MICROPARA AND PARASITOLOGY

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as cows, pigs, and humans. They get food by eating the

PARASITOLOGY host's partly digested food, depriving the host of nutrients.

Branch of microbiology in 3 categories of organism - Fleas harm their hosts, such as dogs, by biting their skin,
⚫ PARASITIC sucking their blood, and causing them to itch. The fleas, in turn,
⚫ HELMINTHS get food and a warm home. Barnacles, which live on the bodies of
⚫ ARTHROPODS whales, do not seriously harm their hosts, but they do itch and are
annoying.
⚫ GARDIA LAMBLIA
FIRST PARASITE RECORDED Host-Parasite relationship
Commensalism- parasite deriving benefit without causing injury
to host (+/0)
Ex: maggots living on dead organism
Parasitism – parasite derives benefits and host suffers injury (+/-
) Ex: ticks that lives in cats or dogs
Mutualism – both benefit (+/+)
Ex: Clownfish and a Sea Anemone. The clownfish benefits from
the sea anemone by providing shelter from predators by hiding
inside of the sea anemone’s poisonous arms. The clownfish
PARASITISM - is a symbiotic relationship that is of benefit to one benefits the sea anemone by consuming parasites that may be on
party or symbiont at the expense of the other party which is the it and providing nutrients from its excrements.
host.
PARASITE – are organism that live on or in other living organism HOST
, at whose expense they gain some advantage ⚫ An organism that harbors a parasitic agent providing
ECTOPARASITE – parasites that live outside the host’s body (ex: nourishment and shelter to the parasite
fleas, arthropods, lice)
ENDOPARASITE – parasite that live inside the host PRIMARY/DEFINITVE HOST
(ex:tapeworm,hookworm) An organism that supports the adult stage or the sexually mature
reproductive form of parasite
CLASSIFICATION OF PARASITE
(based on habitat) INTERMEDIATE HOST/ SECONDARY HOST
ECTOPARASITE ⚫ An organism that host the asexual form of the parasite
- those that live outside of host body (flease,lice) 1Passive intermediate ex: snails
INFESTATION 2.Active intermediate ex: Tsetse fly
- Invasion of the body by ectoparasites
INTERMEDIATE HOST
ENDOPARASITES some tapeworms make use of cows, pigs, and fish as intermediate
- Lives inside the body of host ( helminthes or worms) hosts
INFECTION
- Invasion of the body by endoparasites When any of these animals ingests a tapeworm egg

2 important elements in parasitism
Parasite / Host Relationships
⚫ A parasitic relationship is one in which one organism, the
parasite, lives off of another organism, the host, harming it
and possibly causing death. The parasite lives on or in the
body of the host.
⚫ A few examples of parasites are tapeworms and fleas -
Tapeworms are segmented flatworms that attach
themselves to the insides of the intestines of animals such
the egg hatches and the larva moves from the intestine to the
muscle of the animal where it forms
CYST
Human ingesting a partially cooked or raw meat containing the
cyst may eventually harbor the parasite
when the larva moves out of the cyst and grows into its mature or
reproductive form and begin to reproduce inside the definitive
human host

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RESERVOIR HOST - harbors the pathogen but shows no ill Sexual intercourse
effects and serves as source of infection - Ex. Trichomonas vaginalis
Ex : marmots,blact rats, prairie dogs, chipmunks and squirrel for
bubonic plague. COMMON TYPES OF PARASITE
PARATENIC HOST - Serve as means of transport for the parasite 1. ROUNDWORMS
Ex: insect vectors-so that the infective stage of a certain parasite 2. TAPEWORMS
may reach its final host. 3. HOOKWORMS
4. AMOEBA
PARASITE 5. FLIES,LICE,FLEAS,MITES, TICKS,SPIDERS,BED BUGS
CLASSIFICATION : BASED ON ABILITY TO LIVE
INDEPENDENTLY Route by which humans acquire parasitic infection
1. Contract and penetration of eyes
Faculative Parasite - Acanthamoeba
- Can live independently
- Free- living 2. Inhalation
- Enterobius
Obligate Parasite
- Must exist as parasite inside a host 3. Vector borne
Ex. Plasmodium , Leishmanis, hookworms - Kissing bug
- Mosquito - plasmodium
CLASSIFICATION : BASED ON MODE OF LIVING
4. Fecal-oral , ingestion
Incidental Parasites -Ascaris, Amoeba, Taenia
- Occur on an unusual host
- Ex. Dog tapeworm in humans 5. Contact and penetration of the skin
-Schistosoma
Transitory Parasite
- Larvae develops in a host while the adults is free-living 6. Sexual contact
- Ex. Ecchonoccus granulosus or dog tapeworm -Trichomona

Erratic Parasites Parasites Damages the Host thru 1 or more of the following
- Becomes fixed in an unusual organ diff. Fr. That w/c is ordinarily mechanisms:
parasitized ⚫ Trauma or Physical Damage
-Ex. Ascaris lumbricoides ⚫ Lytic necrosis
⚫ Stimulation of host tissue reaction
MODE OF TRANSMISSION ( MOT) ⚫ Toxic and allergic phenomena
⚫ Opening of pathways for entry of other pathogens into the
INGESTION tissue
⚫ Fr: Contamtuted food & water MOST COMMON
⚫ mot of mouth Intestinal parasites SOURCES OF INFECTION/ INFESTATION
⚫ Exposure to parasites may occur through one or more of the
A. Contamined water following sources:
⚫ -Intestinal protozoa (cyst) ; round tapeworms 1.) contaminated soil or water;
Ascaris lumbricides: Tricchuris trichiura : Enterobius vermicular 2.) food containing the parasite's infective stage;
dwarf tapeworm ( Hymenolepis nana - all in embryonated egg 3.) a blood-sucking insect;
stage.) 4.) a domestic or wild animal harboring the parasite;
5.) another person and his or her clothing, bedding, or the
B. Contaminated food immediate environment he or she has contaminated; or
⚫ Contains mature larvae stage ; Enterobius vermicularis & 6.) one’s self (auto-infection).
dwarf tapeworm ( Hymenolepsis nana - all in embryonated
egg stage) Mechanisms of Disease Production by Parasites
⚫ Pathogenesis refers to the dynamics ho any disease
FR. EATING FOOD CONTAINING MATURE LARVAL STAGE process. Some parasites may cause inapparent infection,
• Ex. Diphyllobothrium latum, intestinal lung flukes causing no symptoms and producing no detectable harm.
The infection can remain inapparent continuously for long
ENTER BODY FR. SOIL via SKIN periods or between short periods of relapse. For most
⚫ Hookworms & Strongyloides helminthic infections, signs and symptoms usually manifest
only if a large number of worms are present.

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1. Trauma or physical damage Protozoa Metazoa
⚫ This mechanism of damage may be manifested due to the (unicellular) (multicecullar)
physical damage caused by the parasite in the organ it / \
parasitizes or at the point of entry of the parasite. Entry of the Helminths Arthropods
infective larvae of hookworms or blood flukes into the skin (worms) (insects)
may produce relatively slight physical damage. Small lesions / \
may result from the bite of mosquitoes (e.g. malaria) and Round Flat (platyhelmints)
other insects (e.g. tsetse fly in African sleeping sickness). (nematodes) / \
Migration of the larval stage of cerain roundworms (Ascaris Flukes Tapeworms
and hookworms) may lead to ruptured (trematodes) ( cestodes)
capillaries in the lungs.
PROTOZOANS
2. Lytic necrosis ⚫ Greek word which means first
⚫ Enzymes and other substances produced by many parasites animals
that are necessary for them to digest food available in the ⚫ Represent the diverse group of
immediate environment may cause harm to the host tissues. eukaryotic protest
Example is that of the parasitic protozoan Entamoeba ⚫ Mostly unicellular
histolytica which releases enzymes that lyse tissue for their ⚫ Leaves freely
nutritional needs. These enzymes also enable the parasite ⚫ Maybe parasitic or symbiotic
to penetrate the tissues of the colon, producing ulceration in ⚫ They are motile locomotive
the colon, and extra-intestinal viscera. organelles (flagella or cilia for
movement)
3. stimulation of host tissue reaction ⚫ Small , not visible needs the help
⚫ Majority of animal parasites provoke host tissue reactions. of microscope
These reactions may be in the form of cellular proliferation ⚫ Nutrition maybe holozoic or
and infiltration at the site of the parasite entry or may involve halophytic
systemic increase in certain types of cells, especially those ⚫ Respiration takes place through
circulating in the blood. One may see an increase in general outer space of the body
circulating eosinophils. This is true for most infections
caused by helminths. In some cases, stimulation of red blood Morphology
cell (RBC) production may occur, especially in infections that • Protozoa are Eukaryotic resemble to animal cell, contain major
lead to mechanical loss or destruction of RBCs,as in cell organelles (including Nucleus, Mitochondria)
hookworm infections or in malaria. Certain parasitic •Their organelles are highly specialized for feeding, reproduction
infections may also lead to stimulation of neoplastic (cancer) and movement
growth in the organ infected. Example is the blood fluke •The cytoplasm of protozoa are divided into an outer layer called
Schistosoma japonicum, may lead to the development of Ectoplasm and an inner layer called Endoplasm
cancer of the liver. Cancer of the biliary ducts may be seen • Ectoplasm helps in movement, feeding and Protection
in infection with the liver fluke Clonorchis sinensis. • Endoplasm houses Nucleus, mitochondria and food
• Some protozoa have special appendages Flagella and cilia that
helps in their movements
4. Toxic and allergic phenomena (Immunopathology) • Freshwater protozoa have contractile vacuoles to pump out
⚫ Proteins or other metabolites produced by the parasites may excess water
lead to hypersensitivity or allergic reactions Due to • Their shape may remain constant (specially in Ciliates) or
stimulation of antibody production. An example of this is change constantly (as seen in Amoeba)
infection with pinworm Enterobius vermicularis where an • The size of Protozoa is range between 3 to 300 micrometer.
allergic reaction occurs in the anus as a response to the • Few ciliate and Amoeba are larger enough to be seen with naked
female worm and its eggs leading to its most prominent eyes (they are about 4 to 5 mm).
manifestation of pruritus ani. • Except Sporozoates, all types of protozoa are motile either
through Flagella, cilia or Pseudopodia
• Have Eyespot that can detect change in light
• Respond to light & learn by trial & error

PROTOZOA CLASS
CONVENTIONAL SCHEME:
1. Amoebas (Sarcodina) – moved by pseudopodia
2. Flagellates (Mastigophora) – moved by flagella
CLASSIFICATION OF PARASITE 3. Ciliates – moved by cilia
PARASITES 4. Sporozoa (Apicomplexa) – exhibit no motility
/ \
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Amoeba ⚫ Early symptoms (in about 1-4 weeks) include loose stools
- E histolytica, N. fowleri and mild abdominal cramping
Flagellates ⚫ If the disease progresses, frequent, watery, and/or bloody
- Giardia stools with severe abdominal cramping
-T. vaginalis ⚫ If the trophozoites reach the intestinal walls and go through
- Leishmania them, symptoms of liver infection such as liver tenderness
Sporozoa and fever are the initial signs and symptoms of liver abscess
- Plasmodium formation (hepatic amebiasis).
-Toxoplasma ⚫ Other organs (heart, lungs, brain [meningoencephalitis], for
Cilliate example) may produce symptoms specific to the organ and
- B. coli produce severe illness and/or death.

I. INSTESITNA & UROGENITAL PROTOZOA Dx: Fresh stool TX: Metronidazole(Flagyl)

Protozoans parasites of humans (AMOEBA) Liver Function Test Tinidazole (Fasigyn)

ENTAMOEBA HYSTOLYTICA Px: 1. Drink bottled or boiled water

1. CAUSES: Amoebic dysentery 2. Avoid milk or dairy product not pasteurized
- about 50mil world wide are affected 3. Avoid street foods
- carried asymptomatically in the digestiv
tract of humans
2. Infections occurs most often by drinking water contaminated w/
feces
3. MOT: ingestion of fecally contaminated water and food by
fecally contaminated hands by food handlers
4. IP: few days to several months usually 2-4 weeks
5. s/sx: Abdominal pain, diarrhea, vomiting fatigue, vomiting,
bloody stool
6. Tx: Metronidazole

GIARDIA INTESTINALIS
1.Found in the intestinal tracts of animals and in the environment
2. Ingestion of dormant microbial cysts
In contaminated water , food
3.IP: 1-3 wks after exposure to parasite 2. Giardia lamblia (Giardia intestinalis)
4.s/sx: diarrhea, abdominal cramps, vomiting, fever
5.Tx: Metronidazole

1.AMOEBIASIS/ENTAMOEBA HISOLYTICA
TRANSMISSION: Fecal contaminating drinking water and foods
- by direct contact w/ dirty hands or objects
S/Sx: GI – 1. diarrhea 2. vomiting 3.abdominal pain 4. fever

HUMANS
\ MODERN SCHEME:
Tropozoites invades other Gardia –flagellate protozoan belonging to subphylum
Parts of the body and reproduce mastigophobia, “Grand old man of intestine”
By division
\ People become infected with Giardia by swallowing Giardia cysts
Cysts hatched in the small (hard shells containing Giardia) found in contaminated food or
Intestine and release amoeba which water.
Divide into tropozoites ⚫ Cysts are instantly infectious once they leave the host
Cyst and tropozoites through feces (poop)
passed into feces ⚫ An infected person might shed 1-10 billion cysts daily in their
\ feces (poop) and this might last for several months.
NON INVASIVE STAGE However, swallowing as few as 10 cysts might cause
Mature cells ingested someone to
INFECTIVE STAGE become ill
⚫ Giardia may be passed from 1. person-to-person or even
from animal-to-person
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2. oral-anal contact during sex has been known to cause infection
⚫ Symptoms of giardiasis normally begin 1 to 3 weeks after a
person has been infected.
1. Multi stool collection -cysts or trophozoites in the feces, using
direct mounts as well as concentration procedures
Repeated samplings may be necessary
2. Direct Immunofluorescence Assay (DFA)
Visualization under a fluorescent microscope shows
the Giardia cysts as green, glowing ovoid objects
3.Subphylum Mastigophora: Trichomonas vaginalis
⚫ Trichomoniasis (or “trich”) is a very common sexually
transmitted disease (STD). It is caused by infection with a
protozoan parasite called Trichomonas vaginalis. Although
symptoms of the disease vary, most people who have the
parasite cannot tell they are infected.
⚫ The parasite passes from an infected person to an
uninfected person during sex.
⚫ In women, the most commonly infected part of the body is
the lower genital tract (vulva, vagina, cervix, or urethra).
⚫ In men, the most commonly infected body part is the inside
of the penis (urethra).
⚫ During sex, the parasite usually spreads from a penis to a
vagina, or from a vagina to a penis. It can also spread from
a vagina to
another vagina. It is not common for the parasite to infect
other body parts, like the hands, mouth, or anus.
⚫ It is unclear why some people with the infection get
symptoms while others do not. It probably depends on
factors like a person’s age and overall health. Infected
people without symptoms can still pass the infection on to
others
Men with trichomoniasis may notice:
⚫ Itching or irritation inside the penis;
⚫ Burning after urination or ejaculatio
⚫ Discharge from the penis.
Women with trichomoniasis may notice:
⚫ Itching, burning, redness or soreness of the genitals;
⚫ Discomfort with urination;
⚫ A change in their vaginal discharge (i.e., thin discharge or
increased volume) that can be clear, white, yellowish, or
greenish with an unusual fishy smell.
⚫ Having trichomoniasis can make it feel unpleasant to have
sex. Without treatment, the infection can last for months or
even years.
4.Phylum Ciliphora: Balantidium coli
⚫ The cysts are found in contaminated water, which when
ingested, undergoes excystation in the small intestines.
From there, the trophozoites travel to the large intestine
where they produce ulcers similar to those seen in
amoebiasis. However, extra-intestinal involvement is not
seen.
Causative Agents
Balantidium (=Neobalantidium) (=Balantioides) coli, a large
ciliated protozoan, is the only ciliate known to be capable of
infecting humans.
⚫ The host most often acquires the cyst through ingestion of
contaminated food or water .
⚫ Following ingestion, excystation occurs in the small intestine,
and the trophozoites colonize the large intestine The
trophozoites reside in the lumen of the large intestine and
appendix of humans and animals, where they replicate by
binary fission, during
which conjugation may occur
⚫ Trophozoites undergo encystation to produce infective cysts
.Some trophozoites invade the wall of the colon and multiply,
causing ulcerative pathology in the colon wall.
Some return to the lumen and disintegrate. Mature cysts are
passed with feces.
ll. BLOOD & TISSUE PROTOZOA
1. Subphylum Sarcodina: Acanthamoeba (Free-living
Amoeba)
⚫ Acanthamoeba is a microscopic, free-living ameba, or
amoeba(single-celled living organism), that can cause rare,
but severe infections of the eye, skin, and central nervous
system
⚫ The ameba is found worldwide in the environment in water
and
⚫ The ameba can be spread to the eyes through contact lens
use, cuts, or skin wounds or by being inhaled into the
⚫ Amoebas that often use pseudopodia for a food capture and
location
⚫ Can be naked, construct a shell of particles, or secretes a
shell
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 immune systems.
While unusual, disseminated infection can also affect
healthy children and adults.
⚫ Conditions that may increase a patient’s risk for

Disseminated infection include:

⚫ AIDS
⚫ Organ/Tissue transplant
⚫ Steroids or excessive use of antibiotic
⚫ Diabetes Mellitus\
⚫ Cancer
⚫ Disorders in which white blood cells in the lymphatic tissue
are over-produced or abnormal
⚫ Most people will be exposed to Acanthamoeba during their ⚫ Disorders in which blood cells or blood clotting
lifetime, but very few will become sick from this exposure. mechanisms do not function properly or are abnormal
The three diseases caused by Acanthamoeba are: ⚫ Liver cirrhosis
⚫ Lupus
1) Acanthamoeba keratitis – An infection of the eye that typically
occurs in healthy persons and can result in permanent visual
impairment or blindness.
2) Granulomatous Amebic Encephalitis (GAE) – A serious
infection of the brain and spinal cord that typically occurs in
persons with a compromised immune system.
3) Disseminated infection – A widespread infection that can
affect the skin, sinuses, lungs, and other organs independently or
in combination. It is also more common in persons with a
compromised immune

Acanthamoeba keratitis
⚫ rare disease that can affect anyone, but is most common
in individuals who wear contact lenses.

For people who wear contact lenses, certain practices can

increase the risk of getting Acanthamoeba keratitis:
1. Storing and handling lenses improperly
2. Disinfecting lenses improperly (such as using tap water or ⚫ 2. Subphylum Sarcodina: Naegleria
topping off solutions when cleaning the lenses or lens case) The known pathogen worldwide is Naegleria fowleri, which
3. Swimming, using a hot tub, or showering while wearing lenses is the only amoeba with three identified morphologic forms
4. Coming into contact with contaminated water – trophozoite, flagellate, and cyst form
5. Having a history of trauma to the cornea
⚫ Contact lens wearers who practice proper lens care and
non-contact lens wearers can still develop the infection.
⚫ There have been no reports of Acanthamoeba keratitis being
spread from one person to

Early inflammation due to Acanthamoeba

keratitis

Granulomatous Amebic Encephalitis (GAE)

Diseases
⚫ Granulomatous Amebic Encephalitis (GAE) and
1. Asymptomatic infection – the most common clinical
disseminated infection are very rare forms of Acanthamoeba
presentation in patients with colonization of the nasal passages.
infection and primarily affect people with compromised
2.Primary amoebic meningoencephalitis (PAM)
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 – the result of colonization of the brain by the amoebid
trophozoites leading to rapid tissue destruction. Patients initially
complain of sore throat, nausea, vomiting, fever an headache.
Patients eventually develop signs of meningeal irritation (e.g.
Kernig’s sign) as well as alterations in their senses of smell and
taste. If untreated, the patients may die within one week after
onset of symptoms.
Laboratory Diagnosis
- Diagnosis is based on the finding of the amoeboid trophozoites
in the cerebrospinal flu
Subphylum Mastigophora: Hemoflagellates Leishmania sp
parasites are distributed worldwide.
⚫ Natural reservoirs include rodents, ant eaters, dogs, and
cats.
⚫ In endemic areas, the parasite may be transmitted in a
human-vector-human cycle
⚫ There are three major strains of Leishmania which differ in
the tissues affected and the resulting clinical
manifestations.
⚫ These are Leishmania donovani (visceral
leishmaniasis),Leishmania tropica (cutaneous
leishmaniasis), and Leishmania basiliensis
(monocutaneous leishmaniasis).
Leishmania
⚫ cutaneous leishmaniasis, which causes skin sores,
⚫ visceral leishmaniasis, which affects several internal organs
(usually spleen, liver, and bone marrow
1. Cutaneous Leishmaniasis/ Leishmania Tropica
⚫ The sores typically develop within a few weeks or months
of the sand fly bite. The sores can change in size
and appearance over time.
⚫ The sores may start out as papules (bumps) or nodules
(lumps) and may end up as ulcers (like a volcano, with a
raised edge and central crater);
- skin ulcers might be covered by scab or crust.
- The sores usually are painless but can be painful.
- Some people have swollen glands near the sores (for
example, under the arm, if the sores are on the arm or hand).
Sand fly is a colloquial name for any species or genus of flying,
biting, blood-sucking dipteran encountered in sandy areas.
2. Visceral Leishmaniasis/ Leishmania Donovani
⚫ the illness typically develops within months (sometimes as
long as years) of the sand fly bite.
- Affected people usually have fever, weight loss, enlargement
(swelling) of the spleen and liver, and low blood counts—a low
red blood cell count (anemia), a low white blood cell count
(leukopenia), and a low platelet count (thrombocytopenia).
3. Mucosal Leishmaniasis/ Monocutaneous/
Leishmania Basliensis
⚫ This form can be a sequela (consequence) of infection with
some of the species (types) of the parasite that cause
cutaneou leishmaniasis in parts of Latin America: certain
types of the parasite might spread from the skin and cause
sores in the mucous membranes of the nose (most
common location), mouth, or throat
⚫ Human infection is caused by more than 20 species.
◆ These include the L. donovani complex with 2 species (L.
donovani, L. infantum [also known as L. chagasi in the
New World]); the
◆ L. mexicana complex with 3 main species (L. mexicana, L.
amazonensis, and L. venezuelensis);
◆ L.tropica; L. major; L. aethiopica; and the subgenus
Viannia with 4 main species (L. [V.] braziliensis, L. [V.]
guyanensis, L. [V.] panamensis, and L. [V.] peruviana
◆ Leishmaniasis is transmitted by bite of infected female
phlebotomine sand flies. The sand flies inject the infective
stage (i.e., promastigotes) from their proboscis during blood
meals (1) . Promastigotes that reach the puncture wound
are phagocytized by macrophages(2) and other types of
mononuclear phagocytic cells. Promastigotes transform in
these cells into the tissue stage of the parasite (i.e.,
amastigotes) (4) which multiply by simple division and
proceed to infect other mononuclear phagocytic cells .
Parasite, host, and other factors affect whether the infection
becomes symptomatic and whether cutaneous or visceral
leishmaniasis results. Sand flies become infected by
ingesting infected cells during blood meals (5,6 ). In sand
flies, amastigotes transform into promastigotes, develop in
the gut (7) in the hindgut for leishmanial organisms in the
Viannia subgenus; in the midgut for organisms in the
Leishmania subgenus), and migrate to the
proboscis
Prevention & Control
⚫ No vaccines or drugs to prevent infection are available.
Travelers prevent infection by protecting themselves from
sand fly bites. To decrease the risk of being bitten, follow
these preventive measures:
⚫ Avoid outdoor activities, especially from dusk to dawn,hen
sand flies generally are the most active.
⚫ When outdoors (or in unprotected quarters):
⚫ Minimize the amount of exposed (uncovered) skin. To the
extent that is tolerable in the climate, wear long-sleeved
shirts, long pants, and socks; and tuck your shirt into your
pants. (See below about wearing insecticide-treated
clothing.)
⚫ Apply insect repellent to exposed skin and under the ends
of sleeves and pant legs. Follow the instructions on the
label of the repellent. The most effective repellents
generally are those that contain the chemical DEET (N,N-
diethylmetatoluamide).
⚫ Note: Bed nets, repellents, and insecticides should be
purchased before traveling and can be found in hardware,
camping, and military surplus stores. Bed nets and clothing
that already have been treated with a pyrethroid-containing
insecticide also are commercially available
Treatment
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⚫ skin sores of cutaneous leishmaniasis usually heal on their
own, even without treatment. But this can take months or
even years
Drug of choice is liposomal amphotericin B (Ambisome). Socium
stibogluconate has also been found to be effective but the
development of resistance may occur. Other patients have
shown favorable response to gamma interferon in combination
with pentavalent antimon
When indoors:
⚫ Stay in well-screened or air-conditioned areas.
⚫ Keep in mind that sand flies are much smaller than
mosquitoes and therefore can get through smaller holes.
⚫ Spray living/sleeping areas with an insecticide to kill
insects.
⚫ If you are not sleeping in a well-screened or air-conditioned
area, use a bed net and tuck it under your mattress. If
possible, use a bed net that has been soaked in or sprayed
with a pyrethroid-containing insecticide. The same
treatment can be applied to screens, curtains, sheets, and
clothing (clothing should be retreated after five
TRYPANOSOMA
⚫ African trypanosomes” or “Old World trypanosomes” are
protozoan hemoflagellates of the genus Trypanosoma, in
the subgenus Trypanozoon.
Two subspecies that are morphologically indistinguishable cause
distinct disease patterns in humans: T. b. gambiense, causing
chronic African trypanosomiasis (“West African sleeping
sickness”) and T. b. rhodesiense, causing acute African
trypanosomiasis (“East African sleeping sickness”). The third
subspecies T. b. brucei is a parasite primarily of cattle and
occasionally other animals, and under normal conditions does not
infect humans.
During a blood meal on the mammalian host, an infected tsetse
fly (genus Glossina) injects metacyclic trypomastigotes into skin
tissue. The parasites enter the lymphatic system and pass into the
bloodstream (1) Inside the host, they transform into bloodstream
trypomastigotes (2), are carried to other sites throughout the body,
reach other body fluids (e.g., lymph, spinal fluid), and continue the
replication by binary fission (3). The entire life cycle of African
trypanosomes is represented by extracellular stages. The tsetse
fly becomes infected with bloodstream trypomastigotes when
taking a blood meal on an infected mammalian host (4) ,(5)In the
fly’s midgut, the parasites transform into procyclic
trypomastigotes, multiply by binary fission (6), leave the midgut,
and transform into epimastigotes (7) . The epimastigotes reach
the fly’s salivary glands and continue multiplication by binary
fission (8). The cycle in the fly takes approximately 3 weeks.
Rarely, T. b. gambiense may be acquired congenitally if the
mother is infected during pregnancy
Trypanosoma cruzi
⚫ Chagas disease is named after the Brazilian physician
Carlos Chagas, who discovered the disease in 1909.
- It is caused by the parasite Trypanosoma cruzi, which is
transmitted to animals and people by insect vectors and is
- found only in the Americas (mainly, in rural areas of Latin
America where poverty is widespread).
- Chagas disease (T. cruzi infection) is also referred to as
American trypanosomiasis.
Chagas disease has an acute and a chronic phase. If untreated,
infection is lifelong.
- Acute Chagas disease occurs immediately after infection,
and can last up to a few weeks or months.
- During the acute phase, parasites may be found in the
circulating blood. This phase of infection is usually mild or
asymptomatic.
- There may be fever or swelling around the site of inoculation
(where the parasite entered into the skin or mucous membrane).
- Rarely, acute infection may result in severe inflammation of
the heart muscle or the brain and lining around the brain
Romaña’s sign, the swelling of the child’s eyelid, is a marker of
acute Chagas disease. Swelling is due to Trypanosoma cruzi
infecting the eyelid when bug feces are accidentally rubbed into
the eye, or because the bite wound was on the same side of the
child’s face as the swelling.
Prevention & Control
8
⚫ In areas of Mexico, Central America, and South America,
where the Trypanosoma cruzi parasite is present in
triatomine bug
⚫ improved housing and spraying insecticide inside housing
to eliminate the bugs has significantly decreased the
spread of Chagas disease.
⚫ Screening of blood donations for Chagas is another
important public health tool to help prevent spreading the
disease through blood transfusions.
⚫ Early detection and treatment of new cases, including
mother-to-baby (congenital) cases, will also help reduce the
burden of the disease
Trypanosoma brucei gambiense and Trypanosoma brucei
rhodesiense
⚫ African Trypanosomiasis, also known as “sleeping
sickness”
- is caused by microscopic parasites of the species
Trypanosoma brucei.
- It is transmitted by the tsetse fly (Glossina species), which is
found only in sub-Saharan Africa.
- Two morphologically indistinguishable subspecies of the
parasite cause distinct disease patterns in humans:
- T. b. gambiense causes a slowly progressing African
trypanosomiasis in western and central Africa and
- T. b. rhodesiense causes a more acute African trypanosomiasis
in eastern and southern Africa.
- Control efforts have reduced the number of annual cases and
for the first time in 50 years.
-Sleeping sickness is curable with medication but is fatal if left
untreated
⚫ Two subspecies of the parasite Trypanosoma brucei, T. b.
gambiense and T. b. rhodesiense, cause disease in
humans, with clinical features of the infection dependent on
the subspecies involved.
T. b. gambiense is endemic in western and central Africa,
while T. b. rhodesiense is restricted to eastern and
southern Africa.
Reservoir:
- Domestic and wild animals are the main reservoir of infection.
-Cattle have been implicated in the spread of the disease to new
areas and in local outbreaks.
- wild animal reservoir is thought to be responsible for sporadic
transmission to hunters and visitors to game parks.
- Infection of international travelers is rare, but it occasionally
occurs and most cases of sleeping sickness imported into the
U.S. have been in travelers who were on safari in East Africa
Reservoir
- Humans are the most important reservoir of infection, although
the parasite can sometimes be found in domestic animals (e.g.,
pigs, dogs, goats).
Occasionally, a pregnant woman can pass the infection to her
unborn baby (T. b. gambiense). In theory, the infection can also
be
transmitted by:
- blood transfusion,
- sexual contact,
- organ transplantation and
- accidental laboratory exposure, but such cases are rare and
poorly documented.
Disease
Transmission:
⚫ Both forms of sleeping sickness are transmitted by the bite
of the tsetse fly (Glossina species).
⚫ Tsetse flies inhabit rural areas, living in the woodlands and
thickets that
dot the East African savanna.
In central and West Africa, they live in the forests and vegetation
along streams.
⚫ Tsetse flies bite during daylight hours. Both male and
female flies can transmit the infection, but even in areas
where the disease is endemic only a very small percentage
of flies are
2 stages
1. an initial haemolymphatic stage followed by a
2. meningoencephalitis stage after the trypanosomes invade the
central nervous system (CNS)
⚫ First-stage symptoms may be preceded by the development
of a trypanosomal chancre at the site of inoculation within
two days to two weeks of being bitten by an infected fly
(occurs most commonly with T. b. rhodesiense, rarely with T.
b. gambiense although chancres are observed with T. b.
gambiense in travelers from non-endemic countries).
-The first stage involves nonspecific, generalized symptoms
occurring 1–3 weeks after the tsetse fly bite with T.
b.rhodesiense; the incubation period for T. b. gambiense is less
well characterized but disease progresses more slowly than that
caused by T. b. rhodesiense.
-First-stage symptoms for both types of sleeping sickness
include headache, malaise, weakness, fatigue, pruritis, and
arthralgia.
-First-stage signs can include hepato-splenomegaly, weight loss
and intermittent fevers lasting one day to one week.
9
⚫ The intervals between fevers can last days or months.
Lymphadenopathy, mainly posterior cervical but in some
cases axillary, inguinal or epitrochlear, may also occur
⚫ T. b. gambiense infection progresses to the second stage
after an average of 300–500 days, whereas T. b.
rhodesiense infection progresses to the second stage after
an estimated 21–60 days.
- For both types of disease, the stage is determined by
examining cerebrospinal fluid (CSF) and observing
trypomastigotes.
- In second-stage disease, invasion of the central nervous
system causes a variety of neuropsychiatric manifestations to
appear in addition to the first-stage signs and symptoms, with
fever occurring less frequently over time.
-The sleep/wake cycle becomes reversed, hence the common
name “African sleeping sickness”, with daytime somnolence,
nocturnal insomnia, and sudden u
-The patient also experiences mental (hallucinations, delirium,
anxiety, emotional lability, attention deficit, apathy, aggression,
mania, confusion), motor (motor weakness, abnormal tone, gait
disturbance, ataxia, tremor, speech disturbances), sensory
(paraesthesia, hyperaesthesia, anaesthesia, pruritis, visual
problems), and neurologic (abnormal reflexes, seizures, coma)
signs and symptoms.
-Compared to T. b. gambiense, T. b. rhodesiense is more likely
to result in endocrine abnormalities such as adrenal
insufficiency, thyroid dysfunction and hypogonadism; and cardiac
involvement, such as myocarditis, is more severe.
of trypanosome
Prevention & Control
⚫ Wear long-sleeved shirts and pants of medium-weight
material in neutral colors that blend with the background
environment. Tsetse flies are attracted to bright or dark
colors, and they can bite through lightweight clothing
⚫ Inspect vehicles before entering. The flies are attracted to
the motion and dust from moving vehicles
⚫ Avoid bushes. The tsetse fly is less active during the hottest
part of the day but will bite if disturbed.
⚫ Use insect repellent. Permethrin-impregnated clothing and
insect repellent have not been proved to be particularly
effective against tsetse flies, but they will prevent other
insect bites that can cause illness
PLASMODIUM
⚫ A sporozoan protozoa belonging to phylum apicomplexa
⚫ An intracellular , blood-inhabiting obligate parasite
MALARIA-is caused by 4 species of plasmodium
1,Vivax 2 most common cause of Infection
2. Falciparum serious one
3. Ovale
4. Malariae
Mosquito Biting Patterns
Anopheles Mosquito
⚫ Indoor and Outdoor biters
⚫ Night biting pattern
⚫ Usually enter house between 5 and 9 pm
⚫ Start biting by late evening, peak at midnight to early morning
⚫ Spreads Malaria

TREATMENT Aedes Mosquito

⚫ Anyone diagnosed with African Trypanosomiasis should be ⚫ Indoor biters
treated, with specific drug and treatment course depending ⚫ Day biting pattern
on type of infection (T. b. gambiense or T. b. rhodesiense) ⚫ Most active 2 hours after sunrise and 4-5 hours before
and disease stage (i.e., presence or absence of central sunset.
nervous system involvement). ⚫ Q Search
⚫ Bite in daylight and well-lit areas at night
- Pentamidine, the recommended drug for first stage T. b. ⚫ Spreads Dengue, Chikungunya and Zika
gambiense infection, is available in the United States.

- The other drugs (suramin, melarsoprol, eflornithine, and

nifurtimox when used in combination with eflornithine) used
to treat African trypanosomiasis are not commercially available in
the United States but can be obtained from CDC.

- Physicians can consult with CDC staff to obtain these otherwise

unavailable treatment drugs. Management will also take into
consideration whether the patient is pregnant or not, the age of
the patient and the stage of the disease.

-There is no test of cure for African trypanosomiasis. After

treatment, patients should be closely followed for 24 months and
monitored for relapse. Recurrence of symptoms will require
examination of body fluids, including CSF, to detect the presence

10
 > 6000 spp of endoparasites (liver,lungs,blood,muscles) Body
and life cycle adapted to parasitc existence.

CESTODES

Toxoplasma Gondii
⚫ Disease - Toxoplasmosis
Toxoplasma gondii is a type of sporozoan that infects a
variety of animals and birds.
⚫ Cats and members of the Felidae family are the most
common ultimate hosts. The oocyst-producing sexual stage
of Toxoplasma can only develop in these hosts.
⚫ Stage that Infects Humans:: Tissue cyst (pseudocysts) in
undercooked meat or oocyst in cat feces

Mode of Transmission:
⚫ Ingestion of cysts in raw meat; contact with cat feces
⚫ also transmitted transplacentally

Stage(s) in Humans Most Associated With Disease:: Rapidly

multiplying trophozoites (tachyzoites) within various cell types;
tachyzoites can pass placenta and infect fetus; slowly multiplying
trophozoites (bradyzoites) in tissue cyst
⚫ Important Stage(s) Outside of Human: Cat ingests tissue
cysts containing bradyzoites → gametes → ookinete →
oocysts in
feces
Diagnosis: Serology; microscopic examination of tissue;
mouse inoculation
Manifestation: immunocompetent adults are
asymptomatic, but some resemble infectious
mononucleosis
- Congenital Manifestations:
A-bortion, stillbirth, or neonatal illness including
encephalitis, chorioretinitis, and hepatosplenomegaly are all
possible outcomes of congenital infection. There is also
fever, jaundice, and intracranial calcifications.
-Most infected newborns are asymptomatic, but some children
will suffer chorioretinitis or mental disability months or years
later. Toxoplasma infection in the womb is one of the most
common birth defects. causes of childhood blindness
PLATYHELMINTHES (flatworms)
Class Monogenea
⚫ ~ 400 spp
⚫ mostly ectoparasites of fish, amphibians.
⚫ Feed on blood, mucus..
⚫ Anterior and posterior ends for clinging, but life cycle
remains simple, with a single free living larval stage
Cestodes, or tapeworms, include multiple species of flat worms
that can reside in the human gastrointestinal tract. The species
that most commonly cause human disease include Taenia
saginatum, Taenia solium, Diphyllobothrium latum and
Hymenolepis nana.
General characteristics:
⚫ Long segmented and tape like
⚫ Dorso ventrally flattened
⚫ Size: varies few mm to several meters
⚫ ADULT WORMS: found in the intestinal canal of man and
animals
HEAD/SCOLEX: with suckers and sometimes
with hooks that serves as attachment
3 parts:
-Head: Scolex
- Neck
- Body: Strobila
SEX: not separate
-No body cavity,
-No alimentary canal,
The body is divided into multiple segments call proglottids. A
series of proglottids is called strobila (plural strobili). All cestodes
are hermaphroditic (self-fertilizing) with each proglottid
containing both male and female reproductive organs.

Class Tematoda : flukes

11
LIFE CYCLE 2.Cysticercosis – the result of larval encystation in various
Egg, larva, and adult worm. tissues of the body. The most common involvement is that of
⚫ the egg contains an embryo called the oncosphere, which the skeletal muscles where patients may complain of muscle
represents the first larval of motile stage.It is equipped with pain. Cysticercosis of the brain (neurocysticercosis) is the most
small hooks (called hooklets) that eventually enable the feared and most severe involvement. It may present with
parasite to pierce the wall of the intestines. The eggs are symptoms associated with increased intracranial pressure. It
excreted in the feces of infected hosts and are transmitted may present with symptoms associated with increased
to the intermediate hosts (cattle, pig or fish.) intracranial pressure such as seizures, headache, and vomiting.
Ocular cysticercosis may lead to visual disturbances due the
Cestodes that are pathogenic to man development of inflammation of the uvea (Uveitis) and retina
⚫ Tenia solium (retinitis).
⚫ Tenia Saginata
⚫ Diphyllobothrium Lattum
⚫ Hymenolepis nana
⚫ Echinococcus Granulosus

1. TENIA SAGINATA
⚫ Beef tapeworm
⚫ Can be up to 4-6 meters long and 12mm broad
⚫ SCOLEX: pear shaped head w/ 4 suckers but no hook, no
neck
⚫ BODY: flat and long w/ hundred of segments
⚫ EGGS: 35 x 45 micrometers , roundish and yellow brown
⚫ ntermediate host the eggs enter the blood vessels
within the cattle’s intestines eggs are then SYMPTOMS
transported to the skeletal muscles of the cattle where they 1. LIGHT INFECTIONS : Asymptomatic
develop into cysticerci (larvae). 2. HEAVIER INFECTIONS : abdominal discomfort, epigastric
l pain, vomiting and diarrhea
INGESTION OF IMPROPOER DX: based on recovery of eggs or proglottids in stool or from
COOKED RAW BEEF CONTAINING LARVAE perianal ar
l TX: Praziquantel
This larvae mature into adult
Worms in the small intestine in a Prevention and control
Period of 3 months ⚫ Proper waste disposal and sanitation practices as well as
l the adequate cooking of beef and pork are the main
Humans are definitive host preventive measures for taeniasis. Freezing of beef meat
for approximately 10 days may kill the encysted larvae.
DISEASE Prompt treatment of infected persons help prevent spread
Taeniasis of the disease.
⚫ Majority of the patients are asymptomatic. Those with high
worm burden may complain of diarrhea, abdominal pain, T. SAGINATA
loss of appetite with resultant weight loss, and body CLINICAL FEATURES
malaise. The gravid proglottids may reach the anus where often asymptomatic, apart from the anal passage of tapeworm
egg-laying may occur resulting in itchiness in the anal segments. Infection may be associated with epigastric pain,
region (pruritus ani). diarrhea and weight loss.

2. TENIA SOLIUM Eggs appear in the feces

⚫ PORK TAPEWORM
⚫ Smaller than T. Saginata
⚫ Scolex: globular w/ 4 suckers and circular row hooks that
gives its solar appearance
⚫ Body: neck is present and long flat body
⚫ Adult worms: measures 2-3 meters and lives up to 25 years
Disease
1.Taeniasis -disease produced by the adult worm. Most cases
are asymptomatic but in the presence of high worm burden,
manifestations may be similar to beef tapeworm infection.
8–12 weeks after infection with the adult T. saginata tapeworm
Reservoir
Cattle
Eggs of T. saginata passed in the feces of an infected person
are only infectious to cattle. Humans are infected by ingestion of
raw or undercooked beef infected with Cyst cercus bovis, the
larval stage of T. saginata. In humans, the adult tapeworm
develops in the intestine over 2–3 months. The cycle of infection
repeats when infectious eggs are passed in the feces and later

12
ingested by cattle, slowly migrating into the flesh and
transforming into the larval stage.
T.SOLIUM
CLINICAL FEATURES
infections are also usually asymptomatic. Many tissues and
organs may be infected by the larval form (cysticercosis).
Eggs appear in the feces
after 10–14 weeks for T. solium
Reservoir
Pigs
Infections by T. solium may follow a similar cycle, with
consumption of infected pork leading to the subsequent
development of adult tapeworms. However, human infection may
also occur through the consumption of T. solium eggs. This
occurs by direct transfer from the feces of an infected person, or
through ingestion of contaminated food or water. When the eggs
of T. solium are ingested by either humans or pigs, the embryos
escape the shells and penetrate the intestinal wall, with
subsequent spread of larvae to various tissues to produce
cysticercosis.
⚫ Beef and pork should be adequately cooked – for example,
at 60 °C for 5 minutes.
⚫ Freezing meat below –5 °C for more than 4 days will kill
cysticerci.
⚫ Meat should be routinely inspected for evidence of
taeniasis at slaughter.
3.DIPHYLLOBOTHRIUM LATUM
⚫ FISH WORM
⚫ Longest tapeworm that can be found in man ranging from
3-10 meters w/ more than 3000 proglottids
Disease: Diphyllobothriasis
1.Asymptomatic disease – the most common presentation
among most individuals infected with the parasite.
2.Diphyllobothriasis - may manifest symptoms of
gastrointestinal involvement, which may include diarrhea and
abdominal discomfort. When the worm attaches itself to the
jejunum and ileum, the patient may develop deficiency of Vitamin
B12, leading to anemia similar to pernicious anemia and is
characterized as megaloblastic anemia
resulting from lack of maturation of RBCs.
4. HYMENOLEPIS NANA (DWARF TAPEWORM)
⚫ Small tapeworm (20 x 0.7mm) infects children
⚫ RESERVOIR: RODENTS
⚫ INFESTATION BY: 1.oro - fecal mode
⚫ 2. cross infections by eggs I in feces
DX: Eggs in feces
S/Sx: Enteritis – inflammation of the intestine accompanied by
severe diarrhea
Prevention: Hygiene
Tx: Niclosamide – Anti helmentic
Prevention and control
Important preventive measures include proper hygiene and
waste disposal, control of transport host population and rodent
control. Proper storage of grains and flour must be observed to
prevent infestation with flour and grain beetles. Prompt treatment
of infected individuals must be instituted to prevent the spread of
the parasite.
5. ECHINOCOCCUS GRANULOSUS
⚫ E. granulosus infection is common in Africa, Europe, Asia,
the Middle East, Central and South America, and in rare
cases, North America (CDC). The embryos develop into
large, fluid-filled hydatid cysts, which act as space-
occupying lesions. In addition, the cyst fluid contains
antigens that can sensitize the host. Rupture of the cyst,
either spontaneously or during trauma or surgical removal,
may lead to the release of these antigens leading to
anaphylaxis and widespread dissemination of the parasite.
Liver cyst – obstructive jaundice
Peribronchial cyst – pulmonary abscess
Brain cyst – produced ICP and jacksonian epilepsy
Kidney cyst – cause renal dysfunction
⚫ Infection is acquired after ingestion of eggs (infective stage)
from food and water contaminated by dog feces or through
contact with contaminated dog feces. Eggs transform into
larvae in the intestines, penetrate the intestines, and
migrate through the bloodstream to different tissues in the
body, particularly the liver and the lungs. The hydatid cyst
(pathogenic stage) then develops in the infected tissues.
Dogs acquire the parasite by eating the visceral organs of
the intermediate host.
Laboratory diagnosis
1. examination of biopsy specimen;
2. serologic tests (e.g. ELISA or indirect hemagglutination
test)
3. radiography to demonstrate the hydatid cysts (e.g. CT
scan or ultrasound).
Care should be exercised when doing biopsy to prevent
rupture of the cyst.
Treatment
In cases when surgery is possible, removal of the cyst has been
considered as the treatment of choice. However, medical
management alone may prove effective, especially if the cyst is
located in inaccessible areas. Drugs that have been proven
effective include mebendazole, albendazole, and
praziquantel.
Prevention and control
Improvement of personal hygiene practices, prevention of
contamination of food and water with dog feces, avoidance of
feeding pet dogs with contaminated viscera, and the prompt
treatment of infected canines and humans are some measures
13
to prevent the spread of the parasite.Chemoprophylaxis should
be given to dogs in endemic areas. Health education is essential.
TREMATODES/FLUKES
⚫ Unlike tapeworms, flukes have a digestive tract.
⚫ .Unlike the Cestode infections, humans never serve as
intermediate hosts for the flukes. In general, flukes have
two intermediate hosts except for the blood flukes where
there is only one intermediate host
Flukes have two intermediate hosts except for the blood flukes
1. the first intermediate hosts are mollusks (snails and clams)
2. second intermediate host varies depending on the parasite
1.Blood flukes: demonstration of eggs in feces, urine, or
rectal biopsy ( SCHISTOSOMIASIS)
2.Liver flukes: demonstration of eggs in
feces(FASCIOLIASIS)
3.Intestinal flukes: demonstration of adult worms or eggs in
feces (FASCIOLOPSIASIS)
4.Lung flukes: demonstration of eggs in sputum or feces
(PARAGONIMIASIS)
SEXUAL CYCLE – HUMANS (DEFINITIVE HOST)
ASEXUAL REPRODUCTION IN FREASHWATER
SNAILS (INTERMEDIATE HOST)
TRANSMISSION TO HUMANS
1.Penetration of the skin by the free swimming cercariae
2.Ingestion of cyst in undercooked (raw) fish or crabs in
Clonorchis and Paragonimus infection
Blood flukes
⚫ Schistosomiasis is prevalent in tropical and subtropical
areas, especially in poor communities without access to
safe drinking water and adequate sanitation. It is estimated
that at least 90% of those requiring treatment for
schistosomiasis live in Africa.
⚫ Schistosomiasis mostly affects poor and rural communities,
particularly agricultural and fishing populations. Women
doing domestic chores in infested water, such as washing
clothes, are also at risk and can develop female genital
schistosomiasis. Inadequate hygiene and contact with
infected water make children especially vulnerable to
infection.
⚫ Lack of hygiene and certain play habits of school-aged
children such as swimming or fishing in infested water
make them especially vulnerable to infection.
⚫ Estimates show that at least 290.8 million people required
preventive treatment for schistosomiasis in 2018, out of
which more than 97.2 million people were reported to have
been treated
Schistosoma spp.
S. Mansoni
⚫ Distributed throughout Africa
⚫ risk of infection in freshwater in southern and sub-Saharan
Africa–including the great lakes and rivers as well as
smaller bodies of water. Transmission also occurs in the
Nile River valley in Sudan and Egypt.
S.Haematobium
⚫ Distributed throughout Africa
⚫ risk of infection in freshwater in southern and sub-Saharan
Africa–including the great lakes and rivers as well as
smaller bodies of water. Transmission also occurs in the
Nile River valley in Egypt and the Maghreb region of
North Africa.
⚫ Found in the areas of Middle East
S.Japonicum
⚫ Found in Indonesia and parts of China and Southeast
Asia.
S. Mekongi
⚫ Found in Cambodia and Laos
S.Intercalatum
⚫ Found in parts of Central and West Africa.
BLOOD FLUKE INFECTION (SCHISTOSOMIASIS) life cycle
14
 infections caused by all Schistosoma species. No vaccine
is available.
⚫ The best way to prevent schistosomiasis is to take the
following steps if you are visiting or live in an area where
schistosomiasis is transmitted:
⚫ Avoid swimming or wading in freshwater when you are in
countries in which schistosomiasis occurs. Swimming in the
ocean and in chlorinated swimming pools is safe.
⚫ Drink safe water. Although schistosomiasis is not
transmitted by swallowing contaminated water, if your
mouth or lips come in contact with water containing the
parasites, you could become infected. Because water
coming directly from canals, lakes, rivers, streams, or
springs may be contaminated with a variety of infectious
organisms, you should either bring your water to a rolling
boil for 1 minute or filter water before drinking it. Bring your
water to a rolling boil for at least 1 minute will kill any
ASSYMPTOMATIC INFECTION harmful parasites, bacteria, or viruses present. Iodine
⚫ Begins shortly after cercarial penetration treatment alone WILL NOT GUARANTEE that water is safe
⚫ Chronic maybe symptomatic and free of all parasites.

EARLY ACUTE INFECTION LIVER FLUKE

⚫ Pruritic papules seen at the site of entry of the parasite ⚫ Liver flukes are parasites that can infect humans and cause
⚫ Called as swimmers itch liver and bile duct disease. There are two families of liver
⚫ 2-3 wks by fever and chills , abdominal pain, cough , flukes that cause disease in humans: Opisthorchiidae
bloody diarrhea, weight loss (which includes species of Clonorchis and Opisthorchis)
and Fasciolidae (which includes species of Fasciola).
KATAYAMA FEVER These two families of liver flukes differ in their geographic
⚫ Rapid onset of fever, myalgia, Body malaise, cough distribution, life cycle, and long-term outcome after clinical
⚫ Eosinophilia 1-2 months infection (CDC).
⚫ Lymphadenopathy hepatosplenomegaly
⚫ Most common cause of death: internal bleeding 1. freshwater snail 2. freshwater fish
/
ASSOCIATED INFECTIONS Developed miracidium
⚫ s.Japonicum /
⚫ - Nephrotic syndrome Penetrates the 1st intermediate host and develop into sporocys
⚫ s.Haematobium That contains numerous larvae stages called rediae
⚫ s.Mansoni – predispose repeated salmonella infection /
⚫ s.Haematobium – development of urinary bladder Larvae released to water where they transforms into cercariae
cancer /
Cercariae enters freshwater and encyst to become
Clinical findings metacercariae
Acute stage /
⚫ Begins shortly after cercarial penetration Larvae excyst in the duodenum, enters biliary duct and turn into
⚫ Eosinophilia adult.
Adult worm produce eggs that are excreted in the feces.
Chronic stage
Significant mortality and morbidity Trematodes Fasciola hepatica
-up to 30 mm by 15 mm
S.Mansoni and S. japonicum
GI Hemorrhage, Hepatomegaly, and massive splenomegaly Trematodes Fasciola gigantica
-up to 75 mm by 15 mm
A. Haematobium
Hematuria ⚫ In the early (acute) phase, symptoms can occur as a result
of the parasite’s migration from the intestines to and
Prevention and Control through the liver. Symptoms can include gastrointestinal
⚫ Safe and effective medication is available for treatment of problems such as nausea, vomiting, and abdominal
both urinary and intestinal schistosomiasis. Praziquantel, a pain/tenderness. Fever, rash, and difficulty breathing
prescription medication, is taken for 1-2 days to treat may occur.
15

⚫ During the chronic phase (after the parasite settles in the
bile ducts), the clinical manifestations may be similar or
more discrete, reflecting inflammation and blockage of
bile ducts, which can be intermittent. Inflammation of
the gallbladder and pancreas also can occur.
PREVENTION
⚫ No vaccine is available to protect people against Fasciola
infection.
⚫ Praziquantel or albendazole are the drugs of choice to treat
Clonorchis infection or DICHLOROPHENOL (BITHIONOL)
for Fa. Hepatica
⚫ Do not eat raw or undercooked freshwater fish. Lightly
salted, smoked, or pickled fish can contain infectious
parasites.
⚫ Drinking river water or other non potable water will not lead
to infection with Clonorchi. The FDA recommends the
following for fish preparation or storage to kill any parasites.
⚫ Cook fish adequately (to an internal temperature of at least
145° F [~63° C]).
⚫ Freezing (Fish)
⚫ At -4°F (-20°C) or below for at least 7 days (total time); or
⚫ At -31°F (-35°C) or below until solid, and storing at -31°F (-
35°C) or below for at least 15 hours; or
⚫ At -31°F (-35°C) or below until solid and storing at -4°F (-
20°C) or below for at least 24 hours.
INTESTINAL FLUKES
Fasciolopsiasis is caused by infection with the intestinal fluke
Fasciolopsis buski.It is found in south and southeastern Asia;
pigs, as well as humans, are a major reservoir of infection.
⚫ People become infected with Fasciolopsis when they eat
raw or undercooked aquatic plants that have the organism
encysted on them
F.BUSKI
⚫ Immature eggs are released into the intestine and then the
stool. The eggs develop into embryos in water and release
miracidia, which invade a suitable snail intermediate host.
⚫ In the snail, the parasites develop into cercariae, which are
released from the snail and encyst as metacercariae on
aquatic plants.
⚫ Mammals (humans and pigs) become infected by ingesting
metacercariae on the aquatic plants. After ingestion, the
metacercariae excyst in the duodenum and attach to the
intestinal wall. There they develop into adult flukes (20-75
mm by 8-20 mm) attached to the intestinal wall of the host.
S/SX
⚫ Many people do not have symptoms from Fasciolopsis
infection. 1. abdominal pain and diarrhea can occur 1 or 2
months after infection.
2. With heavy infections Fasciolopsis flukes can cause
intestinal obstruction, abdominal pain, nausea, vomiting, and
fever.
3.Allergic reactions and swelling of the face and legs can also
occur — and anemia may be present.
Fasciolopsis is not transmitted directly from human to human.
Humans (and pigs) pass eggs in their feces, which develop in
water and infect snails as intermediate hosts. After further
development, the parasites leave the snail intermediate host and
encyst on water plants. Humans become infected as a result of
eating these contaminated water plants raw (or undercooked).
LUNG FLUKES/Paragonimus
⚫ Flatworm that infects the lungs of humans after eating an
infected raw or undercooked crab or crayfish. Less
frequent, but more serious cases of paragonimiasis occur
when the parasite travels to the central nervous system.
⚫ Paragonimus infection also can be very serious if the fluke
travels to the central nervous system, where it can cause
symptoms of meningitis.
⚫ Paragonimus westermani and several other species are
found throughout eastern, southwestern, and southeast
Asia; (including China, the Philippines, Japan, Vietnam,
South Korea, Taiwan, and Thailand). P. africanus is found
in Africa, and P. mexicanus in Central and South America
The eggs are excreted unembryonated in the sputum, or
alternately they are swallowed and passed with stool The
number
1. In the external environment, the eggs become
embryonated
2. miracidia hatch and seek the first intermediate host, a snail,
and penetrate its soft tissues
3. Miracidia go through several developmental stages inside
the snail
4. Sporocysts
5. rediae
6. with the latter giving rise to many cercariae
7. which emerge from the snail. The cercariae invade the
second intermediate host, a crustacean such as a crab or
crayfish, where they encyst and become metacercariae.
This is the infective stage for the mammalian host
8. Human infection with P. westermani occurs by eating
inadequately cooked or pickled crab or crayfish that harbor
metacercariae of the parasite
9. The metacercariae excyst in the duodenum
10. penetrate through the intestinal wall into the peritoneal
cavity, then through the abdominal wall and diaphragm into
the lungs, where they become encapsulated and develop
into adults
CHEST XRAY /CT SCAN
How it is transmitted?
The infection is transmitted by eating infected crab or crawfish
that is either, raw, partially cooked, pickled, or salted. The larval
stages of the parasite are released when the crab or crawfish is
digested. They then migrate within the body, most often ending
up in the lungs. In 6-10 weeks the larvae mature into adult
flukes.
s/sx
Adult flukes living in the lung cause lung disease.
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After 2-15 days, the initial signs and symptoms may be diarrhea INTESTINALNEMATODES
and abdominal pain. 1. Ascaris lumbricoides
This may be followed several days later by fever, chest pain, and 2. Enterobius vermicularis
fatigue. 3. Trichuris trichiura
The symptoms may also include a dry cough initially, which 4. Ancylostoma duodenale
later often becomes productive with rusty-colored or blood- 5. Necator americanus
tinged sputum on exertion. The symptoms of 6. Strongyloides stercoralis
paragonimiasis can be similar to those of tuberculosis. 7. Capillaria philippinensis

Diagnosis TRANSMISSION
The infection is usually diagnosed by identification of 1. Ingestion of eggs
Paragonimus eggs in sputum. The eggs are sometimes found in 2. Penetration of larvae through surfaces
stool samples (coughed-up eggs are swallowed). A tissue biopsy 3. Insect bite
is sometimes performed to look for eggs in a tissue specimen. 4. Ingestion of encysted larvae

PREVENTION Ascariasis/Ascaris Lumbricoides/ROUNDWORM

Never eat raw freshwater crabs or crayfish. Cook crabs and Kingdom: Animalia
crayfish to at least 145°F (~63°C). Travelers should be advised Phylum : Nematoda
to avoid traditional meals containing undercooked freshwater Class: Rhabditea
crustaceans. Order: Ascaridida
Family: Ascarididae
NEMATODES/ nemathelminthes Genus: Ascaris
⚫ MORPHOLOGY Species: lumbricoides
⚫ With completedigestive system
⚫ w/ mouth & anus
⚫ Body covering –cuticle
⚫ Separate sexes=dioecious
⚫ female longer

- Nematodes are roundwomds

- they are the most numerous multicellcular animals on earth.
- Nematodes are responsible for “around 2.2% of the total
carbon emission from soils”

Adult
Shape: cylindrical, fusiform body, similar toearthworm
Color: Pink (alive) , white (dead)
Length: Female : 20-30cm
ivory mixed light red
Male: 15-31cm
MORPHOLOGY reddish pink
ADULT Eggs
⚫ Elongate, cylindrical, bilaterally symmetrical and tapered at 3 kinds of eggs:
both end Fertilized
⚫ With complete digestive system – pseudocoel Unfertilized
⚫ Body wall: 3 layers – protective cuticle, hypodermis , Decorticated – ineffective egg
muscles
⚫ Separate sexes (dioecious) How ascariasis spread?
⚫ female longer ⚫ Ascaris lives in the intestine and Ascaris eggs are passed
in the feces of infected persons. If the infected person
2 types of nematodes defecates outside (near bushes, in a garden, or field), or if
1. Soil transmitted nematodes pinworm the feces of an infected person are used as fertilizer, then
2. Bio source nematodes eggs are deposited on the soil. They can then mature into a
form that is infective. Ascariasis is caused by ingesting
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 infective eggs. This can happen when hands or fingers that
have contaminated dirt on them are put in the mouth or by
consuming vegetables or fruits that have not been carefully
cooked, washed or peeled.
s/symptoms of Ascariasis
Heavy infections can cause intestinal blockage and impair
growth in children
STAGE 1
worm larvae in the bowel attach to bowel walls
STAGE 2
worm larvae migrate into the lungs
STAGE 3
Worm enter the small intestine and mature into worms and
remain there to feed
- abdominal symptoms such as 1. discomfort
2. intestinal blockage
3. severe abdominal pain
- vomiting , restlessness
Diagnosis
1. stool sample and using a microscope to look for the
presence of eggs.
2. Some people notice infection when a worm is passed in
their stool or is coughed up.
3. Blood - eosinophilia
Treatment
⚫ Anthelminthic medications such as Albendazole,
Mebendazole and Ivermectin are the drugs of choice for
treatment. Infections are generally treated for 1-3 days.
⚫ Complications of roundworms:intestinal obstruction,
appendicitis, peritonitis
Prevention & Control
⚫ Avoid ingesting soil that may be contaminated with human
or pig feces, including where human fecal matter (“night
soil”), wastewater, or pig manure is used to fertilize crops.
⚫ Wash your hands with soap and water before handling
food.
⚫ Wash your hands with soap and water after touching or
handling pigs, cleaning pig pens, or handling pig manure.
⚫ Teach children the importance of washing hands to prevent
infection.
⚫ Supervise children around pigs, ensuring that they do not
put unwashed hands in their mouths.
⚫ Wash, peel, or cook all raw vegetables and fruits before
eating, particularly those that have been grown in soil that
has been fertilized with manure.
ENTEROBIUS VERMICULARIS/ pin worm/seat worm
⚫ disease: pinworm infection or enterobiasis
⚫ Dwell in cecum of large intestine, appendix & ascending
colon.
⚫ Lay upto :15,000 eggs at night
⚫ Dx: Scotch tapetest•Primary symptom: pruritus in
perianalarea•Risk factor: poverty, eating w/out washing
hands
⚫ A pinworm (“threadworm”) is a small, thin, white roundworm
(nematode) called Enterobius vermicularis that sometimes
lives in the colon and rectum of humans. Pinworms are
about the length of a staple. While an infected person
sleeps, female pinworms leave the intestine through the
anus and deposit their eggs on the surrounding skin.
Who is at risk for pinworm infection?
Pinworm infection occurs most commonly among:
⚫ school-aged and preschool-aged children,
⚫ institutionalized persons, and
⚫ household members and caretakers of persons with
pinworm infection.
How is pinworm infection spread?
Pinworm eggs become infective within a few hours after being
deposited on the skin around the anus and can survive for 2 to 3
weeks on clothing, bedding, or other objects. People become
infected, usually unknowingly, by swallowing (ingesting) infective
pinworm eggs that are on fingers, under fingernails, or on
clothing, bedding, and other contaminated objects and surfaces.
Because of their small size, pinworm eggs sometimes can
become airborne and ingested while breathing.
⚫ Pinworm infection is spread by the fecal-oral route, that is
by the transfer of infective pinworm eggs from the anus to
someone’s mouth, either directly by hand or indirectly
through contaminated clothing, bedding, food, or other
articles.
Diagnosis:
⚫ Pinworm eggs can be collected and examined using the
“tape test” as soon as the person wakes up. This “test” is
done by firmly pressing the adhesive side of clear,
transparent cellophane tape to the skin around the anus.
The eggs stick to the tape and the tape can be placed on a
slide and looked at under a microscope. Because
washing/bathing or having a bowel movement can remove
eggs from the skin, this test should be done as soon as the
person wakes up in the morning before they wash, bathe,
go to the toilet, or get dressed. The “tape test” should be
done on three consecutive mornings to increase the chance
of finding pinworm eggs.
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TRICHURISTRICHIURA/ WHIP WORM
⚫ Whipworms live in the large intestine and whipworm eggs
are passed in the feces of infected persons. If the infected
person defecates outside (near bushes, in a garden, or
field) or if human feces as used as fertilizer, eggs are
deposited on soil. They can then mature into a form that is
infective. Whipworm infection is caused by ingesting eggs.
This can happen when hands or fingers that have
contaminated dirt on them are put in the mouth or by
consuming vegetables or fruits that have not been carefully
cooked, washed or peeled.
WHO IS AT RISK?
Infection occurs worldwide in warm and humid climates where
sanitation and hygiene are poor, including in temperate climates
during warmer months. Persons in these areas are at risk if soil
contaminated with human feces enters their mouths or if they eat
vegetables or fruits that have not been carefully washed, peeled
or cooked
How is whipworm diagnosed?
Health care providers can diagnose whipworm by taking a stool
sample. By using a microscope, providers can look for the
presence of whipworm eggs.
The female worm is about 35 to 50mm
The male worm measures 30 to 45mm
What are the signs and symptoms of whipworm?
⚫ People with light infections usually have no signs or
symptoms.
⚫ People with heavy infections can experience frequent,
painful passage of stool that contains a mixture of mucus,
water, and blood. The diarrhea typically has an acrid smell.
⚫ In severe cases growth retardation can occur. Rectal
prolapse can also occur.
⚫ In children, heavy infection may be associated with growth
retardation and impaired cognitive development.
PREVENTION:
⚫ Avoid contact with soil that may be contaminated with
human feces, including with human fecal matter (“night
soil”) used to fertilize crops.
⚫ Wash your hands with soap and warm water before
handling food.
⚫ Teach children the importance of washing hands to prevent
infection.
⚫ Wash, peel, or cook all raw vegetables and fruits before
eating, particularly those that have been grown in soil that
has been fertilized with manure.
TREATMENT
⚫ Anthelminthic medications (drugs that rid the body of
parasitic worms), such as Albendazole and Mebendazole,
are the drugs of choice for treatment. Infections are
generally treated for 3 days. The recommended
medications are effective. Health care providers may
decide to repeat a stool exam after treatment. Iron
supplements may also be prescribed if the infected person
suffers from anemia.
HOOK WORM
ANCYLOSTOMATIDAE
/ \
ANCYLOSTOMA NECANOR
DUODENALE AMERICANUS
Present in moist soil.
MOT: Both penetrates skin (ground itch).
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Disease: Hook worm infection Carried by blood to the lungs,
pass up the bronchi & trachea, coughed up and then swallowed
with sputum. In the small intestines, attach to the wall with their
cutting plates
( NECATOR)or teeth(ANCYLOSTOMA)

TREATMENT
Mebendazole : 100mg BD daily for 3 days
Abendazole: single dose
Oral iron
For severe infections w/ protein loss – nutrition support

STRONGYLOIDES STERCORALIS
- Threadworm

⚫ The infection spreads from person to person by mosquito

bites
⚫ . The adult worm lives in the human lymph vessels, mates,
and produces millions of microscopic worms, also known as
microfilariae.
⚫ Microfilariae circulate in the person’s blood and infect the
mosquito when it bites a person who is infected.
Microfilariae grow and develop in the mosquito.
⚫ When the mosquito bites another person, the larval worms
pass from the mosquito into the human skin, and travel to
the lymph vessels.
⚫ They grow into adult worms, a process that takes 6 months
or more. An adult worm lives for about 5–7 years.
⚫ The adult worms mate and release millions of microfilariae
into the blood. People with microfilariae in their blood can
serve as a source of infection to others.

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 Treatment
⚫ Diethylcarbamazine (DEC) is the drug of choice
⚫ 1 or 12-day treatment of DEC (6 mg/kg/day)
⚫ side effects are dizziness, nausea, fever, headache, or pain
in muscles or joints.
⚫ DEC should not be administered to patients who may also
have onchocerciasis as DEC can worsen onchocercal eye
disease.
⚫ In settings where onchoceriasis is present, Ivermectin is the
drug of choice
⚫ adult worm killing with treatment with doxycycline
(200mg/day for 4–6 weeks).

Prevention & Control

⚫ The best way to prevent lymphatic filariasis is to avoid
mosquito bites. The mosquitoes that carry the microscopic
worms usually bite between the hours of dusk and dawn . If
you live in an area with lymphatic filariasis:

Filariasis ⚫ At night
⚫ A small percentage of persons will develop lymphedema. ⚫ Wear long sleeves or sleep under mosquito net
This is caused by fluid collection because of improper
functioning of the lymph system resulting in swelling. This ⚫ Between dusk or dawn
mostly affects the legs, but can also occur in the arms, ⚫ Use mosquito repellent on exposed skin
breasts, and genitalia. Most people develop these
symptoms years after being infected. CAPILLARIA PHILIPPINENSIS
Other name: Pudoc worm
Diagnosis • ingestion of undercooked or raw freshwater fish “bagsit”
The standard method for diagnosing active infection is the • Disease: Intestinal capillariasis
identification of microfilariae in a blood smear by microscopic • Chronic diarrhea, weight loss, low- electrolyte level (K+)
examination. The microfilariae that cause lymphatic filariasis
circulate in the blood at night (called nocturnal periodicity). Blood INTRODUCTION
collection should be done at night to coincide with the TOPIC
appearance of the microfilariae, and a thick smear should be SUB-TOPIC
made and stained with Giemsa or hematoxylin and eosin. For
increased sensitivity, concentration techniques can be used.

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