scolex attached to
Life cycle *Indirect life cycle : eggs ingest by mucosa become mature adult in 18
insect(flour beetles) hatch their to 20 days
intestine liberating onchosphere
penetrate intestine to body cavity
develop to cysticercoid man get
infected by ingestion of infected insect
with food in S.I of man larvae
develop into adult
- light infection usually no symptoms
Pathogenesis - heavy infection produce enteritis as
result of ulceration of mucosa
- lack of appetite and vomiting -most infection are asymptomatic
- abdominal pain with\without diarrhea - mild gastrointestinal disturbances
- urticarial
Clinical picture
- nervous manifestation as dizziness
due to absorption of toxic produced by
parasite
Diagnosis Finding the egg in stool
- Praziquantel (single oral dose 25mg\kg )
- Treatment should be repeated after 10 days ,due to liberation of
Treatment
cysticercoid from villi
- Also should for all family in the same time .
-killing of rats
Prevention& - sanitary disposal of faces
- destruction of insects in store-houses
Control - personal cleanliness
by insecticides
Parasitology SCIENTIFIC COMMITTE ‫ طب بشري‬34 ‫دفعة‬ ‫اللجنة العلمٌة‬

Name Diphyllobothrium latum Diphyllobothrium caninum

Parasite disease (Diphyllobothriasis) (Diphylidiasis )
Europe, America ,Russia ,Japan and Worldwide distribution
Distribution
East Africa
Man in small intestine Small intestine of dogs cat and
D.H & Habitat
occasionally children
Reservoir host Fish eating mammals -------------------
Frist I.H : Cyclops or Diaptomus (fresh-
I.H water crustacean) Dogs & cats
Second I.H : fresh water fish as salmon
Diagnostic stag Immature egg Gravid segment or egg capsules
Plerocercoid larva through eating Cysticercoid larvae through
Infective stag&
undercooked or raw fish , it grows in accidental ingestion of infected dog or
Mode of infection
intestine to reach maturity in 3-5 week cat fleas
Immature eggs pass with fasces in Gravid segment or egg capsule pass in
fresh water ciliated coracidium faces ingested by flea larva of I.H
hatch after 10 days swim until hatch in lumen of their intestine
ingested by 1st I.H in intestine onchosphere liberated and penetrate the
coracidium loses its cilia penetrate intestine body cavity change to
Life cycle
intestinal wall body cavity change to cysticercoid larvae adult flea ingested
procercoid larva ingested by 2nd I.H by D.H cysticercoid larvae liberated in
penetrate intestine wall enter body S.I develop to adult
viscera and muscle become
Plerocercoid larva into about 2 weeks
-most cases asymptomatic
-intestinal disturbance as diarrhea
-neurological manifestation as
- light infection asymptomatic ,but
headache caused by absorption worm
abdominal pain and pruritus may
Pathogenesis& product.
occur in some individual
Clinical picture -pernicious anemia due to competition
of the parasite with the host vitamin
B12.
-intestinal obstruction caused by heavy
infection.
-Anemia - finding Gravid segment or egg
Diagnosis
- finding the operculated eggs in stool capsules in stool
-Praziquantel or Niclosamide as Taenia As H. nana
Treatment
- vitamin B12
- through cooking of fish - house pets should be given periodic
- sanitary disposal of faeces anthelminthic treatment
Prevention& - reservoir hosts must be - avoiding fondling of dogs and cats
Control dewormed - frequent washing and dusting house
- health education pets with insecticides to kill the fleas
Parasitology SCIENTIFIC COMMITTE ‫ طب بشري‬34 ‫دفعة‬ ‫اللجنة العلمٌة‬

Parasite Diphyllobothrium mansoni & Multiceps multiceps

(Disease ) proliferum ( Sparganosis) ( Coenurosis )
Infection of human tissue by Plerocercoid Human infection with Coenurus
Def. of Disease larva of D. mansoni & D. proliferum cerebralis (larval stage of Multiceps
multiceps)
Distribution Far east and east Africa ----------------------------
- Larva stage (Coenurus cerebralis) in
Small intestine of cats and dogs and spinal cord and brain of herbivorous
D.H & Habitat sparganum attack subcutaneous tissue as sheep – rarely found in man
,muscle ,eye - Adult worm (Multiceps multiceps) in
S.I of dogs
Frist I.H : Cyclops(contain Procercoid larva)
I.H Second I.H : snakes ,frogs occasionally man _______________
(containing Plerocercoid larva)
- Plerocercoid larva through ingestion
undercooked flesh of second I.H
Infective stag& - Procercoid larva through accidental
Mode of ingestion of Cyclops ________________
infection - using infected flesh of second I.H as
poultice to wound or inflamed tissue
especially the eye
Man and other I.H get infected by
ingesting eggs passed with faeces of
dogs .in S.I of man egg hatch to
Life cycle --------------------------- liberate onchosphere penetrate
intestinal wall blood localized later
in brain develop to Coenurus
larva
- inflammatory painful swelling of skin
Pathogenesis - Degenerated larvae cause local
____________________
inflammation and necrosis
- Ocular infection produces periorbital
oedema and painful oedematous Symptoms of space- occupying
Clinical picture conjunctivitis with lacrimation and ptosis lesions of CNS as severe headache
- Urticaria ,fever and eosinophilia ,convulsion and epilepsy
Diagnosis -finding the larva in lesions - surgical recovery of the larva
-surgical removal of Plerocercoid
Treatment - Praziquantel (3doses 40mg\kg for Surgical remove
two weeks) if surgical impossible
- endemic areas drinking water should be
Prevention& boiled or filtered ---------------------------
Control - flesh of suspected I.H thoroughly cooked
- avoid using of flesh of I.H as poultice
Parasitology SCIENTIFIC COMMITTE ‫ طب بشري‬34 ‫دفعة‬ ‫اللجنة العلمٌة‬

Hydatid cyst
 Cyst has :
a- Fibrous tissue layer
b- External ,non cellular , laminated layer
c- Inner ,cellular ,germinal layer
 Contents :
a- Individual scolices
b- Hydatid fluid
c- Brood capsules (have only the germinal layer containing scolices)
d- Daughter cyst (formed of two layers of the mother cyst)
e- Hydatid sand, detached scolices, brood capsules and daughter cyst that fall in the
hydatid fluid)
 Classification (more details page 39+40 )
#according to shape: #according to development of cyst:

- Unilocular - Endogenous
- Alveolar - Exogenous
- Polycystic -Metastatic
#According to scolices : #According to fertility :
- Cephalocystic - Fertile cyst
- Acephalocystic - Sterile cyst

 Location in man :
- 70% in liver - 24% in lung
- 3% in kidney - 2%in bone
- 1% in brain
Parasitology SCIENTIFIC COMMITTE ‫ طب بشري‬34 ‫دفعة‬ ‫اللجنة العلمٌة‬

Parasite Echinococcus granulosus Taenia solium

( Disease) (Echiococcosis, Hydatidosis) ( cysticercosis)
Infection with hydatid cyst the larvae
stage of E. granulosus (unilocular Infection of human tissue by
Def. of disease hydatid ),E. multilocularis (multilocular Cysticercus celluloasae (larva stage of
hydatid ) or E. vogeli & E. oligarthrus T. solium
(polycystic)
Distribution Cosmopolitan ----------------
Man in Subcutaneous tissue ,brain,
D.H & Habitat Dogs & other canines in small intestine
heart and eye
Sheep or man
I.H Man
{Man act as blind (closed ) I.H}
Diagnostic stag Hydatid cysts ------------------
-accidental ingestion of egg
(heteroinfection)
Egg through:
- external autoinfection: hand to
- ingestion of water or vegetable
Infective stag& mouth(adult carrier)
polluted by dogs faces
Mode of infection - internal infection : antiperistalsis, ova
- handling infected dogs where the hair
carried to upper portion of duodenum
contaminated with egg
where hatching ,onchosphere
penetrate into intestinal wall
Egg hatch S.I liberating onchosphere
penetrate intestinal wall blood
liver where it develop into hydatid cyst
{if onchosphere succeeds to pass into
liver it settles in lungs} D.H gets ---------------------------
Life cycle
infected{when feed an organ from I.H}
in S.I, scolices evaginates and develop to
adult. Echinococcus never inhabit S.I of
man but normally lives in S.I of dogs and
other canines
- many cases asymptomatic
- cyst produce a foreign body
-small cyst asymptomatic
inflammatory reaction that result in
-large and expanding hydatid cyst cause
production of fibrosis and calcification
pressure necrosis of surrounding tissue.
- During stage of invasion there may be
- after death cyst absorption fluid occurs
slight muscle pain, mild fever
Pathogenesis& and allergic symptoms may follow
&eosinophilia
Clinical picture - rupture of cyst may leading to
- intraorbital pain ,flashes of light
anaphylactic shock and dissemination of
- epilepsy, sever persistent headache
germinal layer with formation of new
,vomiting ,papilledema and loss of
cysts.
vision as a result of increased
intracranial pressure
{ I.P 2 months after infection}
Parasitology SCIENTIFIC COMMITTE ‫ طب بشري‬34 ‫دفعة‬ ‫اللجنة العلمٌة‬

-clinical picture: {dragging pain or slow - eosinophilia

growing tumor - intradermal test & serological test
- X-ray specially pulmonary cyst - ultrasound , CT and MRI
&calcified cyst - X-ray of infected muscle or brain if
- CT & ultrasound for uncalcified cyst have calcified
Diagnosis - Blood : eosinophilia - Biopsy of palpable subcutaneous cyst
- Intradermal test (Casoni test) - clinical manifestation in an endemic
- serological test area
- Molecular test by PCR
- sputum examination
- exploratory aspiration
--surgical :
a- surgical removal
b- PIAR (Percutaneous Aspiration
Injection and Reaspirations)
- Medical :
a- Albendazole { 400mg twice
daily for 4 weeks repeated
every 2 weeks for 12 cycle} - surgical removal
b- Praziquantel {40 mg\kg daily for - Albendazole : 15mg\kg for 8 days
Treatment
15 day } - Praziquantel : 50 mg\kg for 15 days
**medical treatment use in the - vitamin D & calcium to help
following: calcification
- Inoperable cysts
- Preliminary to surgical removal or
aspiration
- Following surgery
** cysts in bone & E. multicularis appear
resistant
-- deworming of dogs and other carriers
of adult - pure water supply
- stray dogs should be destroyed - treatment of adult worm from patient
Prevention& - avoid fondling of dogs and protection - personal hygiene and environmental
Control of water supplies from contamination sanitation
with fasces of dogs - proper washing of vegetable
- hydatid cysts found in slaughtered
animal should be destroyed