Ectoparasitic sp Parasite Bio Clinical Presentation:

- Arthropods 1) Head, body and pubic lice

- Include head lice (Pediculus humanus capitis),
body lice (Pediculus humanus humanus), pubic
lice (Pthirus pubis) and scabies (Sarcoptes
scabiei)
- Feed on blood – die quickly when removed
from host
- itch, irritability, secondary bacterial infection
2) Scabies
- severe itch, rash anywhere the scabies have
burrowed under the skin (commonly hands and
wrists), secondary bacterial infection

Disease: see clinical presentation

Carrierstate: N/A Diagnosis:
Pathogenesis:
1) Observation of live nymph or louse
Direct contact allows Adults sexually 2) Isolation of mites from scrapings
transmission of infective reproduce and
eggs, nymphs or adults lay eggs on hair
or in burrows Treatment and resistance:
- Ivermectin
Larvae mature - Treatment/cleaning of clothing and bedding
into nymphs, and
nymphs mature
into adults Eggs (nits) tach to
release larvae
(scabies only) or
nymphs Prevention: avoid contactBug Cards
infected – S.
individuals Forgie 2004
Strongyloides stercoralis Parasite Bio
- Helminths
- Complex life cycle with both free-living and
parasitic cycles (parasitic cycle examined here)
- Males only produced in free-living
environment
Clinical Presentation:
1) Strongyloidiasis – frequently asymptomatic
- GI symptoms, respiratory symptoms, rash on
buttocks and around waist
- Complications may include shock,
septicemia, CNS damage, and death

Disease: see clinical presentation

Carrierstate: asymptomatic
Pathogenesis:
Larvae in contaminated
soil penetrate human skin
and move to lungs
Eggs hatch and
larvae may
autoinfect or be
passed in stool
Diagnosis:
- Must observe larvae in stool
Move through
bronchial tree to
throat and are
swallowed Treatment and resistance:
- Ivermectin
In small intestines,
mature into adult
females and produce
eggs (parthogenesis) Prevention: avoid contactBug Cards
with soil – S. areas,
in endemic Forgiewear 2004
shoes
Schistosoma sp. Parasite Bio Clinical Presentation:
- Helminths 1) Schistosomiasis
- Most commonly S. haematobium, S. japonicum - fever, cough, abdominal pain, diarrhea,
and S. mansoni hepatosplenomegaly, and eosinophilia
- Require human contact with water to complete - Occasionally CNS involvement or organ
life cycle
failure

Disease: see clinical presentation

Carrierstate: asymptomatic, animal reservoirs Diagnosis:
Pathogenesis:
- Microscopic examination of urine/feces for eggs
Miracidia released in Penetrate skin of - Biopsy
water and infect snail – human and shed
mature into cercariae Schistosomulae,
migrate to tissue Treatment and resistance:
- Safe treatments exist (don’t need to know)
Eggs eliminated
via urine or
feces.
Adult worms reside
in veins, deposit eggs
that migrate towards
intestine/bladder Prevention: avoid contactBug Cards
with fresh water–inS. Forgie
endemic 2004
countries,
use of safe drinking water
Trichonella sp. Parasite Bio Clinical Presentation:
- Most often T. spiralis, but may also include T. 1) Intestinal migration – sometimes accompanied
nativa, T. pseudospiralis, T. nelsoni, T. britovi, by GI symptoms
and T. papuae 2) Larval migration – occurs 1 week after infection
- Helminths - systemic symptoms like eosinophilia, fever,
- Worms 1-2mm in length
conjunctivitis, myalgias, rash
- Severe symptoms like myocarditis and
pneumonitis may occur
- Symptoms subside after encystment

Disease: see clinical presentation

Carrierstate: asymptomatic Diagnosis:
Pathogenesis:
- History
Consumption of uncooked Larvae decysted - Ab detection
meat containing encysted in stomach, and
larvae
- Biopsy
invade intestinal
mucosa Treatment and resistance:
- Should commence as soon as diagnosis is confirmed
Larvae migrate to
muscles where
they encyst
Mature into adults
and sexually
reproduce – release
larvae Prevention: Proper cooking
Bug Cards
of food, game–screening
S. Forgie 2004
programs
Enterobius vermicularis Parasite Bio Clinical Presentation:
- AKA “pinworm” 1) Asymptomatic – most common
- Humans are only known host - perianal itchiness (pruritis) at night
- Some eggs may become aerosolized - may include insomnia, irritability, abdominal
- Adults only 2-10mm long pain

Disease: see clinical presentation

Carrierstate: asymptomatic Diagnosis:
Pathogenesis:
- Scotch tape test
Eggs deposited on Eggs may be - Microscopic examination of eggs
perianal folds at night transmitted to
hands through
scratching Treatment and resistance:
- Isolation until eradication of infection
Adults become
established in
colon and
sexually Eggs are ingested
reproduce and hatch in small
intestine
Prevention: Good hand hygiene
Bug Cards – S. Forgie 2004
Trichomonas vaginalis Parasite Bio Clinical Presentation:
- Flagellate protozoans 1) Females – usually symptomatic
- vaginitis and purulent discharge, lesions,
abdominal pain, dysuria, painful intercourse
2) Males – frequently asymptomatic
- may have urethritis, epididymitis, prostatitis

Disease: see clinical presentation, “the Trich”

Carrierstate: asymptomatic Diagnosis:
Pathogenesis:
- Wet mount of genital or urinary swab
Resides in female genital Transmitted via - Culture or DFA – takes longer
tract and male contact (sexual
genitourinary tract intercourse)
Treatment and resistance:
- Metronidazole for infected and sexual partner(s)
Replicates via - Resistance to metronidazole has been reported
binary fission

Destroys epithelial
cells via contact and
cytotoxicity to obtain
nutrients Prevention: condom use Bug Cards – S. Forgie 2004
Toxoplasma gondii Parasite Bio Clinical Presentation:
- Protozoan 1) Toxoplasmosis – most common sites for cysts
- Felines are definitive hosts include skeletal muscle, myocardium, brain, and
- Transmission from blood transfusion, eating eyes, remain for life
undercooked infected meat, or vertical - often benign and asymptomatic in
immunocompetent
- can cause mass lesions in brain of
immunocompromised
2) Congenital infection – usually due to acute
primary infection of mother
- retinochoroiditis, microcephaly,
hydrocephaly, spontaneous abortion may
occur
Disease: see clinical presentation
Carrierstate: asymptomatic Diagnosis:
Pathogenesis:
- Isolation of parasite in blood
Unsporulated cysts passed Ingested by - PCR/Serology
in infected feline feces humans or other,
and sporulate in 1-5 days transform into
tachyzoites Treatment and resistance:
- Self-limiting
Felines may - MUST treat pregnant women
become infected
by eating tissue
that contains Move into neural and
cysts muscle tissue and
become bradyzoites
(tissue cysts) Prevention: Maternal testing,
Bugavoidance
Cards of–litter
S. Forgie 2004
boxes, proper
food preparation
Ecchinococcus granulosus Parasite Bio
- Dog tapeworm – disease in humans only due to
ingestion of eggs/production of cysts
- Requires infected herbivores to be eaten by
canines to complete life cycle (canines
definitive host)
- No anthroponotic spread
Clinical Presentation:
1) Hyatid disease – may remain silent for years with
no symptoms until cysts reach such a size as to
disrupt the surrounding tissue
- Symptoms depend on location of cysts
- Rupture may be associated with anaphylaxis,
further seeding of cysts
- Cysts contain multiple scoli and grow 1-
5cm/year

Disease: hyatid disease

Carrierstate: N/A Diagnosis:
Pathogenesis:
- Ultrasound/imaging
Eggs passed by infected Ingested by - Serology
canine humans – - Biopsy
oncospheres
hatch Treatment and resistance:
- Surgery
Cysts grow and
multiple
protocysts and
daughter cysts Invade intestinal wall
are formed and migrate to
muscle – develop
into cyst Prevention: Good hand-hygiene
Bug Cards – S. Forgie 2004
Taenia saginata Parasite Bio
- Hermaphroditic helminth
- Beef tapeworm (<5m)
- Non-invasive
- T. solium and T. asiatica may cause similar
disease
-
Disease: see clinical presentation
Carrier state: asymptomatic disease
Pathogenesis:
Eggs or gravid proglottids
ingested by cattle
Scolex attaches
to intestine and
produce gravid
proglottids to be
passed in stool
Clinical Presentation:
1) Asymptomatic – mild abdominal symptoms
- passing of visible proglottids in stool
- rare obstruction due to migrating worms
Diagnosis:
- Stool microscopy to examine for eggs and
Oncospheres proglottids, may need to repeat analysis
hatch and - Speciation requires proglottid examination
invade intestinal
wall to muscle Treatment and resistance:
- Must treat until scolex is passed in stool
Cystecerci in muscle
consumed by human
and scolex released
in stomach Prevention: Good hand-hygiene,
Bug Cards – S. Forgie
proper cooking of food 2004
Taenia solium Parasite Bio Clinical Presentation:
- Hermaphroditic helminth 1) Asymptomatic – associated with tapeworm
- Pork tapeworm (2-7m) infection
- Common where people live in close contact - mild abdominal symptoms
with pigs - passing of visible proglottids in stool
- rare obstruction due to migrating worms
2) Cystecercosis – symptoms based on location of
cystecerci
- may migrate to eyes, muscles, heart, etc.
- migration into brain of greatest concern
(neurocystecercosis), can lead to death

Disease: tapeworm or cystecircosis

Carrierstate: asymptomatic disease Diagnosis:
Pathogenesis:
- Stool microscopy to examine for eggs and
Eggs or gravid proglottids Ingested by pigs proglottids, may need to repeat analysis
passed by infected human or humans – - Demonstration of cyctecercis in tissue
oncospheres
hatch Treatment and resistance:
- Surgery
Cystecerci in - Supportive treatment
pigs may be - Treatment of tapeworm until scolex is passed
consumed and
produce mature Invade intestinal wall
worm in human and migrate to
muscle – develop
into cysticerci Prevention: Good hand-hygiene,
Bug Cards – S. Forgie
proper cooking of food 2004
Ascaris lumbricoides Parasite Bio
- Helminth
- Largest human roundworm (20-30cm)
- Non-invasive
- 1 in 4 infected globally
Disease: see clinical presentation
Carrierstate: asymptomatic disease
Pathogenesis:
Fertilized and mature eggs
ingested from fecal
contaminated food/water
Mature further in
intestine and
sexually
reproduce. Eggs
passed in feces.
Clinical Presentation:
1) Asymptomatic – most common form of infection
- high worm burden may cause obstruction, or
may bock narrow openings (appendix, gall
bladder)
- larval migration may cause mild cough and
throat irritation
- nutritional deficits
Diagnosis:
- Stool microscopy to examine for eggs
Larvae hatch
and invade
intestinal
mucosa Treatment and resistance:
- Ivermectin
Migrate via the portal
vein to the lungs and
mature, travel up the
throat and swallowed Prevention: Good hand-hygiene
Bug Cards – S. Forgie 2004
Entamoeba hystolitica Parasite Bio
- Protozoan
- Spreads contiguously
- Common in subtropical areas, areas with
limited sanitation
- May be spread via vectors
- Venereal spread of trophozoites possible
Disease: diarrhea
Carrierstate: asymptomatic disease
Pathogenesis:
Mature cyst ingested from
fecal contaminated
water/food
Cysts and
trophozoites
passed with feces
(cysts usually
with formed
stools)
Clinical Presentation:
1) Intestinal – dysenteric diarrhea (mucus and blood)
- can also cause colitis, appendicitis, toxic
megacolon
2) Extraintestinal – dissemination of amoebas into
blood through intestinal lumen, can migrate and
invade other tissues
- symptoms depend on location on invasion
- brain, diaphragm and liver common
Diagnosis:
- Stool microscopy to examine for cysts or trophozoites. Must
Excystation in differentiate between E. hystolitica and E. dispar
small intestion
- Serology for invasive disease
to release
trophozoites Treatment and resistance:
- Metronidazole
- Supportive treatment
Trophozoites migrate
to large intestine and
invade intestinal cells
– flask-shaped ulcer Prevention: Good hand-hygiene,
Bug Cards – S. Forgie
water treatment 2004
Cryptosporidium sp. Parasite Bio
- C. hominis and C. parvum most common
- Protozoan
- Not killed by chlorination, can be transmitted
through contact with contaminated recreational
water sources (pools)
- Zoonotic and anthroponotic transmission also
possible
Clinical Presentation:
1) Diarrhea – watery diarrhea
- 2-10 day incubation, 1-2 weeks symptomatic
- May be prolonged and much worse in
immunocompromised (months to years in
duration, entire GI tract involved)
- May include symptoms like dehydration, weight
loss, abdominal pain, fever, nausea and
vomiting
- “Gum to bum”

Disease: diarrhea
Carrierstate: asymptomatic disease
Pathogenesis:
Infective oocyst ingested
from fecal contaminated
water/food
Oocysts fertilized
and excreted or
may autoinfect
host
Diagnosis:
- Stool microscopy to examine for cysts or trophozoites.
Excystation in Multiple samples may be needed (up to 3).
small intestion
- Duodenal aspirate
to release
sporozoites Treatment and resistance:
- Self-limiting in immunocompetent
- Supportive treatment
Sporozoites invade
epithelial cells and
multiply asexually
and sexually Prevention: Good hand-hygiene,
Bug Cards – S. Forgie
water treatment 2004
Giargia lambia Parasite Bio Clinical Presentation:
- AKA “Beaver fever”, “traveler’s diarrhea” 1) Diarrhea – malabsorption and steatorrhea
- Protozoan flagellate - 1-14 day incubation, 1-3 weeks symptomatic
- No tissue invasion

Disease: diarrhea
Carrierstate: animal reservoirs (beavers, dogs, cats) Diagnosis:
Pathogenesis:
- Stool microscopy to examine for cysts or trophozoites.
Infective cyst ingested Excystation in Multiple samples may be needed (up to 3).
from fecal contaminated small intestion to
water/food, anal-oral sex release - Duodenal aspirate
sexual practices trophozoites Treatment and resistance:
- Self-limiting
Encystation - Metronidazole
during transit
towards colon –
corresponds to Trophozoites adhere to
non-diarrheal lumen via suction and
stage feed on mucus – villi
blunting/atrophy Prevention: Good hand-hygiene,
Bug Cards – S. Forgie
water treatment 2004
Plasmodium sp. Parasite Bio
- Protozoans
- Include P. falciparum (sub Saharan Africa), P.
ovale, P. vivax (India), and P. malariae
- Transmitted via Anopheles mosquitos
(definitive host, night biters), endemic in areas
with this species
Clinical Presentation:
1) P. falciparum – most severe, “promiscuous”
2) Other – may relapse due to residual hepatic stage
3) All – symptoms due to blood stage
- includes fever, anemia, chills, sweats, nausea,
anorexia, myalgias, malaise
- organ failure, death common complications
- premature delivery/spontaneous abortion in
pregnant women, more sever disease for
immunocompromised
- partial immunity may come from repeated
exposure, but it wanes quickly

Disease: malaria
Carrierstate: asymptomatic in “immune” Diagnosis:
Pathogenesis:
- History (esp. travel)
Mosquito releases Migrate into - Thick and thin blood smear
sporozoites into human liver and mature
during blood meal
- Dipstick Ag tests, PCR
into schizonts,
then rupture Treatment and resistance:
- If in doubt, treat as P. falciparum!
Gametocytes - Quinine and doxycycline or malarone, artisminins
produced and
- P. falciparum resistance to chloroquine
ingested by
mosquito. Sexual - Primaquine for liver stage, choroquine for P. vivax
Merozoites released
reproduction and infect
occurs, mature erythrocytes and
into sporozoites multiply asexually Prevention: Diagnosis and
Bug Cards
treatment, – S. Forgie
insecticide 2004
treated nets,
indoor residual spraying, travel clinics, chemoprophylaxis